OBESITY - THE DISEASE OF THE MILLENNIUM
Obesity is an epidemic affecting hundreds of millions. As the 21st century approaches it threatens to run out of control.
In many countries more than half the population is overweight and levels of obesity are rising rapidly. Recent estimates suggest around 250 million world-wide are obese; the World Health Organization estimates at least 300 million will be obese by 2025.
IOTF projections show that obesity levels, which have doubled in some countries in the last few decades, could more than double again.
Take the United States:
In 1961 obesity stood around 13% - one in eight
By 1991 it reached more than 22% - one in five
By 2025 it could be as high as 40-45% - two in five.
Or England:
In 1980 obesity stood at 7% - one in fourteen
By 1991 obesity doubled to 14% - one in seven
By 1995 the level was nudging 16% - one in six
By 2025 obesity could reach more than 33% - one in three
In Australia the picture is the same:
In 1980 obesity stood at nearly 9% - one in twelve
By 1989 the figure reached more than 13% - one in seven
In 1995 it jumped to 18% - one in five
By 2025 obesity could reach around 35% - one in three
The trend is clear even in countries like Mauritius and Brazil.
In 1987 obesity affected just under 7% or one in fourteen Mauritius islanders. Five years later the figure was more than 10% and by 2025 it could be reach around 32% - one in three. In Brazil the obesity level in 1975 was less than 6% - one in thirteen. By 1989 it was 9.6% - almost one in ten, and by 2025 it could affect nearly 20% -one in five of the adult population.
OBESITY IS A GLOBAL PROBLEM
In most of Western Europe, obesity levels range between 10% to 25%, while in large parts of the American continent they are between 20% to 25%. They can reach up to 40% for women in eastern European and Mediterranean countries, and even higher among some groups, such as black women, in the USA and South Africa.
Levels are particularly high among some ethnic groups such American Indians, Hispanic Americans, and Pacific Islanders, where the highest rates of obesity in the world are found among Melanesians, Micronesians, and Polynesians. In the urban areas of Western Samoa, 60% of men and 75% of women are obese.
MORE CHILDREN ARE BEING AFFECTED
Childhood obesity is of particular concern because the evidence shows that one in three obese children will become obese adults, increasing their vulnerability to a range of weight-related diseases. Recent evidence in the USA suggests the majority of obese teenagers will remain obese as adults. Obesity affects about one in ten children in industrialized countries.
The IOTF has a special working group, chaired by Prof William Dietz, resolving the best method to assess childhood obesity around the world and to devise recommendations for dealing with the problem.
OBESITY IS A DISEASE THAT IS PREVENTABLE
Obesity is largely preventable through changes in lifestyle, especially diet. Even a modest weight loss can bring significant improvements in health and a reduction in the level of risk.
It is a major factor in several noncommunicable diseases (NCDs) including diabetes mellitus (type 2: non-insulin-dependent), coronary heart disease and stroke. It increases the risk of several types of cancer, gallbladder disease, musculoskeletal disorders and respiratory problems.
The main causes of obesity are sedentary lifestyles and high-fat, energy-dense diets. The impact of changes in traditional lifestyles is being felt in the developing world too, and some countries are facing a double burden of overnutrition and undernutrition among sections of their populations.
OBESITY IS A NEGLECTED PUBLIC HEALTH ISSUE
Better prevention policies are imperative. Many attempts to get across healthy lifestyle messages have had little lasting impact.
The issues of obesity and overweight need to be addressed not just at individual level but at society level. There is a particular need to focus on whole populations to promote healthy lifestyles, including diets of lower energy density (increased consumption of vegetables, fruits, grains and cereals); increased physical activity and behavioural change, with emphasis on long term weight management rather than on short-term extreme weight reduction.
An IOTF working group, chaired by Prof Shiriki Kumanyika, is examining approaches to public health, which can help prevent obesity in the future.
OBESITY IS A HEAVY BURDEN ON TAXPAYERS
Its costs threaten to overwhelm some medical services. In the USA, obesity results in a $100 billion health bill each year. An IOTF working group, chaired by Prof Ian Caterson, is examining economic costs to help governments quantify their "obesity bill" and see the value of better prevention and management.
OBESITY IS STILL IGNORED AS A DISEASE
Placed in the International Classification of Diseases in 1948, obesity remains largely ignored as a disease. Health and medical professions concentrate on treating its results - heart disease, diabetes and other serious illnesses - without recognizing the underlying cause. Doctors need to know how to intervene at an earlier stage to help prevent people gaining weight. A range of therapies is available to help in the management of obesity, which should aim realistically at achieving modest weight loss.
The IOTF is establishing two specialist groups to look at ways to improve methods of management and to introduce better training of health professionals on prevention as well as treatment. The management working group is chaired by Prof George Bray and training is chaired by Prof Peter Kopelman.
THE IOTF AND WHO
The obesity epidemic was the focus of an expert consultation convened by the World Health Organization with the support of the IOTF in June last year.
The consultation report surveys existing understanding of overweight and obesity, and offers recommendations on future approaches to the problem and the search for solutions in differing cultures.
Experts agreed: "Without societal changes, a steadily rising and already substantial proportion of adults will develop the many medical complications of obesity. Obesity's impact is so diverse and extreme that it should now be regarded as one of the greatest neglected public health problems of our time with an impact on health which may well prove to be as great as that of smoking."
"The rising epidemic reflects the profound changes in society and in the behavioural patterns of communities over the last 20-30 years. Individuals may become obese, partly because they have a genetic predisposition to gain weight readily when they are exposed to unhealthy diets and lifestyles. The fundamental causes for the obesity epidemic are changing behaviours and lifestyles, especially diets."
As part of the International Association for the Study of Obesity (IASO),
the IOTF is working with WHO on a three year programme of action. It aims
to:
WHO is expected to publish a technical report on obesity later this year.
for further information contact IOTF 01224 716642 or e-mail obesity@rri.sari.ac.uk