Obese people fall into six distinct categories, a study suggests, leading scientists to call for bespoke treatment rather than a “one size fits all” approach to tackling the epidemic which costs the NHS £6 billion a year.
Researchers have identified the groups as heavy drinking males, young healthy females, the affluent and healthy elderly, the physically sick but happy elderly, the unhappy and anxious middle-aged, and those with the poorest health.
The study, published in the Journal of Public Health, suggests that clinicians should not target all obese people in exactly the same way, but rather treat them according to which "type" they belong to.
Scientists from the University of Sheffield’s School of Health and Related Research analysed data from the Yorkshire Health Study of 4,144 obese individuals with a body mass index (BMI) of 30 or above.
They used a two-step cluster analysis to identify groups of individuals who shared common characteristics, and six groups emerged.
Those in the "heavy drinking males" group had above average levels of physical exercise but also had high levels of alcohol consumption.
Alcohol consumption appears on the list more than once (Alamy)
Meanwhile, "younger healthy females" generally did not have many associated health problems in addition to their obesity.
Researchers said that advice for young men could focus specifically on cutting down on alcohol while young females could be told lose weight through traditional methods of exercise and change of diet.
The "unhappy anxious middle-aged" group was mainly women with poor mental health and high levels of insomnia, anxiety, depression and fatigue. This group had a low sense of well-being and had the lowest alcohol consumption.
Women suffering from depression and fatigue form a group of their own (Alamy/Posed by model)
The final three clusters showed different patterns among older people.
A large proportion of the "affluent healthy elderly" had high blood pressure and above average alcohol consumption, although this group also displayed some healthy characteristics.
Obesity is on the rise in Britain (Alamy/posed by model)
The "physically sick but happy elderly" group had a higher prevalence of chronic health conditions, such as osteoarthritis, diabetes and high blood pressure, but had low levels of anxiety and depression.
Those in the “poor health” group had the highest average BMI, the most chronic health conditions and tended not to engage in healthy behaviours.
The 'physically sick but happy elderly' group have low levels of anxiety (Alamy/Posed by model)
Dr Mark Green, who led the study, said that obese people should not be seen as one homogenous group, but rather treated in a bespoke manner according to which group they belong to.
For example, the anxious middle-aged group could be advised to do more exercise and get counselling, while the poor health group may need to address their chronic health problems before tackling their obesity.
"Policies designed to tackle obesity and encourage healthier lifestyles often target individuals just because they are obese,” Dr Green said.
"But a focus on just the group as a whole is not very efficient. We are all different and different health promotion approaches work for different people.
Healthy young females who indulge in too many snacks make up another group (Alamy)
"Our research showed that those in the groups that we identified are likely to need very different services, and will respond very differently to different health promotion policies.
"In the future, we hope that GPs will keep in mind these six groups when offering advice to their patients."
The report concluded that interventions by clinicians and policy makers should not target obese people “as a whole”, but rather should strategies should be tailored to suit the categories that individuals belong to.
The categories of obesity identified by the study
1 Heavy drinking males
This group were less likely to be managing their weight, although they did report above average levels of physical exercise and walking.
Bill, 32, is an estate agent and a regular at his local pub. Most days after work he meets up with friends for a pint – or three – and his dish of choice, a steak and triple fried chips.
Friday night is a major highlight of the week, since he and his colleagues usually clock off at around 4pm to start a long night of drinking, which will always ends with a late night fry up.
On Sunday mornings he plays a game of five-a-side football, then rewards himself for his hard work with a traditional Sunday roast, always with his signature side dish of a triple Yorkshire pudding.
2 Young healthy females
The study found the largest cluster was "younger healthy females", which was also the youngest group. They displayed the most positive health characteristics of all the clusters and engaged in some healthy behaviours.
Nicola, 25, works in human resources at a corporate law firm. She has a sweet tooth and there is always a ready supply of chocolate, cake and biscuits at the office.
On Friday and Saturday nights she usually goes out drinking and clubbing with friends, or sometimes she stays in for a film and chocolate evening.
3 The affluent and healthy elderly
The "affluent healthy elderly" was the least deprived cluster and had positive health characteristics (although included a large proportion with high blood pressure) and above average alcohol consumption.
Susan, 65, lives life to the full. A retired solicitor with a large pension, she can afford all the luxuries she deserves.
She has a penchant for high tea and entertains friends a few times a week at her home with scones, served with real butter, full fat cream and her delicious home-made jam. If there’s any left over, Susan is more than happy to eat it for breakfast the next day.
She dines out regularly, and goes on at least four cruises a year with her husband and group of friends, enjoying the all-day buffet and drink-as-much-as-you-like wine bar.
4 The physically sick but happy elderly
The "physically sick but happy elderly" group had a higher prevalence of chronic health conditions (including osteoarthritis, diabetes and high blood pressure) but exhibited low levels of anxiety and depression.
Terry, 71, suffers from diabetes and high blood pressure, but he has plenty to smile about – his wife makes sure of that.
An avid stamp collector, he is quite content reviewing his scrapbooks and researching new items online when he feels too weak to get up.
Cooking is another of his hobbies – puddings in particular (he is too old to worry about his weight anyway). His children and grandchildren visit regularly, and often treat him to a meal at a local restaurant.
5 The unhappy and anxious middle-aged
The "unhappy anxious middle-aged" group was primarily female, had poor mental health and reported high levels of insomnia, anxiety, depression and fatigue.
Their sense of well-being was relatively low, but they did engage in healthy physical activity and weight management, and had the lowest alcohol consumption.
Wendy, 53, can’t remember the last time she had a good night’s sleep. She suffered from anorexia as a teenager, and struggled with depression and anxiety into her adult years.
She took early retirement from her job as a social worker after a particularly distressing case pushed her over the edge.
Now she works as a full time carer for her elderly father who lives with her, and often keeps her up and night. When she can’t sleep, she often goes down to the kitchen and binges on junk food to cheer herself up.
6 Those with the poorest health
The final group, made up of those with the "poorest health", was the most deprived, had the highest prevalence of most chronic health conditions, and tended not to engage in healthy behaviours. It also had the highest mean BMI.
Doreen, 43, lives on an estate with her seven children and three grandchildren. She has lung problems - she started smoking when she was a teenager - and doesn’t get out of the house much. She’s never been much good at cooking, and take-aways are much more popular with her family anyway.
She often ends up looking after her grandchildren while their parents are out at work – but since they are only babies this often means just sitting around at home making sure they don’t get up to too much mischief.
"Kama utafiti unavyoonyesha, watu wanene wanagawanyika katika makundi sita tofauti, na hivyo kuwafanya wanasayansi wito kwa matibabu maalum badala ya ""ukubwa mmoja unaofaa wote"" mbinu ya kukabiliana na janga ambalo gharama NHS £ 6 bilioni kwa mwaka." Watafiti wamegundua makundi haya kama wanaume wanaokunywa sana, wanawake vijana wenye afya, wazee wenye utajiri na afya, wazee wenye ugonjwa wa kimwili lakini wenye furaha, wazee wenye huzuni na wasiwasi wa umri wa kati, na wale wenye afya mbaya zaidi. Utafiti huo, uliochapishwa katika jarida la Journal of Public Health, unaonyesha kwamba madaktari hawapaswi kuwaelekeza wagonjwa wote wenye uzito mzito kwa njia ileile, bali badala yake kuwachunga kulingana na "aina" wanayopaswa kuifahamu. Wataalamu wa Chuo Kikuu cha Sheffield School of Health and Related Research walichunguza takwimu kutoka kwa utafiti wa afya wa Yorkshire, ambao ulihusisha watu 4,144 wenye uzito mzito na kiwango cha BMI cha 30 au zaidi. Kwa kutumia uchambuzi wa hatua mbili, kikundi cha watu walioshiriki sifa za kawaida kilitengenezwa. Wale waliokuwa katika kikundi cha "wanaume wanaokunywa sana" walikuwa na viwango vya juu vya mazoezi ya mwili lakini pia walikuwa na viwango vya juu vya matumizi ya pombe. "Wanawake wenye afya na vijana kwa ujumla hawakuwa na matatizo mengi ya afya pamoja na unene wao wa kupita kiasi.""" Watafiti wanasema ushauri kwa vijana wa kiume unaweza kuzingatia hasa kupunguza pombe wakati wanawake vijana wanaweza kuambiwa kupoteza uzito kupitia mbinu za jadi za mazoezi na mabadiliko ya lishe. "Watu wa umri wa kati wenye wasiwasi na wasio na furaha"" walikuwa wanawake wenye afya mbaya ya akili na viwango vya juu vya kukosa usingizi, wasiwasi, unyogovu na uchovu." Kikundi hicho kilikuwa na hisia ndogo ya ustawi na kilikuwa na matumizi ya chini zaidi ya kileo. Wanawake wanaosumbuliwa na unyogovu na uchovu huunda kikundi chao wenyewe (Alamy) makundi matatu ya mwisho yalionyesha mifumo tofauti kati ya watu wazima. Sehemu kubwa ya "watu wazima wenye afya" walikuwa na shinikizo la juu la damu na matumizi ya pombe ya juu ya wastani, ingawa kikundi hiki pia kilionyesha baadhi ya sifa za afya. "Watu walio na uzito wa juu zaidi katika Uingereza, ambao ni ""wenye afya mbaya lakini wenye furaha,"" wana ugonjwa wa ugonjwa wa viungo, ugonjwa wa kisukari na shinikizo la damu la juu, lakini wana viwango vya chini vya wasiwasi na unyogovu." Wale katika kundi la "salama duni" walikuwa na BMI ya wastani ya juu zaidi, hali za afya za muda mrefu zaidi na walikuwa na mwelekeo wa kutoshiriki katika tabia za afya. "Mfano wa ""mzee mwenye afya mbaya lakini mwenye furaha"" ni Mark Green, ambaye aliongoza utafiti huo, ambaye alisema kwamba watu wenye uzito mzito hawapaswi kuonekana kama kikundi kimoja, bali wanapaswa kutibiwa kwa njia ya kawaida kulingana na kikundi wanachokishiriki." Kwa mfano, kikundi cha watu wenye wasiwasi wa umri wa kati wanaweza kushauriwa kufanya mazoezi zaidi na kupata ushauri, wakati kikundi cha afya duni kinaweza kuhitaji kushughulikia matatizo yao ya afya ya muda mrefu kabla ya kushughulikia unene wao. "Sera zilizobuniwa kukabiliana na unene wa mwili na kuhamasisha mtindo wa maisha wenye afya mara nyingi huwalenga watu kwa sababu tu wao ni wanene", alisema Dk Green. "Lakini kukazia fikira kikundi hicho kiwe kikamilifu si jambo lenye matokeo sana. Sisi sote ni tofauti na mbinu tofauti za kukuza afya hufanya kazi kwa watu tofauti. "Wanawake wenye afya na vijana ambao wanakula chakula kidogo sana ni kikundi kingine, utafiti wetu ulionyesha kwamba wale katika vikundi tulivyowatafuta wanahitaji huduma tofauti na watapokea sera tofauti za kukuza afya.""" """Kwa hivyo, tunatumaini kwamba wataalamu wa afya wataendelea kuzingatia vikundi hivi sita wakati wa kutoa ushauri kwa wagonjwa wao." Ripoti hiyo ilihitimisha kwamba uingiliaji wa madaktari na watunga sera haupaswi kulenga watu wanene <unk>kwa ujumla<unk>, lakini badala yake mikakati inapaswa kubadilishwa ili ifanane na makundi ambayo watu binafsi wanahusika. Katika utafiti huo, wanaume waliokula pombe nyingi walikuwa na uwezekano mdogo wa kudhibiti uzito wao, ingawa waliripoti viwango vya juu vya mazoezi ya mwili na kutembea. Bill, mwenye umri wa miaka 32, ni wakala wa mali isiyohamishika na ni mgeni wa kawaida katika baa ya karibu. Siku nyingi baada ya kazi yeye hukutana na marafiki kwa ajili ya pint <unk> au tatu <unk> na sahani yake ya uchaguzi, steak na chips triple fried. Ijumaa jioni ni wakati muhimu wa wiki, kwani yeye na wenzake kwa kawaida huondoka karibu saa nne jioni kuanza usiku mrefu wa kunywa, ambao daima unamalizika na usiku wa manane. Jumapili asubuhi yeye hucheza mchezo wa mpira wa miguu wa pande tano, kisha hujithawabisha kwa kazi yake ngumu na roast ya kawaida ya Jumapili, daima na sahani yake ya saini ya pudding ya Yorkshire mara tatu. "Wanawake vijana wenye afya: ""Wanawake vijana wenye afya"" ndio kikundi kikubwa zaidi cha wanawake wenye afya." Walionyesha sifa za afya nzuri zaidi ya makundi yote na kushiriki katika baadhi ya tabia za afya. Nicola, mwenye umri wa miaka 25, anafanya kazi katika idara ya rasilimali za binadamu katika kampuni ya sheria. Ana jino la tamu na daima kuna ugavi wa chokoleti, keki na biskuti ofisini. Ijumaa na Jumamosi jioni yeye kwa kawaida huenda nje kunywa na klabu na marafiki, au wakati mwingine yeye anakaa katika kwa ajili ya filamu na chocolate jioni. "Wazee wenye afya na wenye utajiri walikuwa ""kikundi cha wazee wenye afya na utajiri"" na walikuwa na sifa nzuri za afya (ingawa ni pamoja na sehemu kubwa na shinikizo la damu la juu) na juu ya wastani wa matumizi ya pombe." Susan, mwenye umri wa miaka 65, anaishi maisha yenye furaha. Akiwa mwanasheria aliyestaafu mwenye pensheni kubwa, anaweza kupata starehe zote anazostahili. Yeye ni mpenzi wa chai ya juu na hufurahisha marafiki mara chache kwa wiki nyumbani kwake na scones, kutumika na siagi halisi, cream kamili ya mafuta na jamu yake ya kupendeza ya nyumbani. Ikiwa kuna chochote kinachobaki, Susan hufurahi sana kukila chakula hicho cha asubuhi siku inayofuata. Yeye hula nje mara kwa mara, na huenda angalau safari nne za baharini kwa mwaka na mumewe na kikundi cha marafiki, kufurahia buffet ya siku nzima na bar ya divai ya kunywa-kama-mengi-kama-unapenda. "Watu wazee wenye afya mbaya lakini wenye furaha walikuwa na ""kiwango cha juu cha hali ya afya ya muda mrefu (ikiwa ni pamoja na ugonjwa wa osteoarthritis, kisukari na shinikizo la damu la juu) lakini walionyesha viwango vya chini vya wasiwasi na unyogovu.""" Terry, mwenye umri wa miaka 71, ana ugonjwa wa kisukari na shinikizo la damu la juu, lakini ana mengi ya kutabasamu - mke wake hujihakikishia hilo. Akiwa mkusanya-stampu mwenye shauku, yeye hufurahia sana kuchunguza vitabu vyake vya kumbukumbu na kuchunguza vitu vipya mtandaoni anapohisi dhaifu sana kusta. Kupika ni moja ya burudani zake <unk> puddings hasa (yeye ni mzee sana kuwa na wasiwasi kuhusu uzito wake hata hivyo). Watoto wake na wajukuu wake humtembelea kwa ukawaida, na mara nyingi humkaribisha kula chakula katika mkahawa wa mahali hapo. "Watu wa umri wa kati wenye wasiwasi na wasio na furaha walikuwa ""wanawake"" na walikuwa na afya mbaya ya akili na waliripoti viwango vya juu vya kukosa usingizi, wasiwasi, unyogovu na uchovu." Walikuwa na hisia ya hali ya chini ya afya, lakini walifanya shughuli za afya za mwili na kudhibiti uzito, na walikuwa na matumizi ya chini ya pombe. Wendy, 53, hawezi kukumbuka mara ya mwisho alipopata usingizi mzuri usiku. Alipatwa na anorexia akiwa tineja, na alipambana na mshuko wa moyo na wasiwasi katika miaka yake ya watu wazima. Alianza kazi yake ya uhamiaji baada ya kukabiliwa na hali ya kutisha. Sasa anafanya kazi ya muda wote kama mlinzi wa baba yake mzee ambaye anaishi naye, na mara nyingi humfanya asile usiku. Anaposhindwa kulala, mara nyingi huenda jikoni na kula vyakula visivyofaa ili kujifurahisha. "Watu walio na afya mbaya zaidi, au ""wenye afya mbaya zaidi,"" walikuwa na kiwango cha juu cha ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa." Pia ilikuwa na wastani wa BMI ya juu zaidi. Doreen, mwenye umri wa miaka 43, anaishi katika nyumba ya kifahari pamoja na watoto wake saba na wajukuu watatu. Ana matatizo ya mapafu - alianza kuvuta sigara alipokuwa tineja - na haondoki nyumbani sana. Yeye hajawahi kuwa mzuri sana katika kupika, na kuchukua-aways ni maarufu zaidi na familia yake hata hivyo. Mara nyingi yeye huishia kuangalia baada ya wajukuu wake wakati wazazi wao ni nje katika kazi <unk> lakini tangu wao ni tu watoto wachanga hii mara nyingi ina maana tu kukaa karibu nyumbani kuhakikisha wao si kupata juu ya uovu sana.