Obesity rising in nations rich and poor


The global obesity problem now affects one in 10 people in the world, it is rising in countries rich and poor, and in many countries it is increasing faster in children than adults, according to a new study.

Researchers estimated more than 107 million children and 603 million adults are obese.

The study — “Health Effects of Overweight and Obesity in 195 Countries over 25 Years” — was led by a team at the University of Washington in Seattle. It was published online Monday by the New England Journal of Medicine and presented at a food science and policy meeting in Stockholm.

Researchers reported on 195 countries, although data was incomplete or nonexistent for many of them. They made assumptions and used mathematical modeling to fill in gaps.

Among the countries and territories that were included in the present study, data regarding overweight, obesity, or BMI (body mass index) were unavailable for only eight — The Bahamas, Antigua and Barbuda, Bermuda, Brunei, Northern Mariana Islands, Saint Vincent and the Grenadines, Turkmenistan, and Venezuela. According to the study, estimates in these countries were constructed purely from the covariates used in the estimation of the linear model, and the weighted and smoothed residuals from data for neighboring countries.

Family medical practitioner Dr. Patrick Whitfield was not surprised statistics from The Bahamas were not included in the study and that researchers needed to extrapolate information from neighboring countries, as he said The Bahamas does not have a central reporting agency or registry.

“We are very weak when it comes to IT [information technology] infrastructure and technology, and so we really and truly do not have an effective and reliable database to be able to reflect the true level of things like obesity and high blood pressure and diabetes in The Bahamas,” said Dr. Whitfield.

He said governments have had many challenges and have been dealing with infrastructure and patient care, but that access to reliable data, which would allow for reporting to the nation on the prevalence and incidence of diseases such as obesity, hypertension and diabetes, had gotten left behind.

“There has been some initial moves to access electronic medical records, for example, through the hospitals and clinics, but if you want reliable data, there has to be interconnectivity between both the private and public sector to be able to achieve that. So for the time being, we need to rely on other countries’ data that can reflect that.”

Because The Bahamas itself does not have the data to reflect the Bahamian population, he said researchers had to resort to looking at a country that has the same ethnic makeup as far as cultural practices and environment, and to rely on countries in the region that have a similar epidemiological profile age structure of the population.

“I’m pretty sure as soon as we can get our act together at the national level to ensure better acquisition and use of data — data collection and analysis — then we would be [able to supply our own statistics],” said Dr. Whitfield. “We focus so much on personal health — as we should — in terms of care in the hospital, in clinics, and primary care and so on, but we have not really been focusing too much on health promotion at the national level, and development of anti-obesity programs.”

He said from many of the countries from which researchers were able to get data, there is more than likely a centralized approach to obesity, because it costs taxpayers enormous amounts of money, given the medical issues that arise as a result.

“So many countries are now tackling this at the central core level involving not just health, but the food industry and schools and so on. Many countries for instance have a diabetic registry. If we’re going to classify obesity at that level or if we were to refer all the information collected at the primary care level to a data collection agency, then there can be some analysis and you can probably get more reliable figures,” said the family medicine practitioner.

According to Dr. Whitfield, the last data he saw generated in The Bahamas from a relatively small survey conducted in the mid-2000s suggested that in females that there was an obesity/overweight rate of 60 percent; and that of that number approximately 40 percent would have been in the overweight category, which he said is reflective of the picture in most other Caribbean countries, with The Bahamas edging them out slightly.

The Bahamas was ranked the sixth most obese country in the world based on 2014 statistics from the World Health Organization in 2015.

Since that report came out, the family practitioner said he has not seen a shift in the Bahamian populace.

“I’m not one who believes that behavior change occurs because of information such as that, but we have no point of reference in terms of national data, but it would not seem so, because people who would have been obese at the time of that study, they’re still obese now. What we would have to look at are what were the levels two years ago, and compare that to this year. But once again, that speaks to the need to have the data that can show that.”

Dr. Whitfield advocates for a diabetes registry moreso than one for obesity. And he said it should be a national one, including information from the Family Islands as well, and able to show who has the highest versus lowest obesity levels, and that the data should be able to be tracked to neighborhoods.

The doctor said he thinks the country is moving towards being able to track medical data, because policy makers recognize the need to use real time data to be able to track things.

The “Health Effects of Overweight and Obesity in 195 Countries over 25 Years” study found obesity has tripled in children and young adults in countries like China, Brazil and Indonesia. And numbers researchers found this particularly troubling, because it meant more young people were on track to become obese adults and develop problems like diabetes, heart disease and a range of cancers, according to some experts.

Edward Gregg, a diabetes expert at the U.S. Centers for Disease Control and Prevention in an Associated Press report said despite the limitations, the study is “the best picture that’s out there for global obesity.” He wrote an editorial that accompanied the study.

Some of the findings:

• Obesity rates doubled in 73 countries between 1980 and 2015. Countries where obesity did not increase significantly included Afghanistan, Bulgaria, and the Democratic Republic of the Congo.

• Worldwide, about five percent of children and 12 percent of adults were obese in 2015. In the U.S. about 17 percent of children and 38 percent of adults are obese, according to earlier CDC estimates.

• Among the 20 largest countries, the United States had the highest level of obesity among children and young adults. Bangladesh had the lowest.

• Egypt had the highest rate of obese adults. Vietnam had the lowest.

• But the United States had the largest number of obese adults in 2015, with 79 million. China came in second with 57 million obese adults — even though China has more than four times as many people as the U.S.

• China had the largest number of obese children, with 15 million. India had 14 million.

• Globally, about four million deaths were attributed to being overweight or obese in 2014, from causes like heart disease and diabetes.

But good news is that improvements in medications and other kinds of healthcare seem to be helping people survive longer, even if they have weight-related health problems. Researchers did not find an increase in weight-related rates of death and disability, Gregg observed.

But with obesity levels rising, there is a pressing need for better nutrition and other efforts to prevent unhealthy weight gain, said one of the authors, Dr. Ashkan Afshin, the study’s lead author.

Unfortunately, “there is no single simple solution for the problem of overweight and obesity,” he said.

The study provides a comprehensive assessment of the trends in high BMI and the associated disease burden. And results show that both the prevalence and disease burden of high BMI are increasing globally, and that findings highlight the need for the implementation of multicomponent interventions to reduce the prevalence and disease burden of high BMI.

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