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Asia Pacific Journal of Clinical Nutrition
Volume 15, Supplement

(September 2006, on-line only
)

Health Economics of weight management

A report for the Weight Management Code Administration Council of Australia


Abstracts & Full papers

Contents

Abstract

Papers

Editorial    
Health economics and weight management: evidence and cost
MARK L WAHLQVIST
pdf
Review Articles    
Epidemiology and health impact of obesity: an Asia Pacific perspective
TIM GILL

html pdf
Socio-economic factors in obesity: a case of slim chance in a fat world?
KYLIE BALL AND DAVID CRAWFORD

html pdf
Weight management in transitional economies: the "double burden of disease" dilemma
WIDJAJA LUKITO AND MARK L WAHLQVIST
html pdf
State of the science: behavioural treatment of obesity
LASHANDA R JONES AND THOMAS A WADDEN

html pdf
State of the science: a focus on physical activity
ANDREW P HILLS AND NUALA M BYRNE
html pdf
State of the science: VLED (Very Low Energy Diet) for obesity
ELIZABETH DELBRIDGE AND JOSEPH PROIETTO

html pdf
Emerging pharmacotherapy for treating obesity and associated cardiometabolic risk
IAN D CATERSON AND NICK FINER
html pdf
Combined strategies in the management of obesity
JOHN B DIXON AND MAUREEN E DIXON

html pdf
The Weight Management Code of Practice of Australia as a framework for the commercial weight management sector
SYLVIA RUTH RIDDELL
html
pdf
Review Articles    

A cost benefit analysis of weight management strategies
JODIE YATES AND CHRIS MURPHY

html pdf

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Epidemiology and health impact of obesity: an Asia Pacific perspective
TIM GILL

This paper compares body mass index, waist circumference, hip circumference, and waist-hip ratio as risk factors for ischaemic heart disease and stroke in Asia Pacific populations. We undertook a pooled analysis involving six cohort studies (45 988 participants) and used Cox proportional hazards regression to assess the associations of the four anthropometric indices with stroke and ischaemic heart disease by age, sex and region. During a mean follow-up of six years, 346 stroke and 601 ischaemic heart disease events (fatal and non-fatal) were documented. Overall, a one-standard deviation increase in index was associated with an increase in risk of ischaemic heart disease of 17% (95% CI 7-27%) for body mass index, 27% (95% CI 14-40%) for waist circumference, 10% (95% CI 1-20%) for hip circumference, and 36% (95% CI 21-52%) for waist-hip ratio. There were no significant differences between age groups, sex, and region. None of the four anthropometric indices had a strong association with risk of stroke. These data indicate that measures of central obesity such as waist circumference and waist-hip ratio are strongly associated with risk of ischaemic heart disease in this region. Therefore, we suggest that, along with calculation of body mass index, measures of central obesity such as waist circumference and waist-hip ratio should be undertaken routinely.
Key Words: abdominal obesity, waist circumference, waist hip ratio, cardiovascular diseases, cohort studies, Asia

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Socio-economic factors in obesity: a case of slim chance in a fat world?
KYLIE BALL AND DAVID CRAWFORD

The global obesity pandemic has been well-documented and widely discussed by the public, the media, health officials, the food industry and academic researchers. While the problem is widely recognised, the potential solutions are far less clear. There is only limited evidence to guide decisions as to how best to manage obesity in individuals and in populations. While widely viewed as a clinical and public health problem in developed countries, it is now clear that many developing countries also have to grapple with this problem or face the crippling healthcare costs resulting from obesity-related morbidity. There is also abundant evidence that obesity is socio-economically distributed. In developed countries persons of lower socio-economic position are more likely to be affected, while in developing countries, it is often those of higher socio-economic position who are overweight or obese. The aim of this paper is to briefly review the evidence that links socio-economic position and obesity, to discuss what is known about underlying mechanisms, and to consider the role of social, physical, policy and cultural environments in explaining the relationships between socio-economic position and obesity. We introduce the concept of 'resilience' as a potential theoretical construct to guide research efforts aimed at understanding how some socio-economically disadvantaged individuals manage to avoid obesity. We conclude by considering an agenda to guide future research and programs focused on understanding and reducing obesity among those of low socio-economic position.
Key Words: socio-economic factors, obesity, environment, social environment, resilience
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Weight management in transitional economies: the "double burden of disease" dilemma
WIDJAJA LUKITO AND MARK L WAHLQVIST
The nature of nutritionally-related disease (NRD) in transitional economies is such that deficiency can frequently co-exist with excess. This is most usually represented by the combination of diets of low nutritional quality (low and little food component density and diversity, FCDD) and decreased levels of physical activity, predicated, in part, on limited affordability of alternatives. Moreover, these changes are not simply inter-generational, as the pace of socio-environmental change is great enough for them to be intra-generational as well. The most troublesome situation is that of maternal undernutrition, with intra-uterine growth retardation, compromised lactation and infant feeding, leading to stunting in early life and to abdominal obesity and its consequences later in life. Weight management in these situations requires pre-conceptional interventions, effective maternal-child health programmes and life-long approaches to avoid inappropriate gene programming and body compositional disorders. It is unlikely that narrow strategies, located solely around energy balance, will do more than attenuate this growing burden of disease for most of the world's populations. The pluralistic approaches to health required are likely to build on more effective lifestyle, behavioural and pharmacotherapeutic strategies to weight management, and do so at all ages, from conception to later life.
Key Words: Nutritionally-Related Disease (NRD), deficiency disorders, body compositional disorders (BCD), energy imbalance, food component density and diversity (FCDD), poverty, affordability, maternal health, child health, life stages
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State of the science: behavioural treatment of obesity
LASHANDA R JONES AND THOMAS A WADDEN

Obesity is a global and preventable epidemic with serious health consequences for individuals worldwide, particularly for those in developed countries. The World Health Organization estimates that at least 1 billion people worldwide are overweight, and 300 million are obese. Research has demonstrated that weight losses as small as 7-10% of initial weight produce significant health benefits. These include reducing the risk of heart disease, stroke, and some cancers. This paper describes behavioural methods to modify maladaptive eating and activity habits to achieve a healthy weight. It also examines the short- and long-term results of behavioural treatment for obesity and methods to improve long-term weight control.
Key Words:
behaviour therapy, obesity, lifestyle intervention, weight-loss, physical activity
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State of the science: a focus on physical activity
ANDREW P HILLS AND NUALA M BYRNE

Diet, exercise, behavioural support and for some obese individuals, pharmacotherapy, represent the set of lifestyle factors necessary for effective management of obesity. An on-going challenge in the prevention, treatment and management of obesity is to arm health professionals in particular, with the necessary knowledge and understanding and time to engage in meaningful weight management counseling. Despite the many barriers to effective management such as lack of relevant education in nutrition and physical activity, perceived patient non-compliance, perceived inability to change patient behaviours, and the cost of specialist behavioural support, there is increasing evidence of the value of behaviour modification techniques to both dietary and exercise counseling, particularly when focusing on current behaviour. Behavioural counseling addresses the barriers to compliance with diet and physical activity goals and also equips the individual with practical strategies and motivation to be more self-responsible. Commonly employed behavioural interventions include stimulus control, reinforcement techniques, self-monitoring, behavioural contracting, and social support programs. This paper addresses one of the key behavioural components in the treatment and management of obesity - physical activity. Higher levels of energy expenditure through increased physical activity are central to successful weight loss and long-term weight maintenance. The specific value derived from physical activity in the context of weight management for the overweight and obese is in large part associated with an appreciation of the role of both physical activity promotion and exercise prescription.
Key Words: behavioural, exercise, obesity, overweight, lifestyle factors, physical activity, prescription, promotion


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State of the science: VLED (Very Low Energy Diet) for obesity
ELIZABETH DELBRIDGE AND JOSEPH PROIETTO

It is often stated, "the faster you lose weight, the faster it is regained". A review of existing literature does not support such a statement - indeed if anything the reverse is true. The origins of this erroneous view are the misconceptions that weight regain is a simple matter of bad dietary and social habits and that it takes time to change these, that physiological adaptations to rapid weight loss are different to those of gradual weight loss and that weight regain is simply due to a return to old habits. Indeed there are many advantages to rapid weight loss achieved with the use of a modern very low energy diet, including the fact that rapid weight loss is a motivating factor, that the mild ketosis that occurs not only suppresses hunger, but also slows protein loss and that adherence is easier with a structured dietary regime. VLEDs are dietary preparations that provide all nutritional requirements together with between 1845 and 3280 KJ (450 and 800 Kcal) per day. An individual takes this meal replacement three times daily as a substitute for breakfast, lunch and dinner. In addition, a bowl of non-starchy vegetables once daily provides some fibre and helps to satisfy the social aspect of eating. A teaspoon of oil on the vegetables contracts the gall bladder to minimise the risk of gall stone formation. Since weight loss, at whatever rate, results in physiological adaptations leading to weight regain, careful attention must be paid to the period after the VLED regime is completed. Lifestyle modification, diet and exercise are instituted optimally with behaviour modification. If, despite the subject's best efforts, weight regain occurs, an appetite suppressant is advisable to help control the drive to eat.
Key Words: weight loss, obesity, leptin, hunger, very low energy diet, VLED, pharmacotherapy

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Emerging pharmacotherapy for treating obesity and associated cardiometabolic risk
IAN D CATERSON AND NICK FINER

The global obesity epidemic is causing much concern among health professionals due to the major health risks associated with obesity. Excess weight, particularly abdominal obesity, elevates multiple cardiovascular and metabolic risk factors, including Type 2 diabetes, hypertension, dyslipidaemia and cardiovascular disease. Thus obesity management goals should encompass health improvement and cardiometabolic risk reduction as well as weight loss. While lifestyle and diet modification form the basis of all effective strategies for weight reduction, some individuals may need additional intervention. About one in four people with BMI >27 kg/m2 (those who have weight-related morbidity and who have been unsuccessful losing weight in standard ways) may require adjunctive therapy such as pharmacotherapy, very low energy diets/meal replacements, or bariatric surgery. This review focuses on appropriate use of pharmacotherapy for obesity and cardiometabolic risk. Sibutramine and orlistat are currently available for use in Australia. Rimonabant has been approved for use in the European Union, and is being considered for regulatory approval in the USA and Australia. The efficacy and safety of these three agents are examined. In addition, several novel pharmacotherapy agents in development are discussed..
Key Words: obesity, pharmacotherapy, sibutramine, orlistat, rimonabant .
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Combined strategies in the management of obesity
JOHN B DIXON AND MAUREEN E DIXON


Obesity is a chronic relapsing disease requiring a similar long term approach to management as that of other chronic conditions. Management needs to be multifaceted aiming to achieve sustainable behavioural changes to physical activity and diet to alter the patient and family microenvironment to one favouring better weight control. A range of therapies including specific diets, calorie counting, meal replacements, very low calorie diets, pharmacotherapy, intragastric balloons and surgery can provide very useful additional benefit. Use of these should be guided by the extent of weight loss required to reduce BMI to an acceptable level with regard to the patient's ethnicity, risk and comorbid conditions. Patients need to set goals that are optimistic, but realistic, and understand the benefits of sustained modest weight loss and the likelihood of weight regain requiring repeat episodes of weight loss. Practitioners need to be informed about the efficacy of current therapies and their combinations to enhance choice of suitable methods for achieving the optimal weight loss required by the patient. They will also need to anticipate trigger points for renewed periods of weight loss in the event of weight regain, as relapse is likely but not a reason for abandoning the battle. .
Key Words: chronic, weight loss, obesity, combined strategies, lifestyle, health, comorbidity, quality of life

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The Weight Management Code of Practice of Australia as a framework for the commercial weight management sector
SYLVIA RUTH RIDDELL
The Weight Management Code of Practice Australia provides a framework for the diversity of players in the weight management industry. In the current worldwide epidemic of overweight and obesity, the potential for the industry to 'do the right thing', comply with the Weight Management Code of Practice Australia, and assist people with long-term weight loss, is far reaching. The Weight Management Code of Practice in Australia is managed by the Weight Management Council Australia Limited. There are many players in the weight management industry, not all will be eligible for membership of Council but there are many who could be eligible. Ideally, all centres, programs and professionals in the industry should have in place business practices and regimens that comply with the Code. The more members of this industry who are willing to modify their business practices and regimens to comply with the Code, the more accountable the industry will be and the better the products and services will be for consumers. The Code has the potential to be implemented in other countries. The Australian Weight Management Code of Practice can be a model for the rest of the world to establish standards by which this huge industry can be governed..

Key Words: Weight Management Code of Practice, Weight Management Council Australia Limited

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A cost benefit analysis of weight management strategies
JODIE YATES AND CHRIS MURPHY

Over the past twenty years, obesity has become a major topic of concern. In particular, this paper estimates that the number of obese adults has risen from around 2.0 million in 1992/93 to about 3.1 million in 2005. With the prevalence of obesity on the rise, the associated economic cost is also increasing significantly. The annual cost of obesity in 1992-93 was estimated at around $840 million per year. This paper shows that the annual cost of obesity in Australia could now be as high as $1,721 million. With the cost of obesity rising, the ability to assess and compare alternative programs for reducing the current prevalence of obesity is very important. This involves weighing up the costs and benefits of the different strategies. So, in addition to providing an updated estimate of the potential cost of obesity in Australia, this paper uses a weight management program to illustrate the methodology used in assessing alternative intervention programs. For illustration, the expected benefit per enrolment in a weight loss program was calculated at $690. The associated cost of the program was $202 per enrolment. It should be noted that the estimate of the cost is more precise than the broad estimate of the average benefit. Nevertheless, the average benefit outweighs the cost by an overwhelming ratio of over three-to-one. So a more detailed analysis is unlikely to overturn the general conclusion that the average benefit clearly outweighs the cost, even if the precise ratio of benefits to costs is likely to change..
Key words: obesity, cost benefit, weight loss strategy, weight reduction programs, health economics

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Last Updated: September 2006