Question

Related to the health care market, what does this have to do with obesity- possibly the most important public health issue for our generation worldwide? Generally speaking, when an obese person goes to the doctor, the doctor will either tell them to lose weight or prescribe insulin. IF we want to confront the obesity epidemic- we have to go more upstream- into the realm of public health. What does this mean for the health care market place? How can we work with an integrated system to address the problems you're bringing up?

Answer 1

Obesity is a public health problem that has become epidemic worldwide. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. Therefore, a public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance. However, public health intervention programs have had limited success in tackling the rising prevalence of obesity.

Maintaining a healthy weight is an extremely important part of overall health. Being overweight or obese contributes to numerous health conditions that limit the quality and length of life, including: Hypertension. High LDL cholesterol, low HDL cholesterol or high levels of triglycerides.

Obesity in childhood can add up to health problems—often for life. In adults, overweight and obesity are linked to increased risk of heart disease, type 2 diabetes (high blood sugar), high blood pressure, certain cancers, and other chronic conditions. Obesity is a public health problem that has raised concern worldwide. According to the World Health Organization (WHO), there will be about 2.3 billion overweight people aged 15 years and above, and over 700 million obese people worldwide. Although a few developed countries such as the United Kingdom and Germany experienced a drop in the prevalence rate of obesity in the past decade, the prevalence of obesity continues to rise in many parts of the world, especially in the Asia Pacific region. An exhaustive body of literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. In the United States, the total costs associated with obesity accounted for 1.2% gross domestic product (GDP). In Europe, up to 10.4 billion Euros was spent on obesity-related healthcare, and the reported relative economic burdens ranged from 0.09% to 0.61% of national GDP. In China, the total medical cost attributable to overweight and obesity was estimated at about 2.74 billion US dollars and these accounted for 3.7% of national total medical costs. The total direct costs attributable to overweight and obesity in Canada has been estimated to be 6.0 billion US dollars (of which 66% is attributable to obesity), corresponding to 4.1% of the total health expenditure. Furthermore, if related co-morbidities were included, the direct cost increased by 25%.

Obesity can be defined as a condition of abnormal or excess fat accumulation in adipose tissue, to the extent that health may be impaired. Body Mass Index (BMI), which is calculated as [(weight in kg) / (height in m)], is considered to be the most useful population-level measure of obesity, and it is a simple index to classify underweight, overweight and obesity in adults. The WHO has classified overweight and obesity in adults based on various BMI cutoffs. These cutoffs are set based on co-morbidities risk associated with BMI. However, the use of BMI does not distinguish between weight associated with muscle and weight associated with fat, and the relationship between BMI and body fat content varies according to body build and proportion. In contrast, the measure of intra-abdominal or central fat accumulation to reflect changes in risk factors for cardiovascular diseases and other forms of chronic diseases is better than BMI. Therefore, an assessment of central fat accumulation greatly assists in defining obesity.

Defining overweight and obesity in children and adolescents is complicated as height is still increasing and body composition changes over time. Different measures and references such as weight-for-height, BMI percentiles, and skinfold thickness have been used. With aging, body composition changes and height decreases, affecting the interpretation of anthropometric data. Older persons generally have more fat than younger adults do at any given BMI, and absolute levels of WC indicate more visceral fat in older persons than in younger persons, because relatively more fat accumulates in the abdomen and less fat at the extremities as people age. Due to the progressive age-decline in stature, using BMI to classify obesity may overestimate adiposity in the elderly. Furthermore, BMI cannot make a discrepancy between fat and muscle mass. The reliability of BMI as an index of obesity is thus questionable, and therefore, other anthropometric indices are proposed to determine the degree of fatness in the elderly. In summary, since the associations between adult values for overweight and obesity and certain adverse health outcomes in elderly populations show conflicting results with a suggestion that higher values may not result in adverse health outcomes, it may not be appropriate to apply existing adult values to elderly people aged 70 year and over. In view of the rapidly growing numbers of people in this age group in many developed countries with population ageing, this has important health implications in terms of health promotion and treatment targets. Further research is indicated in establishing criteria for a healthy weight in people aged 70 years and over, using relevant health outcomes such as functional independence in addition to disease occurrence. The emphasis may likely be on weight maintenance rather than reduction at the extreme of old age, when ability to modify lifestyle may be limited and quality of life may assume greater importance. Of all physical health problems, type II diabetes has the strongest association with obesity. A meta-analysis examined the relative risk of incidence of various co-morbidities related to obesity and overweight. Obesity predisposes an individual to a number of cardiovascular risks including hypertension, dyslipidemia and coronary heart disease. A number of reviews have considered the association of obesity and cancer. There is a wealth of evidence to show that excess weight is an important risk factor in the development of other illnesses, including respiratory diseases, chronic kidney diseases, musculoskeletal disorders, gastrointestinal and hepatic disorders, lower physical functioning performance and psychological problems.

The etiology of obesity is multifactorial, involving complex interactions among the genetic background, hormones and different social and environmental factors, such as sedentary lifestyle and unhealthy dietary habits. Nutrition transition as a result of urbanization and affluence has been considered as the major cause for the obesity epidemic. Major dietary changes include a higher energy density diet with a greater role for fat and added sugars in foods, greater saturated fat intake (mostly from animal sources), marked increases in animal food consumption, reduced intakes of complex carbohydrates and dietary fiber, and reduced fruit and vegetable intake. These dietary changes are compounded by lifestyle changes that reflect reduced physical activity at work and during leisure time. Social inequality as a result of economic insecurity and a failing economic environment is also considered as one of the probable causes of obesity. Energy-dense and nutrient-poor foods become the best way to provide daily calories at an affordable cost by the poor groups, whereas nutrient-rich foods and high-quality diets not only cost more but are consumed by more affluent groups. Lack of accessibility of healthy food choices and the commercial driven food market environment are also considered as other probable causes of obesity. The interaction effects among environmental factors, genetic predisposition and the individual behavior on excess weight gain has received research interests in recent decades. “Gene-environment interaction” refers to a situation in which the response or the adaptation to an environmental agent, a behavior, or a change in behavior is conditional on the genotype of the individual. Observational evidence has shown that susceptibility to obesity is determined largely by genetic factors, but the environment prompts phenotype expression.

An adverse environment during in utero or postnatal periods has also been suggested as one possible cause for the development of obesity, indicating that the mother’s nutrition or perinatal lifestyle could affect the developmental programming of the fetus. The concept of programming in fetal or postnatal life is firstly established from experimental animal studies. A wealth of evidence from animal studies has demonstrated that exposure to an elevated or excess nutrient supply before birth is associated with an increased risk of obesity and associated metabolic disorders in later life. Results from epidemiological studies and experimental studies in human also supported that intrauterine or postnatal nutrition could predispose individuals to obesity in later life.

A public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance and has been advocated in recent years. The development and implementation of obesity prevention strategies should target factors contributing to obesity, should target barriers to lifestyle change at personal, environmental and socioeconomic levels, and actively involve different levels of stakeholders and other major parties.

To alter the food environment such that healthy choices are the easier choices, and to alter the physical activity environment to facilitate higher levels of physical activities and to reduce sedentary lifestyle, are the key targets of obesity prevention policies. There are a wide range of policy areas that could influence the food environments. These areas include fiscal food policies, mandatory nutrition panels on the formulation and reformulation of manufactured foods, implementation of food and nutrition labeling, and restricting marketing and advertising bans of unhealthy foods.

The health risks and health care costs associated with overweight and obesity are considerable. The etiology of obesity is multifactorial, involving complex interactions among genetic background, hormones and different social and environmental factors. A public health approach to develop population-based strategies for the prevention of excess weight gain should target factors contributing to obesity, should be multifaceted, and actively involve different levels of stakeholders and other major parties. Potential policy areas to the development and implementation of such strategies should cross from the home environment to a broader policy level of socioeconomic environments. However, there is likely to be many barriers towards strategies based on policies alone. The prevention and reduction of overweight and obesity depend ultimately on individual lifestyle changes, and further research on motivations for behavior change would be important in combating the obesity epidemic.