Obesity
Too young
to die
The unprecedented growth in the prevalence of childhood obesity is
set to place a heavy burden on the health budgets of many countries and
send countless children to the grave before their parents if urgent
action by governments and the private sector is not taken. Callan Emery
reports.
Obesity has reached
pandemic proportions
around the world and is
now the greatest single
contributor to chronic
disease and the single
biggest preventable cause of
death. The Middle East is
not exempt from this crisis.
To the contrary, prevalence
rates are so high in the
region that it sits behind
only the United States in
the world obesity stakes.
There are now more overweight
people in the world
– one billion – than undernourished
– 800 million –
and the scourge is no longer
confined to the developed
world. Obesity has engulfed
the developing world as
well, as it adopts the physical
and dietary habits of
the affluent western
nations.
And with childhood
obesity forecast to increase
dramatically in most parts
of the world, there is, for
the first time in human
history, the possibility of millions of parents
outliving their children. It
is anticipated that many
children will die at an early
age from obesity-related
illnesses such as diabetes
and cardiovascular disease.
These critical issues were
highlighted at the 10th
International Congress on
Obesity (ICO2006) in
Sydney, Australia, in
September and are at the
core of the drive to reverse
this trend by anti-obesity
campaigners.
At this all-important
congress, held every four years, speakers urged
governments around the
world and international
captains of industry to take
action in the battle against
obesity or face dire consequences
in a few years’
time.
They warned that the
dramatic rise in the prevalence
of obesity in the past
ten years, and which is forecast
to double in many
countries in the next five to
ten years, will place an
extremely heavy burden on
government health budgets.
For example, in 2001 in the United States the total
direct and indirect cost
attributable to obesity was
$123 billion, according to
research (Wolf AM, Manson JE, Colditz GA. The
Economic Impact of
Overweight, Obesity and
Weight Loss. Ed Eckel R in
Obesity. Lippincott,
Williams and Wilkins,
2002).
The researchers
looked at the economic
costs attributable to obesity
for type-2 diabetes, coronary
heart disease, hypertension,
gallbladder disease, breast,
endometrial and colon
cancer, and osteoarthritis.
They also included factors
such as excess physician
visits, work-lost days,
restricted activity, and beddays
attributable to obesity.
Although this study is
slightly dated and USspecific
it gives a good indication
of the massive financial
burden countries
around the world can expect
if this frightening trend in
obesity is not reversed.
Speakers at ICO2006 said
obesity should be considered
the keystone of all
health priorities and
warned governments they
would have to rethink
many national policies if
they wanted to avoid the
massive financial burden
that obesity poses.
They also emphasised
that the private sector had
an important role to play in
reducing the burden of
obesity by promoting
healthy lifestyles and
healthy diet, through
responsible marketing and
improving the price structure
of healthy food.
Overweight and obesity
defined
Overweight and obesity is
assessed by using body mass
index (BMI), defined as the
weight in kilogrammes
divided by the square of the
individual’s height in
metres (kg/m2 ). A BMI over
25 kg/m2 is defined as overweight, and a BMI of over 30 kg/m2 as obese. These
markers provide common
benchmarks for assessment.
Childhood obesity
Childhood obesity is already
epidemic in some areas of the
world and is rising fast in
others. ICO2006 highlighted
this critical issue by making
childhood obesity the central theme of the congress.
The latest estimates by
the International Obesity
Taskforce (IOTF -
www.iotf.org) put the
prevalence of overweight
and obesity in children
aged 5-17 at around 10%, or
155 million, worldwide.
Around 30-45 million
within that figure are classified
as obese – accounting
for 2-3% of the world’s children
of school-going age.
According to earlier IOTF
data a further 22 million
children younger than five
are also estimated to be
overweight. In the World Health
Organisation (WHO)-
defined Eastern Mediterranean
region, which includes the
Levant and all countries on
the Arabian Peninsula, the
prevalence of overweight
and obesity in school-age
children, according to a
1992-2001 survey, is estimated
to be 23.5%, of
which 5.9% are obese.
IOTF
projections estimate these
figures to be 35.3% and
9.4% respectively for 2006,
which will increase to a
phenomenal 41.7% and
11.5% respectively in 2010.
In other words, in the 10
years from 2000 obesity in
school-age children will
double in the region.
These worrying figures
place this region just
slightly behind the
Americas which leads the
world in the obesity stakes.
Professor Philip James,
chairman of the IOTF, referring
to the latest research,
said the new studies provided
“illuminating evidence that
the rapidly worsening
problem of childhood
obesity is not confined to
Europe or indeed the Western
world but to many major
economically developing
countries”.
Dr Tim Lobstein, co-ordinator
of the IOTF’s childhood
and adolescent obesity
research programme, said the
analysis of worldwide trends
he had undertaken with Dr
Youfa Wang from the Department of International
Health at Johns Hopkins
University in the USA,
showed how widespread the
problem was becoming.
“The obesity estimates are
very cautious, but
extremely worrying. When
we looked at the overweight
it was astonishing to see
that nearly half of children
in both North and South
America could be overweight
in just four years
time.
In Europe we are
seeing substantial increases
with overweight at 38% –
up 60% on the level we saw throughout the late 1990s.
Experts at the congress
warned that this is a
problem that will manifest
itself with massive chronic
health consequences when
these overweight and obese
children get older.
Many obese children
carry the antecedents of
several diseases that are
responsible for early
mortality in adults. Of
particular concern in this
regard is the growing prevalence
of type-2 (or adultonset)
diabetes in children.
Children with type-2 diabetes can expect to have
a substantially shortened
life span.
Professor Kate Steinbeck
of Sydney Royal Prince
Alfred Hospital, reiterated
this point when she told
delegates at the ICO2006
that it is likely many children
will die before their
parents as a consequence of
being overweight or obese.
Health impact
So, what are the main
impacts on health of overweight?
The effects of overweight and obesity on health are
now fairly well established.
According to numerous
studies, overweight and
obesity can lead to adverse
metabolic effects on blood
pressure, cholesterol,
triglycerides and insulin
resistance, or what is now
commonly referred to as
Metabolic Syndrome.
This
in turn can lead to cardiovascular
disease, stroke,
type-2 diabetes, certain
types of cancers, especially
the hormonally related and
large-bowel cancers; and
gallbladder disease. Other non-fatal but debilitating
health problems associated
with obesity include
respiratory difficulties, such
as sleep apnoea; chronic
musculoskeletal problems;
skin problems; infertility;
early puberty in young girls;
and often overlooked
psychosocial problems.
Obese kids, obese adults
In recent research which emphasises the importance
of combating obesity in
childhood, it is shown that
obese children are much
more likely to become obese
adults compared to children
who are not overweight.
The study published in
the September issue of Paediatrics shows that children
who are overweight as
toddlers or preschoolers are
more likely to be overweight
or obese in early
adolescence and that obese
adolescents are likely to
become overweight adults.
The research examined
more than 1,000 children
from 10 US locations in the
United States by a team led
by Philip R Nader, MD,
Professor Emeritus of
Pediatrics at the University of
California, San Diego, School
of Medicine.
Dr Lobstein said that the
results if such research
“reinforces the need for
immediate and urgent
action to protect our children
and stop this runaway
trend.
We can only do this
if we seriously address the
need to cut down the
consumption of extra
empty calories in high fat
and high sugar food products,
and do much more to
improve children’s opportunities
to be active.”
Reversing the trend
So what can and should be
done to reign in this approaching obesity
pandemic in children?
First, we have to know
why this is happening.
According to the WHO, the
rising epidemic reflects the
profound changes in society
and in behavioral patterns
of communities over recent
decades.
The health organisation
points out that while
genes are important in
determining a person’s
susceptibility to weight
gain, so is energy balance,
which is determined by the
equilibrium between calorie
intake and physical activity.
Societal changes, such as
increasingly sedentary
lifestyles, and worldwide
nutrition transition, such as
increasing consumption of
high-fat fast food, are
driving the obesity epidemic.
Economic growth, modernisation, urbanisation
and globalisation of
food markets are just some
of the forces underlying the
epidemic.
As incomes rise and populations
become more urban,
diets high in complex
carbohydrates give way to
more varied diets with a
higher proportion of fats,
saturated fats and sugars.
At
the same time, large shifts
towards less physically
demanding work have been
observed worldwide. Moves
towards less physical
activity are also found in
the increasing use of automated
transport, technology
in the home, and
more passive leisure pursuits.
Pointing out just how
insidious the problem can
be, Dr Marie-Laur Frelut,
speaking at the World
Congress of Cardiology in
Barcelona, Spain, in
September, referred to the
effect on childhood obesity
of junk food TV advertising
targeted at children.
“In Europe if you plot the
prevalence of overweight
children in countries with
commercial TV advertising
for children for junk food,
there is a direct correlation
between rate of prevalence
and rate of advertising.”
In other words, more junk
food advertising results in
more overweight children.
Dr Frelut said an inverse
weaker correlation is found
for advertising for healthy
foods.
She said there were many
factors affecting what she
termed “the pressure to
eat”, among them the easy
availability of junk food,
the pricing structure – junk
food costs less than healthy
alternatives – and supersizing
which promoted over
consumption.
The problem is a complex
one and needs to be tackled
on many fronts – in the
home, at local government
level, at national government
level and internationally
in the private sector.
A recent report commissioned
by the US Institute of
Medicine provides a number
of recommendations for the
US Government, which are
applicable to governments in
the Middle East and around
world. The report also
provides recommendations
for private sector industry.
Recommendations for government
The recommendations are
drawn from the report,
Progress in Preventing
Childhood Obesity: How
Do We Measure Up? (2007)
and call on governments to:
- demonstrate leadership by
establishing the childhood
obesity epidemic as an
urgent public health
priority
- prioritise funding
- co-ordinate the public and private-sector response
- establish a robust
information-
gathering system
to monitor progress and
guide the development of programmes and policies
Other elements of the
proposed government
response to the obesity
epidemic include a strong
governmental workforce
and an enhanced organisational
capacity.
Governments have influence
in many spheres. They
can legislate against junk
food advertising for children,
for example. They can effect
change to ensure that
healthy food replaces junk
food in school tuck shops.
To
combat increasing sedentary
lifestyles they can make
extramural sporting activity
compulsory in schools. This
sorely lacking in the
region. In the hot summer
months there are many
indoor sports that can be
played and the in the winter
months outdoor sports.
Recommendations for
industry
The report says market
forces may be very influential
in changing both
consumer and industry behaviours.
All relevant
industry stakeholders –
including food and
beverage companies, quick
serve and full serve restaurants,
food retailers, recreation
and leisure companies,
entertainment
companies, and the media
should share responsibility
for supporting childhood
obesity prevention
goals.
Industry can be
instrumental in changing
social norms so that
reducing childhood obesity
prevalence will be acknowledged
as an important and
preventable health
outcome and healthy eating and regular physical
activity will be the
accepted and encouraged
standard.
The report recommends:
- Increasing the proportion
of a company’s
product portfolio and
marketing resources
devoted to developing,
packaging, and promoting
products that contribute
to healthy lifestyles;
- Reducing the portion
sizes of food and
beverage products and
restaurant meals;
- Disseminating information that promotes healthy diets and regular
physical activity;
-
- Engaging in publicprivate
partnerships to
promote healthy eating
and active lifestyles to
children and their families.
Other recommendations
Dr Frelut offered a few of
recommendations during her
talk at the World Congress of
Cardiology. She noted that
children are vulnerable –
they cannot criticise advertising”.
She suggested
changes that could be made at the local level:
- No TV adverts for kids
under 12
- Protection at school –
no ads, no vending
machines, healthy catering
- Increased physical activity
– in school, leisure and
lifestyle
At the global level she
called for:
- A coherent global food
policy
- Healthy foods at better
prices
- Education with food labelling that is easy to
understand for the
consumer
- Marketing on quality of
food, not only on size of
portions
However, the success of
such recommendations
depends on the will and
commitment of government,
industry and relevant
stakeholders.
As Dr Frelut points out:
“We will succeed only if
international medical federations
collaborate and if
their collaborations are
strong enough to trigger
concern on a political level
among those who have the
power to change the environment.”
