World report on obesity: Prevention

by Frances M. Berg, MS

  "Obesity: Preventing and Managing the Global Epidemic," the 267-page report published in 1998 by the World Health Organization (WHO), reviews current information on obesity and offers recommendations for developing public health policies to deal with what is emerging as a global health problem.1
   The report grew out of a 3-day consultation conference by the International Obesity Task Force bringing together specialists from various countries. Labeling obesity as a chronic "disease" and an escalating "global epidemic," the WHO report emphasizes that obesity is increasing at an alarming rate in both developed and developing countries, and is responsible for increased health and economic costs throughout the world. The global projections for the next decade are considered so serious that action to develop new preventive public health strategies is urgently required.
   Prevention is the main focus of the WHO report. The background information on measurement, related health risks, and economic costs is similar to that of the National Institutes of Health (NIH) Clinical Guidelines on Obesity2 and cites many of the same specialists and sources.
   However, it focuses on addressing the risks of obesity rather than overweight. It suggests that the emphasis for people in the overweight category (BMI of 25-29.9) should be on prevention of weight gain rather than on weight loss.
   The increases seen in most countries are blamed on environmental and behavioral changes, primarily sedentary lifestyles due to a decrease in spontaneous and work-related physical activity, and over-consumption of high-fat, energy-dense foods. An increase is noted in the intake of more fats from plant sources.
   The WHO report takes a more objective approach in evaluating the various weight loss treatments than do the NIH guidelines. Instead of blanket approval, it emphasizes the poor long-term efficacy, high dropout rates, and weight cycling, typical of these programs. It also discusses the need to control the promotion of dangerous and deceptive weight loss aids, miracle cures, and certain drugs and treatments.

Preventative policies
   Effective prevention will require structural changes in societies, says the report. Communities, governments, the media, and the food industry need to work together to modify the environment so that it is less conducive to weight gain. Such partnerships are required to ensure that effective and sustainable changes in diet and everyday levels of physical activity can be achieved throughout the community. This approach encourages obesity prevention strategies that harmonize with existing public health policies and programs.
   The WHO report emphasizes the need to begin preventing overweight and obesity early in life, saying it should involve balanced diets of lower energy density, increased levels of physical activity, and reductions in sedentary behavior.
   Prevention programs are recommended at three levels:

1. Universal public health prevention programs directed at eveyone in the population.
2. Selective prevention directed at subgroups with more risk of developing obesity.
3. Targeted prevention directed at high-risk individuals with existing weight problems but who are not yet obese.

   Frances M. Berg, MS, a licensed nutritionist and adjunct professor at the University of North Dakota School of Medicine, is the editor of Healthy Weight Journal. She is the author of 10 books including the recently published Women Afraid to Eat: Breaking Free in Today's Weight-Obsessed World.
 

References
1.  Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: World Health Organization, 1998. 
2.  National Institutes of Health, National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults -- the evidence report. Obes Res 1998; 6 Suppl 2.