Obesity epidemic; What can be done?

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Obesity what can be done to fight it?

Obesity is a major problem in today's world some have said it's an epidemic. In 2006 24% of adults in England were classed as obese this is an increase of 15% since 1993 (NHS Information centre ). Obesity is defined as a body mass index (BMI) over 30. BMI is an equation that relates weight to height and is used to give a relative fatness or thinness. BMI is worked out using the equation below;

Wikipedia Formula Metric

A BMI < 25 is considered to be overweight and anything < 30 is considered to be obese. The prevalence of obesity is increasing in many countries this global trend shows that the measures put in place to prevent and treat obesity are failing. Obesity is associated with many health risks and carries a significant economic cost to society. The audit office has estimated that almost 18 million days of sickness absence can be attributed to obesity(1). This is the burden on society that obesity brings. Things such as type 2 diabetes, gall bladder disease, cancer of the colon and ovarian cancer are all more common in an obese patient.

“The degree of obesity has for many years been difficult to study because many countries had their own specific criteria for the classification of different degrees of overweight. Gradually, during the 1990s the BMI became a universally accepted measure of the degree of overweight and now identical cut-off points are recommended”. (1).” A recent World Health Organisation (WHO) expert addressed the debate about interpretation of recommended BMI cut off points for determining overweight and obesity in Asian populations, and considered whether population specific cut0off points for BMI are necessary”. No attempt was made to redefine cut off points for each population separately as it is too complicated.(1). “Obesity is most common in western countries, such as the USA and Canada, and is low in China and Japan. Within Europe, prevalence tends to be lowest in Scandinavian countries and highest in eastern European countries, with the UK around the middle of the range (WHO MONICA Project, 1988; Gurney & Gorstein, 1988; laurier et al., 1992; Hodge & Zimmet, 1994). The UK is fortunate in having data available from many studies which can be used to ascertain the relationships between obesity and factors such as gender, age social class, smoking and ethnic group”. (2) Such studies include Knight, 1984 who studied men and women aged 16 - 64, Braddon et al., 1986 & Wadsworth, personal communication, 1997 which studied was a longitudinal study which involved 3322 men and women from birth to the age of 43 and Miller et al., 1988 who studied 163 men aged 45- 54. (2). These are just a snapshot of the studies that have been done. “Much research over the last decade has suggested that, for an accurate classification of overweight and obesity with respect to the health risks, one needs to factor in abdominal fat distribution. Traditionally, this has been indicated by a relatively high waist to hip circumference ratio.” (1) A large waist circumference combined with a BMI < 25 was seen to carry additional health risks. In the UK Data suggests “that in just under a quarter of a century (1980-2002) the prevalence of obesity has increased four-fold”. (1) This shows the obesity epidemic is truly in the UK especially is a major problem for the people and the issue should not be taken lightly. A study by Molarius et al., 2000 showed that the social class differences in the prevelance of obesity are increasing with time. The available data suggest that obesity is increasingly becoming a lower class problem in Europe. With the increasing obesity more and more strain is being put on the NHS and health care throughout the world as with obesity comes a number of increased health risks.

The health implications that occur with obesity are a serious issue faced by the NHS in Britain. “The main cause of the excess mortality among the obese is coronary heart disease (CHD). Myocardial infarction (MI), hypertension and congestive failure are all more common among obese people. Degenerative diseases of weight bearing joints is another common problem for obese people, particularly in the knees of middle aged women (Hartz et al.,1986; Seidell et al., 1986) and causes significant disability (Rissanen et al., 1990). Unlike the risk of heart disease, osteoarthritis is related to the total amount of fat, rather than the amount of intra-abdominal fat (Davis et al., 1990). Weight loss usually brings about considerable pain relief. Obese people have a higher output of cholesterol in bile, with a lower concentration of bile salts, as such, their bile is constantly in danger of forming gallstones (Whiting et al., 1984)”. (2). “Obesity can cause inefficiency of respiratory function by several mechanisms. The mechanical load of fat on the chest wall increases the mechanical work of inspiration, especially when the subject is recumbent, and a large mass of intra- abdominal fat tends to push the liver upward, thus decreasing the intrathoracic space. There is also a mismatch of pulmonary ventilation and perfusion. Therefore much of the blood flowing through the lung capillaries is at the base of the lung where ventilation is poor. These problems may cause the Pickwickian syndrome of chronic hypoxia and carbon dioxide retention, which may manifest itself as inappropriate somnolence (vividly described by Dickens in the fat boy in Pickwick Papers) and obstructive sleep apnoea (OSA)” (2). The risk of obesity related diseases and even mortality are very high for example “the risk of mortality for an obese person is 50% higher than someone who has a normal BMI.” (http://www.ic.nhs.uk/webfiles/publications/opan08/OPAD%20Jan%202008%20final%20v7%20with%20links%20and%20buttons%20-%20NS%20logo%20removed%2020112008.pdf )

With all these health issues related to obesity the fight against obesity is huge. Steps all across the world are being taken to try and prevent obesity these steps differ from educating the young on a healthy and balanced diet, to surgical treatments. Many argue that you cannot cure obese people as they have set in behavioural patterns that cause them to be obese so to solve obesity not only should we address the issue of reducing weight but also include measures to help the patient maintain a new lowered body weight. This can be achieved by giving the patient a new and better quality of life, new self esteem and improved social functioning this should then lead to the patient liking their new self and help maintain their new body weight. Childhood is a key stage at which to prevent obesity. An obvious point that I think needs to be made is that treatment for obesity needs to be cost effective, so the amount of money spent must justify the amount of weight lost by a patient. There are countless diets out there that help people to lose weight. With this again maintenance is a massive issue as patients need individual care to ensure that they maintain a constant lowered body weight. Alongside dietary treatment there is physical activity which increases a patient's energy expenditure. However studies have shown exercise only adds a small amount of weight loss when partnered with a new diet. Exercise not only reduces weight by burning energy but also physical activity improves functional capacity. Lesuire centre besed gyms that provide “exercise prescription schemes have flourished in the UK over the last five years (Fox et al., 1997)” (2). Behavioural treatment for obesity occurred with the belief of the “obese eating style” was the cause of obesity. It was argued that if you could eradicate this behaviour then this would allow the return to ‘normal' body weight (Ferster et al., 1962).Behavioural techniques such as self monitoring are used in cognitive behavioural therapy (CBT). Self monitoring consists of using a diet plan and eating diary as assessment and therapy. If a patient fails to be able to keep this diary this shows that the motivation to lose weight may not be there and so this must be tackled first before the treatment can continue. One common problem with food diaries is that the recorded food intake is lower than the predicted energy intake (Prentice et al., 1989). Stimulus control is also used to help obesity and is one of the central elements of behavioural treatment. Stimulus control is about taking the cues that someone has, either innate or learned and trying to reduce the exposure to the stimuli that trigger eating or trying to remove them completely from the patient's life such as moving cooking equipment further away can increase physical activity throughout the day and help weight loss. Stimulus control may be good for short term results but others may want to remove any urge to eat and a stimulus they may of had before. This is known as exposure and response prevention and is a well recognised behavioural technique. It requires a prolonged exposure to a stimulus that excites a behaviour without the performance of that behaviour, this removes the conditioning. This method was used successfully with bulimic patients to help them learn to look at, taste, binge food without having a binge (Fair-burn & Wilson, 1993). This can help with long term weight loss and help the maintenance of a new lowered body weight. Surgical procedures also exist that can help with weight loss by either physically removing the fat or decreasing your stomach size so you cannot eat as much therefore lowering energy intake. Liposuction is where a trochar is placed under the skin to suck out fatty material. The amount removed safely by this procedure is questioned and so this cannot be sought after as a means of weight loss and a realistic way to help fight obesity. An effective procedure devised by Mason (1982) is the stapled gastroplastry operation. This involves placing a line of staples in stomach forming a small upper pouch with a capacity of about 15ml, which then is connected to the main body of the stomach by a 9mm diameter stoma. When eating the pouch rapidly fills and stops any further ingestion as this extra food would reflux up the oesophagus and so as you can see this is a very good way of limiting food intake. On average the weight loss is about 28.8 kg in a year. The procedure is still under investigation in the ongoing Swedish Obese Subjects (SOS) study (Lindroos et al., 1996) (2).

Obesity, bad diets and lack of exercise are all severe global issues and consequences of today's environment. To make steps against obesity these must be changed. Attention must be brought to better quality of food in our diets and a more physically active lifestyle must be idealised. This can only be done by the support of social community workers and an increased level of funding. For too long obese people have had the blame for the size rest on their own shoulders and as we can see with today that this hasn't prevented obesity increasing so we must change our approach. Support must be there for people who are motivated to lose weight while an infrastructure is in place that develops children who are aware of their diets and their weight and are motivated to stay within the normal boundaries of BMI to reduce the risk to their own health.

Book 1; Obesity prevention and public health. David Crawford Robert Jeffrey. Publish oxford uni press

Book 2; obesity . british nutrition foundation. Blackwell science

Book 3; obesity etiology assment treatment and prevention. Jack h. Wilmore roos e Anderson. Human kinetics