Approaches to obesity management should be reviewed in the light of a new assessment that up to 1.7 billion people worldwide could be overweight or obese, a leading expert warned today.

Prof Philip James, chairman of the London-based International Obesity TaskForce, said the revised figure - 50% higher than earlier estimates - meant that most governments were simply ignoring one of the biggest risks to health affecting the world's population.

The updated estimate takes into account a new recommendation from a WHO expert group, which concluded that obesity-related health risks increase among Asians from a lower body mass index threshold because of their special vulnerability to weight-related disorders.(ref 1)  If the proposal were adopted as a new benchmark, it could add another half billion to current estimates of the world’s overweight population. 

Speaking at a Roche-sponsored meeting of international obesity specialists in Monte Carlo, Prof James said that appropriate medical treatment was rarely provided to manage obesity, yet it was clearly established that even a modest weight reduction and improved weight control could bring benefits both in improved health of the individual and long term cost savings if the prevalence of serious co-morbidities such as type 2 diabetes, heart disease, and some forms of cancer were reduced or prevented. (ref 2)

Part of the International Association for the Study of Obesity, the IOTF is conducting long term research on obesity and the global burden of disease as part of a WHO programme. Existing estimates suggest more than 1.1 billion people already fall into the pre-obese or obese categories using WHO classic definitions based on a body mass index (BMI) of 25 and above for overweight and BMI 30 and above for obesity. 

The proposal from the WHO expert group, of which Prof James was a member, is based on evidence that the risk of obesity-related diseases among Asians rises from a BMI of 23. (ref 3) 

If this were adopted as a new benchmark for overweight in Asians, it would require a major revision of approaches in the Asian sub-regions, where IOTF estimates that a significant proportion of the 3.6 billion population already has a mean body mass index of 23. (ref 4)

Prof James, who previously chaired the United Nations Commission on the Nutrition Challenges of the 21st Century, said there was growing evidence that the impact on health of the escalating obesity epidemic could overtake that of tobacco. "There is a wide spectrum of risk factors related to obesity, which when viewed as a whole, have a tremendous impact on health. By tackling overweight through improvements in diet, activity levels and treatment, we can have a far reaching effect on what is already a huge health burden from cardiovascular diseases and type 2 diabetes."

"It is clear that extreme forms of obesity are rising even faster than the overall epidemic and we are witnessing a real health tragedy unfolding. In the USA the percentage of black women with morbid obesity - a BMI of 40 or more - has doubled in less than a decade to a rather disturbing 15%. Overall 6.3% of US women - that is one in 16 - are morbidly obese. 
 

"We are seeing a rapid increase in morbid obesity in Europe too, although with smaller percentages. The data for England show that morbid obesity in women increased 180% while rising three fold among men in less than a decade! One in 40 women in England now has a body mass index so great they are unquestionably in need of immediate treatment for their obesity, but how many are being helped?" Prof James asked. 

Prof Arne Astrup, president-elect of IASO, said: "There is a global obesity epidemic which underpins the increasing levels of non-communicable diseases which are forecast to explode in the next 20 years. It is vital that we take a more serious approach to the treatment of the huge numbers who are obese, as well as introducing effective measures to prevent the problem getting worse."

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The International Association for the Study of Obesity which represents around 10,000 medical, scientific and health professionals in 44 countries is pleased to partner with Roche in their Monte Carlo symposium.

References
1 Lancet Vol 360 July 20 2002 
2 Obesity: Preventing and Managing the Global Epidemic. WHO Technical Report Series 894 – 2000 
3 Obesity Reviews Volume 3 Issue 3 August 2002
4 International Obesity TaskForce – Global Burden of Disease (WHO/Harvard in press 2003)

For further information contact:

Neville Rigby - mobile +44 7939250347
Director of Policy and Public Affairs
International Association for the Study of Obesity/International Obesity TaskForce
231 North Gower Street, London NW1 2NS
Tel +44 20 7691 1900
IASO is registered as a charity in England. Reg. No. 1076981 
websites: www.iaso.org / www.iotf.org

Notes to editors
Professor Arne Astrup is president elect of IASO, and Director of the Department of Human Nutrition at the Royal Veterinary & Agricultural University, Frederiksberg, Denmark. He is editor in chief of the IASO scientific journal, Obesity Reviews. 

Prof Philip James is former director of the Rowett Research Institute, Aberdeen, Scotland, and chairs the International Obesity TaskForce. He is also vice president of the International Union of Nutrition Sciences.

Background 

Obesity poses a major risk for serious diet-related noncommunicable diseases, including diabetes mellitus, cardiovascular disease, hypertension, and certain forms of cancer. Its health consequences range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life.

The international standard for measuring overweight and obesity, the Body Mass Index (BMI), defined as weight (in kg) divided by the square of one's height (in m): kg/m2. 
For assessing obesity in adult populations, the BMI categories are:

BMI 25kg/m2 for overweight (Pre-obese: BMI 25-29.9 kg/m2) 
BMI 30kg/m2 for obesity: 
-  Class I obese: BMI 30-34.9kg/m2
- Class II obese: BMI 35-39.9kg/m2
- Class III obese: BMI 40kg/m2.

The World Health Report 2002 estimated that more than 2.5 million deaths annually are weight related and forecast this could rise to 5 million by 2020. Deaths directly related to obesity have been estimated at 320,000 a year in Europe and more than 300,000 in the USA. 

Adult obesity rates rose in the UK from 6% of men and 8% of women in 1980 to 21% of men and 23.5% of women in 2001.  In the USA overall adult obesity rates have risen from 14.25% in 1978 to 31% in 2000. Morbid obesity (Class III) has also risen dramatically in the USA and UK. (See table below and attached graphics).