-
.
- Ελληνικά
In the last forty years, the problem of obesity on the planet has tripled in size. In 2016, 1.6 billion adults worldwide were overweight and 650 million were obese. In Greece the phenomenon is particularly pronounced - our country is the EU leader in childhood obesity, and among the leaders in adult obesity. 63% of Greeks over the age of 18 are overweight or obese. What are the consequences of this phenomenon for our health, society and economy? What are its causes? And what could be some possible solutions? DiANEOSIS commissioned a research team under the coordination of Professor Yannis Maniou from Harokopio University to conduct a study that maps the problem in its true dimensions, and proposes a series of actions in schools and primary health structures to address it.
You can read the entire study here. Below we summarise some of its key elements.
1. What is obesity?
Obesity is defined as an increased accumulation of body fat in the human body that can negatively affect health. It was recognized as a disease about half a century ago and is now one of the most important chronic health problems worldwide. Consider this: now in our world more people die from causes related to increased body weight than from causes related to starvation.
Essentially, obesity is caused by a positive balance: the body's energy balance. Every day each and every one of us introduces energy into our bodies through food. At the same time, every day we consume energy through physical exercise, activity and by maintaining the vital functions of the body - staying alive, that is. If the energy we input is more than we consume, this energy is stored in the body as fat. If this is done systematically, fat accumulates, and our body weight increases. People who have accumulated fat above a threshold in their body are counted as overweight. People who have accumulated more than another, upper limit are considered obese. Although the phenomenon is usually referred to as "obesity", many of the problems and diseases mentioned below are generally related to people who have more accumulated body fat than normal - thus, as a rule, overweight people.
Whether a person is obese, overweight or not is determined by measuring their body fat. However, because this is a difficult procedure that requires specialised equipment, the "Body Mass Index" (known by the English acronym "BMI"), which measures body weight in relation to height, thus indirectly assessing the accumulation of fat in the body, is generally used for this task. BMI is calculated by dividing body weight in kilograms by the square of height in meters.
For example, a person who is 1.75 meters tall and weighs 70 kilograms has a BMI of 22.9. As can be seen for the table below, which relates mainly to European/Caucasian adult bodies, people with a BMI over 25 are counted as overweight and people with a BMI over 30 are counted as obese (for people of other ethnic origins the thresholds are slightly different). You can calculate your BMI now, and see which category you fall into.
Other scales are used to measure juvenile obesity, which also vary according to age and gender. These can be found in detail in Appendix 1.1 of the study (p. 189).
Of course, it is worth mentioning that other measures besides BMI are used to assess obesity, such as waist circumference. High values on such measures may indicate a risk of chronic disease even in people who do not have an elevated BMI.
2. Why is obesity a problem?
Obesity is associated with a number of cardiac and metabolic disorders, which can develop into chronic diseases, such as type 2 diabetes mellitus (DM2 - 80-85% of DM2 in humans is attributed to obesity) cardiovascular diseases, some cancers, osteoarthritis, cholelithiasis (gallstones, that is) and severe sleep disturbances. For every 5-point increase in BMI, the risk of coronary heart disease increases by 27% and the risk of stroke by 18%. Obesity also has an impact on mental health, a social impact and a financial cost (particularly to the health system). In children it is associated with iron deficiency and hypovitaminosis D which can negatively affect their cognitive, musculoskeletal and physical development. And, of course, children who are obese are more likely to become obese adults.
But why does the accumulation of fat in the body cause such serious diseases? The cause lies in the fat itself and the increase in the size of fat cells in the body. It is worth saying a few words about what this means. In our body we have adipose tissue, a loose connective tissue made up of fat cells, and it is extremely important for the functioning of the body. This is where the body's energy is stored in the form of fat, but in addition it also helps to mechanically support and protect the bones and organs, as well as insulate the body from heat. However, when the amount of fat in the body increases greatly, in addition to causing a constant, low-intensity inflammation, the physiological secretion of a number of substances secreted by fat cells increases, which in large concentrations can cause damage to the arteries, heart, liver, muscles and pancreas. These damages disrupt, for example, the regulation of blood sugar levels (i.e. the effective functioning of insulin, which is secreted by the pancreas). At the same time, increased body mass causes an increase in blood volume but also systemically higher blood pressure. Consider that compared to normal weight people, overweight people have a 52% greater risk of developing hypertension - and obese people have a nearly 100% greater risk.
Fat gain also triggers a number of other biochemical processes, from increasing the level of certain hormones to disrupting the transport of cholesterol from the liver to the gut (a disorder that can create gallstones) and a number of other disorders, from fat accumulation in the throat that can cause problems with respiratory function during sleep, to pressure on the musculoskeletal system and joints. And fat cells bind vitamin D, which is fat-soluble. Obese people, as they have increased body fat, often have a lower concentration of vitamin D in the blood. Among other consequences of this phenomenon, research has shown that people with vitamin D deficiency are more likely to develop severe disease or death if they become ill with Covid-19.
And in children, in addition to the potential health effects of obesity before adulthood (from increased chances of respiratory or orthopedic problems, to menstrual disorders), but also the increased likelihood of developing from childhood or adolescence pathological conditions that normally occur in adulthood (diabetes mellitus, hypertension - about half of school-age children with obesity have particularly elevated blood pressure levels), there are others: overweight children appear to perform less well at school and are absent from lessons more often and for longer periods of time. And, of course, 70-80% of obese adolescents remain obese as adults.
The social and economic consequences of obesity cannot be ignored. Prejudices in societies often lead to social stigma and discrimination against obese people which, as studies have shown, contribute to anxiety and depression. According to OECD data from 2019, obesity accounts for 9% of annual health expenditure in Greece. According to the same study, the annual GDP in Greece in the period 2020-2050 will be 3% lower than it would be in the absence of the economic consequences of obesity.
3. How big is the problem in Greece?
As we said at the beginning, more than half of all adults in Greece are obese or overweight. According to WHO data from 2019, 37.9% of Greek adults are overweight and 24.9% are obese. 44% of Greeks and 30.8% of Greek women are overweight, while both sexes have equal rates of obesity: one in four Greeks and one in four Greek women fall into this category.
It is also interesting that in three quarters of Greek families at least one of the two parents is overweight or obese. In one in four, both parents are (data from graph 6 p. 47)
At the same time, children in Greece have the highest rates of obesity in Europe. The percentage of children aged 4-6 years old who are obese or overweight is 20.6%. In children aged 6-10 it rises to 38.5% and in children aged 10-12 it reaches 41.2%.
Overweight and obesity rates in children appear to be higher in rural and rural areas than in cities. But disparities also appear within cities: only 2.7% of children in Chalandri are obese; in Keratsini the figure is 20.3%. However, the rates of overweight children are similar almost everywhere - about one in three children in most areas of Greece are overweight. At very young ages, girls are more often overweight or obese than boys, but then the rates equalize until adolescence, when boys also become more likely to be obese.
4. What is the cause of obesity in our society?
As we said at the beginning, obesity is caused by the body's positive energy balance - that is, we put more energy into the body through food than we consume, which results in it accumulating as fat. However, there are various social, environmental and genetic factors that make the risk of developing this imbalance greater. Some of them occur even from the very early stages of life - even before birth. Before looking at these factors in detail, it is worth emphasising that their effect on the phenomenon is combined. The issue of obesity is complex and socially sensitive, and often blaming its occurrence at the level of personal choices or even at the level of the family is simplistic and unfair. You will read below, for example, that the chances of a child being obese are increased if their mother smoked during pregnancy, or if they gain weight too quickly after birth. Or, even that children who are mainly cared for by their grandparents are more likely to be overweight or obese than those who are mainly cared for by their parents. Or that 3 out of 4 Greek adults eat less fruit and vegetables than the recommended amounts. None of these factors are unique and do not lend themselves to easy blame. Rather, they only work in combination with each other and with the other conditions that define the life and environment of modern man. Indeed, some of the most critical ones are little known and rarely mentioned in public discourse related to obesity, such as neighborhood safety, how many homes have yards, the quality of sidewalks, easy access to exercise facilities, or a family's economic comfort. Here are some of the most important factors influencing the phenomenon, which are discussed in the study.
The most well-known factors have, of course, to do with the lifestyles of children and adults. How much and what kind of food we eat, whether we play sports or exercise, and how much time we spend in "sedentary" activities have a dramatic effect on the likelihood of weight gain, regardless of other factors. Recommendations for a proper energy balance for adults are in Table 5 (p. 117 of the study). These are things that some people take for granted but, as it turns out, for many people they are not. According to one of the surveys that collected much of the data presented in the study, only 8% of Greeks know the recommendations for proper nutrition, and only 35.2% know the recommendations for physical activity (numbers well below other European countries).
As mentioned, in our country only 25% of adults consume fruits and vegetables in the amounts recommended. This percentage may be small, but various studies have documented that the eating habits of Greeks are not much worse than those of other nations with much lower rates of obesity. Or perhaps the crucial difference is this: 68% of Greek adults do not exercise at all and do not participate in any sport - the highest proportion in the European Union. And Greeks spend more than three hours a day in front of screens outside work - more than people in 15 other European countries. And, of course, there are other important aggravating factors, from the social environment and the neighbourhood in which one lives, to one's economic situation, available leisure time and sleep duration. Some of these may also explain why Greeks do not exercise enough: in a recent survey question, the percentage of Greeks who said they do not exercise because their neighbourhood "does not have the right infrastructure", "does not have good aesthetics" or "is not safe" was twice as high as in other European countries.
But what about children? The table below shows the recommendations for the diet and activity of children of different ages.
It seems that only a small percentage of families in Greece follow these rules. All relevant research has documented that a lifestyle pattern of higher consumption of energy-dense and high-fat foods (sweets, sugary drinks, snacks), lower fruit consumption, low levels of physical activity, shorter sleep duration and sedentary time (TV and other screens) is more common in obese children - which, of course, is also true in other countries. In addition, the social environment of children plays a very important role. The educational level of parents, the type of food available at home, influences from the educational environment and from peers (especially in adolescence), exposure to media advertising, access to sports facilities or sports equipment, proximity to open play and sports areas, the type of food shops in the neighbourhood and the role of other people who contribute to the care of children (grandparents) are all extremely important factors. As mentioned above, according to a 2010 study (Moschonis et al., 2011), children who are mainly cared for by grandparents are 53% more likely to become overweight or obese than those who are mainly cared for by parents. And, of course, there are more direct correlations. As you might expect, parental obesity increases the likelihood of children becoming obese as well. Interestingly, however, 22.3% of children with normal-weight parents are obese or overweight - a much higher proportion than we find in similar surveys in other countries (only 6.5% in Belgium & Finland, say).
A serious but little-known problem, however, is the underestimation of children's weight by their parents. 88% of parents with preschool children who are overweight and 55.8% of parents with children who are obese consider their child to be of normal body weight. This is certainly not only a Greek characteristic - it is often found in other countries as well.
But these are not the only factors that influence whether a child will become overweight or obese. There are others that act from much, much earlier. As has been documented by many studies, factors such as excessive maternal body weight before pregnancy, excessive maternal weight gain during pregnancy and maternal smoking during pregnancy (active or passive) play a very important role in the later development of the child. A child is 2.6 times more likely to become obese if the mother is obese before pregnancy. 35% of Greek mothers increase their weight excessively during pregnancy - their children are twice as likely to develop obesity as others.
11.5% of Greek mothers report that they smoked during their pregnancy. According to the Feel4Diabetes survey, children born to mothers who smoked during pregnancy are 2.6 times more likely to become obese. This association is documented even for passive smoking.
And after birth, there are other factors that influence whether a child becomes overweight or obese. Babies born at a higher than normal weight are 1.8 times more likely to become obese as children. Around 10% of Greek mothers exclusively breastfeed for the first six months - children who are fed this way during this time are 2 times less likely to become obese than the rest. In addition, children who increase their body weight too quickly in the first two years of life - more than 1 in 3 children in Greece belong to this category - are four times more likely to develop obesity in later stages.
All these "perinatal" factors work in combination. None on its own determines decisively what will happen in a child's future, but together they shape an environment in which a child's chances of becoming obese increase or decrease depending on what happens during pregnancy and the first months of life. The transNEOSIS research writing team previously created an index that accounts for the impact of these factors, which is described in detail in chapter 2 of the study (p. 80).
As with the other factors, although the role of perinatal factors is important, it is not the only one, and therefore blaming mothers or parents (or grandmothers, or grandparents) by isolating each of these factors separately is ineffective and unfair. All the later stages of a person's life, most critically adolescence and the period after adulthood, also affect the phenomenon in complex and complementary ways.
It is also worth keeping these facts in mind.
- 70% of obese adolescents are still obese after the age of 30.
But, at the same time,
- 70% of obese adults were not obese as children.
5. What does the study suggest?
Given that the problem of obesity is caused by so many, complementary factors, many of which are linked to the lifestyle and personal choices of families facing different and sometimes very difficult situations and challenges, a general and across-the-board solution to the issue would be a very difficult task.
However, attempts have been made. Since the 1970s, various obesity awareness and prevention programmes have been implemented in various countries around the world, including awareness-raising activities for children and parents and various forms of interventions in schools and families, some of which have had measurable and significant results. A detailed presentation of such programs for children and adults ( named "Know Your Body", "CATCH", "ToyBox", "Feel4Diabetes", "Finnish Diabetes Prevention Study" and "North Karelia" - the last one of the famous Finnish policy experiments we recorded in that survey is in Part 3 of the study, along with an analysis explaining why the successful programs are successful (p. 159).
The researchers, taking into account all that has gone before (with emphasis on the ToyBox and Feel4Diabetes programmes designed and implemented by the same research team), conclude with the proposal to implement a proposed action plan with two strands: on the one hand, the design and implementation of intervention programmes in schools to promote healthy eating and increase physical activity for children and their families, and on the other hand, the design and implementation of a process for easy and early identification of
The proposed action plan consists of recording the development and health indicators of children, adolescents and their parents through the already institutionalised medical examination of children for the completion of the Pupil's Individual Health Record (PIS). The familiar PAM, which is compulsorily completed by paediatricians for children attending school, can be enriched with data on parents (anthropometric characteristics, diet and exercise habits, other risk factors for chronic diseases), thus creating a system for assessing population health indicators. This will make it possible to identify 'high-risk' families (always, as the study stresses, through strict data protection procedures). These families will be referred to primary health care structures (TOMYs, municipal clinics, health centres) for medical checks and access to specialist advice, interventions, programmes and information tools. The proposed action plan has in its design from the outset procedures for evaluating and measuring its effectiveness. It is described in detail in chapter 3.5.
Source: skai.gr
Contents of this article including associated images are belongs Cyprus Times
Views & opinions expressed are those of the author and/or Cyprus Times
Source
