SUMMARYThis analysis, designed and executed by Ribble Rivers Trust, identifies areas across England with the greatest levels of obesity in adults (aged 18+). Please read the below information to gain a full understanding of what the data shows and how it should be interpreted.ANALYSIS METHODOLOGYThe analysis was carried out using Quality and Outcomes Framework (QOF) data, derived from NHS Digital, relating to obesity in adults (aged 18+).This information was recorded at the GP practice level. However, GP catchment areas are not mutually exclusive: they overlap, with some areas covered by 30+ GP practices. Therefore, to increase the clarity and usability of the data, the GP-level statistics were converted into statistics based on Middle Layer Super Output Area (MSOA) census boundaries.The percentage of each MSOA’s adult population (aged 18+) that are obese was estimated. This was achieved by calculating a weighted average based on:The percentage of the MSOA area that was covered by each GP practice’s catchment areaOf the GPs that covered part of that MSOA: the percentage of registered patients that have that illness The estimated percentage of each MSOA’s adult population that are obese was then combined with Office for National Statistics Mid-Year Population Estimates (2019) data for MSOAs, to estimate the number of people in each MSOA that are obese, within the relevant age range.Each MSOA was assigned a relative score between 1 and 0 (1 = worst, 0 = best) based on:A) the PERCENTAGE of the adult population within that MSOA who are estimated to be obeseB) the NUMBER of adults within that MSOA who are estimated to be obeseAn average of scores A & B was taken, and converted to a relative score between 1 and 0 (1= worst, 0 = best). The closer to 1 the score, the greater both the number and percentage of the population in the MSOA that are estimated to be obese compared to other MSOAs. In other words, those are areas where it’s estimated a large number of people are obese, and where those people make up a large percentage of the population, indicating there is a real issue with obesity within the adult population and the investment of resources to address that issue could have the greatest benefits.LIMITATIONS1. GP data for the financial year 1st April 2018 – 31st March 2019 was used in preference to data for the financial year 1st April 2019 – 31st March 2020, as the onset of the COVID19 pandemic during the latter year could have affected the reporting of medical statistics by GPs. However, for 53 GPs (out of 7670) that did not submit data in 2018/19, data from 2019/20 was used instead. Note also that some GPs (997 out of 7670) did not submit data in either year. This dataset should be viewed in conjunction with the ‘Health and wellbeing statistics (GP-level, England): Missing data and potential outliers’ dataset, to determine areas where data from 2019/20 was used, where one or more GPs did not submit data in either year, or where there were large discrepancies between the 2018/19 and 2019/20 data (differences in statistics that were > mean +/- 1 St.Dev.), which suggests erroneous data in one of those years (it was not feasible for this study to investigate this further), and thus where data should be interpreted with caution. This dataset also shows rural areas (with little or no population) that do not officially fall into any GP catchment area and for which there were no statistics regarding adult obesity (although this will not affect the results of this analysis if there are no people living in those areas).2. It was not feasible to incorporate ultra-fine-scale geographic distribution of populations that are registered with each GP practice or who live within each MSOA. Populations might be concentrated in certain areas of a GP practice’s catchment area or MSOA and relatively sparse in other areas. Therefore, the dataset should be used to identify general areas where there are high levels of adult obesity, rather than interpreting the boundaries between areas as ‘hard’ boundaries that mark definite divisions between areas with differing levels of adult obesity.TO BE VIEWED IN COMBINATION WITH:This dataset should be viewed alongside the following datasets, which highlight areas of missing data and potential outliers in the data:Health and wellbeing statistics (GP-level, England): Missing data and potential outliersLevels of obesity, inactivity and associated illnesses (England): Missing dataDOWNLOADING THIS DATATo access this data on your desktop GIS, download the ‘Levels of obesity, inactivity and associated illnesses: Summary (England)’ dataset.DATA SOURCESThis dataset was produced using:Quality and Outcomes Framework data: Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.GP Catchment Outlines. Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Data was cleaned by Ribble Rivers Trust before use.COPYRIGHT NOTICEThe reproduction of this data must be accompanied by the following statement:© Ribble Rivers Trust 2021. Analysis carried out using data that is: Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.CaBA HEALTH & WELLBEING EVIDENCE BASEThis dataset forms part of the wider CaBA Health and Wellbeing Evidence Base.

This report presents information on obesity, physical activity and diet drawn together from a variety of sources for England. More information can be found in the source publications which contain a wider range of data and analysis. Each section provides an overview of key findings, as well as providing links to relevant documents and sources. Some of the data have been published previously by NHS Digital. A data visualisation tool (link provided within the key facts) allows users to select obesity related hospital admissions data for any Local Authority (as contained in the data tables), along with time series data from 2013/14. Regional and national comparisons are also provided. The report includes information on: Obesity related hospital admissions, including obesity related bariatric surgery. Obesity prevalence. Physical activity levels. Walking and cycling rates. Prescriptions items for the treatment of obesity. Perception of weight and weight management. Food and drink purchases and expenditure. Fruit and vegetable consumption. Key facts cover the latest year of data available: Hospital admissions: 2018/19 Adult obesity: 2018 Childhood obesity: 2018/19 Adult physical activity: 12 months to November 2019 Children and young people's physical activity: 2018/19 academic year

This data shows the percentage of adults (age 18 and over) classed as having Excess Weight. Excess Weight is a major cause of premature deaths and avoidable ill-health. Excess weight is a term used for overweight, which includes obesity. Excess weight is defined in adults as a BMI greater than or equal to 25kg/m2. The data is age-standardised, so differences in the population age structures of areas will not affect comparison of rates. This dataset shows estimates based on sample sizes that may be quite small particularly at district level, so not too much should not be read into apparent differences between districts which might not be statistically significant. Thus as with many other datasets, this data should be used together with other data and resources to obtain a fuller picture. Data source: Public Health England, Public Health Outcomes Framework (PHOF) indicator 2.12. This data is updated annually.

This set of files contains public data used to validate the grocery data. All references to the original sources are provided below.CHILD OBESITYPeriodically, the English National Health Service (NHS) publishes statistics about various aspects of the health and habits of people living in England, including obesity. The NHS National Child Measurement (NCMP) measures the height and weight of children in Reception class (aged 4 to 5) and year 6 (aged 10 to 11), to assess overweight and obesity levels in children within primary schools. The program is carried out every year in England and statistics are produced at the level of Local Authority (that corresponds to Boroughs in London). We report the data for the school year 2015-2016 (file: child_obesity_london_borough_2015-2016.csv). For the school year 2013-2014, statistics in London are also available at ward-level (file: child_obesity_london_ward_2013-2014.csv)The files are comma-separated and contain the following fields: area_id: the id of the boroughnumber_reception_measured: number of children in reception year measurednumber_y6_measured: number of children in reception year measuredprevalence_overweight_reception: the prevalence (percentage) of overweight children in reception year prevalence_overweight_y6: the prevalence (percentage) of overweight children in year 6prevalence_obese_reception: the prevalence (percentage) of obese children in reception yearprevalence_obese_y6: the prevalence (percentage) of obese children in year 6ADULT OBESITYThe Active People Survey (APS) was a survey used to measure the number of adults taking part in sport across England and included two questions about the height and weight of participants. We report the results of the APS for the year 2012. Prevalence of underweight, healthy weight, overweight, and obese people at borough level are provided in the file london_obesity_borough_2012.csv.The file is comma-separated and contains the following fields: area_id: the id of the boroughnumber_measured: number of people who participated in the surveyprevalence_healthy_weight: the prevalence (percentage) of healthy-weight peopleprevalence_overweight: the prevalence (percentage) of overweight peopleprevalence_obese: the prevalence (percentage) of obese peopleBARIATRIC HOSPITALIZATIONThe NHS records and publishes an annual compendium report about the number of hospital admissions attributable to obesity or bariatric surgery (i.e., weight loss surgery used as a treatment for people who are very obese), and the number of prescription items provided in primary care for the treatment of obesity. The NHS provides both raw counts at the Local Authority level and numbers normalized by population living in those areas. In the file obesity_hospitalization_borough_2016.csv, we report the statistics for the year 2015 (measurements made between Jan 2015 and March 2016).The file is comma-separated and contains the following fields:area_id: the id of the boroughtotal_hospitalizations: total number of obesity-related hospitalizationstotal_bariatric: total number of hospitalizations for bariatric surgeryprevalence_hospitalizations: prevalence (percentage) of obesity-related hospitalizations prevalence_bariatric: prevalence (percentage) of bariatric surgery hospitalizations DIABETESThrough the Quality and Outcomes Framework, NHS Digital publishes annually the number of people aged 17+ on a register for diabetes at each GP practice in England. NHS also publishes the number of people living in a census area who are registered to any of the GP in England. Based on these two sources, an estimate is produced about the prevalence of diabetes in each area. The data (file diabetes_estimates_osward_2016.csv) was collected in 2016 at LSOA-level and published at ward-level.The file is comma-separated and contains the following fields:area_id: the id of the wardgp_patients: total number of GP patients gp_patients_diabetes: total number of GP patients with a diabetes diagnosisestimated_diabetes_prevalence: prevalence (percentage) of diabetesAREA MAPPINGMapping of Greater London postcodes into larger geographical aggregations. The file is comma-separated and contains the following fields:pcd: postcodelat: latitudelong: longitudeoa11: output arealsoa11: lower super output areamsoa11: medium super output areaosward: wardoslaua: borough

Proportion of children aged 10 to 11 years classified as living with obesity. For population monitoring purposes, a child’s body mass index (BMI) is classed as overweight or obese where it is on or above the 85th centile or 95th centile, respectively, based on the British 1990 (UK90) growth reference data. The population monitoring cut offs for overweight and obesity are lower than the clinical cut offs (91st and 98th centiles for overweight and obesity) used to assess individual children; this is to capture children in the population in the clinical overweight or obesity BMI categories and those who are at high risk of moving into the clinical overweight or clinical obesity categories. This helps ensure that adequate services are planned and delivered for the whole population.

Rationale There is concern about the rise of childhood obesity and the implications of obesity persisting into adulthood. The risk of obesity in adulthood and risk of future obesity-related ill health are greater as children get older. Studies tracking child obesity into adulthood have found that the probability of children who are overweight or living with obesity becoming overweight or obese adults increases with age[1,2,3]. The health consequences of childhood obesity include: increased blood lipids, glucose intolerance, Type 2 diabetes, hypertension, increases in liver enzymes associated with fatty liver, exacerbation of conditions such as asthma and psychological problems such as social isolation, low self-esteem, teasing and bullying.

It is important to look at the prevalence of weight status across all weight/BMI categories to understand the whole picture and the movement of the population between categories over time.

The National Institute of Health and Clinical Excellence have produced guidelines to tackle obesity in adults and children - http://guidance.nice.org.uk/CG43.

1 Guo SS, Chumlea WC. Tracking of body mass index in children in relation to overweight in adulthood. The American Journal of Clinical Nutrition 1999;70(suppl): 145S-8S.

2 Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Preventative Medicine 1993;22:167-77.

3 Starc G, Strel J. Tracking excess weight and obesity from childhood to young adulthood: a 12-year prospective cohort study in Slovenia. Public Health Nutrition 2011;14:49-55.

Definition of numerator Number of children in year 6 (aged 10 to 11 years) with a valid height and weight measured by the NCMP with a BMI classified as living with obesity or severe obesity (BMI on or above 95th centile of the UK90 growth reference).

Definition of denominator Number of children in year 6 (aged 10 to 11 years) with a valid height and weight measured by the NCMP.

Caveats Data for local authorities may not match that published by NHS England which are based on the local authority of the school attended by the child or based on the local authority that submitted the data. There is a strong correlation between deprivation and child obesity prevalence and users of these data may wish to examine the pattern in their local area. Users may wish to produce thematic maps and charts showing local child obesity prevalence. When presenting data in charts or maps it is important, where possible, to consider the confidence intervals (CIs) around the figures. This analysis supersedes previously published data for small area geographies and historically published data should not be compared to the latest publication. Estimated data published in this fingertips tool is not comparable with previously published data due to changes in methods over the different years of production. These methods changes include; moving from estimated numbers at ward level to actual numbers; revision of geographical boundaries (including ward boundary changes and conversion from 2001 MSOA boundaries to 2011 boundaries); disclosure control methodology changes. The most recently published data applies the same methods across all years of data. There is the potential for error in the collection, collation and interpretation of the data (bias may be introduced due to poor response rates and selective opt out of children with a high BMI for age/sex which it is not possible to control for). There is not a good measure of response bias and the degree of selective opt out, but participation rates (the proportion of eligible school children who were measured) may provide a reasonable proxy; the higher the participation rate, the less chance there is for selective opt out, though this is not a perfect method of assessment. Participation rates for each local authority are available in the https://fingertips.phe.org.uk/profile/national-child-measurement-programme/data#page/4/gid/8000022/ of this profile.

SUMMARYThis analysis, designed and executed by Ribble Rivers Trust, identifies areas across England with the greatest levels of obesity, inactivity and inactivity/obesity-related illnesses. Please read the below information to gain a full understanding of what the data shows and how it should be interpreted.The analysis incorporates data relating to the following:Obesity/inactivity-related illnesses (asthma, cancer, chronic kidney disease, coronary heart disease, depression, diabetes mellitus, hypertension, stroke and transient ischaemic attack)Excess weight in children and obesity in adults (combined)Inactivity in children and adults (combined)The analysis was designed with the intention that this dataset could be used to identify locations where investment could encourage greater levels of activity. In particular, it is hoped the dataset will be used to identify locations where the creation or improvement of accessible green/blue spaces and public engagement programmes could encourage greater levels of outdoor activity within the target population, and reduce the health issues associated with obesity and inactivity.ANALYSIS METHODOLOGY1. Obesity/inactivity-related illnessesThe analysis was carried out using Quality and Outcomes Framework (QOF) data, derived from NHS Digital, relating to:- Asthma (in persons of all ages)- Cancer (in persons of all ages)- Chronic kidney disease (in adults aged 18+)- Coronary heart disease (in persons of all ages)- Depression (in adults aged 18+)- Diabetes mellitus (in persons aged 17+)- Hypertension (in persons of all ages)- Stroke and transient ischaemic attack (in persons of all ages)This information was recorded at the GP practice level. However, GP catchment areas are not mutually exclusive: they overlap, with some areas covered by 30+ GP practices. Therefore, to increase the clarity and usability of the data, the GP-level statistics were converted into statistics based on Middle Layer Super Output Area (MSOA) census boundaries.For each of the above illnesses, the percentage of each MSOA’s population with that illness was estimated. This was achieved by calculating a weighted average based on:The percentage of the MSOA area that was covered by each GP practice’s catchment areaOf the GPs that covered part of that MSOA: the percentage of patients registered with each GP that have that illness The estimated percentage of each MSOA’s population with each illness was then combined with Office for National Statistics Mid-Year Population Estimates (2019) data for MSOAs, to estimate the number of people in each MSOA with each illness, within the relevant age range.For each illness, each MSOA was assigned a relative score between 1 and 0 (1 = worst, 0 = best) based on:A) the PERCENTAGE of the population within that MSOA who are estimated to have that illnessB) the NUMBER of people within that MSOA who are estimated to have that illnessAn average of scores A & B was taken, and converted to a relative score between 1 and 0 (1= worst, 0 = best). The closer to 1 the score, the greater both the number and percentage of the population in the MSOA predicted to have that illness, compared to other MSOAs. In other words, those are areas where a large number of people are predicted to suffer from an illness, and where those people make up a large percentage of the population, indicating there is a real issue with that illness within the population and the investment of resources to address that issue could have the greatest benefits.The scores for each of the 8 illnesses were added together then converted to a relative score between 1 – 0 (1 = worst, 0 = best), to give an overall score for each MSOA: a score close to 1 would indicate that an area has high predicted levels of all obesity/inactivity-related illnesses, and these are areas where the local population could benefit the most from interventions to address those illnesses. A score close to 0 would indicate very low predicted levels of obesity/inactivity-related illnesses and therefore interventions might not be required.2. Excess weight in children and obesity in adults (combined)For each MSOA, the number and percentage of children in Reception and Year 6 with excess weight was combined with population data (up to age 17) to estimate the total number of children with excess weight.The first part of the analysis detailed in section 1 was used to estimate the number of adults with obesity in each MSOA, based on GP-level statistics.The percentage of each MSOA’s adult population (aged 18+) with obesity was estimated, using GP-level data (see section 1 above). This was achieved by calculating a weighted average based on:The percentage of the MSOA area that was covered by each GP practice’s catchment areaOf the GPs that covered part of that MSOA: the percentage of adult patients registered with each GP that are obeseThe estimated percentage of each MSOA’s adult population with obesity was then combined with Office for National Statistics Mid-Year Population Estimates (2019) data for MSOAs, to estimate the number of adults in each MSOA with obesity.The estimated number of children with excess weight and adults with obesity were combined with population data, to give the total number and percentage of the population with excess weight.Each MSOA was assigned a relative score between 1 and 0 (1 = worst, 0 = best) based on:A) the PERCENTAGE of the population within that MSOA who are estimated to have excess weight/obesityB) the NUMBER of people within that MSOA who are estimated to have excess weight/obesityAn average of scores A & B was taken, and converted to a relative score between 1 and 0 (1= worst, 0 = best). The closer to 1 the score, the greater both the number and percentage of the population in the MSOA predicted to have excess weight/obesity, compared to other MSOAs. In other words, those are areas where a large number of people are predicted to suffer from excess weight/obesity, and where those people make up a large percentage of the population, indicating there is a real issue with that excess weight/obesity within the population and the investment of resources to address that issue could have the greatest benefits.3. Inactivity in children and adultsFor each administrative district, the number of children and adults who are inactive was combined with population data to estimate the total number and percentage of the population that are inactive.Each district was assigned a relative score between 1 and 0 (1 = worst, 0 = best) based on:A) the PERCENTAGE of the population within that district who are estimated to be inactiveB) the NUMBER of people within that district who are estimated to be inactiveAn average of scores A & B was taken, and converted to a relative score between 1 and 0 (1= worst, 0 = best). The closer to 1 the score, the greater both the number and percentage of the population in the district predicted to be inactive, compared to other districts. In other words, those are areas where a large number of people are predicted to be inactive, and where those people make up a large percentage of the population, indicating there is a real issue with that inactivity within the population and the investment of resources to address that issue could have the greatest benefits.Summary datasetAn average of the scores calculated in sections 1-3 was taken, and converted to a relative score between 1 and 0 (1= worst, 0 = best). The closer the score to 1, the greater the number and percentage of people suffering from obesity, inactivity and associated illnesses. I.e. these are areas where there are a large number of people (both children and adults) who are obese, inactive and suffer from obesity/inactivity-related illnesses, and where those people make up a large percentage of the local population. These are the locations where interventions could have the greatest health and wellbeing benefits for the local population.LIMITATIONS1. For data recorded at the GP practice level, data for the financial year 1st April 2018 – 31st March 2019 was used in preference to data for the financial year 1st April 2019 – 31st March 2020, as the onset of the COVID19 pandemic during the latter year could have affected the reporting of medical statistics by GPs. However, for 53 GPs (out of 7670) that did not submit data in 2018/19, data from 2019/20 was used instead. Note also that some GPs (997 out of 7670) did not submit data in either year. This dataset should be viewed in conjunction with the ‘Levels of obesity, inactivity and associated illnesses: Summary (England). Areas with data missing’ dataset, to determine areas where data from 2019/20 was used, where one or more GPs did not submit data in either year, or where there were large discrepancies between the 2018/19 and 2019/20 data (differences in statistics that were > mean +/- 1 St.Dev.), which suggests erroneous data in one of those years (it was not feasible for this study to investigate this further), and thus where data should be interpreted with caution. Note also that there are some rural areas (with little or no population) that do not officially fall into any GP catchment area (although this will not affect the results of this analysis if there are no people living in those areas).2. Although all of the obesity/inactivity-related illnesses listed can be caused or exacerbated by inactivity and obesity, it was not possible to distinguish from the data the cause of the illnesses in patients: obesity and inactivity are highly unlikely to be the cause of all cases of each illness. By combining the data with data relating to levels of obesity and inactivity in adults and children, we can identify where obesity/inactivity could be a contributing factor, and where interventions to reduce obesity and increase activity could be most beneficial for the health of the local population.3. It was not feasible to incorporate ultra-fine-scale geographic distribution of

This dataset contains the estimated percentages of adults smokers (18+ years), overweight or obese adults (18+ years) and physically inactive adults (19+ years) by England regions, counties and unitary authorities, and by socioeconomic variables. Data for demographic groups (age, gender, race/ethincity, religion or sexual orientation-based) and comparisons to England and region levels, are also available in the dataset.

SUMMARYThis analysis, designed and executed by Ribble Rivers Trust, identifies areas across England with the greatest levels of depression in adults (aged 18+). Please read the below information to gain a full understanding of what the data shows and how it should be interpreted.ANALYSIS METHODOLOGYThe analysis was carried out using Quality and Outcomes Framework (QOF) data, derived from NHS Digital, relating to depression in adults (aged 18+).This information was recorded at the GP practice level. However, GP catchment areas are not mutually exclusive: they overlap, with some areas covered by 30+ GP practices. Therefore, to increase the clarity and usability of the data, the GP-level statistics were converted into statistics based on Middle Layer Super Output Area (MSOA) census boundaries.The percentage of each MSOA’s population (aged 18+) with depression was estimated. This was achieved by calculating a weighted average based on:The percentage of the MSOA area that was covered by each GP practice’s catchment areaOf the GPs that covered part of that MSOA: the percentage of registered patients that have that illness The estimated percentage of each MSOA’s population with depression was then combined with Office for National Statistics Mid-Year Population Estimates (2019) data for MSOAs, to estimate the number of people in each MSOA with depression, within the relevant age range.Each MSOA was assigned a relative score between 1 and 0 (1 = worst, 0 = best) based on:A) the PERCENTAGE of the population within that MSOA who are estimated to have depressionB) the NUMBER of people within that MSOA who are estimated to have depressionAn average of scores A & B was taken, and converted to a relative score between 1 and 0 (1= worst, 0 = best). The closer to 1 the score, the greater both the number and percentage of the population in the MSOA that are estimated to have depression, compared to other MSOAs. In other words, those are areas where it’s estimated a large number of people suffer from depression, and where those people make up a large percentage of the population, indicating there is a real issue with depression within the population and the investment of resources to address that issue could have the greatest benefits.LIMITATIONS1. GP data for the financial year 1st April 2018 – 31st March 2019 was used in preference to data for the financial year 1st April 2019 – 31st March 2020, as the onset of the COVID19 pandemic during the latter year could have affected the reporting of medical statistics by GPs. However, for 53 GPs (out of 7670) that did not submit data in 2018/19, data from 2019/20 was used instead. Note also that some GPs (997 out of 7670) did not submit data in either year. This dataset should be viewed in conjunction with the ‘Health and wellbeing statistics (GP-level, England): Missing data and potential outliers’ dataset, to determine areas where data from 2019/20 was used, where one or more GPs did not submit data in either year, or where there were large discrepancies between the 2018/19 and 2019/20 data (differences in statistics that were > mean +/- 1 St.Dev.), which suggests erroneous data in one of those years (it was not feasible for this study to investigate this further), and thus where data should be interpreted with caution. Note also that there are some rural areas (with little or no population) that do not officially fall into any GP catchment area (although this will not affect the results of this analysis if there are no people living in those areas).2. Although all of the obesity/inactivity-related illnesses listed can be caused or exacerbated by inactivity and obesity, it was not possible to distinguish from the data the cause of the illnesses in patients: obesity and inactivity are highly unlikely to be the cause of all cases of each illness. By combining the data with data relating to levels of obesity and inactivity in adults and children (see the ‘Levels of obesity, inactivity and associated illnesses: Summary (England)’ dataset), we can identify where obesity/inactivity could be a contributing factor, and where interventions to reduce obesity and increase activity could be most beneficial for the health of the local population.3. It was not feasible to incorporate ultra-fine-scale geographic distribution of populations that are registered with each GP practice or who live within each MSOA. Populations might be concentrated in certain areas of a GP practice’s catchment area or MSOA and relatively sparse in other areas. Therefore, the dataset should be used to identify general areas where there are high levels of depression, rather than interpreting the boundaries between areas as ‘hard’ boundaries that mark definite divisions between areas with differing levels of depression.TO BE VIEWED IN COMBINATION WITH:This dataset should be viewed alongside the following datasets, which highlight areas of missing data and potential outliers in the data:Health and wellbeing statistics (GP-level, England): Missing data and potential outliersLevels of obesity, inactivity and associated illnesses (England): Missing dataDOWNLOADING THIS DATATo access this data on your desktop GIS, download the ‘Levels of obesity, inactivity and associated illnesses: Summary (England)’ dataset.DATA SOURCESThis dataset was produced using:Quality and Outcomes Framework data: Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.GP Catchment Outlines. Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Data was cleaned by Ribble Rivers Trust before use.COPYRIGHT NOTICEThe reproduction of this data must be accompanied by the following statement:© Ribble Rivers Trust 2021. Analysis carried out using data that is: Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.CaBA HEALTH & WELLBEING EVIDENCE BASEThis dataset forms part of the wider CaBA Health and Wellbeing Evidence Base.

The proportion of adult respondents (aged 16+) classified as obese and overweight from Health Survey Northern Ireland 2010/11 - 2015/16

Proportion of children aged 4 to 5 years classified as overweight or living with obesity. For population monitoring purposes, a child’s body mass index (BMI) is classed as overweight or obese where it is on or above the 85th centile or 95th centile, respectively, based on the British 1990 (UK90) growth reference data. The population monitoring cut offs for overweight and obesity are lower than the clinical cut offs (91st and 98th centiles for overweight and obesity) used to assess individual children; this is to capture children in the population in the clinical overweight or obesity BMI categories and those who are at high risk of moving into the clinical overweight or clinical obesity categories. This helps ensure that adequate services are planned and delivered for the whole population.

Rationale There is concern about the rise of childhood obesity and the implications of obesity persisting into adulthood. The risk of obesity in adulthood and risk of future obesity-related ill health are greater as children get older. Studies tracking child obesity into adulthood have found that the probability of children who are overweight or living with obesity becoming overweight or obese adults increases with age[1,2,3]. The health consequences of childhood obesity include: increased blood lipids, glucose intolerance, Type 2 diabetes, hypertension, increases in liver enzymes associated with fatty liver, exacerbation of conditions such as asthma and psychological problems such as social isolation, low self-esteem, teasing and bullying.

It is important to look at the prevalence of weight status across all weight/BMI categories to understand the whole picture and the movement of the population between categories over time.

The National Institute of Health and Clinical Excellence have produced guidelines to tackle obesity in adults and children - http://guidance.nice.org.uk/CG43.

1 Guo SS, Chumlea WC. Tracking of body mass index in children in relation to overweight in adulthood. The American Journal of Clinical Nutrition 1999;70(suppl): 145S-8S.

2 Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Preventative Medicine 1993;22:167-77.

3 Starc G, Strel J. Tracking excess weight and obesity from childhood to young adulthood: a 12-year prospective cohort study in Slovenia. Public Health Nutrition 2011;14:49-55.

Definition of numerator Number of children in reception (aged 4 to 5 years) with a valid height and weight measured by the NCMP with a BMI classified as overweight or living with obesity, including severe obesity (BMI on or above the 85th centile of the UK90 growth reference).

Definition of denominator Number of children in reception (aged 4 to 5 years) with a valid height and weight measured by the NCMP.

Caveats Data for local authorities may not match that published by NHS England which are based on the local authority of the school attended by the child or based on the local authority that submitted the data. There is a strong correlation between deprivation and child obesity prevalence and users of these data may wish to examine the pattern in their local area. Users may wish to produce thematic maps and charts showing local child obesity prevalence. When presenting data in charts or maps it is important, where possible, to consider the confidence intervals (CIs) around the figures. This analysis supersedes previously published data for small area geographies and historically published data should not be compared to the latest publication. Estimated data published in this fingertips tool is not comparable with previously published data due to changes in methods over the different years of production. These methods changes include; moving from estimated numbers at ward level to actual numbers; revision of geographical boundaries (including ward boundary changes and conversion from 2001 MSOA boundaries to 2011 boundaries); disclosure control methodology changes. The most recently published data applies the same methods across all years of data. There is the potential for error in the collection, collation and interpretation of the data (bias may be introduced due to poor response rates and selective opt out of children with a high BMI for age/sex which it is not possible to control for). There is not a good measure of response bias and the degree of selective opt out, but participation rates (the proportion of eligible school children who were measured) may provide a reasonable proxy; the higher the participation rate, the less chance there is for selective opt out, though this is not a perfect method of assessment. Participation rates for each local authority are available in the https://fingertips.phe.org.uk/profile/national-child-measurement-programme/data#page/4/gid/8000022/ of this profile.

Utilising a regression analysis we created a correlation matrix utilising a number of demographic indicators from the Local Insight platform. This application is showing the distribution of the datasets that were found to have the strongest relationships, with the base comparison dataset of estimated percentage of obesity prevalence. This app contains the following datasets: proportion of people in employment working in the occupation group skilled trade occupations, proportion of people in employment working in the manufacturing industry, proportion of people in employment working in the information and communication sector, percentage of people aged 45 and over with knee osteoarthritis, estimated percentage of COPD prevalence, proportion of people in employment in the approximated social grade N-SEC 6. semi-routine occupations, proportion of residents who have self-reported very good health, proportion of adults aged 25 to 34 with their highest level of qualification at Level 2, estimated percentage of rheumatoid arthritis prevalence and proportion of adults aged 25 to 34 with their highest level of qualification at Level 4 and above.

SUMMARYThis analysis, designed and executed by Ribble Rivers Trust, identifies areas across England with the greatest levels of chronic kidney disease in adults (aged 18+). Please read the below information to gain a full understanding of what the data shows and how it should be interpreted.ANALYSIS METHODOLOGYThe analysis was carried out using Quality and Outcomes Framework (QOF) data, derived from NHS Digital, relating to chronic kidney disease in adults (aged 18+).This information was recorded at the GP practice level. However, GP catchment areas are not mutually exclusive: they overlap, with some areas covered by 30+ GP practices. Therefore, to increase the clarity and usability of the data, the GP-level statistics were converted into statistics based on Middle Layer Super Output Area (MSOA) census boundaries.The percentage of each MSOA’s population (aged 18+) with chronic kidney disease was estimated. This was achieved by calculating a weighted average based on:The percentage of the MSOA area that was covered by each GP practice’s catchment areaOf the GPs that covered part of that MSOA: the percentage of registered patients that have that illness The estimated percentage of each MSOA’s population with chronic kidney disease was then combined with Office for National Statistics Mid-Year Population Estimates (2019) data for MSOAs, to estimate the number of people in each MSOA with chronic kidney disease, within the relevant age range.Each MSOA was assigned a relative score between 1 and 0 (1 = worst, 0 = best) based on:A) the PERCENTAGE of the population within that MSOA who are estimated to have chronic kidney diseaseB) the NUMBER of people within that MSOA who are estimated to have chronic kidney diseaseAn average of scores A & B was taken, and converted to a relative score between 1 and 0 (1= worst, 0 = best). The closer to 1 the score, the greater both the number and percentage of the population in the MSOA that are estimated to have chronic kidney disease, compared to other MSOAs. In other words, those are areas where it’s estimated a large number of people suffer from chronic kidney disease, and where those people make up a large percentage of the population, indicating there is a real issue with chronic kidney disease within the population and the investment of resources to address that issue could have the greatest benefits.LIMITATIONS1. GP data for the financial year 1st April 2018 – 31st March 2019 was used in preference to data for the financial year 1st April 2019 – 31st March 2020, as the onset of the COVID19 pandemic during the latter year could have affected the reporting of medical statistics by GPs. However, for 53 GPs (out of 7670) that did not submit data in 2018/19, data from 2019/20 was used instead. Note also that some GPs (997 out of 7670) did not submit data in either year. This dataset should be viewed in conjunction with the ‘Health and wellbeing statistics (GP-level, England): Missing data and potential outliers’ dataset, to determine areas where data from 2019/20 was used, where one or more GPs did not submit data in either year, or where there were large discrepancies between the 2018/19 and 2019/20 data (differences in statistics that were > mean +/- 1 St.Dev.), which suggests erroneous data in one of those years (it was not feasible for this study to investigate this further), and thus where data should be interpreted with caution. Note also that there are some rural areas (with little or no population) that do not officially fall into any GP catchment area (although this will not affect the results of this analysis if there are no people living in those areas).2. Although all of the obesity/inactivity-related illnesses listed can be caused or exacerbated by inactivity and obesity, it was not possible to distinguish from the data the cause of the illnesses in patients: obesity and inactivity are highly unlikely to be the cause of all cases of each illness. By combining the data with data relating to levels of obesity and inactivity in adults and children (see the ‘Levels of obesity, inactivity and associated illnesses: Summary (England)’ dataset), we can identify where obesity/inactivity could be a contributing factor, and where interventions to reduce obesity and increase activity could be most beneficial for the health of the local population.3. It was not feasible to incorporate ultra-fine-scale geographic distribution of populations that are registered with each GP practice or who live within each MSOA. Populations might be concentrated in certain areas of a GP practice’s catchment area or MSOA and relatively sparse in other areas. Therefore, the dataset should be used to identify general areas where there are high levels of chronic kidney disease, rather than interpreting the boundaries between areas as ‘hard’ boundaries that mark definite divisions between areas with differing levels of chronic kidney disease.TO BE VIEWED IN COMBINATION WITH:This dataset should be viewed alongside the following datasets, which highlight areas of missing data and potential outliers in the data:Health and wellbeing statistics (GP-level, England): Missing data and potential outliersLevels of obesity, inactivity and associated illnesses (England): Missing dataDOWNLOADING THIS DATATo access this data on your desktop GIS, download the ‘Levels of obesity, inactivity and associated illnesses: Summary (England)’ dataset.DATA SOURCESThis dataset was produced using:Quality and Outcomes Framework data: Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.GP Catchment Outlines. Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Data was cleaned by Ribble Rivers Trust before use.COPYRIGHT NOTICEThe reproduction of this data must be accompanied by the following statement:© Ribble Rivers Trust 2021. Analysis carried out using data that is: Copyright © 2020, Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.CaBA HEALTH & WELLBEING EVIDENCE BASEThis dataset forms part of the wider CaBA Health and Wellbeing Evidence Base.

Optimal linear and non-linear models.

Predictions of obesity prevalence in 2035, with the linear and non-linear models.

Supplementary files for article "Acceptance among the public of weight screening and interventions delivered by dental professionals: observational study"Objective: The objective of this study was to explore the acceptability to the public of receiving weight screening and the offer of support to lose weight from dental teams.Methods: A cross-sectional survey was conducted with recruitment of adults from dental practices and community and hospital settings in England and the National Institute for Health and Care Research (NIHR) Be Part of Research initiative.Results: A total of 3580 participants were recruited across 22 dental sites and the NIHR Be Part of Research initiative. Sixty percent (n = 2055/3430) of participants reported that they would be comfortable with their height and weight being measured at a dental appointment. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting weight screening (odds ratio [OR]: 1.98, 95% CI: 1.66–2.36; OR: 2.07, 95% CI: 1.42–3.03). Fifty-seven percent (n = 1915/3375) of participants reported that it would be acceptable for their dental team to offer support to help with weight management. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting support (OR: 1.79, 95% CI: 1.49–2.13; OR: 1.62, 95% CI: 1.11–2.37). The most accepted form of support was provision of information on local weight-management programs (n = 1989/2379, 83.6%).Conclusions: The public is largely receptive to receiving weight screening and the offer of weight interventions from dental teams. Feasibility studies to test the implementation of lifestyle weight interventions in dental settings are required.© The Author(s), CC BY 4.0

MR, mendelian randomization. (XLSX)

Characteristics of adults with severe and complex obesity in CPRD GOLD undergoing bariatric surgery in England, by BMI group (all years 2007–2020).

MR, mendelian randomization. (XLSX)