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Causes, Consequences and Tackling obesity.
Professor Paul GatelyCarnegie Weight ManagementLeeds Metropolitan University
What is overweight ?• This boy is 3 years, 3 weeks
old.• Is his BMI-for-age
- below the 5th percentile? - 5th to <85th percentile: normalweight? - >85th to <95th percentile:
overweight? - >95th percentile:
obese?
Photo from UC Berkeley Longitudinal Study, 1973
Measurements:
Age=3 y 3 wks
Height=100.8 cm (39.7 in)
Weight=18.6 kg(41 lb)
BMI=18.3
BMI-for-age= >95th percentile = obese
Plotted BMI-for-Age
Boys: 2 to 20 years
BMI BMI
BMI BMI
Body Mass Index (kg/m2)
Probability density
Source: Rose, G. (1991) .
BMI distribution curves over timeBMI distribution curves over time
14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 440.00
0.05
0.10
O/WT OBESE
W.Samoa (urban)
Kuwait
East Germany
USA
Saudi Arabia
W. Germany
Czech Republic
England
Canada
Netherlands
Australia
Brazil
Japan
China
Women Men
80 70 60 50 40 30 20 10 0 10 20 30 40 50 60 70 80
% population
Age rangeYear *
* Most recent available data. Surveys conducted between 1988 and 1994.
25-6918+
25-6420-74
15+25-6920-6516-6418-7420-5920-6915-6425-64
20+20-45
GLOBAL PREVALENCE OF OBESITY (defined as BMI >30)
Changes in prevalence
Why is this a concern?Pulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndrome
Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseaseSteatosisSteatosisSteatohepatitisSteatohepatitiscirrhosiscirrhosis
Coronary heart diseaseCoronary heart disease
DiabetesDiabetes
DyslipidemiaDyslipidemia
HypertensionHypertension
Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndrome
OsteoarthritisOsteoarthritis
SkinSkin
Gall bladder diseaseGall bladder disease
CancerCancerbreast, uterus, cervixbreast, uterus, cervixcolon, esophagus, pancreascolon, esophagus, pancreaskidney, prostatekidney, prostate
PhlebitisPhlebitisvenous stasisvenous stasis
GoutGout
Idiopathic intracranial Idiopathic intracranial hypertensionhypertension
StrokeStroke
CataractsCataracts
Severe pancreatitisSevere pancreatitis
Source: www.obesityonline.org
Psycho social factors12-year old girls and boys
2
2.2
2.4
2.6
2.8
3
3.2
Self-worth School Athletic Behaviour
Obese boys Normal wtObese girls
* p<.01 **p<.001
Fat-teasing in boys & girls (Murphy & Hill, 2003)
1.8
2
2.2
2.4
2.6
2.8
3
3.2
Self-worth School Social Athletic Appearance Behaviour
Non victimised Fat teased boysFat teased girls * p<.05 **p<.001
****** ***
Toxic or obesogenic environment
Obesity is a normal response to an abnormal environment
side-effect of technological advances reflects natural human preferences (eg easy, convenient, fast,
low effort, value for money)
key factors• energy-saving machines, passive recreation• energy-dense foods & drinks, large portion sizes
Biological and cultural mismatches to the modern environment
FOOD Strong signals to eat Weak signals to stop Increased availability Eating is rewarding No viable alternatives Eating well is high status
ACTIVITY Weak activity signal Strong signals to stop Reduced availability Inactivity is rewarding Inactivity is a viable alternative Inactivity is high status
Where should the focus be?
1 in 3 children are overweight or obese.
1 in 3 children who will become overweight or obese adults.
1 in 3 children who are and will remain normalweight /underweight?
4,563,865
9,266,033
33%
77%
Gately (2007)
NORMAL WEIGHT
OVERWEIGHT
Health costs
↑ 20%
1797887
2,765,980
20%
13%
Gately (2007)
OBESE
Health costs ↑ 50%
691495
1382990
1797887
138,299
553196
1%
4%
5%
10%
13%
Gately (2007)
OBESE +++
Health costs
? Min ↑100%
Is policy having an impact on weight change?
Initiative Cost Impact Measurement/evaluation
Prevention
Sahota (UK) ? No Impact BMI
Gortmaker (US) ? No Impact BMI
Lupeka (US) ? No Impact BMI
Fruit and Veg Field (US) ? No impact BMI
PESSCL ? No evidence No evaluation
School Food Programme £235m? No evidence No evaluation
Healthy Schools ? No evidence No evaluation
Play £155m? No evidence No evaluation
Social Marketing ? No evidence No evaluation
Extended schools £125m? No evidence No evaluation
Results of process research
Comments on exercise:• “I prefer to do sports than watch TV, just don’t get the chance, I’m too
fat.”• “I don’t like walking or running its boring, just never do it.”• “I like doing sports, because I’m having fun with friends.”
Potential of extended schools and PESSCL? • “I would get laughed at it I turned up for an afterschool sports club, they
are not for kids like me” • “After I lost weight and got fitter I felt more like joining in PE and clubs”
Carnegie Weight Management
Treatment programmesCamps (residential & day),
clubs
Multi mediaResearch,
ConsultancyTraining
Broadcast
Carnegie Curriculum
Diet
PhysicalActivity SocialActivities
BehaviourChangeTheory
&Tools
Carnegie Weight Management
Interventions Prevention Practice based Research
Broadcast
Consultancy
Web
Community clubs
Training
Web
Community camps
Web
Residential Camps-
schools
Web
Research evidence
No Evidence No Evidence 1%↓ BMI SDS 6m 4 %↓ BMI SDS 10%↓ BMI SDS 1-3 yr
Costs ratio 1.0 1.2 1.5 2.0 ?
UK n= (SDS) 8.5m (<1.04) 4.5m (>1.04) 2.7m (>1.69) 691k (>2.5) 140K (>3.0)
Skill based exercisePre and post camp scores for sports skills (Gately 2005)
0
10
20
30
40
50
60
Badminton Serve Basketball shot Football Dribbling(secs)
Volleyball Volley
Skills
Sco
re
Week 1
Week 6
***
***
*** P<0.001 pre to post
***
***
Self Perception Profile for Children (SPPC)
1.6
1.8
2
2.2
2.4
2.6
2.8
3
3.2
Self-worth School Social Athletic Appearance Behaviour
Normal weight
Pre-camp
Post-camp
** ****
Source: Walker et al. (2002)** (P<0.01)
Long term results of residential programme
1
1.5
2
2.5
3
3.5
4
Pre 1 Post 1 Pre 2 Post 2 Pre 3 Post 3 Pre 4 Post 4
Time
Stan
dard
ised
BM
I sc
ore
Mean one year follow up data
Mean two year follow up data
Mean three year follow updata
Community club outcomes
Change Children Parents
Body mass (kg) 0.7 + 2.3 -1.1 + 2.5
BMI (kg.m-2) -0.19 + 1 -0.31 + 0.8
BMI SDS -0.11 + 0.23 NA
Waist (cm) -8.7 + 4.2 -5.9 + 4.2
% Body fat -1.75 + 2.6 -1.2 + 5.3
Fitness (l.min-1) 0.2 + 0.4 0.3 + 0.3
Impact of obesity interventions on participants
1 Very little published evidence on the effectiveness of whole-school obesity interventions in the UK. What exists is not overwhelmingly positive
SurgeryDrugs
(e.g. Sibutramine, Orlistat)
Whole School
Approach¹Prevention CWM
Reduces BMI z-score ? x Increases fitness x x ? ? Improves self-esteem x x ? ? Improves family relationships x x ? ? Builds capacity within communities x x ?
Comparative attributes of obesity interventions
SurgeryDrugs
(e.g. Sibutramine, Orlistat)
Whole School
ApproachPrevention CMW
Positive experience x x x x Scalable x Evidence-based x x Failure rate Low Medium n/a ? Low
Health risk High Medium Low Low Low
Cost of intervention
(£/person)£5,665
£444 & £386 (9 months)
No UK
data? Varies
Sustainability of weight loss
High Low x x High
Carnegie Weight ManagementThe Grange
Headingley CampusLeeds Metropolitan University
LeedsLS6 3QS
Tel. +441138123579p.gately@leedsmet.ac.uk
www.carnegieweightmanagement.com
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