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Prof. W. Philip T. James International Obesity TaskForce Delivering successful strategies for changing diet & physical activity Current IOTF initiatives and supported global developments 2000.

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Prof. W. Philip T. James International Obesity TaskForce

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Prof. W. Philip T. James

International Obesity TaskForce

Delivering successful strategies

for changing diet & physical activity


Current IOTF initiatives and supported global developments 2000.

  • Chinese Action Group established April 26: obesity burden analyses & preventive options - Beijing, Dec. 11-13.

  • EU Diet & Health: policy needs proposed - Crete, May 18-20

  • FLASO Initiative: Ata do Rio de Janeiro - June 30-July 2.

  • WHO Europe - Health Ministers' Regional Committee, Sept. 15-16. Obesity now a priority.

  • Commonwealth Health Ministers. IOTF/WHO Workshops

    • Pacific Islands: 17 countries, Sept. 26-29.

    • Caribbean: over 15 countries, November 20-22.

  • WHO Global Burden of Disease: Dec. 5-7 - Auckland, NZ.

  • French Presidential Initiative Council of Health Ministers; Paris launch on Dec. 15. Obesity to be highlighted.


The strength of evidence on diet and disease

1.Ecological studies of associations

2.Clinical observations

3.Case / control studies

4.Cohort studies + indices of individuality

5.Clinical therapy - analyses of different treatments

6.Population comparisons, e.g. of cities / state responses

7.Randomised controlled trials (+ double-blind placebo)


Public Health Strategies to implement FBDG and enhance lifestyles

  • MYTHS:

  • Primary prevention strategies are not effective

  • They take too long to have an effect

  • People do not like to be told what to do

  • the food industry will suffer

  • Nutritionists do not agree

Need resources for public health strategies on diet and physical activity.


Rose's population approach

Required reduction in mean to halve prevalence of high risk groups

Variable (definition of high)

Systolic B.P. (>140 mmHg)

8 mmHg

4 mmHg

Diastolic B.P. (>90 mmHg)

Obesity (BMI >30)

2.6 (kg/m2)

39 mmol/d

Sodium intake (>250 mmol/d)

Rose, G. in CHD Epidemiology. Ed. Marmot & Elliott, Oxford Med. Pub. 1992.


BMI distribution curves from the Intersalt Study populations

Probability density

Body Mass Index (kg/m2)

Source: Rose, G. (1991) .


Optimum nutrient intakes derived from international (especially European) reports


Optimum nutrient or dietary intakes derived from international (especially European) reports


The traditional Mediterranean diet

* Chemical Analyses in the 7-Country Study with Crete 36%, Corfu 27%. Recent re-evaluation of some original diet records suggest 42% for Crete(Kafatos et al. 2000). Some fatty acid values estimated by difference.


Prevention of diabetes in glucose intolerant adults.

Cumulative incidence diabetes %

Control

*

+0.3-1.8

25.8 + 3.8

45

-0.8-3.5

31

55

1.7%-3.7%

26.6 + 3.1

48

Weight loss kg (%):

Baseline BMI + SD

Age (yrs):

*

Dietary change in all three studies involved detailed recurrent dietetic advice. Physical training in sports centre or on own for >12 months with 6 year follow-up and recurrent monitoring and help.


Legislation

Health education

Community development

Fiscal

change

Organisational change

Re-orientation of services

PUBLIC HEALTH NUTRITION STRATEGIES


A step-by-step approach to FBDG

  • IDENTIFY:

  • Major food sources of nutrient of interest

  • Foods providing substantial part of population intake

  • Foods explaining variations in intakes

    Then formulate FBDG


Total lipids % E in food supply for the Caribbean - 1990

Calculated by Ferro-Luzzi from FAO Food Balance Sheets


Saturated Fatty Acids % Energy in food supply for the Caribbean - 1990

Calculated by Ferro-Luzzi from FAO Food Balance Sheets


The traditional Mediterranean diet


Fruit and Vegetable intake - 1990.

Calculated by Ferro-Luzzi from FAO Food Balance Sheets


The % contribution to total fat intake (% energy from fat) in Irish Adults (18 years+)

Food Group Contribution

Fresh meat18

Spreadable fats17

Milk16

Biscuits/cakes/pastries/ desserts11

Meat products 7

Potatoes 6

Eggs 5

Bread 5

Other dairy products 4

Chocolate confectionery 2

Savoury snacks 1

92% of total

Institute of European Food Studies (IEFS) Ireland, 2000


Sources of non-milk extrinsic sugars (NMES) in pre-school children


Physical activity and age-adjusted mortality rates


Odds ratios and 95% confidence intervals of being overweight / obese (BMI >25) if sedentary.

Progressively higher physical activity level (PAL) values have been used to discriminate sedentary from active lifestyles.

Ferro-Luzzi & Martino. 1996 Obesity and Physical Activity - Ciba Foundation Symposium 20, publs. John Wiley & Sons, pp. 207-221


Options for increasing physical activity to desirable 1.7 PAL

ALTERNATIVE STRATEGIES

A normal sedentary day

Daily

Once weekly

Walk 60'

BMRx4.0

Jog 20'

BMRx11.0

Jog 140'

BMRx11.0

Walk 420'

BMRx4.0

Travel (BMR x 2.56)

Domestic activity

(BMR x 2.82)

Work (BMR x 1.60)

Time allocation mins/day

Active leisure

Passive leisure

Sleeping, washing etc.

(BMR x 1.06)

The day's PAL

From Ferro-Luzzi and Martino (1996). Modelling was performed for an average 70 kg male to determine the nature, duration and timing of active leisure required to achieve an overall mean physical activity level of around 1.70. Columns 2 and 3 indicate how this can be achieved by exercising on a daily basis, whilst columns 4 and 5 show what is required if exercise is concentrated into one day per week.


Extracurricular sports in children aged 7-11 years at primary school and their enjoyment of these activities during lessons


The percentage of English secondary schoolchildren aged 12-13 years who engaged in each sport more than 10 times per year

These levels of physical activity are much lower than in many other countries.

Taken from Mason, 1995. Young people and Sport in England, 1994. A National Survey.


Television watching and weight gain in children

18 lessons 30-50 mins. Over 2-3 months to to 92 children aged 9 yrs. in intervention and 100 in control school. Random assignment of school: T.V. stopped for 10 days (67%) then 7 hr/week budget and "intelligent viewing". No link to obesity.

Robinson, T.N., 1999. JAMA;282:1561


The ANGELO Strategy

Socio-

cultural

Constraints

Physical

Economics

Political

Environmental

Micro

Macro

Egger, G. and Swinburn B. An ecological approach to the obesity pandemic. BMJ, 1997; 315: 477-480.


Options for change: food

  • 1.Target nutrients / foods

    • Total fat

    • Saturated fats

    • Free sugars

    • Salt

    • Vegetables

    • Fruits


Physical

Micro-settings:

  • Neighbourhood:Shop availabilitySafe walking / cycle pathsrecreation & sports facilities.

  • School:Canteens serving foodTuck shopsPlay grounds

  • Home:Gardens

  • Market: Local food availability (fruit &vegetables

  • Work:Food arrangementsCycle shedsChanging facilities


Options for change: food

  • 2.Target places to eat:-

    • Hotels

    • Restaurants

    • Schools

    • Workplace: public and private

    • Street stalls

    • Home


Options for change: food purchasers

  • Incremental but progressive changes targeting:-

    • Importers

    • Hotels

    • Supermarkets


Options for change: physical activity (1)

  • Standing

  • Walking

  • Cycling

  • Elevators / stairs

  • Leisure activities: target women particularly

    • Dancing

    • Swimming

    • Other single / dual activities ?


Options for change: physical activity (2)

  • Healthy active schools: Education Dept.

  • Walkway/pedestrian areas : Planning Dept.

  • Cycle paths: need coherent transport policy - treasury ?

  • Swimming lessons: Education Dept.

  • Work facilities: Employment/CommerceDepts.


Options for change: socio-cultural targets

  • Vegetables types

  • Sugary drinks

  • Use of salt

  • Foods in pregnancy

  • Fats / Fries

  • Overweight women

  • Waistline

  • Exercising women


Recommendations on Public Health Strategies

  • Health care:

  • Better training

  • Involve in broader community programmes

  • Establish European Forum

  • Guidelines for primary care on activity promotion

  • Link primary care to other regional services.

  • Change health care personnel’s own behaviour !


Recommendations on Public Health Strategies

  • Schools:

  • Curriculum on diet and activity from pre-school

  • Integrate school meals into education

  • Train teachers / assistants

  • Involve school health services

  • Create healthy, active school environments

  • Encourage family and community involvement.


Recommendations on Public Health Strategies

  • Employers:

  • Help intervention programmes for work force

    • management

    • work force

    • local resource use

  • Regional strategies

  • Sectoral grouping

  • Individual companies


Recommendations on Public Health Strategies

  • Food industry:

  • A key to future development

  • Support healthier eating

    • pricing

    • product formulation

    • labelling initiatives

    • partnership with health sector


Motivators of change

  • Politicians

  • Professionals

  • People:

    • Women's groups

    • Men's groups

    • Churches

    • Media


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