Obesity—time to wake up
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7569.640 (Published 21 September 2006) Cite this as: BMJ 2006;333:640All rapid responses
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I work with a lot of immigrants from the Pacific Islands - big
people, everyone
knows that, but Darwinianly healthy. For many, though, their weight soars
when
they come to California. A patient recently explained to me that the
culture on
the Islands is a food-based one - "there's fruit on the trees and fish in
the sea"
she said. However, that healthy, readily available sustenance is not so
easy to
get in an industrial society, and all-you-can-eat buffets become social
gathering
places.
So my initial advice, when asked for help with regaining healthy
weight, is
threefold: Eat at home with your friends and family (like your
grandparents did,
as the brilliant Michael Pollan suggests), throw away the bathroom scales
(and
let me weigh you monthly), and buy a very long tape measure!
Competing interests:
None declared
Competing interests: No competing interests
Haslam et al. make an excellent introduction into the series
regarding the consequences of obesity. Nevertheless, they do not mention
an important associated condition that deserves greater recognition: non-
alcoholic fatty liver disease (NAFLD).
Both body mass index and waist circumference have been shown to be
associated with NAFLD prevalence.(1) It is surprisingly common, occurring
in between 16-30% of unselected populations, and appears to be rising.(2)
Although closely related to the metabolic syndrome (previous investigators
have suggested a NAFLD prevalence of 72.5%), the two are not mutually
inclusive.(3) Furthermore, there is wide variation in diagnosis and
screening.(4)
As with obesity, NAFLD is a challenge for primary and secondary care
throughout the world: increased education and awareness is paramount.
1. Church TS, Kuk JL, Ross R, et al. Association of cardiorespiratory
fitness, body mass index, and waist circumference to nonalcoholic fatty
liver disease. Gastroenterology. 2006 Jun;130(7):2023-30.
2. Angulo P. Non-alcoholic fatty liver disease. N Engl J Med 2002;
346:1221-31.
3. Sorrentino et al. Silent non-alcoholic fatty liver disease – a clinical
histological study. J Hepatol 2004;41:751-7
4. Riley MR, Bass NM, Rosenthal P, Merriman RB. Underdiagnosis of
pediatric obesity and underscreening for fatty liver disease and metabolic
syndrome by pediatricians and pediatric subspecialists. J Pediatr. 2005
Dec;147(6):839-42.
Competing interests:
None declared
Competing interests: No competing interests
The BMJ this week contains two excellent articles on diet and ill-
health. They
are complementary. A bit of joined-up editing would have made that clear,
to the benefit of all.
Haslam, Sattar and Lean provide a brutal summary of the significance
of the
obesity epidemic. It is an ABC guide, so it is not the content which is
remarkable, but the prose. It sets out the practical consequences in
blunt
and vivid language that is appropriate but rare in medical journals.
Bryan Christie summarises a report by Lang and colleagues on why
there has
been so little progress over the past decade in reforming the worst diet
in the
UK, in Scotland. It highlights the need for everyone concerned about
public
health to engage with our dysfunctional food system.
Both articles acknowledge the complexity of the problems, the need
for both
prevention and treatment. But the emphases are different, one focussing
on
what doctors can do with patients, the other on the need to improve the
products and promotional practices of food manufacturers.
Together they make a whole. A comprehensive policy response requires
both
changing people and changing food. A bit of editorial linkage and
guidance
from the BMJ would have greatly aided understanding, helping readers to
put
one half together with the other half to make one.
Competing interests:
None declared
Competing interests: No competing interests
wake up call for developing world too
The article on obesity by Haslam et al. is an eye opener equally to
the developing world which is gradually being affected by the epidemic of
obesity. Sri Lanka is no exception. However, unlike the developed
countries, Sri Lanka is facing this problem with the current existence of
29% underweight among children and a prevalence of 30% of anaemia among
children under five and women 1. Implications of an epidemic of obesity
may overburden a health system which is expected to cater to the need of
an increasing burden of non communicable diseases due to the
epidemiological and demographic transition
In a recent study done in four provinces in Sri Lanka, the prevalence
of obesity was estimated to be 20.3% in men and 36.5 % in women. The
authors reported that the highest prevalence of obesity was reported
from the more urbanised Western Province 2. In another study, among adults
in the most urbanised, Colombo district, prevalence of obesity was
estimated to be 32.2% 3.
There is an increasing trend in the prevalence of obesity due to the
demographic changes, urbanisation and life style changes that took place
during the last decade or so. Most of the risk factors were behaviour
related and hence influenced by urbanisation and unhealthy life styles
such as deviation from traditional Sri Lankan diet to fast food culture
and low physical activity 3.
Urban-Rural difference in these two extreme conditions prevailing
in the country was summarised explicitly in a rapid response to the BMJ by
an expatriate Sri Lankan professional:
“I increasingly encounter big 'M's, 'KFC' Colonels, pizza parlours, sari
wrapped barrels in chauffeur driven autos and third trimester looking
politicos in urban areas. Bill boards blaring, "GYM" attracts your
attention. In the rural areas, among coconut groves, paddy fields, tea
gardens etc. poverty and poor nutrition frame the picture. “4
It is high time that the public health authorities in the country
wake up, as suggested in the article, to take measures to contain the
impending epidemic of obesity before it further over burdens the health
budget of the lower middle income country.
References:
1. World Bank. Nutrition in Sri Lanka : Rethink Yesterday, change
tomorrow. Consultation Workshop Examines Enigma of Malnutrition.
Available online URL :
http://www.worldbank.lk/
WBSITE/EXTERNAL/COUNTRIES/
SOUTHASIAEXT/SRILANKAEXTN/
0,,contentMDK:20982671~menu
PK:232812~pagePK:2865066~piPK:
2865079~theSitePK:233047,00.html
2. Wijewardene K, Mohideen MR, Mendis S, Fernando DS, Kulathilaka T,
Weerasekara D, Uluwitta P. Prevalence of hypertension, diabetes and
obesity: baseline findings of a population based survey in four provinces
in Sri Lanka. Ceylon Medical Journal. 2005 Jun;50(2):62-70
3. Arambepola C, Fernando, DF. Distribution and determinants of
abdominal obesity in an adult population in the district of Colombo, Sri
Lanka. Available online
URL:http://iussp2005.princeton.edu/download.aspx?submissionId=51592.
4. Amarasinghe A A W. Scenario in Sri Lanka. British Medical
Journal. 2005; 331: 1333-1336. Available online
URL:http://bmj.bmjjournals.com/cgi/eletters/331/7528/1333#122894
Competing interests:
None declared
Competing interests: No competing interests