Alan Marquis debates the issues surrounding the UK's current obesity problem and asks the question, does size really matter?
There is an ongoing media spotlight on the 'time bomb' of childhood obesity and critique of body shapes from 'size zero' to 'super size', and this obsession with body shape is not without foundation. The UK has seen a dramatic increase in childhood obesity in recent years and has lead to various Government schemes trying to reverse the trend of a rising percentage of overweight people.
What is obesity?
A person is classed as obese when their weight has increased to a point where it seriously endangers their health. Obesity is diagnosed when a person's body mass index (BMI) exceeds 30. BMI is calculated by dividing weight in kilogrammes by height in metres squared. Between 25 and 30 is overweight according to World Health Organisation guidelines.
n In England, 43% of men and 33% of women are overweight and an additional 22% of men and 23% of women are obese, according to the Department of Health's Health Survey for England 2003.
n The Department of Health's Forecasting Obesity to 2010 report warns that more than 12 million adults and one million children may be obese by 2010.
n Nearly one third of men will be obese by 2010.
n Every year the health service spends at least £2bn on treatment for ill health related to poor diet.
Most people understand that being overweight may affect their health in a great number of ways. The biggest perceived health risks are heart disease and type two diabetes, however, according to Cancer Research UK, as little as 3% of the British population realise that a BMI above the healthy range (over 25) can greatly increase the risk of cancer, of the colon, oesophagus and kidney.
Besides measuring BMI, another way to determine if weight is putting health at risk is by measuring waist circumference. Waist measurement in itself does not determine if someone is overweight, but it does indicate if they have excess fat in their abdomen. This is important because extra fat around the waist may increase health risks even more than fat elsewhere on the body. A waist circumference of more than 40 inches in men, and more than 35 inches in women has been proposed by the National Institutes of Health in America as representing increased health risk. This has been incorporated into the National Cholesterol Education Programme definition of the condition metabolic syndrome.
What is Metabolic Syndrome?
Metabolic syndrome is a group of obesity-related risk factors for coronary heart disease and diabetes. A person has metabolic syndrome if they have three or more of the following risk factors:
n A large waistline. More than 40 inches for men and more than 35 inches for women.
n High triglycerides or taking medication to treat high triglycerides. Triglycerides are blood fats related to calorie and carbohydrate intake and are part of a standard cholesterol profile test.
n Low levels of HDL ("good") cholesterol or taking medications to treat low HDL. HDL cholesterol is one of many cardiovascular risk factors and a high level can partially mitigate the adverse effect of other risk factors.
n High blood pressure or taking medications to treat high blood pressure. High blood pressure is 130 mm Hg or higher for systolic blood pressure (the top number) or 85 mm Hg or higher for diastolic blood pressure (the bottom number).
n High fasting blood glucose (sugar) or taking medications to treat high blood sugar. This means a fasting blood sugar of 6.1 mmol/l or higher.
A person with metabolic syndrome has approximately twice the risk for coronary heart disease and five times the risk for type two diabetes.
The metabolic syndrome is strongly linked to obesity, especially abdominal obesity. Other risk factors include physical inactivity, insulin resistance, genetics, and old age.
Obesity is a risk factor for the metabolic syndrome because it raises blood pressure and triglycerides, lowers good cholesterol, and contributes to insulin resistance causing type two diabetes. Excess fat around the abdomen carries even higher risks.
The benefits of weight loss
n Losing 5% to 10% of weight can lower a person's chances of developing coronary heart disease or having a stroke.
n They may lower their risk of developing type two diabetes and cancer by losing weight and increasing the amount of physical activity they do.
n Losing weight and being physically active can help control your blood sugar levels. It can also reduce the build-up of fat in the liver which can cause non-alcoholic steatohepatitis, commonly known as fatty liver disease.
Assessing risk
The clinical approach to determining cardiovascular risk is to estimate the overall probability of future disease (heart attack or stroke) by taking into account the level of all cardiovascular risk factors present, for example, smoking, blood pressure and cholesterol. Using independent thresholds to make decisions regarding treatment of a single risk factor, without regard to the effect of others, has been discarded in favour of a holistic approach to vascular risk. The clinical decision to modify risk factors in those without cardiovascular disease (primary prevention) is based on the quantification of absolute cardiovascular risk. This is determined by taking into consideration the cumulative effect of all the potential risk factors.
It remains to be seen whether Government targets and initiatives to tackle at risk families and promotion of healthier food choices, investment in activity programmes at schools and restrictive advertising of junk foods will reverse the anticipated obesity explosion. However, through greater awareness of multi-factorial assessment in clinical medicine and with prevention of long-term illness strategies, this will continue to influence the development of the insurance industry's approach. n
Alan Marquis is senior life and disability underwriter at Aegon Scottish Equitable
