Causes, Consequences and Tackling obesity. Professor Paul Gately Carnegie Weight Management Leeds Metropolitan University

What is overweight ? This boy is 3 years, 3 weeks old. Is his BMI-for-age - below the 5 th percentile? - 5 th to <85 th percentile: normalweight? - >85 th to <95 th percentile: overweight? - >95 th percentile: obese? Photo from UC Berkeley Longitudinal Study, 1973

Measurements: Age=3 y 3 wks Height=100.8 cm (39.7 in) Weight=18.6 kg(41 lb) BMI=18.3 BMI-for-age= >95 th percentile =obese Plotted BMI-for-Age Boys: 2 to 20 years BMI

Body Mass Index (kg/m 2 ) Probability density Source: Rose, G. (1991). BMI distribution curves over time O/WTOBESE

Changes in prevalence

Why is this a concern? Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease SteatosisSteatohepatitiscirrhosis Coronary heart disease Diabetes Diabetes Dyslipidemia Dyslipidemia Hypertension Hypertension Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis Gout Idiopathic intracranial hypertension Stroke Cataracts Severe pancreatitis Source:

Psycho social factors 12-year old girls and boys

Fat-teasing in boys & girls (Murphy & Hill, 2003) ** *

Toxic or obesogenic environment Obesity is a normal response to an abnormal environment  side-effect of technological advances  reflects natural human preferences (eg easy, convenient, fast, low effort, value for money)  key factors energy-saving machines, passive recreation energy-dense foods & drinks, large portion sizes

Biological and cultural mismatches to the modern environment FOOD  Strong signals to eat  Weak signals to stop  Increased availability  Eating is rewarding  No viable alternatives  Eating well is high status ACTIVITY  Weak activity signal  Strong signals to stop  Reduced availability  Inactivity is rewarding  Inactivity is a viable alternative  Inactivity is high status

Where should the focus be? 1 in 3 children are overweight or obese. 1 in 3 children who will become overweight or obese adults. 1 in 3 children who are and will remain normalweight /underweight?

Gately (2007) NORMAL WEIGHT OVERWEIGHT Health costs ↑ 20%

Gately (2007) OBESE Health costs ↑ 50%

Gately (2007) OBESE +++ Health costs ? Min ↑100%

Is policy having an impact on weight change? InitiativeCostImpactMeasurement/evaluation Prevention Sahota (UK)?No ImpactBMI Gortmaker (US)?No ImpactBMI Lupeka (US)?No ImpactBMI Fruit and Veg Field (US)?No impactBMI PESSCL?No evidenceNo evaluation School Food Programme£235m?No evidenceNo evaluation Healthy Schools?No evidenceNo evaluation Play£155m?No evidenceNo evaluation Social Marketing?No evidenceNo evaluation Extended schools£125m?No evidenceNo evaluation

Results of process research  Comments on exercise: “I prefer to do sports than watch TV, just don’t get the chance, I’m too fat.” “I don’t like walking or running its boring, just never do it.” “I like doing sports, because I’m having fun with friends.”  Potential of extended schools and PESSCL? “I would get laughed at it I turned up for an afterschool sports club, they are not for kids like me” “After I lost weight and got fitter I felt more like joining in PE and clubs”

Broadcast

Carnegie Curriculum Behaviour Change Theory & Tools

Carnegie Weight Management InterventionsPreventionPractice based Research Broadcast Consultancy Web Community clubs Training Web Community camps Web Residential Camps- schools Web Research evidence No Evidence 1% ↓ BMI SDS 6m4 % ↓ BMI SDS10% ↓ BMI SDS 1-3 yr Costs ratio ? UK n= (SDS)8.5m (<1.04)4.5m (>1.04)2.7m (>1.69)691k (>2.5)140K (>3.0)

Skill based exercise *** *** P<0.001 pre to post ***

Self Perception Profile for Children (SPPC) ** Source: Walker et al. (2002) ** (P<0.01)

Long term results of residential programme

Community club outcomes Change ChildrenParents Body mass (kg) BMI (kg.m -2 ) BMI SDS NA Waist (cm) % Body fat Fitness (l.min -1 )

Impact of obesity interventions on participants 1 Very little published evidence on the effectiveness of whole-school obesity interventions in the UK. What exists is not overwhelmingly positive Surgery Drugs (e.g. Sibutramine, Orlistat) Whole School Approach¹ PreventionCWM Reduces BMI z-score ?x Increases fitness xx?? Improves self-esteem xx?? Improves family relationships xx?? Builds capacity within communities xx ?

Comparative attributes of obesity interventions Surgery Drugs (e.g. Sibutramine, Orlistat) Whole School Approach PreventionCMW Positive experience xxxx Scalable x Evidence-based xx Failure rateLow Medium n/a ? Low Health riskHighMediumLow Cost of intervention (£/person) £5,665 £444 & £386 (9 months) No UK data ? Varies Sustainability of weight loss HighLow xx High

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