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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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slide1

Prof. W. Philip T. James

International Obesity TaskForce

Delivering successful strategies

for changing diet & physical activity

slide2

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.
slide3

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)

slide5

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.

slide8

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.

slide9

BMI distribution curves from the Intersalt Study populations

Probability density

Body Mass Index (kg/m2)

Source: Rose, G. (1991) .

slide15

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

slide16

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.

slide22

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.

slide23

Legislation

Health education

Community development

Fiscal

change

Organisational change

Re-orientation of services

PUBLIC HEALTH NUTRITION STRATEGIES

slide24

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

slide27

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

Calculated by Ferro-Luzzi from FAO Food Balance Sheets

slide28

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

Calculated by Ferro-Luzzi from FAO Food Balance Sheets

slide30

Fruit and Vegetable intake - 1990.

Calculated by Ferro-Luzzi from FAO Food Balance Sheets

slide31

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

Food Group Contribution

Fresh meat 18

Spreadable fats 17

Milk 16

Biscuits/cakes/pastries/ desserts 11

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

slide34

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

slide37

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.

slide39

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

slide40

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.

slide41

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

slide43

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.

slide44

Options for change: food

  • 1. Target nutrients / foods
    • Total fat
    • Saturated fats
    • Free sugars
    • Salt
    • Vegetables
    • Fruits
slide45

Physical

Micro-settings:

  • Neighbourhood: Shop availability Safe walking / cycle paths recreation & sports facilities.
  • School: Canteens serving food Tuck shops Play grounds
  • Home: Gardens
  • Market: Local food availability (fruit & vegetables
  • Work: Food arrangements Cycle sheds Changing facilities
slide46

Options for change: food

  • 2. Target places to eat:-
    • Hotels
    • Restaurants
    • Schools
    • Workplace: public and private
    • Street stalls
    • Home
slide47

Options for change: food purchasers

  • Incremental but progressive changes targeting:-
    • Importers
    • Hotels
    • Supermarkets
slide48

Options for change: physical activity (1)

  • Standing
  • Walking
  • Cycling
  • Elevators / stairs
  • Leisure activities: target women particularly
    • Dancing
    • Swimming
    • Other single / dual activities ?
slide49

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/Commerce Depts.
slide50

Options for change: socio-cultural targets

  • Vegetables types
  • Sugary drinks
  • Use of salt
  • Foods in pregnancy
  • Fats / Fries
  • Overweight women
  • Waistline
  • Exercising women
slide51

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 !
slide52

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.
slide53

Recommendations on Public Health Strategies

  • Employers:
  • Help intervention programmes for work force
    • management
    • work force
    • local resource use
  • Regional strategies
  • Sectoral grouping
  • Individual companies
slide54

Recommendations on Public Health Strategies

  • Food industry:
  • A key to future development
  • Support healthier eating
    • pricing
    • product formulation
    • labelling initiatives
    • partnership with health sector
slide55

Motivators of change

  • Politicians
  • Professionals
  • People:
    • Women's groups
    • Men's groups
    • Churches
    • Media