Slides used for opening lecture in Crete

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Prof. W. Philip T. James International Obesity
TaskForce
Delivering successful strategies for changing
diet physical activity
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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.

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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)
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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.
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BMI distribution curves from the Intersalt Study
populations
Probability density
Body Mass Index (kg/m2)
Source Rose, G. (1991) .
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Optimum nutrient intakes derived from
international (especially European) reports
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Optimum nutrient or dietary intakes derived from
international (especially European) reports
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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.
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PUBLIC HEALTH NUTRITION STRATEGIES
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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

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Total lipids E in food supply for the Caribbean
- 1990
Calculated by Ferro-Luzzi from FAO Food Balance
Sheets
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Saturated Fatty Acids Energy in food supply
for the Caribbean - 1990
Calculated by Ferro-Luzzi from FAO Food Balance
Sheets
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The traditional Mediterranean diet
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Fruit and Vegetable intake - 1990.
Calculated by Ferro-Luzzi from FAO Food Balance
Sheets
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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
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Sources of non-milk extrinsic sugars (NMES) in
pre-school children
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Physical activity and age-adjusted mortality rates
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Odds ratios and 95 confidence intervals of being
overweight / obese (BMI gt25) 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
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Extracurricular sports in children aged 7-11
years at primary school and their enjoyment of
these activities during lessons
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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. JAMA2821561
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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.
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Options for change food

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

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Options for change food

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

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Options for change food purchasers

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

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Options for change physical activity (1)

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

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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.

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Options for change socio-cultural targets

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

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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 personnels own behaviour !

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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.

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Recommendations on Public Health Strategies

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

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Recommendations on Public Health Strategies

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

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