ObesitA Worldwide Epidemic

Obesity a Worldwide EpidemicCauses Why We Must ActInternational PolicyExamples of National InterventionsEffectiveness of Obesity InterventionsSuccess Factors of InterventionsSummary/ Conclusion

Obesity- A Worldwide EpidemicObesity is increasing all over the world and together with lack of physical activity it is one of the leading causes of non-communicable diseases such as cardiovascular diseases, type II diabetes and certain types of cancer.

In 2001 chronic diseases were responsible 60% of global reported deaths

It has been projected that by 2020 chronic diseases will account for almost three-quarters of all deaths worldwide.

Obesity in ThailandAccording to the WHO in 2006 10.4% of preschool children are overweightAbout 8.1% of school children are overweight. This differs depending on which area.According to the WHO in 2005 27.5% of males and 35.2% of females over the age of 15 were overweight (BMI > 25).

-data from Thailand Nutrition survey 2003-4

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0.081

0.037

0.052

0.068

0.092

0.15

Overweight

Region

Amount (%)

Amount of Overweight Children in Thailnd per region

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RegionOverweight

Whole country8.10%

South3.70%

North5.20%

Northeast6.80%

Centre9.20%

Bangkok15.00%

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0

0

0

0

0

0

Overweight

Region

Amount (%)

Amount of Overweight Children in Thailnd per region

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Prevalence of Overweight, Underweight, Obesity and BMI Normal Adults in some Countries

(Data taken from: http://www.who.int/bmi/index.jsp)

Prevalence of Overweight, Underweight, Obesity and BMI Normal Adults in some Countries

(Data taken from: http://www.who.int/bmi/index.jsp)Thailand

OBESITY5.Food Prices1. Unhealthy Diet3. Lifestyle7. Education2. Physical activity6. Food Marketing8. Food Availability9. Poverty4. Family LifeCauses of Obesity

10. PsychologicalFactor11. Genetics 12. Early Life Influences

Causes of Obesity1. Diet a.) Breastfeeding It has been shown that the longer children are breastfed the lower their chance of becoming obese

b.) High intake of saturated fatty acids and high intake of sugars through increased consumption of Fast Food: - Sugar consumption in Thailand has increased 12.7kg/person in 1983 to 30.5 kg/person in 2003. Food and vegetable consumption among urban residents has decreased. - Soft Drink and sweet beverage consumption is higher in Bangkok than it is in other areas in Thailand. - In Bangkok 8.8% of children eat fast food every day. In rural areas this is less.

Causes of Obesity Fast Food Consumption in children aged 6-14 per region

RegionEat Every Day5-6 Days per week1-4 Days per weekDo not eat/ less than once per weekCenter6.8%1.2%1.5%90.5%North5%0.6%094.4%Northeast3.9%0.6%095.2%South4%0.3%095.7%Bangkok8.8%5.8%16.6%68.8%Whole country4.7%0.7%0.4%94.2%

Causes of Obesity

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0.1510.312

0.0920.095

0.0680.045

0.0520.056

0.0370.043

Percentage of Overweight Children

Percentage of Children Eating Fast Food

Percentage of Overweight Children and Children Eating Fast Food per Region

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South AsiaSub-Saharan AfricaMiddle East and North AfricaLatin America and CarribeanAsia and the Pacific

301415108

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30

14

15

10

8

Low Birthweight in %

Prevalence of Low Birthweight

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RegionEat every day5-6 days per week1-4 days per weekpercentage of overweightfast food consumption

Center6.80%1.20%1.50%9.20%9.50%78.00%

North5%0.60%05.20%5.60%

Northeast3.90%0.60%06.80%4.50%

South4%0.30%03.70%4.30%

Bangkok8.80%5.80%16.60%15.10%31.20%82%

Whole country4.70%0.70%0.40%

OverweightFastfood consumptionSoft Drink

Bangkok15.10%31.20%82.00%

Centre9.20%9.50%78%

Northeast6.80%4.50%62.00%

North5.20%5.60%67.00%

South3.70%4.30%

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Percentage of Overweight Children

Percentage of Children Eating Fast Food

Percentage of Overweight Children and Children Eating Fast Food per Region

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Causes of Obesity 2. Physical ActivityEnergy Intake should equal expenditureChildrens activities are based on video games or TV watching that do not include physical activity.Not enough facilities in big citiesGyms too expensive?

3. LifestylePeople are busier: There is less time for physical activity More sedentary lifestyle. Less time to prepare meals/ and family meals leads to increased consumption of fast foods and ready made meals.

Causes of Obesity4. Family Life a.) In many countries it becomes more dangerous to let children run around outside which leads to a decrease physical activity. b.) Parents have less time to entertain their children. Children therefore spend more time in front of the TV and playin video games: In Thailand Children spend an average of 4 hrs and 6 hrs watching TV on weekdays and weekends respectively. Thai regulations state that TV Stations should not screen more than 12 minutes of advertising per hour. Many advertisements for unhealthy snacks.

c.) Reduction in family meals/ family time (mothers are not staying at home)

Causes of Obesity5. Food PricesFood Prices influence consumption patternsIn the UK fast food (i.e. fish and chips) is cheap and convenient In the EU and the US industrial strategies allow cheaper oils and fats to be produced and sold.In many developing countries consumption of oils containing trans fatty acids, the unhealthiest form of fat, is high because hydrogenated soybean oil is among the cheapest fats available.

6. Food MarketingPromotion of energy dense, high fat and high sugar foods affects childrens food choice and therefore nutritional status.Children are not critical about marketing and advertising approaches

7. EducationLack of knowledge about importance of nutrition leads to consumption of unhealthy foodsMost consumers get their nutritional health information from commercial sources which may lead to misinformation

Causes of Obesity8. Food AvailabilityFood availability and accessibility influence consumption.Unhealthy food may be available more easily.

Causes of Obesity9. PovertyFast Foods may be cheaper than fresh fruit and vegetables.In the UK poorer women are likely to eat low amounts of fruit and vegetables, whole grains and fish, and higher amounts of sugar and sweetened soft drinks. Large supermarkets where food is cheaper are often only accessible by car A relationship between food insecurity and overweight has been shown in mexican school children. Poor households acquire more low cost and high energy density foods.In India an extreme increase in body mass index has been shown in the population that move from extreme nutritionally disadvantaged circumstances in the villages into the city slums.In developed countries low socioeconomic status is associated with higher risk of CVD and Diabetes.

Causes of Obesity10. Psychological FactorUnhappiness and depression may lead to increased food consumption.Stigma associated with obesity may lead to bullying in schools

11. GeneticsMore than 300 genes and chromosomal regions have been associated with obesity phenotypes.

Causes of Obesity12. Early Life Influences

The Barker Hypothesis (Fetal origins of adult disease)1.) Environmental influences during the fetal stage influence the lifelong phenotype, i.e. the risk of disease. E.g. Fetal adaptations to undernutrition result in permanent changes in the offspring and thus susceptibility to certain diseases.Study of the Dutch Hunger Winter has shown that famine during early gestation is likely to increase the risk of being overweight in later life.2.) The intrauterine environment during the fetal stages modifies the lifelong phenotype in order to best deal with the environment after birth.Undernutrition in fetal life leads to metabolic and endocrine changes which would be beneficial if nutrition remained scarce after birth. If nutrition becomes plentiful these changes predispose to obesity and impaired glucose tolerance.

This Hypothesis predicts that heart disease and impaired glucose tolerance will be increased in populations that are undergoing the nutrition transition

Causes of Obesity

Why We must act

Psychological problemsRisk factor for CVDNon-insulin dependent diabetesCancerObesity imposes financial burdens on health care systems:Obesity has been estimated to cost the health service around 8% of the total health costs in some European countriesDirect costs of obesity are 5.7% of total health expenditures in the US and 2.4% of the total health care budget in Canada.

International Obesity PolicyBecause of the severity of the problem in May 2004 the 57th World Health Assembly (WHA) endorsed the Global Strategy on Diet, Physical Activity and Health (Resolution WHA 57.17).

Resolution WHA 57.17 states that:

Global, regional, national and community policies and action plans with clearly de