WHO should take the lead in combating obesity
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7501.1168-b (Published 19 May 2005) Cite this as: BMJ 2005;330:1168All rapid responses
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Why should the WHO, an unrepresentative and unelected body with no
public mandate, be given responsibilty for public health of any kind?
It is time the British public had a representative, elected body,
unburdened by vested interests to represent all public health interests;
possibly, if other countries have the same public concerns, connected
through the UN.
It became very clear through recent parliamentary criticisms of so-
called public bodies such as the DoH, the MCA, and others like the HPA
where scientists and executives are employed who for too long had cosy
dealings with big pharma that appear to contradict their public duty -
including receiving sponsorship and funding from big pharma in
relationships and benefits that involved WHO projects and funding.
It is publicly funded and accountable health bodies that should "take
the lead in combatting health problems" in concert with other publicly
funded and accountable bodies required to ensure that every aspect
(social, political, health, educational and spiritual) of any problem be
dealt with in the public interest. The WHO is a fount of knowledge and
expertise from whom advice might be sought, it is neither a publicly
accountable, nor a United Nations, body and as such should never been
given "the lead" in any public interest endeavour.
Regards
John H.
Competing interests:
None declared
Competing interests: No competing interests
As a doctoral scholar of policy and strategy issues in management of
obesity, I follow not just the literature in this area but also closely
the methodologies of research and how often new reports corroborate
findings from other researches.
In the other rapid response to this article, however, I find it
interesting to see how quickly we all forget our own childhood
propensities and our own adolescent behavioural preferences, and tend to
suggest simplistic solutions.
The child and teenager of today undoubtedly faces much more complex
set of external factors shaping their expectations of their own body image
as well as their behaviours, than any previous generation did.
Obesity is never simple, but in this case, it is even more complex
than usual.
In children and teens, obesity incidence is complicated by the
additional complexities of metabolism of growth years.
Add to the psychological and somatic factors, a cocktail of
environmental factors, such as lack of creative physical activities, and
the recipe for overweight and obesity is complete.
It is not as simple as linking icecream to school results; it
requires more commitment from all involved in shaping these young people -
parents, teacher, primary health care workers, and policy makers - to
prevention, failing which, early recognition, diagnosis and active
intervention.
Competing interests:
None declared
Competing interests: No competing interests
As a chronic disease, prevalent in both developed and developing
countries, and affecting children as well as adults, it is now so common
that it is replacing the more traditional public health concerns including
undernutrition. It is one of the most significant contributors of ill
health. The aetiology of obesity is complex, and is one of multiple
causation.
(a)Age: Obesity can occur at any age and generally increases with age.
Infants with excessive weight gain have an increased incidence of obesity
in later life.
(b)Sex: Men gain most weight between the ages of 29 to 35years while women
gain most between 45 to 49 years of age.
(c)Physical inactivity: Physical inactivity may cause obesity; which in
turn restrict activity.
(d)Socioeconomic status: There is a clear inverse relationship between
socio-economic status and obesity.
(e)Eating habits: Eating habits like eating in between meals, preference
to sweets, refined foods and fats contribute significantly to obesity.
(g)Psychosocial factors: Overeating may be a symptom of depression,
anxiety, frustration and loneliness in childhood as it is in adulthood.
I firmly believe that to overcome this problem first we have to quantify
the multiple factors of disease and we have to arrange them in priority
sequence for modification and amelioration.
Competing interests:
None declared
Competing interests: No competing interests
it interests me that the incidence of overweight among "couch potatoes" (people who like to stay in front of TV) was shown to be higher than others (1). i tend to suggest that two problems related to obesity could arise from watching television for a long period of time:
a. lack of physical exercise, and
b. tendency to eat snacks while enjoying the TV program.
unfortunately these problems are also aggravated by reduction in the number of youngsters who ride bicycles instead of motored vehicles, as well as the space available for children and adolescents to play around or socialise (as the result of population growth). i'm sure adolescents are aware of the risk of overweight - at least it would adversely affect their appearance as well as their confidence - and want to lose their weight. however, this requires them to avoid some (if not most) of their favourite food items. interestingly, according to the International Food Information Council (IFIC), when one's access to their favourite foods is denied, they would eat MORE (not less), to compensate with their fear of missing those kinds of food (2) - and consequently they fail to lose weight.
taken together, these factors would pose a higher risk to obesity in school-aged youths.
however i would prefer to say that this type of obesity is avoidable (or at least can be reduced), as i could see some solutions to the obesity problem. to begin with, the efforts of city councils to encourage cycling and walking (i.e. by providing more space for cyclists and pedestrians, as well as reducing pollution in the environment) would be a good idea to increase the opportunity for adolescents to do physical exercise.
secondly, while teenagers' desire to enjoy snacks is inevitable, it would probably be better not to withhold the snacks from them. instead, we could give them more access to "nutritious but delicious snacks" such as adding ice cream and prunes to their breakfast cereals or bran flakes, or allowing them to enjoy their "french fries" with tomato sauce, nuggets, and stir-fried green-leafy vegetables. to avoid being worried of "missing their favourite food forever", we could apply the advice given in IFIC's "new nutrition conversation with consumers" (2): to eat in moderation. for example, ice creams are allowed once a week, and would be given if the student has performed well in their exams.
Acknowledgments:
I would like to thank the IFIC for allowing the use of its resources.
Works Cited:
1. Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C, Currie C, Pickett W. "Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns." Obesity Reviews 2005;6:123-132. In: Dobson R. WHO should take the lead in combating obesity. News roundup. BMJ 2005;330:1168.
2. International Food Information Council. New Nutrition Conversation with Consumers (PowerPoint version). Available at: http://www.ific.org/tools/upload/NNCCPE.ppt. Accessed 20 May 2005.
Competing interests:
None declared
Competing interests: No competing interests
Obesity Research and Fat Fabrications
Yet another report, another catchy headline, ‘WHO should take the
lead in combating obesity’ (BMJ 2005; 330:1168 (21 May) calling for action
on ‘obesity’, this time emanating from researchers at Edinburgh
University. Yet more data adding, it seems, to professional and lay
understandings of the nature of ‘the obesity problem’ and how it should be
resolved.
It’s breathtakingly simple. Increase physical activity and watch less
TV.
Needless to say, this news has been instantly recycled in the popular
media (national newspapers, radio and TV) with the usual mixture of glee
and concern. The message is clear, the Nation (the UK) is seriously
unhealthy; overweight, too fat and at risk, unless action is taken to
exercise and become thin.
But lets look at some of the ‘facts’ around such claims. In the
latest report a neat obesity league table is presented to illustrate the
magnitude of ‘the obesity problem’ worldwide. The table shows the
‘Prevalence of overweight and obesity in schoolchildren aged 10- 16 years,
as defined by body mass index’. Without any qualifying commentary (as far
as we can tell) on how cautious one must be when using BMI as a measure of
children’s health, we seem to be offered evidence confirming (yet again)
that the UK is now in the bottom five of unhealthy (fat) nations, with the
USA and Malta propping up the league. Lithuania and Russia sit proudly at
the top. Now, while the table doesn’t directly make the connection, lay
public and professionals in this field, we suspect, are supposed to read
this as a ‘league of health’. After all, in this discourse ‘overweight’
and ‘obesity’ are routinely offered as indices either of an individual’s
or a nations’ health. All very well until we look at life expectancy in
these countries; 59 and 67 for men in Russia and Lithuania and 74 and 76
for men in the US and Malta respectively. Clearly, if longevity is your
goal you wouldn’t want to live in Russia or Lithuania with a mission to
get thin. In the topsy turvey world of obesity research, however,
‘overweight’, which is quite a good indices of any Nation’s ‘health’ (if
defined in terms of life expectancy) is inverted to signify the opposite
of what it represents, and becomes a measure of a nations ‘ill-health’.
Actually, the table, if studied carefully in these terms, points to the
fascinating complexity of obesity and health so that, for example, Poland
(near the top of the league) like the USA and the UK (toward the bottom),
has relatively high life expectancy. In short, this table tells us next to
nothing about the complex social, environmental and lifestyle
associations, contingencies and ‘confounding factors’, that have to be in
play to turn ‘obesity’ or ‘overweight’ into either a health or ill health
concern.
We are also told that watching too much television and being inactive
lie at the heart of this ‘obesity’ problem. The assumption here is that
exercise is good for your health. And so it is, we suspect, though we
don’t know how much or in what form, or whether those who watch a lot of
TV do more or less of it. The research community has not provided
conclusive, unequivocal evidence on the relationships between ‘health’ and
IT. Even when we do exercise it may have little to do with levels of
obesity and overweight. Again, we might point to the obesity league table
for some indication of how much more complex is the equation between
exercise and health than this latest evidence would have us believe. For
example, France, it seems, is ‘healthier’ (and generally thinner) than the
USA. We might, therefore, assume that young people in the latter country
are also less active. But, hey ho, again in the upside down world of
obesity discourse we also learn that ‘The prevalence of adolescents who
were physically active for 60 or more minutes on five days per week ranged
from 19.3% in France to 49% in the United States”. So, it seems,
populations can be generally active but still rather too fat. Whether
these active kids also watched too much television and this nullified the
exercise effect, we simply can not tell. Indeed the neat association
between TV watching and ‘overweight’ is hugely problematic but hardly
something to be worried about given that, as far as we can tell from this
data, there is no accompanying causal association or correlation between
exercise, overweight and ill health.
The researchers at Edinburgh are to be applauded for their endeavour
to throw light on a contemporary health issue, and we are pretty certain
that they too would want to offer a more complex version of obesity and
health than is offered by the popular and respectable press. Until this is
achieved, we are unlikely to see any real inroads being made into a
‘condition’ which for some people, in certain circumstance, may be a real
health concern.
Competing interests:
None declared
Competing interests: No competing interests