How can we overcome Australia’s obesity epidemic?

Rates of obesity have reached epidemic proportions in Australia and other developed nations. Obesity remains a serious health issue due to its various co-morbidities including type 2 diabetes, hypertension, dyslipidaemia, orthopaedic problems and obstructive sleep apnoea. Treatment is therefore essential and long-term public health measures are required to address this issue. In the individual obese patient, a multidisciplinary and integrative treatment approach should be used which may include lifestyle changes, behaviour therapy, pharmacotherapies and surgical techniques.

Obesity is broadly defined as an excess of body fat or more precisely as a body mass index (BMI) greater than 30. Obesity should be considered as a chronic disease given its associated cardiovascular, metabolic and physical morbidities.

Rates of obesity have risen dramatically in recent decades. Current statistics suggest that over 70% of Australian males and over 50% of Australian females are overweight or obese. More alarming is the rates of obesity in children with 20-25% of children and adolescents now meeting classifications for overweight or obese. Unfortunately Australia is now classified as one of the fattest developed nations in the world.

Several factors have contributed to Australia’s obesity epidemic and controlling the rise of obesity remains an ongoing public health challenge. Increasingly sedentary lifestyles (with less need for physical activity) and easy accessibility and affordability of palatable, high fat foods have been important contributing factors.

Fortunately various management options are available for individual patients suffering from obesity. Lifestyle changes however remain the mainstay of treatment. All weight loss programs should include a healthy, nutritious and applicable dietary program that promotes lifelong changes in eating behaviours. In addition, all patients should be encouraged to increase their physical activity to promote energy expenditure and maintenance of weight loss. Patients should aim for moderate intensity exercise (appropriate to their level of fitness) for 30 minutes at least 3-5 times per week.

Increased levels of obesity have heightened interest in more specific obesity treatments such as pharmacological therapies and surgical procedures. These treatments are generally reserved for patients with more severe levels of obesity and associated health conditions. Sibutramine and Orlistat are currently marketed weight loss drugs in Australia which can cause losses of up to 10% of body weight. However, their role remains limited given the lack of long term efficacy data, potential for abuse and significant side effects. Surgical options (in particular laparoscopic gastric banding) offer some hope for the morbidly obese who have failed other therapies. Furthermore, surgery is the only treatment shown to produce significant and sustained weight loss in these patients.

Regardless of the treatment option, patients must be well educated and extremely dedicated to achieve successful weight loss. Studies have proven that even modest reductions in excess weight lead to marked improvements in patient’s health and significant reductions in co-morbidities. Therefore you should set realistic goals with your patients and be encouraging and supportive during their weight loss battle.

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References:

1. Obesity Treatment, Virtual Medical Centre, 2007. Available [online] at URL: /lifestyles/nutrition/an-introduction-to-obesity-treatments/
2. Proietto J, Baur L. Management of obesity, MJA 2004; 180 (9): 474-480.