Editorials

Weight changes and health in Cuba

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1777 (Published 09 April 2013) Cite this as: BMJ 2013;346:f1777
  1. Walter C Willett, professor and chair
  1. 1Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
  1. walter.willett{at}channing.harvard.edu

Learning from hardship

Changes in food supplies and reductions in physical activity are fueling increases in overweight and obesity, diabetes, and cardiovascular disease worldwide.1 We have had few opportunities to see a reversal of this process, which is continuing inexorably almost everywhere. One such opportunity was provided by the well developed public health surveillance systems in Cuba, which were maintained during a period of serious economic hardship in the early 1990s. In a linked study (doi:10.1136/bmj.f1515), Franco and colleagues used these systems to look at the effects of reduced energy intake and increased physical activity on body weight and the occurrence of diabetes, cardiovascular disease, cancer, and death.2

In Cuba, decreased food availability and increased physical activity, supported by the distribution of more than a million bicycles during 1991 to 1995, led to an average 5.5 kg reduction in weight over five years, shifting the whole population distribution of weight downwards. Predictably, a profound and almost immediate reduction in the incidence of diabetes occurred, and a striking decline in cardiovascular mortality began, with a lag of about five years. These findings …

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