Causes, Consequences and Tackling obesity.

Professor Paul GatelyCarnegie Weight ManagementLeeds Metropolitan University

What is overweight ?• This boy is 3 years, 3 weeks

old.• Is his BMI-for-age

- below the 5th percentile? - 5th to <85th percentile: normalweight? - >85th to <95th percentile:

overweight? - >95th percentile:

obese?

Photo from UC Berkeley Longitudinal Study, 1973

Measurements:

Age=3 y 3 wks

Height=100.8 cm (39.7 in)

Weight=18.6 kg(41 lb)

BMI=18.3

BMI-for-age= >95th percentile = obese

Plotted BMI-for-Age

Boys: 2 to 20 years

BMI BMI

BMI BMI

Body Mass Index (kg/m2)

Probability density

Source: Rose, G. (1991) .

BMI distribution curves over timeBMI distribution curves over time

14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 440.00

0.05

0.10

O/WT OBESE

W.Samoa (urban)

Kuwait

East Germany

USA

Saudi Arabia

W. Germany

Czech Republic

England

Canada

Netherlands

Australia

Brazil

Japan

China

Women Men

80 70 60 50 40 30 20 10 0 10 20 30 40 50 60 70 80

% population

Age rangeYear *

* Most recent available data. Surveys conducted between 1988 and 1994.

25-6918+

25-6420-74

15+25-6920-6516-6418-7420-5920-6915-6425-64

20+20-45

GLOBAL PREVALENCE OF OBESITY (defined as BMI >30)

Changes in prevalence

Why is this a concern?Pulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndrome

Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseaseSteatosisSteatosisSteatohepatitisSteatohepatitiscirrhosiscirrhosis

Coronary heart diseaseCoronary heart disease

DiabetesDiabetes

DyslipidemiaDyslipidemia

HypertensionHypertension

Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndrome

OsteoarthritisOsteoarthritis

SkinSkin

Gall bladder diseaseGall bladder disease

CancerCancerbreast, uterus, cervixbreast, uterus, cervixcolon, esophagus, pancreascolon, esophagus, pancreaskidney, prostatekidney, prostate

PhlebitisPhlebitisvenous stasisvenous stasis

GoutGout

Idiopathic intracranial Idiopathic intracranial hypertensionhypertension

StrokeStroke

CataractsCataracts

Severe pancreatitisSevere pancreatitis

Source: www.obesityonline.org

Psycho social factors12-year old girls and boys

2

2.2

2.4

2.6

2.8

3

3.2

Self-worth School Athletic Behaviour

Obese boys Normal wtObese girls

* p<.01 **p<.001

Fat-teasing in boys & girls (Murphy & Hill, 2003)

1.8

2

2.2

2.4

2.6

2.8

3

3.2

Self-worth School Social Athletic Appearance Behaviour

Non victimised Fat teased boysFat teased girls * p<.05 **p<.001

****** ***

Toxic or obesogenic environment

Obesity is a normal response to an abnormal environment

side-effect of technological advances reflects natural human preferences (eg easy, convenient, fast,

low effort, value for money)

key factors• energy-saving machines, passive recreation• energy-dense foods & drinks, large portion sizes

Biological and cultural mismatches to the modern environment

FOOD Strong signals to eat Weak signals to stop Increased availability Eating is rewarding No viable alternatives Eating well is high status

ACTIVITY Weak activity signal Strong signals to stop Reduced availability Inactivity is rewarding Inactivity is a viable alternative Inactivity is high status

Where should the focus be?

1 in 3 children are overweight or obese.

1 in 3 children who will become overweight or obese adults.

1 in 3 children who are and will remain normalweight /underweight?

4,563,865

9,266,033

33%

77%

Gately (2007)

NORMAL WEIGHT

OVERWEIGHT

Health costs

↑ 20%

1797887

2,765,980

20%

13%

Gately (2007)

OBESE

Health costs ↑ 50%

691495

1382990

1797887

138,299

553196

1%

4%

5%

10%

13%

Gately (2007)

OBESE +++

Health costs

? Min ↑100%

Is policy having an impact on weight change?

Initiative Cost Impact Measurement/evaluation

Prevention

Sahota (UK) ? No Impact BMI

Gortmaker (US) ? No Impact BMI

Lupeka (US) ? No Impact BMI

Fruit and Veg Field (US) ? No impact BMI

PESSCL ? No evidence No evaluation

School Food Programme £235m? No evidence No evaluation

Healthy Schools ? No evidence No evaluation

Play £155m? No evidence No evaluation

Social Marketing ? No evidence No evaluation

Extended schools £125m? No evidence No evaluation

Results of process research

Comments on exercise:• “I prefer to do sports than watch TV, just don’t get the chance, I’m too

fat.”• “I don’t like walking or running its boring, just never do it.”• “I like doing sports, because I’m having fun with friends.”

Potential of extended schools and PESSCL? • “I would get laughed at it I turned up for an afterschool sports club, they

are not for kids like me” • “After I lost weight and got fitter I felt more like joining in PE and clubs”

Carnegie Weight Management

Treatment programmesCamps (residential & day),

clubs

Multi mediaResearch,

ConsultancyTraining

Broadcast

Carnegie Curriculum

Diet

PhysicalActivity SocialActivities

BehaviourChangeTheory

&Tools

Carnegie Weight Management

Interventions Prevention Practice based Research

Broadcast

Consultancy

Web

Community clubs

Training

Web

Community camps

Web

Residential Camps-

schools

Web

Research evidence

No Evidence No Evidence 1%↓ BMI SDS 6m 4 %↓ BMI SDS 10%↓ BMI SDS 1-3 yr

Costs ratio 1.0 1.2 1.5 2.0 ?

UK n= (SDS) 8.5m (<1.04) 4.5m (>1.04) 2.7m (>1.69) 691k (>2.5) 140K (>3.0)

Skill based exercisePre and post camp scores for sports skills (Gately 2005)

0

10

20

30

40

50

60

Badminton Serve Basketball shot Football Dribbling(secs)

Volleyball Volley

Skills

Sco

re

Week 1

Week 6

***

***

*** P<0.001 pre to post

***

***

Self Perception Profile for Children (SPPC)

1.6

1.8

2

2.2

2.4

2.6

2.8

3

3.2

Self-worth School Social Athletic Appearance Behaviour

Normal weight

Pre-camp

Post-camp

** ****

Source: Walker et al. (2002)** (P<0.01)

Long term results of residential programme

1

1.5

2

2.5

3

3.5

4

Pre 1 Post 1 Pre 2 Post 2 Pre 3 Post 3 Pre 4 Post 4

Time

Stan

dard

ised

BM

I sc

ore

Mean one year follow up data

Mean two year follow up data

Mean three year follow updata

Community club outcomes

Change Children Parents

Body mass (kg) 0.7 + 2.3 -1.1 + 2.5

BMI (kg.m-2) -0.19 + 1 -0.31 + 0.8

BMI SDS -0.11 + 0.23 NA

Waist (cm) -8.7 + 4.2 -5.9 + 4.2

% Body fat -1.75 + 2.6 -1.2 + 5.3

Fitness (l.min-1) 0.2 + 0.4 0.3 + 0.3

Impact of obesity interventions on participants

1 Very little published evidence on the effectiveness of whole-school obesity interventions in the UK. What exists is not overwhelmingly positive

SurgeryDrugs

(e.g. Sibutramine, Orlistat)

Whole School

Approach¹Prevention CWM

Reduces BMI z-score ? x Increases fitness x x ? ? Improves self-esteem x x ? ? Improves family relationships x x ? ? Builds capacity within communities x x ?

Comparative attributes of obesity interventions

SurgeryDrugs

(e.g. Sibutramine, Orlistat)

Whole School

ApproachPrevention CMW

Positive experience x x x x Scalable x Evidence-based x x Failure rate Low Medium n/a ? Low

Health risk High Medium Low Low Low

Cost of intervention

(£/person)£5,665

£444 & £386 (9 months)

No UK

data? Varies

Sustainability of weight loss

High Low x x High

Carnegie Weight ManagementThe Grange

Headingley CampusLeeds Metropolitan University

LeedsLS6 3QS

Tel. +441138123579p.gately@leedsmet.ac.uk

www.carnegieweightmanagement.com