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Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.

BackgroundInternationally, the prevalence of adults with obesity is a major public health concern. Few studies investigate the explanatory pathways between fast-food outlets and body mass index (BMI). We use structural equation modelling to explore an alternative hypothesis to existing research using area-level deprivation as the predictor of BMI and fast-food outlets and diet quality as mediators.MethodsAdults (n=7544) from wave II of the Yorkshire Health Study provided self-reported diet, height and weight (used to calculate BMI). Diet quality was based on sugary drinks, wholemeal (wholegrain) bread and portions of fruit and vegetables. Fast-food outlets were mapped using the Ordnance Survey Points of Interest within 2 km radial buffers around home postcode which were summed to indicate availability. Age (years), gender (female/male) and long-standing health conditions (yes/no) were included as covariates.ResultsThere was little evidence linking fast-food outlets to diet or BMI. An independent association between fast-food outlet availability and BMI operated counterintuitively and was small in effect. There was also little evidence of mediation between fast-food outlet availability and BMI. However, there was more evidence that area-level deprivation was associated with increased BMI, both as an independent effect and through poorer diet quality.ConclusionThis exploratory study offers a first step for considering complexity and pathways linking fast-food outlets, area-level deprivation, diet quality and BMI. Research should respond to and build on the hypothesised pathways and our simple framework presented within our study.

Methods An appraisal framework, based on relevant items from existing tools (i.e. COSMIN, FDA, EMPRO, SAC) was developed. Initial testing was conducted as part of a systematic review, in which data were extracted from 100 papers describing parental feeding practices measures (HomeSTEAD). Next, the framework was expanded to include a scoring system for items related to conceptual framework, reliability, validity and responsiveness testing. The expanded framework was then used in a systematic review of 353 papers describing outcome measures used in childhood obesity treatment evaluations (CoOR).

Background Obesity is an important public health problem. There is clear evidence that the rate of obesity has increased in recent years, and that obesity is associated with chronic health conditions, including diabetes. However, evidence is less clear for effective interventions to reduce bodyweight. It is crucial that we build up a strong knowledge base of effective interventions and that we encourage the discontinuation of ineffective interventions that waste public resources. As well as good quality academic intervention research, pragmatic assessments of ongoing weight management and obesity prevention programmes are urgently needed. However, this process is hampered by inconsistency in measurement. Research by public health practitioners in the UK suggests that although weight management interventions are being commissioned by various organisations, they are often poorly assessed, with inconsistent data being gathered for outputs, effects, and outcomes. The National Obesity Observatory set out to improve the assessment of weight management interventions through the development a standard evaluation framework that could be used to help assessors to obtain data that could be more easily compared with similar programmes. Methods The framework was developed in conjunction with leading academics and public health practitioners to ensure that the document was evidence-based and suitable for practical application by public health practitioners. Key criteria were developed and refined after consultation and testing with experts and the target audience. Findings We have published a standard evaluation framework for weight management interventions. This framework describes standards for a set of essential criteria for data to be obtained during assessment of weight management interventions, such as weight of participants before and after the intervention. Further desirable criteria are also listed that would improve the quality of any assessment, such as qualitative data for participants' perceptions of the intervention. A survey of key stakeholders registered with the National Obesity Observatory (n=175) showed that the framework had been used by three of four respondents. Discussions at training workshops, submitted case studies, and feedback from the Department of Health have shown the framework to be widely used and is mandatory for commissioning in some regions. We have now developed separate frameworks for physical activity and diet and nutrition interventions, which provide detailed guidance for measurement of key outcomes related to these determinants of obesity, with validated methods when possible. Interpretation Although the framework seems to have contributed to some systematic assessments of weight management interventions, some important challenges remain. Managers of obesity programmes in primary care trusts and local authorities continue to report that commissioners seem to be reluctant to allocate sufficient resources for assessment. A high demand for practical assessment support and training remains. Funding National Obesity Observatory and UK Department of Health.