Environmental Waist Health and Social Implications

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Environmental WaistHealth and Social Implications

• Professor Iain Broom
• Research Professor and Consultant in
• Clinical Biochemistry and Metabolic Medicine
• The Robert Gordon University and NHS Grampian

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• Homo Sapiens Homo Adipatus
• 50 Years
• A NEW SPECIES ?

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Homo Adipatus
Homo Sapiens
2.5 Million Years
50 Years
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Factors involved in the creation of Homo
Adipatus
Genetic
Biochemical
Neurologic andPhysiologic
Cultural and Socio-economic
Environmental
1. Adapted from Weighing the Options 199552. 2.
Clinical guidelines. National Heart, Lung, and
Blood Institute Web site. Available at
http//www.nhlbi.nih.gov/guidelines/obesity/ob_hom
e.htm. Accessed March, 2001.
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Abdominal Fat DistributionObesity and Risk

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Definition of Metabolic SyndromeWHO and ATP III
(1)
Risk factor WHO ATP III Fasting glucose gt
6.1 mmol/L gt 6.1 mmol/L 2h post-OGTT glucose
- gt 6.7 mmol/L Insulin resistance
- Yes Abdominal obesity Men WC gt 102
cm WC gt 102 cm Women WC gt 88 cm WC gt 88
cm
WHO (website)_ NCEP Expert Panel - ATP III JAMA
2001 2852486-97
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Definition of Metabolic SyndromeWHO and ATP III
(2)
Risk factor WHO ATP
III Triglycerides gt 1.7 mmol/L gt 1.7
mmol/L HDL-cholesterol Men lt 0.9
mmol/L lt 1.0 mmol/L Women lt 1.0
mmol/L lt 1.3 mmol/L Blood pressure gt
140/90 mm Hg gt 130/85 mm Hg Microalbuminuri
a UAE gt 20 g/min or albcreatinine gt 30 mg/g
WHO (website)_ NCEP Expert Panel - ATP III JAMA
2001 2852486-97
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Metabolic Syndrome
? LDL ? VLDL ? HDL
Hyperinsulinaemia
? Na ? SNS
OBESITY
Insulin Resistance
Lack of Exercise
Hypertension
Inherited Factors
Inability of beta-cells to compensate
Type 2 Diabetes
IGT
? CVS risk
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Prevalence of Metabolic Syndrome
US adults 23.7 men 24.0, women 23.4 (Data
from NHANES III) 8.8 - 14.3 of middle-aged men
in Finland 23 of men, 12 of women in France 56
of overweight and obese patients with CV risk
factors in France 40 of obese patients in
Sweden Marques-Vidal Diabetes Care 2002 25
1371-1377 Ford JAMA 2002 287 356-359 Lakka JAMA
2002 288 2709 - 2716 Davidson ADA 2003
Guy-Grand ECO 2003
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Obesity Prevalence UK 1980 - 2010
? ?
31 29
30 20 10
23 21
16 14
8 6
1980 1990 2000 2010
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Prevalence of overweight obesity in England
Wales
Classification BMI (kg/m2) Population Pre-obese
26-29 gt 50 Obese gt 30 23
males 23 females
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The prevalence of obesity
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All data 1991 or later
Men
Women
30
population with BMI ³30 kg/m2
20
10
0
UK
France
Czech Republic
Russia
Finland
Canada
USA hispanics
Australia
E Germany
USAwhite
W Germany
Netherlands
USAblacks
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BMI distribution in obese sub sample compared
across Counterweight regions
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Economic costs of obesity

• Country Year Definition Estimated
  national health of
  obesity direct costs care costs
• Australia 1989-90 gt30 AU 464 million
  gt2
• France 1992 ³27 FFr 12 000 million
  2
• Netherlands 1981-89 gt25 Dfl. 1000 million
  4
• USA 1995 ³29 US 51.64 billion 5.7

WHO Obesity preventing and managing the global
epidemic. WHO, 1998Wolf AM, Colditz GA. Obesity
Research 1998
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Consequences of obesity
Stroke
Cardiovascular risk factors
Respiratory disease
Heart disease
Diabetes
Gall bladder disease
Osteoarthritis
Cancer
Hormonal abnormalities
Hyperuricaemia and gout
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Comorbidity Costs 1995/6e

• Disease Total Cost PAF Obesity Cost
• Million age Million
• ________________________________________________
• Diabetes 2,350 49.0 1,151.5
• Hypertension 364 20.0 72.8
• IHD 1,326 19.0 251.94
• Stroke 1,343 5.0 67.15
• Cancer 1,043 2.3 23.98
• Musculoskeletal 1,230 10.0 123.00
• __________________________________________________
  __
• Total cost of Comorbidities 1,690,379,000

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Obesity is the Primary Risk Factorfor Type 2
Diabetes
Age-adjusted relative risk of type 2 diabetes
50
100
93
Men1
Women2
42
40
75
30
50
40
20
12
25
10
2.2
8.1
1.0
1.0
0
0
lt23
25
31
?35
lt22
25
31
?35
BMI
1Chan JM et al. Diabetes Care 1994 17 961-9
2Colditz G et al. Ann Intern Med 1995 122 481-6
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Increasing prevalence ofType 2 Diabetes
Millions of People
300
Industrialisedcountries
Industrialisingcountries
200
170
42
100
0
1995
2025
1995
2025
Venkat Narayan KM. Diabetes Res Clin Pract 2000
50 (Suppl. 2) S77-84
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Environmental changesEvolutionary Flashpoint

• Energy Expenditure
• Energy Intake
• Automation
• COMPUTERISATION

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Calories Usage changed over 50 years

• Per week 1950s / 2000s
• Shopping on foot/car supermarket 2400 / 275
• Washing clothes by hand/machine 1500 / 270
• Making a coal fire/gas fire 1300 / 3
• Per hour
• Hand lawn mower/electric mower 500 / 180
• No power steering/ with power 96 / 75

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School Children involved in sporting activities
(USA)
H/S - High School M/S - Middle School
1991 1999
80 60 40 20
H/S M/S H/S M/S Data
from Centre for Disease Control 2000
3 DROP per annum
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Computerisation and Obesity

• Year Computer Status Obesity
• 1979 First desktop Computer 6 8
• 1980s Computerised machines 12 14
• Microwaves
• Automated Washing Machines
• 1990s Computer Games 16 18
• Childhood obesity
• 2000s Widespread computerisation
• Globalisation
• Free Market Economy 23
• expenditure on computer Childhood obesity
• education and comorbidities
• School activity (Sport)

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The Risk Society

• Not all environmental by force of nature (eg
• global warming)
• Interrelated changes within contemporary
• social life
• Shifting employment patterns
• Heightened job insecurity
• Erosion of traditional family patterns

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Index of Economic Freedom (IEF) and Obesity Rates
Country IEF OBESE Australia 1.88 20 Fr
ance 2.63 8 Finland 1.95 13 Netherlands
2.04 8 Norway 2.25 7 UK 1.79 17 US
A 1.85 25
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Globalisation and the Free Market Economy

• AUSTRALIA, USA and UK - DEREGULATED in an
• uncontrolled fashion with no political
  intervention
• NETHERLANDS - CONTROLLED DEREGULATION
• prevention of inequalities in job security
• food choice and leisure time activities
• SCANDINAVIA - similar political
  intervention to
• regulate the forces of globalisation

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Globalisation

• Effects are not inevitable
• Political intervention is possible
• Beneficial effects on
• Food consumption
• leisure time energy expenditure

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Treatment/Prevention Strategies

• Not just an NHS issue
• Government (local and national)
• inter-department cooperation
• Public and Government Education
• Simple Messages do not work
• Complex related strategies needed

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Treatment/Prevention Strategies

• Population
• Society
• Individual