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The obesity epidemic in the United Kingdom is out of control, and none of the measures being undertaken show signs of halting the problem, let alone reversing. Obesity, an excessive body fat content with increased risk of morbidity, has become increasingly common in children and adolescents. Confusion exists. Obesity is an epidemic, says the World Health Organization. The prevalence of adult obesity has exceeded 30% in the United States, is over 20% in most of.
Viner R, Nicholls D. Virtually all the costs personal, health, and economic of obesity are met in adulthood and result from fat that has accumulated in adulthood, but there is a likely additional cost due to inactivity and overweight in childhood that should also be considered. So some thin people may be active and eat a lot to achieve energy balance, but overweight people have to eat more than most thin people to avoid weight loss. America on the Move uses the principle that increasing the daily number of steps walked by above current levels using a pedometer , plus choosing one way to cut out kcal, can prevent weight gain in most children and their parents. Paediatric obesity is also associated with many other comorbid conditions. Obesity, an excessive body fat content with increased risk of morbidity, has become increasingly common in children and adolescents.
Changes in diet and physical activity are necessary for weight loss but do not guarantee it. To avoid compensation between changes in physical activity and changes in appetite , effective interventions must tackle both diet and physical activity, and in an integrated way.
There seems to be strong biological resistance to weight loss once obesity is established. The long term solution must now include effective prevention directed at the whole population. A successful intervention for obesity prevention must influence energy balance but must also be sustainable.
Changes in diet and physical activity need to be incorporated into new behaviour patterns, as a need for constant reminders or rewards will result in non-sustainability. Prevalence of obesity in the adult Scottish population. These figures combine all ages. Among older people, only a quarter to a third remain in the desirable weight range.
Data from Scottish health survey, www. A permanent change in the environment is the best way to ensure permanent changes. Actions should focus on a enabling people to manage energy balance better in the current environment; b modifying the vectors of obesity; and c changing the current sociopolitical environment, which currently rewards the manufacturers of products and processes that contribute to obesity.
Effective programmes for obesity prevention probably encourage both healthy eating and physical activity rather than rely on separate strategies for eating and activity. Among this group, many avoid weight gain only by conscious efforts. Precisely how they do this is uncertain because of systematic errors in survey methods.
Data from Med Sci Sports Exerc ; Participants in the US National Weight Control Registry who have successfully lost an average of 30 kg and maintained that loss report high levels of physical activity, equivalent to about an hour a day of moderate intensity physical activity.
People aged over 60—particularly widowers, those in low income families, and obese individuals—are the main group who would benefit from increased physical activity. Watching television for over three hours a day is a major barrier to physical activity.
Combining a low fat diet with exercise is particularly valuable for preventing diabetes and hypertension and is likely to be effective in preventing weight gain. Interventions have included increasing physical activity; reducing physical inactivity usually reducing television viewing ; reducing total calories and energy density of foods or dietary fats; and a combination of these strategies.
Meta-analysis of role of unrestricted low fat diets in body weight control: Adapted from Astrup et al see Further Reading box. Systematic reviews by England's Health Development Agency now incorporated into the National Institute for Health and Clinical Excellence and others have concluded that exercise added to a diet programme improves weight loss.
A meta-analysis of studies on reducing dietary fats by using normal food or food lower in fat concluded that people spontaneously consumed about kcal a day less when following lower fat diets, effectively resetting energy balance at a lower level, thereby avoiding about 15 kg of weight gain.
Measures successful in preventing weight regain after weight loss are likely to apply in primary prevention. Increasing physical activity is a key factor, along with reducing energy intake. Long term prevention has not yet been demonstrated.
The weight gain and current obesity levels in the US population have been shown to result from only a slight shift towards positive energy balance. Thus most weight gain could be prevented with small behavioural changes of this order, such as increased walking, small decreases in dietary fat or sugar intake, and smaller portion sizes.
This approach is likely to be more sustainable and effective in preventing weight gain than advocating unnecessary larger changes. School based programmes seem promising. They can increase physical activity, particularly in girls, and to a certain extent can modify dietary intake.
The effects on weight are not apparent, possibly owing to the short duration of the interventions. Changing the school environment to reduce consumption of high energy food, such as fizzy drinks and foods high in fat and sugar, may help.
For example, reducing the consumption of fizzy drinks for 12 months among year olds can reduce the prevalence of overweight and obesity by 7.
Serving lower fat versions of some popular school lunch items reduces fat intake without affecting attractiveness or palatability. The World Health Organization's Regional Office for Europe considers obesity prevention to be one of its highest priorities. It called for immediate, comprehensive action by governments and others in society by arranging a ministerial conference on counteracting obesity for November this year.
The organisation is advocating a range of actions that would make it easier for people to adopt a healthy lifestyle. The aim is to prevent further increase in obesity rates and to reduce rates progressively in the next decade. Given the rising prevalence of obesity, even attenuating the rise should be seen as a success.
A further problem for health planners is that obesity and its secondary health costs are associated with more socially deprived and minority population groups.
Any measures based on cognitive, educative interventions will tend to benefit more educated and affluent people, thus accentuating the social health gradient. Measures directed at changing the price, availability, and nutritional characteristics of food may have a positive effect across social groups. WHO has advocated the involvement of the different government sectors, as well as the private sector and civil society.
The relevance and effectiveness of these commitments is being evaluated. America on the Move uses the principle that increasing the daily number of steps walked by above current levels using a pedometer , plus choosing one way to cut out kcal, can prevent weight gain in most children and their parents. One scenario includes the reduction of existing obesity. On average, adults now eat kcal more than they did 30 years ago, of which 50 kcal a day represent continuing weight gain and about kcal a day maintain current levels of overweight and obesity.
If everyone were to eat kcal a day less than they currently do, then their weight would fall by kg and current obesity levels would reduce to those of 30 years ago. This strategy aims to increase physical activity and reduce energy intake both by kcal a day to prevent further weight gain.
It accepts that those already overweight and obese will remain so. The next generation is thus the true target for obesity prevention—lifestyle changes would be started in childhood and sustained for life.
The series will be published as a book by Blackwell Publishing in early Competing interests: Pharmaceuticals, and Slimfast Nutrition. He has received funding from McNeil Nutritionals.
For series editors' competing interests, see the first article in this series. National Center for Biotechnology Information , U.
Journal List BMJ v. Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Major benefits for individuals from dramatic interventions, like obesity surgery, have been shown. Optimal medical treatment can also produce major weight loss for many patients outside the constraints of randomised controlled trials.
For example, this amount of weight loss increases life expectancy years for overweight patients with type 2 diabetes, which is impressive.
Obesity management includes priority treatment of risk factors for cardiovascular disease. The benefits of treatment are greater for overweight and obese people because their risks are higher. Primary prevention of obesity and overweight would prevent much secondary disease. Many people do stay at normal weight, but there is no proven effective intervention.
The most clinically telling physical sign of serious underlying disease is increased waist circumference, which is linked to insulin resistance, hypertension, dyslipidaemia, a proinflammatory state, type 2 diabetes, and coronary heart disease. More than years ago, Giovanni Battista Morgagni used surgical dissection to show visceral fat. He linked its presence to hypertension, hyperuricaemia, and atherosclerosis.
Jean Vague in the s and '50s and Per Bjorntorp in the s led the interest in gender specific body types of android and gynoid fat distribution. Pear shaped women tend to carry metabolically less active fat on their hips and thighs. Men generally have more central fat distribution, giving them an apple shape when they become obese, although obese women can have a similar shape.
Stereotypical apple metabolically harmful, more common in men and pear metabolically protective and more common in women shapes. Making obesity an object of humour has impeded the understanding of its medical consequences. Obesity can contribute to musculoskeletal and psychological problems and have profound effects on quality of life. Cross-sectional studies show that waist to hip ratio is a strong correlate of other diseases.
Prospective studies, however, show a large waist as the strongest anthropometric predictor of vascular events and diabetes because it predicts risk independently of BMI, hip circumference, and other risk factors.
Clinical practice in the UK focuses on secondary prevention for chronic diseases. Obesity is often neglected in evidence based approaches to managing its consequences. One problem is in recording the diagnosis. Computerised medical records and better linking of datasets will help monitor efforts to reduce obesity locally and nationally.
The diagnosis of obesity is rarely recorded in reports from hospital admissions or outpatient attendance. A survey of secondary prevention of coronary heart disease shows that, despite the importance of obesity as a coronary heart disease risk factor, it is still poorly managed, even in high risk patients.
Although patients with type 2 diabetes are often overweight, most are managed in primary care and few regularly see a dietician. The first revision of the general medical services contract gives practices eight points for creating registers of obese adults, but this is only a start in readiness for a more emphatic second revision of the contract. BMI is seldom measured in people of normal weight so their progression to becoming overweight is missed, and with it the opportunity to prevent more than half of the burden of diabetes in the UK.
Producing a register of obese individuals is futile unless something is done with the list. Weight management and measurement of fasting lipid profile, glucose, and blood pressure should be encouraged. This could be used to identify people at high risk of cardiovascular disease and diabetes through risk factors related to obesity, which individually might fall below treatment thresholds.
Without these steps the contract creates more work with no clinical benefit. The arguments are strong for awarding points for assessing obese individuals and offering weight management programmes. The clinical and economic benefit will be extended if effective obesity prevention strategies can be developed. These are not alternative strategies: Obesity affects almost every aspect of life and medical practice.
The rise in obesity and its complications threatens to bankrupt the healthcare system. Early treatment and prevention offer multiple long term health benefits, and they are the only way towards a sustainable health service. Doctors in all medical and surgical specialties can contribute. The figure showing obesity in English girls and boys aged uses data from Health Survey for England using criteria of the International Obesity Task Force for overweight and obesity , and is adapted from British Medical Association Board of Science.
Preventing childhood obesity , www. The box showing health consequences of obesity is adapted from International Obesity Taskforce www. Obesity as a disease. Br Med Bull ; The series will be published as a book by Blackwell Publishing early in Competing interests: NS has received fees for consulting and speaking from Sanofi-Aventis, GlaxoSmithKline, and Merck, and from several companies in the field of lipid lowering therapy.
ML has received personal and departmental funding from most major pharmaceutical companies involved in obesity research, and from several food companies. A full list can be seen on www. National Center for Biotechnology Information , U. Journal List BMJ v. Copyright and License information Disclaimer.
This article has been cited by other articles in PMC. Open in a separate window. Figure 1. Table 1 Definition of obesity. Limited time to act Obesity can be dealt with using three expensive options: Treat an almost exponential rise in secondary clinical consequences of obesity Treat the underlying obesity in a soaring number of people to prevent secondary clinical complications Reverse the societal and commercial changes of the past years, which have conspired with our genes to make overweight or obesity more normal.