OBESITY AND HEALTH PROMOTION

Obesity And Health Promotion

Obesity And Health Promotion

Introduction

When energy intake exceeds energy expenditure, the excess energy is converted to fat, body weight increases and ultimately obesity ensues. In adults, obesity is defined as a body mass index of 30 kg/m2 or greater. This simplistic definition suggests that by limiting our food and therefore energy intake to correct the imbalance, obesity will be prevented or reversed. It sounds like a relatively easy task - but in today's society it is not. Eating is so much more than energy intake, it is a highly social, culturally steeped activity controlled by a huge variety of complex factors including genetic predisposition, appetite, our views about the importance of food, where and how we live and many more.The control of obesity is therefore fraught with difficulty as we are only just beginning to understand why it happens and how it can be prevented. Health problems associated with obesity have increased as the prevalence of obesity has risen dramatically over the last 20 years. In the UK one in five adults is now obese. Obesity and malnutrition are measured using Body Mass Index (BMI), calculated by weight (kg) divided by height (m) squared. Prior to standardisation by the World Health Organisation (WHO) in 1997, international comparisons were difficult due to national variations in interpretation of BMI. Each culture has its own interpretation about where normality begins and obesity starts and normal, overweight and obese are arbitrary classifications on a continuum. WHO standard BMI classification for normal adults is shown in Table 1. However, body builders, babies, adolescents and pregnant women have distorted ratios and do not fit into standard classification systems(Jelalian Mehlenbeck Lloyd-Richardson Birmaher Wing 2006 pp.31-9).

Obesity as a public health issue

Obesity is associated with increased risk of morbidity and mortality. As well as physical problems, the psychological effects of being overweight or obese can be substantial. Problems include the following (although this is not an exhaustive list). Type 2 diabetes Musculoskeletal problems Coronary heart disease High blood pressure Hypertension Stroke Depression Respiratory difficulties Cancers Low self esteem Excess fat deposited around the abdominal area tends to be associated with greater health risks than fat located in the thighs, or other parts of the body. A waist circumference of more than 32 inches for women and 37 inches for men is associated with an increased risk of morbidity. (Hill Coates Buckley Ross Thielecke Howe 2007 pp.396S-402S.)

Type 2 diabetes

There is a close link between obesity and Type 2 diabetes. Eighty percent of those with Type 2 diabetes are overweight or obese.Type 2 diabetes is associated with an increased risk of premature death, as well as blindness, kidney, circulatory and nerve problems. Since the onset is often insidious, the average person has diabetes for several years before diagnosis is made and during the intervening years considerable body system damage may occur. Early investigation and treatment is important as it may delay the onset of complications. Recognising the importance of this, the National Institute for Clinical Excellence (NICE) has just issued two clinical guidelines for the management of Type 2 diabetes. They cover screening for and management of eye problems and the prevention and management of kidney disease. An estimated 135 million people world wide had diagnosed diabetes in 1995, and this number is expected to rise to at least 300 million by 2025. Between 1995 and 2025 the number of people with diabetes will increase by 42% (from 51 to 72 million) in industrialised countries and by ...