WORLD HEALTH ORGANIZATION

GLOBAL STRATEGY ON DIET, PHYSICAL ACTIVITY AND HEALTH

OBESITY AND OVERWEIGHT

FACTS: Globally, there are more than 1 billion overweight adults, at least 300 million o them obese! "besity and overweight #ose a ma$or ris% or &hroni& diseases, in&luding ty#e ' diabetes, &ardiovas&ular disease, hy#ertension and stro%e, and &ertain orms o &an&er! The %ey &auses are in&reased &onsum#tion o energy(dense oods high in saturated ats and sugars, and redu&ed #hysi&al a&tivity

OBESITY AND OVERWEIGHT

besity has rea&hed e#idemi& #ro#ortions globally, with more than 1 billion adults overweight ( at least 300 million o them &lini&ally obese ( and is a ma$or &ontributor to the global burden o &hroni& disease and disability! " ten &oe)isting in develo#ing &ountries with under(nutrition, obesity is a &om#le) &ondition, with serious so&ial and #sy&hologi&al dimensions, a e&ting virtually all ages and so&ioe&onomi& grou#s *n&reased &onsum#tion o more energy(dense, nutrient(#oor oods with high levels o sugar and saturated ats, &ombined with redu&ed #hysi&al a&tivity, have led to obesity rates that have risen three( old or more sin&e 1+,0 in some areas o -orth Ameri&a, the .nited /ingdom, 0astern 0uro#e, the 1iddle 0ast, the 2a&i i& *slands, Australasia and China!The obesity e#idemi& is not restri&ted to industriali3ed so&ieties4 this in&rease is o ten aster in develo#ing &ountries than in the develo#ed world
"besity and overweight #ose a ma$or ris% or serious diet(related &hroni& diseases, in&luding ty#e ' diabetes, &ardiovas&ular disease, hy#ertension and stro%e, and &ertain orms o &an&er! The health &onse5uen&es range rom in&reased ris% o #remature death, to serious &hroni& &onditions that redu&e the overall 5uality o li e! " es#e&ial &on&ern is the in&reasing in&iden&e o &hild obesity WHY IS THIS HAPPENING The rising e#idemi& re le&ts the #ro ound &hanges in so&iety and in behavioural #atterns o &ommunities over re&ent de&ades!6hile genes are im#ortant in determining a #erson7s sus&e#tibility to weight gain, energy balan&e is determined by &alorie inta%e and #hysi&al a&tivity! Thus so&ietal &hanges and worldwide nutrition transition are driving the obesity

e#idemi&! 0&onomi& growth, moderni3ation, urbani3ation and globali3ation o ood mar%ets are $ust some o the or&es thought to underlie the e#idemi&! As in&omes rise and #o#ulations be&ome more urban, diets high in &om#le) &arbohydrates give way to more varied diets with a higher #ro#ortion o ats, saturated ats and sugars! At the same time, large shi ts towards less #hysi&ally demanding wor% have been observed worldwide! 1oves towards less #hysi&al a&tivity are also ound in the in&reasing use o automated trans#ort, te&hnology in the home, and more #assive leisure #ursuits
HOW DO WE DEFINE OBESITY AND OVERWEIGHT?

The #revalen&e o overweight and obesity is &ommonly assessed by using body mass inde) 891*:, de ined as the weight in %ilograms divided by the s5uare o the height in metres 8%g;m ':! A 91* over '< %g;m' is de ined as overweight, and a 91* o over 30 %g;m ' as obese! These mar%ers #rovide &ommon ben&hmar%s or assessment, but the ris%s o disease in all #o#ulations &an in&rease #rogressively rom lower 91* levels Adult mean 91* levels o ''('3 %g;m' are ound in A ri&a and Asia, while levels o '<('= %g;m' are #revalent a&ross -orth Ameri&a, 0uro#e, and in some >atin Ameri&an, -orth A ri&an and 2a&i i& *sland &ountries! 91* in&reases amongst middle(aged elderly #eo#le, who are at the greatest ris% o health &om#li&ations! *n &ountries undergoing nutrition transition, overnutrition o ten &o(e)ists with undernutrition! 2eo#le with a 91* below 1,!< %g;m' tend to be underweight! The distribution o 91* is shi ting u#wards in many #o#ulations! And re&ent studies have shown that #eo#le who were undernourished in early li e and then be&ome obese in adulthood, tend to develo# &onditions su&h as high blood #ressure, heart disease and diabetes at an earlier age and in more severe orm than those who were never undernourishe THE EXTENT OF THE PROBLEM Currently more than 1 billion adults are overweight ? and at least 300 million o them are &lini&ally obese! Current obesity levels range rom below <@ in China, Aa#an and &ertain A ri&an nations, to over =<@ in urban Samoa! 9ut even in relatively low #revalen&e &ountries li%e China, rates are almost '0@ in some &ities! Childhood obesity is already e#idemi& in some areas and on the rise in others! An estimated 1=!B million &hildren under ive are estimated to be overweight worldwide! A&&ording to the .S Surgeon General, in the .SA the number o overweight &hildren has doubled and the number o overweight adoles&ents has trebled sin&e 1+,0! The #revalen&e o obese &hildren aged B(to(11 years has more than doubled sin&e the 1+B0s! "besity #revalen&e in youths aged 1'(1= has in&reased dramati&ally rom <@ to 13@ in boys and rom <@ to +@ in girls between 1+BB(=0 and 1+,,(+1 in the .SA! The #roblem is global and in&reasingly e)tends into the develo#ing world4 or e)am#le, in Thailand the #revalen&e o obesity in <(to(1' year olds &hildren rose rom1'!'@ to 1<(B@ in $ust two years! "besity a&&ounts or '(B@ o total health &are &osts in several develo#ed &ountries4 some estimates #ut the igure as high as =@! The true &osts are undoubtedly mu&h greater as not all obesity(related &onditions are in&luded inthe &al&ulations!

HOW DOES EXCESS BODY FAT IMPACT HEALTH? "verweight and obesity lead to adverse metaboli& e e&ts on blood #ressure, &holesterol, trigly&erides and insulin resistan&e! Some &on usion o the &onse5uen&es o obesity arise be&ause resear&hers have used di erent 91* &ut(o s, and be&ause the #resen&e o many medi&al &onditions involved in the develo#ment o obesity may &on use the e e&ts o obesity itsel The non( atal, but debilitating health #roblems asso&iated with obesity in&lude res#iratory di i&ulties, &hroni& mus&ulos%eletal #roblems, s%in #roblems and in ertility! The more li e(threatening #roblems all into our main areas: CCD #roblems4 &onditions asso&iated with insulin resistan&e su&h as ty#e ' diabetes4 &ertain ty#es o &an&ers, es#e&ially the hormonally related and large(bowel &an&ers4 and gallbladder disease! The li%elihood o develo#ing Ty#e ' diabetes and hy#ertension rises stee#ly with in&reasing body atness! Con ined to older adults or most o the '0th &entury, this disease now a e&ts obese &hildren even be ore #uberty! A##ro)imately ,<@ o #eo#le with diabetes are ty#e ', and o these, +0@ are obese or overweight! And this is in&reasingly be&oming a develo#ing world #roblem! *n 1++<, the 0merging 1ar%et 0&onomies had the highest number o diabeti&s! * &urrent trends &ontinue, *ndia and the 1iddle 0astern &res&ent will have ta%en over by '0'<! >arge in&reases would also be observed in China, >atin Ameri&a and the Caribbean, and the rest o Asia! Eaised 91* also in&reases the ris%s o &an&er o the breast, &olon, #rostrate, endometroium, %idney and gallbladder! Chroni& overweight and obesity &ontribute signi i&antly to osteoarthritis, a ma$or &ause o disability in adults! Although obesity should be &onsidered a disease in its own right, it is also one o the %ey ris% a&tors or other &hroni& diseases together with smo%ing, high blood #ressure and high blood &holesterol! *n the analyses &arried out or 6orld Fealth Ee#ort '00', a##ro)imately <,@ o diabetes and '1@ o is&haemi& heart disease and ,(G'@ o &ertain &an&ers globally were attributable to a 91* above '1 %g;m WHAT CAN WE DO ABOUT IT? 0 e&tive weight management or individuals and grou#s at ris% o develo#ing obesity involves a range o long(term strategies! These in&lude #revention, weight maintenan&e, management o &o(morbidities and weight loss! They should be #art o an integrated, multi(se&toral, #o#ulation( based a##roa&h, whi&h in&ludes environmental su##ort or healthy diets and regular #hysi&al a&tivity! /ey elements in&lude Creating su##ortive #o#ulation(based environments through #ubli& #oli&ies that #romote the availability and a&&essibility o a variety o low( at, high( ibre oods, and that #rovide o##ortunities or #hysi&al a&tivity! 2romoting healthy behaviours to en&ourage, motivate and enable individuals to lose weight by: ( eating more ruit and vegetables, as well as nuts and whole grains4 ( engaging in daily moderate #hysi&al a&tivity or at least 30 minutes4 ( &utting the amount o atty, sugary oods in the diet4 ( moving rom saturated animal(based ats to unsaturated vegetable(oil based ats 1ounting a &lini&al res#onse to the e)isting burden o obesity and asso&iated &onditions through &lini&al #rogrammes and sta training to ensure e e&tive su##ort or those a e&ted to lose weight or avoid urther weight gain