Obesity

The toolkit for obesity is available here: http://www.newhealth.govt.nz/toolkits/obesity.htm

Here are links to resources on obesity:

• New Zealand
• Maori and Pacific
• International
• NZ Links and other resources
  

New Zealand

• ‘Healthy Weight’ at What Cost? ‘Bulimia’ and a Discourse of Weight Control: Burns M.; Gavey N.; Journal of Health Psychology, July 2004, vol. 9, no. 4, pp. 549-565(17)
  Public health messages emphasizing ‘healthy weight’ link good health to a narrow range of body weights and stress energy regulation to achieve this. We examined whether women who practise bulimia deploy notions of ‘healthy weight’ in their talk about body management activities. Analysis is based on interviews with 15 women who practise bulimia and on material collected from cultural locations containing ‘health promotion’ advice. Poststructuralist discourse analysis revealed that slenderness was constituted as healthy in both sites and that the careful regulation of energy intake and output was similarly reified as a healthy practice. We conclude that a discourse of ‘healthy weight’ cannot be unhinged from a cultural imperative of slenderness for women, and that paradoxically ‘health’ practices provide a rationality that supports the practices of binge eating and compensating.
• Dietary Interventions to Prevent Obesity in Primary Care: A Literature Review, Robyn Whittaker, Public Health Protection, September 2001 (pdf 78kb)
  Obesity is now recognised world wide as a significant public health problem. In New Zealand, more than half of the adult population is overweight or obese, and reducing the prevalence of obesity has become a population health objective. Prevention of obesity is thought to be easier, less expensive and potentially more effective than treatment, however there has been little research into methods for prevention in Primary Care. Go to http://www.arphs.govt.nz/publications/Publications.asp and scroll down to Obesity Prevention Review to get .pdf
• Carryer, J. B. (1998). Challenging Society's Outlook of 'large women'. Official newsletter of the New Zealand Dietetic Association (113) 10-11.
• Carryer, J. B. (1998). Medicalisation of body size. 6 November, New Zealand Society of Gastroenterology, Palmerston North.\
• Carryer, J.B. (1999). Is Xenical a real solution to a real problem?. Women's Studies Seminar Series, Massey University, August 2, Palmerston North, NZ.
• Ryan, K. & Carryer, J. (2000). The discursive construction of obesity. Women's Studies Journal, 16 (1), 32-48.
• Carryer, J. (2001). Embodied Largeness: A Significant Women's Health Issue. Nursing Inquiry, 8 (2), 90-97.
• Childhood obesity — not just ‘puppy fat’
  In 1997, obesity cost New Zealand $135 million in healthcare. Obesity is the major cause of preventable diseases such as diabetes, heart disease and high blood pressure.While there are many factors causing obesity, the two most commonly identified are a sedentary lifestyle andpoor nutrition. Physical inactivity is directly associated with 8% of all deaths in this country and only 40% of all adults are sufficiently active, according to the Ministry of Health. There is insufficient information about the role nutrition plays in obesity and the dynamics that prevent existing knowledge about healthy nutrition and exercise from being applied. Research, although far from conclusive, is beginning to suggest that obesity in childhood can lead to a continuation of the problem into adulthood. The government is about to embark on a national childhood nutrition survey to address the currently fragmented picture of childhood obesity. Christine King has been part of Ministry of Health focus groups for the development of healthy nutrition and physical activity standards and was a member of the expert group that created an Obesity Tool Kit in 2001 for district health board use. She has commenced a research programme at UNITEC to study the effects of physical activity and nutrition on obese children. In this seven-month study, 20 intermediate school age children considered overweight were brought to UNITEC, where they were given a healthy afternoon tea and an opportunity to exercise through games. This was supplemented by evening nutrition sessions for the whole family. These sessions were useful in gathering information about what children of this age actually ate, as well as providing an opportunity to offer nutritional advice. The children were weighed and measured at different times throughout the project, given questionnaires about eating habits and physical activity, and asked to keep food intake diaries. Results from the programme have been encouraging. A significant proportion of the children had only minimal weight increases associated with increases in height, and some had decreased in waist measurements. A number of children were clearly more confident and comfortable playing games as a result of their participation in the programme, increasing their self-esteem. One of the schools involved is now intending to start a similar afterschool games programme for its students. Environmental (including school environments) and socio-economic factors are likely to underlie any lack of attitudinal change in this country towards physical activity levels and nutritional habits. Most children can no longer walk or cycle to school because of distances and safety issues, and many children appear to be making their own food choices because both parents work. Poor attendance at the evening nutrition sessions throughout the programme was, for example, thought to be due to parental work schedules. The relationship of poverty to food security and obesity requires more research, as do the family dynamics that keep poor nutritional habits in place. Schools have a part to play due to the kinds of fatty foods they continue to sell in canteens. Local shops, which offer ice creams, chips and takeaways, are also linked to poor nutritional habits and obesity. Christine’s study will contribute to the information to be gathered from the national nutrition survey, suggesting as it does that the application of this knowledge is still lacking in homes and schools despite much effort going into public education about healthy lifestyles. Obesity prevention thus needs to be addressed within a social context and at an early age. Christine King (School of Sport, Faculty of Health and Environmental Sciences) is a registered dietician and nutritionist. She lectures in sport and exercise nutrition at the School of Sport and advises athletes and teams for the New Zealand Academy of Sport. Her professional interests are in sport and exercise nutrition and she has been involved for many years in community nutrition work. cking@unitec.ac.nz
• King, C. (2001). Ministry of Health Expert Advisory Group Report on the Obesity Toolkit.
•  Metcalf, P.A., Scragg, R., Willoughby, P.3, Finau, S.2, Tipene-Leach, D.2 ‘Ethnic differences in perceptions of body size in European, Maori and Pacific Islands people living in New Zealand’. Int J Obesity 24, 593-599, 200
  

Maori and Pacific

• Metcalf, P.A., Scragg, R., Willoughby, P.3, Finau, S.2, Tipene-Leach, D.2 ‘Ethnic differences in perceptions of body size in European, Maori and Pacific Islands people living in New Zealand’. Int J Obesity 24, 593-599, 2000

International

• Contested geographies of obesity - AAG Annual Meeting, San Francisco, USA 17-21 April, 2007
  Geographical engagements with issues of size/fatness/obesity are wide ranging and can be contextualised within a variety of subdisciplinary interests.This session aims to demonstrate the significance of these different approaches as well as outlining the connections and tensions within them. Engagements with size/fatness/obesity reflect the multiple ways in which the fat/obese body can be conceptualised. This includes building upon medical and public health policies concerning what has been termed the 'epidemic of obesity' in order to identify and explain the spatial variations and environmental causes and consequences of overweight. This can be seen, for example, through work on 'obesogenic' environments, and through investigations of local, regional and global variations in the incidence of and responses to 'obesity'. However, 'obesity' has also been recognised as a contested term within critical geographical work which highlights the need to recognise the uncertainties behind current methods of defining and diagnosing obesity. This can be seen in the growth of geographical work on size/fatness/obesity/ which considers the embodied and emotional experiences of living as a fat/obese body, within wider discourses which link body size, shape and composition with ill health.
• Pill Less Effective for Overweight Women?
  (Ivanhoe Newswire) -- A new study shows overweight and obese women who take oral contraceptives are more likely to get pregnant while on the pill. Researchers from the Fred Hutchinson’s Public Health Sciences Division compared the weight and body mass indexes of 248 women who became pregnant while on the pill to that of 533 women who did not become pregnant while on the pill.
  Results show overweight and obese women were between 60-percent and 70-percent more likely to get pregnant while on the birth control pill.
  See more at: http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=10276
• Obesity Leads to Brain-tissue Loss
  A new study suggests being overweight or obese can increase the risk of dementia. Investigators from Sweden observed significantly greater loss of brain tissue among elderly women with higher body mass indexes.
  “This study indicates that a high BMI is a risk factor for dementia in women,” says Deborah Gustafson, Ph.D., study author. “Obesity is another factor that should be actively intervened upon to reduce diseases of advanced aging.”
  The research involved 290 women born between 1908 and 1922 who were followed from 1968 to 1992. A computed tomography (CT) scan conducted at the final exam found nearly 50 percent of the women had lost brain tissue, mainly in the temporal lobe. Women with this loss of brain tissue had an average BMI of 27, about one- to 1.5-points higher than women without the brain loss.
  Why would being overweight cause brain loss? Gustafson suggests obesity might increase the secretion of the hormone cortisol, which could lead to brain atrophy. She also notes obesity is linked to numerous other conditions including stroke, high blood pressure, and cardiovascular disease, all of which have also been associated with a higher risk of dementia.
  “The epidemic of obesity that is being observed in aging Western societies presents a serious public health problem,” writes Dr. Gustafson and her colleagues. “If overweight and obesity contribute not only to diseases of middle age but also to degenerative diseases of late life, the health ramifications ... will stress health care systems for many years to come.” .
  SOURCE: Neurology, 2004;63:1876-1881
• Obesity and Nutrition in Women Throughout Adulthood; Karen H. Morin; Mary A. Stark; Kimberly Searing; Journal of Obstetric, Gynecologic, and Neonatal Nursing, December 2004, vol. 33, no. 6, pp. 823-832(10)
• Nutritional challenges are particularly relevant to women. Almost 62% of women are overweight; of these women, 33% are obese. The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Women who are overweight or obese experience a greater number of adverse health outcomes, including an increased incidence of cardiovascular disease and breast and colon cancer. Dietary patterns influence health outcomes, with a heart-healthy pattern having the most positive health outcomes. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats.
• Colorectal Cancer Screening Disparities Related to Obesity and Gender; Allison B. Rosen; Eric C. Schneider; Journal of General Internal Medicine, April 2004, vol. 19, no. 4, pp. 332-338(7)
  BACKGROUND: Obesity is associated with a higher incidence of colorectal cancer and increased colorectal cancer mortality. Obese women are less likely to undergo breast and cervical cancer screening than nonobese women. It is not known whether obesity is associated with a lower likelihood of colorectal cancer screening.
  OBJECTIVE: To evaluate whether there is an association between body mass index (BMI) and rates of colorectal cancer screening. To examine whether BMI-related disparities in colorectal cancer screening differ between men and women.
• Smoking cessation and weight gain; Filozof C.; Fernández Pinilla M.C; Fernández-Cruz A.; Obesity Reviews, May 2004, vol. 5, no. 2, pp. 95-103(9); Blackwell Publishing
  Summary:  Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits. Weight gain is cited as a primary reason for not trying to quit smoking. There is a great variability in the amount of weight gain but younger ages, lower socio-economic status and heavier smoking are predictors of higher weight gain. Weight change after smoking cessation appears to be influenced by underlying genetic factors. Besides, weight gain after smoking cessation is largely because of increased body fat and some studies suggest that it mostly occurs in the subcutaneous region of the body. The mechanism of weight gain includes increased energy intake, decreased resting metabolic rate, decreased physical activity and increased lipoprotein lipase activity. Although there is convincing evidence for the association between smoking cessation and weight gain, the molecular mechanisms underlying this relationship are not well understood. This review summarizes current information of the effects of nicotine on peptides involved in feeding behaviour. Smoking was shown to impair glucose tolerance and insulin sensitivity and cross-sectional studies have demonstrated that smokers are insulin-resistant and hyperinsulinaemic, as compared with non-smokers. Smoking cessation seems to improve insulin sensitivity in spite of the weight gain. Nicotine replacement – in particular nicotine gum – appears to be effective in delaying post-cessation weight gain. In a group of women who failed to quit smoking because of weight gain, a dietary intervention (intermittent very-low-calorie diet) plus nicotine gum showed to both increase success rate in terms of smoking cessation and prevent weight gain. On the other hand, body weight gain at the end of treatment was significantly lower in the patients receiving bupropion or bupropion plus nicotine patch, compared with placebo. Studies with new drugs available for the treatment of obesity – sibutramine and orlistat – are warranted.
• Number of Children Associated with Obesity in Middle-Aged Women and Men: Results from the Health and Retirement Study; Weng H.H; Bastian L.A; Taylor Jr. D.H; Moser B.K.; Ostbye T.; Journal of Women's Health, 1 January 2004, vol. 13, no. 1, pp. 85-91(7)
  Objective: To study associations between number of children and obesity in middle-aged women and men.
  Methods: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] ge 30) in 9046 middle-aged women and men (4523 couples).
  Results: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women. Men (n = 4523) who were obese were younger, were more frequently African American, and were more frequently less educated and poorer compared with nonobese men. Among women, a 7% increase in risk of obesity was noted for each additional child, adjusting for age, race, household income, work status, physical activity, tobacco use, and alcohol use. Among men, a 4% increase in risk of obesity was noted for each additional child, adjusting for the same covariates. These sex differences were not significantly different.
  Conclusions: Previous research has demonstrated an association between number of children and obesity among women. These results suggest a similar association among men. Public health interventions focused on obesity prevention should target both parents, especially those parents with several children.
• Changes in Obesity Prevalence Among Women Aged 50 Years and Older: Results from the Behavioral Risk Factor Surveillance System, 1990-2000; Zablotsky D.; Mack K.A.; Research on Aging, January 2004, vol. 26, no. 1, pp. 13-30(18)
  Abstract: Obesity is an important public health issue facing Americans of all ages. Behavioral Risk Factor Surveillance System data are used to illustrate the change in body mass index distribution in just one decade (1990-2000) in women aged = 50. The sample size ranged from 18,474women = 50 in 1990 to 45,820 in 2000. Forwomen aged = 50, there is a slight decline in the prevalence of underweight (from 3.1% in 1990 to 2.4% in 2000) and a significant increase in obesity (from 14.4% to 21.7%). Not smoking, having less education, being in poor health, having diabetes, and not exercising are all associated with increased odds of being obese. Although factors significantly related to obesity in older women are consistent with those previously identified in younger women, the weight group distributions in olderwomen differ. The physical and social influences of age and gender need to be incorporated into health promotion programs.
• A new report "Overweight and Obesity in Canada: A Population Health Perspective" is now available in the Publications section of the Canadian Institute for Health Information web site (links below). The report was commissioned by CIHI's Canadian Population Health Initiative and authored by Dr. Kim Raine, Director and Professor at the Centre for Health Promotion Studies at the University of Alberta.
  CPHI Report English version - http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1130_E
• Saris, W.H.M.3, Astrup, A.3, Prentice, A.M.3, Zunft, F.3, Foriguera, X.3, Verboerket Van Der Venne, W.P.H.G.3, Raben, A.3, Poppitt, S.D. et al. ‘Randomised controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrate on body weight and body lipids, the CARMEN study’. Int J Obesity 24, 1310-18, 2000. 574, 1999 .
• Obesity and Cancer: A deadly link
• Obesity Worsens Women's Colon Cancer Prognosis But men don't suffer same risk, study finds
  MONDAY, June 30 (HealthDayNews) -- Obesity raises the risk of death from colon cancer in women, but not men.
  More at: http://www.healthday.com/view.cfm?id=513904
  

NZ Links and other resources

• Healthy Weight New Zealand Report 2001 In 2001, ANA commissioned the Healthy Weight New Zealand Report, to provide an update of the scientific understanding of weight as an index of health and health risk.  The primary author of this report is Gillian Tustin, with assistance from Sue Zimmerman. To download Healthy Weight New Zealand 2001 click on the following link.  Healthy Weight New Zealand Report 2001
• Grant No. 981
  The APPLE Study: Pilot Design.
  Ms Rachael Taylor (Funded by the Southland Medical Foundation) Because of labour saving devices, changing preferences for leisure activities and an abundant food supply, we live in an environment which promotes obesity. Thus in order to reduce obesity, we need to educate people about healthy lifestyles but also ensure that a healthy lifestyle is available to everyone. #Therefore we need to know if removing perceived barriers to a healthy lifestyle actually changes behaviour. The aim of our project is to assess what factors promote obesity in children in several small towns, in order to develop a suitable intervention programme that attempts to change those factors which promote obesity.
  

From Women's Health Action publications

• Eating Disorders
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Obesity and Cancer: A deadly link

The risk of dying from cancer increases significantly for both men and women who are obese, according to a new study published in the April 24th, 2003 issue of The New England Journal of Medicine. This increased risk is shown to affect women more often than men. Being overweight or obese, categories defined by measuring body mass index (BMI) accounts for roughly 14 percent of cancer deaths in men and 20 percent of deaths in women, according to the results of the study.

In this prospective study, researchers from the American Cancer Society examined the relationship between BMI and death from cancer in more than 900,000 adults. They found that increased body weight raises the risk of death from all cancers combined and from cancers at multiple specific sites. In addition, among patients in the heaviest weight category, with a BMI greater than or equal to 40, the risk of cancer death was 52 percent higher in men and 62 percent higher in women when compared with normal weight adults. BMI is calculated by dividing weight (kilograms) by height (meters) squared.

Women are affected more often than men for several reasons. Many studies have established a strong association between breast cancer risk and increased body weight and only a modest association between prostate cancer and obesity. "Obese women double their risk of breast cancer," according to Dr. Carmen Rodriguez, MD, MPH Senior Epidemiologist at the American Cancer Society and one of the authors of the study. Therefore, increased body weight plays a more significant role among women compared to men suffering from the most common forms of cancer. In addition, Dr. Rodriguez explains: "the percentage of obese women is higher than men, 33% versus 28%."

The incidence of obesity in the United States has increased significantly over the last two decades. According to the Centers for Disease Control and Prevention, obesity is defined as a BMI greater than or equal to 30. To be classified as overweight, the BMI is between 25 and 29.9. Recent data from the National Center for Health Statistics in Hyattsville, Maryland, shows that roughly 31 percent of the adult population aged 20 years or older meet the criteria for obesity. And the numbers continue to rise.

While the reasons underlying the association between cancer death and obesity are not fully understood, female hormones are thought to play a role. "Obesity increases the risk of breast cancer only among post-menopausal women," explains Dr. Rodriguez. Because many post-menopausal breast cancers are stimulated by estrogen and fat increases circulating hormones in the body, the risk of cancer increases for obese women.

Obesity has been linked to many serious health conditions, including cardiovascular disease, diabetes, stroke, and high blood pressure. According to Dr. Rodriguez, there aren't many studies showing that weight control programs lower the risk of cancer death: "We can speculate that if you lower your weight, you will lower your risk as well. But it is not easy to do an observational study with enough people who have been obese and lower and maintain their weight." She recommends maintaining a healthy weight as well as good nutrition and exercise habits throughout life.

May 1, 2003

by Jennifer Wider, MD
Society for Women's Health Research

SOURCES
Centers for Disease Control and Prevention, BMI worksheet.
National Center for Health Statistics, factsheet.
Calle E, Rodriguez C, et al. Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults. NEJM. 2003; 348:1625-1638.

Dangers of Obesity Extend into the Womb

Women who are obese prior to pregnancy increase the risk of birth defects to their children, according to a new study published in the journal Pediatrics. In addition to regularly monitoring their weight gain during the course of their pregnancies, all women should be mindful of their body weight even before conceiving.

In a population-based case-control study, researchers from the Centers for Disease Control and Prevention in Atlanta, Georgia interviewed hundreds of women to determine the relationship between prepregnancy weight and certain birth defects. They found that obese women were more likely to have an infant with spina bifida, a neural tube defect; omphalocele, a defect in the development of the abdominal wall; and heart defects. An increased risk of heart defects or other congenital anomalies was also seen in overweight mothers who did not quite meet the criteria for obesity.

The participants' weight was determined by calculating Body Mass Index (BMI), weight in kilograms divided by height in meters, squared. The risks for obese women and overweight women were compared with those for normal-weight women. Obese women were defined as those having a BMI greater than or equal to 30; overweight women were defined as those having a BMI between 25.0 and 29.9; normal-weight women had a BMI less than 24.9.

"The reason(s) for the greater risk among obese women is/are not known," explains lead researcher Cynthia A. Moore, M.D., Ph.D. of the National Center on Birth Defects and Developmental Disabilities. Dr. Moore and colleagues discuss several possible mechanisms for the correlation between excessive maternal weight and birth defects. They propose abnormalities in metabolism of glucose, insulin or hormones, which may affect the development of the fetus. They also explain that overweight women are at greater risk for gestational diabetes, or diabetes of pregnancy, which has been linked to an increase risk of birth defects. In addition, women who are pregnant require 400 micrograms of folic acid daily in order to prevent neural tube defects. The researchers suggest that heavier women may need increased requirements of certain nutrients like folic acid to prevent defects in their fetuses.

The incidence of obesity is on the rise in the United States and it has become increasingly clear that weight control can have a dramatic effect on the health of unborn children. "From this study, we have identified that women who are at a healthy weight before pregnancy lower their risk of having a child with certain birth defects than do women who are obese; therefore, prevention efforts should focus on attaining a healthy weight before pregnancy," according to Dr. Moore.

There are several other measures women can take to ensure healthy pregnancies. Dr. Moore adds, "(Women can) abstain from alcohol and smoking during pregnancy, discuss all medication use with their doctor, and take a multivitamin with (at least) 400 micrograms of folic acid daily." These simple actions can significantly improve the chances of having a healthy baby.

Several other tips for a healthy pregnancy are available at the Web site: http://www.cdc.gov/ncbddd/bd/abc.htm.

May 13, 2003

by Jennifer Wider, MD
Society for Women's Health Research

Sources
Watkins ML, Rasmussen S, Moore CA, et al. Maternal Obesity and Risk for Birth Defects. Pediatrics 2003; 111(5): 1152-1158.