Τhe burden of obesity in Asia: Challenges in assessment, prevention and management
Author:Rodolfo F Florentino, MD,PhD
Keywords:Asia, challenges in assessment, obesity, overweight, prevention, management
Abstract:Οverweight and obesity have started to emerge as a significant public health problem in Asia. As a whole, the
situation has arisen from the changing dietary pattern towards energy-dense and high fat diets, together with a
more sedentary lifestyle arising from increasing urbanization. Obesity’s threat to the health and economy of the
population gives urgency to meeting the problem headlong before it gets any worse. Fundamental knowledge
gaps, however, constrain the institution of appropriate measures to prevent and manage this growing problem.
Foremost is the paucity of national prevalence and epidemiological data in many countries in the region, coupled
with a lack of uniformity in reference standards and cut-off points. While the principles of dietary management,
physical activity and behaviour modification are well known, integrating these strategies into a national policy
and program in the face of competing priorities is the greatest challenge of all. This requires the collaboration
of government, academia, the food industry, the private sector, NGOs and the community, with the assistance of
international and bilateral aid agencies, to develop and implement such policies and programs.
Asia Pac J Clin Nutr. 2002;11(11):S676-S680.doi:
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Body mass index as an indicator of obesity
Author:Robert C Weisell PhD
Keywords:Asia, body mass index, chronic energy deficiency, consequence, Food and Agriculture Organization, obesity, overweight
Abstract:Undernutrition and hunger have always formed the foundation of the Food and Agriculture Organisation’s
(FAO) mandate. Working in collaboration with the International Dietary Energy Consultative Group (IDECG),
FAO began to examine both appropriate cut-off points of the body mass index (BMI) at the lower end of the
spectrum and the functional consequences of low BMI (<16.0 = Category III Chronic Energy Deficiency (CED);
16.0 – 16.9 = Category II CED; 17.0 – 18.4 = Category I CED). Over the past decade FAO has recognized the
growing obesity epidemic occurring not only in the developed world but also among all income and socioeconomic groups of the developing world. In response, FAO and the World Health Organization (WHO) have
collaborated together in joint initiatives. Following the WHO 1998 Obesity Consultation on Preventing and
Managing the Global Epidemic, a number of regions examined their individual situation regarding obesity. In
looking at the BMI risk-based cut-off points, there appeared to be need for a tailoring of the cut-off points for
Asia. The publication The Asia-Pacific Perspective: Redefining Obesity and its Treatment (2000)proposed areaspecific cut points. While such efforts to individualize reference values to a region or situation are attractive and
even commendable, there is always the danger of creating confusion particularly if later these figures are
changed. It is very important that before values are promulgated, a thorough review is conducted and full
confidence can be placed on them.
Asia Pac J Clin Nutr. 2002;11(11):S681-S684.doi:
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Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults
Author:Zhou Bei-Fan and the Cooperative Meta-analysis Gro
Keywords:body mass index, Chinese adults, obesity, overweight, waist circumference
Abstract:For prevention of obesity in the Chinese population, it is necessary to define the optimal range of healthy weight
and the appropriate cut-off points of body mass index (BMI) and waist circumference for Chinese adults. The
Working Group on Obesity in China under the support of the International Life Sciences Institute Focal Point in
China organized a meta-analysis on the relationship between BMI, waist circumference and risk factors of
related chronic diseases (e.g., high diabetes, diabetes mellitus, and lipoprotein disorders). Thirteen population
studies in all met the criteria for enrolment, with data of 239 972 adults (20–70 years of age) surveyed in the
1990s. Data on waist circumference was available for 111 411 persons, and data on serum lipids and glucose
were available for more than 80 000. The study populations were located in 21 provinces, municipalities and
autonomous regions in mainland China as well as in Taiwan. Each enrolled study provided data according to a
common protocol and uniform format. The Center for Data Management in the Department of Epidemiology, Fu
Wai Hospital, was responsible for the statistical analysis. The prevalence of hypertension, diabetes, dyslipidemia
and clustering of risk factors all increased with increasing levels of BMI or waist circumference. A BMI of 24
with best sensitivity and specificity for identification of the risk factors was recommended as the cut-off point
for overweight; a BMI of 28, which may identify the risk factors with specificity around 90%, was recommended
as the cut-off point for obesity. A waist circumference over 85 cm for men and over 80 cm for women were
recommended as the cut-off points for central obesity. Analysis of a population-attributable risk percentage
illustrated that reducing the BMI to the normal range (<24) could prevent 45–50% of the clustering of risk
factors. Treatment of obese persons (BMI = 28) with drugs could prevent 15–17% of clustering of risk factors.
When waist circumference is controlled at under 85 cm for men and under 80 cm for women, it could prevent
47–58% of clustering of risk factors. Based on these guidelines, a classification of overweight and obesity for
Chinese adults is recommended.
Asia Pac J Clin Nutr. 2002;11(11):S685-S693.doi:
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Obesity in Asia: prevalence and issues in assessment methodologies
Author:E-Siong Tee PhD
Keywords:adult, Asia, assessment, children, methodology, obesity, overweight
Abstract:The dramatic changes in the lifestyle of many Asian communities, and the resultant changes in the food and
nutrition issues facing the communities in the region have been documented by various investigators. Health
authorities and researchers have given greater attention to the problem of overweight and obesity. Available data
are lacking, but various estimates have indicated that the emerging problem of overweight amongst children
cannot be ignored. Estimates of overweight by the World Health Organization (WHO) amongst preschool
children in Asia in 1995 was around 2.9%. Data extracted from selected studies in individual Asian countries
show much higher prevalences, ranging from 5% to 9% amongst several urban cities in Asia. In several other
developing countries in the region, the prevalence is probably very low, with prevalences of less than 1%. There
is thus considerable variation in this prevalence amongst the various countries. The problem of increasing
overweight and obesity amongst adults in Asia has been highlighted for more than a decade. The database on the
extent of the problem is far from being comprehensive, but various studies have pointed out the severity of the
problem. Various reports in the 1990s have pointed out prevalences of overweight of over 20% and obesity of
over 5% amongst urban population groups of the more developed countries in the region. It is also to be noted
that there are also reports indicating that the most affluent societies in the region, such as Seoul and Tokyo, did
not have the highest prevalence of overweight. There are also data on increasing prevalence of overweight
among rural areas in the last 10 years. The situation for children is similar: there is considerable variation in the
severity of the problem. In the Philippines National Surveys, for example, slightly lower prevalences have been
reported. Countries in the region will continue to progress, accompanied by continued changes in lifestyle of
communities. It is therefore of utmost importance to continue to monitor the nutritional status of communities.
The lack of nationally representative data which is regularly updated is a major concern. The lack of data for
certain age groups such as the adolescents and the elderly need to be addressed. One of the main obstacles in the
formulation and effective implementation of intervention programs in developing countries is the lack of
comprehensive data on the extent of the problems in many cases and the causes of such problems specific to the
communities concerned. In addition to the lack of good data, other concerns too need to be addressed. These
include methodological issues such as the need for harmonization of methods in assessment of nutritional status
for the various groups, the appropriateness of criteria for cut-offs, growth reference to be used, and association
of overweight and obesity with comorbidities.
Asia Pac J Clin Nutr. 2002;11(11):S694-S701.doi:
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Consequences of childhood and adolescent obesity
Author:Kah Yin Loke MBBS, MMed(Paeds), MRCP(UK), MRCPCH,
Keywords:adolescent, childhood, economic consequences, obesity, physical, psycho-social
Abstract:Obesity, increasingly recognized as a chronic disease, is associated with physical, psychosocial and economic
consequences to society. With the burgeoning global epidemic, health care workers must rally together to
understand, treat and prevent obesity and its complications.
Asia Pac J Clin Nutr. 2002;11(11):S702-S704.doi:
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Causes and consequences of adult obesity: health, social and economic impacts in the United States
Author:Nancy S Wellman, PhD, RD, FADAand Barbara Friedber
Keywords:economic, health, impact, obesity, social
Abstract:Obesity has been identified as an epidemic in the United States for more than two decades and yet the numbers
of overweight and obese adults and children continue to grow. Currently, the rates of both overweight and
obesity in the US are 61% and 14% in adults and children, respectively. Among US adults aged 20–74 years, the
prevalence of overweight (defined as BMI 25.0–29.9) has increased from 33% in 1980 to 35% of the population
in 1999. In the same population, obesity (defined as BMI ≥30) has nearly doubled from approximately 15% in
1980 to an estimated 27% in 1999. The percentage of children and adolescents who are defined as overweight
has more than doubled since the early 1970s. About 14% of children and adolescents are now seriously
overweight. Obesity burdens the health care system, strains economic resources, and has far reaching social
consequences. The disease is associated with several serious health conditions including: type 2 diabetes
mellitus, heart disease, high blood pressure and stroke. It is also linked to higher rates of certain types of cancer.
Obesity is an independent risk factor for heart disease, hypoxia, sleep apnea, hernia, and arthritis. Obesity is the
seventh leading cause of death in the US. The total cost of overweight and obesity by some estimates is $100
billion annually. Others put the cost of health care for obesity alone at $70 billion. Other annual costs associated
with obesity are 40 million workdays of productivity lost, 63 million doctors’ office visits made, and 239 million
restricted activity days and 90 million bed-bound days. Emotional suffering may be among the most painful
aspects of obesity. American society emphasizes physical appearance and often equates attractiveness with
slimness, especially for women. Such messages may be devastating to overweight people. Many think that obese
individuals are gluttonous, lazy, or both, even though this is not true. As a result, obese people often face
prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or
depression are common. Since the 1950s, national dietary recommendations have come to acknowledge obesity
as a significant societal trend. The Surgeon General’s 2001 Call To Action, Healthy People 2010, and the
Dietary Guidelines for Americans 2000all emphasize the importance of healthy weight. There are some new
tools available to help in the fight against overweight and obesity: Weight Control Information Network, The
Third National Cholesterol Education Program’s Adult Treatment Panel, and The Practical Guide: Identification, Evaluation, & Treatment of Overweight & Obesity in Adultsfrom the National Institutes of Health and
National Heart Lung and Blood Institute.
Asia Pac J Clin Nutr. 2002;11(11):S705-S709.doi:
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Impact of physical activity on the emerging crisis of obesity in Asia
Author:James Levine MD, PhD, John Peters PhD, Wim Saris M
Keywords:Asia, energy expenditure, malnutrition, nutrition, obesity, physical activity
Abstract:Obesity is associated with devastating health and fiscal consequences in countries where it is epidemic. It is
beholden on us all to try to prevent obesity emerging in countries where its prevalence is starting to increase.
There are many countries in Asia where this is so. Obesity prevention necessitates attention to both increasing
physical activity and improving nutrition. In this paper we discuss a strategic approach for increasing physical
activity. First, we need to better understand physical activity levels and the factors that impact it. Next, we
need to design specific and targeted governmentally supported strategies to promote physical activity. Finally
we need to critically and objectively evaluate these strategies and then promote those that are successful, and
channel limited resources away from those that are not. These goals are achievable through collaborating
and sharing technologies. We hope to prevent obesity from engulfing Asia.
Asia Pac J Clin Nutr. 2002;11(11):S710-S713.doi:
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The challenge of managing body weight in the modern world
Author:John C Peters PhD
Keywords:environmental determinants, lifestyle behaviours, obesity, overweight, social change
Abstract:Obesity prevalence has increased dramatically in parallel with rapid economic development and rising standards
of living around the world. There is growing recognition that this ‘epidemic’ of overweight is being driven by
environmental factors that affect our eating and physical activity behaviours. In effect, the environment
overwhelms our biological capacity to maintain a healthy weight. There is little scientific evidence to quantify
the relative contributions of various environmental factors to risk of overweight and obesity. However, it is easy
to characterize the environment as one in which food is readily available, convenient, inexpensive and great
tasting. Likewise, the modern environment discourages physical activity at work, at home and in the community,
and attractive sedentary pursuits compete with activity for leisure time. In fact, the causes of obesity in our
society are so manifold as to be inseparable from the way we live. Many of the forces that drive individuals to
eat too much and move too little are coupled to a desire for self-efficacy and increased productivity. It can be
argued therefore that obesity is an unintended consequence of the emphasis we collectively place on productivity
and a desire to achieve ‘the good life’. In this sense, obesity is not really a biological problem, but a social
problem that requires a multifactorial social solution. In order to create demand for environmental change to
promote healthy lifestyle behaviours, we will need to create a greater sense of crisis among average citizens. We
will need to explore solutions that make economic sense for everyone. We will need to create a new social norm
for healthy eating and active living. The magnitude of the challenge is daunting, but we can begin by engaging
broad scale public private partnerships. After all, we are all part of the global community that is affected by this
emerging crisis.
Asia Pac J Clin Nutr. 2002;11(11):S714-S717.doi:
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Behavioural determinants of the obesity epidemic
Author:David Crawford PhDand Kylie Ball PhD
Keywords:eating behaviour, epidemiology, physical activity
Abstract:Obesity is a serious and growing public health problem affecting developed and developing countries. It is
generally agreed that the causes of the current obesity epidemic are not genetic in origin, but are the result of
changes in the environments in which we live. While acknowledging the importance of environmental factors,
the central role of behaviour in the obesity epidemic cannot be ignored. It is our eating, physical activity and
sedentary behaviours that form the interface between our biology and the environments to which we are
exposed. However, a lack of understanding of the specific behaviours that are important in the aetiology of
obesity poses a major constraint to preventing obesity. A better understanding of the behaviours that contribute
to weight gain and obesity is critical in order to plan and implement effective obesity prevention initiatives.
Theory-driven investigations of eating, physical activity and sedentary behaviours, their determinants, and their
role in weight gain and obesity among different population groups are urgent research priorities. Without an
understanding of the key behaviours that contribute to weight gain, and the influences on these behaviours, it
will remain difficult to identify where to intervene in the environment and be confident that action will prevent
obesity.
Asia Pac J Clin Nutr. 2002;11(11):S718-S721.doi:
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Pharmacotherapy and surgery in the treatment of obesity: evaluating risks and benefits
Author:CHEE FANG SUM
Keywords:
Abstract:The prevalence of obesity is rising in many parts of the world. In Singapore, the 1998 National Health Survey reported the crude prevalence of obesity (BMI 30 kg/m2) amongst adults as 6%. Together with the increase in obesity in certain sectors of the Singapore population (Malay community) there has been a parallel increase in the prevalence of impaired glucose tolerance. If left unchecked, this epidemic of obesity and its comorbidities will lead to reduced quality of life amongst its sufferers as well as an increase in consumption of healthcare resources. Although strategies at the community level are important to check this epidemic, when managing the individual patient with clinically significant obesity and its comorbidities, adjunctive pharmacotherapy and surgical measures are sometimes required besides lifestyle measures and behaviour therapy. Since these therapeutic measures are not without risks, a customized approach utilizing risk-benefit evaluation is appropriate. Pharmacotherapy for the management of obesity has had a chequered history Prom the early disrepute brought about by patient dependence when using amphetamine-like agents, it improved in standing when obesity became more widely accepted as a chronic disorder requiring chronic adjunctive pharmacotherapy. However, the adverse cardiovascular effects reported with the 'fen-phen' combination again reduced enthusiasm for long-term pharmacotherapy. Subsequently, the availability of intestinal lipase inhibitor, orlistat, followed by the mixed noradrenergic-serotoninergic re-uptake inhibitor, sibutramine, gave fresh impetus to this therapeutic area. Both agents were made available for clinical use only after published clinical trial experience of one to two years duration. The difficulties encountered in management of patients with marked obesity have prompted adjunctive surgical initiatives. Follow-up reports from the Swedish Obese Subjects study which began in 1987, have provided valuable data on the effect of surgery on obesity as well as its comorbidities. At the same time, technological advances in surgery have facilitated the widespread use of less invasive approaches to bariatric surgery. It is hoped that with these technological advances, this group of patients will be able to enjoy the benefits of surgery without being exposed to excessive surgical risks.
Asia Pac J Clin Nutr. 2002;11(11):S722-S725.doi:
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ACTIVATE: A childhood overweight prevention initiative
Author:Nancy S Wellman, PhD, RD, FADA
Keywords:ACTIVATE, childhood, obesity, prevention
Abstract:
Asia Pac J Clin Nutr. 2002;11(11):S726.doi:
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Epidemiology of obesity and public health strategies for its control in Japan
Author:Nobuo Yoshiike MD, Fumi Kaneda MSand Hidemi Takimo
Keywords:body mass index, epidemiology, Japan, national nutrition survey, obesity, public health policy
Abstract:Obesity has become a public health problem in Japan. The National Nutrition Survey (2000) showed prevalence
of preobese (body mass index: 25–29.9 kg/m
2
) and obesity (≥30 kg/m2
) was 24.5% and 2.3%, respectively, in
males, and 17.8% and 3.4%, respectively, in females aged 20 years and over. Trends in prevalence of overweight
in the last 25 years differed among age-sex groups and across residential areas. The most significant increase
in overweight was observed in men in small towns, whilst there was a remarkable decrease in women in
metropolitan areas. In the 10 year national plan for health promotion named ‘Health Japan 21’, maintaining
appropriate body weight (obesity control and prevention of thinness brought about by dieting in young women)
is a core component of the prioritized issues. Increasing the number of people who know their healthy body
weight and practice weight control is also listed as an important objective. The proportion of people engaged in
regular exercise for health and following the recommended average number of steps in daily life is a major
indicator for evaluation of the program. We conclude that when formulating effective public health strategies for
obesity control, it is important to consider each country’s own situation related to obesity issues including the
proper BMI cutoff point, which might be much different from that in western societies.
Asia Pac J Clin Nutr. 2002;11(11):S727-S731.doi:
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Criteria and classification of obesity in Japan and Asia-Oceania
Author:Masao Kanazawa MD,PhD, Nobuo Yoshiike MD,PhD, Tosh
Keywords:Asia-Oceania, classification, criteria, Japan, obesity
Abstract:In 1997 when WHO initiated the formation of the International Obesity Task Force (IOTF), the Task Force
proposed the cut-offs for overweight and obesity as BMI 25 and BMI 30, respectively. If we accept the criteria
of BMI ≥30 to indicate obesity, it would appear that the prevalence of obesity in Japan of less than 3% has
changed little during the last 40 years, and we cannot explain the rapid increase in incidence of obesityassociated chronic diseases such as diabetes, hypertension and hyperlipidemia. Thus, JASSO decided to define
BMI ≥25 as obesity. This cut-off has been proposed for use in the Asia-Oceania Region, and WHO Western
Pacific Region noted this proposal. According to this criterion the prevalence of obesity in Japan would average
20%, with a high of 30% in men over 30 years old, and women over 40 years old. Thus the rates would have
increased four times in men and three times in women during these last 40 years. What has caused the increased
prevalence of obesity in Japan? Several causes of obesity have been advanced: (i) overeating (ii) errors of eating
pattern (iii) inactivity (iv) heredity, and (v) disturbance in thermogenesis. Hyperphagia and inactivity are two
major risk factors for obesity. Hyperphagia may be an important factor in individuals. However, the average
energy intake in adult people in Japan has not increased; in fact it has declined (2104 kcal/day to 1967 kcal/day)
during these 40 years. During this period, the prevalence of obesity has increased three or more times as
mentioned above. This indicates that inactivity may be the main cause for the increased incidence of obesity in
Japan. Errors of eating pattern (irregular eating, night eating, etc.), including a high proportion of fat to total
energy intake (8.7% increased to 26.5%), and a high incidence of β3-adrenergic polymorphism, might also have
contributed to the increased incidence of obesity in Japan.
Asia Pac J Clin Nutr. 2002;11(11):S732-S737.doi:
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Healthy lifestyles . . . healthy people – The Mega Country Health Promotion Network
Author:Eileen Kennedy, DSc
Keywords:health campaigns, Mega Country Health Promotion, obesity, WHO
Abstract:In December 2001, the World Health Organization launched the Mega Country Health Promotion Network.
This network includes the countries with populations of 100 million or more. The 11 countries that are part of
this network account for more than 60% of the world’s population. The overall goal of this network is to promote
healthy lifestyles; much of the focus of activities will be on promoting a healthy diet, based on food-based
dietary guidelines and increased physical activity. Data will be presented that illustrate the ‘double burden’ of
disease in the low income populations in these 11 countries. The network is attempting to identify new
paradigms for health promotion, including the innovative use of public/private partnerships. Examples of these
innovations will be presented.
Asia Pac J Clin Nutr. 2002;11(11):S738-S739.doi:
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Assessment of factors that contribute to the percentage of body fat among Malaysian adolescents
Author:
Keywords:
Abstract:
Asia Pac J Clin Nutr. 2002;11(11):S740-S746.doi:
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