Question

topic: Obesity Explain why this topic interests you. Provide a brief background of the topic and speculate on arguments you could pose or problems you could solve. Additionally, draft a potential problem statement. Pose ideas and solicit feedback from your peers on your ideas.

In your responses, provide your peers with constructive criticism. Identify topics that might seem too broad or too narrow in focus. Identify possible challenges and offer ideas and solutions for improvement.

Answer 1

Obesity is a common and preventable disease of clinical and public health importance. It is often a major risk factor for the development of several non-communicable diseases, significant disability and premature death. There is presently a global epidemic of obesity in all age groups and in both developed and developing countries. The increasing prevalence of obesity places a large burden on health care use and costs. Weight loss is associated with significant health and economic benefits. Effective weight loss strategies include dietary therapy, physical activity and lifestyle modification. Drug therapy is reserved for obese or overweight patients who have concomitant obesity-related risk factors or diseases. Population-wide prevention programmes have a greater potential of stemming the obesity epidemic and being more cost-effective than clinic-based weight-loss programmes. Ghana is going through an economic and nutrition transition and experiencing an increase in the prevalence of obesity and obesity-related illnesses, especially among women and urban dwellers. A national taskforce to address this epidemic and to draw up a national policy on related non-communicable diseases is urgently needed.

Keywords: Obesity, Overweight, Type 2 Diabetes Mellitus, Hypertension, Cardiovascular Disease, Non-communicable Disease

Introdcution

Obesity is a common but often underestimated condition of clinical and public health importance in many countries around the world. Its general acceptance by many societies as a sign of well-being or a symbol of high social status, and the denial by health care professionals and the public alike that it is a disease in its own right, have contributed to its improper identification and management and the lack of effective public health strategies to combat its rise to epidemic proportions.

Obesity is defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired¹. The amount of excess fat in absolute terms, and its distribution in the body - either around the waist and trunk (abdominal, central or android obesity) or peripherally around the body (gynoid obesity) - have important health implications.

In general, obesity is associated with a greater risk of disability or premature death due to type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) such as hypertension, stroke and coronary heart disease as well as gall bladder disease, certain cancers (endometrial, breast, prostate, colon) and non-fatal conditions including gout, respiratory conditions, gastro-esophageal reflux disease, osteoarthritis and infertility. Obesity also carries serious implications for psychosocial health, mainly due to societal prejudice against fatness.

A central distribution of body fat is associated with a higher risk of morbidity and mortality than a more peripheral distribution². Furthermore, individuals with CVD risk factors such as T2DM, hypertension and smoking are exposed to significant health risks at lower levels of obesity. It is therefore imperative to assess individuals who are overweight or obese not only to determine the extent of adiposity, but also for the body fat distribution and the presence of co-morbid factors.

The body mass index (BMI) is a simple and commonly used parameter for classifying various degrees of adiposity. It is derived from the weight of the individual in kilograms divided by the square of the height in metres (kg/m²). By the current World Health Organisation (WHO) criteria, a BMI <18.5kg/m² is considered underweight, 18.5–24.9 kg/m² ideal weight and 25–29.9kg/m² overweight or pre-obese. The obese category is sub-divided into obese class I (30–34.9kg/m²), obese class II (35–39.9kg/m²) and obese class III (≥40kg/m²)³. A BMI greater than 28kg/m² in adults is associated with a three to four-fold greater risk of morbidity due to T2DM and CVDs than in the general population⁴.

Measurement of the waist circumference - measured at the midpoint between the lower border of the rib cage and the iliac crest^5,6, or the waist:hip ratio (WHR)⁵ provide useful indices of abdominal fat accumulation and a better correlation with an increased risk of ill health and mortality than BMI alone². An abdominal girth in excess of 108 cm (40 inches) for men and 98 cm (35 inches) for women or a WHR > 1.0 and 0.85 in men and women, respectively, are the currently accepted indicators of excessive abdominal fat accumulation which correlate with a substantially increased risk of metabolic complications^{3, 5}.

Despite certain limitations with its use, there is general agreement with the applicability of BMI measurements for assessing underweight, overweight and obesity in adults. The case for children and adolescents is, however, different because unlike adults, BMI changes significantly with age during these stages of growth. In the late 1970's WHO recommended the use of a growth reference for young children developed by the United States National Centre for Health Statistics⁷. The data from which this reference was derived is now old and, based on children from only the USA, cannot realistically be applied to all populations worldwide. The WHO has recently replaced this reference with a new one which draws data from a community-based, multi-country study of infants and young children from birth to 6 years in all of the world's major regions, including developed and developing countries. Ghana was one of the six participating countries in the new study⁸. What is now awaited is a similar international growth reference for older children and adolescents. Until then, age and gender specific BMI charts derived from data sets from six different reference populations (Brazil, Great Britain, Hong Kong, the Netherlands, Singapore and the USA)⁹ could be used.