Intended for healthcare professionals

Practice ABC of obesity

Obesity—time to wake up

BMJ 2006; 333 doi: (Published 21 September 2006) Cite this as: BMJ 2006;333:640
  1. David Haslam, general practitioner and clinical director of the National Obesity Forum,
  2. Naveed Sattar,
  3. Mike Lean

    The obesity epidemic in the United Kingdom is out of control, and none of the measures being undertaken show signs of halting the problem, let alone reversing the trend. The United States is about 10 years ahead in terms of its obesity problem, and it has an epidemic of type 2 diabetes with obesity levels that are rocketing. Obesity is a global problem—levels are rising all over the world. Moreover, certain ethnic groups seem to be more sensitive than others to the adverse metabolic effects of obesity. For example, high levels of diabetes and related diseases are found in South Asian and Arab populations. Although most of the medical complications and costs of obesity are found in adults, obesity levels are also rising in children in the UK and elsewhere.

    Prevalence of obesity worldwide. Adapted from Haslam D, James WP. Lancet 2005;366: 1197-209

    View this table:

    Definition of obesity

    Limited time to act

    Obesity can be dealt with using three expensive options:

    • Treat an almost exponential rise in secondary clinical consequences of obesity

    • Treat the underlying obesity in a soaring number of people to prevent secondary clinical complications

    • Reverse the societal and commercial changes of the past 200 years, which have conspired with our genes to make overweight or obesity more normal.

    Sheaves of evidence based guidelines give advice on the treatment of all the medical consequences of obesity, and an evidence base for identifying and treating obesity is accumulating. Although the principles of achieving energy balance are known, an evidence base of effective measures for preventing obesity does not exist. The methods of randomised clinical trials are inappropriate, and so some form of continuous improvement methodology is needed.

    Results from Health Survey for England 2002. The most recent Health Survey for England (2004) states that “Between 1995 and 2001, mean BMI increased among boys (from 17.6 …

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