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Published on May 8, 2008

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ACHSE Symposium on Obesity, August 2007, Melbourne Obesity: Understanding the “Millennium Disease”:  ACHSE Symposium on Obesity, August 2007, Melbourne Obesity: Understanding the “Millennium Disease” Louise A Baur Discipline of Paediatrics & Child Health, University of Sydney NSW Centre for Overweight & Obesity The Children’s Hospital at Westmead Email: louiseb3@chw.edu.au Obesity:  One of today’s most blatantly visible – yet most neglected – public health problems The public health equivalent of climate change The Millennium Disease Obesity WHO; www.who.int/nut/obs.htm; Laing & Rayner, Obesity Reviews 2007; www.iotf.org How big is the problem for Australian adults?:  How big is the problem for Australian adults? Australian adults 1999-2000: 2 out of 3 men and 1 in 2 women overweight or obese … and 1 in 5 obese:  Australian adults 1999-2000: 2 out of 3 men and 1 in 2 women overweight or obese … and 1 in 5 obese Overw’t & obesity Obesity (BMI >25 kg/m2) (BMI >30 kg/m2) Adult males 67.5% 19.3% Adult females 52.2% 22.2% AusDiab Study: Cameron et al, MJA 2003 Measured heights & weights; adults >25 y Risks of obesity in Caucasians:  Risks of obesity in Caucasians Relative risk Greatly increased (RR >>3) Moderately increased (RR 2–3) Slightly increased (RR 1-2) Disease Type 2 diabetes Dyslipidaemia Insulin resistance Sleep apnoea Gall bladder disease Heart disease Hypertension Cancer Osteoarthritis Gout Infertility Anaesthetic risk Polycystic ovary syndrome Obesity is associated with high costs:  Obesity is associated with high costs The economic costs of obesity. Access Economics, 2006. Financial cost of obesity $ 3.8 billion Net cost of lost well-being $17.2 billion Total cost of obesity $21.0 billion What about children and adolescents?:  What about children and adolescents? Slide8:  Trends in combined overweight & obesity in school-aged children since 1970 0 5 10 15 20 25 30 35 1970 1980 1990 2000 Prevalence % Lobstein et al. Obesity Reviews 2004 Slide9:  Trends in combined overweight & obesity in school-aged children since 1970 0 5 10 15 20 25 30 35 1970 1980 1990 2000 Prevalence % Lobstein et al. Obesity Reviews 2004 NZ - 2002 NSW - 2004 Lobstein et al. Obesity Reviews 2004; NZ Children’s Nutrition Survey 2002; NSW Schools Physical Activity & Nutrition Survey, Booth et al, 2006 Slide10:  Trends in combined overweight & obesity in school-aged children since 1970 0 5 10 15 20 25 30 35 1970 1980 1990 2000 Prevalence % Lobstein et al. Obesity Reviews 2004 NZ - 2002 NSW - 2004 Lobstein et al. Obesity Reviews 2004; NZ Children’s Nutrition Survey 2002; NSW Schools Physical Activity & Nutrition Survey, Booth et al, 2006 1 in 4 Australia children & adolescents are overweight or obese Prevalence rates are increasing Slide11:  Complications of obesity in children and adolescents Source: Ebbeling et al, Lancet 2002 Slide12:  Complications of obesity in children and adolescents Source: Ebbeling et al, Lancet 2002 What are the health & economic consequences of increased numbers of adolescents entering adulthood with: Established obesity Established type 2 diabetes Risk factors for heart disease & diabetes Other co-morbidities? What causes obesity?:  What causes obesity? Slide14:  Genetic predisposition Chronic energy imbalance What are the factors in our environment promoting the development of obesity?:  What are the factors in our environment promoting the development of obesity? Summary of trends in obesity-related behaviours - 1:  Summary of trends in obesity-related behaviours - 1       ADULTS CHILDREN & ADOLESCENTS Weight-related behaviour Current situation Recent trends Current situation Recent trends High Increased slightly (3-4%) High Increased substantially (11-15%) Total sugar intake High Increased (6-12%) High Increased substantially (19-25%) Sweetened drink intake High Increased (9-15%) High Increased substantially (29-48%) NSW Centre for Public Health Nutrition 2003 Australian data for longitudinal trends Summary of trends in obesity-related behaviours - 2:        ADULTS CHILDREN & ADOLESCENTS Weight-related behaviour Current situation Recent trends Current situation Recent trends Fast food intake High Increased High Increased Confectionery Moderate Increased (28%) High Substantial increase (40-56%) Level of physical activity Low Decreased (9%) Moderate Probably stable Passive leisure TV, computer games .. High Probably stable High Increased Active travel to work/school Low Decreased Low Decreased NSW Centre for Public Health Nutrition 2003 Australian data for longitudinal trends Summary of trends in obesity-related behaviours - 2 What factors are influencing food and physical activity behaviours?:  What factors are influencing food and physical activity behaviours? The rise in home TV, video, DVD, Playstation and IT use by children and adults :  The rise in home TV, video, DVD, Playstation and IT use by children and adults Slide20:  The changing food environment Slide21:  http://hp2010.nhlbihin.net/portion/index.htm 20 y ago Now Portion sizes have increased Per capita consumption of milk and soft drink - Australia:  Per capita consumption of milk and soft drink - Australia 0 20 40 60 80 100 120 140 160 Per capita consumption (L) Milk Soft drink 1939 1949 1959 1969 1979 1989 1999 Apparent Consumption of Foodstuffs. ABS 4306.0 ? What role marketing?:  What role marketing? TV and radio (ads, program sponsorship, product placement) Cinema (ads, product placement) Websites Phone promotions Text messaging Direct marketing Sponsorship of events, teams, clubs Branded toys & computer games In store (shelf, special offers, displays) On, or in, the product (product formulation, portions, gifts & vouchers) Schools (sponsorship, vending machines, participation in promotion schemes) Blogs Interactive digital billboards The wide range of types of marketing of foods & beverages Slide24:  What about advergaming? On-line games involving consumer products Changing urban landscape – the car rules:  Changing urban landscape – the car rules Urban planning that promotes car use rather than “walkability” and active transport:  Urban planning that promotes car use rather than “walkability” and active transport Where is the play space?:  Where is the play space? In the early 21st century the unhealthy choices (around food and physical activity) are the easy choices:  In the early 21st century the unhealthy choices (around food and physical activity) are the easy choices We live in the most obesity-conducive environment known in the history of humankind So, how do we tackle this epidemic?:  So, how do we tackle this epidemic? Slide30:  Individual behaviour change Adapted from Puska P, 2004 Healthy eating Healthy activity Healthy weight Complementary approaches to prevention The environmental gradient is steep Environmental change Slide31:  Individual behaviour change Adapted from Puska P, 2004 Healthy eating Healthy activity Healthy weight Complementary approaches to prevention So, changing the gradient … Environmental change Slide32:  Individual behaviour change Adapted from Puska P, 2004 Healthy eating Healthy activity Healthy weight Complementary approaches to prevention … will make it easier to change behaviour Environmental change Slide33:  So, what approaches can: Make the gradient less steep? and/or Support individuals and families to change behaviour? Some of the Australian obesity policies and guidelines to date:  Some of the Australian obesity policies and guidelines to date Slide35:  ! The reports have lots of great ideas The challenge has been getting them into funded policy Many types & levels of intervention are needed:  Many types & levels of intervention are needed SUPPORTING FAMILIES - parenting support healthy food & activity environments in child care SCHOOLS/ CHILD CARE healthy school canteens support & fund PE & sports vending machines school sponsorships URBAN DESIGN protect open spaces pedestrian precincts, bike paths links with public transport HEALTH CARE health professional training coordinated health service delivery funding for services MARKETING & MEDIA regulation of food marketing to children promotion of fruit & veg public health campaigns underpinning other strategies FOOD INDUSTRY healthy food choices portion sizes food labelling TRANSPORT - expand & support public transport & active transport WORK SITES healthy food choices physical activity opportunities Many types & levels of intervention are needed:  Many types & levels of intervention are needed SUPPORTING FAMILIES - parenting support healthy food & activity environments in child care SCHOOLS/ CHILD CARE healthy school canteens support & fund PE & sports vending machines school sponsorships URBAN DESIGN protect open spaces pedestrian precincts, bike paths links with public transport HEALTH CARE health professional training coordinated health service delivery funding for services MARKETING & MEDIA regulation of food marketing to children promotion of fruit & veg public health campaigns underpinning other strategies FOOD INDUSTRY healthy food choices portion sizes food labelling TRANSPORT - expand & support public transport & active transport WORK SITES healthy food choices physical activity opportunities Most of these settings for intervention are beyond the scope of the Health Sector! So, what can the Health Sector do to tackle obesity - 1?:  So, what can the Health Sector do to tackle obesity - 1? Opportunities for Primary Prevention: Leadership in advocating for health promotion & obesity prevention Interventions with other sectors (transport, agriculture, education, local government, urban planning …) Health services and hospitals: Healthy food policies (Sydney-West Area-Health Service is finalising policies for contracts with food vendors) Planning to promote physical activity (eg public transport, walkability, sign-posted stairwells, staff pedometers & gyms) Sponsorship & marketing policies etc….. So, what can the Health Sector do to tackle obesity - 2?:  So, what can the Health Sector do to tackle obesity - 2? Effective management of obesity & co-morbidities Models of care required for obesity, not just its co-morbidities Consider adapting the Chronic Disease Care pyramid Slide40:  Level 1 70-80% of o’wt/obese patients Self-care & community based care Level 2 High risk patients Multidisciplinary care Level 3 Obesity and the chronic disease care pyramid Complex patients Specialist care GPs, other 1o care Group programs Acute care facilities Specialist allied health Group programs Acute care facilities & special obesity clinics Specialist teams Health promotion Slide41:  Level 1 70-80% of o’wt/obese patients Self-care & community based care Level 2 High risk patients Multidisciplinary care Level 3 Obesity and the chronic disease care pyramid Complex patients Specialist care GPs, other 1o care Group programs Acute care facilities Specialist allied health Group programs Acute care facilities & special obesity clinics Specialist teams Health promotion So, what can the Health Sector do to tackle obesity - 2?:  So, what can the Health Sector do to tackle obesity - 2? Effective management of obesity & co-morbidities Models of care required for obesity, not just its co-morbidities Consider adapting the Chronic Disease Care pyramid How do primary care, the community health sector & secondary & tertiary care services link up around obesity? So, what can the Health Sector do to tackle obesity - 2?:  So, what can the Health Sector do to tackle obesity - 2? Effective management of obesity & co-morbidities Models of care required for obesity, not just its co-morbidities Consider adapting the Chronic Disease Care pyramid How do primary care, the community health sector & secondary & tertiary care services link up around obesity? Equipment and protocols for sensitively managing larger patients Bariatric surgery implications Management of patients who have obesity complicating the disease which is their primary reason for contacting the health system Obesity - summary:  Obesity - summary The Millennium Disease – a major public health problem Healthy lifestyle choices for individuals and families are difficult in 21st century Australia Obesity – the questions to consider::  Obesity – the questions to consider: How do we make the environmental gradient less steep? How do we support individuals and families so they can make healthy lifestyle choices? What models of care are needed to treat the large numbers of affected people? Extra slides:  Extra slides Slide48:  http://www.iuns.org/features/obesity/tabfig.htm#Figure%201: Adult obesity – prevalence in different countries Health consequences of adult obesity:  Health consequences of adult obesity Being obese at age 40 y takes 7 y off your life Being overweight at age 40 y takes 1 y off your life Obesity leads to a more than 3-fold risk of: type 2 diabetes, high blood pressure, sleep apnoea, insulin resistance, breathlessness … and increases the risk of many other diseases Peeters et al Ann Intern Med 2003 WHO, 2002 Slide50:  Economic costs of obesity. Access Economics 2006. Web-site: http://www.accesseconomics.com.au/publicationsreports/showreport.php?id=102 Net financial cost of obesity: $3.767 billion Net cost of lost well-being (dollar value of burden of disease): An additional $17.2 billion How would you respond to a disease with the following characteristics? Take 1:  How would you respond to a disease with the following characteristics? Take 1 Affecting increasing numbers of the population – mainly adults, but increasingly seen even in children Associated with decreased quality of life, increased disability and shortened life expectancy Strong genetic predisposition Globally prevalent High economic burden A significant contributor to death from other major diseases Most health professionals are untrained in its management !!!!!!!!!!:  !!!!!!!!!! Action stations! How would you respond to a disease with the following characteristics? Take 2:  How would you respond to a disease with the following characteristics? Take 2 Strong genetic predisposition, but this is only manifest in a given environment Highly stigmatised Not perceived as a disease by much of the community and the medical profession The subject of media voyeurism and victim-blaming Affected individuals are seen as: Less attractive Weak-willed, morally vulnerable, lacking will-power and strength Bringing the disease on themselves Probably of lower value than those who are unaffected Welcome to the issue of obesity!:  Welcome to the issue of obesity! Slide55:  Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipatis V. IOTF website 1999: http://www.iotf.org Societal policies and processes influencing the population prevalence of obesity Slide56:  http://hp2010.nhlbihin.net/portion/index.htm 20 y ago Now Portion sizes have increased Who owns the streets? The private car? Pedestrians? Cyclists?:  Who owns the streets? The private car? Pedestrians? Cyclists?

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