The ONS published updated healthy life expectancy figures in February 2026. Of course the headline is concerning: people in the UK are now expected to spend fewer years in good health than at any point since this data series began in 2011. For males that is 60.7 years, for females 60.9 years - both down by nearly two years on the previous period. In the worst-affected local areas, people are entering ill health in their early fifties, well over a decade before state pension age.

These figures matter. Nutriri is not here to argue otherwise.

What we are here to argue is that the data are being picked up and used in ways that will lead policy in the wrong direction (again!) - and that there are questions the ONS methodology cannot answer, which urgently need to be part of any honest conversation about what is actually going on.

How healthy life expectancy is calculated - and why that matters

Healthy life expectancy is not a clinical measure. It combines mortality data with responses to a single survey question asking people to rate their general health as very good, good, fair, bad, or very bad. Years rated as "good" or "very good" count as healthy life expectancy. 

A self-reported question - it is the standard approach, i believe used internationally. But it has consequences that are rarely named when the results are presented to policymakers or the public.

Self-reported health does not exist in a vacuum.

It reflects our current weight centric policy and healthcare systems. It reflects what people have been told about their bodies. It reflects whether they trust the healthcare system enough to engage with it. It reflects accumulated experiences of being dismissed, or told that their weight is the cause of whatever they came in for, rather than having symptoms investigated. Shaw and Meadows (2022) are direct on this: weight stigma among healthcare providers is linked to healthcare avoidance in patients, including under-utilisation of preventive healthcare and screening, and the evidence consistently demonstrates that stigma is more likely to lead to increased allostatic load, higher prevalence of chronic diseases, and further weight gain - independent of BMI.

If stigma is shaping people's relationship with health services, it is also shaping how they answer a question about whether they consider themselves to be in good health.

We cannot look at the ONS figures and say with confidence how much of the decline in self-reported health reflects worsening physical function, and how much reflects what happens when body weight is regarded as a valid proxy for health; over diagnosed and over treated.

The data cannot tell us - because we simply do not measure for health beyond weight metrics in the general population. And yet that distinction determines whether the right policy response is more "weight management" programmes and medicated weight-loss or something structurally different.

Weight loss - by any means - is mostly temporary, and that matters for the data

Here is something that rarely makes it into public discussion: the health benefits of intentional weight loss are, in most cases, temporary - because in most cases the weight loss itself is temporary. Clinical evidence is clear that weight recovery begins on cessation of any weight loss intervention, evidenced with weight-loss medications and cardiovascular benefits also reversing. This is consistent across dietary interventions, behavioural programmes, and medications (Chastain, Meadows & Adams, 2026).

Weight cycling - repeated loss and weight recovery - is not a neutral experience.

It carries its own independent cardiovascular consequences: increased risk through hypertension, insulin resistance, and dyslipidaemia (Montani et al., 2006). In people with established coronary artery disease, body-weight fluctuation has been associated with substantially elevated risks of coronary events, cardiovascular events, and death, independent of traditional risk factors (Bangalore et al., 2017). If the people most likely to have engaged with “weight management” programmes are also the people whose self-reported health has declined most sharply, we should at minimum be asking whether weight cycling - generated by the system's own interventions - is embedded in these figures. The ONS data cannot answer that question. As nobody is asking it.

What gets missed when weight is the clinical starting point

The ONS data show declining health in working-age populations across the UK. Nutriri's concern is that the diagnostic lens through which higher-weight people access healthcare means that many of the conditions driving that decline go unnamed and untreated for years.

Clinicians attribute presenting symptoms to body weight, provide less health education to higher-weight patients, and are less likely to perform examinations that would identify serious conditions (Phelan et al., 2015). The conditions most commonly conflated with higher weight - hypothyroidism, PCOS, obstructive sleep apnoea, depression, osteoarthritis, chronic pain - have their own clinical pathways and will often not resolve with weight loss. Lipoedema, which affects an estimated 10% of women worldwide, does not respond to diet or weight change (Cifarelli et al., 2025), yet misdiagnosis rates may be as high as 80% (Mortada et al., 2025). Where weight loss is the default response, the diagnostic process stalls. People continue to feel unwell. They rate their health as poor. That response enters the HLE calculation.

Data that measures for health not weight

Where a person does not smoke, reduces alcohol, balances nutrition, and moves regularly, all-cause mortality is near-equal across the bodyweight spectrum (Matheson, King & Everett, 2012). Health behaviours sustained are protective. They are also almost entirely invisible in a policy framework oriented around weight as the primary outcome measure.

The ONS figures are consistent with a weight stigma hypothesis at least as much as they are consistent with a weight prevalence hypothesis. The data cannot distinguish between the two. That is not a reason to ignore the figures - it is a reason to be far more careful about what we conclude from them, and far more rigorous about what we can do next.

What Nutriri's work points to is a Higher Weight Health Strategy - not a Healthy Weight one. Pathways built around access, dignity, and sustaining health behaviours regardless of weight change intentions or outcomes. Weight Inclusive Triage: no wrong door, no outcome-contingent access, no drop-off point that generates yet another cycle of loss and weight recovery.

And a genuine reckoning with the fact that weight stigma is not a secondary concern alongside declining healthy life expectancy - it is one of its causes.