Obesity as a Pandemic BY /Essam Adel Wahab Associated lecturer of Internal Medicine
Rise in Childhood Obesity Bundred et al, BMJ Feb 2001
Most important disease states in the world? 2020 1990 Communicable Diseases Chronic Disease Injuries Source : Harvard School of Public Health
Obesity Trends Among U.S. Adults (BMI > 30) BRFSS, 1991, 1995, and 2000 1991 1995 2000 No Data < 10% 10%-14% 15-19% 20%
Global effect of Over weight
Globally WHO estimates that:
58% of Diabetes mellitus,
21% Ischemic heart diseases,
4-42% of certain cancer,
Were attributable to BMI above 21 kg/m²
Prevalence of overweight and obesity * Obesity only
Over weight and Obesity among females is 54% & 48%among Male
Hazards of the obesity اضرار السمنة Financial costs Health problems
£2.6 billion pa, UK (1998)
Co-morbidities, health service expend, prescriptions,hospitals, drugs
Disability, unemployment, early retirement
18 million sick days, 40 000 lost years working life, obese die 9 years early
Loss self esteem, relationships, pain
The Costs of Obesity
Burden of Obesity
Obesity is killing around, 150.000 men and women each year.
Health Risks of Excessive Fat
Impaired cardiac function
HPN, stroke, and DVD
Type 2 diabetes (80% of these patients are overweight)
Osteoarthritis, degenerative joint disease, gout
Endometrial, prostrate. breast, colon cancers
Abnormal plasma lipid and lipoprotein levels
Physical Effects of Obesity Cardiovascular Respiratory disease Gall bladder disease Hormonal abnormalities Hyperuricaemia and gout Stroke Diabetes Osteoarthritis Cancer
chronic diseases result in percent of deaths worldwide... 4 50 Cardiovascular Chronic Respiratory Disease Type 2 Diabetes Cancer
Association of Obesity and related diseases Obesity Cancer Gall-bladder disease Kidney failure Stroke Heart failure Hyper-tension Type 2 diabetes Athero-sclerosis
RISK FACTORS Diabetes 2 in 10 Hypertension 1 in 4 Smoking 1 in 3 Obesity 1 in 2 Dyslipidaemia 1 in 2 Physical Inactivity 8 in 10
Source : Hinkle et al., CDC 1997 What matters most in health care? Lifestyle Factors Human Biology Environmental Factors Medical Care
3 … and are caused by risk factors Tobacco Poor Diet Lack of Exercise
Size is every thing
Obesity is caused by what?
Rare syndromes can be identified with monogenic aetiologies ( e.g.leptin deficiency)
Polygenic conditions can be identified with obesity as part of the syndrome (Prader-Willi syndrome )
Majority of obesity is caused by an imbalance between energy consumption and energy expenditure…
Energy Expenditure Energy Intake الميزان
Pathways to Obesity
Fat intake (“cafeteria” diet)
Inactivity (25% get regular exercise)
“ Thrifty genome”
Combinations of above
Or, in simple terms
… We are eating too much and doing too little exercise
Body fat distribution Apple shaped obesity Women >88 cm (80cm) = Increased risk Men >102 cm (90cm) = Increased risk cm
Waist Measurement or BMI?
WHO criteria for Over weight and Obesity
Overweight = BMI of 25-29 Kg/ m²
Obesity = BMI of 30 kg/ m²
How to deal ???
“ Obesity cannot be prevented or managed solely by governments (or health professionals). The food industry, international agencies, the media, communities and individuals need to work together so that the environment is less conducive to weight gain”
Governments : “Food is the responsibility of the individual”
Doctors: “Diabetes is a disease, but obesity is compatible with a long and happy life”
Scientists: “Obesity is genetic”
Rich individuals: “I only eat lettuce”
Poor individuals: “The best value meal I can find is fast food”
Nonsense! Nonsense! Nonsense! Nonsense! True!
Role of Media
Food is advertised, and marketed. Choices depend on availability Governments have a responsibility for food standards and labelling
Los Angeles 25 th Nov 2003
What we need
Role of media.
Role of health providers.
Role of person.
Last options – Surgery, drugs.
Success in weight management? Starting weight Time Natural course of weight gain Increasing success Body weight (kg) Weight loss phase Weight maintenance phase years months
Heads of state: Not in focus
Health ministries: Inadequate capacity and budget
WHO: Has tried for 48 years
Academic health centres: Not a priority
International donors: Only for HIV/AIDS (tobacco)
Private-public partnerships: All on infectious diseases
Global NGOs: No support
Pharmaceutical industry: Major contribution??????????????????????
Who is responsible for policy response to Obesity?
Multiple stakeholder interventions can be effective
Prevention of smoking in public places
Health campaigns to stop smoking
Transport smoking bans
Health warnings on packets
Raising community awareness (Eat less – Walk more):
Since obesity is the major risk factor, not only for diabetes, but also for hypertension and cardiovascular diseases, it is essential to create awareness in the community about obesity, the risk factors involved and the importance of a healthy lifestyle, including intake of fewer calories and more physical activity.
NEGLECTING OVERWEIGHT-OBESITY IS A disaster
“ All segments of the society must unite across the world to provide a global obesity
NO MATTER HOW FAR YOU HAVE GONE ON THE WRONG ROAD, JUST TURN BACK
عن صالح بن يحيى بن المقدام : سمعت رسول الله صلى الله عليه وسلم يقول : ( ما ملأ آدمي وعاءً شراً من بطن، حسبك يا ابن آدم لقيمات يقمن صلبك ، فإن كان لا بد ، فثلث طعام ، وثلث شراب ، وثلث نفس . صدق رسول الله