The solutions to obesity, diabetes and their many associated problems can only come from ourselves!

Obesity is defined by WHO ‘as abnormal or excessive fat accumulation that presents a risk to health’ (WHO 2017). Several parameters have been proposed as means of defining, grading levels of and communicating obesity and its severity.  In this article the body mass index (BMI) will be used to define and grade obesity.  The BMI is calculated by the following relatively straight forward formula:

BMI = (Weight in kilograms) ÷ {Height (in metres)}²  (Evidence for BMI as good for now)Ref

Other anthropometric parameters used and have been shown to be as effective as BMI include, waist circumference (WC), Hip to waist (circumference) ratio.  In a large Japanese study the level of adiposity as measure by the dexa scan was use as a measure of obesity.

While there are variations in the actual quantitative definition of obesity, a field of ongoing study, ‘the BMI is a good indicator of overall adiposity’, Hu F. (2008) as quoted by Whitlock G et al (2009).  The BMI is the most widely studied parameter in terms of its correlation with ‘risk to health’ and is currently accepted and used by major international bodies involved in developing evidence based clinical practice guidelines for the management of obesity and obesity related co-morbidities.

Whitlock G et al (2009), in a large study published in Lancet, showed strong evidence that:

BMI is in itself a strong predictor of overall mortality both above and below the   apparent optimum of about 22·5–25 kg/m². The progressive excess mortality      above this range was due mainly to vascular disease and is probably largely causal.           At 30–35 kg/m², median survival is reduced by 2–4 years; at 40–45 kg/m², it is      reduced by 8–10 years (which is comparable with the effects of smoking) 

Overweight and obesity according to the World Health Organisation (W.H.O.): are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. This form of malnutrition (over nutrition) was once considered a problem only in high income countries, however today is dramatically on the rise in low- and middle-income countries, particularly in urban settings. (WHO 2017)

Like many other low to middle income countries the dramatic rise in the prevalence of obesity, seen in Port Moresby and other urban centres in PNG has been brought about by two fundamental changes in society. Firstly, the rapid shift from a traditional, more physically active lifestyle to one that is in general comparably sedentary and secondly, this change in the general level of physical activity in the population has been coupled with a parallel shift in the average diet from a traditional one that is composed of high fibre, unprocessed, low glycaemic foods to one with more processed foods, lower in fibre and higher in saturated fats (mainly animal derived fats).

Modernity and how we are developing is truly a double edged sword, a sword that may be cutting deeper in a way that is detrimental to society rather than in a way that is improving society.  The costs of dealing with obesity and its associated problems is huge, both financially and emotional to the individual, families and the country as a whole. For example the numbers of people turning up to our ill-equipped hospitals with heart attacks, strokes and as a result of acute and chronic complications of obesity and diabetes has risen and will continue to rise in parallel to the rise in obesity. There are not too many people reading this that has not had their lives affected by an obesity or diabetes related condition.  As a young country we have lost and will continue to lose many precious citizens many years before their time.

The situation is grim; there is no rosier way of putting it.  The best way to stem this disastrous trend lies firstly in accepting this grimness, and then coming to terms with the fact that the solutions can only come from us. By putting in place strategies that are simple, immediately doable at an individual and community level yet so fundamental in nature it will encourage a shift towards a much healthier lifestyle on a societal level.

 

  1. WHO (2017), Obesity, available at http://www.who.int/topics/obesity/en/, accessed: 13/01/17

 

  1. Whitlock G, Lewington S, Sherlike P – Prospective Studies Collaboration (2009), ‘Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies’ Lancet, 373: 1083–96 

About Dr. Poyap J Rooney

Dr. Rooney is a medical doctor who has gained both his undergraduate medical degree and more recently his post graduate masters degree in clinical biochemistry at the University of Papua New Guinea.
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