Introduction
Obesity represents one of the most pressing public health challenges in the United Kingdom, with profound implications for individual health, community well-being, and healthcare systems. Defined as a body mass index (BMI) of 30 or above, obesity is associated with a range of comorbidities and increased mortality rates, placing a significant burden on the National Health Service (NHS). From a chiropractic perspective, obesity is particularly relevant due to its impact on musculoskeletal health, including lower back pain and joint dysfunction, which are common reasons for seeking chiropractic care. This essay aims to explore obesity as a public health issue, examining its implications for patient health, links to other diseases, and effects on mortality. Furthermore, it will discuss the wider community impact, contributing factors using a model of health, and existing health inequalities. Finally, the essay will introduce the COM-B model of behaviour change and discuss its application in supporting patients with obesity, alongside relevant resources to promote a healthy lifestyle.
Obesity: Description and Implications for Patient Health
Obesity is a complex, multifactorial condition characterised by excessive body fat accumulation that poses risks to physical and mental health. According to the NHS, in 2021-2022, approximately 25.9% of adults in England were classified as obese (NHS Digital, 2022). For patients, obesity significantly increases the risk of chronic conditions such as type 2 diabetes, cardiovascular disease, and certain cancers. From a chiropractic standpoint, obesity exacerbates musculoskeletal issues, particularly lower back pain, due to increased mechanical stress on the spine and joints (Shiri et al., 2010). Indeed, patients with obesity often present with reduced mobility and postural imbalances, which can complicate manual therapies and necessitate tailored treatment plans.
Moreover, obesity is intricately linked to other diseases, creating a web of interrelated health challenges. For instance, it is a primary risk factor for hypertension and dyslipidaemia, both of which contribute to cardiovascular disease—a leading cause of premature death in the UK (Public Health England, 2017). The impact on mortality is stark; obesity is estimated to reduce life expectancy by an average of 3 to 10 years, depending on severity (Whitlock et al., 2009). These statistics underscore the urgency of addressing obesity not only to improve quality of life but also to reduce preventable deaths.
Impact on the Wider Community
The repercussions of obesity extend beyond individual health, affecting communities and society at large. Economically, obesity costs the NHS over £6 billion annually, a figure expected to rise with increasing prevalence (Public Health England, 2017). This financial burden strains public resources, diverting funds from other critical areas of care. Socially, obesity can perpetuate stigma and discrimination, leading to reduced social participation and mental health challenges within communities. Furthermore, high obesity rates in specific demographics—such as in deprived areas—can exacerbate health disparities, creating cycles of inequality that are difficult to break. From a chiropractic lens, communities with high obesity prevalence may experience greater demand for musculoskeletal care, highlighting the need for integrated public health and clinical approaches to address this issue holistically.
Contributing Factors and the Biopsychosocial Model
To understand the development of obesity, the biopsychosocial model provides a comprehensive framework, integrating biological, psychological, and social dimensions of health. Biologically, genetic predispositions and metabolic factors can increase susceptibility to weight gain (Locke et al., 2015). Psychologically, stress, depression, and poor coping mechanisms often lead to emotional eating or reduced motivation for physical activity. Socially, environmental factors such as access to affordable healthy food, socioeconomic status, and cultural norms around diet and exercise play significant roles. For example, individuals in low-income areas may face barriers to obtaining fresh produce, relying instead on cheaper, calorie-dense processed foods (Public Health England, 2017). As chiropractors, recognising these multifaceted contributors is essential when addressing obesity-related musculoskeletal complaints, ensuring that interventions consider the broader context of a patient’s life rather than focusing solely on physical symptoms.
Health Inequalities in Obesity
Health inequalities are particularly evident in the distribution of obesity across the UK population. Data from the Office for National Statistics (ONS) reveals that obesity prevalence is higher in deprived areas, with 31% of adults in the most deprived quintile classified as obese compared to 20% in the least deprived (ONS, 2020). These disparities are driven by systemic issues such as limited access to recreational facilities, lower health literacy, and economic constraints. Additionally, gender and ethnicity play roles; for instance, women and individuals from Black and South Asian backgrounds are disproportionately affected (Public Health England, 2017). Such inequalities not only exacerbate health outcomes but also limit access to preventive and therapeutic interventions. Chiropractors must be aware of these disparities, advocating for equitable care and tailoring advice to address the specific barriers faced by vulnerable populations.
Applying the COM-B Model for Behaviour Change
Addressing obesity in clinical practice requires effective strategies to support behaviour change. The COM-B model, developed by Michie et al. (2011), offers a valuable framework by identifying three key components: Capability, Opportunity, and Motivation. Capability refers to an individual’s psychological and physical ability to engage in healthier behaviours, such as understanding nutritional information or having the skills to exercise despite physical limitations. Opportunity encompasses external factors, including access to healthy food options or social support networks. Motivation involves both conscious goals (e.g., desire to lose weight) and unconscious drives (e.g., habits or emotional triggers).
Applying the COM-B model to a patient with obesity might involve assessing their capability through education on balanced diets and safe physical activities suitable for their musculoskeletal condition. Chiropractors can enhance opportunity by linking patients with community resources, such as local walking groups or subsidised gym programmes. To boost motivation, practitioners might use empathetic dialogue to explore personal goals and barriers, fostering a sense of agency. This approach aligns with motivational interviewing techniques, encouraging patients to articulate their own reasons for change, thereby increasing commitment (Miller and Rollnick, 2013). For example, a chiropractor might guide a patient with obesity-related back pain to set incremental goals for weight management, integrating these with spinal health objectives.
Resources to Address Obesity and Promote Health
Numerous resources are available to support patients in tackling obesity and adopting healthier lifestyles. The NHS provides accessible tools such as the “NHS Weight Loss Plan,” a free 12-week programme offering dietary and exercise guidance (NHS, 2023). Public Health England’s “Change4Life” campaign offers family-oriented resources to encourage healthy eating and activity, which can be particularly useful for patients within community settings. Additionally, referral to dietitians or local weight management services can provide tailored support. For chiropractors, collaborating with multidisciplinary teams and signposting these resources ensures a holistic approach, addressing both the physical and lifestyle components of obesity. Integrating advice on posture and low-impact exercises during consultations can further complement these efforts, promoting sustainable health improvements.
Conclusion
In summary, obesity stands as a critical public health issue with far-reaching implications for individual health, mortality, and community well-being. Its links to chronic diseases and musculoskeletal conditions highlight its relevance to chiropractic practice, necessitating a comprehensive understanding of its causes and consequences. The biopsychosocial model illuminates the diverse factors contributing to obesity, while evidence of health inequalities underscores the need for targeted interventions. Using the COM-B model, chiropractors can support behaviour change by addressing capability, opportunity, and motivation, complemented by resources like the NHS Weight Loss Plan. Ultimately, tackling obesity requires a collaborative, equitable approach that acknowledges systemic barriers and empowers patients. By integrating public health strategies with clinical care, chiropractors can play a vital role in mitigating the impact of obesity and fostering healthier communities.
References
- Locke, A.E., Kahali, B., Berndt, S.I. et al. (2015) Genetic studies of body mass index yield new insights for obesity biology. Nature, 518(7538), pp. 197-206.
- Michie, S., van Stralen, M.M. and West, R. (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(42).
- Miller, W.R. and Rollnick, S. (2013) Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford Press.
- NHS Digital (2022) Statistics on Obesity, Physical Activity and Diet, England, 2022. NHS Digital.
- NHS (2023) NHS Weight Loss Plan. NHS.
- Office for National Statistics (ONS) (2020) Health state life expectancies by national deprivation deciles, England: 2016 to 2018. ONS.
- Public Health England (2017) Health Matters: Obesity and the food environment. Public Health England.
- Shiri, R., Karppinen, J., Leino-Arjas, P., Solovieva, S. and Viikari-Juntura, E. (2010) The association between obesity and low back pain: A meta-analysis. American Journal of Epidemiology, 171(2), pp. 135-154.
- Whitlock, G., Lewington, S., Sherliker, P. et al. (2009) Body-mass index and cause-specific mortality in 900,000 adults: Collaborative analyses of 57 prospective studies. The Lancet, 373(9669), pp. 1083-1096.
