What does Health Survey for England 2021 data tell us about the obesity challenge?

New data from the Health Survey for England (HSE) shows that around a quarter of adults in England were obese in 2021. In the second year of the pandemic, the HSE shows that as many as three in five adults were carrying excess weight. 

While the national picture between 2019 and 2021 looks stable, regional and neighbourhood variations point to disparities. The share of adults who are overweight and obese increased by three percentage points in the most deprived areas, but decreased by one percentage point in the least deprived areas. The share of adults who are obese is highest in the North East (34%) and North West (30%) and lowest in the South West (22%).

These differences could be explained by the uneven experience of the pandemic, as well as how variations in the food environment – where we live, work, shop and learn – affect the food we eat and, therefore, our health. 

Another notable trend is that there are an increasing share of obese and overweight adults who have doctor-diagnosed diabetes. As many as 11% of adults who were obese reported that they had received a diagnosis of diabetes from a doctor, compared with 5% of overweight adults and 3% of those who were neither overweight nor obese. This is a change from 2019 when 9% of adults who were obese had a diabetes diagnosis and 6% of overweight adults did.

What is the Health Survey for England and what does it cover?

On 15th December 2022, the Government published new Health Survey for England (HSE) data. 

The series covers some core topics every year and monitors trends and provides information about adults aged 16 and over, and children aged 0 to 15.

After a year’s pause in 2020, the survey was adapted so that it could continue during the pandemic with a reduced version of the questionnaire. The data released in December 2022 covers weight and obesity, cigarette smoking and e-cigarette use as well as alcohol consumption. Part two is released in Spring 2023 and covers adult health, physical activity, wellbeing and loneliness, social care and gambling. 

The Health Survey for England 2021 covers adult obesity levels in England during the pandemic

Nesta is on a decade-long drive to help halve obesity rates in the UK. This is because obesity increases the risk of many preventable diseases including diabetes, cardiovascular disease and some cancers, as well as reducing life expectancy. It is estimated that 56,000 people died prematurely as a result of excess weight and obesity in the UK in 2019. This is 20 times the number of deaths from road accidents in the same period.

The pandemic added new barriers and challenges to healthy eating and physical activity. Data suggested that eating habits and food environments changed – with more meals cooked at home, more snacking and more food being ordered online. There was also a dip in physical activity.

The HSE is a nationally-representative sample of the general population, so it can be used to understand trends in adult overweight and obesity rates from the second year of the pandemic. Here are the five things we learned from the data.

1. Overweight and obesity rates show little sign of reversing

The past 10 years have seen the adult overweight and obesity rate in England stabilising. This trend looks to have continued between 2019 and 2021, when the overweight and obesity rate increased by one percentage point from 63% to 64%. Focusing on the adult obesity rate, an estimated 28% of adults were obese in 2019; in 2021 it stands at 26%. 

The latest statistics show that in England in 2021, over three in five adults were overweight or obese and around a quarter are living with obesity. This means there are approximately 12,096,604 people in England living with obesity compared to 12,639,000 in 2019.

2. Height and weight data this year was entirely self-reported, meaning we should be cautious about interpreting it

Before exploring the data in more detail, it should be noted that there was a change in the way height and weight were measured in 2021. Both height and weight are usually measured by an interviewer, but this year’s survey was adapted so that height and weight were self-reported at interview. 

Previous analysis by NHS Digital used HSE data collected in each survey between 2011 and 2016 (when self-reported and measured data was collected) and showed there to be a disparity between self-reported and measured BMI of on average one point. Studies have shown that adults tend to overestimate height and underestimate weight compared with measured values.

To account for this discrepancy, and because the data published in the 2021 release is exclusively self-reported, a linear regression model was used to estimate measured weight and height from self-reported weight, height and age. The prediction equations correct weight and height values differently according to age.

This correction is an excellent attempt to make the years comparable and the best that could be done given the collection limitations of 2021, but we won't really be sure until we have seen objectively measured data – either if nurse-measured height and weight data comes out in the spring, or the next survey when we have objectively measured data again.

3. The North East has the highest share of adults who are obese

In 2021, the North East and North West were the English regions with the highest share of adults who are obese (34% and 30%); the South West had the lowest share with 22%. 

Data from previous surveys, viewable in the map below by pressing play, shows that the adult obesity rate for a given region does vary from year to year. Nevertheless, places such as London and the South East consistently sit below the English average, whereas places such as the North East and West Midlands tend to be above the English average. 

4. The share of adults who are overweight or obese went up in most deprived neighbourhoods and down in least deprived areas

Obesity prevalence was lowest among adults living in the least deprived areas (20%) and the highest in the most deprived areas (34%).

Although the national picture looks stable (and in many regions, overall adult obesity rates in 2021 have declined), the data shows significant disparities at neighbourhood level in overweight and obesity rates.

The below chart depicts the share of adults who were overweight or obese in 2019 and 2021 by neighbourhood deprivation quintile. In the most deprived neighbourhoods, the share of adults who were overweight or obese increased (demonstrated by the blue square being to the right – ie, higher shares of overweight and obesity – of the pink square). 

In the middle-to-least deprived neighbourhoods, the share of adults who were overweight or obese fell or remained relatively stable (demonstrated by the blue square being to the left – ie, lower shares of overweight and obesity – of the pink square).

Although these small changes may look like “noise” in the survey, this trend is in line with previous years, which gives us more confidence that the observed change from 2019 is real. It is important that we look for early warning signs of worsening inequality, particularly during a cost of living crisis – indeed many of the pandemic’s direct and indirect effects fell disproportionately on lower-income communities. We know that obesity is strongly correlated with regional and neighbourhood-level deprivation. This data shows that overweight and obesity rates seem to be moving in different directions depending on where people live. 

5. A greater share of obese and overweight adults have doctor-diagnosed diabetes 

As many as 11% of adults who were obese reported that they had received a diagnosis of diabetes from a doctor, compared with 5% of overweight adults and 3% of those who were neither overweight nor obese. This is an increase on 2019 when 9% of adults who were obese had a diabetes diagnosis and 6% of overweight adults did.

In 2019, the HSE measured undiagnosed diabetes too –this was found to increase the total rate from 7% to 10%. If the same pattern held this year, diabetes rates for people living with obesity would be over 15%. 

The chart below represents the total population of England by share of BMI category and diabetic status. The squares represent the adults in a given weight category who are also diabetic. At the top of the chart is the share of adults who are obese. The chart shows that higher shares of obese or overweight adults are diabetic compared to those who are not overweight or obese.

The HSE interview makes no distinction between Type 1 and Type 2 diabetes. We appreciate that only Type 2 diabetes has strong associations with excess weight as a risk factor but a further breakdown was not available in this data.

What does this mean for tackling the obesity challenge in England? 

The adult obesity rate in England shows little sign of reversing. Health inequalities have increased with obesity prevalence highest in the most deprived areas.

We can change this by adapting  food environments. Where people live, work, shop and learn can affect the food they eat and how healthy they are. The “food environment”includes everything we experience in those places relating to food.

In coalition with communities, industry and policy makers, Nesta’s healthy life mission is working to halve the number of people with obesity over the ten years to 2030 by designing, testing and scaling food environment interventions.

In the coming months we’ll publish research which will show where we need to get to in population terms to halve obesity, along with ideas and pathways to help us get there. If you’re interested in working with us, please get in touch with the team.