On Dec 27, 2016, in the midst of festive overindulgences—and burgeoning resolutions of good health—Public Health England (PHE) released its latest analysis from the Health Survey for England. The report supports the re-launch of the One You: New Year, New You campaign, and focused on the behaviour and health of adults in the UK aged from 40 to 60 years. Worryingly, and yet unsurprisingly, the data show that between 1991–93 and 2011–13 the proportion of overweight or obese individuals has increased from 66·7% to 76·8% for men, and from 54·8% to 63·4% for women.
PHE’s One You campaign offers a free online quiz, which calculates a health score (out of 10), with traffic light scores for the components of moving, eating, drinking, and smoking. The quiz outcome links participants to tailored, localised information, tools, and apps. Since its initial launch in March, 2016, more than 1·1 million people have taken the quiz, of whom over 250 000 subsequently downloaded the popular Couch to 5K running app. The toolkit offered by PHE is well designed, grounded in a solid evidence base, and offers a coordinated approach to important information and resources to tackle health risk factors, which is useful for both individuals and clinicians. But beyond downloads, questions remain about how the efficacy of this and other similar campaigns should be measured, and more broadly on the extent to which measures focusing on individuals’ personal responsibility can be effective. As a paper by Christina Roberto and colleagues in the Lancet’s 2015 Obesity Series explained, “people bear some personal responsibility for their health, but environmental factors can readily support or undermine the ability of people to act in their own self-interest”. The paper questions the oversimplified dichotomy of individual versus environmental responsibility and emphasises the reciprocal interplay between the environment and the individual.
December also saw the publication of updated diabetes guidelines from the American Diabetes Association, a disease for which obesity is the main modifiable risk factor. Standards of Medical Care in Diabetes—2017 includes a new section on lifestyle management, containing the recommendations that sedentary behaviour be interrupted with periods of physical activity every 30 minutes, and advising that health-care providers assess patients’ sleep patterns because poor sleep quality might adversely alter blood glucose management. There is increased recognition of the psychological and emotional consequences of diabetes, with a new guideline on screening for diabetes-associated distress, depression, anxiety, and eating disorders.
The guidelines also place an increased emphasis on a comprehensive patient-centred approach to management—both by an expansion of the list of diabetes comorbidities that require coordinated management and the recommendation that health-care providers assess their patients within relevant social contexts. Financial concerns, access to health care and insurance, food insecurity, and a lack of housing stability are recognised as barriers to successful treatment for some individuals with diabetes. Elimination of these health-care disparities relies on culturally appropriate approaches, increased community support, and system-level interventions.
Rising levels of increasingly severe obesity mean that, worldwide, populations are on the brink of a catastrophic epidemic of diabetes. The latest global estimates from the International Diabetes Federation forecast that by 2040, 642 million people will be living with diabetes. Measures such as One You, directed to help individuals address their health risk factors, and improved strategies to manage the resulting diseases such as the ADA guidelines are welcome. But they will not stem the growing burden of these diseases. A failure to appreciate the interconnected and maladapted systems underlying lifestyle changes over the past 20 years, a desire to place too much importance on individual responsibility, and a reluctance to legislate industry stakeholders all culminate in a gross underestimation of the scale of change required to tackle these epidemics.
The Lancet Commission on Obesity is due to report in 2018. By examining the roles of nutrition, physical activity, urban planning, food systems, agriculture, climate change, economics, governance and politics, law, business, marketing, and communication, among others, the Commission will make recommendations for coordinated approaches and a framework for accountability. Individuals, clinicians, and governments should use this new year to reflect on the reality of health in 2017, exposing and challenging unhealthy working environments, living, and dietary habits rather than dismissing them as unavoidable consequences of modern life: obesity and diabetes should not become the new normal.