Obesity: A Global Epidemic

 

 

Introduction

There has been more than a double increase in global rates of obesity since 1980, according to statistics by the WHO (World Health Organization 2016). Consequently, obesity levels are now projected to have reached global epidemic proportions.  As of 2014, over 1.9 billion adults aged 18 years and above where categorised as being obese overweight, while 600,000 of these were rated as being obese (WHO 2016). The WHO defines obesity and overweight as excessive or abnormal accumulation of fat which could hinder one's health. In the case of adults, obesity is defined as BMI (Body mass index0 of more than or equal to 30, while overweight is classified as BMI of more than or equal to 25. In this case, BMI is computed by calculating one's weight in divided by the square of their height in meters (kg/m2). Obesity is now a global epidemic, seeing as nearly 2.8 million individual are dying every year due to being obese or overweight (WHO 2014). Even as obesity was previously linked to high-income nations, it is now also prevalent in both middle-income and low-income countries. Consequently, governments, the civil society, non governmental organizations and international partners all have crucial roles to play in contributing towards the prevention of obesity. The premise of the current essay is to examine obesity as a global epidemic, and to explore reasons that could have contributed to this. In addition, the essay shall also attempt to discuss the role that the physiotherapist has in reversing this trend.

Obesity as a global epidemic

Obesity impacts on the overall health of individuals within a population. The WHO classifies obesity and overweight as the fifth leading cause of global death (Shukla, Kumar & Singh 2014). In addition, obesity is closely associated with the causations of such non-communicable diseases (NCDs) as musculoskeletal disorders, cardiovascular diseases, diabetes, as well as various forms of cancers (WHO 2013). Statistics show that nearly 44 % of the diabetes burden, between 7% and 41% of various cancer as well as 23% of cardiovascular disease burden is linked to obesity and overweight (WHO 2013). Between 1993 and 2013, the proportions of adults in the UK with normal BMI reduced from 49.5 per cent to 40.8 among women and 41.0 per cent to 31.2 per cent among men (HSCIC 2015). However, there was a reported stable proportion of obesity for both women and men over the same period (at approximately 32 per cent in the case of women, and between 41 and 46 per cent, in the case of men).

On the other hand, the proportion of obese individuals in the UK increased significantly during this period. In 1993, the prevalence of obesity among men was pegged at 13.2 per cent but by 2013, it had almost doubled, to 26.0 per cent. On the other hand, the proportion of obesity had increased from 16.4 per cent in 1993 to 23.8 per cent in 2013, according to statistics by Health Survey for England (Craig, Fuller & Mindell 2015). At the same time, there was an increase in the number of individuals in the UK categorised as being overweight (including the ones termed as obese) from 1993 to 2013. In the case of men, the proportion increased from 57.6 per cent to 67.1 per cent during this period, while that of women increased from 48.6 per cent to 57.2 per cent over the same period. 

Prevalence of obesity differ by age, with the 16-24 age group reporting the lowest proportions, while older age groups among women and men indicate higher prevalence of obesity. While the adult population bears most of the social and medical burden of obesity, obese children are also increasingly enduring significant morbidity. Obese children demonstrate such cardiovascular risk factors as insulin resistance, dyslipidaemia, and hypertension. Importantly, the drastic increase in incidence of type 2 diabetes among children in recent decades seems to be linked to the rising levels of childhood obesity (Mongan 2006).

Why the rise in obesity to epidemic proportions?

The increase in the global obesity epidemic is indicative of significant changes in society as well as behavioural patterns of global communities in recent decades. Even as genetics plays a key role in determining an individual's probability of weight gain, it is important however to note that energy balance is largely determined by physical activity and calories intake. As such, global nutrition transition and societal changes are the driving force behind the current obesity epidemic (WHO 2003). Several forces have thus been associated with underlying the obesity epidemic, key among them being modernization, economic growth, globalisation, and modernization. Increase in income among populations lead to increased rates of urbanization.

There is also a resultant change of diet, with complex carbohydrates in the diet being replaced with varied diets characterised by a higher proportion of sugars and saturated fats. It is also important to note that the global population has been seen to abandon physically demanding work in favour of less physically demanding work, with increased use of automated technology such as in transport having played a key role in this shift (NICE 2006). An increasingly larger number of individuals have been seen to pursue passive leisure time such as watching of television.

While there could be a decrease in energy intake among the global population, there has been a resultant rise in the energy density of our diet. Over the past few decades, the percentage of dietary fat consumed has been seen to increase, even as several studies reveal a link between obesity and high fat diets. On the other hand, low fat diets are associated with strategies aimed at attaining weight loss.  Considering that fat is more energy dense and less satiating in comparison with say, protein and carbohydrates, a diet rich in fat thus enhances the probability of over-consumption of energy (WHO 2013). Decreased physical activity leads to positive energy balance linked to weight gain. Limited physical activity is associated with changes in metabolic activity and low daily energy requirement. These could lead to obesity unless we restrict energy intake as required.  Reduced muscle activity in the form of limited physical activity causes limited fat oxidation which appears to favour fat imbalance. In contrast, regular physical activity stimulates fat oxidation, which in turn helps to minimise the risk of weight gain.

Using real world examples, discuss the role that the physiotherapist has in reversing this trend

A physiotherapist plays a crucial role in the prevention and management of obesity. This mainly entails the provision of exercise programs to groups of individuals who are already obese and hence at risk of the co-morbidities associated with this epidemic. More importantly, physiotherapists are vital in the treatment of a good number of the secondary health issues linked to obesity.  NICE guidance for obesity management recommend that the initial stage of management should encompass various interventions aimed at modifying physical activity behaviours and diet. Physical activity is thus crucial for not only maintaining long-term weight loss, but also in as far the management of associated co-morbidities is concerned (NICE 2012).  Obesity has been shown to hinder movement, in effect affecting one's engagement in physical activity (Morris, Kitchin & Clark 2009). Accordingly, the role of a physiotherapist is crucial in its prevention and management (The Chartered Society of Physiotherapy 2014).  Movement and exercise are a key aspect of the physiotherapists combines a patient-centred, problem solving, and holistic approach in the management of obesity. This, coupled with their advanced skills and knowledge in physiological, psychological, and anatomical mechanism of disease and health, evaluation and diagnosis;  biomechanics; behaviour change, management of long-term conditions, therapeutic exercise and exercise prescription; and ability to manage long-term conditions make physiotherapist the best placed professions to deal with the psychological and physical complexities associated with obesity (WHO 2014). 

While management of obesity consists of a multi-disciplinary team (MDT), physiotherapists are active participants of this team in helping to optimise patient experience and clinical outcomes. Even as the value of being physically active in managing obesity is well documented, the truth is that patients often encounter difficulties in trying to partake in physical activities. There is a need therefore top facilitate such patient to enhance their physical activity to recommended levels, and a physiotherapist is best placed to facilitate this goal (The Chartered Society of Physiotherapy 2014). Physiotherapists possess the skills and competence to assess an individual obese patient and come up with a treatment plan that is best suited to enable the patient in question overcome barriers to exercise (WHO 2016).

The CSP (Chartered Society of Physiotherapy) acknowledges that in order to prevent and manage obesity, there is need for a comprehensive and aggressive approach that tackles the multifaceted and complex issues (The Chartered Society of Physiotherapy 2012).  Nonetheless, so far, there seems to be confusion regarding the role of a physiotherapist in preventing and managing obesity. Additionally, these professionals have not been actively involved in managing the obesity epidemic. It is important to stress on the significance of activity, lifestyle, and exercise, seeing as weight management programs developed by dieticians do not address these issues.

According to Craig, Fuller and Mindwell (2015), nearly 68-69 per cent of adults in the UK were either not aware of the recommendations on physical activity or underestimated the level of input required in order to derive health benefits from physical activity.  The physiotherapist is best placed to shed light on this issue, seeing as it falls under their area of expertise. Consequently, it is important to ensure that physiotherapists are key players of the MDT involved in the prevention and management of obesity, as well as in maintaining weight loss. On account of the expertise and breadth of knowledge of physiotherapists, they are better placed to manage obesity. Confidence and negative body image issues could hinder a patient's willingness to participate in exercise programs. With the prevalence of obesity predicted to increase in the coming years, there is a dire need to implement a MDT that will be pivotal in managing this population (Grave et al. 2011).

In their study, Epstein and Ogden (2005) established that general practitioners do not regard obesity as constituting their domain as it does not encompass effective medical interventions like drug therapy On the other hand, only about 3 per dent of general practitioners refer obese patients for further cognitive behavioural therapy in order to establish the root cause of the problem. Consequently, many of the patients end up developing musculoskeletal problems that might demand physiotherapeutic treatment.  Physiotherapists in the NHS (National Health Service) enjoy lengthened contact time with obese patients and as such, they are in a better position to make a huge impact on the other health professionals (NHS 2012). Besides, physiotherapists are well versed in the secondary complications of obesity like diabetes, hypertension, as well as complex significant physiological changes.  As such, physiotherapists are best suited to identify such patients and also treat them accordingly. 

Conclusion

Modern lifestyles have created a generation of obese adults and children. Prevalence of obesity is highest in Europe and the United States, although other parts of the globe like Asia, South America and Africa are also catching up. There is a dire need to tackle the obesity epidemic given its social and financial implications on the governments, societies.  This has thus prompted various governments, non-governmental organizations and health professionals across the globe to search for strategies on how to prevent and control it. There is compelling evidence in existing literature to show that obesity can be effectively managed by restricting dietary intake, especially low fat and low calories diets. Increased physical activity also leads to weight loss. However, social, cultural, and environmental factors hinder attempts by obese individuals to lose weight.  Prevention and management of obesity therefore is a concerted effort that puts together a MDT of healthcare professionals who all work together to ensure that an individual patient realises his/her goal or weight loss. A key player in this MDT is the physiotherapist. Physiotherapists are well versed in matters of human physiology, anatomy, and cardiovascular systems, as well as the secondary complications of obesity like diabetes and cardiovascular diseases. Given the long duration of time that physiotherapists interact with obese patients in the NSH, there are best placed to effectively and autonomously deliver personalised, high quality lifestyle and exercise interventions to not only prevent obesity, but also deal with the various barriers to participation in physical activity.

 

 

 

 

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