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Obesity & Nutrition

According to the WHO, worldwide obesity has nearly tripled since 1975. Worldwide more than 1 billion people have obesity – 650 million adults, 340 million adolescents and 39 million children. Obesity is associated with reduced life expectancy, and has been identified as a risk factor for various diseases including cardiovascular disease, diabetes mellitus type 2, 13 different types of cancer, liver disease, respiratory disease and mental health disorders. At least 2.8 million people die each year as a result of being overweight or obese.

Definitions of overweight and obesity

Overweight and obesity are terms which refer to the excess accumulation of body fat. These classifications are different for adults and children. In adults, the classifications are usually measured using Body Mass Index (BMI). BMI uses your height and weight to work out if your weight is healthy. In children, the relationship between BMI and healthy weight varies according to age and gender.

Figure 1: BMI classification chart

We are aware of the limitations regarding using BMI as an individual indication of weight, however at a population level it is a helpful indicator as to the healthy weight status of a population. This is why we also include the definition of being underweight.

Obesity Statistics – Self-reported data

The following data has been extracted from the 2021 Health and Lifestyle Survey. This survey was conducted during the COVID-19 pandemic lockdown period, which may have affected the results. It is also important to note that the participants of this survey were asked to self-report on the questions asked. This means that only limited conclusions can be drawn from the findings.

According to the health and lifestyle survey data, 28.8% of the adult population are obese and 65.6% are overweight.

Actual obesity levels maybe higher as commonly, self-reporting leads to under estimation of weight and over estimation of height. In 2015, 41% reported themselves to be in the normal BMI range, 35% overweight and 24% obese (none were underweight). Further data is required in order to establish actual trends on obesity in Gibraltar.

Figure 2: Overall obesity levels in Gibraltar (self-reported)

Figure 3: Prevalence of Obesity by Age (self-reported)

Self-reported data extracted from the Health and Lifestyle survey 2021 found that those aged 16-24 years were most likely to report being underweight. No respondents in the youngest age group, 16-24 years reported being obese or morbidly obese. Of all the age groups, the youngest age group, 16-24 years, was most likely to report being of normal weight (60.80%). Those aged 25-44 years were most likely to repot being overweight. Those over the age of 65 years were most likely to report being obese and morbidly obese, compared to other age groups.

Obesity Statistics – Gibraltar Health Authority BMI data

The following data has been extracted from a sample of 21,448 Gibraltar Health Authority patient records with recorded BMI dated between 2015-2022. Of these records, 16,024 (74.7%) were aged 18 years or over. Age was missing for one individual. Of the 16,024 adults, 14,030 had calculable BMI, the remainder of the records were excluded from BMI analysis as they were either missing height, weight or had clearly erroneous values.

Figure 4: Proportion of BMI category by year of BMI score for all those with recorded (calculable) BMI, Gibraltar, 2015-2022

Among those with BMI scores dated between 2015 to 2022, overall trends indicate that those at either end of the BMI categories – under-weight and severely obese – consistently comprise the lowest proportions each year.  However, since 2020, the proportion of people in the severely obese BMI category has increased. The proportion of people at a healthy weight has decreased every year since 2019.

Figure 5: Sex specific proportion of BMI category, by year of BMI score, Gibraltar 2015-2022

Between 2015 and 2021 ,the greatest proportion of females were categorised as being in the ‘healthy weight’ category. In 2022, the largest proportion of females are categorised as being ‘obese’. The percentage of severely obese females has steadily increased between 2019-2022.

The greatest proportions of males are currently categorised as obese or overweight. The percentage of healthy weight males decreased between 2019 and 2021, before starting to increase again in 2022. Generally, a greater proportion of males were obese or overweight in 2022 compared to females, with a greater percentage of females categorised in the healthy BMI category also.

Nutrition

Eating a balanced, healthy diet means eating a wide variety of foods in the right proportions, and consuming the correct amounts of food and drink.  A balanced diet is a vital part of strengthening our immunity, avoiding illness, preventing nutritional deficiencies and maintaining a healthy body weight. 

It is important to note that if you are a healthy body weight you may still be deficient in vital vitamins and minerals hence the importance of consuming a balanced diet.

According to the Eatwell guide, people following a  balanced diet should try to include :

  • At least 5 portions of a variety of fruit and vegetables every day (see 5 A Day)
  • Incorporate higher fibre starchy foods into your daily diet, such as lentils, pulses, wholegrain bread, brown rice or pasta, nuts and seeds.
  • Have some dairy or dairy alternatives (such as plant-based fortified drinks )
  • Eat some beans, pulses, fish, eggs, meat and other protein
  • Choose unsaturated oils and spreads, and eat them in small amounts
  • Drink plenty of fluids (at least 6 to 8 glasses a day)
  • Limit your salt intake to 6 grams (one teaspoon) per day.

The 2021 Health and Lifestyle survey found that 82% of adult participants in Gibraltar failed to meet daily recommended amount of at least 5 portions of fruit and vegetables. This is compared to recent data which found that 72% of the UK population are failing to meet their 5-a-day requirement.

Fruit and vegetables are an excellent source of vitamins and minerals, including folate, vitamin C and potassium. They’re an excellent source of dietary fibre, which can help to maintain a healthy gut and prevent constipation and other digestion problems. A diet high in fibre can also reduce your risk of bowel cancer. A diet high in fruit and vegetables can help to reduce your risk of heart disease, stroke and some types of cancer (National Health Service, 2023).

Recommendations & future directions 

Understanding trends in local obesity prevalence helps provide a local picture of the community and identifies those groups who are most at risk. The Joint Strategic Needs Assessment also aims to serve as a baseline against which progress can be measured. Future phases of the Joint Strategic Needs Assessment aim to include local statistics on Childhood Obesity. Gibraltar has just commenced a program to take a whole systems approach to healthy weight and the data provided by the JSNA will be vital to explore trends, identify drivers for not being able to achieve a healthy weight and to monitor progress of interventions. This work is being based upon the whole systems approach methodology set within the context of Gibraltar – Health matters: whole systems approach to obesity – GOV.UK (www.gov.uk).

Page last reviewed: December 2023

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