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Lancet global obesity report – experts respond

Posted in Expert Reactions on May 29th, 2014.

A brand new analysis of obesity worldwide has shown that global rates have climbed steadily over the last three decades and New Zealand, unfortunately, is leading the charge.

NZObesityThe percentage of overweight and obese individuals has climbed markedly among New Zealanders since 1980, according to a new, first-of-its-kind analysis of trend data from 188 countries.

The research, published in the leading medical journal the Lancet, is part of the wide-ranging Global Burden of Disease project.

Between 1980 and 2013, the study found the proportion of obese adult males in New Zealand increased more than in any other country, jumping from 13% to 28%.

New Zealand’s rate of overweight and obese adults increased from 50% to 66% over the same time frame. Among children in New Zealand, 29% are now either obese or overweight, up from 18% three decades ago. New Zealand’s rates of adult and child obesity are the highest in Australasia, according to the study.

A growing global issue

Globally, the study found 2.1 billion people — nearly 30% of the world’s population — are either obese or overweight.

The rise in global obesity rates over the last three decades has been substantial and widespread, presenting a major public health epidemic in both the developed and the developing world.

No countries have had significant decreases in obesity in the last 33 years.

“Obesity is an issue affecting people of all ages and incomes, everywhere,” said Dr. Christopher Murray, director of The Institute for Health Metrics and Evaluation (IHME) and a co-founder of the Global Burden of Disease study. “In the last three decades, not one country has achieved success in reducing obesity rates, and we expect obesity to rise steadily as incomes rise in low- and middle-income countries in particular, unless urgent steps are taken to address this public health crisis.”

The IHME have created a data visualisation tool that can be used to explore the statistics behind the report.

The SMC has gathered the following expert reaction to the Lancet report’s findings:

Prof Boyd Swinburn, Professor of Population Nutrition and Global Health at the University of Auckland, comments:

“These new obesity statistics for New Zealand are nothing to be proud of, especially for children. It is abundantly clear that, as a country, we have not done nearly enough to reduce childhood obesity. There is some cause for optimism with the government starting to re-invest in community-based approaches to promoting healthy eating and physical activity after years of dis-investment.

“In addition, Sir Peter Gluckman, Chief Science Advisor to the Prime Minister has just been named as the Chair of the Science and Evidence Working Group for the newly announced WHO Commission to End Childhood Obesity. This is excellent news that WHO is on a mission to specifically reduce childhood obesity, it should give real momentum to ensuring healthy food policies in schools and preschools and reducing the marketing of junk food to children. Successive New Zealand governments have been unwilling to take on the food industry by regulating the marketing of the very foods which are causing childhood obesity. The priority is to protect the health of children and support parents from the pester power created by junk food ads – these are more important than the profits of the junk food industry.”

“I am optimistic that shock from these new statistics, the WHO drive to end childhood obesity, and the newly announced funding for Healthy Families NZ programs in 10 sites around the country will bring the focus onto reducing childhood obesity, which I believe should be a national health target.”

Prof Valery Feigin, Director of the National Institute for Stroke and Applied Neurosciences, AUT, was a co-author of the Lancet report. He comments:

“Being overweight is a well-established risk factor for stroke, heart attack, dementia and cancer – the four major causes of death and disability in New Zealand. Therefore, the fact that New Zealand has the highest rates of adult and child obesity in the region is very alarming. The extent of the overweight and obesity epidemic gives us two particularly important insights. Firstly, that the current strategies for maintaining a healthy weight are not working and, secondly, that action is urgently needed at both a government and individual level.

“Government interventions such as tax exemptions on fruit and vegetables, regulation of soft drink availability in schools and other public places, and consistent educational campaigns on the need and means of maintaining a healthy diet and weight should be considered; individually – steps such as culturally appropriate and effective cognitive-behavioural interventions, to help people achieve and maintain a healthy weight. If this obesity epidemic is not stopped, we will suffer an increase in the burden of these most devastating disorders.”

Assoc Prof Tony Merriman, Department of Biochemistry, University of Otago, was a co-author of the Lancet report. He comments:

“It is widely accepted that increased calorific intake from energy dense and nutrient poor processed foods is a major driver of the increasing obesity rates in NZ and world-wide. Decreasing levels of physical activity owing to society-wide changes in lifestyle in adults and children also contribute. In my opinion the intervention required to reverse the increasing obesity rates is not straightforward and certainly will be multifactorial, requiring strategic co-ordination by government. It has to begin with public health approaches to reduce the total calorific intake of New Zealanders alongside approaches to increase physical activity. The former would require governmental policy change and specific interventions, such as reducing the price disparity between nutritious healthy foods and energy dense nutrition-poor unhealthy food. The food industry would also need to be engaged in this. This is generally a politically unpopular approach and would need to be coincidental with increasing public education and awareness of the biological causes of obesity. Increasing physical activity would be need to be multi-sectorial – local and central government, workplaces, schools.

“Alongside the approaches above it is my opinion that research efforts in New Zealand should be stepped up to focus on the biological drivers of obesity, particularly in Maori and Pacific people, with strong public dissemination strategies. The National Science Challenges should be able to address this question. This research is required in order to change ingrained societal attitudes to the obese. Obesity is widely perceived to be the fault of the individual, who lacks the will to be lean. Contrary to this view, however, overseas research has shown that obesity is a heritable neurobehavioral condition sensitive to environmental conditions. The ‘obesogenic’ environment increases the average weight, but genes are a major part of the explanation as to why some people are obese and others aren’t, explaining 60-70% of the inter-individual variation in weight. These genetic variants, because they are inherited at conception, define biological causes of obesity. Many of these genetic variants have been identified – they highlight inadequate satiety signals and energy balance as important biological drivers of obesity. People who have inherited a greater proportion of obesity-predisposing genetic variants need to exercise more conscious effort to remain lean in an obesogenic environment (ie to feel hungry in the presence of abundant food) than that required by a naturally lean person. Wider public understanding of these biological causes should swing the public opinion pendulum on obesity from antipathy to sympathy, necessary for any successful governmental and other interventions to address obesity.”

Associate Professor Nick Wilson, Co-Director BODE3: Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago comments:

“This new Lancet study is an important one in terms of providing an international context for the obesity problem. The pattern is of a worse problem for New Zealand relative to Australia – though with only some of the differences being statistically significant (eg, obesity in males aged under 20 years). Overweight and obesity is certainly a problem that New Zealand researchers and health workers are well aware of already – as detailed in the Ministry of Health’s report last year on health loss. In the latter report, overweight and obesity are predicted to be currently overtaking tobacco as the leading risk factor for health loss in New Zealanders.

“There are many policy solutions, some of which are already underway in New Zealand (eg, Project Energize in a growing number of New Zealand schools). But actions that are quite likely to be highly cost-effective (even cost-saving to the NZ taxpayer) are to tax various aspects of the obesogenic environment – starting with soft drinks. Higher taxes on vehicle fuel could also go to expand walkways and cycleways – with a study from Oregon suggesting that cycleway infrastructure is very cost-effective. Not only does increased active transport help prevent and control obesity – it may also be good for mental health, reducing air pollution, and reducing the harm New Zealand is doing to the global environment through relatively high greenhouse gas emissions per capita.”

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