Title: Obesity What is it in Asia? Why is it in Asia?
1ObesityWhat is it in Asia?Why is it in Asia?
2What is obesity?
- Obesity is not weight or size
- Obesity is extra fatness
- How can this be measured?
- Obesity is a health problem
- Obesity is not a fashion problem
- How can we get this through?
3Definition of Obesity
- Classification BMI Risk
of Co-morbidities - Underweight lt 18.5 Low (risk of other clinical
- problems increased)
- Normal range 18.5 - 24.9 Average
- Overweight gt 25
- Pre-obese 25 - 29.9 Increased
- Obese class I 30.0 - 34.9 Moderate
- Obese class II 35.0 - 39.9 Severe
- Obese Class III gt 40.0 Very Severe
4Prevalence of Obesity (Males)
5Prevalence of Obesity among U.S. AdultsBRFSS,
1991
(Approximately 30 pounds overweight)
Source Mokdad AH, et al. J Am Med Assoc
199928216.
6Prevalence of Obesity among U.S. Adults BRFSS,
1998
(Approximately 30 pounds overweight)
Source Mokdad AH, et al. J Am Med Assoc
199928216.
7Obesity in the Middle East
8Overweight Obesity in Asia
9BMI in Urban Malaysian Males
Source Ismail et al. (1995)
10Prevalence Obesity Taiwan 1993-96 Nutrition
Health Survey
11Obesity Prevalence Korea1994-7
12What is obesity in the Asian region ?
- A long history of discussion indecision
- Previous meetings
- IOTF discussions
- WHO Technical Report 1997
- Regional Forum (held with PASOO)
- Formation of Asia Pacific Region of IASO
- WHO Meeting Tokyo 1998
- Meeting Hong Kong (IASO, IOTF WHO)
- Meeting Milan 1999
- Working Group on Obesity in China 2000 (and 2001)
- Asia Pacific Perspective, February 2000
13Historical Facts
- Japanese higher BP for weight compared to
Americans - (Comstock et al., 1985, Baba et al., 1991)
- Australian Aboriginals (ODea)
- Diabetes at BMI gt 22
- Haemoglobin A1C increased (Tai et al., 1992)
- BMI of 24.1 in urban Japanese
- BMI of 23.1 Chinese (Taiwan)
- Melbourne Chinese (Hsu-Hage et al., 1993)
- 50 the overweight obesity yet same
hypertension dyslipidaemia - High WHR
14History continued
- Cervical Cancer (Guo et al., 1994)
- Mortality related to BMI gt 22
- Blood Pressure in Japanese (Inoue)
- 3 times risk at BMI 24.9
- Increment at 22.3
- Southern Chinese (Folsom etal., 1994)
- Despite low BMI - dyslipidaemia, BP
15Coronary Heart Disease and BMI in Asian
populations.
- Japanese Americans (Burchfield et al., 1996)
- Risk increases at BMI gt 23
- Risk doubles at BMI gt 26
- Hong Kong Chinese (Ho et al., 1994)
- BMI 20.4 -23.7, lowest mortality in women
- Remember, age standardised CHD mortality in Hong
Kong Chinese in Japanese is 25 of that for USA
and UK (Woo et al., 1998)
16Overweight Obesity in Asia
- Japan
- High W/H ratios
- Nadir of BMI 22.2
- Hypertension (3x increased at BMI 24.9)
- BMI increase related to fat intake
- Malaysia
- Appearing in rural population
- Android obesity in females (30.6)
- Younger are overweight not obese
- Indian womens weight increases after 1st child
17 Differences in the relationship between body fat
percent and body mass index between Indonesian
and Dutch males and females.
Deurenberg et al, 1999
18Risks of Obesity
- RR gtgt 3 RR 2-3 RR 1-2
- Type 2 diabetes CHD Cancer
- Dyslipidaemia Hypertension PCOS
- Insulin Resistance
- Gall bladder disease Osteoarthritis Infertility
- Sleep apnoea Gout Anaesthetic risk
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21Relative Risk of Metabolic DiseaseTaiwan Series
2000, age sex adjusted, 148,545 individuals
22Risks of Obesity (Korea)
- Annual Health Examination Survey 1994-7
- BMI gt 28 (adjusted for age sex)
- hypertension 4.1
- diabetes 2.2
- dyslipidaemia 3.7
- Kim et al., 1997
- BMI gt 26 (m), BMI gt 25 (f)
- diabetes 3.2
- increased TG 2.1
23Obesity in Asia
- BMI Classification Action
- 18.5-22.9 Healthy Maintain
- 23-25 Overweight At least maintain
- or reduce
-
- 25-30 Obesity 1 Program
- Drug
-
- 30 Obesity II Program Drug
- VLCD
24Obesity (BMI gt25) in China
25Relative risk of type 2 diabetes according to
waist circumference (women)
26Abdominal Adiposity 3Men WomenDespres et al.,
1994
27Abdominal Adiposity in Asia
- Knowledge that abdominal adiposity
- More common
- Greater at lower BMI
- Recommendations for high risk
- Male gt 90 cm (102 cm)
- Female gt 80 cm (88 cm)
- These need to be determined !
28Conservative estimates of the direct healthcare
costs of obesity
Estimated direct costs
National healthcare costs
Country
Year
Australia Canada France Netherlands NZ US
1989/90 1997 1992 1981/89 1990/91 1995
AUD 464 million Can 1.8 million FF 12
billion Guilders 1 billion NZ 135 million US 52
billion
gt 2 2.4 2 4 2.5 5.7
29Obesity in perspective
30Aetiology of Obesity
- Genes havent changed
- Therefore
- Environment has changed
- Relative affluence
- Availability of food
- Urbanisation
- Alteration in Food intake
- Less Activity
31Genetics Obesity
- Several single gene defects
- Leptin synthesis
- MCR4 gene
- cleavage enzyme
- Extreme obesity, hypogonadotrophic hypogonadism
- Varying types of inheritance
- Mainly recessive
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33Energy Intake in Japan 1955-95
34 Fat in Chinese diet 1992
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36Weight, Fat Activity
- UK period 1970-90
- Energy intake -750 cal
- BMI 1.0
- Body weight 2.5kg
- (Prentice Jebb, 1995)
- Energy needed for weight gain
- 50 cal/day
- Physical activity must have fallen by 800
cal/day!
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38Prenatal environment
- Small babies (lt2.5kg) more likely to develop
metabolic disease as adults - Problem in India
- Urban poor, late adolescence
- 50 hypertension
- 15 diabetes, 15 IGT
- ? Due to inadequate nutrition
- ? Particular problem in whole of Asia
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40Management Strategies
- Prevention of weight gain
- Promotion of weight maintenance
- PUBLIC HEALTH PROGRAMS
- Management of co-morbidities
- Promotion of weight loss
- INDIVIDUAL TREATMENT PROGRAMS
41The management of obesity
42Effects of 10 weight loss
- Mortality
- 20 decrease in overall
- 30 decrease in diabetes related deaths
- 40 decrease in cancer related deaths
- Blood pressure
- 10 mm Hg decrease
- Lipids
- 15 decrease in cholesterol
- Decreases in other lipids
- Diabetes
- Better control
- Less medications SIGN, 1996
43Reality
- Assessment
- Anthropometry
- BMI
- waist
- Risks
- BP
- glucose, insulin
- lipids
- heart disease
- sleep apnoea
- Management
- 1. general advice
- 2. activity
- 3. eating
- 4. Program
- 5. Drugs
- Sibutramine
- 6. VLCDs
- 7. Surgery
44Program
- Eating
- Activity
- Incidental
- Exercise
- Behaviour Habit
- Medical
- Pharmacotherapy
- Follow up
45Obesity in our region
- BMI WHO Asia
- 18.5 -24.9 Healthy
- 18.5 - 23 Healthy
- 23 - 25 At risk
- 25 - 29.9 Pre-obese Obese I
- 30 - 34.9 Obese I Obese II
- 35 - 39.9 Obese II
- 40 Obese III
46When to use Sibutramine
- High BMI (gt30)
- Relate BMI and risk - in Asia BMI gt 25
- Abdominal adiposity
- Diabetes
- Dyslipidaemia
- IHD
- OSA
- Inadequate loss after 12 weeks in Lifestyle
Program - Acute loss necessary
47Use of Sibutramine in Asia
- BMI gt 25
- Program
- Add Sibutramine if no loss in 12 weeks
- BMI gt 25 with risks
- Program
- Add Sibutramine
- Treat risks (diabetes, BP, dyslipidaemia)
- BMI gt 30
- Program Sibutramine
- Consider additional therapy