Globesity marches on

30-May-2014

Worldwide, there has been a startling increase in rates of obesity and overweight in both adults (28% increase) and children (up by 47%) in the past 33 years, with the number of overweight and obese people rising from 857 million in 1980 to 2.1 billion in 2013, according to a major new analysis from the Global Burden of Disease Study 2013, published in The Lancet.1

Almost a third of the world is now fat, and no country has been able to curb obesity rates in the last three decades. However, the rates vary widely throughout the world, with more than half of the world\'s 671 million obese individuals living in just 10 countries: the US (more than 13%), China and India (15% combined), Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia.

In the past 30 years, the highest rises in obesity levels among women have been in Egypt, Saudi Arabia, Oman, Honduras and Bahrain, and among men in New Zealand, Bahrain, Kuwait, Saudi Arabia, and the US. In high-income countries, some of the biggest increases in adult obesity prevalence have been in the US (where roughly a third of the adult population is obese), Australia (where 28% of men and 30% of women are obese) and the UK (where around a quarter of the adult population is obese).

The findings come from new analysis of the global, regional and national prevalence of overweight and obesity in adults aged 20 years and older and in children and adolescents aged 2–19 years. The statistics cover 1980 to 2013.

"It\'s pretty grim," said Christopher Murray of the Institute for Health Metrics and Evaluation at the University of Washington, who led the study. He and colleagues reviewed more than 1,700 studies covering 188 countries.

"When we realised that not a single country has had a significant decline in obesity, that tells you how hard a challenge this is."

Murray said there was a strong link between income and obesity; as people get richer, their waistlines also tend to start bulging. He said scientists have noticed accompanying spikes in diabetes and that rates of cancers linked to weight, such as pancreatic cancer, are also rising.

Unlike other major global health risks, such as smoking and childhood nutrition, obesity is not decreasing worldwide

The authors warn that the study presents a worrying picture of substantial rises in obesity rates across the world and say that concerted action is urgently needed to reverse this trend. Unlike other major global health risks, such as smoking and childhood nutrition, obesity is not decreasing worldwide. The findings show that increases in obesity have been substantial, widespread, and have arisen in a short time. However, there is some evidence of a plateau in adult obesity rates that provides some hope that the epidemic might have peaked in some developed countries and that populations in other countries might not reach the very high rates of more than 40% reported in some developing countries.

"Our analysis suggests that the UN\'s target to stop the rise in obesity by 2025 is very ambitious and is unlikely to be achieved without concerted action and further research to assess the effect of population-wide interventions, and how effectively to translate that knowledge into national obesity control programmes. In particular, urgent global leadership is needed to help low-and middle-income countries intervene to reduce excessive calorie intake, physical inactivity, and active promotion of food consumption by industry," added Murray.

Key Findings
In the developed world, men have higher rates of obesity than women, whereas the opposite is true in developing countries. Currently, 62% of the world\'s obese people live in developing countries.
The greatest gain in overweight and obesity occurred globally between 1992 and 2002, mainly among people aged between 20 and 40.
Especially high rates of overweight and obesity have already been reached in Tonga where levels of obesity in men and women exceed 50%, and in Kuwait, Libya, Qatar and the Pacific Islands of Kiribati, Federated States of Micronesia and Samoa, where most (more than 50%) of women are obese.
The prevalence of overweight and obesity in childhood has increased remarkably in developed countries, from 17% in 1980 to 24% in 2013 in boys and from 16–23% in girls. Similarly, in developing countries, rates have risen from roughly 8–13% in both boys and girls during the three decades.
In 2013, the proportion of obesity in girls reached 23% in Kuwait and 30% or more in Samoa, Micronesia and Kiribati, the highest levels calculated. Similar trends in obesity were found in boys, with the Pacific Islands of Samoa and Kiribati showing the greatest obesity prevalence.
In Western Europe, levels of obesity in boys ranged from 14% in Israel and 13% in Malta, to 4% in the Netherlands and Sweden. Levels of obesity in girls were highest in Luxembourg (13%) and Israel (11%), and lowest in the Netherlands Norway and Sweden (4%).
In developed countries, the rate of increase in adult obesity has started to slow down in the past 8 years, and there is some evidence that more recent birth cohorts are gaining weight more slowly than previous ones.

NICE recommendations

In a timely announcement, the UK\'s National Institute for Health and Care Excellence (NICE) has recently stated that adults who are overweight or obese can improve their health by losing even a small amount of weight – if they keep it off.2 Obesity increases the risk of serious conditions, including diabetes, heart disease and some cancers. Although the greater the weight loss, the greater the benefit; even a modest weight loss of 3% kept off for life may improve or prevent health problems.

New guidance published by NICE looks at how lifestyle weight management programmes focusing on diet, activity and the way people live their lives (behaviour change) can help people who are overweight or obese to lose weight and to keep it off.3 Professor Mike Kelly, Director of the Centre for Public Health at NICE, said: "The number of people who are overweight or obese in England is rising. More than a quarter of adults are now classified as obese and a further 42% of men and a third of women are overweight.4 It not only damages their health but dealing with the long-term consequences of obesity costs the NHS around £5.1 billion each year. It is a huge cost to the health service.

Lifestyle weight management programmes can help people to identify strategies that suit them

Lifestyle weight management programmes can help people to identify strategies that suit them

"Lifestyle programmes are one part of the solution. An environment that makes it easier for people to be active and eat well is also crucial, as are services for people with other issues that affect their health and well-being.5 The guidance isn\'t about quick fixes. There is no magic bullet. It is about ensuring effective services are there to support people in the long-term."

Professor Kate Jolly, Professor of Public Health at the University of Birmingham and NICE guidance developer, said: "Obesity and overweight is an immense problem in our society – with huge personal health cost to individuals and a huge financial cost to the NHS. However, by losing even a small amount of weight and keeping it off, overweight and obese people can improve their health. We all know that eating less and being more active will help us to lose weight, but it can be quite hard to put it into action, especially in the long-term, which is why some people need additional support. Lifestyle weight management programmes can help people to identify strategies that suit them to help maintain these changes in the future."

Recommendations in the new guidance include:

  • Ensuring services cause no physical or mental harm
  • Addressing the expectations and information needs of adults thinking about joining a lifestyle weight management programme
  • Improving programme uptake, adherence and outcomes
  • Commissioning programmes that include the core components for effective weight loss and prevent weight regain
  • Referring overweight and obese adults to a lifestyle weight management programme

Industry response

Dr Sally Norton, NHS weight-loss surgeon, expert and consultant, and founder of Vavista.com, commented: "I welcome these recommendations, which are so in-tune with my research and experiences in dealing with misguided weight-loss advice and solutions. Current approaches are clearly not working and quick fix diets are just adding to a growing list of long-term obesity and health issues – the fall-out of which is placing bigger and bigger demands on the NHS."

The NICE analysis showed that, on average, participants of weight loss programmes lost less than 1.5kg of weight after two years. Norton noted: "It’s important, therefore, that the NHS does not simply leap into a scheme to offer a solution but, instead, works with companies to test and evaluate offerings that genuinely can make a difference to our approach to weight-loss to successfully relieve the growing time and financial pressures on the NHS." As a weight-loss surgeon, Norton has people queuing at the door for weight-loss surgery because the currently available diets simply do not work and just lead to abnormal eating behaviour that cost the NHS hundreds of thousands of pounds each year.

Mobile and Internet technology have had an enormous impact on lifestyle management programmes

Tim Davis, CEO and Founder of Exco InTouch, added: "The prevalence of chronic diseases such as diabetes is growing rapidly, causing enormous pressure on the NHS and, of course, on people’s lives. It’s great to see that NICE recognises the need to help people change their behaviour and better manage their lifestyles rather than simply telling them to change without the support and guidance required to do so. Mobile and Internet technology have had an enormous impact on lifestyle management programmes. Some already choose to download apps that tackle aspects such as calorie counting, activity tracking and the like. However, although take-up for these standalone apps is growing, dropout rates are very high as people lose interest or motivation after a few weeks."

Exco InTouch has, for some time, been building lifestyle management programmes based on many years of patient intervention, and has found that to achieve behavioural change for sustained periods of time, a holistic approach is required to build a collaborative relationship with the individual. This is achieved, says Davis, by creating adaptive programmes that capture the type of information you might expect – activity, diet and how you are feeling today – but that goes further than simply tracking this data, adapting the interface, the motivation aspects and the information shared according to the progress of each individual.

To achieve behavioural change for sustained periods of time, a holistic approach is required

Davis concluded: "Setting a target of losing a stone can be disheartening and demotivating. But, by combining an adaptive programme with guidance on setting personal, but realistic goals – maybe just losing a pound a week and cheering you on as you meet it each week – can make all the difference. Some solutions even go a step further; for instance, a system to allow people to join together and work through collaborative goals, linking people and providing additional motivation to achieving common goals. These emerging adaptive solutions that support patient’s real-world needs and provide a more targeted and effective engagement with their healthcare services are leading the way in addressing the unprecedented challenges faced by the NHS in meeting the obesity epidemic."

A healthier future

Commenting on the implications of the study, Professor Klim McPherson from Oxford University, said: "An appropriate rebalancing of the primal needs of humans with food availability is essential, which would entail curtailing many aspects of production and marketing for food industries. To prevent unsustainable health consequences, BMI levels need to return to what they were 30 years ago. It has been calculated that to reduce BMI figures to 1980 levels in the UK would require an 8% reduction in consumption across the country, costing the food industry roughly £8.7bn per year."

He added: "The solution has to be mainly political and the questions remain, as with climate change, where is the international will to act decisively in a way that might restrict economic growth in a competitive world, for the public’s health? Nowhere yet, but voluntary salt reduction might be setting a more achievable trend. Politicians can no longer hide behind ignorance or confusion."

References

1. M. Ng, et al., \'Global, Regional and National Prevalence of Overweight and Obesity in Children and Adults During 1980–2013: A Systematic Analysis for the Global Burden of Disease Study 2013,\' The Lancet: DOI: 10.1016/S0140-6736(14)60460-8 (2014).

2. NICE, \'Adults Who Are Obese Can Improve Their Health by Losing Even a Small Amount of Weight\', www.nice.org.uk/newsroom/pressreleases/NICEAdultsObeseImproveHealthLosingEvenSmallAmountOfWeight.jsp.

3. www.nice.org.uk/guidance/index.jsp?action=byID&o=14530.

4. Statistics on Obesity, Physical Activity and Diet — England, 2014: http://www.hscic.gov.uk/catalogue/PUB13648.

5. They might include a behavioural issue such as substance misuse, specific conditions such as those limiting mobility or learning, mental health conditions, substantive or life-threatening comorbidities, dietary needs or personal social circumstances such as homelessness.

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