Public Health Epidemiology and Statistics

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Section A

The epidemiology of obesity

Obesity can be considered as the complex as well as a multifactorial disease that is increasing day by day. According to the view of Biadgi Lin et al. (2017), obesity can be found to increase in all ages and in both sexes irrespective of socioeconomic status, ethnicity and geographical locality as well. However, the prevalence of obesity is generally greater in women or older people than male and children. In order to define overweight as well as obesity “Body Mass Index” or BMI is used. It can be observed that the worldwide spread of obesity has doubled from 1980 to the extent that one-third population of the world can be classified as the obsessed people (Rawla et al. 2019).

Generally, eating too much and moving less can be considered as the major cause of obesity. After taking a high amount of food, not burning that food energy off by physical activity, surplus energy can be stored by the body (Harper et al. 2019). Improving lifestyle can play an important role in making a reduction in the risks of obesity so that people especially children can be safe from this factor. Adapting some good, habits such as having healthy diets as well as having good sleeping timing can reduce the chances to be obsessed especially in the children and in the older age as well.

Obesity develops gradually as the result of several factors like poor lifestyle and selection of diet. Factors such as following a poor diet, eating too much as well as having some bad habits like drinking too much alcohol can enhance the chances of obesity. Apart from this, lack of physical activity can be a cause of increasing obesity, especially in middle-aged males and females. It can be observed from a survey that a total of 1.9 billion as well as 609 million people can be estimated in 2015 that accounts for approximately 39% of the total population globally. The age of beyond 20 years and old onwards are found to have a greater risk of obesity globally both in males and females.

Figure 1: Prevalence of obesity globally

(Source: Metabolismjournal.com, 2018)

Thousands of adults, as well as children, are found to be overweight in Wolverhampton and having serious health issues that need to be reduced (Wolverhamptonccg.nhs.uk, 2021). In the year 2020, a “Clinical Commissioning Group” can be notified of an obesity awareness week that was run from 13 to 20th January 2020 (Wolverhamptonccg.nhs.uk, 2021). The latest statistics reveal that 29% of the children and 66% of the adults are at risk of obesity in Wolverhampton (Wolverhamptonccg.nhs.uk, 2021). As per the view of Lanigan (2018), being obsessed can cause the risk of stroke, cardiovascular disease as well as a chronic disease like Type-2 diabetes. Making some small changes in lifestyle can play an important role in making these risks reduce, especially among the children.

According to the latest data, the Wolverhampton can be considered as the overweight or obsessed city as it accounts for 40% of obsessed children (Wolverhamptonccg.nhs.uk, 2021). This is above the national average leading the city to be classified as the overweight city. It can be found that the rate of obesity increased from 9.3% to 9.6% in 2017 in Wolverhampton (Wolverhamptonccg.nhs.uk, 2021). More than one child of the year six can be noticed to be obsessed or overweight in this year.

A model named EPOCH was produced in 2009 in order to reduce the risk of obesity in children. This model generally helps in determining the fact that early interventions for childhood obesity have an impact on BMI (Ncbi.nlm.nih.gov, 2019). Childhood obesity can be considered as a serious health problem not only in Wolverhampton but also globally. EPOCH models allow the researcher to update the internal model parameters so that the results can be reliable (Ncbi.nlm.nih.gov, 2019). In order to describe a conceptual structure of a health economic model, to evaluate the childhood obesity interventions as well as epidemiologic prediction EPOCH model have been introduced (Ncbi.nlm.nih.gov, 2019).

The EPOCH model allows making a concept on the prediction of both the BMI trajectories as well as the prevalence of obesity for both boys and girls (Ncbi.nlm.nih.gov, 2019). Future development of this model also allows the researcher to determine the socio-economic position as well as the impact of obesity on the increasing health care cost (Ncbi.nlm.nih.gov, 2019). Apart from this, EPOCH can be helpful in answering the best time to intervene in childhood. Moreover, the most cost-effective approaches, as well as the population group that can be benefited by the intervention, can be determined by the development of this model (Ncbi.nlm.nih.gov, 2019).

A model for Planned behaviour can play an important role in helping to improve the behaviour leading to reduce the risk factors associated with obesity. This model addresses three major aspects: attitude, behavioural control, as well as subjective norms. The attitude refers to the judgement and values to the healthy diet that has been recommended (Morrissey et al. 2020). Subjective norm refers to the importance of having a healthy diet in order to control the risk of obesity not only in children but also among adults. Perception of behavioural control helps in assessing the people’s awareness in keeping a healthy diet in order to prevent obesity. This model assumes that human behaviours are mainly based on conscious thought. In the case of controlling obesity, children, as well as adults, should reduce the use of unhealthy diets.

Figure 2: Comparison between local, regional and international data

(Source: Who.int, 2021)

This model also enables an introduction of the concept that change can be introduced to the people by a brief intervention. This can play an important role in making human behaviour good for having a healthy diet so that they can be able to reduce the chances of obesity. Planned behaviour usually aims to get an individual person to engage in healthy diet behaviour (Hill, 2017). Minimal interventions can play a pivotal role in helping health professionals to assess the concept of general people on obesity. Moreover, it can help in conveying the message about the importance of having a healthy diet in order to reduce the risk factors of obesity.

It can be observed that Wolverhampton accounts for 29% of male children having obesity that can be considered as a risky percentage (Who.int, 2021). On the other hand, global data can be found to show 26.9% of male children having obesity. It can be found that Wolverhampton having a greater percentage in obesity should be reduced in order to recover. Moreover, in middle-aged males, obesity can be found to show 66%, whereas global data are showing that 83% of middle-age males are having obesity (Who.int, 2021). This indicates that in Wolverhampton middle-aged people have less obesity in the comparison of global data. It can also be found that in teenagers, Wolverhampton accounts for 18% obesity whereas global obesity level can be found to account for 39%. On the other hand, at old age, 77.1% of the people can be found with obesity in Wolverhampton, whereas 37.5% can be found with obesity globally. This data indicates that having risk in obesity can be found mostly in the obsessed people (Who. int, 2021).

Section B

Determinants of health

Poor health is not only an issue for a person but also an issue for the nation. Initiatives must be taken to prevent all the health-related problems, which can be recovered. Obesity has nowadays seemed like a big problem that portrays its dark side to public health. Political figures in Wolverhampton take governmental strategies to mitigate the risk of obesity of the public. As per Alford et al. (2018), reality tells that children to older age have trouble to get obesity due to their unhealthy lifestyle, unhealthy food taking, less exercise and others. Therefore, political advocacy has to take initiatives to prevent it in the metropolitan city of Wolverhampton.

Council of the city observed that people are less active in physical work; therefore, they have a tendency to get obesity. As cited by Bagnall et al. (2019), legislation has been taken initiatives regarding labelling the calories in the food menu of restaurants and street foods. Therefore, people will get immediate alert during noticing the menu and maybe they will not be going to purchase or eat high calories based foods. World Yoga Day has been observed in this city authorized by governments to aware people regarding obesity and its dark impact on the public body. As mentioned by Bray et al. (2018), governments have been thinking of opening yoga and gym centres under governmental facilitation to encourage people to perform physical activities. Moreover, the government of the city has further taken initiatives regarding opening some public parks and gardens to encourage more people to jog, run and other health benefits of physical activity performances.

NHS Wolverhampton Clinical Commissioning Group had operated obesity awareness campaign days on 13 January 2020 to 20th January 2020 (NHS Wolverhampton CCG, 2021). In this campaign, political figures had been encouraging people to take part in that campaign and stay fit and healthy in order to prevent obesity. As per the view of Lake et al. (2017), approximately 66% of adults and more or less 29% of children in this city have been classified as getting overweight rapidly. It is a critical situation as many disorders or diseases for instance arthritis, heart blockage, cholesterol increasing in blood, high blood pressure, Type-II diabetes, stroke, Gallbladder stone, osteoarthritis and others can occur due to being overweight.  According to Medvedyuk et al. (2018), on the other hand, patients may have a tendency to get mental health issues such as stress, depression, anxiety and others. Therefore, the government of this city has to take initiatives to prevent all of that.

The government has issued some exceptional hospitals, which are represented to spread awareness regarding obesity in people. As mentioned by Rubino et al. (2020), medical practitioners, nurses and other medical board team members have decided to prescribe anti-obesity drugs under political inferences only to the patients who faced difficulties with this. Otherwise, normal obesity based patients will be treated naturally through yoga, gym, running and another way of physical activities (NHS Wolverhampton CCG, 2021).

This city’s government has paid attention to decreased unhealthy high-calorie-based food menu in the restaurant and has decided to replace those with healthy food. As mentioned by Salas et al. (2019), the government has paid attention to advertising methods on the TV, newspaper and other areas to spared awareness regarding obesity. Apart from this, political figures of Wolverhampton have advertising obesity preventing understanding in the social media platform such as Facebook, Instagram, Tweeter and other sites through some popular social media content creators and influencers (Wolfenden et al. 2019). It helps to increase awareness among the public of the city, and awareness campaigns may face success in the future. In order to reduce mental health issues due to arisen by obesity has been further taken as a serious topic to research by the political advocacy of Wolverhampton.

In order to reduce inequalities in obesity-related levels political interference in Wolverhampton has shown an active stage in three central part mentioned below;

• Consolidation individuals: It is a person-based approach to improve the health of a depressed individual (NHS Wolverhampton CCG, 2021).
• Strengthening communities: It approaches improving health and spreading awareness of the communities.
• Improving educational environments and living culture: It deals with sparse awareness from the school and other education; systems.
• Introducing healthy micro policies: Introducing micro policies on communities’ level will highly affect the public’s thought process and helps to think according to their health purpose (NHS Wolverhampton CCG, 2021).

People with obesity have been taken care of by the doctors perfectly so that they do not get mental health issues. In case any patients with obesity have shown mental health issues, the doctors treat them with extra gentle care. In that means, doctors hold a consulting session with patients to understand their perspective and problems faced by obesity. It literally helps people to stay mentally healthy while treating obesity. As per the view of Alford et al. (2018), local authorities in some areas of this city have been issued to observe the number of people overweight and collected this data to understand from where they will have to start to mitigate the risk of obesity from spreading.

After that, they notice the people and encourage them to get active and perform the physical exercise to reduce the fat from their body and gain healthy weight. It amazingly works well as people are showing inherent to this process and listening to their advice. As cited by Bagnall et al. (2019), the governments of this city have started many schemes to encourage people to lose overweight from their body and those schemes are cycling and walking routes and others. Dr Salma Reehana, Chair of NHS Wolverhampton CCG, said that the people with obesity have to raise awareness to prevent overweight-related disease and disorder (NHS Wolverhampton CCG, 2021). She also said that overweight people have the risk of shirt life. The governments have spread awareness through some policies such as fat tax, sugar tax, diet-related policies and others.

 Section C

1. Interpretation of data

Provided statistical data has portrayed the rate of diabetic and non-diabetic patients’ BMI. The major strength of this data is to analyses it with paired t-test. A diabetic patient has been taken to understand the risk of diabetes on their body comparatively higher in non-diabetic patients. The data has been presented only based on Asian diabetic patients where non-Asian diabetic patients’ BMI rate is not mentioned. Therefore, major limitation is that the study has not developed adequately based on two groups Asian and non-Asian, where the statement of the hypothesis is conducted based on both these communities.

The study has been shown the rate of standard deviation on behalf of BMI based on paired t-test experiments. Statistical data has been developed based on where it has been noticed that diabetic patients have a high risk of getting sick due to high BMI compared to non-diabetic patients. Furthermore, the study has been proved to apply recovery measurements based on the treatment of diabetic patients to prevent them from any other risky disease. Risk will higher in case patients is not treated properly with accurate techniques such as they have to take anti diabetic medicine  and do physical exercise to reduce in order to increased BMI.

2. Identification of statistical test and its suitability

Analysed the provided statistical data, it has been seen that Asian people’s Body Mass Index (BMI) is higher than the non-diabetic people are. About 152 Asian people with diabetes have participated in the conducted research to analyses the BMI on their body. On the hand, the research has also included about 448 non-diabetic people with diabetes to know the exact comparative value of BMI in both of these communities. Asian diabetic people’s BMI was average, 27.26 units and non-diabetic people’s BMI were averages of 28.34 units. The statistical data has been presented as per the Paired t-test as the test deal with two-level, and its functional factors have to know the outcome of BMI.

The standard deviation of Asian diabetic people was up to 4.779, and on the other hand, for non-diabetic people, it was approximately 5.232. Therefore, it is noticeable that Asian people with diabetes have a comparatively higher BMI than non-diabetic people, as the number of chosen people is high in non-diabetic and lower at the diabetes level. The high number shows that high-risk factors for diabetic patients have to mitigate it immediately with proper treatment.

3. Discussion on the hypothesis

From the statistical data, it has been observed that Asian people have a lower risk than the non-diabetic people with diabetes do. It has been observed that Asian people with diabetes have more physically active; therefore, their BMI is higher. On the other hand, less performed physical activities non-diabetic people deal with serious health-related issues, including diabetes. About 152 Asian people have a mean BMI of 27.26 unit, which is moderately on the good side compared to non-diabetic people who have a mean BMI of 28.34 out of 448 people.

It is already noticeable that higher numbers of people have less mean BMI, which shows that non-diabetic people with diabetes have not much active in physical activities; therefore, the average mean BMI is higher. Discussing all the data, it is observable that, the hypothesis has been stated that Asian diabetic people with diabetes have higher BMI than non-diabetic patient. Analysing this data, it is further noticeable that the hypothesis’s statement is not matched with the data perfectly as data tell about only Asian people where non-Asian people rate is not mentioned.

4. Design of epidemiological study to test the hypothesis

After getting analytical data, further research has been conducted with the case-control study.  Asian and non-Asian group has been selected to part of this experiment. Diabetic patients of both Asian and non-Asian communities have been selected as case study group whereas other non-diabetic groups have been selected as a control group. The first experiment has been holding within one month where the study experienced that, non-diabetic patients have high BMI than diabetic patients. It is further observed that the group has less risk of getting any secondary disease caused by diabetes. Therefore, experimenting on non-diabetic patients providing accurate data of risk factors.  After conducting 1-month experiments, the study has been holding after three months and long-term span about five months.

This experimental study has noticed that a diabetic patient’s BMI is higher than non-diabetic within appropriate standard deviation. Under paired t-test, this study has been developed to meet the BMI present on the diabetic communities and compared it with non-diabetic communities. Risk factors noticed in that case, and non-diabetic patients have no major risk. Still, diabetic patients have major risk such as obesity; heart attack, brain-damaged, blood vessels may be extremely large, cholesterol high and others. Therefore, the case-control group has been taken to observe which risk will be reduced from diabetic patients.

Reference list

Section A

Beyer, F., Kharabian Masouleh, S., Huntenburg, J.M., Lampe, L., Luck, T., Riedel‐Heller, S.G., Loeffler, M., Schroeter, M.L., Stumvoll, M., Villringer, A. and Witte, A.V., 2017. Higher body mass index is associated with reduced posterior default mode connectivity in older adults. Human Brain Mapping, 38(7), pp.3502-3515.

Biadgilign, S., Mgutshini, T., Haile, D., Gebremichael, B., Moges, Y. and Tilahun, K., 2017. Epidemiology of obesity and overweight in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ open, 7(11), p.e017666.

Cunha, P.M., Ribeiro, A.S., Tomeleri, C.M., Schoenfeld, B.J., Silva, A.M., Souza, M.F., Nascimento, M.A., Sardinha, L.B. and Cyrino, E.S., 2018. The effects of resistance training volume on osteosarcopenic obesity in older women. Journal of Sports Sciences, 36(14), pp.1564-1571.

Harper, R., Nevill, A., Senghore, N. and Khan, I., 2019. Socioeconomic and ethnic status of two-and three-year-olds undergoing dental extractions under general anaesthesia in Wolverhampton, 2011-2016. British dental journal, 226(5), pp.349-353.

Hill, A.J., 2017. Obesity in children and the ‘Myth of Psychological Maladjustment’: self-esteem in the spotlight. Current obesity reports, 6(1), pp.63-70.

Lanigan, J., 2018. Prevention of overweight and obesity in early life. Proceedings of the Nutrition Society, 77(3), pp.247-256.

Morrissey, B., Taveras, E., Allender, S. and Strugnell, C., 2020. Sleep and obesity among children: A systematic review of multiple sleep dimensions. Pediatric obesity, 15(4), p.e12619.

Ncbi.nlm.nih.gov, 2020, A New Model for Evaluation of Interventions to Prevent Obesity in Early Childhood , Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405882/ [Accessed on: 9^th January, 2021].

Peralta, M., Ramos, M., Lipert, A., Martins, J. and Marques, A., 2018. Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013. Scandinavian journal of public health, 46(5), pp.522-529.

Prokopidis, K., Cervo, M.M., Gandham, A. and Scott, D., 2020. Impact of protein intake in older adults with sarcopenia and obesity: A gut microbiota perspective. Nutrients, 12(8), p.2285.

Rawla, P., Thandra, K.C. and Sunkara, T., 2019. Pancreatic cancer and obesity: epidemiology, mechanism, and preventive strategies. Clinical journal of gastroenterology, 12(4), pp.285-291.

Who.int, 2021, Obesity and overweight,  Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:~:text=In%202016%2C%20more%20than%201.9%20billion%20adults%20aged%2018%20years,650%20million%20adults%20were%20obese.&text=Overall%2C%20about%2013%25%20of%20the,tripled%20between%201975%20and%202016. [Accessed on: 9^th January, 2021].

Wolverhamptonccg.nhs.uk, 2021, Call to combat obesity in Wolverhampton Available at: https://wolverhamptonccg.nhs.uk/about-us/news/1013-call-to-combat-obesity-in-wolverhampton#:~:text=Latest%20statistics%20show%20that%20in,cancers%20and%20poor%20mental%20health. [Accessed on: 9^th January, 2021].

Section B

Alford, S., Patel, D., Perakakis, N. and Mantzoros, C.S., 2018. Obesity as a risk factor for Alzheimer’s disease: weighing the evidence. Obesity reviews, 19(2), pp.269-280.

Bagnall, A.M., Radley, D., Jones, R., Gately, P., Nobles, J., Van Dijk, M., Blackshaw, J., Montel, S. and Sahota, P., 2019. Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC Public Health, 19(1), p.8.

Bray, I., Slater, A., Lewis-Smith, H., Bird, E. and Sabey, A., 2018. Promoting positive body image and tackling overweight/obesity in children and adolescents: A combined health psychology and public health approach. Preventive medicine, 116, pp.219-221.

Lake, A.A., Henderson, E.J. and Townshend, T.G., 2017. Exploring planners’ and public health practitioners’ views on addressing obesity: lessons from local government in England. Cities & health, 1(2), pp.185-193.

Medvedyuk, S., Ali, A. and Raphael, D., 2018. Ideology, obesity and the social determinants of health: a critical analysis of the obesity and health relationship. Critical Public Health, 28(5), pp.573-585.

NHS Wolverhampton CCG, 2021, Call to combat obesity in Wolverhampton, available at: https://wolverhamptonccg.nhs.uk/about-us/news/1013-call-to-combat-obesity-in-wolverhampton [accessed on: 10^th January 2021].

Rubino, F., Puhl, R.M., Cummings, D.E., Eckel, R.H., Ryan, D.H., Mechanick, J.I., Nadglowski, J., Salas, X.R., Schauer, P.R., Twenefour, D. and Apovian, C.M., 2020. Joint international consensus statement for ending stigma of obesity. Nature medicine, pp.1-13.

Salas, X.R., Forhan, M., Caulfield, T., Sharma, A.M. and Raine, K., 2017. A critical analysis of obesity prevention policies and strategies. Canadian Journal of Public Health, 108(5-6), pp.e598-e608.

Wolfenden, L., Ezzati, M., Larijani, B. and Dietz, W., 2019. The challenge for global health systems in preventing and managing obesity. Obesity Reviews, 20, pp.185-193.

 Appendices

Appendix 1: Comparison of local, regional and national data of obesity among different age group people

(Source: Who.int, 2021)

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