OBESITY – meeting the challenge

Obesity is a major health problem in the 21^st century both across the UK and worldwide. It is defined as a body mass index equal to or over 30kg/m2 (Health Survey for England 2006).

According to the government’s foresight report (2007), by the year 2050 sixty percent of men and fifty percent of women in the UK could be obese due to ‘passive obesity’ – a state in which the effects of modern living overpower biological control of body weight. The result is that every generation becomes heavier than the previous one.

 

This report has shown that in today’s society individual’s cannot prevent this rise in obesity on their own but that changes must be made across the whole of society to assist individual’s personal efforts to both lose weight and prevent weight gain.

 

Health impacts of obesity

Obesity is a risk factor for several conditions, especially abdominal obesity. These include coronary heart disease, type 2 diabetes (Wang et al 2005) and cerebrovascular disease (Kim et al 2004).

 

Benefits of weight loss

For obese people a weight loss of 5-10% can significantly improve health.

For someone weighing 100kg, a 10% weight loss can result in:

Blood Pressure                     10mmHg fall in systolic pressure

                                                20mmHg fall in diastolic pressure

Lipids                                     Drop of 10% total cholesterol

                                            Drop of 15% LDL (low density lipoprotein)                                                   cholesterol

Rise of 8% HDL (high density lipoprotein)cholesterol  Drop of 30% triglycerides

Diabetes (new diagnosis)    Reduction of 50% fasting glucose

 

From: Jung 1997; Mulvihill and Quigley, 2003

 

Impact of diet on weight gain

Today’s diet and lifestyle is considerably different to our ancestors who were more active and ate more natural, less refined foods. This contributes significantly to the current obesity epidemic. Evidence suggests that this gulf between the modern diet and less active lifestyle plays a significant role in the development of high blood pressure, diabetes and cardiovascular disease (O’Keefe and Cordain, 2006).

 

More fast foods are consumed which by nature tend to have a high fat and sugar content and a low fibre content (Bowman et al, 2004). Studies have shown that there is a connection between obesity and intake of fast foods. This may be due to people’s inability to reduce the amount of food eaten to maintain calorie intake. (Prentice and Jebb, 2003)

Portion sizes have also increased over the years to the extent where large portions are now considered the ‘norm’. By reducing portion sizes and energy dense food, energy intake can be significantly reduced.

 

High sugar drinks also appear to contribute to obesity as they are often consumed in addition to food rather than in place of it. (WHO 2003)

 

 

Impact of exercise on cardiovascular risk

 

A rise in the use of labour saving devices has resulted in reduced levels of exercise. Adults in the

UK

are recommended to engage in 30 minutes of physical activity five times a week just to maintain good health and 1 hour a day to lose weight. (Department of Health, DH, 2004a). But in reality only 37% of men and 24% of women achieve this goal (DH 2004b).

There is also a correlation between lack of exercise and consumption of a poor diet. Those who lead a sedentary lifestyle are less likely to eat a healthy diet compared to those who are more active (Gillman et al, 2001)

 

Management:

 

Careful assessment of the individual should be made to determine the most appropriate line of management.

Options include:

• Diet advice
• Medication
• Surgery

 

Role of the Nutritional Therapist:

 

• Information needs to be individualised depending on the client’s current diet, level of understanding and knowledge.
• Both long and short term goals should be set in conjunction with the client.
• Regular monitoring of progress
• Evaluation of effectiveness of diet plan and readjustment where necessary
• Referral to medical profession if felt necessary e.g. for assessment of lipid profile, diabetes management/medication.

 

 

Excess body fat is a significant risk factor for cardiovascular disease, hypertension and type 2 diabetes requiring lifestyle changes to minimise these risks.

 

Adapting lifestyle and diet can help achieve this but referral to the medical profession may be required for some.

 

All interventions must be aimed with the individual in mind and encouragement from therapists, family, friends and members of the medical team play a significant part in success.

 

Department of Health (2004a) At least five times a week: evidence on the impact of physical activity and its relationship to health. The Stationary Office,

London

 

Department of Health (2004b) Health Survey for England 2003: volume 2. Risk factors for cardiovascular disease. http://tinyurl.com/65sipp

 

Foresight (2007) Trends and drivers of obesity

 

Gillman MW, Pinto BM, Tennstedt S, Glanz K, Marcus B, Friedman RH (2001( Relationships of physical activity with dietary behaviours among adults. Prev Med 32 (3): 295-301

 

Health Survey for

England

(2006) Health Survey for

England

(2005): Latest trends. http://tinyurl.com/4knc5c

 

Jung R (1997) Obesity as a disease. Br Med Bull 53(2):307-21

 

Kim SK, Kim HJ,

Hur

,

KY

,Choi SH (2004) Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases. Am J Clin Nut 79(4):593-9

 

O’Keefe JH Jr, Cordain L (2004) Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21^st century hunter-gatherer. Mayo Clin Proc 79(1): 101-8

 

Prentice AM, Jebb SA (2003)Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev4(4): 187-94

 

World Health Organisation (2003) Diet, nutrition and the prevention of chronic diseases. Technical Report Series 916, www.who.int/dietphysical activity/publications/trs916/download/en/index.html