The epidemic of obesity and overweight poses a major challenge to the prevention of chronic noncommunicable diseases throughout the world. In some developing countries it presents a double burden alongside enduring problems of undernutrition. Current IOTF estimates suggest that at least 1.1 billion adults are overweight including 312 million who are obese. The prevalence of obesity has doubled or even risen threefold in less than two decades, while in children this is rising at an even faster rate in some regions of Europe to levels of up to 36% in parts of Italy and elsewhere. The comparative burden of disease due to raised body mass index is among the top five leading risk factors in both developed and low mortality developing countries. When viewed in conjunction with the burden of raised cholesterol and hypertension, these components of the metabolic syndrome form the major cause of mortality and disease in Europe and are guaranteed to increase with the rising trend in overweight and obesity while amplifying the burden of cardiovascular disease. The increase in childhood obesity will, unchecked, accentuate the rise in early adult type 2 diabetes and cardiovascular disease.A fundamental policy shift is required to widen responsibility for the prevention of diet, activity and weight-related ill health across the whole of Europe's population. Only such a comprehensive approach offers any realistic prospect of averting a public health catastrophe for Europe and indeed for the whole world.
Overweight/obesity is associated with significant morbidity, mortality and costs. Weight loss has been shown to reverse some of these effects, reducing the risk of chronic diseases such as cardiovascular disease (CVD).To determine the potential monies available, from an English National Health Service perspective, for weight loss interventions to be cost-effective in the prevention of CVD.A Markov model was developed, populated with overweight/obese individuals from the Health Survey for England, aged 30-74 years, free of pre-existing CVD and with available risk factor information to calculate CVD risk. All individuals were free of CVD at baseline and, with each annual cycle, could transition to other health states of primary CVD, secondary CVD or death according to transition probabilities for a maximum period of 10 years, or until death. Utilities, costs and the effects of weight loss on CVD risk factors were applied. The potential monies available for CVD prevention strategies, provided the incremental cost-effectiveness ratio met UK arbitrary limits of between £20 000 and £30 000, was determined.Applying the effects of weight loss on CVD risk factors prevented 4 CVD events and saved 17 quality-adjusted life-years over 10 years per 1000 individuals. £34 to £51 was available per person per year for up to 10 years when meeting the UK arbitrary limits.Individual annual financial allowances for weight loss interventions to be considered cost-effective is relatively low; however, as a large proportion of the population is affected, wide cheap societal interventions are important.
Abstract: The problem of obesity was only accepted by the World Health Organization as of major public health importance in 1997 when the criteria for the specification of the metabolic syndrome were also being sought. Then the risk factor analyses of the determinants of global ill health at the start of the millennium showed that an excessive body mass index (BMI) above the optimum of 21 was one of the top 10 contributors. No analyses could be related to abdominal obesity because of the absence of systematic representative surveys of waist circumferences but the ill health attributable to excess weight included the risk factors specified in the metabolic syndrome and showed that the co‐morbidities in Asia were far greater than those predicted from simply an excess weight. The recent proposed definition of the metabolic syndrome includes these different criteria specified on an ethnic basis but there is now a need to recognize that abdominal obesity is more common on the developing world and linked to childhood stunting and early deprivation. The importance of intrauterine and postnatal epigenetic and altered organ function needs to be recognized. Thus the co‐morbidities associated with weight gain and the development of the metabolic syndrome dominate in the developing world where the majority of the population is proving more susceptible to the effects of weight gain than Caucasians now living in affluent societies. This therefore presents a major challenge in both research and public policy terms.
Background Cardiovascular diseases and their nutritional risk factors—including overweight and obesity, elevated blood pressure, and cholesterol—are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development. Methods and Findings We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about I$5,000 (international dollars) and peaked at about I$12,500 for females and I$17,000 for males. Cholesterol's point of inflection and peak were at higher income levels than those of BMI (about I$8,000 and I$18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not correlated or only weakly correlated with the economic factors considered, or with cholesterol and BMI. Conclusions When considered together with evidence on shifts in income–risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low-income and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol.
Obesity is a chronic relapsing condition affecting a rapidly increasing number of people worldwide. The United Nations has stated that universal health coverage is an essential element of the globally-agreed sustainable development goals. This article provides a preliminary report of a survey of relevant health professionals and other interest groups on the readiness of health systems to provide obesity treatment services. Interviews and questionnaires were completed by 274 respondents from a total of 68 low, middle and high income countries. Respondents in the majority of countries stated that there were professional guidelines for obesity treatment, but that there was a lack of adequate services, especially in lower income countries, and in rural areas of most countries. Lack of treatment was attributed to a broad range of issues including: no clear care pathways from primary care to secondary services; absent or limited secondary services in some regions; lack of trained multi-disciplinary support professionals; potentially high costs to patients; long waiting times for surgery; and stigma experienced by patients within the health care services. Defining obesity as a disease may help to overcome stigma and may also help to secure better funding streams for treatment services. However, the survey found that few countries were ready to accept this definition. Furthermore, until countries fully adopt and implement obesity prevention policies the need for treatment will continue to rise while the necessary conditions for treatment will remain inadequate.
Sulfadoxine-pyrimethamine for uncomplicated falciparum malaria Sulfadoxine-pyrimethamine is not working in MalawiEditor-The paper by Plowe et al entitled "Sustained clinical efficacy of sulfadoxinepyrimethamine for uncomplicated falciparum malaria" might be better titled "Sustained lack of efficacy of sulfadoxinepyrimethamine. ..." 1 By the start of the study period five years ago, molecular genotyping showed that Plasmodium falciparum in Malawi had already acquired significant resistance to the combination. 1 2This explains the sustained lack of efficacy; 28 day cure rates in children with acute falciparum malaria remained steadily less than 40% over the five year study period.This is confirmed by the Malawi component of recent WHO-Special Programme for Research and Training in Tropical Diseases (TDR) multicentre trials; the 28 day cure rate with sulfadoxine-pyrimethamine in children with acute falciparum malaria was only 23%, 3 and this for a major killing disease of childhood.A 77% failure rate is among the worst responses ever documented.Only 7% (5/71) of reported trials on sulfadoxinepyrimethamine have had worse failure rates. 4efore sulfadoxine-pyrimethamine was introduced widely it was very effective in Malawi, but, since then, efficacy has fallen dramatically (table).The front page of the BMJ was wrong: sulfadoxine-pyrimethamine is not "still working."A drug giving a cure rate of consistently less than 40% for a potentially life threatening infection cannot be described as having "good efficacy," particularly when highly effective alternatives exist.Can you imagine endorsing an antibiotic with a more than 60% failure rate for use in European or American children with those words?Demographic surveillance system data from eastern and southern Africa show that mortality attributable to malaria in children almost doubled between 1990 and 1998, whereas by contrast non-malaria related mortality fell.The use of ineffective drugs, such as sulfadoxine-pyrimethamine in Malawi, may well be to blame.
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