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Medicine Interview Hot Topics: Rising Prevalence of Obesity

​Key Information

In 2017, the Health Survey for England estimated that 28.7% of adults in England were obese, with 35.6% overweight but not yet classifiable as obese. More men were obese or overweight than women (67.2% vs 61.5%), and those aged 65-74 were the most likely to be overweight. Obesity costs the National Health Service just over five billion pounds per year.

​Childhood Obesity

Perhaps the real concern for the future is the fast rise in childhood obesity. In 2018-19, 22.6% of children aged between 4 and 5 in England were found to be overweight by the National Child Measurement Programme, which is an increase of 0.2% on just the previous year. In 10 to 11 year olds, a third are classified as obese. Increased reliance on home entertainment, with decreasing rates of exercise, and poor dietary choices, are all to blame. The NHS knows that obese children are more likely to become obese adults. Additionally, they have an increased risk of developing type 2 diabetes – the number of children with diabetes in the UK having increased almost 50% in the last 5 years.

Taking into account the high obesity rates across the British population, and thinking especially about the increased rate in our very young children, we begin to understand the rationale behind the Sugar Tax, a much publicised tax introduced in the UK budget in 2016.

The Sugar Tax

British people have a true love affair with sugary, fizzy drinks. In 2015, British citizens drank 232.9 litres of fizzy drinks each. This led to David Cameron’s Conservative government supporting calls by medical professionals for a ‘sugar tax,’ with the Chancellor of the Exchequer saying, ‘I am not prepared to look back at my time here in this parliament doing this job, and say to my children’s generation, ‘I’m sorry, we knew there was a problem with sugary drinks, we knew it caused disease, but we ducked the difficult decisions and we did nothing.”’
 
Introduction Of The Sugar Tax
The Sugar Tax came into effect in April 2018, decreeing that sugar sweetened drinks which contained more than five grams of sugar per 100ml would be taxed 18 pence per litre. If the drink contained more than eight grams of sugar per 100ml, then the tax would rise to 24 pence per litre. Pure fruit juice is excluded from the sugar tax. The sugar tax is not as revolutionary as it may seem; indeed other countries like France and Finland had already introduced a tax on sugary drinks. The money raised from the Sugar Tax (originally forecast to be as much as 500 million pounds a year). In 10 to 11 year olds, a third are classified as obese. However, after bringing the tax in, the government has made no effort to direct the money in this way.
 
Has The Sugar Tax Been Effective?
Whether or not the sugar tax works is open to debate;according to a government review, there was a 3% reduction in the average amount of sugar per 100g in drinks sold in 2019 compared to those sold in 2015. However, whilst 11% of consumers initially said that they would stop buying sugary drinks initially, this has since fallen to only 1%. In parallel with this, the number of people expressing an intention to continue buying sugary drinks grew from 31% in February 2018 to 44% by June 2018. It should be noted though that manufacturers did heed the sugar tax, with the vast majority of drinks now falling in the tax-free bracket.
 
The Role of Public Health

Certainly the sugar tax stands as a great example of a public health campaign that caught the attention of the press and the general population, was passed by government, and has had at least some positive impact. By increasing public awareness of obesity, and of the importance of diet and exercise, and through bringing manufacturers to account, it is an important step in the fight against obesity in the UK.

Example Interview Questions

  • What are some of the public health issues facing the NHS at the moment?
  • Why is obesity such a problem in the UK today?
  • Why is childhood obesity such an issue?
  • What are the causes of the increased prevalence of diabetes in the UK?
  • What is the Sugar Tax?
  • Do public health interventions like the Sugar Tax work?
  • What public health intervention would you support, or instigate, if you were Minister for Health?

How to answer questions on obesity

Be aware of obesity’s role as a comorbidity. Obesity is linked to diabetes, heart disease, and cancer, as well as worse outcomes in COVID-19 and many other diseases. Through lowering the rate of obesity via public health interventions, a vast amount of money could be saved by the NHS that must currently be spent on the treatment of problems caused by, or exacerbated by, obesity.

Interview Questions & Example Answers

What are some of the public health issues facing the NHS at the moment?

The NHS currently faces a global pandemic – COVID-19, alongside ongoing issues like understaffing, lack of investment, and an aging population. There is also an ongoing mental health crisis, with mental health deteriorating faster than ever before. However, of notable concern as well is the fast rise in childhood obesity. In 2018-19, 22.6% of children aged between 4 and 5 in England were found to be overweight by the National Child Measurement Programme. When looking at 10 to 11 year olds, one finds a third of children are obese. The NHS knows that obese children are more likely to become obese adults. Additionally, they have an increased risk of developing type 2 diabetes.


Why is obesity such a problem in the UK today?

There are a variety of reasons for obesity being an issue today. Increased reliance on home entertainment, with decreasing rates of exercise, and poor dietary choices, are chiefly to blame. We can also – versus previous generations – consider the ease of access to both food in general, and to processed foods that can be either ordered, delivered or prepared in minutes, at any time of day. The British population, alongside these dietary issues and its sedentary nature, is also hugely fond of fizzy drinks, with the average Britain drinking 232.9 litres of fizzy drinks in 2015.
 

Why is childhood obesity such an issue?

Childhood obesity is an issue, primarily, because an obese child is likely to be an obese adult. An obese adult is likely to suffer a variety of ongoing health problems and comorbidities – be it heart disease, breathing problems, or high blood pressure. Additionally, obesity hugely increases the risk of developing type 2 diabetes, and the number of children with diabetes in the UK has increased almost 50% in the last 5 years. Diabetes costs the NHS a huge amount of its funding each year, as do obesity and its complications – reducing childhood obesity now will have huge positive benefits further down the line.


What are the causes of the increased prevalence of diabetes in the UK?

When considering increased rates of diabetes, we are chiefly looking at type II diabetes as diabetes type I is an autoimmune condition. Type II diabetes’ causes are multifactorial in the majority of cases – meaning that more than one cause is involved. In fact, a family history of diabetes is the most common cause. However, there are various risk factors which may lead to an increased risk of developing the condition, and we can see easily how they align with recent public health problems in the UK. They are: obesity, living a sedentary lifestyle, aging and bad dietary choices. Pregnancy and illness may also increase the risk of developing type II diabetes.


What is the Sugar Tax?

The Sugar Tax was passed in April 2018 and decreed that sugar sweetened drinks which contained more than five grams of sugar per 100ml would be taxed 18 pence per litre. If the drink contained more than eight grams of sugar per 100ml, then the tax would rise to 24 pence per litre. Pure fruit juice is excluded from the sugar tax. The money raised from the Sugar Tax (originally forecast to be as much as £500m a year) ought to be used by the government on children’s sports and food and was intended by the government to be used as such – although it has yet to be.


Do public health interventions like the Sugar Tax work?

Looking specifically at the Sugar Tax, we find that there was a 3% reduction in the average amount of sugar per 100g in drinks sold in 2019 compared to those sold in 2015, according to a government review. However, the number of consumers who say that they would stop buying sugary drinks has since fallen to only 1%, from 11% initially. Additionally, the number of people expressing an intention to continue buying sugary drinks grew from 31% in February 2018 to 44% by June 2018. However, it has improved awareness of both obesity and the importance of good diets, as well as bringing these issues into the news more than ever before.


What public health intervention would you support, or instigate, if you were Minister for Health?

The continuation of free school meals in the holidays has recently been a topic of much debate. I believe that continuing this – providing children access to healthy food, with fruit and vegetables, adequate protein, and avoiding salt, sugar and fizzy drinks – is a crucial move for the government to make. This is a step that would not just provide a healthy diet but would actually provide food to many children whose parents may be struggling to provide it – leaving them hungry, affecting their ability to concentrate, to grow healthily, and to enjoy their life as a child. 

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