Obesity in London: The Role of Social Determinants

Table of Contents

Introduction. 2

Obesity in London: The Role of Social Determinants. 3

Food insecurity. 3

Poverty and Income Inequality. 4

Lack of education. 5

Community Development and Social Action Theories. 6

Assets and Partnerships for Sustainable Change in London. 10

Conclusion. 10

References. 12

 

Introduction

Obesity is a growing health challenge on both the global and national scale. Globally, a marked increase has been observed in obesity with over billion people are estimated to be affected by overweight in 2021.  It is a pressing health issue worldwide and London is no exception. It has profound impact on both individuals and society overall. The UK faces an obesity crisis with 63.8% of adults fall into the category of obese or overweight. Moreover, London has one of the highest childhood obesity rate among European cities with 40% of children that are between 10 and 11 are either overweight or obese. This epidemic is not merely because of poor lifestyle choices, as commonly perceived, but also deeply rooted in the structural inequalities, particularly food insecurity, poverty, and educational disparities. The NHS costs related to obesity and overweight are projected to get double to £10 billion per year by the 2050. More critically, the obesity’s relationship with social determinants creates a cycle of self-perpetuating disadvantage. The food insecurity affects nearly 1.5 million Londoners who lives in places where healthy food and nutritious options are scarce and expensive, whereas the ultra-processed, calorie-dense alternatives are available in a breeze. The food commodification in London’s most deprived areas such as Barking and Dagenham, Tower Hamlets has created an obesogenic environment. Disproportionately affects low-income households, who are forced to rely on energy-dense, processed foods which ultimately contribute to obesity. Rising costs of living with families cluttered in a place, have lack of fresh and healthy options. Lower health literacy further add fuel to this existing fire.

The aim of this essay is to do a critical evaluation of how public health experts can use the social action approaches to address this issue especially in the context of London. Addressing obesity requires serious social action approach that empower every class with education, policy reforms, and economic support.

Obesity in London: The Role of Social Determinants

Social determinants of health (SDOH) are the non-medical factors that shape health outcomes. These factors include the conditions in which people are born, grow, live, work, and age, and in the wider system societal forces and systems that shape the daily life. According to Marmot (2010) addressing the social factors are of utmost importance for reducing the health issues, and inequalities which reflects in improving the overall health of a person. Obesity is not just a person’s health choice any more, it is rather increasingly recognized as a health condition which is greatly impacted by these social determinants. To develop some practical and effective public health interventions that are more than just traditional behaviour change programs, there is a critical need to understand the relationship between these factors.

Food insecurity

Food insecurity is one of these underlying factors. It is defined as the lack of of consistent access to enough affordable, nutritious food. It is one of the most significant contributors to the “obesogenic environment” in London. The obesity issue disproportionately affects certain household types but the major concentration is found in deprived areas. 1.5 million Londoners face food insecurity that means they cannot afford healthy meals reliably.  According to BBC Barking and Dagenham's has some areas that are most deprived yet they have five times more fast-food outlets than supermarkets. These food areas provide processed, long-lasting items like pasta and canned goods, that usually lack the proper nutrition values. Families prefer skipping meals and overeating these cheap quick to eat foods which disrupt metabolism and increase in weight. The high cost of healthy foods and scarcity of organic food options in such areas directly restricts the dietary choices. The concept of "food deserts" is directly linked to the geographical location and socioeconomic status to the capacity to afford and access healthy food. This shows a systematic problem rather than just personal choices driving poor dietary choices.

On other hand, the ultra-processed foods that are normally high in calories, sugar, salt, and unhealthy fats, are more affordable and easily available options in such London’s deprived areas. Convenience stores and fast-food outlets stock a great portion of these unhealthy options hence they are more popular in low-income areas. Moreover, the marketing and advertising strategies specifically target these populations and promote their energy-dense, nutrient-poor food products that impact their purchasing decisions. The economic friendly advantage and convenience of ultra-processed foods overall create a powerful driving force for their consumption in low-income communities in London.

Specifying our research to London’s specific areas further strengthen this connection. Barking and Dagenham consistently reports high rates of childhood obesity with a striking rate of 29.3% out of all London boroughs. This area likely faces considerable challenges related to food insecurity and poverty that causes unhealthy diet choices among its residents. Similarly, the Tower Hamlets shows some improvement in adult obesity rates the issues of food access and affordability is consistently pinching these areas. The percentage of overweight in Tower Hamlet is 48% as compared to London’s average of 56%. The low percentage of young people in Tower Hamlets are consuming the recommended diet that include the five or more portions of fruit and vegetables daily, shows the ongoing dietary challenges which are associated with food insecurity. According to the London Borough of Tower Hamlets and Trust for London the eastern borough of London that include the Tower Hamlets have historically experiencing relatively high rates of childhood obesity, which has a strong relationship with poverty. These local examples provide concrete evidence of the relationship between socioeconomic deprivation, food insecurity, and higher obesity rates in London.

Poverty and Income Inequality

Poverty and Income Inequality are another important social determinant causing this problem. Over 37% of children in London live in poverty after housing costs. Low-income families of areas like Newham and Southwark face impossible trade-off, for instance 57% of Tower Hamlets children grow up in households that rely on means-tested benefits which force them to have reliance on cheap, calorie-dense foods. For example, a parent that earn the the London Living Wage (£10.55/hour) spends 42% of his total income on rent, leaving a very little portion for fresh produce. According to the London Child Obesity Taskforce the children in the top 10% of deprived areas more likely (twice) to be obese as those in the least deprive. The rising housing and transport costs gulp the majority portion of budget. Families that are living in Hackney and Tower Hamlets spend 30% more on essentials than the average person in UK. It leave a very less for gym memberships, spendings on vitamins and minerals, or recreational activities that keeps a person healthy.

Lack of education

Lack of health education or specifically lower health literacy is another important roleplayer in the obesity in London. A considerable portion of working age adults in England, including London, have limited health literacy which cause them to struggle in understanding and utilizing the health information such as the nutritious value of food, and what body part requires what type of food etc. This also include the comprehension of health advice by professionals, and make informed decisions about healthy lifestyle and day to day health related choices. Such limited health literacy is then reflected in the poorer dietary choices and lower levels of physical activity. Studies shows that parents, even those who have obese children, often misperceive the child’s weight status which ultimately reflects in their behavior of ignorance in recognizing the potential health risks associated with excess weight. This interplay between Food insecurity, poverty, and lack of education are deeply interconnected social determinant that mutually create a complex disadvantage cycle that increase the obesity risk in London. Interventions that are solely focused on only one determinant may have limited impact if the others are ignored and not addressed.

 

Community Development and Social Action Theories

Community development (CD) is the process of collaboration and working together of people for their own aspirations and needs. The core principle of CD is fostering community participation and make sure people or group of people take ownership of initiatives, endorsing equal access, and building social investment. Community-led plans are increasingly getting popular to achieve meaningful and sustainable improvements in health to reduce the health inequalities. For instance, there is a blue zone in America where the longevity is the main focus; the Loma Linda, California. It is categorized as blue zone, these are the regions that are identified by author Dan Buettner and researchers after extensive research where people have longer and healthier life than average. Other Blue Zones include Okinawa (Japan), Sardinia (Italy), Nicoya (Costa Rica), and Ikaria (Greece).

Figure 1: Blue Zones in world (Thomas, 2023)

In this research, Author Dan wrote that one of the reasons why people lives longer in these blue zones are strong community ties, Community gardens and plant-based food access. He named this Volunteerism and shared purpose as “ikigai”.

Figure 2: Loma Linda California, Blue zone (Buettner, 2008)

Several initiatives have been taken to promote the community development principles in London to tackle health issues. Such programs include, Thrive LDN, Social Prescribing (NHS England & Greater London Authority), Well Communities (Healthy London Partnership) etc. The aim of such programs is ultimately to adopt healthier lifestyles. Such Well London programs focused on promoting healthier eating, physical activity, and mental well-being in some of the city's most deprived neighborhoods. These examples show the noteworthy potential of community development and how the locally tailored solutions can empower residents to take greater control over their health and overall health.  

Understanding the fundamental motivations for community involvement is of paramount importance for the success of social action initiatives. Relevant Social Action Theories, such as Max Weber's types of social action and Social Cognitive Theory, gives a clear and valuable lens for analyzing and examining these motivations. Max Weber's theory stresses that there is a need to interpret the subjective meanings that individuals attach to their actions inside specific social contexts. His classification of social action into instrumental rational, value rational, affectual, and traditional types are of paramount importance to understand the multifaced motivations that motivates both healthy and unhealthy behaviors within communities. In contrast, Social Cognitive Theory said that when a person observes a model performing something and the consequences of his action, he remembers. In other words, it focuses on the dynamic and reciprocal interactions between personal factors, behavioral capabilities, and environmental influences to shape human behavior. This theory focuses particularly on the role of self-efficacy, a person’s belief in their capacity to execute behaviors that are compulsory to achieve specific outcomes. This theory sees the social support as critical factor to influence positive behavior changes in a person especially related to diet and physical activity.

Empirical studies, such as that of Adhikari et al (2018) confirm that Social Cognitive Theory (SCT) based interventions are effective in promoting healthy lifestyle behavior in individuals that can reduce the obesity risks. Studies such as that of Islam et al. (2023) demonstrate that the SCT-based interventions, such as the “StrongPeople” and “Healthy Weight program” can reduce obesity by empowering people through skill-building and peer modeling. One such strong people program is illustrated in Fig below.

Figure 3: Program Leaders (strongpeopleprogram, 2021)

Given London's highly multicultural landscape it is of paramount importance to critically analyze the importance of considering diversity, cultural values, beliefs, and ethics when implementing any social action approach. London is a city having rich diversity, with numerous ethnic and religious groups. All of them possess unique cultural values and beliefs that impact their health behaviors and dietary practices. Holman and Borgstrom (2015) argue that health behaviors are not just individual choices but they are socially situated practices that are shaped by many connected factors like cultural norms and environmental constraints.  Research by Khan et al. (2021) on carpet weavers in Kashmir shows that how values such as respect for elders and religious customs greatly influence the dietary habits and openness of people to health interventions. Furthermore, a study by Renzaho et al. (2011) stresses on the necessity of culturally tailored solutions in London’s African communities that can link value-based understanding in order to improve dietary outcomes in health programs. Another study by Lobstein et al. (2015) in London-based schools used SCT to develop such peer-led programs that boost student’s confidence in developing healthy food habits and making healthy choices, moreover increasing physical activity levels. These all shows that how self-efficacy and modeled behavior can drive health improvements. Consequently, interventions must be thoughtfully designed keeping the cultural sensitivity in front and tailor them to meet the specific needs and preferences of diverse communities. Schwartz Theory of Basic Values gives a good framework in this regard to understand the different value orientations across cultures that can influence health-related behaviors. For instance, Holman and Borgstrom (2015) applying Schwartz’s Theory of Basic Values found that, in multicultural contexts aligning interventions with community-specific values (e.g., familial responsibility in South Asian communities) improves the participation as well as sustainability. Moreover, it is important to uphold the ethical considerations in public health interventions when targeting obesity. It is important to make sure that all approaches avoid stigmatizing people or groups and that these initiatives respect the autonomy and diverse values keeping the London's multicultural population in front.

Assets and Partnerships for Sustainable Change in London

Asset-based approaches means the need to focus on strengths and using existing resources, and capabilities of people and communities to achieve a desired common target rather than just solely focusing on deficits and needs. Asset-Based Community Development (ABCD) can be seen in the work of Kretzmann and McKnight (1993), who focused on the mobilization of community strengths for example the social networks, local knowledge, and cultural practices over the deficiencies. Research by Corcoran et al. (2017) examined community food-growing initiatives in Denver, Colorado, USA, similar to boroughs like Tower Hamlets and Lambeth. The research revealed that there has been seen an improved nutrition awareness, food access, and increased consumption of fresh produce among diverse communities.

Such approaches give a valuable strategy to address the obesity in London by shift focus from finding community deficits to harnessing the existing strengths and resources.

Conclusion

To address the complex and pervasive issue of obesity in London necessitates a fundamental shift towards embracing social action approaches that directly confront the deep-seated social determinants of health. The evidence compellingly demonstrates that traditional interventions, primarily focused on individual behavior change, have proven insufficient in reversing the concerning upward trajectory of obesity rates, particularly within the diverse and often socioeconomically challenged communities of the capital. By acknowledging the multifaceted nature of obesity, its profound and far-reaching impacts on individuals and society, and its strong and persistent links to underlying factors such as poverty, food insecurity, and limited health literacy, we can fully appreciate the critical need for interventions that extend beyond individual choices and instead target the broader environmental and social contexts that shape health behaviors.

The principles of community development, with their emphasis on empowerment, active participation, and local ownership, offer a robust and promising framework for effectively mobilizing London's diverse communities in the collective effort to combat obesity. Strategically leveraging the existing strengths and resources within communities, coupled with the cultivation of strong and collaborative partnerships across various sectors, are crucial for creating sustainable and culturally relevant solutions that resonate with the lived experiences of Londoners. Social action theories provide invaluable lenses through which to understand the complex motivations and behaviors of individuals and communities, enabling the design and implementation of more effective and precisely targeted interventions. Moreover, within the richly diverse cultural landscape of London, the careful consideration of cultural values, beliefs, and fundamental ethical principles is paramount to ensure that all social action initiatives are inclusive, respectful, and ultimately contribute to achieving health equity for all residents.

Ultimately, the successful and sustained implementation of comprehensive social action strategies holds immense potential for achieving significant and lasting improvements in the overall health and well-being of London's diverse population.

References

Adhikari, C., Puri, A., Thapa, D., Thapa, R., Magar, S. and GC, S. (2019). Application of Social Cognitive Theory in Obesity Prevention: A Rapid Review. Journal of Health and Allied Sciences, [online] 7(1), pp.53–62. doi:https://doi.org/10.37107/jhas.23.

Alaimo, K., Beavers, A.W., Coringrato, E., Lacy, K., Ma, W., Hurley, T.G. and Hébert, J.R. (2023). Community Gardening Increases Vegetable Intake and Seasonal Eating From Baseline to Harvest: Results from a Mixed Methods Randomized Controlled Trial. Current Developments in Nutrition, [online] 7(5), p.100077. doi:https://doi.org/10.1016/j.cdnut.2023.100077.

Buettner, D. (2008). Loma Linda, California. [online] Blue Zones. Available at: https://www.bluezones.com/explorations/loma-linda-california/.

centreforlondon.org. (n.d.). Health and wellbeing. [online] Available at: https://centreforlondon.org/reader/the-london-intelligence-health-and-wellbeing/data/.

Greater London Authority (2011). Childhood Obesity in London. [online] Available at: https://www.london.gov.uk/sites/default/files/gla_migrate_files_destination/glae-childhood-obesity.pdf.

HACT. (2023). Food insecurity | Collaboration | The Centre | HACT. [online] Available at: https://hact.org.uk/collaboration/london-food-insecurity/ [Accessed 15 Apr. 2025].

Hasan, M. (2022). Principles and Process in Community Development. ecampusontario.pressbooks.pub. [online] Available at: https://ecampusontario.pressbooks.pub/communitydevelopmentpractice/chapter/27/.

Health (2025). Local Authority Health Profiles - Data | Fingertips | Department of Health and Social Care. [online] Phe.org.uk. Available at: https://fingertips.phe.org.uk/profile/health-profiles/data#page/3/gid/1938132694/pat/6/par/E12000007/ati/301/are/E09000008/iid/93088/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 [Accessed 15 Apr. 2025].

Holman, D. and Borgstrom, E. (2015). Applying social theory to understand health-related behaviours. Medical Humanities, [online] 42(2), pp.143–145. doi:https://doi.org/10.1136/medhum-2015-010688.

Islam, K.F., Awal, A., Mazumder, H., Munni, U.R., Majumder, K., Afroz, K., Tabassum, M.N. and Hossain, M.M. (2023). Social Cognitive theory-based Health Promotion in Primary Care practice: a Scoping Review. Heliyon, [online] 9(4). doi:https://doi.org/10.1016/j.heliyon.2023.e14889.

Ives, L. (2018). Deprived areas ‘have five times more fast food outlets’. BBC News. [online] 28 Jun. Available at: https://www.bbc.co.uk/news/health-44642027.

Khan, T.A., Farooqi , I., Swalehin, M. and Hamid , W. (2021). OUP accepted manuscript. Health Promotion International. doi:https://doi.org/10.1093/heapro/daab046.

Lobstein, T., Jackson-Leach, R., Moodie, M.L., Hall, K.D., Gortmaker, S.L., Swinburn, B.A., James, W.P.T., Wang, Y. and McPherson, K. (2015). Child and adolescent obesity: part of a bigger picture. The Lancet, [online] 385(9986), pp.2510–2520. doi:https://doi.org/10.1016/s0140-6736(14)61746-3.

London Sports (n.d.). Tower Hamlets Area profile. [online] Available at: https://londonsport.org/wp-content/uploads/2024/04/Tower-Hamlets.pdf.

Obesity Evidence Hub (2023). Global obesity trends in adults. [online] Obesity Evidence Hub. Available at: https://www.obesityevidencehub.org.au/collections/trends/adults-global.

Sochealth (n.d.). Community Development and Health - Socialist Health Association. [online] https://sochealth.co.uk/. Available at: https://sochealth.co.uk/national-health-service/public-health-and-wellbeing/community-development-and-health/.

strongpeopleprogram (2021). Program Leaders. [online] StrongPeople. Available at: https://strongpeopleprogram.org/program-leaders/ [Accessed 17 Apr. 2025].

THE PRACTICE OF HOPE_MODULE 2 1 Asset-Based Community Development (ABCD). (n.d.). Available at: https://www.cswe.org/CSWE/media/Diversity-Center/2-Module-2_Asset-Based-Community-Development_2.pdf.

Thomas, L. (2023). Unlocking the Secrets of Blue Zones: A Blueprint for Longevity and Health. [online] News-Medical.net. Available at: https://www.news-medical.net/health/Unlocking-the-Secrets-of-Blue-Zones-A-Blueprint-for-Longevity-and-Health.aspx.

Trust For London (2024). Blocked. [online] Trustforlondon.org.uk. Available at: https://trustforlondon.org.uk/data/topics/health/?tab=child-obesity.

Trust for London. (2021). Children. [online] Available at: https://trustforlondon.org.uk/data/demographics/children/.

WHO (2024). One in eight people are now living with obesity. [online] www.who.int. Available at: https://www.who.int/news/item/01-03-2024-one-in-eight-people-are-now-living-with-obesity.