19
ISSUES: Fitness & Health
Chapter 2: Understanding obesity
obesity such as waist:hip ratio and
waist circumference provide more
robust indices of overall obesity-
related health risk than BMI alone.
Health impact of obesity
Obesity is an important cause of
morbidity, disability and premature
death (WHO, 2004). Obesity increases
the risk for a wide range of chronic
diseases; BMI is thought to account for
about 60% of the risk of developing
type 2 diabetes, over 20% of that for
hypertension
and
coronary-heart
disease and between 10 and 30% for
various cancers. Other co-morbidities
include gall-bladder disease, fatty liver,
sleep apnoea and osteoarthritis.
The disability attributable to obesity and
its consequences in 2004 was calculated
at over 36 million disability-adjusted life
years (DALYs), due primarily to ischaemic
heart disease and type 2 diabetes (WHO
Global Health Risks Report, 2004).
Obesity shortens life expectancy. In
2004, increasedBMI alonewas estimated
to account for 2.8 million deaths, while
the combined total with physical
inactivity was 6.0 million (WHO Global
Health Risks Report, 2004) – surpassing
the excess mortality associated with
tobacco, and approaching that of high
blood pressure, the top risk factor for
death.
Relationships between obesity and
health risks vary between populations.
Asians,
for
example,
are
more
susceptible and thus BMI risk thresholds
are lower than other populations, with
an action point for overweight defined
at 23 kg/m
2
.
Obesity in children
Childhood obesity is already common,
especially in westernised countries.
In 2004, according to IOTF criteria, it
was estimated that ~10% of children
worldwide aged five to 17 years were
overweight and that two to 3% were
obese (Lobstein et al., 2004). Prevalence
rates vary considerably between
different regions and countries, from
<5% in Africa and parts of Asia to >20%
in Europe and >30% in the Americas
and some countries in the Middle East.
Becoming obese earlier in life clearly
amplifies certainhealth risks, particularly
for type 2 diabetes.
The IOTF criteria for overweight and
obesity in children have recently been
updated.
Social impact of obesity
For individuals, psychological problems
associated with obesity are common,
wide-ranging and potentially serious.
Growingworldwideawarenessofobesity
may have reinforced prejudice against
the obese, who are often stigmatised.
Depression and low self-esteem can
affect an individual’s quality of life,
mental health, educational achievement
and employment prospects. Cultural
and
ethnic
factors
undoubtedly
modulate the social impact of obesity,
as well as its perception. In some parts
of the world – notably the Pacific Islands
and parts of Africa – obesity may still
carry historic and cultural connotations
of power, beauty and affluence.
Costs of obesity
Obesity has substantial direct and
indirect costs that put a strain on
healthcare and social resources.
Directmedicalcostsincludepreventative,
diagnostic and treatment services
related to overweight and associated
co-morbidities. European nations spend
two to 8% of their healthcare budgets
on obesity, equating to 0.6% of gross
domestic product (GDP) for some
(Müller-Riemenschneider,
Reinhold,
Berghöfer, andWillich, 2008). In the USA,
estimates based on 2008 data indicated
that overweight and obesity account for
$147 billion in total medical expenditure
(Finkelstein, Trogdon, Cohen and Dietz,
2009). Although indirect costs to society
can be substantially higher, they are
often neglected. They relate to income
lost from decreased productivity,
reduced opportunities and restricted
activity, illness, absenteeism and
premature death. In addition, there
are high costs associated with the
numerous infrastructure changes that
societies must make to cope with obese
people (i.e. reinforced beds, operating
tables and wheel chairs; enlarged
turnstiles and seats in sports-grounds
and modifications to transport safety
standards).
Conclusion
Obesity is now reaching pandemic
proportions across much of the world
and its consequences are set to impose
unprecedented health, financial and
social burdens on global society unless
effective actions are taken to reverse the
trend.
10 October 2015
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The above information is reprinted
with kind permission from World
Obesity Federation. Please visit
for further
information.
© 2017 World Obesity Federation
