Obesity

There is currently an epidemic of childhood obesity in the USA. Data from the National Health and Nutrition Evaluation Surveys from 1963-65 until the present, show that obesity has increased three- to fourfold, so that now 16% of American children are obese (as assessed by body mass index (BMI) greater than the 95th percentile for age and gender) and a third are above the mark to be considered overweight (greater than the 85th percentile). This has fuelled an epidemic of type 2 diabetes in young people.

Obesity, currently a worldwide epidemic, is associated with a number of conditions, including coronary artery disease, lipid abnormalities, gallstones, cancer and type 2  diabetes, obstructive sleep apnoea, and obesity hypoventilation. Recently, studies have shown that asthma may also be associated with, and perhaps worsened by, obesity. Ongoing research suggests that type 2 diabetes and asthma may be linked to obesity through chronic systemic inflammation.

Most developed countries and a growing number of low- to middle-income countries have seen an increase in the prevalence of overweight and obesity, and the trend is accelerating. Obesity represents a major public health issue in women due to its association with increased insensitivity to insulin, negative implications for reproductive health, including polycystic ovary syndrome and infertility, higher obstetric risks, gestational diabetes, type 2 diabetes, and cardiovascular disease.

Calabar is the capital city of Cross River State of Nigeria. It is a cosmopolitan town with a population of about half a million people. The population of Cross River State stands at around 2.5 million. Inhabitants of the region are mostly farmers, fishermen and civil servants. The Efik in south Calabar are a proud people with a rich cultural heritage. In Efik communities, the preservation of centuries-old values and customs is central to the tradition of ‘fattening rooms’.

Obesity has become a pandemic, affecting adults and children around the world.  Considerable medical, scientific and lifestyle-related knowledge and resources are being channelled into the identification of strategies to combat this major public health problem. Despite these multidisciplinary efforts, however, little attention has been paid to the damaging social and psychological consequences of obesity.

Despite a fall in diabetes prevalence from around 35% in 1975 to 16% in 2004, obesity and non-communicable diseases, including type 2 diabetes, remain the primary threat to health and well-being confronting Nauru in the 21st century. Nauru has few natural resources and, with a population of only 10,000, does not have the critical mass to support manufacturing. Nor, with a tiny land mass of 21 km² and unfavourable topography and soil conditions, can it support farming.

Over recent decades, there has been a worldwide increase in the number of people with obesity – currently around 300 million according to the International Obesity Task Force – and there are no signs of a slow-down. Furthermore, rates of overweight and obesity in adults and children are rising dramatically in developing countries. A large and growing body of evidence points to the transformation of lifestyles worldwide – over-consumption of energy-dense food and decreased physical activity – as the driving force behind this pandemic.

Aged 42 years, ‘S’, friend and colleague of the author, weighed 204 kg. Now, three years later, after undergoing intensive dieting and psychotherapy, she has lost nearly 10% of her body weight. But she remains 38 BMI units over and above the 30 kg/m threshold for the ‘obese’ category; she is in the range of ‘morbid obesity’. In a few weeks she will undergo dramatic abdominal surgery for this condition. Rhys Williams tells her story.

In many cases, overweight and obesity in children constitute a grim warning for future health: if no action is taken, an overweight or obese child is likely to grow into an overweight or obese adult with a series of chronic health problems – among them, type 2 diabetes. Indeed, obesity-related health conditions, including the metabolic syndrome – a strong risk factor for cardiovascular diseases – are increasingly prevalent among children around the world.

A culturally sensitive, intensive diabetes education service is being delivered in the community to people of ethnic-minority origin living with type 2 diabetes in Lothian, Scotland. Designed by a pharmacist, the initiative began as a research project, but the effectiveness and popularity of the programme resulted in its development and implementation as part of the local diabetes care package.