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1. PLAN = 500 words

Part - 1

In the part one of this report, a public health issue that is prevailing in the United Kingdom is
selected for the analysis and discussion purpose of the report. The public health issue that is
selected in this report (which is Obesity in our case) will be discussed with the statistics. The
proper data and stats will be included to describe why obesity is a significant health issue that is
affecting the population health in the UK. Also, this part of the report will consider which part of
the population is highly affected by the obesity in the UK. This part may be divided based on
multiple factors like age, gender, ethnicity, income, etc. Also, the report will try to gather the
data and status of the last decade in the UK regarding the obesity and determine the current
status, i.e. whether it has improved or worsened. Overall idea of Obesity in the UK and its status
in the past years will be presented in this part.

Part 2 -

In the second part of the report, the major focus will remain on the model of social health
determinants. The non-medical factors that are responsible in somewhat influencing the health
and wellbeing of the individual are discussed in brief. Three of the social factors that have been
found to affect the Obesity in the UK population are presented with reasonable examples and
references. The conceptual model of social determinant model proposed by WHO and the one
which is being followed beyond 2005 is used to explain the impacts of social determinants in the
public health.

Part 3-Explain

Following the state of Obesity in the UK and the social determinants of the public health that are
influencing the health of the general population, we now will discuss about the public health
approaches that can be applied to the public health issues. In our case we will analyze about the
structural, settings, and behavior change public health approach to the public health issue of
Obesity. Two of the approaches will be applied for the control of obesity. This application will
be discussed briefly in this part. These approaches will includes the tried and tested
implementations especially in the UK.

Part 4- Explain

Final part of the report will be the part-4. This part – 4 will include the discussions related to the
policy regarding the public health issue of Obesity in the UK. First of all this section will try to
identify the policies that have been proposed and implemented by the UK government. And
among those the policy that is addressing the problem of Obesity will be described in brief. The
major or the key points of that policy will be presented. Also, the examples that can provide the
evidence of the approaches that have been used in the policy will be presented in this par -4 of
the report. How the structural, settings or behavior change approaches are being addressed or
used by the policy is described in short.
2. REPORT

Introduction
As much as the world is getting advanced in the technology, and medical sector, there has been
observed a significant surge in the numbers of public health-related issues and problems. These
medical issues are seen to affect a significant section of the population. Several public health
issues are prevailing in the world. Some examples include Overweight and obesity, smoking,
HIV/AIDS, mental health issue, etc. Among these, in this report, the problem related to Obesity,
specifically in the UK is presented. Obesity 1 is the state of having excess fat in the body of the
individual than a normal amount or quantity. It is often mistaken as a cosmetic concern, but it is
more than just that. Obesity increases the risk of other illnesses and health-related problems like
heart problems, diabetes, blood pressure, cancer, etc. The UK is a developed country that is still
fighting the problem of Obesity. The report describes the current state of obesity in the UK and
also compares the situation in the past decades. The disease is caused not only by medical factors
but also by some non-medical factors i.e. social determinants of health. Obesity and its risk
factors are well explained in the report. Also, there have been some approaches of public health
that try to minimize the growth of this disease. The change in structure and settings of the
environment and community can be done to deal with obesity, or the behavioral change can be
applied in order to curtail the problem of obesity. Also, this report presents some key points of
the policies that have been implanted in the UK to fight obesity. 

1
https://doi.org/10.1038/35007508
Overview of the Report

Part 1. Obesity in the UK

The UK, one of the most developed countries in the world, suffers from killer diseases like heart
disease, stroke, lung and liver-related diseases, and cancer in major. Obesity is significant
because it is directly related to the poor mental health state and declined quality of life. It itself
might not impact directly on the health, but other illnesses resulting as a consequence of obesity
are life-ending ones. Obesity is measured based on the body mass index (BMI) of the individual.
According to the National Health Service, an individual that has a BMI in the range of 30 to 39.9
is considered to be obese.
According to a BBC report2 over 150,000 deaths of under-75s in the UK are due to the above-
mentioned five killer diseases. Among these deaths, 30,000 are supposed to be completely
avoidable. All these diseases are the consequences of the major public health issue named:
Obesity. So, obesity is one of the most significant issues that affect the population health in the
UK. It is observed3 that 28% of the adult population in the UK are obese, while a total of 36.2%
are overweight however not fall under the category of obese. Almost three-quarters of the
population aged between 45-and 74 are obese in the UK. Compared to the 1993AD obesity has
increased by 13% i.e. from 15% to 28% up to 2019. Also, it is commonly seen among the
children of the age group 4-5 and 10-11. A Health Survey for England 4 suggests that out of every
1,000 adults in UK 280 are obese of which 33 are morbidly obese. Looking at the same report, it
can be observed that the obesity rate has crept up in the last decades, although slight fluctuations
can be observed that could have been caused by the survey errors.

2
https://www.bbc.com/news/health-21667065#:~:text=Five%20big%20killers%20%2D%20heart%20disease,of
%20these%20are%20entirely%20avoidable.
3
https://researchbriefings.files.parliament.uk/documents/SN03336/SN03336.pdf
4
https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england
 5

Considering the obesity trend by the gender over last two decades 27% of males and 29% of
females were obese. A steady increase in obesity is observed. When the stats are looked at based
on the age group the obesity is found to be excessive in the cases ages 45 to 74. 13% population
of the age group 16-24, 23% population of the age group 25-34, 30% population of the age group
35-44, and 26% population of the age group 75+ are affected by the public health issue of
obesity.

All these data and stats suggest that the status of obesity in the UK is degrading every year. The
numbers are getting piled up and the population is falling into the trap of the disease. Instead of
improving the status of public health in the country, the condition is looking fearful and worse
than that in the early years of the last decade. Quadrupling the obesity rate among the working
adults of the UK in the last 25 years, meaning in every 4 1 falling into this category is in no way
good for the health sector of the country. The UK was found to be topping the charts of obesity
in Europe.

5
https://researchbriefings.files.parliament.uk/documents/SN03336/SN03336.pdf
https://commonslibrary.parliament.uk/research-briefings/sn03336/#:~:text=Adult%20obesity%20in
6

%20England&text=BMI%20between%2025%20and%2030,to%20be%20overweight%20or%20obese.
Part 2. Social health determinants of obesity
Discussing the public health issue, there can be some non-biological and non-medical terms
associated with them. The disease is not always associated with the direct factors that one may
think. Several social factors that influence the health of the population are called social
determinants of health. In the case of obesity also we can analyze these factors. There are several
models of social health determinants that can influence the public health issue. We will be
considering the model that has been followed beyond 2005 and proposed by WHO. The
conceptual framework7 for public health suggests three distinct categories based on which the
social determinants can be categorized. The first one is the common and classic indicator,
another one is the demographic indicator, and the last one is the complementary indicator. The
classic indicators include income, occupation along with education-like factors. Education is
the most common factor that has a complicated relationship with income and occupation. People
who have high education levels are believed to be highly socialized and have better lifestyles,
jobs, and economies in general. In the case of the demographic indicators, the factors like
genetics, gender, race/ethnicity, age groups, religion, marital status, etc. are included. Genetics
combined with the age and gender factors affect the health status. In terms of complementary
indicators, the wealth and assets of the individual, social capital, support from the family,
friends, society, and community, cultures, access to health services, etc. are included. Social
capital means the trust the individual has in the community.

For example if the person is not educated than he/she cannot know about the nutritional values of
the foods, and the importance of the balanced diet. Moreover illiterate individual is often
deprived of the jobs, so low salary resulting in unmanaged and irregular fooding habits.
Accessibility of the food needs to be a right but is being a privilege in the current scenario. The
adults of the deprived regions8 of the UK have almost twice the prevalence of obesity compared
to the ones from the least deprived regions.

7
https://www.researchgate.net/publication/
316738069_Conceptual_Models_of_Social_Determinants_of_Health_A_Narrative_Review
8
https://www.rcplondon.ac.uk/news/health-inequalities-and-obesity#:~:text=A%20myriad%20of%20socio
%2Deconomic,our%20risk%20of%20developing%20obesity.
Another example of social determinant is the genetics and gender. The genetics defines how the
fat is accumulated in the body of an individual. Traditionally the men have an apple shape and
the women have a pear shaped structure of the obese body. According to a research the fat
distribution is regulated by the genetics and not by the diet. If any population has a niche genetic
Predisposition to store the fat in the dangerous parts of the body, obesity will appear in the early
ages of the individual.

Similarly, another social determinant social capital9 is found to be directly proportional to the
odds of having or suffering from obesity. The relationship 10 of the social capital with the public
health issue of obesity is impacted by the interpersonal relationships, beliefs, values, and norms
of the community. People have a norm and behavior regarding the shape of their body, diet they
take, physical activities they perform, and so on. According to a study that provided social
support to the people, the population follows a downward weight-loss trend by following the
dietary regimens.

9
https://doi.org/10.22088/cjim.10.3.281
10
https://dx.doi.org/10.22088%2Fcjim.10.3.281
Part 3. Public Health Approach
Public health approaches are ways to address and solve the public health issues such as Obesity.
Structural, behavioral, and settings are some of the major approaches followed globally.
Structural Approach:1112
The structural approach of dealing with the public health issues refers to techniques in which
change in any physical structure of our society help in improve the public health issue. Such
structure could be political structure, environmental structure, and social structure. But structural
change cannot guarantee the solution of any public health issues as there are multiple factors
such as leadership and new living values that affects this approach.
Behavioral Approach:
The behavioral change approach of dealing with public health issues is another theory-based
approach in which one or multiple factors of behavior are attempted to be changed. Such
determinants could be person’s attitude towards health or self-efficacy. The behavioral change
approach not only tells the people what to change, but also it emphasizes on how to change.
Settings Approach:13
Settings approach of public health is a unique approach to deal with the public health issues, in
this approach the places where people gathered on a regular basis where environmental, personal
and organizational factors are interacted, is taken into consideration. Educational institutes,
organizations, work places can be suitable places to develop settings approach.

1. Structural Approach to deal with Obesity:14

The structural changes in politics, social, environment can help to prevent Obesity
problems of any country. One of the aspects of structural approach is to empower people.
When people and communities are empowered by the education and right trainings then
they can adopt a healthy lifestyle as it helps in power distribution. Another aspect is
human right. A change in basic human right structure can help in dealing with Obesity.

11
https://journals.sagepub.com/doi/abs/10.1177/1090198113503342?journalCode=hebc
12
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408629/
13
https://nccid.ca/publications/the-settings-approach-in-public-health/
14
https://www.longdom.org/open-access/obesity-and-structural-and-cognitivebehavioral-approaches-to-therapy-
2161-0940-1000220.pdf
 People should have right of having healthy food and a healthy life. Sometimes, what
happens is that the higher authority of the government thinks that everything in control
but reality can be different than this, the change in authority structure can also help in
prevention from the Obesity. A good leader will promote healthy life style in contrast to
an average leader who does not give more emphasis on promoting healthy life style.
2. Behavioral Approach to deal with Obesity:15
Behavioral and comprehensive lifestyle interventions are most recommended approach
when it comes to dealing with the Obesity and overweight problems. It is a globally
recognized and has been found effective approach because it drives people to change
their behavior for a healthy habit. The behavioral chance approach suggests people how
they can lose the extra weight and what behavioral change they need to accomplish the
goal. Such behaviors could be stop smoking, not eating junk foods all the time and join
the gym or do some regular exercises. The behavioral approach helps to keep track of
multiple components such as food and activity record, nutrition record, physical activity
record, eating speed record, cognitive therapy record. Studies suggest that these
components, especially, self-monitoring and physical activity helps in better weight
control.

15
https://academic.oup.com/ajcn/article/82/1/230S/4863396?login=true
Part 4. Policy addressing the Obesity in the UK
Many countries across the globe have developed policies to deal with the Obesity and over
weight problems. These policies guide authorities and communities to work effectively and in a
well-directed way to deal with it. The suitable Obesity Policy that fits in this case is the “Obesity
Policy in England”. The United Kingdom government recognized the Obesity as a population
health challenge for the first time in 1991. Since then, fourteen different government plans have
been dealing with obesity in the United Kingdom, either fully or partially. Even though
government has been trying tackling the Obesity, they have not been succeeded yet. This is why
they have been criticized for not be able to deliver what they have said in the policy.
The policies of England government to deal with obesity has always been proposed in a way that
it never concluded with any implementation. The government has constantly been failing at this.
The government rarely tries to evaluate their policies and outcomes. Even though the polices
have been failing the government does not seem learning from it and improving. Health of the
nation[1992], reducing health inequalities[1999], Saving lives: our healthier Nation[1999],
Choosing health[2004], Choosing Health[2005], Choosing better Diet[2005], Healthy Weight,
Healthy Lives[2008], Food Matters[2008], Healthy Lives, Healthy People[2010], A call to action
on obesity in England[2011], Childhood obesity: A plan for action[2016], Childhood obesity: A
plan for obesity, chapter 2[2018], Childhood Obesity: A plan for obesity, chapter 3[2019],
Tackling obesity[2020] are the policies adopted by the government from 1991 to till date.
It is very clear that government has been trying to deal with the Obesity problem, but the result
of these policies is not as welcoming as it could be. The policies explain two strands of the health
policies – health care and public health. Health policies are more related with the health care
systems whereas public health is related with population health, prevention of illness and a
longer healthy life through a common effort from a society. These can be categories in terms of
approaches of the public health. For example, public health tells that people’s behavior such as
social and economic factors evaluate the health outcomes. Similarly, the structural changing
approach can be found in the polices in which department of health and social care is responsible
for making sure that the polices have been implemented effectively. The UK government has
been focusing on the settings approach as well, policies like childhood obesity: A plan for action
was heavily focused on school setting, nutrition labelling. This policy is based on the evidences
that show that human food preferences and the environment in which those preferences are made
plays important role in food culture. That is why, such polices are developed in a way that the
environment can be changed through the settings approach. The policy “A call to obesity: A plan
for obesity” was a policy of the UK government through which they wanted to prevent children
from getting over weights. For this they used all three approaches viz. structural, settings, and
behavioral changing approaches. They run collaborative efforts among schools, parents,
physicians to educate not letting kids becoming obese and they made sure that kids know about
obese and nutrition, exercise so that they do not face over weight related problem at their
adulthood.16

16
https://www.liebertpub.com/doi/abs/10.1089/bar.2009.9996
Conclusion
Obesity is not often looked like a serious public health issue, however, the stats show the major
deaths are caused due to the consequences resulting from obesity. The obesity-affected
population has been ever increasing in the UK for decades over decades. Despite having so many
medical services, and awareness programs in the country, there has not been any significant dip
in the graph of the population impacted by obesity. More males than females are found to be
obese due to poor physical activities. The age group of 45 to 74 ae the major population under
the threat of obesity in the UK. Even the children of the age group 4-5 and 10-11 are found to be
trapped by this issue. Social determinants like education, income, social capital, and genetics are
found to significantly hinder health and well-being in the case of obesity in the UK. People often
tend to ignore the socio-economic aspects, and consider them to be independent of the health.
But the health and wellbeing is actually being determined and defined by those factors which are
non-medical too. The public health issue of obesity can be handled by the structural, settings, or
behavioral changes approach. By changing the community and norms from the root level and
making the individual follow the healthy plans of food and physical activities, obesity can be
reduced. Since identifying the Obesity as the public health problem back in 1991, the UK
government has been coming up with several policies to minimize it, but all in vain.