Front Cover 1
Public Health Mini-Guide: Obesity 4
Copyright 5
Contents 6
Series Info 7
Series preface 8
What the Public Health Mini-Guides provide 8
References 9
Preface 10
Chapter 1: Defining the obesity problem 12
What is obesity? 12
Measuring obesity 12
Surveillance programmes 12
Measurement of obesity 14
Common measures of obesity 14
Body Mass Index (BMI) 14
Weaknesses and strengths of BMI 15
Other height to weight indices 16
Abdominal circumference measurements 16
Weaknesses and strengths of abdominal circumference measures 18
Skinfold estimation methods 19
Weaknesses and strengths of skinfold estimation methods 19
Bio Impedance Analysis 20
Weaknesses and strengths of Bio Impedance Analysis 20
Technical measures of obesity 22
Body density measurements 22
Weaknesses and strengths of body density measures 22
Chemical measures 23
Weaknesses and strengths of chemical measures 23
Internal scanning 23
Weaknesses and strengths of internal scans 24
Body imaging 24
Weaknesses and strengths of imaging 25
Classifying obesity in children 26
1. British 1990 growth reference (UK90) 27
2. International Obesity Task Force (IOTF) cut-offs 27
3. World Health Organization (WHO) Child Growth Standard 28
4. World Health Organization (WHO) 2007 growth reference 28
United States Centers for Disease Control and Prevention (CDC) 2000 growth reference 29
Adiposity rebound 29
Web pages and resources 31
Further reading 31
Chapter 2: Obesity prevalence and trends 33
UK and Ireland prevalence figures 33
England 33
Adult prevalence 33
Child prevalence 33
Scotland 35
Adult prevalence 35
Child prevalence 35
Wales 35
Adult prevalence 35
Child prevalence 35
Northern Ireland 35
Adult prevalence 35
Child prevalence 35
Ireland 36
Adult prevalence 36
Child prevalence 36
Access to UK data on obesity 37
North America 37
United States of America 37
Adult prevalence 37
Child prevalence 38
Canada 38
Adult prevalence 38
Child prevalence 38
Australasia 38
Australia 38
Adult prevalence 38
Child prevalence 39
New Zealand 39
Adult prevalence 39
Child prevalence 39
International prevalence of obesity 40
WHO Global Health Observatory (apps.who.int/ghodata) 40
Details 40
WHO Global Infobase ( https://apps.who.int/infobase/Comparisons.aspx) 41
Details 41
WHO Global database on body mass index (http://apps.who.int/bmi) 41
Details 41
OECD StatExtracts – Health Stats (www.oecd.org) 42
Details 42
IASO Obesity Data (www.iaso.org) 42
Details 42
Adult international prevalence 42
Child international prevalence 44
Adult international trends 45
Predicting future trends 48
Prevalence within countries 50
Sex 50
Age 50
Ethnicity 51
Deprivation 53
Regions 56
Web pages and resources 58
Further reading 58
Chapter 3: The health consequences of obesity 59
Difficulties evaluating the health consequences of obesity 59
Fat as an active tissue 60
Abdominal fat 60
Types of ill health associated with obesity 61
Circulatory system 61
Hypertension 61
Elevated cholesterol 62
CVDs 62
Cancer 63
Metabolic 64
Diabetes 64
Metabolic syndrome 64
Gastrointestinal and liver 65
Gallstones 65
Pancreatitis 66
Gastroesophageal reflux disease (GERD) 66
Non-alcoholic liver disease 67
Musculoskeletal 67
Joint pain 67
Osteoarthritis 68
Gout 68
Other musculoskeletal conditions 68
Respiratory system 68
Respiratory function 68
Obstructive sleep apnoea 69
Asthma 69
Other respiratory conditions 69
Reproductive health 69
Polycystic ovary syndrome 69
Female fertility 69
Male fertility 70
Erectile dysfunction 70
Contraceptive failure 70
Pregnancy 70
Urology 71
Urinary incontinence 71
Benign prostatic hyperplasia 71
Kidney stones 71
Chronic kidney disease 71
Psychological and social difficulties 71
Stigmatisation 71
Depression 72
Dementia 72
Dermatology 72
Skin infections 72
Acanthosis nigricans 72
Psoriasis 72
Pressure sores 73
Stretch marks 73
Differences in risk between ethnic group 73
Children and adolescents 74
Mortality 74
Societal impact of obesity 75
Economic impact of obesity 75
Web pages and resources 77
Further reading 77
Chapter 4: Causes of obesity 78
Energy balance 78
Energy intake 78
Regulation of energy intake 79
Energy expenditure 80
Influences on obesity 81
Individual influences on obesity 82
Biological/genes 82
Sex 82
Age 83
Socioeconomic status 84
Ethnicity 85
Intrapersonal 86
Interpersonal 87
Environmental factors 88
Microenvironmental 89
Macroenvironmental 90
Economic development 90
Food taxes 90
Urban design 91
Food industry 92
Web pages and resources 93
Further reading 93
Chapter 5: Individual interventions to treat obesity 95
Consultation 95
1. Screening to identify risk and willingness to change 96
2. Counselling to provide information and increase motivation 97
3. Referral for those at high risk to intervention 98
4. Follow-up to track progress and overcome barriers 98
Adult interventions 98
Non-clinical interventions targeting obesity 99
Diet 99
Reduced-energy diet (RED) 101
Low-energy diet (LED) 101
Very-low-energy diets (VLED) 101
Fixed-energy-deficit (FED) 101
Physical activity 101
Behavioural 102
Child interventions 103
Drug therapy 105
Anti-obesity drugs 106
Lipase inhibitors 107
Appetite suppressants 108
Surgical intervention 108
Web pages and resources 113
Further reading 113
Chapter 6: Population approaches to preventing obesity 114
Population approach 114
Targeting, development and monitoring 115
Targeting 115
Development 116
Monitoring 116
Multifactorial approach 117
Policy 117
Information 119
Fiscal intervention 120
Legislation 121
Stakeholders 122
National government 122
Local government 122
Health and social services 123
International agencies 123
Private sector 123
Media 124
Other stakeholders 124
Settings 124
Schools 124
Work place 125
Communities 125
Web pages and resources 128
Further reading 128
References 130
Chapter 1 130
Chapter 2 132
Chapter 3 133
Chapter 4 134
Chapter 5 136
Chapter 6 137
Index 140
References 148
Chapter 1 148
Chapter 2 154
Chapter 3 157
Chapter 4 165
Chapter 5 176
Chapter 6 182