Obesity, Chronic Disease, and Economic Growth: A Case for “Big Picture” Prevention

The discovery of a form of chronic, low-grade systemic inflammation (“metaflammation”) linked with obesity, but also associated with several lifestyle-related behaviours not necessarily causing obesity, suggests a re-consideration of obesity as a direct cause of chronic disease and a search for the main drivers—or cause of causes. Factors contributing to this are considered here within an environmental context, leading to the conclusion that humans have an immune reaction to aspects of the modern techno-industrial environment, to which they have not fully adapted. It is suggested that economic growth—beyond a point—leads to increases in chronic diseases and climate change and that obesity is a signal of these problems. This is supported by data from Sweden over 200 years, as well as “natural” experiments in disrupted economies like Cuba and Nauru, which have shown a positive health effect with economic downturns. The effect is reflected both in human health and environmental problems such as climate change, thus pointing to the need for greater cross-disciplinary communication and a concept shift in thinking on prevention if economic growth is to continue to benefit human health and well-being

The runaway weight gain train: too many accelerators, not enough brakes

Obesity seems to be perpetuated by a series of vicious cycles, which, in combination with increasingly obesogenic environments, accelerate weight gain and represent a major challenge for weight managemen

Using pedometers to increase physical activity in overweight and obese women: a pilot study

Background: Most public health guidelines recommend that adults participate in 30 minutes of moderate intensity physical activity on most days of the week. Establishing new ways to achieve these targets in sedentary populations need to be explored. This research evaluated whether the daily use of pedometers could increase physical activity and improve health outcomes in sedentary overweight and obese women. Methods: Twenty six overweight and obese middle-aged women were randomized into two groups: The control group was not able to record their steps daily, whilst the pedometer group, were asked to record the number of steps on a daily basis for 12 weeks. Results: Our data showed that the pedometer group significantly increased their steps/day, by 36%, at the end of the 12 weeks, whereas the control group\u27s physical activity levels remained unchanged. There was no significant difference in weight or body fat composition in the pedometer group compared to the control group. However, there was a significant decrease in systolic blood pressure in the pedometer group (112.8 ± 2.44 mm Hg) compared to the control group (117.3 ± 2.03 mm Hg) (p = 0.003). Conclusion: In conclusion, this pilot study shows that the combination of having step goals and immediate feedback from using a pedometer was effective in increasing physical activity levels in sedentary overweight and obese women

Shared medical appointments and mindfulness for Type 2 diabetes : a mixed-methods feasibility study

Introduction: Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia. Materials and Methods: We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, selfreported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer. Results: Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034). Conclusion: pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted. Clinical Trial Registration: Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112

Lifestyle medicine: the Australian experience

Changes in disease patterns from predominantly infectious to predominantly chronic diseases in Australia, in line with economic development throughout the developed world, have led to the need for changes in conventional health practice. This has resulted in a movement toward an evidence-based discipline of lifestyle medicine incorporating aspects of both public health and clinical medicine, aimed at moderating lifestyle and environmentally based etiologies. A professional association, postgraduate and continuing professional development training, working text, interactive Web site, and annual conference, as described here, are designed to complement conventional medical knowledge and practices. Changes to the Australian health system, which operates on a dual public/private model have made this approach more feasible and continue to be adapted to allow a more comprehensive approach to lifestyle-related health problems

Weight management: facts and fallacies

There is a great deal of misunderstanding about the facts around weight loss among health professionals, and the general public. Possible reasons for this include lack of adequate education of doctors in this area, misreporting of health research in the popular media, and a need for further research in some areas. Training doctors in \u27lifestyle medicine\u27 may be helpful. Standards of evidence in media reports could be significantly improved

A big-picture approach to big people

To the Editor: Your focus on obesity in the 20 February 2012 issue of the Journal expresses the frustration of many of us working in this area. After 25 years, it is clear that we have achieved little in reducing the problem at the population level and that the existing model for dealing with obesity, based on personal behaviour change, has failed

Helping patients lose weight: what works?

Background Over one in two Australians are now overweight or obese. Weight loss is difficult for patients to achieve and maintain in the current ‘obesogenic’ environment. However, new developments have resulted in a number of strategies and methods with a good evidence base. A 5–10% reduction in weight can result in a 35% decrease in health risk. Objective This article discusses the evidence base behind weight loss strategies for use in clinical practice. Discussion Obesity treatments with good evidence include counselling and behavioural approaches, exercise based programs, pre-prepared low energy meals, meal replacement, and bariatric surgery (the most effective for long term weight loss). Medication can be useful in some settings. Limited data suggests commercial diets and self help may be of some benefit. Alternative noningestible treatments (eg. creams and body wrapping) and the majority of over-the-counter medications (with the notable exception of orlistat) have no convincing evidence for efficacy. All successful strategies include some form of lifestyle change resulting in a reduction in energy consumed versus energy expended. The most effective treatments are likely to involve combining and matching strategies to the characteristics of the patient

Modern Australians - Part 2. The apple and pear generation. by Garry Egger

The implications of the rise of the big and the fat

In search of a germ theory equivalent for chronic disease

The fight against infectious disease advanced dramatically with the consolidation of the germ theory in the 19th century. This focus on a predominant cause of infections (ie, microbial pathogens) ultimately led to medical and public health advances (eg, immunization, pasteurization, antibiotics). However, the resulting declines in infections in the 20th century were matched by a rise in chronic, noncommunicable diseases, for which there is no single underlying etiology. The discovery of a form of low-grade systemic and chronic inflammation (“metaflammation”), linked to inducers (broadly termed “anthropogens”) associated with modern man-made environments and lifestyles, suggests an underlying basis for chronic disease that could provide a 21st-century equivalent of the germ theory