Asia
Pacific Journal of Clinical Nutrition
Volume 11, supplement 7,
2002
Symposium and Workshop on Forging Effective Strategies
for Prevention and Management of Overweight and Obesity in Asia
|
Contents
|
Abstract
|
Paper
|
|
 The
burden of obesity in Asia: Challenges in assessment, prevention
and management
Rodolfo F Florentino
Asia
Pac J Clin Nutr. 2002;11(S7):S676-680.
|
|
|
|
Body
mass index as an indicator of obesity
ROBERT C WEISELLl
Asia
Pac J Clin Nutr. 2002;11(S7):S681-684.
|
|
|
|
Predictive
values of body mass index and waist circumference for risk factors
of certain related diseases in Chinese adults: study on optimal
cut-off points of body mass index and waist circumference in Chinese
adults ZHOU BEI-FAN, THE COOPERATIVE META-ANALYSIS
GROUP OF WORKING GROUP ON OBESITY IN CHINA
Asia
Pac J Clin Nutr. 2002;11(S7):S685-693.
|
|
|
|
Obesity
in Asia: prevalence and issues in assessment methodologies
SE-SIONG TEE
Asia
Pac J Clin Nutr. 2002;11(S7):S694-701.
|
|
|
|
Consequences
of childhood and adolescent obesity
KAH YIN LOKE
Asia
Pac J Clin Nutr. 2002;11(S7):S702-704.
|
|
|
|
Causes
and consequences of adult obesity: health, social and economic
impacts in the United States
NANCY S WELLMAN, BARBARA FRIEDBERG
Asia
Pac J Clin Nutr. 2002;11(S7):S705-709.
|
|
|
|
Impact
of physical activity on the emerging crisis of obesity in Asia
JAMES LEVINE, JOHN PETERS, WIM SARIS, JAMES
HILL
Asia
Pac J Clin Nutr. 2002;11(S7):S710-713.
|
|
|
|
The
challenge of managing body weight in the modern world
JOHN C PETERS
Asia
Pac J Clin Nutr. 2002;11(S7):S714-717.
|
|
|
|
Behavioural
determinants of the obesity epidemic
DAVID CRAWFORD, KYLIE BALL
Asia
Pac J Clin Nutr. 2002;11(S7):S718-721.
|
|
|
|
Pharmacotherapy
and surgery in the treatment of obesity: evaluating risks and
benefits CHEE
FANG SUM
Asia Pac J
Clin Nutr. 2002;11(S7):S722-725.
|
|
|
|
ACTIVATE:
A childhood overweight prevention initiative
NANCY S WELLMAN
Asia
Pac J Clin Nutr. 2002;11(S7):S726.
|
|
|
|
Epidemiology
of obesity and public health strategies for its control in Japan
NOBUO YOSHIIKE, FUMI KANEDA, HIDEMI TAKIMOTO
Asia
Pac J Clin Nutr. 2002;11(S7):S727-731.
|
|
|
|
Criteria
and classification of obesity in Japan and Asia-Oceania
MASAO KANAZAWA, NOBUO YOSHIIKE, TOSHIMASA OSAKA, YOSHIO NUMBA,
PAUL ZIMMET, SHUJI INOUE
Asia
Pac J Clin Nutr. 2002;11(S7):S732-737.
|
|
|
|
Healthy
lifestyles . . . healthy people The Mega Country Health Promotion
Network EILEEN KENNEDY
Asia
Pac J Clin Nutr. 2002;11(S7):S738-739.
|
|
|
top
The
burden of obesity in Asia: Challenges in assessment, prevention and
management S676
RODOLFO F FLORENTINO
Overweight and obesity have started to emerge as a significant public
health arisen from the changing dietary
pattern towards energy-dense and high fat diets, together with a more
sedentarylifestyle arising from increasing urbanization. Obesity's
threat to the health and economy of the population gives urgency to
meeting the problem headlong before it gets any worse. Fundamental
knowledge gaps, however, constrain the institution prevent and manage
this growing problem. Foremost the region, coupled with a lack of
uniformity in reference standards and cut-off points. While the principles
of dietary management, physical activity and behaviour modification
are well known, integrating these strategies into a national policy
and program in the face of competing priorities is the greatest challenge
of all. This requires the collaboration of government, academia, the
food industry, the private sector, NGOs and the community, with the
assistance of international and bilateral aid agencies, to develop
and implement such policies and programs.
top
Body
mass index as an indicator of obesity S681
ROBERT C WEISELLl
Undernutrition and hunger have always formed the foundation of the
Food and Agriculture Organisation's (FAO) mandate. Working in collaboration
with the International Dietary Energy Consultative Group (IDECG),
FAO began to examine both appropriate cut-off points of the body mass
index (BMI) at the lower end of the
spectrum and the functional consequences of low BMI (<16.0 = Category
III Chronic Energy Deficiency (CED); 16.0 16.9 = Category II CED;
17.0 18.4 = Category I CED). Over the past decade FAO has recognized
the
growing obesity epidemic occurring not only in the developed world
but also among all income and socio-economic groups of the developing
world. In response, FAO and the World Health Organization (WHO) have
collaborated together in joint initiatives. Following the WHO 1998
Obesity Consultation on Preventing and Managing the Global Epidemic,
a number of regions examined their individual situation regarding
obesity. In looking at the BMI risk-based cut-off points, there appeared
to be need for a tailoring of the cut-off points for Asia. The publication
The Asia-Pacific Perspective: Redefining Obesity and its Treatment
(2000) proposed area-specific cut points. While such efforts to individualize
reference values to a region or situation are attractive and even
commendable, there is always the danger of creating confusion particularly
if later these figures are changed. It is very important that before
values are promulgated, a thorough review is conducted and full confidence
can be placed on them.
top
Predictive
values of body mass index and waist circumference for risk factors
of certain related diseases in Chinese adults: study on optimal cut-off
points of body mass index and waist circumference in Chinese adults
S685
ZHOU
BEI-FAN, THE COOPERATIVE META-ANALYSIS GROUP OF WORKING GROUP ON OBESITY
IN CHINA
For
prevention of obesity in the Chinese population, it is necessary to
define the optimal range of healthy weight and the appropriate cut-off
points of body mass index (BMI) and waist circumference for Chinese
adults. The Working Group on Obesity in China under the support of
the International Life Sciences Institute Focal Point in China organized
a meta-analysis on the relationship between BMI, waist circumference
and risk factors of related chronic diseases (e.g., high diabetes,
diabetes mellitus, and lipoprotein disorders). Thirteen population
studies in all met the criteria for enrolment, with data of 239 972
adults (2070 years of age) surveyed in the 1990s. Data on waist circumference
was available for 111 411 persons, and data on serum lipids and glucose
were available for more than 80 000. The study populations were located
in 21 provinces, municipalities and autonomous regions in mainland
China as well as in Taiwan. Each enrolled study provided data according
to a common protocol and uniform format. The Center for Data Management
in the Department of Epidemiology, Fu Wai Hospital, was responsible
for the statistical analysis. The prevalence of hypertension, diabetes,
dyslipidemia and clustering of risk factors all increased with increasing
levels of BMI or waist circumference. A BMI of 24 with best sensitivity
and specificity for identification of the risk factors was recommended
as the cut-off point for overweight; a BMI of 28, which may identify
the risk factors with specificity around 90%, was recommended as the
cut-off point for obesity. A waist circumference over 85 cm for men
and over 80 cm for women were recommended as the cut-off points for
central obesity. Analysis of a population-attributable risk percentage
illustrated that reducing the BMI to the normal range (<24) could
prevent 4550% of the clustering of risk factors. Treatment of obese
persons (BMI = 28) with drugs could prevent 1517% of clustering of
risk factors. When waist circumference is controlled at under 85 cm
for men and under 80 cm for women, it could prevent 47 58% of clustering
of risk factors. Based on these guidelines, a classification of overweight
and obesity for Chinese adults is recommended. For prevention of obesity
in the Chinese population, it is necessary to define the optimal range
of healthy weight and the appropriate cut-off points of body mass
index (BMI) and waist circumference for Chinese adults. The Working
Group on Obesity in China under the support of the International Life
Sciences Institute Focal Point in China organized a meta-analysis
on the relationship between BMI, waist circumference and risk factors
of related chronic diseases (e.g., high diabetes, diabetes mellitus,
and lipoprotein disorders). Thirteen population studies in all met
the criteria for enrolment, with data of 239 972 adults (2070 years
of age) surveyed in the 1990s. Data on waist circumference was available
for 111 411 persons, and data on serum lipids and glucose were available
for more than 80 000. The study populations were located in 21 provinces,
municipalities and autonomous regions in mainland China as well as
in Taiwan. Each enrolled study provided data according to a common
protocol and uniform format. The Center for Data Management in the
Department of Epidemiology, Fu Wai Hospital, was responsible for the
statistical analysis. The prevalence of hypertension, diabetes, dyslipidemia
and clustering of risk factors all increased with increasing levels
of BMI or waist circumference. A BMI of 24 with best sensitivity and
specificity for identification of the risk factors was recommended
as the cut-off point for
overweight; a BMI of 28, which may identify the risk factors with
specificity around 90%, was recommended as the cut-off point for obesity.
A waist circumference over 85 cm for men and over 80 cm for women
were recommended as the cut-off points for central obesity. Analysis
of a population-attributable risk percentage illustrated that reducing
the BMI to the normal range (<24) could prevent 4550% of the clustering
of risk factors. Treatment of obese persons (BMI = 28) with drugs
could prevent 1517% of clustering of risk factors. When waist circumference
is controlled at under 85 cm for men and under 80 cm for women, it
could prevent 47 58% of clustering of risk factors. Based on these
guidelines, a classification of overweight and obesity for Chinese
adults is recommended.
top
Obesity
in Asia: prevalence and issues in assessment methodologies
S694
SE-SIONG TEE
The dramatic changes
in the lifestyle of many Asian communities, and the resultant changes
in the food and nutrition issues facing the communities in the region
have been documented by various investigators. Health authorities
and researchers have given greater attention to the problem of overweight
and obesity. Available data are lacking, but various estimates have
indicated that the emerging problem of overweight amongst children
cannot be ignored. Estimates of overweight by the World Health Organization
(WHO) amongst preschool children in Asia in 1995 was around 2.9%.
Data extracted from selected studies in individual Asian countries
show much higher prevalences, ranging from 5% to 9% amongst several
urban cities in Asia. In several other developing countries in the
region, the prevalence is probably very low, with prevalences of less
than 1%. There is thus
considerable variation in this prevalence amongst the various countries.
The problem of increasing overweight and obesity amongst adults in
Asia has been highlighted for more than a decade. The database on
the extent of the problem is far from being comprehensive, but various
studies have pointed out the severity of the problem. Various reports
in the 1990s have pointed out prevalences of overweight of over 20%
and obesity of over 5% amongst urban population groups of the more
developed countries in the region. It is also to be noted that there
are also reports indicating that the most affluent societies in the
region, such as Seoul and Tokyo, did not have the highest prevalence
of overweight. There are also data on increasing prevalence of overweight
among rural areas in the last 10 years. The situation for children
is similar: there is considerable variation in the severity of the
problem. In the Philippines National Surveys, for example, slightly
lower prevalences have been reported. Countries in the region will
continue to progress, accompanied by continued changes in lifestyle
of communities. It is therefore of utmost importance to continue to
monitor the nutritional status of communities. The lack of nationally
representative data which is regularly updated is a major concern.
The lack of data for certain age groups such as the adolescents and
the elderly need to be addressed. One of the main obstacles in the
formulation and effective implementation of intervention programs
in developing countries is the lack of comprehensive data on the extent
of the problems in many cases and the causes of such problems specific
to the communities concerned. In addition to the lack of good data,
other concerns too need to be addressed. These include methodological
issues such as the need for harmonization of methods in assessment
of nutritional status for the various groups, the appropriateness
of criteria for cut-offs, growth reference to be used, and association
of overweight and obesity with comorbidities.
top
Consequences of childhood and adolescent obesity
S702
KAH YIN LOKE
Obesity, increasingly recognized as a chronic disease, is associated
with physical, psychosocial and economic consequences to society.
With the burgeoning global epidemic, health care workers must rally
together to understand, treat and prevent obesity and its complications.
top
Causes
and consequences of adult obesity: health, social and economic impacts
in the United States S705
NANCY S WELLMAN, BARBARA FRIEDBERG
Obesity has been
identified as an epidemic in the United States for more than two decades
and yet the numbers of overweight and obese adults and children continue
to grow. Currently, the rates of both overweight and obesity in the
US are 61% and 14% in adults and children, respectively. Among US
adults aged 2074 years, the prevalence of overweight (defined as BMI
25.029.9) has increased from 33% in 1980 to 35% of the population
in 1999. In the same population, obesity (defined as BMI 30) has nearly
doubled from approximately 15% in 1980 to an estimated 27% in 1999.
The percentage of children and adolescents who are defined as overweight
has more than doubled since the early 1970s. About 14% of children
and adolescents are now seriously overweight. Obesity burdens the
health care system, strains economic resources, and has far reaching
social consequences. The disease is associated with several serious
health conditions including: type 2 diabetes mellitus, heart disease,
high blood pressure and stroke. It is also linked to higher rates
of certain types of cancer. Obesity is an independent risk factor
for heart disease, hypoxia, sleep apnea, hernia, and arthritis. Obesity
is the seventh leading cause of death in the US. The total cost of
overweight and obesity by some estimates is $100 billion annually.
Others put the cost of health care for obesity alone at $70 billion.
Other annual costs associated with obesity are 40 million workdays
of productivity lost, 63 million doctors' office visits made, and
239 million restricted activity days and 90 million bed-bound days.
Emotional suffering may be among the most painful aspects of obesity.
American society emphasizes physical appearance and often equates
attractiveness with slimness, especially for women. Such messages
may be devastating to overweight people. Many think that obese individuals
are gluttonous, lazy, or both, even though this is not true. As a
result, obese people often face prejudice or discrimination in the
job market, at school, and in social situations. Feelings of rejection,
shame, or depression are common. Since the 1950s, national dietary
recommendations have come to acknowledge obesity as a significant
societal trend. The Surgeon General's 2001 Call To Action, Healthy
People 2010, and the Dietary Guidelines for Americans 2000 all emphasize
the importance of healthy weight. There are some new tools available
to help in the fight against overweight and obesity: Weight Control
Information Network, The Third National Cholesterol Education Program's
Adult Treatment Panel, and The Practical Guide: Identification,
Evaluation, & Treatment of Overweight & Obesity in Adults
from the National Institutes of Health and National Heart Lung and
Blood Institute.
top
Impact of physical activity on the emerging crisis of obesity in Asia
S710
JAMES LEVINE, JOHN PETERS, WIM SARIS, JAMES HILL
Obesity
is associated with devastating health and fiscal consequences in countries
where it is epidemic. It is beholden on us all to try to prevent obesity
emerging in countries where its prevalence is starting to increase.
There are many countries in Asia where this is so. Obesity prevention
necessitates attention to both increasing physical activity and improving
nutrition. In this paper we discuss a strategic approach for increasing
physical activity. First, we need to better understand physical activity
levels and the factors that impact it. Next, we need to design specific
and targeted governmentally supported strategies to promote physical
activity. Finally we need to critically and objectively evaluate these
strategies and then promote those that are successful, and channel
limited resources away from those that are not. These goals are achievable
through collaborating and sharing technologies. We hope to prevent
obesity from engulfing Asia.
top
The
challenge of managing body weight in the modern world S714
JOHN C PETERS
Obesity prevalence has increased dramatically in parallel with rapid
economic development and rising standards of living around the world.
There is growing recognition that this 'epidemic' of overweight is
being driven by environmental factors that affect our eating and physical
activity behaviours. In effect, the environment overwhelms our biological
capacity to maintain a healthy weight. There is little scientific
evidence to quantify the relative contributions of various environmental
factors to risk of overweight and obesity. However, it is easy to
characterize the environment as one in which food is readily available,
convenient, inexpensive and great tasting. Likewise, the modern environment
discourages physical activity at work, at home and in the community,
and attractive sedentary pursuits compete with activity for leisure
time. In fact, the causes of obesity in our society are so manifold
as to be inseparable from the way we live. Many of the forces that
drive individuals to eat too much and move too little are coupled
to a desire for self-efficacy and increased productivity. It can be
argued therefore that obesity is an unintended consequence of the
emphasis we collectively place on productivity and a desire to achieve
'the good life'. In this sense, obesity is not really a biological
problem, but a social problem that requires a multifactorial social
solution. In order to create demand for environmental change to promote
healthy lifestyle behaviours, we will need to create a greater sense
of crisis among average citizens. We will need to explore solutions
that make economic sense for everyone. We will need to create a new
social norm for healthy eating and active living. The magnitude of
the challenge is daunting, but we can begin by engaging broad scale
public private partnerships. After all, we are all part of the global
community that is affected by this emerging crisis.
top
Behavioural
determinants of the obesity epidemic S718
DAVID CRAWFORD, KYLIE BALL
Obesity is a serious and growing public health problem affecting developed
and developing countries. It is generally agreed that the causes of
the current obesity epidemic are not genetic in origin, but are the
result of changes in the environments in which we live. While acknowledging
the importance of environmental factors, the central role of behaviour
in the obesity epidemic cannot be ignored. It is our eating, physical
activity and sedentary behaviours that form the interface between
our biology and the environments to which we are exposed. However,
a lack of understanding of the specific behaviours that are important
in the aetiology of obesity poses a major constraint to preventing
obesity. A better understanding of the behaviours that contribute
to weight gain and obesity is critical in order to plan and implement
effective obesity prevention initiatives. Theory-driven investigations
of eating, physical activity and sedentary behaviours, their determinants,
and their role in weight gain and obesity among different population
groups are urgent research priorities. Without an understanding of
the
key behaviours that contribute to weight gain, and the influences
on these behaviours, it will remain difficult to identify where to
intervene in the environment and be confident that action will prevent
obesity.
top
Pharmacotherapy
and surgery in the treatment of obesity: evaluating risks and benefits
S722
CHEE FANG SUM
The prevalence
of obesity is rising in many parts of the world. In Singapore, the
1998 National Health Survey reported the crude prevalence of obesity
(BMI 30 kg/m2) amongst adults as 6%. Together with the increase in
obesity in certain sectors of the Singapore population (Malay community)
there has been a parallel increase in the prevalence of impaired glucose
tolerance. If left unchecked, this epidemic of obesity and its comorbidities
will lead to reduced quality of life amongst its sufferers as well
as an increase in consumption of healthcare resources. Although strategies
at the community level are important to check this epidemic, when
managing the individual patient with clinically significant obesity
and its comorbidities, adjunctive pharmacotherapy and surgical measures
are sometimes required besides lifestyle measures and behaviour therapy.
Since these therapeutic measures are not without risks, a customized
approach utilizing risk-benefit evaluation is appropriate. Pharmacotherapy
for the management of obesity has had a chequered history Prom the
early disrepute brought about by patient dependence when using amphetamine-like
agents, it improved in standing when obesity became more widely accepted
as a chronic disorder requiring chronic adjunctive pharmacotherapy.
However, the adverse cardiovascular effects reported with the 'fen-phen'
combination again reduced enthusiasm for long-term pharmacotherapy.
Subsequently, the availability of intestinal lipase inhibitor, orlistat,
followed by the mixed noradrenergic-serotoninergic re-uptake inhibitor,
sibutramine, gave fresh impetus to this therapeutic area. Both agents
were made available for clinical use only after published clinical
trial experience of one to two years duration. The difficulties encountered
in management of patients with marked obesity have prompted adjunctive
surgical initiatives. Follow-up reports from the Swedish Obese Subjects
study which began in 1987, have provided valuable data on the effect
of surgery on obesity as well as its comorbidities. At the same time,
technological advances in surgery have facilitated the widespread
use of less invasive approaches to bariatric surgery. It is hoped
that with these technological advances, this group of patients will
be able to enjoy the benefits of surgery without being exposed to
excessive surgical risks.
top
ACTIVATE:
A childhood overweight prevention initiative S726
NANCY S WELLMAN
ACTIVATE
was initiated in 1999 by the International Food Information Council
(IFIC) Foundation and the International Life Sciences Institute Center
for Health Promotion. Extensive qualitative research was conducted
to help understand consumer beliefs, attitudes, and perceptions about
preventing overweight, specifically overweight in childhood. ACTIVATE
then used the research findings to develop potential avenues for communicating
obesity prevention messages. The research, conducted with children
and their parents, consisted of three progressive phases of focus
groups, with each building on information obtained from the previous
phase. The findings suggest the need for parents and children to work
together to address the obesity prevention issue, as well as the need
for effective tools to facilitate this conversation. Parents
need to learn how to talk about eating and exercise habits with their
children in positive and encouraging ways and how to help sustain
their child's involvement in eating healthily and staying physically
active. Children themselves need direct messages to motivate them
to change their exercise and eating habits, as well as tips on partnering
with their parents to achieve fitness goals. Children and parents
both stated that positive and realistic approaches to getting fit
that seem achievable and accessible would be of great help in their
efforts. Both groups considered ongoing encouragement and 'small victories'
to sustain involvement in getting fitter to be critical factors to
success. Children and parents are also looking for support and customized
information to help them in their efforts. ACTIVATE responds to the
critical need for comprehensive obesity prevention initiatives. It
is a communications program designed to help children and their families
achieve healthy lifestyles through regular physical activity and good
nutrition. ACTIVATE promotes sound nutrition advice by emphasizing
that healthy eating is based on the overall diet, not any one food
or any one meal. The
message that all foods can fit into a healthy diet when consumed in
moderation is an integral piece of ACTIVATE. Being physically active
is equally as important as eating well, and various ways to incorporate
activity into children's lives are emphasized. Particular attention
is placed on making physical activities fun, enjoyable, and sustainable.
ACTIVATE is also a unique partnership. The IFIC Foundation is working
closely with several organizations to develop ACTIVATE's program elements
and to extend ACTIVATE's reach. These partner organizations are the
American Academy of Family Physicians (AAPP); the American College
of Sports Medicine (ACSM); the American Dietetic Association (ADA);
the International Life Sciences Institute Center for Health Promotion
(ILSI CHP); and the National Recreation and Park Association (NRPA).
In addition, ACTIVATE is advised by individual experts in physical
activity, nutrition, family medicine, and child psychology. Currently,
the IFIC Foundation and its partners are using the research findings
to develop ACTIVATE's customized program elements program elements
that will deliver positive, balanced information on physical activity
and nutrition to help families achieve healthy lifestyles.
top
Epidemiology
of obesity and public health strategies for its control in Japan
S727
NOBUO YOSHIIKE, FUMI KANEDA, HIDEMI TAKIMOTO
Epidemiology of obesity and public health strategies for its control
in Japan Nobuo Yoshiike MD, Fumi Kaneda MS and Hidemi Takimoto MD
Obesity has become a public health problem in Japan. The National
Nutrition survey (2000) showed prevalence of preobese (body mass index:
2529.9 kg/m2) and obesity ( 30 kg/m2) was 24.5% and 2.3%, respectively,
in males, and 17.8% and 3.4%, respectively, in females aged 20 years
and over. Trends in prevalence of overweight in the last 25 years
differed among age-sex groups and across residential areas. The most
significant increase in overweight was observed in men in small towns,
whilst there was a remarkable decrease in women in metropolitan areas.
In the 10 year national plan for health promotion named 'Health Japan
21', maintaining appropriate body weight (obesity control and prevention
of thinness brought about by dieting in young women) is a core component
of the prioritized issues. Increasing the number of people who know
their healthy body weight and practice weight control is also listed
as an important objective. The proportion of people engaged in regular
exercise for health and following the recommended average number of
steps in daily life is a major indicator for evaluation of the program.
We conclude that when formulating effective public health strategies
for obesity control, it is important to consider each country's own
situation related to obesity issues including the proper BMI cutoff
point, which might be much different from that in western societies.
top
Crieria
and classification of obesity in Japan and Asia-Oceania
MASAO KANAZAWA, NOBUO YOSHIIKE, TOSHIMASA OSAKA, YOSHIO NUMBA, PAUL
ZIMMET, SHUJI INOUE
see pdf
top
Healthy
lifestyles . . . healthy people The Mega Country Health Promotion
Network S738 EILEEN KENNEDY
In
December 2001, the World Health Organization launched the Mega Country
Health Promotion Network. This network includes the countries with
populations of 100 million or more. The 11 countries that are part
of this network account for more than 60% of the world's population.
The overall goal of this network is to promote healthy lifestyles;
much of the focus of activities will be on promoting a healthy diet,
based on food-based dietary guidelines and increased physical activity.
Data will be presented that illustrate the 'double burden' of disease
in the low income populations in these 11 countries. The network is
attempting to identify new paradigms for health promotion, including
the innovative use of public/private partnerships. Examples of these
innovations will be presented.
top
Last
Updated: September 2004
HEC
PRESS Publisher
of the 
