[EQ] The challenge of obesity in the WHO European Region and the strategies for response

The challenge of obesity in the WHO European Region and the strategies for response

 

Edited by:

Francesco Branca, Haik Nikogosian and Tim Lobstein

WHO Regional Office for Europe, 2007

 

Available online PDF file [339p.] at: http://www.euro.who.int/document/E90711.pdf

 

“……In response to the emerging challenge of the obesity epidemic, the WHO Regional Office for Europe organized the WHO European Ministerial Conference on Counteracting Obesity, which took place in Istanbul, Turkey on 15–17 November 2006.

This book collects the papers that were written by a large group of experts in public health, nutrition and medicine to provide background for the Conference; a smaller book already published by the Regional Office summarizes many of their conclusions.1 Both this book and the summary illustrate the dynamics of the epidemic and its impact on public health throughout the European Region. In particular, the obesity epidemic’s rapid expansion to the countries in the eastern half of the Region causes great concern, as they now suffer from a double burden of disease linked to both under- and overnutrition….”

 

Content

Foreword

1. Current prevalence and trends of overweight and obesity

2. Impact of obesity on health

3. Economic consequences of obesity

4. Physical activity, sedentary behaviour, physical fitness and obesity

5. Dietary determinants of obesity

6. Effects of early nutrition on development of obesity

7. Dietary patterns in Europe

8. Microenvironmental determinants of dietary patterns

9. Macroenvironmental determinants of food consumption

10. Promotional marketing of food

11. Macro- and microenvironmental determinants of physical activity

12. Socioeconomic inequalities in obesity in Europe: issues and policy implications

13. Actions and policies to prevent obesity

14. Economic instruments for reducing consumption of energy-dense foods

15. Actions and policies to promote physical activity

16. Designing and developing a strategy to prevent obesity

17. Preventing obesity: selecting the best investments

18. Involving different stakeholders

19. Monitoring and evaluating policies and programmes

20. National policies in the European Region

21. Implementing the WHO Strategy on Diet, Physical Activity and Health: analysis of global progress

22. Effective treatment: an evidence base for the treatment of overweight and obesity

23. Obesity policy: the next steps
Annex 1. Recent reviews on obesity prevention

 

 

 

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[EQ] Impact of Energy Intake, Physical Activity, and Population-wide Weight Loss on Cardiovascular Disease and Diabetes Mortality in Cuba

 Impact of Energy Intake, Physical Activity, and Population-wide Weight Loss on  
 Cardiovascular Disease and Diabetes Mortality in Cuba, 1980–2005

  Manuel Franco¹, Pedro Orduñez², Benjamín Caballero³, José A. Tapia Granados⁴, Mariana Lazo¹,  
 José Luís Bernal², Eliseo Guallar^1,5 and Richard S. Cooper⁶

¹ Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School 
  of Public Health, Johns Hopkins University, Baltimore, MD
² Hospital Universitario "Dr. Gustavo Aldereguia Lima," Cienfuegos, Cuba
³ Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
⁴ Institute of Labor and Industrial Relations and School of Social Work, University of Michigan, Ann Arbor, MI
⁵ Department of Epidemiology, Centro Nacional de Investigacion Cardiovascular, Madrid, Spain
⁶ Department of Preventive Medicine and Epidemiology, Stritch School of Medicine, Loyola University, Maywood, IL  

American Journal of Epidemiology  -   Advance Access published online on September 19, 2007 

Website: http://aje.oxfordjournals.org/cgi/content/full/kwm226v1

 "..... Cuba's economic crisis of 1989–2000 resulted in reduced energy intake, increased physical activity, and sustained  
 population-wide weight loss. The authors evaluated the possible association of these factors with mortality trends.  
 Data on per capita daily energy intake, physical activity, weight loss, and smoking were systematically retrieved from  
 national and local surveys. National vital statistics from 1980–2005 were used to assess trends in mortality from diabetes,  
 coronary heart disease, stroke, cancer, and all causes.

The crisis reduced per capita daily energy intake from 2,899 calories to 1,863 calories. During the crisis period, the  
 proportion of physically active adults increased from 30% to 67%, and a 1.5-unit shift in the body mass index distribution  
 was observed, along with a change in the distribution of body mass index categories.

The prevalence of obesity declined from 14% to 7%, the prevalence of overweight increased 1%, and the prevalence of  
 normal weight increased 4%. During 1997–2002, there were declines in deaths attributed to diabetes (51%), coronary  
 heart disease (35%), stroke (20%), and all causes (18%). An outbreak of neuropathy and a modest increase in the  
 all-cause death rate among the elderly were also observed. These results suggest that population-wide measures  
 designed to reduce energy stores, without affecting nutritional sufficiency, may lead to declines in diabetes and  
 cardiovascular disease prevalence and mortality.  ^..." 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area] 

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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[EQ] The rise and fall of epidemiology, 1950-2000 A.D

         The rise and fall of epidemiology, 1950–2000 A.D.

Kenneth J Rothman  - Harvard School of Public Health, Boston, MA USA
International Journal of Epidemiology 2007 36(4):708-710; doi:10.1093/ije/dym150

[Extract] [Full Text] [PDF] 

"....In 1662 John Graunt, a London haberdasher, published his magnum opus, Natural and Political Observations ...
Made upon the Bills of Mortality, and thereby established the field of epidemiology.¹ Graunt brought to light a
diversity of facts about human life and disease that had not previously been appreciated. He was the first to notice
that the number of births and deaths of males exceeded those of females (by the ratio of 14 to 13); he noticed, too,
that despite their greater mortality, men had less morbidity than women. Graunt quantified for the first time the high
mortality in children, noting that one-third died by the age of five. He documented that plague actually claimed many
more deaths than had been ascribed to it, and he demonstrated that the frequency of rickets increased over the span
of a few years from zero fatal cases to a level that indicated a serious epidemic.  ^..."

Commentary: Epidemiology still ascendant
Kenneth J Rothman - Harvard School of Public Health, Boston, MA USA

Int. J. Epidemiol. 2007 36: 710-711; doi:10.1093/ije/dym151 [Extract] [Full Text] [PDF]

".....Though published in 1981, the footnote on the first page of ‘The Rise and Fall of Epidemiology’¹ indicates that it was
a preprint of a talk ‘to be presented December 10, 2004, at the annual meeting of the John Graunt Literary Society,
Harvard School of Public Health, Boston.’ Back in the 1970s, the facetiously named John Graunt Literary Society,
or JGLS, met each Friday in the late afternoon at the Harvard epidemiology department to celebrate Graunt's legacy
with brewed beverages. Although the December date 23 years in the future at the time of publication was in fact a
Friday, the ‘preprint’ implied that the JGLS was destined to evolve from a weekly beerfest into a yearly gathering of
sober, serious speeches. In an essay that many readers took to be a cynical rant laden with gloomy predictions,
this forecast for the JGLS was the gloomiest of all.

In fact the essay was not intended to predict the future of epidemiology, which I have always held to be bright.
It was meant to be a warning about the growth of research bureaucracy and its effect on epidemiologic research...."

Commentary: Epidemiology and futurology—why did Rothman get it wrong?
Cesar G Victora - Universidade Federal de Pelotas, CP 464-96001-970 Pelotas, RS, Brazil.
Int. J. Epidemiol. 2007 36: 712-713; doi:10.1093/ije/dym153 [Extract] [Full Text] [PDF] 

".....Ken Rothman is a household name for epidemiologists all over the world. The appearance of his book
‘Modern Epidemiology’¹ in the mid-1980s consolidated his reputation as a major thinker in our discipline.
I remember finding his book truly inspirational when I first read it as a junior epidemiologist.

Rothman's commentary on ‘The rise and fall of Epidemiology, 1950–2000 A.D.’,² however, made many
epidemiologists worry. This paper, published in 1981, reads as if it had been written in the beginning of the
21st century, for presentation at the ‘John Graunt Literary Society’ at Harvard in 2004, pretending to look
back at the downfall of our discipline ..."

Commentary: The rise and rise of corporate epidemiology and the narrowing of epidemiology's vision
Neil Pearce - Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand.
Int. J. Epidemiol. 2007 36: 713-717; doi:10.1093/ije/dym152 [Extract] [Full Text] [PDF]

 

"......with regards to the corporate influences on epidemiology, there is no simple solution. However, for the last
two decades there has been substantial discussion on ethics in epidemiology,^49–52 partly in response to the
unethical conduct of many industry-funded consultants.
A number of websites (e.g. http://www.ucsusa.org/scientific_integrity/ and http://www.cspinet.org/integrity/)
are now devoted to fostering integrity in science. Recently there have been renewed calls for scientists to
‘engage in processes to assert positive principles of ... how science should work, and how it should be
applied to public policy decisions’ rather than simply having a list of what not to do.³⁰ This will require
‘strong pressure from within the scientific community for codes of ethics conduct and financial conflict
of interest’³⁰ with the goal, not of restricting what people can do, but to ensure complete transparency
‘through full declaration of potential sources of conflicts of interest’.¹⁴ Ultimately, perhaps what is
needed is to create some sort of licensure in which epidemiologists would ‘sign up’ to not take funding
from any vested interests (corporate or otherwise)..."

Commentary: Epidemiology needs the patients to survive
J W W Coebergh - Professor of Cancer Surveillance, Erasmus MC Rotterdam
Department of Public Health,  The Netherlands
Int. J. Epidemiol. 2007 36: 717-719; doi:10.1093/ije/dym163 [Extract] [Full Text] [PDF]

".....According to Pubmed, the pessimistic and rather emotional paper of Ken Rothman on the presumed rise and
fall of epidemiology in 1980¹ was his 59th after being in the ‘business’ for almost 10 years. He was undoubtedly
speaking on behalf of many of his colleagues at the time in expressing the threatened demise of his profession.
By 2007, having become an influential teacher, he has been involved in 209 articles on a wide range of subjects,
often in the domain of congenital defects, early life exposures, pharmaco-epidemiology and disease aetiology. I
n 1981, he was still optimistic enough to found the New England Epidemiology Institute which was to successfully
train a large number of post-graduate students in the subsequent 20 years, and he became the first editor of
Epidemiology in 1990. Today, he is still actively teaching and advising all over the world and co-authoring articles.
So, if he did not live up to his own prediction or sought to refute it, were his alarming early warnings appropriate? ^..."

 

Commentary: Is epidemiology really dead, anyway?
• A look back at Kenneth Rothman's ‘The rise and fall of epidemiology, 1950–2000 AD’
Michel P Coleman - Cancer Research UK Cancer Survival Group, Non-Communicable Disease
Epidemiology Unit, London School of Hygiene and Tropical Medicine
Int. J. Epidemiol. 2007 36: 719-723; doi:10.1093/ije/dym160 [Extract] [Full Text] [PDF]

".....Epidemiologists are in increasing demand to provide answers to new problems of health and the causes of disease,
of disease prevention and of health care, and to refine the methods used to monitor or predict trends in disease control.
The public health applications of epidemiology continue to expand, from malaria control in Malawi to the eradication of
onchocerciasis in sub-Saharan Africa; from reducing the toll of road traffic accidents to designing cancer control programmes;
from health services research to defusing the obesity timebomb; and from racial or socio-economic inequalities in the outcome
of health care to projections of the tobacco-related disease epidemic in China.

Rothman's terrible gloom in 1981 overlooked the inherent strength of epidemiology. It is a science that tells us what we
want to know about the human condition and, often, how it might be improved, in a way which no other science can offer.
It is the science that underpins public health.

Less than 10 years ago, tongue firmly in cheek, Rothman co-wrote: ‘Should the mission of epidemiology include the
eradication of poverty?’⁴² Mission impossible, even for a science that can contribute hugely, but Rothman the
epidemiologist seems to have recovered his panache.

A science lives by the strength of its precepts, the intellectual vigour of those who practise it and the benefits it
brings to mankind. By those standards, epidemiology is still very much alive, and looking good. ^...."

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area] 

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.