Obesit A Worldwide Epidemic Obesit A Worldwide Epidemic.

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Obesit Obesit A Worldwide A Worldwide Epidemic Epidemic

Transcript of Obesit A Worldwide Epidemic Obesit A Worldwide Epidemic.

Page 1: Obesit A Worldwide Epidemic Obesit A Worldwide Epidemic.

ObesitObesitA Worldwide EpidemicA Worldwide Epidemic

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1.1. Obesity – a Worldwide EpidemicObesity – a Worldwide Epidemic

2.2. Causes Causes

3.3. Why We Must ActWhy We Must Act

4.4. International PolicyInternational Policy

5.5. Examples of National InterventionsExamples of National Interventions

6.6. Effectiveness of Obesity InterventionsEffectiveness of Obesity Interventions

7.7. Success Factors of InterventionsSuccess Factors of Interventions

8.8. Summary/ ConclusionSummary/ Conclusion

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Obesity- A Worldwide EpidemicObesity- A Worldwide Epidemic

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

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

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

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

--

Amount of Overweight Children in Thailnd per region

8.10%

3.70%5.20%

6.80%

9.20%

15.00%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

Wholecountry

South North Northeast Centre Bangkok

Region

Am

ou

nt

(%)

data from Thailand Nutrition survey 2003-4

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

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BMI NormalAdults

ObeseAdults

OverweightAdults

UnderweightAdults

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

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

0

10

20

30

40

50

60

70

80

90

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BMI NormalAdults

ObeseAdults

OverweightAdults

UnderweightAdults

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

Thailand

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OBESITY

5.Food Prices

1. Unhealthy Diet

3. Lifestyle

7. Education

2. Physical activity

6. Food Marketing

8. Food Availability

9. Poverty

4. Family Life

Causes of Obesity

10. PsychologicalFactor

11. Genetics 12. Early Life Influences

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Causes of ObesityCauses of Obesity

1. Diet1. Diet a.) Breastfeedinga.) Breastfeeding It has been shown that the longer children are breastfed the lower It has been shown that the longer children are breastfed the lower their chance of becoming obesetheir chance of becoming obese

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

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Causes of ObesityCauses 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 week

Center 6.8% 1.2% 1.5% 90.5%

North 5% 0.6% 0 94.4%

Northeast 3.9% 0.6% 0 95.2%

South 4% 0.3% 0 95.7%

Bangkok 8.8% 5.8% 16.6% 68.8%

Whole country

4.7% 0.7% 0.4% 94.2%

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Causes of ObesityCauses of Obesity

Percentage of Overweight Children and Children Eating Fast Food per Region

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Bangkok Centre Northeast North South

Percentage ofOverweightChildren

Percentage ofChildrenEating FastFood

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Causes of Obesity Causes of Obesity

2. Physical Activity2. Physical Activity Energy Intake should equal expenditureEnergy Intake should equal expenditure Children’s activities are based on video games or TV watching that do not Children’s activities are based on video games or TV watching that do not

include physical activity.include physical activity. Not enough facilities in big citiesNot enough facilities in big cities Gyms too expensive?Gyms too expensive?

3. Lifestyle3. LifestylePeople are People are bbusierusier:: There is less time for physical There is less time for physical aactivityctivity More sedentary lifestyle.More sedentary lifestyle. LLess time to prepare meals/ and family mealsess time to prepare meals/ and family meals → → leads to increased consumption of fast foods and ready made leads to increased consumption of fast foods and ready made meals.meals.

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Causes of ObesityCauses of Obesity

4. Family Life4. Family Life a.) a.) IIn many countries itn many countries it becomes more dangerous to let becomes more dangerous to let cchildren run hildren run around around outside which leads to a decrease physical activity.outside which leads to a decrease physical activity. b.) Parents have less time tob.) Parents have less time to entertain entertain their their childrenchildren. . Children therefore spend more time in front of the TV and playin video Children therefore spend more time in front of the TV and playin video

games:games: → → In Thailand Children spend an average of 4 hrs and 6 hrs watchingIn Thailand Children spend an average of 4 hrs and 6 hrs watching TV on weekdays and weekends respectively.TV on weekdays and weekends respectively. → → Thai regulations state that TV Stations should not screen moreThai regulations state that TV Stations should not screen more than 12 minutes of advertising per hour. Many advertisements for than 12 minutes of advertising per hour. Many advertisements for

unhealthy snacks. unhealthy snacks.

c.) c.) Reduction in Reduction in ffamily amily mmeals/ eals/ ffamily time (mothers are not staying at amily time (mothers are not staying at home)home)

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Causes of ObesityCauses of Obesity

5. Food Prices5. Food Prices Food Prices influence consumption patternsFood Prices influence consumption patterns In the UK fast food (i.e. fish and chips) is cheap and convenient In 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 In the EU and the US industrial strategies allow cheaper oils and fats to

be produced and sold.be produced and sold. In many developing countries consumption of oils containing trans fatty In many developing countries consumption of oils containing trans fatty

acids, the unhealthiest form of fat, is high because hydrogenated acids, the unhealthiest form of fat, is high because hydrogenated soybean oil is among the cheapest fats available.soybean oil is among the cheapest fats available.

6. Food Marketing6. Food Marketing Promotion of energy dense, high fat and high sugar foods affects Promotion of energy dense, high fat and high sugar foods affects

childrens food choice and therefore nutritional status.childrens food choice and therefore nutritional status. Children are not critical about marketing and advertising approachesChildren are not critical about marketing and advertising approaches

7. Education7. Education Lack of knowledge about importance of nutrition leads to consumption Lack of knowledge about importance of nutrition leads to consumption

of unhealthy foodsof unhealthy foods Most consumers get their nutritional health information from commercial Most consumers get their nutritional health information from commercial

sources which may lead to misinformationsources which may lead to misinformation

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Causes of ObesityCauses of Obesity

8. Food Availability8. Food Availability Food availability and accessibility Food availability and accessibility

influence consumption.influence consumption. Unhealthy food may be available more Unhealthy food may be available more

easily.easily.

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Causes of ObesityCauses of Obesity

9. Poverty9. Poverty Fast Foods may be cheaper than fresh fruit and vegetables.Fast Foods may be cheaper than fresh fruit and vegetables. In the UK poorer women are likely to eat low amounts of fruit In the UK poorer women are likely to eat low amounts of fruit

and vegetables, whole grains and fish, and higher amounts of and vegetables, whole grains and fish, and higher amounts of sugar and sweetened soft drinks. sugar and sweetened soft drinks.

Large supermarkets where food is cheaper are often only Large supermarkets where food is cheaper are often only accessible by car accessible by car

A relationship between food insecurity and overweight has been A relationship between food insecurity and overweight has been shown in mexican school children. Poor households acquire shown in mexican school children. Poor households acquire more low cost and high energy density foods.more low cost and high energy density foods.

In India an extreme increase in body mass index has been In India an extreme increase in body mass index has been shown in the population that move from extreme nutritionally shown in the population that move from extreme nutritionally disadvantaged circumstances in the villages into the city slums.disadvantaged circumstances in the villages into the city slums.

In developed countries low socioeconomic status is associated In developed countries low socioeconomic status is associated with higher risk of CVD and Diabetes.with higher risk of CVD and Diabetes.

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Causes of ObesityCauses of Obesity

10. Psychological Factor10. Psychological Factor Unhappiness and depression may lead to increased food consumption.Unhappiness and depression may lead to increased food consumption. Stigma associated with obesity may lead to bullying in schoolsStigma associated with obesity may lead to bullying in schools

11. Genetics11. Genetics More than 300 genes and chromosomal regions have been associated with More than 300 genes and chromosomal regions have been associated with

obesity phenotypes. obesity phenotypes.

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Causes of ObesityCauses of Obesity12. Early Life Influences12. Early Life Influences

The Barker Hypothesis (Fetal origins of adult disease)The Barker Hypothesis (Fetal origins of adult disease)– 1.) Environmental influences during the fetal stage influence the 1.) Environmental influences during the fetal stage influence the

lifelong phenotype, i.e. the risk of disease. E.g. Fetal adaptations lifelong phenotype, i.e. the risk of disease. E.g. Fetal adaptations to undernutrition result in permanent changes in the offspring and to undernutrition result in permanent changes in the offspring and thus susceptibility to certain diseases.thus susceptibility to certain diseases.

Study of the Dutch Hunger Winter has shown that famine during early 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.gestation is likely to increase the risk of being overweight in later life.

– 2.) The intrauterine environment during the fetal stages modifies 2.) The intrauterine environment during the fetal stages modifies the lifelong phenotype in order to best deal with the environment the lifelong phenotype in order to best deal with the environment after birth.after birth.

Undernutrition in fetal life leads to metabolic and endocrine changes which Undernutrition in fetal life leads to metabolic and endocrine changes which would be beneficial if nutrition remained scarce after birth. If nutrition would be beneficial if nutrition remained scarce after birth. If nutrition becomes plentiful these changes predispose to obesity and impaired becomes plentiful these changes predispose to obesity and impaired glucose tolerance.glucose tolerance.

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

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Causes of ObesityCauses of Obesity

Genotype Phenotype

Environment after Birth

Environment before Birth predicts

Two Options:1.) Environment after birth differs from environment before birth (Prediction goes wrong)→ DISEASE2.) Environment after birth matches environment before birth → HEALTH

Risk of disease

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Why We must actWhy We must act

Psychological problemsPsychological problemsRisk factor for CVDRisk factor for CVDNon-insulin dependent diabetesNon-insulin dependent diabetesCancerCancerOObesity imposes financial burdens on health care besity imposes financial burdens on health care systems:systems:– Obesity has been estimated to cost the health service Obesity has been estimated to cost the health service

around around 8%8% of the total health costs in some European of the total health costs in some European countriescountries

– Direct costs of obesity are 5.7% of total health Direct costs of obesity are 5.7% of total health expenditures in the US and 2.4% of the total health expenditures in the US and 2.4% of the total health care budget in Canada.care budget in Canada.

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

Resolution WHA 57.17 states that:Resolution WHA 57.17 states that:

– Global, regional, national and community policies and action plans with clearly defined goals Global, regional, national and community policies and action plans with clearly defined goals and objectives and timeframes where possible should be developed, implemented, monitored and objectives and timeframes where possible should be developed, implemented, monitored and evaluated and evaluated

– Strategies to reduce non-communicable diseases should be part of broader, comprehensive Strategies to reduce non-communicable diseases should be part of broader, comprehensive and coordinated public health efforts.and coordinated public health efforts.

– strategies should be based on the best available scientific evidencestrategies should be based on the best available scientific evidence

– National strategies and action plans should take gender and cultural differences into accountNational strategies and action plans should take gender and cultural differences into account

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Resolution WHA 57.17 states that:Resolution WHA 57.17 states that:

– Public awareness, communication campaigns and education for children and Public awareness, communication campaigns and education for children and adults are very important in order to enhance knowledge about diet, physical adults are very important in order to enhance knowledge about diet, physical activity and health.activity and health.

– A life-course perspective is essential for the prevention and control of A life-course perspective is essential for the prevention and control of noncommunicable diseases. This approach starts with maternal health and noncommunicable diseases. This approach starts with maternal health and prenatal nutrition, pregnancy outcomes,exclusive breastfeeding for six months, prenatal nutrition, pregnancy outcomes,exclusive breastfeeding for six months, and child and adolescent health; reaches children at schools, adults at worksites and child and adolescent health; reaches children at schools, adults at worksites and other settings, and the elderly; and encourages a healthy diet and regular and other settings, and the elderly; and encourages a healthy diet and regular physical activity from youth into old age.physical activity from youth into old age.

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With With RRegard to egard to DDiet the iet the RResolution states that:esolution states that:

NNational dietary guidelines should be set. ational dietary guidelines should be set.

Recommendations for a healthy diet should include achieving energy Recommendations for a healthy diet should include achieving energy balance, limit energy from total fat, decrease consumption of saturated fatty balance, limit energy from total fat, decrease consumption of saturated fatty acids, avoid trans fatty acids, limit intake of free sugars and salt and acids, avoid trans fatty acids, limit intake of free sugars and salt and increase consumption of fruits, vegetables, whole grains and nuts. increase consumption of fruits, vegetables, whole grains and nuts.

TTraditional foods should be preservedraditional foods should be preserved..

NNutrition programmes in schools should be developed that include nutrition utrition programmes in schools should be developed that include nutrition education for children as well as healthy school lunches. education for children as well as healthy school lunches. Availability of Availability of unhealthy foods should be limited.unhealthy foods should be limited.

Healthy eating should be promoted at the workplace.Healthy eating should be promoted at the workplace.

Food should be labeled to give consumers the option to make healthy Food should be labeled to give consumers the option to make healthy choices; health claims should not be misleading; food products consistent choices; health claims should not be misleading; food products consistent with a healthy diet should be promoted; with a healthy diet should be promoted;

FFood safety should be incorporated into food and nutrition policy. ood safety should be incorporated into food and nutrition policy.

Furthermore it is possible to encourage healthy eating by reducing prices of Furthermore it is possible to encourage healthy eating by reducing prices of healthy food through taxation or direct pricing.healthy food through taxation or direct pricing.

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With regard to physical activity the resolution states that:With regard to physical activity the resolution states that:

Physical activity should be promoted and guidelines should be set.Physical activity should be promoted and guidelines should be set.

Recommendations for physical activity include Recommendations for physical activity include 3030 minutes of regular minutes of regular moderate-intensity physical activity on most days as this reduces the risk of moderate-intensity physical activity on most days as this reduces the risk of cardiovascular disease, diabetes, colon and breast cancer. For weight cardiovascular disease, diabetes, colon and breast cancer. For weight control more activity may be required.control more activity may be required.

National and local governments should frame policies and provide National and local governments should frame policies and provide incentives to ensure that walking, cycling and other forms of physical activity incentives to ensure that walking, cycling and other forms of physical activity are accessible and safe are accessible and safe

Exercise facilities should be available at work settingsExercise facilities should be available at work settings

Schools are encouraged to provide students with daily physicalSchools are encouraged to provide students with daily physical

education and should be equipped with appropriate facilities and equipment education and should be equipped with appropriate facilities and equipment

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Obesity InterventionsObesity Interventions

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Obesity InterventionsObesity Interventions

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. .

Pharmacotherapy or SurgeryPharmacotherapy or Surgery Pharmacotherapy with Sibutramine or Orlistat is another Pharmacotherapy with Sibutramine or Orlistat is another

option. Should be accompanied by behavioral option. Should be accompanied by behavioral interventions. interventions.

Surgical treatment may be an option for patients with Surgical treatment may be an option for patients with BMI 35 or greater. BMI 35 or greater.

Obesity InterventionsObesity Interventions

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OBESITY

5.Food Prices

1. Unhealthy Diet

3. Lifestyle

7. Education

2. Physical activity

6. Food Marketing

8. Food Availability

9. Poverty

4. Family Life

Do Programs tackle all causes ?

10. PsychologicalFactor

11. Genetics 12. Early Life Influences

???

?

?

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Effectiveness of Obesity InterventionsEffectiveness of Obesity Interventions

Obesity Interventions21 Systematic Reviews

Physical Activity

Several programs on reducing sedentarybehavior had positive results even an effect on BMI

Programs for increasingP.A: Modest effects onBMI but

May increase amountof physical activity engaged in

Combined Interventions

No significant change in BMI

Improvement of knowledge

Increase in physical activity

Nutritional Intake

Slight Improvement of diet

Slight Improvement of diet

Overall modest results. Some statistically significant differences but not sure whether they are clinically Significant. Even though treatment is favoured over no treatment28. The reviews give the following suggestions:

Childrens nutritional behaviour can bemodifioed when the foodsource is modified

Programs in schools are helpful

Pharmacotherapy or Surgery

Patients taking Orlistat or sibutramine show Increased weight losscompared to thosetreated withplacebo

Medically supervised or supervised by dietitian is more effective

Surgical treatment is effectiveFor people with BMI 30 or greater.

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Success Factors for Obesity Success Factors for Obesity Interventions Interventions

The Intervention shouldThe Intervention should– Have clear goalsHave clear goals– Include follow up and evaluation Include follow up and evaluation – Include several information sessions and workshops per year Include several information sessions and workshops per year – Address long-term behavior change Address long-term behavior change

The Intervention Should be Multifactorial. I.e. it should target:The Intervention Should be Multifactorial. I.e. it should target:– StudentsStudents– ParentsParents– Schools, school cafeterias, school curriculaSchools, school cafeterias, school curricula– CommunityCommunity– Mass media Mass media – Environment ( unhealthy foods should be unavailable and facilities for Environment ( unhealthy foods should be unavailable and facilities for

physical activities should be available) physical activities should be available)

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Success Factors for Obesity Success Factors for Obesity Interventions Interventions

When designing an intervention it is important to:When designing an intervention it is important to:– Remember that population subgroups are different. Differences between Remember that population subgroups are different. Differences between

males, females and different ethnic groups should be consideredmales, females and different ethnic groups should be considered– Take the environment into account (i.e. there is no point in telling a Take the environment into account (i.e. there is no point in telling a

population group to increase consumption of fish if this is not available)population group to increase consumption of fish if this is not available)– Understand behavior, attitudes, he cultural context and religious beliefs Understand behavior, attitudes, he cultural context and religious beliefs

of the target population.of the target population.– Remember that obesity may have a psychological component (for some Remember that obesity may have a psychological component (for some

people counseling is necessary)people counseling is necessary)– Avoid stigmatisationAvoid stigmatisation

Schools are a good place for interventionsSchools are a good place for interventions

Prevention programs are importantPrevention programs are important

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Success Factors for Obesity Success Factors for Obesity Interventions Interventions

The Intervention should include Community Empowerment and The Intervention should include Community Empowerment and ParticipationParticipation– Families, Schools, Communities should be involved in design and Families, Schools, Communities should be involved in design and

implementationimplementation

Centrally managed activities and initiatives within the communities Centrally managed activities and initiatives within the communities should be balancedshould be balanced

Staff involved in implementation and participants should be Staff involved in implementation and participants should be motivatedmotivated

Pharmacotherapy Interventions should be accompanied by Pharmacotherapy Interventions should be accompanied by behavioral therapy.behavioral therapy.

Printed or computer based individually tailored information is an Printed or computer based individually tailored information is an alternative to face to face contactalternative to face to face contact

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Success Factors for Interventions Success Factors for Interventions Improving Nutritional IntakeImproving Nutritional Intake

Nutrition goals should be integrated into national development goalsNutrition goals should be integrated into national development goals

Nutritional advice given by a dietitian is more successful than from Nutritional advice given by a dietitian is more successful than from other health professionalsother health professionals

Environmental Interventions: Intake can be modified if the food Environmental Interventions: Intake can be modified if the food source is modified. i.e. no soft drinks in vending machines.source is modified. i.e. no soft drinks in vending machines.

Distribution of educational Material Distribution of educational Material

Educational messages about healthy eating should be targeted at Educational messages about healthy eating should be targeted at behaviour change rather than just improving knowledgebehaviour change rather than just improving knowledge

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Success Factors for Interventions Success Factors for Interventions Increasing Physical ActivityIncreasing Physical Activity

Classes should focus on aerobic exercise rather than skill Classes should focus on aerobic exercise rather than skill development development

Teachers leading Physical education Classes should be experts or Teachers leading Physical education Classes should be experts or trained by expertstrained by experts

Strategies should also be aimed at reducing sedentaryStrategies should also be aimed at reducing sedentary lifestyle. I.e. TV watching, playing video games lifestyle. I.e. TV watching, playing video games

Schools are good settings to increase phsysical activitySchools are good settings to increase phsysical activity

Urban areas should be designed To incorporate safe routes for Urban areas should be designed To incorporate safe routes for children to walk to schoolchildren to walk to school

Increased access to physical activity facilities.Increased access to physical activity facilities.

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Cost-Effectiveness of InterventionsCost-Effectiveness of InterventionsOf the thirty review not many addressed cost-effectiveness.Of the thirty review not many addressed cost-effectiveness.

Example: ACE-Obesity. Assessing Cost-Effectiveness of Obesity Interventions in Children and Adolescents. By Example: ACE-Obesity. Assessing Cost-Effectiveness of Obesity Interventions in Children and Adolescents. By Victorian Government Department of Human Services Melbourne, Victoria.Victorian Government Department of Human Services Melbourne, Victoria.

Assessed 13 Interventions. And looked at cost-effectiveness of obesity interventions while looking at reduction of Assessed 13 Interventions. And looked at cost-effectiveness of obesity interventions while looking at reduction of disability adjusted life years (DALYs)disability adjusted life years (DALYs)

Not Cost-effective Cost-effective

Incr

ea

sin

g C

ost

-Eff

ect

ive

ne

ss-Walking School Bus

-After School Exercise Program-Travelsmart Program

1.) Orlistat Therapy2.)Family Based GP-Mediated Interventions targeting overweight and Obese children3.)Multi-faceted school based interventionWithout physical education4.)laparascopic gastric banding for severely Obese Adolescents5.)School-based Health promotion program to reduce TV Viewing6.) Multi-faceted school based intervention with additionalActive physical exercise7.) School-based focussed nutrition education interventionTo reduce consumption of carbonated drinks.8.)Family based targeted program for obese children9.)A multi-faceted school-based intervention targeted at overweight or obese children (7-10yrs)10.) Reductio in TV advertising of high fat/ high sugar foodsAnd beverages directed at children.

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Cost-Effectiveness of InterventionsCost-Effectiveness of InterventionsSome evidence that workplace programs seem to be cost-effective as Some evidence that workplace programs seem to be cost-effective as they reduce absenteeism, sick leave, health plan costs, workers they reduce absenteeism, sick leave, health plan costs, workers compensation and disability for a net total benefit.compensation and disability for a net total benefit.

Medically Supervised programs more effective but more expensive Medically Supervised programs more effective but more expensive than other commercial programsthan other commercial programs

Costs are low for weight reduction and behavioral therapy higher for Costs are low for weight reduction and behavioral therapy higher for pharmacotherapy. Most population based preventive programs are pharmacotherapy. Most population based preventive programs are not very effectivenot very effective

Computerised tailoring of weight control programs may help weight Computerised tailoring of weight control programs may help weight loss programs in a cost-effective wayloss programs in a cost-effective way

School health programs providing safe and low cost health service School health programs providing safe and low cost health service interventions such as screening and health education are a very cost-interventions such as screening and health education are a very cost-effective investment for a nationeffective investment for a nationWell managed nutrition education programmes can at relatively low Well managed nutrition education programmes can at relatively low cost lead to behavior changes and improved nutritional well beingcost lead to behavior changes and improved nutritional well beingPrevention programmes are cost effectivePrevention programmes are cost effective

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Summary/ ConclusionSummary/ Conclusion

Obesity is a major public health problem Obesity is a major public health problem throughout the worldthroughout the worldIt has many causesIt has many causesMultiple interventions exist.Multiple interventions exist.Prevention should be a PriorityPrevention should be a PriorityEffectiveness analysis has shown that many Effectiveness analysis has shown that many programs are not very effective. This may be programs are not very effective. This may be however due to the way it is measured.however due to the way it is measured.It is important that interventions are multi-It is important that interventions are multi-factorial.factorial.

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ConclusionConclusion

Interventions should address maternal health Interventions should address maternal health before birth.before birth.The aspect of poverty should be addressedThe aspect of poverty should be addressedCounselling should be a part of interventionsCounselling should be a part of interventionsImprovement of diet should not only lead to Improvement of diet should not only lead to reduction in calories (as there are e.g. some oils reduction in calories (as there are e.g. some oils and fatty acids that are healthy)and fatty acids that are healthy)More importance should be given to waist More importance should be given to waist circumference and waist hip ratio in addition to circumference and waist hip ratio in addition to BMI, as abdominal obesity is more dangerous BMI, as abdominal obesity is more dangerous that the pear shaped or gynoid obesity.that the pear shaped or gynoid obesity.

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ObesitObesitA Worldwide EpidemicA Worldwide Epidemic