Health Survey for England, 2022 Part 2

This report examines the prevalence of overweight and obesity among adults in 2022.

Detailed tables accompanying this report can be accessed here.

• In 2022, 29% of adults were living with obesity, and 64% were overweight or living with obesity. 
• Obesity prevalence was highest among older adults: 36% of adults aged 55 to 64, and 35% of adults aged 64 to 74, were living with obesity.
• 45% of adults were trying to lose weight, and this was more common among women (52%) than men (38%).

Obesity is a major public health problem in England and globally (Source: World Health Organization, 2021). In adults, overweight and obesity are associated with life-limiting conditions, such as Type 2 diabetes, cardiovascular disease, and some cancers.

The burden on the National Health Service (NHS) due to obesity and related illnesses is well recognised. The monetary cost each year, uplifted for inflation, was estimated at £6.5 billion in 2022 (Source: Frontier Economics, 2022).

The COVID-19 pandemic has had a disproportionate effect on people with obesity, who are at increased risk of being hospitalised, admitted to intensive care, and of dying from COVID-19 (Sources: Public Health England, 2020, ONS, 2022, Saul, Gursul and Piernas, 2022).

The Health Survey for England (HSE) is the main data source for monitoring overweight and obesity in the general population in England. In 2022, the survey returned to physical measurements of height and weight, comparable with previous survey years 1993 to 2019. Due to COVID-19 precautions, this was not possible in 2020 and 2021; for more information see the HSE 2021 Methods report, available here. Measured height and weight were used to calculate body mass index (BMI). Waist measurements were also taken, to monitor central (abdominal) obesity.

Height and weight were measured during the interviewer visit, while waist and hip circumferences were measured during the health visit, for both adults and children.

Full details of the protocols for carrying out all the measurements are contained in the HSE 2022 Methods report. 

Body mass index

To define overweight or obesity, a measurement of height is required that allows for differences in weight due to height. A widely accepted measure of weight for height, body mass index (BMI), defined as weight in kilograms divided by the square of the height in metres (kg/m²), is used for this purpose in the HSE series.

Participants were classified into the following three mutually exclusive BMI groups according to the World Health Organization’s BMI classification (Source: WHO, 2010). 

Table A: Classification of body mass index (BMI) groups

BMI categories of overweight and obese were combined to show the proportion of participants who are either overweight or living with obesity (BMI 25kg/m² or more). A BMI threshold of 30kg/m² has been used to define participants as living with obesity, and a subset of the obese category has also been used to define morbid obesity (BMI 40kg/m² or more). These definitions were applied to all participants aged 16 and over, as this is how adults are defined in the HSE series.

Waist circumference among adults

BMI does not distinguish between mass due to body fat and mass due to muscular physique. It also does not take account of the distribution of fat.

In order to measure abdominal obesity (central adiposity) in adults, waist circumference is measured, and categorised into desirable, high and very high by sex-specific thresholds (Source: WHO, 2000). This allows comparisons with previous HSE reports. One criticism of these fixed thresholds is that they do not take account of height. Since 2022, NICE has recommended that adults keep their waist/height ratio below 0.5 (so that their waist measurement is less than half their height) (Source: NICE, 2023). This report will use both definitions of waist circumference.

Table B: Classification of waist circumference and waist/height groups

In 2022, the mean height of men was 176.2cm, and of women was 162.3cm. Height in men has increased by just less than 2cm since 1993 (174.4cm), and height in women has increased by just over 1cm in that period (161.1cm).

Between 1993 and 2022, mean weight increased from 78.9kg to 85.8kg among men, and from 66.6kg to 72.8kg among women.

For more information: Tables 1 and 2 

Mean BMI was 27.6kg/m² for both men and women in 2022. BMI generally increased with age and was lowest among adults aged 16 to 24 (24.3kg/m²) and highest among those aged 55 to 64 (28.9kg/m²). There has been no change in BMI for men and women in recent years.

For more information: Tables 3 and 4

In 2022, 29% of adults were living with obesity, and 64% were overweight or living with obesity. Obesity prevalence increased with age from 14% of adults aged 16 to 24, peaking among adults aged 55 to 74 years (35% to 36%).

The prevalence of overweight (including obesity) was more common among men (67%) than women (61%). Among men, the prevalence of overweight (including obesity) was lowest among those aged 16 to 24 (35%), and highest among men aged 55 to 64 (80%). Among women, the age difference was less pronounced. Overweight (including obesity) increased from 38% of women aged 16 to 24, peaking at 69% among women aged 55 to 74.

For more information: Tables 3 and 4

28% of men were living with obesity in 2022, similar to pre-pandemic years where obesity prevalence varied between 26% to 27% from 2016 to 2019. The proportion of men who were overweight or living with obesity was 67% in 2022. This was also similar to recent years, varying between 66% to 68% from 2016 to 2019.

The proportion of women who were living with obesity (30%), or who were overweight or living with obesity (61%) in 2022 was also similar in 2017 to 2019, where obesity prevalence among women ranged from 29% to 30%, and overweight (including obesity) ranged from 60% to 62%.

Adult obesity prevalence increased rapidly between 1993 and 2008 (from 15% to 25% in 15 years), and more slowly since then. Obesity prevalence has remained relatively stable at around 28% to 29% since 2017. Overweight (including obesity) increased from 53% in 1993 to 62% in 2001, and since then the increase has been more gradual. Overweight (including obesity) has been relatively stable at 63% to 64% between 2017 and 2022.

For more information: Table 3

The charts above show the overweight and obesity prevalence averaged over three years, between 1993 and 2019; and the single-year prevalence in 2022. Averaged data is plotted on the middle year. 

Note that 2021 data are not directly comparable with other years due to changes in survey methodology and response rates, and as such are excluded from the 3 year averages above. The overweight and obesity findings presented in the HSE 2021 report are based on self-reported rather than measured height and weight.

Overweight and obesity prevalence estimates by region are shown in the tables as both observed and age-standardised. Observed estimates show the actual obesity prevalence in each region. Comparisons between regions should be based on the age-standardised data, which account for the different regional age profiles.

The mean (age-standardised) BMI of adults varied by region, and was highest in the North East (28.6kg/m²) and Yorkshire and the Humber (28.5kg/m²). The lowest regional mean BMI was 26.6kg/m² in London.

The age-standardised prevalence of overweight or obesity among adults differed by region. Obesity was most prevalent in the North East (39%) and least prevalent in London (21%). Overweight (including obesity) was most prevalent in Yorkshire and the Humber (72%) and least prevalent in London (59%).

For more information: Table 5

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods report.

Mean BMI among adults was greater in more deprived areas, increasing from 26.7kg/m² in the least deprived to 28.4kg/m² in the most deprived quintile of multiple deprivation.

Both the prevalence of obesity, and overweight (including obesity) were higher in more deprived areas. For example, 22% of adults in the least deprived quintile were living with obesity, compared with 36% of those in the most deprived quintile.

For more information: Table 6

Mean waist circumference increased with age, particularly for men compared with women. Among men, mean waist circumference increased from 88.7cm among those aged 16 to 34, to 104.5cm among men aged 65 to 74. Among women, mean waist circumference increased from 83.3cm among women aged 16 to 34, to over 91cm among women aged 55 and over.

High or very high waist circumference was more prevalent among women (68%) than men (58%) and increased with age. Among men, the prevalence of high or very high waist circumference increased, from 31% among men aged 16 to 34, to 75 to 76% of men aged 55 and over. Among women, 50% of women aged 16 to 34 had a high or very high waist circumference, increasing to 78% to 86% of women aged 55 and over.

For more information: Table 7

While waist circumference thresholds are widely used as a measure of abdominal obesity, they do not account for differences in height. Since 2022, NICE has recommended that adults keep their waist-to-height ratio below 0.5 (so that their waist measurement is less than half their height) (Source: NICE, 2023). 

The mean waist-to-height ratio was 0.55 for men and 0.54 for women. Among all adults, the mean waist-to-height ratio increased with age, from 0.50 among those aged 16 to 34 to 0.59 among those aged 75 and over.

71% of men and 62% of women had a waist-to-height ratio above the recommended level. This increased from 43% of those aged 16 to 34, to 89% of those aged 75 and over.

For more information: Table 7

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods report. 

The prevalence of having a high or very high waist circumference was greater in more deprived areas. 58% of those in the least deprived areas had a high or very high waist circumference, compared with 71% of those in the most deprived areas.

For more information: Table 8

In 2014, NICE published guidance on the identification, assessment and management of overweight and obesity in children, young people and adults, which partially updated its 2006 guidance. The guidance included a recommendation for health professionals to ‘think about using waist circumference, in addition to BMI, in people with a BMI less than 35kg/m²’. The recommendation is to base the assessment of health risks associated with being overweight or obese on BMI and waist circumference, as in Table C below. This is because some people, despite having a BMI of less than 35kg/m², may have a higher risk of disease due to having a more ‘central’ fat distribution as identified by a high or very high waist circumference (Source: WHO, 2008).

For those with a BMI of 35kg/m² or more, waist circumference has little added predictive power of disease risk, and these individuals are also unlikely to have a low waist circumference (Source: Schneider et al, 2010).

Table C: Health risk from BMI and waist circumference

45% of men and 40% of women had an overall health risk group of ‘no increased risk’, similar to recent years. The majority of the ‘no increased risk’ group were adults with a healthy BMI and desirable waist circumference (29% of men and 25% of women). A further 17% of men and 12% of women had ‘increased’ overall health risk, most of whom were overweight with a high waist circumference (16% of men and 10% of women).

Women were more likely than men to be at a ‘high’ or ‘very high risk’. 14% of men and 18% of women had ‘high risk’, and 23% of men and 27% of women had ‘very high risk’. The most common ‘high risk’ group were those who were overweight with a very high waist circumference (11% of men and 16% of women). Similarly, most of the ‘very high risk’ group had a BMI of 30-34.9kg/m², combined with a very high waist circumference (15% of men and women).

For more information: Table 9

Diabetes is characterised by high blood glucose levels (hyperglycaemia). Untreated hyperglycaemia is associated with damage and possible failure of many organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Diabetes substantially increases the risk of cardiovascular disease (CVD) and tends to worsen the effect of other risk factors for CVD, such as abnormal levels of blood fats, raised blood pressure, smoking and obesity (Source: Garcia et al, 1974). Being overweight is a risk factor for Type 2 diabetes (Source: Diabetes UK).

Doctor-diagnosed diabetes was measured by asking participants:

• Do you now have, or have you ever had diabetes?
• [If yes] Were you told by a doctor that you had diabetes?

Across the whole sample, 7% of men and 5% of women had diagnosed diabetes, and 5% of adults had undiagnosed diabetes. Overall, total diabetes prevalence was 11% in men and 9% in women. For more data about diabetes see the HSE 2022 Adult health topic report.

After accounting for age, doctor-diagnosed diabetes was strongly related to adults’ BMI category: 4% of adults who were a healthy weight or overweight had doctor diagnosed diabetes, rising to 9% of those living with obesity. Undiagnosed diabetes also increased with BMI. The prevalence of undiagnosed diabetes was 2-3% of those who were healthy weight, or overweight, and 9% of obese. Taking diagnosed and undiagnosed diabetes together, 6% of adults who were a healthy weight or overweight had diabetes, compared with 18% among those living with obesity.

For more information: Table 10

After accounting for age, doctor-diagnosed diabetes was related to waist circumference. Among men, 3% to 4% of those with a desirable or high waist circumference had doctor-diagnosed diabetes, and 8% of men with a very high waist circumference had doctor-diagnosed diabetes. Among women, 2% of those with a desirable or high waist circumference, and 6% of those with a very high waist circumference, had doctor-diagnosed diabetes.

Undiagnosed diabetes was also more prevalent among those with a very high waist circumference: 8% of men and 7% of women, compared with 2% to 3% of men and women with a desirable or high waist circumference.

Taking diagnosed and undiagnosed diabetes together, 16% of men and 13% of women with a very high waist circumference had diabetes, compared with 6% of men and 4% of women with desirable or high waist circumference.

For more information: Table 11

During the interview, adults were asked the following question, as part of the self-completion questionnaire:

• At the present time are you trying to lose weight, trying to gain weight, or are you not trying to change your weight?

45% of adults were trying to lose weight. A slight majority of women (52%) were trying to lose weight, while 3% were trying to gain weight, and 45% were not trying to change. Men were less likely to be trying to lose weight (38%), and more likely to report trying to gain weight (8%) or not trying to change (54%).

As BMI increased, so did the proportion of adults trying to lose weight. Among men, 11% of those who were a healthy weight were trying to lose weight, while 39% of those who were overweight and 68% of those living with obesity were trying to do so. Among women, the proportion trying to lose weight increased from 27% of those with a healthy weight, to 62% of those who were overweight and 77% of those living with obesity.

For more information: Table 12

During the interview, adults were asked the following question, as part of the self-completion questionnaire:

• Given your age and height, would you say that you are…
  • About the right weight
  • Too heavy
  • Or too light?
  • Not sure

Men were more likely to perceive their weight as about right than women (47% of men, and 40% of women). Women were more likely to perceive their weight as too heavy (48% of women, 40% of men).

Men and women differed somewhat in the relationship between their BMI category and their self-perceived weight.

Among those of healthy weight:

• 76% of men and women perceived their weight as being about right
• women were more likely to say they were too heavy (11%) than men (4%)
• and men were more likely to say they were too light (13%) than women (5%)

Among those who were overweight but not obese:

• 51% of men felt their weight was about right, and 40% too heavy
• 58% of women felt they were too heavy, and 30% about right

Among adults living with obesity, 82% of men and 89% of women perceived themselves as too heavy.

For more information: Table 13