The Obesity Challenge: Levels, Consequences and

Transcript:The Obesity Challenge: Levels, Consequences and:
The Obesity Challenge: Levels, Consequences and Proposed Interventions in Ghanaian Women Allan G. Hill Dept. of Social Statistics and Demography The Broad Outlines of the Problem At much lower income levels, obesity is equally common in many African urban populations The rates of obesity are higher everywhere for women Adult obesity and childhood under-nutrition exists side by side Dietary change and increased exercise regimens are more difficult in lower income societies Obesity levels compared: BMI >30 in adults over age 16. Source: OECD Health Data 2012 - Version: October 2012 Correlates of obesity and overweight in Accra women 2010 Benkeser, Biritwum and Hill. 2012 Ghana Med J 46(2): 66-75. Accra women: measured body heights and weights by age in 2010 BMI categories by age in Accra women in 2010. Body size preferences using the Stunkard scale Evidence on preferences: “current’’ body silhouette compared with “ideal” and “healthiest”. Not all preferences in one direction... Intervention options Contextual interventions School meals, physical education Pricing and availability of fatty foods Urban planning and transport arrangements Community and social interventions Fitness and sport promotion: clubs Obesity as a preventable illness Individual Diet and exercise Weight watchers and the like... Small Steps. Big Rewards. A GAME PLAN to Prevent Type 2 Diabetes Diabetes prevention and management c.f. Obesity directly GAME PLAN 50 small steps, not a single intervention (e.g. Weight Watchers) Food and activity tracker Fat and calorie counter Scientific evidence The Diabetes Prevention Program (DPP) was a major clinical trial, or research study, aimed at discovering whether either diet and exercise or the oral diabetes drug metformin could prevent or delay the onset of type 2 diabetes in people with impaired glucose tolerance (IGT). The DPP found that over the three years of the study, diet and exercise sharply reduced the chances that a person with IGT would develop diabetes. Metformin also reduced risk, although less dramatically. The DPP resolved these questions so quickly that, on the advice of an external monitoring board, the program was halted a year early. New England J of Med February 7, 2002 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study During the 10·0-year (IQR 9·0—10·5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained. Diabetes incidence rates during the DPP were 4·8 cases per 100 person-years (95% CI