Weight, Health and the Economy

In the last two decades, the rate of obesity has risen three-fold. It is more than 30 percent in some European countries. In Europe, about 50 percent of all adults are categorised as overweight. Obesity increases the risk of hypertension, diabetes, and atherosclerosis.

Reports of an ‘obesity epidemic’ appear with increasing frequency and rising concern in Australia. Particular attention is given to reports of the accelerating rate of obesity among Australian children.

In 1995 the Australian Institute of Health and Welfare (AIHW) reported the following prevalence rates:

Estimates taken in 2000 suggest that, while more men are overweight than women (67 per cent compared to 52 per cent), obesity is more common among women (22 per cent) than men (18 per cent).

Obesity increases the risk of many chronic and potentially lethal diseases. Most of these diseases can be prevented with lifestyle changes including proper nutrition and regular exercise.

Some of the many chronic conditions and diseases associated with obesity include:

• Insulin resistance
• High blood pressure
• Atherosclerosis
• Cardiovascular disease
• Stroke
• Some cancers including breast, endometrial and colon cancer
• Type 2 diabetes (non-insulin dependent diabetes mellitus)
• Gall bladder disease
• Polycystic ovarian syndrome
• Musculoskeletal problems such as osteoarthritis and back pain
• Gout
• Cataracts
• Stress incontinence
• Sleep apnoea

Factors known to increase the risk of obesity include:

• Genes – researchers have found that genetics play a part in regulating body weight. However these genes explain only a small part of the variation in body weight.
• Birth factors – some studies suggest that a person is more likely to become obese later in life if they experienced poor nutrition in utero, had a low birth weight and weren’t breast fed. However, other studies show that high birth weight is a stronger risk for becoming overweight.
• Eating more kilojoules than you use – whatever your genetic background, you will deposit fat on your body if you eat more energy (kilojoules) than you use.
• Inactivity – for most of us, physical activity is no longer a natural part of our daily schedule. Obese people tend to live sedentary lifestyles.
• Modern living – most modern conveniences, such as cars, computers and home appliances, reduce the need to be physically active.
• Socioeconomic factors – people with lower levels of education and lower incomes are more likely to be overweight or obese. This may be because they have less opportunity to eat healthy foods and take part in physical activities.

The medical costs associated with treating these diseases will strain the health care system and economy in the years to come, experts say.

To stop gaining weight, people need to either burn 100 calories more a day with physical activity or eat 100 calories less every day.

Some statistics about child obesity in Australia according to the Australian government:

1. An estimated 1.5 million people under the age 18 are considered overweight or obese.
2. This means about 20-25% of Australian children are overweight or obese.
3. The proportion of overweight or obese children in Australian is increasing at an accelerating rate. This pattern, showing up since the 1980’s, is similar internationally.
4. Children are getting less aerobic exercise.
5. The amount of aerobic fitness is decreasing about .4% a year.
6. Between 1985 and 1997 obesity levels in the population doubled.
7. While obesity increased 2-4 times, being overweight increased 60-70%. This shows signs not just of increasing, but accelerating.
8. If weight gain continues the path it is following, by the year 2020, 80% of all Australian adults and a third of all children will be overweight or obese.
9. A study in Queensland showed that up to 30% of Australian children have low fitness levels while 60% have poor motor skills.
10. There is an indication that walking and cycling are used less for transportation for Australian children. Studies also seem to show that those among the least fit of Australian children are the group deteriorating the fastest over time.
11. In Australian schools, physical education is being reduced even with no dispute about how important physical education is.
12. 50% of obese adolescents continue to be obese as adults.
13. Studies show that relative body weight is most often carried from childhood to adulthood. Once a child or adolescent is obese or overweight, they are not likely to reduce it as an adult.
14. Obesity in a child or adult is defined as a condition where excess fat has accumulated to the point that it can impair health.
15. A primary cause of obesity is an energy imbalance.
16. An intake of high energy foods, combined with a low level of exercise or a sedentary lifestyle is a cause of this energy imbalance.
17. One study estimates that for every 1% increase in the proportion of physically active people, nearly 122 lives can be saved that would have been lost to coronary heart disease, colon cancer, and type 2 diabetes. All of these diseases have links to obesity.
18. It is estimated that in 1995-1996 the cost of obesity in Australia was between $680-$1239 million.
19. Obesity as a child is linked to an increase in cardiovascular morbidity and mortality in an adult regardless of the adult weight. Being overweight as a child brings and an increase for heart related diseases like high blood pressure, high blood cholesterol, and high blood sugar.
20. Child obesity is also related to many medical conditions like respiratory disorders, orthopaedic problems, release of growth hormone, arthritis, and gastric problems.
21. A study estimated that less than 70% of girls that were year 8 and year 10 students remained adequately active over winter in 1997.
22. Basically, what you can see from statistics like these is that being overweight or obesity in a child is increasing.
23. A primary cause can be an increasing lack of exercise compared to an intake of high energy foods. It must also be noted that once a child is obese or overweight, it can be difficult to lose that weight during a lifetime. Obesity in a child may also lead to an increase in obesity related diseases.
24. Also in the report on child obesity in Australia, were statistics showing that there in an increase in homes with both parents at work. Also noted was an increase between 1986 and 1999 where a sole parent was working.
25. A lot must be done to reverse child obesity in Australia and child obesity worldwide.
26. An emphasis must be made on the need for exercise and eating the right foods. Also, we need to understand not just how a child becomes obese, but the why they become obese may be just as important. If nothing is done, the possible 2020 statistic of 80% obese or overweight Australian adults may become true from today’s child obesity in Australia.

A Potential Drug Treatment

There are very few safe and effective drugs presently available for the treatment of obesity. As a result, there is a need for alternative approaches to weight loss that are safe and easily tolerated and that can also lower the risks associated with obesity.

Denmark’s Novo Nordisk claims that tests conducted on its new big drug hope, liraglutide, has led to significant weight loss in obese people treated over one year.

Even over 20 weeks it was found that liraglutide treatment is well tolerated, induces weight loss, lowered blood pressure, improved blood sugar control and reduces pre-diabetes.

Liraglutide is a compound that was developed by Novo Nordisk for the treatment of type 2 diabetes. The drug received marketing authorization in the United States in the fall of 2009 and in Europe in January, 2010. It is not currently approved for use in Australia.

Liraglutide requires once-daily injections. The drug can cause nausea, vomiting, and diarrhoea, although these side effects tend to go away after the first month of treatment. Though patients may have an increased risk of infections.

The FDA in America has approved liraglutide (also known as Victoza), though there needs to be more safety studies as there are concerns due to the increased risk of pancreatitis, and some studies showing Victoza caused tumors of the thyroid gland in rats and mice.

Liraglutide is an injectable GLP-1 analogue. It can be used in treatment of Type 2 Diabetes Mellitus in combination with tablets. Victoza can help weight loss in patients with Type 2 Diabetes Mellitus. Liraglutide does not have licence for use in Gestational Diabetes Mellitus. Not for use in Type 1 Diabetes Mellitus.

Australian Research

According to Canberra University’s National Centre for Social and Economic Modelling (NATSEM) one in seven Australians will suffer from Type 2 diabetes by 2050, costing the nation more than $14 billion each year.

Type 2 is the most common form of diabetes, affecting 85-90% of all people with diabetes.

The alarming thing is that it usually affects older adults, but now more younger people, even children, are getting type 2 diabetes.

In type 2 diabetes, the pancreas, a large gland behind the stomach, makes some insulin but it is not produced in the amount your body needs and it does not work effectively.

Cause of Type 2 Diabetes

• have a family history of diabetes
• are older (over 55 years of age ) – the risk increases as we age
• are over 45 years of age and are overweight
• are over 45 years of age and have high blood pressure
• are over 35 years of age and are from an Aboriginal or Torres Strait Islander background
• are over 35 years of age and are from Pacific Island, Indian subcontient or Chinese cultural background
• are a women who has given birth to a child over 4.5 kgs (9 lbs), or had gestational diabetes when pregnant, or had a condition known as Polycystic Ovarian Syndrome.

In type 1 diabetes the pancreas stops making insulin and without insulin the body burns its own fats as a substitute, a process which then causes dangerous chemical substances to accumulate in their blood unless treated with daily injections of insulin.

Symptoms of Type 1 and Type 2 Diabetes

• Being excessively thirsty
• Passing more urine
• Feeling tired and lethargic
• Always feeling hungry
• Having cuts that heal slowly
• Itching, skin infections
• Blurred vision
• Unexplained weight loss
• Mood swings
• Headaches
• Feeling dizzy
• Leg cramps.

A NATSEM team of researchers has completed the development of a model that projects the number of Australians that will have Type 2 diabetes or pre-diabetes over a 45 year period and the potential effect of diabetes prevention programs aimed at reducing the prevalence of this disorder.

The number of adult Australians with Type 2 diabetes is estimated to increase 2-3 fold over the next 30-40 years. The Diabetes Model simulates current trends in the number of adult Australians that have risk factors associated with Type 2 diabetes such as:

• being overweight
• being physically inactive
• having high blood pressure
• or cholesterol levels
• or being a smoker
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The NATSEM report projects by 2050 the prevalence of complications experienced by Australians living with Type 2 diabetes will include over 270,000 coronary bypass grafting procedures, over 250,000 heart attacks and more than 750,000 renal complications.

The number of children developing the disease is growing by around four per cent each year, putting Australia in the top 10 countries in the world with the highest rates of the disease, government figures released earlier this year show.

The report studied five key interventions:

• improving use of medicines
• improving exercise
• enhancing primary care
• introducing new drugs
• counselling patients

Bridging the Gap in Meeting Clinical Targets for the Treatment of Type 2 Diabetes

Download Report (1258kb)