Taking account of research around the relationship between genetics and our new ‘food environment’, Dr Robyn Toomath (endocrinologist and Clinical Director Wellington Hospital) argues that we are in the middle of an obesity epidemic which impacts widely on public health. She advocates for new approaches to obesity based not on blame or impossible personal goals, but on outcomes. She argues it is the responsibility of all to become informed and active (personally and politically), in working for change to present health policies and gives examples of what can be done.
http://dosomething.org.nz
3. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
4. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
5. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
6. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
15. Table 1 Health risks associated with increasing Body Mass Index (BMI) Overweight/obesity plus hypertension is associated with increased risk of ischaemic stroke Obesity is a contributing factor to cardiac failure in >10% of patients 70% of obese women with hypertension have left ventricular hypertrophy Dyslipidaemia progressively develops as BMI increases from 21 kg m −2 with rise in small particle low-density lipoprotein 3.6× risk of CAD for each unit change in BMI Coronary artery disease (CAD) and stroke 85% of hypertension is associated with a BMI >25 kg m −2 66% of hypertension is linked to excess weight 5× risk in obesity Hypertension 90% of type 2 diabetics have a body mass index (BMI) of >23 kg m −2 Type 2 diabetes 30% of middle-aged people in developed countries have features of metabolic syndrome Metabolic syndrome
16. Table 1 Health risks associated with increasing Body Mass Index (BMI) 4 Obesity Related Morbidity. Obesity Reviews 8 (s1), 13-17. 3× risk of gall bladder disease in women with a BMI of >32 kg m −2 ; 7× risk if BMI of >45 kg m −2 Overweight and obesity associated with non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). 40% of NASH patients are obese; 20% have dyslipidaemia Liver and gall bladder disease Frequent association in the elderly with increasing body weight – risk of disability attributable to OA equal to heart disease and greater to any other medical disorder of the elderly Osteoarthritis (OA) Impotency and infertility are frequently associated with obesity in men 6% of primary infertility in women is attributable to obesity Reproductive function 10% of all cancer deaths among non-smokers are related to obesity (30% of endometrial cancers) Cancers Neck circumference of >43 cm in men and >40.5 cm in women is associated with obstructive sleep apnoea, daytime somnolence and development of pulmonary hypertension Respiratory effects
22. The body-mass index of twins who have been reared apart AJ Stunkard, JR Harris, NL Pedersen, and GE McClearn Next Pr evious Number 21 May 24, 1990 Volume 322:1483-1487
32. 1998 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2007 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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36. “ Genetic epidemiological studies and multiple genome-wide linkage analyses have established that the causes of common obesity are complex involving a Westernized lifestyle in the presence of genetic predisposition” Dahlman I and Arner P. Review. Int J Obes (2007) 31, 1629-1641.
37. Genes and the Environment BMI 1977 2006 * * * Genetically thin Genetically fat
38. How should we tackle the problem? Personal endeavour or environmental engineering?
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Notas do Editor
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
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