Episode 14: How Did We Get Here? The Rise of Obesity in the UK

Episode 14 of The Dokkcast is out. Dr Nara Daubeney is joined by Professor John Deanfield CBE for the first of several conversations about obesity. In this opening episode, How Did We Get Here?, they ask how rates have risen so far, why it matters for our health, and why it is not simply a question of willpower.

Watch the full conversation here, or listen on our episodes page, Spotify, Apple Podcasts or YouTube.

In this episode

• How big the problem is, in the UK and around the world
• What obesity is, and how BMI is used to measure it
• Why this is not a failure of willpower, and what has changed around us
• Why obesity is a medical issue and not only a cosmetic one
• Why childhood obesity matters so much
• The case for prevention, and what Professor Deanfield calls "investing in our arteries"
• How the Our Future Health programme and the NHS fit in

Key points from the conversation

Everything below is Professor Deanfield's view, as he put it in the episode.

A bigger problem, starting earlier

Professor Deanfield describes obesity as "probably the biggest driver of ill health and future disease in the population". It is not only a UK problem, he says: developing countries are seeing the same trend, and it is starting earlier in life. In the UK, he told us, fewer than 1% of the population were obese in 1950. Today it is over 30%.

How obesity is defined

Doctors use body mass index (BMI), a measure based on height and weight. A healthy BMI is between 20 and 25, 25 to 30 is classed as overweight, and 30 or above as obese. He is clear that BMI is "not perfect" and the boundaries are arbitrary, but they describe a continuum in which risk rises with weight.

Not a failure of willpower

Could the rise be a collective failure of willpower? Professor Deanfield thinks that is very unlikely. What has changed, he argues, is the world around us: the food we eat, how we eat our meals, how we work and how we spend our free time. Both matter, the individual and the environment. In his words, "one without the other is not going to work". He pointed to countries such as France and Japan as having fared better than the UK and the US.

Why it matters

Beyond appearance, Professor Deanfield says, weight is linked to a range of serious conditions: type 2 diabetes, heart disease and kidney disease, and also cancer, and possibly dementia. He gave one illustration of what is at stake: someone of normal weight has about an 80% chance of reaching the age of 70, he said, compared with 50 to 60% for someone who is overweight or obese.

Children

The conversation turns to children, and Professor Deanfield's message is that this is not something they simply grow out of. He described a US study in which children in the top 5% for weight at the age of two had an 80% chance of being overweight or obese at 35. He also cited a World Health Organization prediction that half of the children born today will become overweight or obese adults. Childhood obesity, he says, is "the elephant in the room" for the population's future health.

Prevention: investing in our arteries

Professor Deanfield compares health with saving for retirement. He asks us to imagine starting to save for retirement at 64: it would not be much of a strategy, yet he says medicine often treats disease only once it has developed. Risk factors such as obesity, high cholesterol and high blood pressure can damage us silently over decades, so acting early brings what he calls "compound interest" later. He is clear that there is no quick fix: awareness, the environment around us, and new treatments all have a part to play.

Our Future Health and the NHS

Professor Deanfield explains that the Our Future Health programme grew out of the idea that following people's health over time shows how disease develops, and where prevention can help. Building on UK Biobank, which followed around half a million people, it aims to recruit five million, and he said more than two million are already involved. He sees the NHS as excellent at treating disease, but argues it cannot keep us healthy on its own. In parallel, he says, we need a new partnership between governments, healthcare providers and the public.

Living longer, and living well

The aim, he says, is not just to live longer but to live longer well: "to dodge the bullets", by delaying conditions such as diabetes, stroke and heart failure for as long as possible.

The take-home message

Asked how the public should think about obesity, Professor Deanfield's answer was:

Managing obesity is not just an issue of how you look, it's an issue of how you're going to live and how well you're going to live and how long you're going to live.

What's next

This is the first of several conversations. In later episodes, Dr Nara and Professor Deanfield will turn to what can be done about obesity, including diet and food, and new treatments such as GLP-1 medicines. Follow The Dokkcast on Spotify, Apple Podcasts or YouTube so you don't miss them.

About our guest

Professor John Deanfield CBE is Professor of Cardiology at University College London. He has specialised in both paediatric and adult cardiology, was a steering committee member of the SELECT trial of GLP-1 therapy in obesity, became the UK government's first Champion for Personalised Prevention in 2023, and is a trustee of Our Future Health. You can read more in our earlier post about the episode.

Chapters

• 0:00 Introduction
• 2:20 Welcome, and Professor Deanfield's work
• 4:57 How did we get here?
• 5:47 How big is the problem?
• 6:38 What is obesity?
• 7:55 What has changed since 1950
• 9:47 Why some countries have done better
• 12:53 Why it matters for our health
• 16:31 Childhood obesity
• 18:56 Protecting the next generation
• 20:26 Raising awareness
• 21:33 Investing in our arteries
• 25:38 Our Future Health
• 29:15 The role of the NHS
• 32:35 Longevity: living well, not just longer
• 36:21 Take-home message