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Tackling obesity

Coordinated initiatives can battle obesity epidemic

UK urged to re-think obesity programmes
Increased coordination and government driven intervention needed
Philip James

In a second Keynote presentation at the 3rd BOMSS Annucal Scieidntific meeting, Professor Philip James, President of the INternational Association for the Study of Obesity, claimed that rising obesity levels could be stemmed through coordinated programmes and effective use of new data. He said that nationwide programmes in European countries had already worked to reverse rates of obesity and diabetes. A combinatory approach including regulation, taxation, and intervention in groups recognised as high-risk could have a real effect on rates of obesity.

However, the UK risked “losing out” unless the government adjusted its attitude towards battling obesity. “I think that we’re in danger of something bad”, he said.

Contradictory evidence

Obesity rates have doubled or even tripled in many countries since 1980. However, said James, some evidence suggests that rates are beginning to stabilise. In 2008, the Centre for Disease Control in the USA said that the epidemic in American had stopped; between 2000 and 2008, there was a slight median increase in male obesity, and no increase in women.

Despite this, said James, diabetes rates are expected to continue to rise. One study (Brown et al, February 2010: National Heart Forum) has projected that more than 6.6% of the UK population will have diabetes by 2046. “There isn’t a country in the world that is going to be able to treat diabetes long-term,” said James.

James also voiced his fears of an “intergenerational amplification” in obesity rates. One study found a positive correlation between a mother’s pre-pregnancy BMI and her child’s resultant fat mass index (FMI). The effect was particularly pronounced in girls: the average FMI for girls with mothers with BMI between 20.3 and 21.9 was 1.8; this rose to 2.4 when the mothers’ BMI rose above 24.3 (p < 0.001). 

This could lead to an effect whereby current levels of obesity could feed into increased levels of obesity in the next generation. 

European initiatives

James did, however, offer hopeful evidence that these trends could be reversed. Effective intitiatives, he said, worked through raising the price of fatty food, limiting its marketing, or limiting its availability.

Countries in Europe have begun to introduce initiatives along these lines. Denmark, Austria and Switzerland have banned trans fats, while Finland and Hungary have introduced taxes on foods with high fats, salts and sugars.

In France, the government has taken total control of food and drink in schools, banned marketing to children, and restricted marketing of foods high in fat, sugar and salt unless it is taxed and marketed with a health warning. In 2000, 18.1% of children were overweight and 3.8% were obese. By 2007, this had dropped to 15.5% and 2.8% respectively.

Finland’s FINRISK system identifies groups who are at risk of developing diabetes by observing factors including weight and family history, and engages them in detailed intervention, encouraging them to live a heathier lifestyle. Over a period of five years, says James, they have managed to shift the distribution of obesity in Finland.

James was less optimistic about the UK government’s attempts to tackle obesity, which are mostly pinned on a voluntary “Responsibility Deal” with food manufacturers to encourage them create healthier products and inform customers on the risk. “Most of the measures that have been taken, a lot of them have been rescinded in the last few months,” he said. 

However, he encouraged the British bariatric community to engage in a public debate. “Can we start making progress and getting obesity rates down? Yes. We might be able to shame the UK into doing things. Doctors, by getting organised and being coherent, can [have an effect], not just for the benefit of the few, but the many,” he said.

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