Healthy Weight - Amazon Web Services

Healthy Weight

Population Health Monograph

Contents

Executive Summary

4

Introduction

5

Measuring Weight Status

6

Impact of Overweight

8

and Obesity

Causes of Obesity

10

Life Stages, Overweight

12

and Obesity

Pregnancy and Weight

12

Childhood and Weight

12

Ageing and Weight

12

Effective Interventions

14

Current Weight Management Interventions 16

Lifestyle Modification Programs in SA

17

Psychology and Obesity

18

Consulting Community

19

on Obesity Policy -

a Citizens Jury

Overweight and Obesity Rates 20 within the CAHML Region

South Australian Medicare Locals -

20

How do they compare?

Overweight Rates within

21

the CAHML Region

Overweight - Gender Distribution

22

Obesity within the CAHML Region

23

Obesity - Gender Distribution

24

Managing Overweight and 25 Obesity in General Practice

Summary

26

Overweight and Obesity in General Practice Pathway Document

Insert

Recommendations for

27

Systems and Policy

National Healthy Eating

28

Activity and Lifestyle

(HEALTM) Program -

an Evidence Based Lifestyle

Modification Program

References

29

2

Central Adelaide and Hills Medicare Local - Healthy Weight

Central Adelaide and Hills Medicare Local coordinates and delivers primary health care, on the lands and seas of the traditional custodians, the Kaurna and Peramangk people. We recognise them as the traditional custodians, and respect that Aboriginal and Torres Strait Islander people represent the continuum of the world's longest living culture, and that these historical relationships are enduring.

Central Adelaide and Hills Medicare Local - Healthy Weight

3

Executive Summary

Australia is experiencing one of the greatest public health dilemmas facing industrialised nations in trying to manage the growth in obesity. With 62% of adult residents from the Central Adelaide and Hills Medicare Local (CAHML) region either overweight or obese, it clearly was a priority health issue for CAHML and continues to be an issue into the future for Primary Health.

This Healthy Weight monograph examines the prevalence and impact of Overweight and Obesity across our communities. It also explores how this health issue has changed overtime and how primary health can work towards reaching a possible solution and subsequently reduce the impact of excessive weight in our population.

Like other industrialised nations, Australia's obesity rates have been increasing significantly over the past 40 years. A simple equation suggests that our physical activity has reduced and our food energy intake has increased. However the solution is not as linear as less energy in and more energy out, as it ignores the psychological influences on behaviour change.

Our daily living and employment practices now mean that we spend more sedentary time looking at screens and sitting rather than pursuing more physically demanding practices of old. It is also sad reflection on our society when a high energy takeaway meal is significantly cheaper and easier to access than a more labour intensive and nutritious home cooked meal.

Why does Australia, New Zealand and the USA lead the rates of Obesity in industrialised nations? For one thing our population distribution and standard of living means we are more dependent on motor vehicles compared to countries like Denmark and the Netherlands. The result is that we have reduced capacity for incidental exercise. Consider the impact of a multilevel bike park such as outside Amsterdam's central train station.

What can we do, have we faced similar problems in the past? Certainly Australia faced a significant public health problem with tobacco smoking last century. In 1945 a staggering 72% of Australian men were daily smokers compared to 17.4% in 2014. Government regulations (taxation and control) as well as public health massages certainly had an influence in reducing smoking rates in the later part of the 20th century.

In part there does need to be more interest taken by governments to exercise a greater appetite regarding taxation and control. Imagine how the market might respond if there was a tax on fat and or sugar? Physical exercise is a much more difficult public health issue to address. With our geographic spread it is much more difficult than making "bike friendly" or public transport focussed cities alone. However it certainly does require public debate on how we can increase our daily physical activity.

This monograph is CAHML's response to the significant issue that we identified for our communities and faced by our health professionals. It is our intent that we all need to seriously look at our community and cultural lifestyles and practices that continues to grow the number of overweight and obese population.

If we are to address this issue we all will have a part to play, individually through our own actions and behaviours, for our families and for our workplaces to support heathier choices and options.

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Central Adelaide and Hills Medicare Local - Healthy Weight

Introduction

The monograph provides an overview of the health needs of the CAHML population looking at:

1. The burden of disease 2. Current trends; and 3. Future directions

South Australian weight trend data reveals statistically significant increases in unhealthy weight and prevalence amongst both male and female adults. Between 2002 and 2013 prevalence amongst males increased from 62.7% to 64.6% and amongst females from 46.3% to 52.2%.

Unlike many health issues, high rates of overweight are found equally in advantaged areas as in disadvantaged areas. Recent data identifies the highest rates of overweight in the Adelaide Hills, Mt Barker, Woodside, Lobethal and Nairne, Burnside, Unley and North Adelaide. Where there is a distinction between advantage and disadvantage is with obesity, which is more prevalent in areas of disadvantage such as in the western suburbs and some hills areas. With the emergence of new areas of significance, there is a need to realign priorities and rethink the way overweight and obesity is addressed collectively.

It is clear that a multi-faceted, multi-sectoral and culturally appropriate approach to obesity prevention is the most effective mechanism for change across population groups. Working

across education, local councils, neighbourhoods, workplace and health to address the environmental and individual barriers to healthy eating and physical activity is an effective way to address risk factors. (Swinburne et.al, 2005: Flynn et.al 2005: Sanigorski et.al 2008; Sacks et.al 2009;WHO 2014)

Systems change in essential in addressing the complexities of obesity and behaviour change. Individual behaviours do not occur in isolation. It is important to strive toward a coordinated approach to managing overweight and obesity, avoiding continued loss of unsustainable prevention strategies. (Huang et al 2009)

Being overweight or obese is a significant risk factor for developing chronic disease such as type 2 diabetes, cardio vascular disease and some cancers. In addition, obesity contributes to the risk of conditions such as infertility, sleep apnoea, depression and anxiety along with impacted mobility due to osteoarthritis and joint stress on ankles, knees, hips and the lower back. (Dixon, 2009; Guh et.al 2009; Shiri et.al 2010; Chang 2010)

Overweight and obesity is a complex health issue with no one simple answer. Prevention and early intervention in children, prevention and careful management of obesity and body image in adolescence along with reducing lifestyle risk factors in adults will significantly improve individual and population health.

Central Adelaide and Hills Medicare Local - Healthy Weight

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Measuring Weight Status

Australia is ranked 4th in the world for overweight and obesity with 63% of Australian adults overweight or obese.

Council of Australian Governments COAG 2014

Australian national weight trends identify 63% of the adult population as being either overweight (35%) or obese (26%). In 2011-12, 1 in 4 adults were classified as obese compared to 1 in 5 in 1995. Childhood obesity rates have stabilised at 25.3% however, physical inactivity has increased across all age groups and self-reported fruit and vegetable consumption does not meet the national guidelines of two fruit and five vegetables. (Australian National Preventive Health Agency 2014)

Also on the rise at a national level, are the rates of adults in obese classes 2 and 3 which indicate a body mass index (BMI) of 35 kg/m? and over. These rates increased from 1 in 20 in 1995, to 1 in 10 in 2011-12. (Australian National Preventive Health Agency 2014)

Overweight and obesity is measured by calculating the body mass index (BMI) ((height) ? ? weight) (see Table 1)

Table 1 - BMI Measures (Australian Department of Health)

Classification

kg/m?

Underweight

< 18.5

Normal weight

18.5 - 24.9

Overweight

25 - 29.9

Obese

> 30

Class 1

30 - 34.9

Class 2

35 - 39.9

Class 3

> 40

While BMI is the most common measure for overweight or obesity it is not always as accurate as waist circumference as an indicator of risk. Consistent evidence now shows that a larger waist circumference is associated with greater risk for type 2 diabetes and cardio vascular disease as well as a higher mortality. (Burkhauser 2007; Jacobs et.al 2010; Chemichow et.al 2011; Ashwell et.al 2012) Waist circumference is a good indicator of total body fat and is also a useful predictor of visceral fat. (NHMRC 2013) (see Table 2)

6

Central Adelaide and Hills Medicare Local - Healthy Weight

Gender

Men Women

Table 2 - National Heart Foundation 2014

Your health is at risk if your waist circumference is

Your health is at high risk if your waist circumference is

Greater than 94cm

Greater than 102cm

Greater than 80cm

Greater than 88cm

World Health Organisation (WHO) 10 Facts on Obesity

Curbing the global obesity epidemic requires a populationbased multi-sectoral, multi-disciplinary, and culturally relevant approach.

World Health Organisation 2013

? Overweight and obesity are defined as "abnormal or excessive fat accumulation that may impair health"

? More than 1.4 billion adults were overweight in 2008, and more than half a billion were obese

? Globally, over 40 million preschool children were overweight in 2008

? Overweight and obesity are linked to more deaths worldwide than underweight

? For an individual, obesity is usually the result of an imbalance between calories consumed and calories expended

? Supportive environments and communities are fundamental in shaping peoples choices and preventing obesity

? Children's choices, diet and physical activity habits are influenced by their surrounding environment

? Eating a healthy diet can help prevent obesity

? Regular physical activity helps maintain a healthy body

? Curbing the global obesity epidemic requires a population-based multi-sectoral, multi-- disciplinary, and culturally relevant approach

Central Adelaide and Hills Medicare Local - Healthy Weight

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Impact of Overweight and Obesity

Overweight and obesity continues to be a major risk factor in preventable diseases.

Overweight and obesity continues to be a major risk factor in preventable diseases such as Type 2 diabetes, hypertension, stroke, heart disease and some cancers. Adults who are obese experience a significantly reduced life expectancy of 2-4 years for those with a BMI of 30-35 kg/m? and by 8-10 years for those with BMI 40 > kg/m?. (Fontaine 2003: ABS 2011)

Individuals who are obese and severely obese are more likely to experience poor quality of life, poor mobility, skin infections, depression or anxiety, joint pain, infertility, greater social isolation and unemployment. They require greater support and access to specialist health care, particularly, metabolic, endocrine, cardiac, orthopaedic and mental health services. Patients often present frequently to general practice and hospital outpatient services for long term care and management of chronic conditions.

Health services require specialist (bariatric) facilities to manage obese patients. Bariatric facilities include wider chairs in waiting rooms with greater weight load limits, wider examination couches, wider doorways for wheel chairs and walking aids, wider operating tables,

larger gowns and blood pressure cuffs. Other bariatric modifications include greater space around beds to provide adequate opportunity for staff to negotiate lifting machines and provide general patient care. With the increase in bariatric patient numbers Work Health Safety becomes a significant issue and needs to be addressed. (Hignett 2009: Robertson 2008)

Bariatric patients more often experience complications following procedures and post-surgical management resulting in longer hospital stays. (Christou et al 2004: Bamgbade et al 2007: Doyle et al 2009::Dorman et al 2012)

In addition, a number of studies have found a significant correlation between obesity and mental illness including depression, anxiety and more complex mental health disorders including binge eating disorder, body image and self-esteem issues. Mood disorders lead to a higher risk of overweight and obesity in children, adolescents and young women (Larsson et al 2002; McElroy et al 2003; Scott et al 2007)

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Central Adelaide and Hills Medicare Local - Healthy Weight

Central Adelaide and Hills Medicare Local - Healthy Weight

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