Environmental WaistHealth and Social Implications

Professor Iain BroomResearch Professor and Consultant in

Clinical Biochemistry and Metabolic MedicineThe Robert Gordon University and NHS Grampian

Homo Sapiens Homo Adipatus

50 Years

A NEW SPECIES ?

2.5 Million Years 50 Years

Homo AdipatusHomo Sapiens

Genetic

Neurologic and

Physiologic

Biochemical

Environmental Cultural and Socio-economic

1. Adapted from Weighing the Options; 1995:52. 2. Clinical guidelines. National Heart, Lung, and Blood Institute

Web site. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm. Accessed March, 2001.

Factors involved in the creation of “Homo Adipatus”

Abdominal Fat DistributionObesity and Risk

Definition of Metabolic Syndrome:WHO and ATP III (1)

Risk factor WHO ATP III

Fasting glucose > 6.1 mmol/L > 6.1 mmol/L

2h post-OGTT glucose - > 6.7 mmol/L

Insulin resistance - Yes

Abdominal obesity

Men WC > 102 cm WC > 102 cm

Women WC > 88 cm WC > 88 cm

WHO (website)_NCEP Expert Panel - ATP III JAMA 2001; 285:2486-97

Definition of Metabolic Syndrome:WHO and ATP III (2)

Risk factor ` WHO ATP III

Triglycerides > 1.7 mmol/L > 1.7 mmol/L

HDL-cholesterol

Men < 0.9 mmol/L < 1.0 mmol/L

Women < 1.0 mmol/L < 1.3 mmol/L

Blood pressure > 140/90 mm Hg > 130/85 mm Hg

Microalbuminuria UAE > 20 g/minor alb:creatinine > 30 mg/g

WHO (website)_NCEP Expert Panel - ATP III JAMA 2001; 285:2486-97

Metabolic Syndrome

Hyperinsulinaemia

OBESITY

Lack ofExercise

InheritedFactors

InsulinResistance

Inability ofbeta-cellsto compensate

IGT

Hypertension

Na + SNS

Type 2Diabetes CVS risk

LDL VLDL HDL

Prevalence of Metabolic Syndrome

US adults 23.7%; men 24.0%, women 23.4% (Data from NHANES III)8.8 - 14.3% of middle-aged men in Finland23% of men, 12% of women in France56% of overweight and obese patients with CV risk factors in France40% of obese patients in Sweden

Marques-Vidal Diabetes Care 2002; 25: 1371-1377Ford JAMA 2002; 287: 356-359Lakka JAMA 2002; 288: 2709 - 2716Davidson ADA 2003; Guy-Grand ECO 2003

Obesity Prevalence UK 1980 - 2010

30

20

10

♂

♀

8 6

16 14

3129

1980 1990 2000 2010

2321

Prevalence of overweight & obesity in England & Wales

Classification BMI (kg/m2) % Population

Pre-obese 26-29 > 50%

Obese > 30 23% males

23% females

The prevalence of obesity%

po

pu

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on

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h B

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2

0

10

20

30

40

MenWomen

All data 1991 or later

Fra

nce

Net

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ds

Fin

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UK

W G

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Cze

ch

Rep

ub

lic

E G

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Ru

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US

A–w

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SA

–h

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sU

SA

–bla

cks

Can

ada

Au

stra

lia

0

10

20

30

40

50

60

70

80

30-34.9 35-39.9 40-44.9 45-49.9 50+

% o

f aud

it po

pula

tion

Aberdeen Bath Birmingham Glasgow Hammersmith Leeds Luton National Aggregate

BMI distribution in obese sub sample compared across Counterweight regions

Economic costs of obesity

Country Year Definition Estimated % national health

of obesity direct costs care costs

Australia 1989-90 >30 AU$ 464 million >2%

France 1992 27 FFr 12 000 million 2%

Netherlands 1981-89 >25 Dfl. 1000 million 4%

USA 1995 29 US$ 51.64 billion 5.7%

WHO Obesity: preventing and managing the global epidemic. WHO, 1998Wolf AM, Colditz GA. Obesity Research 1998

Consequences of obesity

Respiratory diseaseHeart disease

Gall bladder disease

Hormonal abnormalities

Hyperuricaemiaand gout

Stroke

Cardiovascular risk factors

Diabetes

OsteoarthritisCancer

Comorbidity Costs 1995/6e

Disease Total Cost PAF Obesity Cost

£ Million %age £ Million

________________________________________________Diabetes 2,350 49.0 1,151.5

Hypertension 364 20.0 72.8

IHD 1,326 19.0 251.94

Stroke 1,343 5.0 67.15

Cancer 1,043 2.3 23.98

Musculoskeletal 1,230 10.0 123.00

____________________________________________________

Total cost of Comorbidities £1,690,379,000

0

10

20

30

40

50

1.02.2

12

42

0

25

50

75

100

1.08.1

40

93

<23 25 31 35 <22 25 31 35

Men1 Women2

BMI1Chan JM et al. Diabetes Care 1994; 17: 961-9; 2Colditz G et al. Ann Intern Med 1995; 122: 481-6

Age-adjusted relative risk of type 2 diabetes

Obesity is the Primary Risk Factorfor Type 2 Diabetes

Increasing prevalence ofType 2 Diabetes

Industrialisedcountries

Industrialisingcountries

Millions of People

1995 2025

Venkat Narayan KM. Diabetes Res Clin Pract 2000; 50 (Suppl. 2): S77-84

0

300

200

100

1995 2025

42%

170%

Environmental changesEvolutionary Flashpoint

• Energy Expenditure

• Energy Intake

• Automation

• COMPUTERISATION

Calories Usage changed over 50 years

Per week 1950’s / 2000’s

• Shopping on foot/car & supermarket 2400 / 275• Washing clothes by hand/machine 1500 / 270• Making a coal fire/gas fire 1300 / 3

Per hour

• Hand lawn mower/electric mower 500 / 180• No power steering/ with power 96 / 75

School Children involved in sporting activities (USA)

80

60

40

20

H/S - High SchoolM/S - Middle School

H/S M/S H/S M/S

Data from Centre for Disease Control 2000

1991 1999

3% DROP per annum

Computerisation and ObesityYear Computer Status % Obesity

1979 First desktop Computer 6 – 8 %

1980’s Computerised machines 12 – 14%MicrowavesAutomated Washing Machines

1990’s Computer Games 16 – 18% Childhood obesity2000’s Widespread computerisation

GlobalisationFree Market Economy 23% expenditure on computer Childhood obesity education and comorbidities School activity (Sport)

The Risk Society

• Not all environmental by force of nature (eg global warming)

• Interrelated changes within contemporary social life

• Shifting employment patterns

• Heightened job insecurity

• Erosion of traditional family patterns

Index of Economic Freedom (IEF) and Obesity Rates

Country IEF % OBESE

Australia 1.88 20France 2.63 8Finland 1.95 13Netherlands 2.04 8Norway 2.25 7UK 1.79 17USA 1.85 25

Globalisation and the Free Market Economy

• AUSTRALIA, USA and UK - DEREGULATED in an uncontrolled fashion with no political intervention

• NETHERLANDS - CONTROLLED DEREGULATIONprevention of inequalities in job securityfood choice and leisure time activities

• SCANDINAVIA - similar political intervention to regulate the forces of globalisation

Globalisation

• Effects are not inevitable

• Political intervention is possible

• Beneficial effects on Food consumption leisure time energy

expenditure

Treatment/Prevention Strategies

• Not just an NHS issue

• Government (local and national)

inter-department cooperation

• Public and Government Education

• Simple Messages do not work

• Complex related strategies needed

Treatment/Prevention Strategies

• Population

• Society

• Individual