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Obesity - the global crisis |
Obesity has become an epidemic on a global scale and poses one of the greatest threats to human health and well being as the 21st century approaches. The World Health Organisation has declared that obesity is a disease of pandemic significance, which threatens the developing world as well as developed countries.
Obesity has now been changed from a minor to a major risk factor for coronary heart disease by the American Heart Association. The other major CHD risk factors are smoking, high blood pressure, high blood cholesterol and a sedentary lifestyle.
In 1980 one in 14 Australians was obese. By 1989 the figure had jumped to one in seven, in 1995 it was one in five and based on current trends, by 2025 it could be one in three. 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%. Levels are particularly high amongst ethnic groups such as American Indians, Hispanic Americans, Australian Aboriginals and Pacific Islanders. The highest obesity levels in the world are found among the urban populations of Western Samoa, affecting 60% of men and 80% of women.
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. The majority of obese teenagers will remain obese as adults. Obesity affects about one in 10 children in industrialised countries.
Obesity is still ignored as a disease. Health and medical professions concentrate on treating its results - heart disease, diabetes, hypertension, gallstones, sleep apnoea, bowel cancer, etc. It is a preventable disease through changes in diet and by becoming more physically active. Even modest weight loss can bring significant improvements in health and a reduction in level of risk.
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 and some countries are facing the double burden of over-nutrition and under-nutrition among sections of their communties.
Tackling the problem is an enormous challenge that goes far beyond giving out healthy lifestyle messages. Such strategies have failed in recent times.There needs to be an approach that acknowledges that obesity is a normal response to an abnormal environment rather than vice versa. Understanding, measuring and altering the 'obesogenic' environment is critical to success.(1)
The individual intereacts with a number of micro-environmental settings (eg. home, work, supermarket, local community). These micro-environments are in turn influenced by one or more macro-environment sectors (eg. food industry, local government, transportation system). The physical environment refers to what is available such as expertise, technology, exercise facilities, low-fat food options. The economic environment, which includes the cost of goods and services, is a powerful determinant in a capitalist society. Lower fat foods are often more expensive. The political environment refers to rules in the form of legislation and regulation (eg. food labelling), rules (eg. school rules) or policy (eg. nutrition policies for manufacturers). The socio-cultural environment refers to norms in society for behaviour, beliefs, attitudes, knowledge, customs and traditions.(2)
Any program aimed at having an impact on the obesity problem needs to take into account the whole environment and to ascertain what aspects of that environment can be influenced by intervention. In our own environment we have a major crisis in the health of our Aboriginal population with obesity and its complications becoming more prevalent. There is an urgent need to address this problem.
Dr Andrew Binns has just attended the 8th International Congress on Obesity in Paris, France.
References
1. An ecological approach to the obesity pandemic Garry Egger, Boyd Swinburn BMJ Vol 315 23 Aug 1997
2. Dissecting the obesogenic environment: the theoretical framework for environmnetal audits Boyd Swinburn, Garry Egger - presented to the 8th International Congress on Obesity 29 Aug - 3 Sept 1998
(NB Body Mass Index BMI is the ratio between height and weight in kilograms per metre squared. Obesity is defined as those people with a BMI of 30 or more. The normal BMI range is between 18.5 and 24.9 while the overweight range is 25 to 29.9)
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