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Beyond BMI: A new framework for diagnosing obesity with a focus on overall health
The traditional method of diagnosing and managing obesity, which heavily relies on body mass index (BMI), is increasingly seen as inadequate. Acknowledging this, the European Association for the Study of Obesity (EASO) has introduced a comprehensive new framework for diagnosing, staging, and managing adult obesity. Detailed in a recent publication in Nature Medicine, this framework aims to incorporate the latest scientific insights and advancements, including novel obesity medications, to ensure more effective and inclusive treatment strategies.
Obesity is widely recognised as a multifactorial, chronic, relapsing, non-communicable disease characterised by an abnormal and/or excessive accumulation of body fat. Traditionally, the diagnosis has been predominantly based on BMI cut-off values. This method fails to consider critical factors such as the distribution and functional roles of adipose tissue in the disease’s severity.
The EASO Steering Group, comprising current and former association presidents among other experts, has crafted a series of statements that update the obesity management approach to reflect the latest scientific knowledge. A key update in this new framework is the revised approach to the anthropometric component of obesity diagnosis. The authors explain, “An important novelty of our framework regards the anthropometric component of the diagnosis. The basis for this change is the recognition that BMI alone is insufficient as a diagnostic criterion, and that body fat distribution has a substantial effect on health.” They specifically highlight the health risks associated with the accumulation of abdominal fat, noting its association with an increased risk of cardiometabolic complications and its significance as a determinant of disease, even in individuals with a BMI below traditional obesity thresholds.
The new framework underscores the importance of considering abdominal (visceral) fat accumulation as a critical health risk factor, even in individuals with lower BMI (≥25–30 kg/m^2) who exhibit significant abdominal fat but may lack overt clinical symptoms. This broader definition aims to reduce the risk of undertreating these individuals compared to the current BMI-based criteria.
Treatment recommendations within the framework align with existing guidelines but emphasise behavioural changes such as dietary adjustments, increased physical activity, stress management, and improved sleep quality. Psychological therapy, obesity medications, and metabolic or bariatric procedures are also considered crucial, depending on individual needs.
The steering committee has pointed out that the traditional reliance on BMI cut-offs in clinical trials and guidelines often excludes individuals who, despite having a lower BMI, carry a significant obesity-related health burden. The committee suggests a shift towards including patients with a BMI of at least 25 kg/m^2 and a waist-to-height ratio above 0.5, who also exhibit medical, functional, or psychological impairments, in obesity medication and treatment programmes.
The authors make a call to action to pharmaceutical companies and regulatory bodies: “This statement may also be seen as a call to pharmacological companies and regulatory authorities to use inclusion criteria that are more adherent to the clinical staging of obesity and less to traditional BMI cut-offs when designing future clinical trials with obesity medications.”
In conclusion, the authors advocate for a paradigm shift in obesity management, likening it to the management of other chronic non-communicable diseases. They emphasise the importance of defining long-term, personalised therapeutic goals from the outset of treatment, considering the disease’s stage and severity, therapeutic options, side effects, patient preferences, and individual challenges. They stress the necessity for a comprehensive, life-long treatment plan over mere short-term weight reduction, stating, “Emphasis on the need for a long-term or life-long comprehensive treatment plan rather than short-term body weight reduction is warranted.”
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China initiates comprehensive three-year strategy to combat obesity epidemic
China has launched a three-year public initiative aimed at improving weight management to address the escalating issue of obesity within its populace. This initiative involves a collaborative effort among the National Health Commission (NHC), the Ministry of Education, the Ministry of Civil Affairs, and 13 additional governmental departments. These bodies have collectively issued a detailed strategy that is set to commence this year.
The primary objectives of this initiative include heightening public awareness regarding effective weight management strategies and fostering an environment conducive to healthy living nationwide.
According to the newly released strategy, there is a targeted focus on enhancing the weight status of various demographic groups, including pregnant women, young adults, children, the elderly, and workers in certain occupational sectors.
Guo Yanhong, who heads the NHC’s Health Emergency Response Office, highlighted the urgent need for this campaign given the rising rates of obesity. The comprehensive plan suggests that employers should enhance facilities to encourage physical activities at workplaces.
Furthermore, the initiative seeks to boost physical activity among students by promoting the establishment of health-conscious dining facilities within schools and ensuring students engage in at least one hour of physical exercise during and after school each day. There is also a push to decrease the availability of high-salt, high-sugar, and high-fat foods on school premises.
The strategy supports incorporating traditional Chinese medicinal practices into weight management regimes and advocates for a shift towards “healthy consumption” habits. This includes modifying food processing methods to bolster nutritional content while reducing the levels of oil, salt, and sugar in processed foods.
Recognising the link between body weight and overall health, the NHC points out that obesity often predisposes individuals to chronic diseases such as metabolic syndromes, cardiovascular diseases, and certain cancers. A pivotal goal of this campaign is to preemptively address these health issues by focusing on holistic wellness rather than merely treating diseases. The campaign also aims to include support for underweight individuals and those suffering from malnutrition.
In addition to dietary and exercise recommendations, the action plan calls for the adoption of advanced technology. It recommends the development and use of intelligent wearable devices that can monitor weight and other health metrics effectively. The integration of big data and artificial intelligence is also encouraged to tailor personal health management plans.
This announcement was made shortly after China’s approval of the widely acclaimed weight loss drug Wegovy, manufactured by Novo Nordisk. Following the endorsement by China’s National Medical Products Administration, Novo Nordisk is set to market its injectable weight-loss medication within China, where approximately 16.4% of the population is currently considered overweight.
This approval has sparked a surge in the demand for weight loss pharmaceuticals in China, prompting several companies to develop medications akin to Novo Nordisk’s Ozempic and Wegovy.
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Poor muscle health in Individuals with obesity increases risk of early death, study finds
A pivotal study presented at the European Congress on Obesity (ECO) in Venice, Italy, from 12-15 May, 2024, has unveiled a stark correlation between suboptimal muscle health and an increased risk of premature death among individuals with obesity.
The research, carried out by a Swedish team on a UK cohort, established that individuals with compromised muscle composition were three times more likely to die during the study period compared to those with healthier muscle conditions. Dr. Jennifer Linge of AMRA Medical in Linköping, Sweden, spearheaded the research and shared compelling insights. “By examining muscle composition, we can predict which individuals with obesity are most at risk of early death in the forthcoming years,” Dr. Linge explained, highlighting the potential of muscle analysis as a predictive tool for mortality.
In recent years, weight loss has become a central strategy in managing chronic conditions such as type 2 diabetes and cardiovascular diseases. With pharmaceutical advancements, patients are now achieving significant weight reductions, previously possible only through surgical interventions. However, this brings to light concerns about possible detrimental effects on muscle health, including severe muscle mass loss and reduced mobility.
Dr. Linge elaborated on the complexities of muscle health in individuals with obesity, “Although individuals with obesity typically have more muscle mass, their muscles tend to be comparatively weaker. They also exhibit lower muscle quality, as well as reduced mobility and function.” She emphasised the importance of thorough muscle composition assessments, which consider both muscle quantity and quality, in evaluating the safety of rapid weight loss treatments, particularly for more vulnerable patients, such as those with sarcopenic obesity or advanced age.
The study also highlighted a critical gap in research concerning muscle health among populations with obesity, despite existing evidence from MRI studies that link poor muscle health with reduced functional performance, increased illness, and higher mortality rates in individuals with non-alcoholic fatty liver disease (NAFLD) and the general populace.
To address this, Dr. Linge and her colleagues utilised the AMRA Researcher software to analyse MRI scans from 56,109 participants in the UK Biobank study. They measured muscle volume and muscle fat, establishing a personalised muscle volume z-score to benchmark each individual’s muscle volume against the norm for their sex and body size.
From the extensive dataset, 9,840 participants—half of whom were men, with an average age of 64.4 years and a mean BMI of 33.5 kg/m²—were identified as having obesity and had comprehensive data on muscle composition. Of these, 2,001 (20.3%) exhibited adverse muscle composition. Over an average follow-up of 3.9 years, 174 participants died, predominantly from ischemic and hypertensive diseases.
The study findings indicated that neither low muscle volume z-score nor high muscle fat alone significantly influenced mortality risk. However, adverse muscle composition—characterised by both low muscle volume and high muscle fat—was strongly associated with a tripled risk of death during the follow-up period. This association persisted even when adjustments were made for factors like strength (hand grip), other diseases (cancer, type 2 diabetes, and coronary heart disease), and lifestyle factors (smoking, alcohol consumption, and physical activity), revealing a 70% increased risk of early death.
Sex, age, type 2 diabetes, and smoking were also noted as factors increasing the risk of premature death.
Dr. Linge concluded, “These results underscore the paramount importance of maintaining muscle health in people with obesity. It is crucial to determine whether drugs that achieve significant or rapid weight loss are inadvertently causing excessive muscle loss or worsening muscle quality, to ensure safer treatment approaches for obesity, particularly for those at greater risk.” This call to action not only emphasises the significance of maintaining muscle health but also the necessity of careful evaluation of treatment strategies for obesity.
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Workers with obesity are twice as likely to take long-term sick leave
In a comprehensive study recently presented at the European Congress on Obesity in Venice, it was discovered that employees with obesity are significantly more likely to require sick leave compared to their healthier counterparts, highlighting a growing concern over obesity’s impact on workforce productivity and economic output. This pioneering research offers a detailed analysis of how obesity levels are influencing work attendance, revealing that the issue is contributing to a culture of increased sickness absence, which is straining the economy.
The study, which scrutinised the behaviour of 123,000 workers across Europe, including the UK, indicates that Britain’s performance is notably poor, with six out of ten adults classified as having either overweight or obesity. This finding places the UK among the worst of 28 countries examined. The timing of this revelation is critical as the UK is currently experiencing unprecedented levels of long-term sickness.
Researchers reported that workers in the highest obesity bracket were 2.5 times more likely to have been absent from work due to illness for a week or more over the past year, compared to those maintaining a healthy weight. Additionally, even individuals with mild overweight were found 22% more likely to have taken at least seven sick days annually.
This alarming data coincides with UK Prime Minister Rishi Sunak’s appeal last month to curb the “sick note culture” by not overly medicalising normal life stresses, a statement made in light of proposed welfare reforms. This appeal comes as the Office for National Statistics highlights that long-term sick leave figures have surged from 2.1 million to 2.8 million people since before the pandemic, with an estimated £50 billion allocated annually towards sickness benefits for working-age individuals.
Critics argue that the government’s efforts to address sick leave will be futile without serious measures against obesity, a major public health threat linked to numerous long-term illnesses. They emphasise the grave consequences facing the UK, branding it the “sick man of Europe” due to its inability to address significant health issues, with obesity being the foremost.
Presented at the European Congress on Obesity in Venice, the study’s findings further establish that higher body weight correlates with increased absenteeism. Separate studies corroborate these findings, showing the UK as having the third highest obesity rates among Organisation for Economic Co-operation and Development (OECD) countries. This extensive research is the first to detail how obesity impairs productivity by keeping individuals out of work, thereby exacerbating societal exclusion.
In the UK, long-term sickness has now become the leading cause of women exiting the workforce, with an additional 500,000 women becoming economically inactive due to this issue in the past five years. This surge is largely attributed to conditions like back pain, often exacerbated by excessive weight.
The study’s lead, Dr Thomas Czypionka from the Health Economics and Health Policy Research Group at the Institute for Advanced Studies in Vienna, emphasised the broad spectrum of health complications arising from obesity, including hypertension, diabetes, arthritis, and sleep apnoea. He highlighted the urgent need for stringent measures to tackle obesity, particularly through the reduction of ultra-processed food consumption.
Policy makers and health experts agree that addressing obesity is critical for improving public health and economic productivity. The government has initiated steps such as imposing sugar reduction targets in soft drinks and mandating calorie counts on menus to mitigate obesity levels. Further, a £2.5 billion plan aims to assist over a million people, including those with obesity-related health conditions, to overcome barriers to employment.
This comprehensive study not only underscores the profound individual and societal impacts of obesity but also stresses the imperative for coherent public health strategies to curb this escalating issue.
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Close to half of all cancer diagnoses linked to obesity, research finds
A pivotal study has revealed a significant correlation between obesity and an increased risk of various cancers, intensifying concerns over a looming public health crisis. Conducted at Lund University in Malmo, Sweden, this extensive research tracked over four million adults over four decades, uncovering that excess weight could be a contributing factor in more than 30 different types of cancer.
This landmark research, set to be unveiled at the European Congress on Obesity in Venice, has been described as “groundbreaking” by experts, highlighting a potential health crisis in the making. The urgency of these findings has prompted health charities to call for immediate governmental action in response to this alarming revelation. They emphasise the economic burden of obesity, which is estimated to cost the UK nearly £100 billion annually, with NHS expenses alone reaching £19 billion.
The Health Secretary, Victoria Atkins, asserted the government’s commitment to addressing this issue robustly, with plans to leverage apps and technology to transform public health approaches expected to roll out this summer. Atkins stressed the government’s goal for citizens to enjoy longer, healthier lives.
Detailed findings from the study indicated that, of the 332,500 cancer cases recorded during the research period, 40% could be linked to obesity. Annually, the UK sees around 390,000 new cancer diagnoses, suggesting approximately 150,000 cases could be obesity-related. Previously, global studies had identified 13 cancers linked to excess weight, including cancers of the bowel, breast, womb, and kidney. This latest study has extended that list, identifying a total of 32 cancer types associated with obesity. Notably, a five-point increase in Body Mass Index (BMI) was found to enhance cancer risks significantly—by 24% in men and 12% in women for previously established obesity-related cancers. Additionally, this increase was connected to a 17% higher risk for men and 13% for women in 19 other newly associated cancers, including malignant melanoma and various rare cancers like those of the pituitary glands and small intestine.
The comprehensive nature of the study, examining 122 types and subtypes of cancer over 100 million years of follow-up, underlines the severe public health implications. Researchers highlighted that keeping a normal weight could potentially prevent a substantial proportion of cancer cases, with established obesity-related cancers accounting for 25% of all cases and this proportion rising to 40% when including potential obesity-related cancers.
Obesity rates in the UK have nearly doubled since the 1990s, with a current 26% of adults in England categorised as having obesity and another 38% as having overweight. Obesity now surpasses smoking as the primary cause of four major cancers, though smoking remains a significant risk factor.
Forecasts by Cancer Research UK suggest that reducing obesity could prevent approximately 8,000 cancer cases in England by 2040. Prof Jason Halford, president of the European Association for the Study of Obesity, emphasised the strength of the analysis and the need for further research to confirm these associations and explore the underlying mechanisms.
The NHS is exploring innovative approaches, including the use of weight loss medications like Wegovy, to tackle obesity effectively. Government plans to promote healthier lifestyles through technology and legislative measures are also underway, aiming to make healthy choices more accessible to the populace.
Katharine Jenner, director of the Obesity Health Alliance, a coalition of 50 health charities, stressed the clear results of the study and the need for urgent, effective public health policies to prevent obesity and associated diet-related cancers. This includes implementing restrictions on junk food marketing and introducing levies on unhealthy foods to facilitate healthier choices for all.
Lead researcher Dr Ming Sun highlighted that the impact of obesity on cancer might be more extensive than previously understood, suggesting it as a risk factor for more cancer types, particularly rarer ones that have seldom been studied in this context. The study’s findings underscore the necessity of public health measures to tackle the obesity epidemic and its detrimental effects on health outcomes comprehensively. Dr Jennifer L Baker, co-chairman of EASO’s childhood obesity working group, further elucidated potential biological mechanisms such as chronic inflammation and hormonal changes that might explain the increased cancer risk associated with obesity.
In conclusion, this study serves as a critical indicator of the link between obesity and an increased risk of various cancers, urging immediate and robust action to mitigate this public health threat.
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Research indicates higher likelihood of midlife obesity in individuals whose parents had obesity
In the midst of growing concerns regarding global health, a pivotal study poised for presentation at the esteemed European Congress on Obesity (ECO) in Venice, from 12th to 15th May 2024, sheds light on the intergenerational transmission of obesity, revealing profound insights into how parental obesity significantly influences the likelihood of obesity in their offspring during middle age.
This groundbreaking research, led by Mari Mikkelsen from the Department of Community Medicine at UiT Arctic University of Norway in Tromsø, embarks on a novel investigation into the persistence of obesity from one generation to the next, particularly extending beyond adolescence and well into adulthood—a period often overlooked in previous studies. Mikkelsen’s team delved into the intricate relationship between the Body Mass Index (BMI) of parents and their adult children, employing data meticulously gathered from the Tromsø Study, a comprehensive, ongoing population-based health study.
The analysis encompassed 2,068 parent-offspring trios, focusing on individuals aged 40-59 years who participated in the seventh wave (2015-2016) of the Tromsø Study, with their parents’ data drawn from the fourth wave (1994-1995). The findings illuminate a compelling correlation between the BMI of parents in their middle years and that of their children at a similar stage in life, underscoring a pronounced genetic and environmental legacy of obesity.
Specifically, the study reveals that when both parents had a BMI indicating obesity (BMI ≥ 30 kg/m²) during their forties and fifties, their offspring were six times more likely to experience obesity at the same age compared to those whose parents were within a normal weight range (BMI 18.5-24.9 kg/m²). Moreover, the presence of obesity in just one parent still significantly elevated the likelihood of the offspring living with obesity, with the odds being over three times higher.
An intriguing aspect of the research was the quantification of the BMI transmission effect: an offspring’s BMI increased by 0.8 units for each 4-unit rise in the mother’s BMI and by 0.74 units for every 3.1-unit increase in the father’s BMI. These findings persisted even after adjustments for several variables, including the sex, age, education, and physical activity levels of both parents and offspring.
Mikkelsen’s team provides a nuanced understanding of the multifaceted factors contributing to this familial trend in obesity. Genetic predispositions play a crucial role by influencing susceptibility to weight gain and shaping reactions to an increasingly obesogenic environment. Additionally, shared family behaviours concerning diet and exercise, established during childhood and adolescence, may further perpetuate similar BMI statuses within families.
This profound research not only reinforces the enduring impact of familial obesity patterns but also emphasises the critical need for effective obesity prevention and treatment strategies. By highlighting the long-lasting consequences of parental obesity on their children into middle age, the study paves the way for future research aimed at identifying and mitigating the factors responsible for the intergenerational transmission of obesity. In doing so, it offers hope for breaking the cycle of obesity and fostering a healthier future for subsequent generations.
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Study indicates significant benefits from obesity care, though few receive it
Obesity represents a significant global health challenge, marked by its complex aetiology and the substantial health risks it poses. Effective management of obesity can dramatically improve health outcomes, yet access to comprehensive obesity care remains limited for many. A recent study conducted by a team from Michigan Medicine at the University of Michigan has shed light on the effectiveness of various obesity treatment strategies and highlighted the disparity in access to these interventions.
The study, engaging tens of thousands of individuals diagnosed with obesity, meticulously evaluated the outcomes of diverse weight management interventions, including nutrition counselling, medically supervised meal replacements, anti-obesity medications, and bariatric surgery. The findings revealed that the likelihood of achieving a weight loss of 5% or more within a year varied significantly across the different treatment modalities, ranging from nearly one in four to almost certain success, depending on the specific intervention utilised.
Notably, the research emphasised that a modest weight loss of just 5% can have profound health benefits, underscoring the importance of accessible and effective weight management strategies. However, a critical observation from the study was the underutilisation of available treatments, with a mere fraction of the study population receiving any form of medically endorsed weight management care from their primary healthcare providers.
The investigation revealed a troubling gap in the provision of obesity-related healthcare, with the majority of individuals suffering from obesity not receiving adequate treatment through their regular healthcare channels. This gap is not due to a lack of effective treatments but rather to a systemic failure to integrate these options into standard care practices. The study’s authors advocate for a more proactive approach by primary care clinics, health systems, and insurers to facilitate access to and engagement with effective obesity treatments.
In response to these findings, the University of Michigan has embarked on an innovative programme aimed at transforming obesity care. The Weight Navigation Program, spearheaded by Dina Hafez Griauzde, M.D., M.Sc., and Andrew Kraftson, M.D., seeks to offer personalised treatment paths for patients, leveraging the expertise of board-certified obesity medicine physicians and ongoing support mechanisms, including digital communication tools, to ensure long-term engagement and success.
This initiative not only provides immediate care options for individuals struggling with obesity but also serves as a model for integrating evidence-based weight management strategies into primary care, potentially reshaping the landscape of obesity treatment.
The study conducted by Michigan Medicine highlights the critical need for improved access to and utilisation of weight management treatments in the fight against obesity. By demonstrating the efficacy of various treatment options and pioneering new approaches to care delivery, the research team has laid a foundation for a more inclusive and effective obesity care framework. As healthcare systems and insurers begin to recognise and address the barriers to obesity treatment, there is hope for a future where comprehensive, personalised obesity care is accessible to all who need it.
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Over a billion people now affected by obesity worldwide, comprehensive analysis shows
A groundbreaking analysis published in The Lancet has highlighted a concerning milestone in global health: the number of children, adolescents, and adults living with obesity worldwide has exceeded one billion. This significant finding marks a shift in the nutritional challenges faced globally, with obesity now surpassing undernutrition as the predominant form of malnutrition in the majority of countries.
This detailed examination of global data reveals a stark increase in obesity rates among the world’s youth in 2022, which are now four times higher than they were in 1990. For adults, the increase is equally alarming, with obesity rates more than doubling for women and nearly tripling for men. Specifically, the analysis found that 159 million children and adolescents, along with 879 million adults, were living with obesity in 2022.
Simultaneously, the study reports a decline in the prevalence of underweight individuals since 1990, indicating progress in one area of malnutrition but highlighting the growing concern of obesity. Professor Majid Ezzati of Imperial College London, a leading figure in the study, expressed grave concerns about the obesity epidemic’s expansion into younger demographics and stressed the importance of improving access to healthy, nutritious foods to combat both obesity and undernutrition.
The study, a collaborative effort between the NCD Risk Factor Collaboration (NCD-RisC) and the World Health Organization (WHO), analysed weight and height measurements from over 220 million people aged five years and older across more than 190 countries. This extensive data collection aimed to trace the evolution of obesity and underweight from 1990 to 2022, using Body Mass Index (BMI) as a key measure.
The findings reveal a dramatic rise in obesity rates globally, with significant increases observed in nearly all countries examined. In parallel, there has been a notable decline in underweight rates, shifting the focus of nutritional health challenges.
Regionally, the study provides detailed insights into the prevalence of obesity and underweight. For instance, in Polynesia and Micronesia, as well as in the Caribbean and the Middle East and North Africa, obesity rates have surged, surpassing those in many high-income industrialised countries, particularly in Europe. Specifically, Tonga and American Samoa reported the highest prevalence of obesity among women, while American Samoa and Nauru topped the list for men.
In contrast, the United Kingdom saw its obesity rates climb from 13.8% to 28.3% for women and from 10.7% to 26.9% for men between 1990 and 2022. Similarly, the United States experienced a significant increase in obesity rates, with women’s rates jumping from 21.2% to 43.8% and men’s from 16.9% to 41.6% over the same period.
China and India also witnessed notable increases in obesity rates, albeit from lower baselines. China’s obesity rates rose from 2.0% to 7.8% for women and from 0.8% to 8.9% for men, while India saw increases from 1.2% to 9.8% for women and from 0.5% to 5.4% for men.
Despite these increases, the study also highlighted countries where underweight remains a significant concern, with Eritrea and Timor-Leste for women, and Eritrea and Ethiopia for men, recording the highest prevalence of underweight in 2022.
The study underscores the complex global challenge of addressing both obesity and undernutrition, emphasising the need for comprehensive policy measures and international cooperation to tackle these issues effectively. Despite limitations, such as the imperfect nature of BMI as a measure and variable data availability, the analysis provides a crucial overview of global nutritional trends, highlighting the urgent need for action to create a healthier global population.
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Study confirms light exercise effectively counters childhood obesity
Childhood obesity, a growing concern worldwide, might have a surprisingly straightforward solution: light exercise. Recent research led by an international team of scientists from the Universities of Exeter, Eastern Finland, Bristol, and Colorado, underscores the profound impact of light physical activity in combating the rise of obesity in children.
Drawing from the University of Bristol’s Children of the 90s study, the research tracked 6,059 children (53% female) from age 11 to 24. Amid global reports revealing a worrying trend of inactivity among adolescents — with over 80% failing to meet the World Health Organization’s guidelines for daily physical activity — the study presents an urgent narrative. The lack of exercise is anticipated to contribute to 500 million new cases of noncommunicable diseases by 2030, costing an estimated $23 million annually.
What’s striking about the study is the revelation that light physical activity, rather than moderate-to-vigorous exertion, plays a crucial role in reducing fat mass gain in youth. Dr. Andrew Agbaje of the University of Exeter, a key contributor to the study, emphasises the overlooked benefits of light physical activities like walking, household chores, and leisurely swimming. He suggests shifting public health messages from an emphasis on 60 minutes of moderate-to-vigorous activity to encouraging at least three hours of light activity daily.
Participants were observed over 13 years, with physical activity levels and health markers meticulously monitored using waist-worn accelerometers and dual-energy X-ray absorptiometry. The results were startling: each additional minute of sedentary behaviour correlated with a 1.3-gram increase in total body fat mass. In contrast, each minute of light physical activity corresponded to a 3.6-gram decrease in total body fat mass, amounting to a significant reduction of 950 grams to 1.5 kilograms over the study period.
In comparison, moderate-to-vigorous physical activity showed a minimal effect, reducing total body fat mass by only about 0.7 to 1.7 percent. This finding challenges the prevailing public health guidelines, which predominantly advocate for higher-intensity exercise.
The study, published in Nature Communications, calls for a reevaluation of health guidelines and policy statements, urging public health experts, policymakers, and parents alike to promote light physical activity as a key strategy in preventing childhood obesity. As Dr. Agbaje concludes, sustaining light physical activity can be the much-needed antidote to the detrimental effects of a sedentary lifestyle in young populations.
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UK government criticised for delaying vital anti-obesity policies, endangering children’s health
A recent independent report, commissioned by the UK government, has highlighted the severe risks posed to children’s health in England due to the postponement of crucial anti-obesity measures until 2025. The report underscores the grave consequences of this policy inaction, with children facing an increased risk of diabetes, heart disease, and other severe health issues.
The report points out that ultra-processed foods (UPF) and products high in fat, sugar, and salt (HFSS) have become alarmingly commonplace in children’s diets. This trend is particularly pronounced among lower-income families, who often find it challenging to limit these unhealthy foods. The delay in implementing measures such as the proposed 9pm watershed for junk food advertising and the ban on online ads and unhealthy buy-one-get-one-free deals is exacerbating the issue.
City, University of London, which undertook the government-commissioned research, found that UPFs, along with fatty, sugary, and salty foods, have become a standard component of children’s diets. The report reveals that access to healthy foods like fruits and vegetables is increasingly difficult for many families, especially those with lower incomes. Consequently, children are at a heightened risk of developing long-term health problems, including type 2 diabetes.
The research suggests that families with higher incomes are in a better position to maintain a healthier diet for their children, often avoiding retail environments that promote unhealthy food choices. In contrast, lower-income families find themselves reliant on multi-buy deals and promotions for UPFs, making these unhealthy options appear more economical.
The report’s authors urgently call for the introduction of shelved anti-obesity measures to reduce the appeal of UPF and HFSS and improve access to healthier food alternatives. Recommended actions include expanding access to Healthy Start vouchers, ensuring a living wage that covers the cost of a healthy diet, incorporating fruit and vegetable education in schools, and stricter regulation of misleading health claims on food packaging.
Dr Paul Coleman, one of the study’s authors and a former honorary senior research fellow at City, expressed concern over the early introduction of UPFs in children’s diets. He highlighted the lasting impact these dietary patterns can have into adulthood and their link to serious health outcomes later in life.
Childhood obesity is a significant public health challenge in England, with statistics showing that two in five children leave primary school with overweight or obesity. This puts them at a higher risk of chronic illnesses, mental health problems, and a reduced lifespan.
Katharine Jenner, director of the Obesity Health Alliance, emphasised the urgency for government intervention. She pointed out that parents on low incomes often find it economically risky to purchase healthier foods, such as whole fruits, for their children.
The report also notes that healthier snacks are, on average, three times more expensive per calorie than less healthy options, further complicating the choice for low-income families.
In response, a government spokesperson cited initiatives such as the distribution of fruit and vegetables to school children and voluntary sugar reduction programmes. They also mentioned new calorie labelling requirements in restaurants, cafes, and takeaways, and restrictions on the placement of less healthy products in shops and online to curb impulsive unhealthy purchases. However, these measures fall short of the comprehensive policy action called for in the report.
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NHS reports over 3,000 daily admissions linked to obesity
NHS figures have alarmingly revealed that hospital admissions related to obesity in the UK have doubled in the past six years, now exceeding 3,000 cases daily. This alarming statistic underscores the growing weight problem in the UK, with obesity increasingly exacerbating illnesses and complicating treatments for a diverse group of patients, including expectant mothers, arthritis sufferers, and cancer patients. Notably, hospital admissions due to obesity now outnumber those linked to smoking by threefold. Furthermore, over 20 children are admitted each day due to obesity-related issues, a figure that has also seen a significant rise in recent years.
Government ministers are facing criticism for their perceived inaction on a problem that is not only detrimentally impacting public health but also stunting economic progress. This is after the government decided to postpone stringent anti-obesity measures. The impact of obesity is disproportionately felt in poorer areas, where hospital admissions are twice as likely compared to the wealthiest regions, thus impeding efforts to rejuvenate the labour market.
Luton, in particular, has emerged as the area in England most affected by health issues related to obesity, with one in every 20 residents admitted to hospital due to weight-related problems last year. This rate is more than tenfold higher than that in Bracknell Forest, which recorded the lowest rate.
Recent data estimates the annual cost of obesity to the UK economy at a staggering £98 billion, encompassing both NHS treatment costs of £19 billion and economic productivity losses amounting to £15 billion. NHS Digital’s latest figures for England reveal a record 1.2 million admissions where obesity was a factor in 2022-23, a significant increase from 617,000 in 2016-17. These admissions include cases where obesity was the primary reason for hospitalisation, often for bariatric surgery, as well as numerous instances where obesity was a secondary diagnosis, either contributing to hospital stays or complicating treatments.
Among those most affected are pregnant women, with 147,143 maternity admissions where obesity was a complicating factor for either the mother or child. Other conditions such as arthritis, gallstones, breast cancer, heart disease, and general pain also contributed to more than 10,000 admissions annually.
Daisy Cooper, Deputy Leader of the Liberal Democrats, criticised the government for missing multiple opportunities to foster a healthier living environment in the UK. She stressed that investing in public health would alleviate the burden on the NHS and bolster the economy by enabling more people to work.
The figures reveal a concerning trend among the younger population, with 8,261 admissions among under-16s, a significant increase from 4,062 in 2016-17. In the ten most deprived areas, there were 3,393 admissions per 100,000 people for obesity, more than double the rate in the wealthiest tenth.
Areas such as Gloucestershire, Southampton, Salford, Rotherham, Bradford, and much of east London have recorded rates above 4,000 per 100,000 people. In contrast, Bracknell Forest reported a rate of 420 per 100,000, with Windsor, Wokingham, Slough, Oxfordshire, Reading, and Brighton all reporting rates below 1,000.
In response to its high obesity rate, Luton has recently implemented a ban on advertising unhealthy food on council-owned properties. The rise in obesity-related admissions is partly attributed to increased medical awareness of the conditions excess weight can cause. However, local differences in how obesity is recorded also influence these statistics.
Victoria Atkins, the Health Secretary, has expressed a preference for focusing on healthy-living advice over measures she has termed “nanny-statish”, a stance that has disappointed health campaigners. Cooper has called for the revival of delayed plans for a 9pm watershed on junk food advertising and a ban on buy-one-get-one-free deals on unhealthy food. She also advocated for increased funding for public health initiatives at the council level.
Admissions for weight-loss surgery have not returned to pre-pandemic levels, with 5,099 admissions last year compared to over 6,000 five years ago. This decline in admissions where obesity is the primary reason is attributed to pressures on the NHS.
Despite this, 638 children under 16 were admitted primarily for obesity, nearly matching pre-pandemic figures. In response to these concerning trends, a government spokesman highlighted measures like compulsory calorie labelling and healthy food vouchers for low-income households. The spokesman emphasised the government’s commitment to tackling obesity across all socio-economic groups and in deprived areas, recognising it as a major cause of cancer.
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UK’s obesity challenge: Learning from Japan’s effective approach
In Japan, a unique festive tradition involving Colonel Sanders statues dressed as Santa Claus outside KFC branches marks the start of the Christmas season. This tradition, a result of a marketing strategy from the 1970s, has become a cultural phenomenon, with millions participating in the “KFC Special Christmas Dinner”. This period is significant for KFC Japan, contributing to a substantial portion of their annual sales.
This contrasts sharply with the UK, where traditional home-cooked Christmas dinners are preferred. However, the issue for the UK lies in the dietary habits adopted for the rest of the year. The British tendency towards unhealthy eating has led to an escalating obesity crisis, now costing the economy almost £100 billion annually and impacting productivity far more than previously estimated.
The report by the Tony Blair Institute indicates a worrying trend: two-thirds of the UK’s population are either overweight or have obesity, a figure that has risen by around 11% since 1993. The economic impact of obesity, including healthcare costs and reduced productivity, is projected to increase by an additional £10 billion in the next 15 years. Henry Dimbleby, the government’s former food advisor, highlights the dire consequences of this trend. He points out that by 2035, the costs of treating Type 2 diabetes alone could surpass the current expenditure on all cancer treatments within the NHS.
Comparatively, Japan stands out with one of the lowest obesity rates among developed nations, a mere 4%. This has not always been the case. In the 1960s, Japan was considered one of the least healthy countries in the G7, with a diet heavily reliant on cheap US food imports post-World War II. However, over the following decades, Japan underwent a dramatic cultural shift concerning food, resulting in the world’s highest life expectancy. This transformation demonstrates that obesity is an addressable issue, requiring a change in cultural attitudes towards food rather than reliance on medication.
In Japan, the “bukatsudō” programme plays a pivotal role in promoting physical activity among schoolchildren. This initiative, coupled with the provision of healthier school meals, has contributed to Japan’s low obesity rates among children. In contrast, recent NHS figures show concerning trends in the UK, with significant percentages of children categorised as having overweight or obesity from a young age.
The traditional Japanese diet, which includes fresh fish, small portions of meat, tofu, and vegetables, is inherently healthier than typical Western diets. Andrew Kojima, a celebrity chef, suggests that the UK could benefit from adopting Japanese dining philosophies such as eating until only 80% full and ensuring a variety of colours and types of food in meals.
In Japan, there is a lesser emphasis on snacking and takeaway food compared to the UK. The quality of institutional food in Japan is also notably healthier. Dimbleby recalls a stay in a Tokyo hospital, where meals included healthy options such as pickles, rice porridge, grilled fish, miso soup, and steamed vegetables. He argues that such changes are feasible in the UK without significantly increasing budgets.
Dimbleby’s charity, Chefs in Schools, aims to improve the quality of school meals across England and advocates for an inspection regime similar to Ofsted for school dinners. Another potential strategy is adapting Japan’s “metabo” law, which mandates waistline measurements for citizens aged 40 to 74, with counselling and incentives for those who do not meet the standards. This approach could be implemented in the UK through voluntary annual health checks in workplaces.
Despite the need for action, the UK government has shown reluctance to intervene effectively. The National Food Strategy’s recommendations have been largely overlooked, and proposed anti-obesity measures like junk food deal bans and advertising restrictions have been delayed. Campaigners are calling for the sugar tax on soft drinks to be extended, but there is little movement from the government.
The lack of government intervention and the influence of corporations promoting high-calorie foods mean the UK continues to struggle with an obesity crisis. As the report highlights, Britain urgently needs to adopt successful strategies like those in Japan to address both the public health and economic challenges posed by obesity.
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