Intended for healthcare professionals

Observations Public Health

Chief medical officer urges action to tackle overweight and obesity

BMJ 2014; 348 doi: (Published 27 March 2014) Cite this as: BMJ 2014;348:g2375
  1. Simon J Howard, public health specialty registrar,
  2. Sally C Davies, chief medical officer for England
  1. 1Office of the Chief Medical Officer, Department of Health, London, UK
  1. sjhoward{at}

A “sugar tax” may be one possible sanction if the food and drink industry fails to reduce sugar content voluntarily

Almost two thirds of adults and a third of children are overweight or obese.1 This represents a profound change in the health of the nation over recent decades: in 1980 around 7% of adults were obese,2 whereas today the proportion is around 25%.1 The prevalence of overweight and obesity is discussed so often that the statistics have become familiar to many of us, yet the statistics remain profoundly alarming.

Overweight and obesity are associated with an increased risk of hypertension, type 2 diabetes, musculoskeletal disease, stroke, cardiovascular disease, several cancers, and other diseases. The causes of overweight and obesity are multifactorial, complex, and not fully understood. Yet the alarming prevalence compels us to use evidence based interventions and act, at individual and population levels, even while research into the underlying causes continues.

The Annual Report of the Chief Medical Officer, Surveillance Volume 2012: On the State of the Public’s Health, published this week,3 sets out increasing concern regarding society’s normalisation of overweight. In England the average man weighs around 84 kg and is 175 cm tall, and the average woman weighs around 70 kg and is 162cm tall.4 With body mass indices of 27.4 and 26.7, respectively, the average man and average woman have become overweight.

Despite the risks associated with overweight, the evidence shows that many people do not recognise the condition in themselves or their children. Around 52% of overweight men and 30% of overweight women think they are “about the right weight,” along with 11% of obese men and 6% of obese women.4 Still more worrying, 77% of parents of overweight children do not recognise that their child weighs more than they should.5

The chief medical officer for England has long been concerned about the presentation of underweight as an ideal weight, particularly in the fashion industry. Yet in the light of these new statistics it is increasingly worrying that society is normalising overweight. For example, large mannequins are being introduced into clothes shops6; “size inflation” means that clothes with the same size label have become progressively larger over recent decades7; and media stories about overweight often feature pictures of severely obese people, which are unrepresentative of the majority of the overweight population.

An increasingly sedentary lifestyle plays a part in the overweight and obesity picture. The UK chief medical officers recommend that adults complete a minimum of 2.5 hours of moderate intensity activity a week. Around 40% of adults do not achieve this. By comparison, adults watched an average of 1648 minutes (27.5 hours) of television a week in 2013.8

Diet also has an important role. For example, among adults and children of all ages the average consumption of added sugar and saturated fat is higher than recommended by the Scientific Advisory Committee on Nutrition.3 Among secondary school age children in England (ages 11-18), almost a third of the added sugar in the average diet comes from soft drinks (including carbonated drinks, smoothies, and fruit juices with added sugar).3 Soft drinks are a source of added sugar that is easily avoidable, as the Change4Life Smart Swaps campaign advises.9 The public needs a solid understanding of which products contain added sugar, which could be achieved through clearer labelling.

Yet individual action on diet must be supported by population level interventions that tackle the obesogenic environment. The chief medical officer would like manufacturers to ramp up reformulation and resizing of products to use less added sugar. It is pleasing that some progress has been made on a voluntary basis in product reformulation for salt reduction (though there is still much further to go),10 and the chief medical officer is hopeful that manufacturers will also make progress on reduction of added sugar on a voluntary basis. However, if voluntary efforts fail to deliver, then society may need to consider whether net public health benefit could be derived from regulation such as a “sugar tax.”

This week’s annual report by the chief medical officer presents data showing an association between the number of fast food restaurants per 100 000 population and area level deprivation, which may suggest that people living in deprived areas have easier access to cheap, palatable, energy dense food that lacks nutritional value.2 The association between food availability and obesity is not fully understood.11 However, concern about the effect of fast food outlets is growing: work published in recent weeks indicates that children who live near fast food restaurants are more likely to be overweight12 and that geographical exposure to fast food outlets is associated with an increased body mass index and greater odds of obesity in adults.13

In 1931 the chief medical officer, George Newman, warned that some people were “over-fed—giving their poor bodies little rest, clogging them with yet more food.”14 In the intervening 83 years, understanding of the complex causes of obesity has improved but remains incomplete. Yet over the same period the prevalence of overweight and obesity has increased to an alarming level and has become normal in society. Given evidence based interventions and the risk of inaction, action must continue, even while research continues into the causes. Otherwise the consequences of the increased burden of disease could be extreme.


Cite this as: BMJ 2014;348:g2375


  • Acknowledgments: For proofreading and comment on successive drafts we thank Rebecca Cansdale, assistant private secretary, Office of the Chief Medical Officer, and Wendy Funston, specialty trainee in respiratory and general medicine, Northumbria Healthcare NHS Foundation Trust.

  • Contributors: SJH and SCD contributed equally to the drafting of the manuscript.

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not peer reviewed.

  • Research: Associations between exposure to takeaway food outlets, takeaway food consumption, and body weight in Cambridgeshire, UK (BMJ 2014;348:g1464, doi:10.1136/bmj.g1464); Research: Fried food consumption, genetic risk, and body mass index: gene-diet interaction analysis in three US cohort studies (BMJ 2014;348:g1610, doi:10.1136/bmj.g1610); Editorial: Obesity, genetic risk, and environment (BMJ 2014;348:g1900, doi:10.1136/bmj.g1900)


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