Tackling obesity and diabetes in diverse communities: why food matters

The increasing prevalence of type 2 diabetes is a major global public health concern. According to the World Health Organization, diabetes currently affects 422 million people worldwide, with the prevalence almost doubling from 4.7 per cent in 1980 to 8.5 per cent in 2014. Similar trends are occurring in the UK, with cases of type 2 diabetes rising from 1.4 million to 3.5 million since 1996, and this is projected to rise to 5 million by 2025.

Approximately 22,000 people with diabetes die in the UK every year, and type 2 diabetes is a major contributor to heart attack, stroke and kidney failure. Treatment accounts for about £8.8 billion each year. Obesity is a major risk factor for type 2 diabetes, and eating a healthy diet and engaging in regular physical activity are recognised as the most effective lifestyle strategies to reduce obesity and prevent or delay the onset of type 2 diabetes.

The burden of obesity and type 2 diabetes is not equitably distributed across all socioeconomic and ethnic groups. People experiencing higher levels of deprivation have substantially higher risk for both obesity and type 2 diabetes. In addition, people of South Asian, African-Caribbean or Black African descent are two to four times more likely to be diagnosed with type 2 diabetes than people of White European descent.

In addition to the millions of people who have already been diagnosed with type 2 diabetes, it is estimated that an additional 5 million people in England are at high risk, with many of these cases being preventable. This has led to the recent roll-out of Healthier You, the NHS Diabetes Prevention Programme (NHS DPP), which is identifying people at high risk and referring them onto a lifestyle programme to reduce their risk by changing their eating and physical activity behaviours. The NHS DPP was offered to 20,000 high-risk individuals in 2016; by 2020 it is expected there will be 100,000 referrals available each year.

Despite the overwhelming evidence that obesity is one of the primary contributors to increasing a person’s risk for type 2 diabetes, recent budget cuts have resulted in local authorities having to reduce or fully decommission weight loss programmes and services. There is overwhelming evidence that eating a healthy diet and increasing physical activity are effective in reducing obesity and type 2 diabetes.

However, the predominant approach to behaviour change is to target individuals, with minimal or no changes made to the surrounding physical or social environments in which people live and make choices. This is problematic, as changing human behaviour is challenging and can be difficult to sustain in the longer term, and it does not translate into broad changes at the community level. As such, there is a clear need to examine how we might work across various sectors to optimise community food and physical activity environments, and how we can support people to engage with their environments to promote healthier lifestyles.

To address this gap, the University of Birmingham Institute of Advanced Studies is supporting a workshop led by the School of Sport, Exercise and Rehabilitation Sciences called FOOD MATTERS: Sustainable Diets and Nutrition To Tackle Obesity and Diabetes in Diverse Communities. The workshop, held on 8 February 2017, brought together experts and policy makers across a range of disciplines and sectors to explore how we could develop and integrate a whole systems approach to changing our communities. It looked at helping people to make healthy food choices and integrate physical activity into their daily routine.

Over 50 community-based researchers, policy makers, food entrepreneurs, public health professionals, local authority leaders and diabetes prevention social enterprises across the UK and Europe gathered to discuss how we can drive change at the grassroots level, and re-think how we manage food systems in our communities.

A range of questions were asked including: what policy levers could be used to influence people’s food choices? What are other European cities doing that may be different from the Birmingham model? What can other cities learn from and contribute to Birmingham? How can we share best practice?

The workshop coincides with the EUROCITIES working group on food network meeting, hosted in Birmingham on 9 and 10 February.

Professor Janice L Thompson
School of Sport, Exercise and Rehabilitation Sciences