J Mindell

Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012

Background: This study aims to project the prevalence of adult obesity to 2012 by age groups and social class, by extrapolating the prevalence trends from 1993 to 2004. Repeated cross-sectional surveys were carried out of representative samples of the general population living in households in England conducted annually (1993 to 2004). Methods: Participants were classified as obese if their body mass index was over 30 kg/m2. Projections of obesity prevalence by 2012 were based on three scenarios: extrapolation of linear trend in prevalence from 1993 to 2004; acceleration (or slowing down) in rate of change based on the best fitting curve (power or exponential); and extrapolation of linear trend based on the six most recent years (1999 to 2004). Results: The prevalence of obesity increased significantly from 1993 to 2004 from 13.6% to 24.0% among men and from 16.9% to 24.4% among women. If obesity prevalence continues to increase at the same rate, it is projected that the prevalence of obesity in 2012 will be 32.1% (95% CI 30.4 to 34.8) in men and 31.0% (95% CI 29.0 to 33.1) in women. The projected 2012 prevalence for adults in manual social classes is higher (43%) than for adults in non-manual social classes (35%). Conclusion: If recent trends in adult obesity continue, about a third of all adults (almost 13 million individuals) would be obese by 2012. Of these, around 43% are from manual social classes, thereby adding to the public health burden of obesity-related illnesses. This highlights the need for public health action to halt or reverse current trends and narrow social class inequalities in health.

Time trends in childhood and adolescent obesity in England from 1995 to 2007 and projections of prevalence to 2015

Background The aim was to examine the 1995–2007 childhood and adolescent obesity trends and project prevalence to 2015 by age group and social class. Methods Participants were children aged 2–10 and adolescents aged 11–18 years from general population households in England studied using repeated cross-sectional surveys. Obesity was computed using international standards. Prevalence projections to 2015 were based on extrapolation of linear and non-linear trends. Results Obesity prevalence increased from 1995 to 2007 from 3.1% to 6.9% among boys, and 5.2% to 7.4% among girls. There are signs of a levelling off trend past 2004/5. Assuming a linear trend, the 2015 projected obesity prevalence is 10.1% (95% CI 7.5 to 12.6) in boys and 8.9% (5.8 to 12.1) in girls, and 8.0% (4.5, 11.5) in male and 9.7% (6.0, 13.3) in female adolescents. Projected prevalence in manual social classes is markedly higher than in non-manual classes [boys: 10.7% (6.6 to 14.9) vs 7.9% (3.7 to 12.1); girls: 11.2% (7.0 to 15.3) vs 5.4% (1.3 to 9.4); male adolescents: 10.0% (5.2 to 14.8) vs 6.7% (3.4 to 10.0); female adolescents: 10.4% (5.0 to 15.8) vs 8.3% (4.3 to 12.4)]. Conclusion If the trends in young obesity continue, the percentage and numbers of obese young people in England will increase considerably by 2015 and the existing obesity gap between manual and non-manual classes will widen further. This highlights the need for public health action to reverse recent trends and narrow social inequalities in health.

Undiagnosed diabetes - data from the English Longitudinal Study of Ageing

Aims  Diabetes UK estimates a quarter of UK cases of diabetes are undiagnosed; 750 000 people have undiagnosed diabetes in addition to 2.25 million with known diabetes, but research studies examining this are contradictory. The aim was to determine the prevalence of, and risk factors for, undiagnosed diabetes in the population of England aged > 50 years and to calculate the percentage of cases of undiagnosed diabetes.

Physical Activity and Risk of All-Cause and Cardiovascular Disease Mortality in Diabetic Adults From Great Britain: Pooled Analysis of 10 Population-Based Cohorts

OBJECTIVE To examine associations between specific types of physical activity and all-cause and cardiovascular disease (CVD) mortality in a large nationally representative sample of adults with diabetes from Great Britain. RESEARCH DESIGN AND METHODS There were a total of 3,038 participants (675 deaths) with diabetes in the Health Survey for England and the Scottish Health Surveys conducted between 1997 and 2008. Participants aged ≥50 years at baseline were followed up for an average of 75.2 months for all-cause and CVD mortality. Data were collected on self-reported frequency, duration, and intensity of participation in sports and exercise, walking, and domestic physical activity, from which the number of MET-hours/week were derived. Sex-specific medians of time spent in each type of physical activity (for those physically active) were calculated, and Cox proportional hazards regression conducted to examine type-specific associations between the level of physical activity and all-cause and CVD mortality risk. RESULTS Inverse associations with all-cause and CVD mortality were observed for overall physical activity in a dose-response manner after adjusting for covariates. Compared with those who individuals were inactive, participants who reported some activity, but below the recommended amount, or who met the physical activity recommendations had a 26% (95% CI 39–11) and 35% (95% CI 47–21) lower all-cause mortality, respectively. Similar results were found for below/above median physical activity levels. Sports and exercise participation was inversely associated with all-cause (but not CVD) mortality, as were above average levels of walking. Domestic physical activity was not associated with mortality. CONCLUSIONS Moderate physical activity levels were associated with better prognosis in diabetic adults.

Biomarkers of diabetes risk in the National Diet and Nutrition Survey rolling programme (2008-2011).

This study describes the distribution of glycosylated haemoglobin (HbA1c) and glucose concentrations in the combined year 1 (2008–2009), year 2 (2009–2010) and year 3 (2010–2011) of the National Diet and Nutrition Survey (NDNS) rolling programme. The NDNS rolling programme is a nationally representative survey of food consumption, nutrient intakes and nutritional status of people aged 1.5 years and over living in England, Wales, Scotland and Northern Ireland. The study population comprised survey members who completed three or four days of dietary recording and who provided a blood sample. After excluding survey members with self-reported diabetes (n=25), there were 1016 results for HbA1c and 942 for glucose (not the same individuals in each case). Around 5.4% of men and 1.7% of women aged 19–64 years, and 5.1% of men and 5.9% of women aged ≥65 years had impaired fasting glucose (glucose concentrations 6.1–6.9 mmol/L). Over 20% of men aged ≥65 years had fasting glucose concentrations above the clinical cut-off for diabetes (≥7 mmol/L) compared to 2.1% of women of similar age (p=0.007). Similarly, 16.4% of men had HbA1c concentrations ≥6.5%, compared to 1.5% of women (p=0.003). Children and teenagers had fasting glucose and HbA1c values largely within the normal range. To conclude, this is the first study to provide data on the distribution of HbA1c and glucose concentrations in a nationally representative sample of the British population. The high prevalence of men aged ≥65 years with HbA1c and glucose concentrations above the clinical cut-off of diabetes warrants further attention.

P35 Objective and subjective method of physical activity measurement in a cross-section of English adults: health survey for England 2008

Objective To describe and compare physical activity levels, sedentary and moderate-to-vigorous physical activity (MVPA) behaviour in HSE2008 in a representative sample of the adult population, using both objective (accelerometry) and subjective (self-report via questionnaire) methods of measurement. Design Nationally representative cross-sectional population data from Health Survey for England, 2008. Setting Random sample of the general population living in private households in England. Participants Subsample of 4507 adults aged 16+ were selected for accelerometry wear, of whom 2115 adults had valid accelerometry data wear (with at least 600 min per day). Main Outcome Measure Prevalence of those adults who meet the current physical activity (PA) recommendations by accelerometry data. Mean sedentary (minutes) and MVPA minutes (accelerometry). Results Based on accelerometry data, 6% of men and 4% of women met the Chief Medical Officers current minimum recommendations for PA by achieving at least 30 min of moderate or vigorous activity on at least 5 days in the week of accelerometer wear. Men and women aged 16–34 were most likely to have met the recommendations (11% and 8%, respectively). In contrast, based on self-report measures, 39% of men and 29% of women were said to have met the PA recommendations. Only 10% of men and 8% of women whose self-reported activity level corresponded with meeting the recommendations also met the recommendations based on accelerometry. Overall, men had significantly longer periods of sedentary time per day than women (595 min and 584 min, respectively), (p=0.003). While men spent an average of 31 min in MVPA in total per day, and women an average of 24 min, most of this was sporadic activity. Those who were not overweight or obese spent few minutes on average in sedentary time (591 min for men and 577 min for women) than those who were obese (612 min for men and 585 for women). Similarly, adults not overweight or obese spent more MVPA minutes than those who were overweight or obese. This pattern was similar with each BMI category. Conclusion Subjective self-reported method of assessing physical activity resulted in higher levels of activity than objective accelerometry data. Despite this, the results from objective accelerometer data corroborate self-report findings across age and sex. Objective measures provide more accurate data and should be used where available. Comparison between objective and subjective methods indicates that people over estimate their actual physical activity levels.

Under-reporting of tobacco use among Bangladeshi women in England; a cross-sectional study

To investigate the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group. Cross-sectional surveys. Private households in England. 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without, in the 1999 and 2004 Health Surveys for England. Prevalence of under-reported tobacco use (estimated using self-reported tobacco …

P47 High prevalence of obesity in the gambia: evidence from a nationwide population-based cross sectional health examination survey

Background The prevalence of obesity has more than doubled in West Africa over the past 15 years. Obesity is increasing at a faster rate in developing countries compared with developed countries. Possible explanations include epidemiological and nutritional transition, increased consumption of processed foods, and urbanisation. A 1996 study revealed a double burden of over- and under-weight in The Gambia. We examined overweight and obesity prevalence and the associated risk factors in Gambian adults. Methods This study uses a random nationally-representative sample of 4111 adults aged 25–64 years (78% response rate) collected in 2010 using the WHO STEPwise survey methods, restricted to non-pregnant participants with valid weight and height measurements (n=3533). We categorised body mass index from measured height and weight to determine underweight, overweight and obesity (WHO thresholds). Analyses were stratified by gender. All analyses were weighted for non-response and adjusted for complex survey design using STATA14. We conducted multivariate multinomial regression analysis to identify factors associated with underweight, overweight and obesity, using normal weight as reference. Fully adjusted relative risk ratios (ARRR) with their corresponding 95% confidence intervals (CI) are reported. Results Two-fifths of adults in The Gambia were overweight or obese, with a higher prevalence of obesity in women (17.0%, [95% CI 14.7% to 19.7%] vs 8.1% in men, [6.0–11.0%]) and urban residents. Urban residence, abdominal obesity, higher education, and age were significantly associated with obesity among both men and women. Obesity was also significantly associated with low fruit and vegetable intake in men, and with hypertension and ethnicity in women. Most of these variables were also significantly associated with overweight. Compared with rural residents, the risk of overweight and obesity among urban residents were three- and six-fold higher respectively in men (overweight: ARRR 3.1, 95% CI 1.7 to 5.6; obesity: 6.6, 2.5–17.2) and in women (overweight: 3.2, 1.9–5.4; obesity: 5.9, 3.1–11.2). No significant associations were found for underweight, except for smoking and ethnicity in men and old age and ethnicity in women. Conclusion This study reveals that the burden of obesity is increasing at an alarming rate in The Gambia. Preventive strategies should be directed at raising awareness of the risk factors, discouraging harmful beliefs on weight, and the promotion of healthy diet and physical activity particularly in urban areas and among women.

P65 Association of food outlet density and obesity: a cross-sectional study of urban areas in mexico

Background Obesity is an important and highly prevalent risk factor for non-communicable diseases in both developed and developing countries. Obesity prevalence is influenced by a complex, multifaceted system of determinants among which the food retailing and advertising environment is pivotal. Current food environments are often characterised by pervasive exposure to unprecedented availability and marketing of energy-rich and nutrient-poor foods. Mexico has one of the highest obesity rates in the world: 70% of the population is overweight or obese. The country has experienced a dietary and food retail transition involving increased high-calorie-dense food and drink availability. The aims of this study were 1) to analyse the associations between total food outlet density and BMI; 2) to examine the association of the retail food environment index (RFEI) and obesity; and 3) to study the association of the density of individual food outlets and obesity in Mexican adults in urban areas. Methods The National Institute of Statistics and Geography in Mexico provided geographical and food outlet data; BMI, calculated from anthropometric measurements, and socio-economic characteristics of a nationally-representative sample of adults aged 18+, came from participants in the National Health and Nutrition Survey in Mexico (ENSANUT) 2012. I calculated densities of supermarkets, restaurants, chain and non-chain convenience stores, and fruit and vegetable stores in total and by individual type per 1000 people per census tract area, using ArcGIS. I calculated RFEI, the ratio of ‘unhealthy’ to ‘healthy’ food outlets. Using multilevel linear regression, I analysed the relationship between density of food outlet types and obesity using complex survey design in STATA14. All analyses were adjusted for sex, age, socioeconomic status and physical activity. Results Both non-chain convenience store density [β=3.10, 95% CI 0.97 to 5.23, p=0.004] and non-chain combined with chain-type convenience store density [β=2.71, 95% CI 0.63 to 4.80, p=0.011] were significantly associated with obesity. Total food outlet density showed no significant association with obesity. However, the RFEI was associated with higher levels of obesity [β=0.040, 95% CI 0.00049 to 0.02, p=0.040]. Conclusion Convenience stores, which offer a greater availability of energy dense foods with low nutrient content, pose a risk to higher levels of obesity. A balance of healthier food outlets versus non-healthy food outlets could decrease the risk of obesity in urban areas of Mexico.

P136 Close residential proximity to busy roads may deter local walking among adults: Results from a survey of three Southeast England neighbourhoods

Background Traffic and transport infrastructure can signal an area’s socially beneficial economic vitality. They can also cause harm by inhibiting pedestrian mobility of nearby residents. Living near busy roads is associated with increased cardiovascular mortality. The pathways of community severance (the negative impacts of traffic and transport on local people’s health) are unclear owing to inadequate metrics. We investigated the association between residential proximity to busy roads and perceived ability to walk locally, using a novel cross-sectional survey developed to measure community severance. Methods Participants (N = 441; aged ≥18 y; 54% female) were randomly selected from addresses in three Southeast England neighbourhoods identified as likely to be affected by community severance, each bisected by a major road. A questionnaire was administered to measure participants’ demographic, socioeconomic and health characteristics, travel behaviours, and perceptions of neighbourhood traffic and transport infrastructure. Distance along the road and path network from each participant’s home address to their self-reported busiest local road was calculated using ArcGIS software. Associations between this distance and the extent to which traffic speed and volume affected participants’ perceived ability to walk locally were estimated by logistic regression. Results Traffic speed was reported by 23% of participants, and traffic volume by 24%, as often/ always affecting their ability to walk locally, and both factors were significantly associated with worse self-rated health. Compared with participants who lived >400 m from their busiest road (the reference category), those who lived ≤100 m from it had three times higher odds of reporting that their ability to walk locally was often/ always affected by traffic speed (OR 3.5, 1.7–6.9). A similar result was found for traffic volume (3.4, 1.7–6.8). These associations were attenuated after adjustment for demographic and socioeconomic factors (2.7, 1.3–5.6; 2.9, 1.4–6.0 respectively). Using the same reference group, the odds of participants living >100 m to ≤200 m from their busiest road reporting impaired walking were around twice as high for traffic speed (2.3, 1.1–4.8) and for volume (2.5, 1.2–5.1) but adjustment rendered these associations non-significant (1.6, 0.8–3.5; 1.9, 0.9–4.0 respectively). Conclusion Closer residential proximity to a road considered the busiest locally is associated with greater likelihood that local traffic speed and volume will often or always affect residents’ ability to walk in the area. Noise and air pollution likely explain much of the association between residential proximity to busy roads and poor health. A deterrent effect of busy roads on local walking, and therein health-promoting physical activity, warrants further investigation.