When exercise is limited or reduced

The opportunities for exercise may be more limited for those with a physical disability. A sudden reduction in activity (for example when athletes or army personnel retire or sustain injury) can also lead to weight gain. For individuals confined to a wheelchair, every care should be taken to ensure that there is access to facilities that allow exercise. Guidance on how to match energy intake to energy needs should also be provided.

Smoking cessation

Giving up smoking should always take priority when it comes to improving health.

However, many cite the fear of weight gain as a reason for their reluctance to  top smoking. The chemical nicotine is a metabolic stimulant, explaining why heavy smokers can have up to a 10% greater energy expenditure than non-smokers.³³ Tobacco is also known to dull the sensation of taste and smell, thereby affecting appetite. It is difficult to find accurate estimates of the weight gain related to smoking cessation but a large retrospective study conducted in the US calculated that the mean weight gain attributable to the cessation of smoking in men and women ( n=768 ) was 2.8 kg and 3.8 kg respectively.³⁴ Co-ordinating the medical management of smoking cessation and weight control is essential. However, during the cessation period, weight maintenance rather than weight loss may be a realistic goal in obese smokers.

Poverty

Obesity is linked with poverty.³⁵ Although obesity is increasing at the same rate in all social classes, the prevalence of obesity is higher in lower socio-economic groups, particularly in women. The factors accounting for the association between deprivation and obesity are many. Dietary surveys show that lower income families have less variety in their diet, eat fewer essential nutrients but eat more fat and sugar.³⁶ This is not surprising as processed foods higher in salt, fat and sugar are cheaper per unit of energy than healthier foods such as fruit and vegetables. The health survey for England reported that participation in sports and exercise and walking is strongly related to household income, with those on lower incomes less likely to be regular participants. The prevalence of obesity is advancing rapidly in the developing world as well, and obesity should not be thought of as a disease of affluence. Obesity is also linked with poor levels of education.³²

Ethnicity

There is a higher prevalence of obesity among certain ethnic groups, particularly among Black Caribbean and Pakistani women living in the UK. Data from the Health Survey for England showed that Black Caribbean women were twice as likely to have morbid obesity compared with women in general. The Health of Minority Ethnic Groups Survey (1999) found that compared with the general population, South Asian and Chinese men and women were much less likely to participate in physical activities.³⁷ Bangladeshi men and women had the lowest levels of physical activity. The high rates of diabetes among the South Asian ethnic population in Britain has led to the suggestion that South Asian individuals should be considered obese with a BMI of 27 kg/m2. The International Obesity TaskForce (IOTF) have proposed a more population-specific classification of BMI for Asia.³⁸

Adapted from Weisell, 2002 ³⁹