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Ciara Kehoe

on 3 March 2013

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Transcript of Obesity

Obesity INDIVIDUAL BMI Epidemic Choice Disease IRELAND OBESE Body Mass Index (BMI) Response Bias
Defined by the WHO as "excessive fat accumulation that presents a risk to health..." 1 What is BMI ? Conclusion Public Health SYNERGY Future USA A MATTER FOR THE INDIVIDUAL OR A COSTLY PUBLIC HEALTH MATTER? Obesity: Epidemiology In 1990... In 2008... Over one third (37.5%) of US
adults are obese [8] Obesity classed as an epidemic
by WHO in 1990 [1]

1995: 200 million obese worldwide
2000: 300 million obese
2008: 400 million obese [10] Ciara Kehoe, Syarena Rosli,
Precious Nwafor & Raihan Ramli. Weight (kg) divided by square of height (m). 61% Irish adults overweight or obese [3] 31% population obese in 2007 (a 5% rise in 6 years- current rate?) [4] 1 in 10 Irish men were obese [3] 1 in 4 men obese (and counting...) [5] Childhood Obesity Age & sex- specific BMI percentiles
> 85th percentile= overweight
>95th percentile= obese [6]

Most prevalent childhood
disorder in EU (1 in 6) [3] 2025 projections: Almost half of American adults will be obese [4] FACTORS [9] Genetics Lifestyle Metabolics The probability of a person being overweight
increases by 25% if one or both of their parents is obese.
May also influence the location of fat accumulation – hips or stomach. The rate of energy expenditure varies for each person Diet

Physical Activities Obese or not? Sum of influences that the surroundings, opportunity, or conditions of life have on promoting obesity on individual [10] Not so easy to prevent!! Personal choice? Obesogenic Environment Consumers Food Companies? Food Scientists? What we eat, who decides? [11] Food Nutritionists? Trying to stay in business Decide what food is healthy Perform research and inspect food products Eating Habits [3] From 10364 respondents in 2007:

48% snacked between meals
86% consumed more than 3 daily servings food at the top of shelf of pyramid
26% consume the recommended 6 or more daily servings of cereals, bread and potatoes. Exercise Exercise?
NO WAY! [12] Low self - esteem Costly
gym equipment I'm too fat!! Friends don't exercise...why should I? Why is it a Public Health Matter? Costs


Health Effects Costs to Ireland’s economy: Direct and Indirect costs in 2009: €1.13 billion [13] What is the Irish Government doing? The current key policy on obesity is “Obesity, The Policy Challenges – Report of the Taskforce on Obesity”, 2005 [5] Made 96 recommendations in [5]: HSE Minister for Health, James Reilly Main Priorities HSE Framework for Action on Obesity 2008 – 2012
Other projects:
Providing growth monitoring equipment
Directing research into obesity – ‘Growing up in Ireland Study’
Initiating different prevention programmes, such as HSE Dublin North East’s ‘Be Active After School Activity Programme’ [3] “Special Action Group on Obesity.’’[3] Calorie posting on menus

Introduction of a tax on sugar sweetened drinks

Nutritional labelling

Restrictions on the marketing of food and drinks to children

Promotion of physical activity [3] Did any of this work? Progress of the Taskforce recommendations [3] What about in the USA? How is America tackling the problem? NO true strategies dealing with obesity on a national level!

Some state legislation LET'S MOVE CAMPAIGN! Aim to reduce childhood obesity to 5% in 2030 - ambitious!

Early childhood interventions
Empowerment of parents and caregivers
Healthy foods in schools
Access to healthy and affordable food
Increase physical activity [15] Combating obesity;
obesity interventions [3]

Denmark, Finland, France, Hungary have already passed legislation to tax food
rich in fat and sugar. [16,17] Taxation on Food FOOD TAXING Denmark:

All foods with more than 2.3% saturated fat. Hungary:

Pre-packaged foods containing high salt or sugar. (crisps, chocolates and salted nuts) France:
Sweetened drinks Food taxes:
Are they working?
2 studies from US: taxation of 1-8% is too low to cause an effect.

In 1980, a study of the taxation on soft drinks: for every 10% increase in price, there is 11% decrease in consumption.

One systemic review: larger price changes could cause a better change in obesity prevalence. Natural experiment [16]
Point-of-Purchase Price and Education Intervention to Reduce Consumption of Sugary Soft Drinks; Am J Public Health.

Venue: cafeteria in Brigham and Women's Hospital.

Results: regular soft drink sales declined by 26% with a $0.45 (35%) increase in price Controlled trials [16] IMPROVING
OF TAXING [16] Taxing a large
range of
food Taxing of
at least 20% "Policy interventions for obesity can only
be realistically aimed at the environment (making healthy choices easier) rather than the individual (compelling them to take the healthy choices)." [18] Formal physical education in school does not work. [19]
Aim to increase the physical activity of children.
Randomised controlled trials for at least 4 weeks. [20]
Measured using accelerometers. Obesity Policy: Physical Education
Results: only about 4 minutes more walking or running per day on the children’s overall activity levels.
Limited success in reducing BMI. [19,20] In 2010, the US Surgeon General said that
there is a need for grass root efforts
by the citizens altogether. [21]

Grass root efforts result in healthier lifestyles &
behaviour in the communities Synergy SYNERGY International
Organisations Government Media Civil
society Professional
Network Our Recommendations Ban on HFSS food advertisement during children’s TV. [22]
Subsidise healthy foods
Food industry: reformulate the food content. (sugar, saturated fats, salt) 1) World Health Organisation. Obesity and Overweight [Internet]. Location Unknown; WHO: Undated [cited 25/2/13]. Available from: http://www.who.int/topics/obesity/en/

2) World Health Organisation. 10 Facts on Obesity [Internet].Location Unknown; WHO: Undated [cited 25/2/13]. Available from: http://www.who.int/features/factfiles/obesity/facts/en/index.html

3)Houses of the Oireachtas. Spotlight: Obesity- A Growing Problem? [Internet] Dublin: Oireachtas Library and Research Service; 2011. Available from: http://www.oireachtas.ie/parliament/media/housesoftheoireachtas/libraryresearch/spotlights/spotObesity071111_150658.pdf

4) Health Service Executive. Framework for Action on Obesity [Internet]. Dublin; Department of Health: 2008 [cited 25/2/13]. Available from: http://www.getirelandactive.ie/content/wp-content/uploads/2011/12/HSE-Framework-for-Action-on-Obesity.pdf

5) Harrington, J., Perry, I., Lutomski, J., Morgan, K., McGee, H., Shelley, E., Watson, D. and Barry, M. SLÁN 2007: Survey of Lifestyle, Attitudes and Nutrition in Ireland. Dietary Habits of the Irish Population, Department of Health and Children [Internet]. Dublin: The Stationery Office; 2008 [cited 25/2/13]. Available from: http://www.dohc.ie/publications/pdf/slan07_report.pdf?direct=1

6) OECD, European Union. Health at a Glance: Europe 2010. Brussels; OECD Publishing: 2010 [cited 25/3/2012] [Figure]. Available from: http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2010_health_glance-2010-en;jsessionid=97mmen2q2f5hr.delta
7)Centre for Disease Control. Basics of Childhood Obesity [Internet]. USA; CDC: 27/4/2012 [cited 25/3/2012]. Available from: http://www.cdc.gov/obesity/childhood/basics.html

8) Centre of Disease Control. Adult Obesity Facts [Internet]. USA ; CDC: 13/7/2012 [cited 25/3/2012]. Available from: http://www.cdc.gov/nchs/data/databriefs/db82.pdf

9)The Official US Obesity Rates Timeline [Video]. USA; CDC: 2011. Available from: (link on Power Point Presentation)

10)Department of Health. Obesity: The Policy Challenges- Report of the National Taskforce on Obesity [Internet]. Dublin: 2005[cited 25/3/2012]. Available from: http://www.dohc.ie/publications/pdf/report_taskforce_on_obesity.pdf?direct=1

11)Stanford Hospital and Clinics. What Causes Obesity?[Internet]. Stanford : Stanford Hospital and Clinics [undated; cited 2013 February 22 ]. Available from : http://stanfordhospital.org/clinicsmedServices/COE/surgicalServices/generalSurgery/bariatricsurgery/obesity/causes.html

12) Lake A, Townshend T. The Journal of Royal Society for Promotion of Health. 2006 November [cited 2013 February 22] Vol 126. 6. Available from : http://www.ncbi.nlm.nih.gov/pubmed/17152319

13) Lucey J.A. Who decides on what we eat [Internet]. Wincosin : University of Wincosin-Madison. 2009 [cited 2013 February 23]. Available from http://blog.gobigread.wisc.edu/2009/09/who-decides-what-we-eat.html

14) Bell D. Americans Need More Exercise Why Don’t They Get It? [Internet]. Okla : [Publisher Unknown]; 2012 [cited 2013 February 23]. Available from : http://theactivepursuit.com/americans-need-more-exercise-why-dont-they-get-it/

15)Safefood. The cost of overweight and obesity on the island of Ireland. [Internet] November, 2012. Last accessed: 26th February 2013. Available at: http://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Publications/Research%20Reports/Final-Exec-Summary-The-Economic-Cost-of-Obesity.pdf

16) Dor, A. Ferguson, C. Langwith, C. Tan, E. A Heavy Burden: The Individual Costs of Being Overweight and Obese in the United States. [Internet] Sept, 2010. Last accessed: 26th February 2013. Available at: http://sphhs.gwu.edu/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_35308C47-5056-9D20-3DB157B39AC53093.pdf

17) U.S. Department of Health, Let’s Move. USA: 2010 Last Accessed: 26th February 2013. Available at: http://www.letsmove.gov/learn-facts/epidemic-childhood-obesity
18) Mytton O.T, Clarke D, Rayner M. Taxing unhealthy food and drinks to improve health. BMJ [Internet]. 2011 May 15. [cited 2013 February 27]; 34 (4): 29-31. Available from: http://www.bmj.com/content/344/bmj.e2931?ijkey=anbZh0Tu5xuqTVc&keytype=ref

19) European Public Health Alliance. Food Taxation in Europe: Evolution of the Legislation. [Internet]. Belgium: Eropean Public Health Alliance; 2012. [updated 2012 October 16; cited 2013 March 3]. Available from: http://www.epha.org/a/4814

20) Swinburn, B.A, Sacks G, Hall K.D, McPherson K, Finegood D.T, Moodie M.L, Gortmaker S.L. The global obesity pandemic: shaped by global drivers and local environments’, Lancet [Internet]. 2011 August 27 [cited 2013 February 27]; 378 (1): 804-14. Available from: http://www.nutrociencia.com.br/upload_files/artigos_download/Swinburn_2011.pdf

21) Painter K. Activity programs fail to get kids moving, study says. USA Today [Internet] 2012 Sept 28 [cited 2013 Feb 25]; News: [about 3 screens]. Available from: http://usatoday30.usatoday.com/news/nation/story/2012/09/28/physical-activity-programs-fail-to-get-children-moving-study-says/57849062/1

22) Metcalf B., Henley W, Terence W. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54). BMJ [Internet]. 2012 Aug [cited 2013 February 25]; BMJ 34 (5): 58-88. Available from: http://www.bmj.com/content/345/bmj.e5888

23) Lagerros Y.T, Rossner S. Obesity management: what brings success? Pubmed Central [Internet] 2013 Jan [cited 2013 Feb 25]; 6(1): 77–88. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539294/

24) Broadcasting Authority of Ireland. BAI Signals new rules to govern advertising of food and drink in children’s advertising [Internet]. Ireland: Broadcasting Authority of Ireland. [updated 2012 October 12, cited 2013 March 1]. Available from: http://www.bai.ie/?p=2792 REFERENCES REFERENCES REFERENCES REFERENCES THANKS FOR LISTENING! Any Questions? HEALTH COSTS DIABETES LOSS OF PRODUCTIVITY CARDIOVASCULAR
Sweets and soft drinks Obesity rises by 1% every year [6] [9]
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