Obesity crisis needs medical answer

LIZ HUNT

Health Editor

A global campaign to combat obesity was launched by the World Health Organisation yesterday, with a warning that the present public-health strategies to stop people becoming dangerously fat are failing.

The incidence of obesity is rising throughout the developed and emerging world, and is widely regarded as the result of affluence with over-eating and laziness as prime factors.

But Professor Philip James, a leading British expert on nutrition and chairman of WHO's new International Task Force on Obesity, said the problem is more complicated than that. He says it is a disease state which requires medical treatment, including long-term drug therapy and surgery where appropriate. He says that the perception that people are to blame for their own obesity must be banished.

"[Doctors] are very confused by a continuous welter of publications which appear to imply that it is all to do with sloth or gluttony. That is operating to the disadvantage of patients and we now require a completely new, coherent approach by the health services . . . The people who constantly say it is all a matter of self-control neglect all the chemistry and biology we are now beginning to understand. They are usually the thin people who . . . just have the right chemistry."

A person is said to be overweight if their body mass index (weight in kilograms divided by height in metres squared) is 25 or higher, and obese if their BMI exceeds 30. In those aged 25 to 30 severe obesity is linked with a 12-fold increase in mortality compared with thinner people. High blood pressure, diabetes, high cholesterol levels, anxiety and depression are up to six times higher in obese individuals. The direct and indirect costs of obesity total nearly 10 per cent of all sick-care costs in Western countries.

In the United Kingdom between 1980 and 1992, the overweight and obese rose to 54 per cent of men and 45 per cent of women. In the United States the entire population would be obese by 2230 if present trends continued, according to the task force.

In parts of India, Africa and Central and Southern America, obesity is a growing problem among the newly affluent classes, who tend to develop obesity related diseases earlier than people in developed countries, according to Professor James: "This has a huge impact on health services and on society at other levels too, because it is the educated and professional groups who are affected."

Professor James, director of the Rowett Research Institute in Aberdeen, said new strategies will be drawn up by the task force based on methods proven to be effective. This will include drugs and may include surgery backed by new data from Sweden which suggests it can help the most severely affected.

He added: "There are also new drugs coming down the line which need to be used in a completely different way from the methods currently used where . . . it is assumed that as soon as you drop someone's weight you take them off the drug. That is mad - you would never take a diabetic or someone with high blood pressure off their drugs once you brought them down to normal."

The task force, which will present its first report at the European Congress on Obesity in Barcelona in May, has set itself three main goals:

t To raise awareness at all levels that obesity is a serious medical condition and health problem.

t To develop policy recommendations for a coherent and effective global approach to manage and prevent obesity.

t To identify and implement strategies in collaboration with experts, professional organisations, patient groups and national health agencies.