Weight gains in profile

Leading scientists have highlighted an impending obesity crisis in the UK and suggest that planning and urban design can provide vital cross-cutting solutions, reports Huw Morris.

Sir David King, the government's chief scientific adviser, could not have put it more dramatically. Obesity is the "climate change of public health" and time is running out before the crisis overwhelms the health services.

King is the leader of the government's futures think-tank Foresight, which comprises 250 experts and scientists. Its recently completed two-year study of obesity offers a highly disturbing message - modern lifestyles mean that the UK is sleepwalking into a disaster. Being overweight in the UK is already the norm. If current trends continue, more than half the population will be obese by 2050 and this will have disastrous consequences for the NHS.

The associated chronic health problems, such as heart disease, strokes, diabetes and cancer, are projected to cost the UK an additional £45.5 billion a year. Reversing this trend could take at least 30 years, Foresight warns. "Already more than 50 per cent of adults are overweight," says King. "The overweight will be the obese of the future if this continues."

Describing obesity as a "much more passive phenomenon than is often assumed", Foresight argues that the technological revolution of the 20th century has led to weight gain becoming inevitable for most people because our biological make-up is out of step with our surroundings.

Compared with 30 years ago, there are fewer manual jobs, while the physically active elements of housework or shopping have substantially diminished. In short, we are now destined to put on weight. "We must fight the notion that the current obesity epidemic arises from individual over-indulgence or laziness," argues King.

"Personal responsibility is important, but our study shows that the problem is much more complicated. It indicates that only change across many elements of society will help us tackle obesity. Stocking up on food was key to survival in prehistoric times. Now, with cheap energy-dense foods, labour-saving devices, motorised transport and sedentary work, obesity is rapidly becoming a consequence of modern life."

Over the past 30 years, physical activity has not so much declined as collapsed. In England the average person walked 410km in 1975-76. In 2003, it was 309km. In the same period, distances cycled fell from 82km per person to 55km. Car use increased by more than ten per cent. A fifth of all journeys of less than a mile are made by car.

People are also much less active in their leisure time. Television viewing has doubled since the 1960s, when the average person watched for 13 hours a week. Today it is more than 26 hours. "We may only be putting on a tiny bit of weight every day. But in the long-term it shows through," King notes. "If men walked 60 miles a year more than they do - just over a mile a week - the effects on weight gain would be significant."

According to the government's chief medical officer Sir Liam Donaldson, the health benefits of being physically active at least five times a week are compelling, not least in significantly lowering the risk of chronic diseases. The original government target was to see 70 per cent of the population reasonably active, taking 30 minutes of moderate exercise five times a week by 2020. But it now concedes that this may be unachievable.

As yet, there are no concerted strategies or policy models that square up to the crisis. Indeed, the problem is so systemic that Foresight admits there is no "magic bullet". Even if a wonder drug to suppress appetite were launched tomorrow it would not avert the crisis. As with global warming, it needs cross-cutting social change.

Urban design plays central role in fitness

But the scientists stress that increasing everyday activity through built environment and transport design will be crucial. Susan Jebb, a nutritional scientist at the Medical Research Council and a Foresight member, emphasises the importance of planning and space, claiming that there is a need to "rethink planning to meet today's challenges and not just those of the previous century".

Residents of "highly walkable neighbourhoods are more active and have slightly lower body weights than their counterparts in less walkable neighbourhoods", the group says. Open spaces, walking routes and cycle lanes are particularly favoured to encourage people to exercise.

"It validates what the planning system has been trying to do for some time by reducing vehicle use," says Colin Haylock of the RTPI urban design network. "If you look back to the work done by the government's Urban Task Force, you see the drive for high-density development and producing tolerable environments. We have been trying to reduce the trend towards lower-density living and are trying to be economical with land use."

Clusters of high-density development can sustain better public transport, Haylock points out. "When public transport is turn-up-and-go rather than forcing people to check the timetable, they will change how they travel. The carrot is producing high-density places in which people want to live, where employment and leisure are close and the environment is safe, convenient and high-quality. Walking to the shops then becomes a natural activity rather than once a week."

Report confronts issue of sustainability

According to RTPI policy adviser Kelvin MacDonald, the Foresight report is a benchmark in planning's drive to create healthy sustainable communities. It extends beyond just "designing out" car-dependency, he claims, and should focus on how we as a society want our cities to look. In turn, it means taking tough decisions on such issues as building on back gardens, creating family homes as well as flats, developing in the green belt and the role of parks and active green space.

"Cities could be much more densely developed," MacDonald argues. "This could mean developing spaces such as playing fields and back gardens. Alternatively, we could look again at green belts and ask if they are forcing development to take place on inappropriate sites. Creating healthy environments is a central tenet of the new holistic approach to spatial planning."

According to Business in Sport and Leisure, the umbrella body for the private sport and leisure and industry, ministers must introduce a national planning policy on physical activity and the built environment. "It would mean that every building and refurbishment would have to include features that encourage activity and every local plan would include policies to promote physical activity," says chief executive Brigid Simmonds.

As well as a national wake-up call, the Foresight study may also hark back to other times. The RTPI points out that planning and public health have a long shared history - John Snow's discovery of contaminated water sources in 19th century London led to sanitation reform and the beginning of the sewerage system we use today.

At the same time, early planning efforts focused on overcoming the health problems associated with slum housing. Health, fitness and the built environment are inextricably linked, although that may have been forgotten of late. "Unless the government makes physical activity a key cross-departmental priority as it has for sustainability, little will change," Simmonds warns.

"The key issue is building sustainable communities and at the core of that is health," says Paul Tomlinson, RTPI environmental planning and protection network chairman. "We have drifted apart as two disciplines. Health and planning have to work closer together because although health issues may seem ephemeral they interlock with agendas such as climate change and energy use. This is everything that planning is about."

Strategic environmental assessment is obliged to consider health issues, Tomlinson points out. Moreover, health authorities and primary care trusts are encouraged to take part under local area agreements. "We are gradually getting together as part of this process," he concludes.

Tackling Obesities: Future Choices is available at PlanningResource.co.uk/doc


- According to the Department of Health (DoH), 65 per cent of men and 56 per cent of woman are overweight and more than a third of individuals are obese.

- If current trends continue, about 60 per cent of men, 50 per cent of women and 25 per cent of children will be obese by 2050.

- Physically active people's risk of premature death is reduced by about 30 per cent and they are up to 50 per cent less likely to be at risk of chronic illnesses such as coronary heart disease, stroke, diabetes and cancer.

- Adults should take at least 30 minutes of at least moderate physical activity on five or more days a week. This can be achieved either in one burst or through several shorter bouts of ten minutes or more.

- Almost three-quarters of adults do not achieve the recommended weekly amount of physical activity.

- The DoH estimates that physical inactivity in England already costs the economy and the NHS £8.2 billion a year. This does not include inactivity's contribution to obesity, which in itself is estimated at £2.5 billion a year.

- The cost of treating obesity and related illnesses in England is expected to reach £3.5 billion by 2010.

- If current rates of obesity continue, by 2050 the cost will be an additional £45.5 billion.

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