Trends in Dietary and Social Habits

Trends in Dietary and Social Habits

If this is your first visit please to Introduction or alternatively to the Index of All Posts.

This post will provide an overview of the various trends in dietary and social habits that are generally attributed to the rise in Obesity and Chronic Diseases (or Non-Communicable Diseases – NCDs). If you have not read the previous post about NCDs please go here.

In part 1 we will discuss a number of dietary/exercise habits. I will not provide any suggestions yet on these. We will cover these in more detail in future posts.

This is likely to be the last post where we will deal with as many figures/charts in any given post. As discussed in the past, there is a temptation to start giving solutions around diet and exercise without understanding the underlying causes (perhaps this may be one of the reasons why so many attempts at dieting fail..). So please stay with me.

My take on the current thinking among most people ( and as proferred by media, governments and official agencies, doctors, scientists etc.) on Obesity and NCDs is as follows:

  1. People eat too many calories
  2. People eat too much fat
  3. People are eating too much red meat
  4. People do not eat enough vegetables or fruit
  5. People are sedentary and don’t undertake enough physical activity or exercise
  6. Most of the middle income and upper income people do not exert themselves physically at work

Now let us examine the various trends and habits using some facts and figures keeping mind the above. Very good stats are available for the US (courtesy US Dept of Agriculture, Centre for Disease Control and other Departments). I also would rather pick one country and examine the trends than using worldwide data since increases in some countries can be masked by other countries.

It is quite possible that within the US, there are sections of population whose habits can be masked by average data as used here in this post. I doubt this is a significant issue given that 2 out of 3 people are either Overweight or Obese. There isn’t much room to hide.

1. People are eating too many Calories

Let us look at a chart from USDA

The above chart shows the Nutrient and Food components available per Capita not actual consumption.

The second chart shows calories per capita and there is a general increase from 2100 to 2550-2600 in the last 40 years.

Observation: There is a general upward trend in average food energy available as well as the food energy consumed. An increase of approx 400-500 Kcal can be observed over 40-50 years.

2. People eat too much fat and too much saturated fat

Let us look at a few charts from USDA

Observation: This shows that the “Total Fat” consumption has been pretty flat over the past 50 years with some minor ups and downs (same with Protein too). The consumption of Carbogydrates (including grains, sugar and sweeteners) has increased by 20% or so. On average US population seems to consume 500g or half a kilo of Carbs every day.

The second chart shows breakdown the “Total Fat” into constituent components

The next 2 charts shows various categories or types of fat consumed.

Observations:

  • Consumption of Butter, Lard has decreased significantly
  • Consumption of a) Salad and Cooking oils and b) Shortening and c) Margarine has increased significantly (with margarine on downward trend again)
  • There has been a significant shift from Animal fats and oils to Vegetable oils
  • Consumption of “Saturated Fat” has decreased over the period and of “Mono” and “Poly” unsaturated fats have increased

Note: Shortenings are mostly hydrogenated or partially hydrogenated (including Trans Fats).

3. People eat too much Red Meat

Let us look at a chart showing consumption of Red Meat and Lean Meat (Chicken etc.)
Observation: This chart shows that Red Meat consumption has decreased and Lean Meat consumption (chicken) and Fish consumption (both of these are meant to be healthy per official guidelines) have increased.

4.. People do not eat enough vegetables or fruit

Let us look at a chart showing intake of Vegetables and Fruit

Observation: So contrary to popular belief, both Vegetable and Fruit intake in the US has been increasing on average (remember five a day !!)

5. People are sedentary and don’t undertake enough physical activity or exercise

Let us look at a chart showing percentage of people NOT undertaking any physical activity

There is also a lot of other evidence which shows that more people are undertaking leisure pursuits. The fitness industry is booming and approx 60 million US citizens are members of some form a fitness club/centre.

Observation: Average levels of physical activity have been increasing

6. Middle / upper income people do not exert themselves physically at work

Chart 1 shows the levels of Obesity by income group in Utah city in the US and Chart 2 shows the same for UK.

Observations

Obesity is as (or slightly more) common in the lower income group men and more common in lower group women who are supposed to undertake more physically demanding work on day to day basis.

7. Consumption of Sugar and Calorific Sweeteners

Observations: The above chart shows a 200% increase in the consumption of Calorific soft drinks in Gallons (which contributes to total calorific intake). In general, the intake of Cane and Beet sugar has come down and this has been offset by increase in HFCS (High Fructose Corn Syrup).

The average per capita consumption in the US of Sugar/Sweeteners is a massive 150 pounds per year.

Summary (US)

  1. There is an increase in total calories consumed in the US per person. This is most likely due to increase in consumption of Carbohydrates/Sweeteners and Cooking & Vegetable oils and not because of saturated fat consumption
  2. Consumption of Red Meat has decreased and Lean Meat and Fish (supposedly healthier alternatives) has increased
  3. Animal fat and saturated fat intake has decreased and total fat and protein consumption over the past 50 years has remained pretty much constant
  4. Fruit and Vegetable intake has increased
  5. Physical activity has increased
  6. Lower income people has more (slightly) Obesity than upper income people

I believe the above observations are contrary to popular beliefs in most instances. If the official dietary and associated guidelines are correct then Obesity and incidence of Chronic Diseases should be falling rapidly.

But we know that is not the truth. Despite all the above the Obesity levels are going through the roof and incidence of Chronic Diseases is increasing (see previous post)

Part 2 discusses a few more trends and habits

Go to Part 2

 

 

Why should we care about Obesity or Weight ( and Chronic Diseases) – Part 2

Continued from Part 1 (read Part 1 first !!)

3. Obesity

Obesity is preventable !!

Obesity and being Overweight is seen as one of the top 3 risk factors and is associated with a host of NCDs (Diabetes, Hypertension, Heart Disease, Stroke and even Cancers etc.) But Obesity is a risk factor but not an input factor (like Tobacco or Alcohol).

The official line is that Obesity is caused by Diet, physical inactivity (and stress by some).

We will be talking about a lot about these in the next posts but first an overview of Obesity and Overweight.

3.1 Obesity is common, serious and costly (CDC – US)

  • More than one-third of U.S. adults (35.7%) are obese
  • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death
  • In 2008, medical costs associated with obesity were estimated at $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight

3.2 Worldwide (WHO)

  • Worldwide obesity has more than doubled since 1980.
  • In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.
  • 65% of the world’s population live in countries where overweight and obesity kills more people than underweight.
  • More than 40 million children under the age of five were overweight in 2010.

3.3 Definitions – Overweight and obesity?

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

Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).

The WHO definition is:

  • a BMI greater than or equal to 25 is overweight
  • a BMI greater than or equal to 30 is obesity

BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide (crude measure – my words) because it may not correspond to the same degree of fatness in different individuals.

So let us look at a few figures – first prevalence and then some trends

Adult Obesity Prevalence
Adult Overweight Prevalence
Adult Obesity Trends
Child Obesity Trends

The following charts show the Relative Risk of mortality by BMI (for Men and Women)

Relative Risk (RR) the relative odds of a person (who has the incidence) dying compared to a normal or control adult. If RR is 2 it means the Relative odds of a person dying are 2:1 or 200% of normal or 100% more than normal.

Some Observations

  1. In developed countries approximately 2 in 3 adults will be either Overweight or Obese
  2. In developed countries 1 in 3 children are going to be Overweight or Obese
  3. Both Obesity and Overweight are on an upward trend both in adults and children
  4. The Relative Risk graphs are for Caucasians. For Asians, my personal feeling is that the graph needs to be shifted to the LEFT by 2 or 3 units because research indicates that the incidence of NCDs occur in Asians at a smaller BMI compared to Caucasians (so a 25 BMI in Whites is comparable to a 22 BMI in Asians)
  5. Though Obesity and Overweight increase the risk, being Underweight also increases the odds. This has anecdotally been confirmed by a few of my doctor friends who reckon between an underweight and an overweight person, the underweight person is more at risk (relatively) in surgical procedures etc.

 4 Costs related to NCDs

I am taking some liberty with the word costs here and the term will be used to cover a number of aspects – economic and social

4.1 Individual Costs

  1. Chronic diseases introduce restrictions to some extent on mobility and flexibility of the individual (some if not all) who is suffering from them. This meant these people cannot undertake leisure pursuits (Holiday travel, Cinema/Theatre, Visiting friends/family etc.
  2. They may also have to give up certain job opportunities because of these restrictions. Estimates indicate that some of the individuals may have to forego anywhere between 25 to 50% of their earnings due to Chronic Diseases
  3. Some NCDs would be associated with some degree of pain and suffering
  4. NCDs will make it harder for insurance to be obtained (medical and life) or make it more expensive. In countries where Universal healthcare is provided this may not be immediately a problem for the individual and the family but it will cost the society at large quite a bit
  5. There are costs associated with medical care
  6. There is an opportunity cost for the time spent in visiting physicians, labs etc.
  7. Perhaps the most understated of all is the lingering feeling of the “(negatively) perceived health” which may change the outlook on life and change some of the decisions taken or avoid risks (which otherwise may have been taken) – moving jobs, house, country, starting own firm etc.

4.2 Family or Care-Giver Costs

Not so well understood is the impact on family / friends or the caregiver

  1. The family member or the care giver may have to forego or significantly alter the jobs that they accept and undertake. This translates into potential lost earning (so in effect this may be a double loss of income)
  2. The mobility and flexibility of the family member or caregiver may be restricted

I quote the following extract from the abstract of a study undertaken in Netherlands (rather academic but I hope it drives home the point)

“A chronic physical disease not only has direct consequences for the chronically ill person but can also distort the life of the healthy partner. The most prevailing consequences, experienced by more than half of the partners, were related to personal life strain and intrinsic rewards. An impact on social relations and financial situation was reported by 20% of the partners. Partners of patients with cancer, musculoskeletal, or digestive disorders are more vulnerable for the consequences of the chronic disease. The impact on female partners is higher for all 4 impact factors. The findings make clear that living with a chronically ill person has an impact on the partner’s life that goes beyond the consequences of caregiving”

4.3 Social Costs

Perhaps the biggest cost of all is the loss of economic output and treatment costs to the society at large.

The following charts from a Milken Institute study show the impact (US)

 

These numbers are massive!

If we extrapolate across the entire global (given the global population is approx 20-25 times US population) but assuming an average of a fifth of US costs, we are talking about approximately USD 5 trillion.

Assuming an adult population of approx 250 million in the USA in 2015, the avoidable costs are approx USD 1300 per capita.

It has been written in the popular media that as at 2008, General Motors (the car maker in the US) is contributing the equivalent of  approximately USD 1,500 for every car manufactured towards healthcare costs for existing employees and retirees.

We may be oblivious to the above numbers but in the end citizens and consumers have to pay for it in terms of higher taxes (to government) or higher prices (for goods) as the spiralling health-care costs will hit every country, every government, every society and every company.

We have a moral and ethical duty to avoid these where we can apart from an individual and family interest.

5. Diabetes

The incidence of diabetes is on the rise as well as the incidence of pre-diabetes. Though there is a lot of awareness now a days and testing done for diabetes, I believe it is critical to identify the people who are a in a pre-diabetic condition. There are some studies that show that damage to health and internal organs tends to be done many years before a person becomes diabetic.

I also believe strongly that metabolic disorders are one of the main causes for NCDs (including Hypertension, Obesity, Cancers, Heart Disease and Stroke).

Pre-diabetes is also loosely associated to Impaired Fasting Glucose, Impaired Glucose Tolerance, Insulin Resistance etc.

I will write more about this in a later post but want to give some stats around diabetes (from International Diabetes Federation) for now.

As can be seen below, China and India will lead the world (and already leading) in Diabetes

  1. One in 10 people globally will suffer from the silent killer, Diabetes and one in six will suffer from Diabetes + Pre-Diabetes
  2. Half of people with Diabetes are undiagnosed
  3. Number of people with Diabetes is increasing in every Country

We will talk about one last thing before I sign-off for now.

6. Morbidity and Mortality

The following will provide another perspective as to why we need to remain vigilant and healthy and do our bit to manage our health

The first picture shows the trend in life expectancy for some countries which has been on a consistent upward path for a while.

(I read an interesting quote somewhere that says the most significant contributors to increased life expectancy are increased sanitation, food hygiene, better homes, vaccination and emergency response care as opposed to medication and surgical procedures).

But what is not known commonly is the fact that a significant amount of people are spending the last few years with NCDs (and people are starting to acquire this at an younger age now). Thanks to advances in diagnostics, emergency medical care..

So the full human potential is not available in the later years. I wanted to show this graphically but cannot find one so put a loose one together.

What this graph is intended to portray is the fact that the last 10 to 20 years of a lot of people’s lives are being spent currently with reduced ability and perhaps dependent on medication (another interesting anectode is that in US people take anywhere between 6 and 12 pills a day for multiple Chronic Diseases on average in later years).

By living a healthy life we can aim to steepen the green curve so it starts falling at 70 or so and not 50.

I know it has been a rather long post and so thanks for staying with me (assuming you have come this far).

But let me end on a positive note. A lot of the NCDs are modifiable and avoidable and that is what we will discuss in the forthcoming posts.

Thanks and have a good day.

The next post will talk about trends in various social and dietary habits. Pls click here.

 

Why should we care about Obesity or Weight (and Chronic Diseases)

Why should we care about Obesity or Weight (and Chronic Diseases)?

If this is your first visit pls go to the Introduction

I was tempted to start writing about Diet, Exercise, Blood Sugar and Insulin but then thought the best way for people to appreciate why we need to lead a healthy lifestyle is to give a rounded perspective on the key lifestyle factors that are responsible for chronic diseases and the impact/burden they can cause.

This post will contain a lot of facts/figures/graphs mostly published by WHO, International Diabetes Federation and Milken Group. It is a rather long post I am afraid so please be patient and stay with me.

Why should we care about Diet and Lifestyle changes?

There is strong evidence to suggest that the following are the TOP 3 factors responsible for a number of Chronic Diseases

1. Consumption of Tobacco related products

2. Consumption of excess Alcohol

3. Being Obese / Overweight

I would actually modify the last point to “Having excessive Blood Glucose and Insulin levels” (more details in a later post)

You might think – “Can I not take a few pills (like statins or anti-diabetic medication) and get on with it”.  

Perhaps but not always because

“Chronic diseases impose a considerable burden on you, your family and friends and the society at large”

Most of us intuitively know that Chronic Diseases will impact us to some extent but perhaps not all of us know the full potential impact.

Let us get into a little more detail here.

First of all what are Chronic Diseases?

In general, diseases are grouped into 3 categories by healthcare groups

1. Communicable diseases (infectious diseases like pneumonia etc.)

2. Injuries (accidents etc.)

3. Non-Communicable diseases (also called NCDs)

I will loosely refer to the 3rd group above as “Chronic Diseases” (we will refer to this interchangeably as NCDs or Chronic Diseases from now on).

There are many but the following eight are mainly referred to:  

Hypertension, HeartDisease, Cancers, Stroke, Diabetes, Mental Disorders and Pulmonary (Lung/Respiratory) and musculoskeletal conditions (arthritis, osteoporosis and joint disorders).

Chronic Diseases that impact us over a longer duration and slower progression.

This blog will only be covering items highlighted in bold.

 Facts (per WHO)

 1. A total of 57 million deaths occurred in the world during 2008; 36 million (63%) due to NCDs.

2. The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million)

3. Diabetes caused an additional 1.3 million deaths

The following chart gives an idea about the incidence of NCDs

The following table shows the top 10 leading causes of death in High and Middle Income countries 

 As can be seen, a good 70% of the risks are related to the top 3 risk factors.

All 3 (Tobacco, Alcohol and Overweight/Obese (diet/exercise)) are seen as modifiable risk factors (meaning they can be treated or controlled – often at an individual level through better choices e.g. smoking and excess alcohol consumption – whereas air pollution is not necessarily as modifiable).

Healthcare groups and Health authorities calculate something known as a DALY (Disability adjusted Life Years) – essentially a common currency measure of one lost year of “healthy” life.

It is calculated as 

DALYs for a disease or injury are calculated as the sum of the years of life lost due to premature mortality (YLL) in the popula¬tion and the years lost due to disability (YLD) for incident cases of the disease or injury.

The following table gives DALYs associated with NCDs (WHO)

 

Let us get into the Top 3 into a little more detail

1. Tobacco consumption

The following charts show tobacco use across countries in 2005 and separately its impact.

In fact, tobacco use has been falling in the developed countries and increasing in the developing countries (mostly Russia, Eastern Europe and China).

Health authorities in the UK estimate that up to 50% of decrease in NCDs can be directly attributed to decrease in tobacco consumption. But given the usage in the past, the effects are lingering on and are likely to be felt for a few more years.

 We will not be discussing about Tobacco consumption in any further posts but my key message is 

“There is no nutritional or physiological need for tobacco and it is proven (this is one of the two or three things that all healthcare groups agree on) to cause NCDs. So better give up now. No reason not do so”.

2. Excessive alcohol consumption (WHO)

Alcohol contributes to more than 60 types of disease and injury, although it can also decrease the risk of coronary heart disease, stroke and diabetes. There is wide variation in alcohol consumption across regions. Consumption levels in some Eastern Euro¬pean countries are around 2.5 times higher than the global average of 6.2 litres of pure alcohol per year. With the exception of a few countries, the lowest consumption levels are in Africa and the Eastern Mediterranean. 

The net effect of alcohol on cardiovascular disease in older people may be protective in regions where alcohol is consumed lightly to moderately in a regular fashion without binge drinking. Ischaemic stroke deaths, for example, would be 11% higher in high-income countries if no one drank alcohol. However, even in high-income countries, although the net impact on cardiovascular disease is beneficial, the overall impact of alcohol on the burden of disease is harmful.

The official recommendation in the UK for Alcohol consumption (also called “Recommended Safe Limits of Alcohol) are 

• Men should drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week.

• Women should drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week.

• Pregnant women. Advice from the Department of Health states that … “pregnant women or women trying to conceive should not drink alcohol at all. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk

For those of you who need details are what 1 Unit means – One unit of alcohol is 10 ml (1 cl) by volume, or 8 g by weight, of pure alcohol. To calculate number of units:

Multiply the alcohol %age for the drink by the volume of drink and divide by 10

One unit of alcohol is about equal to:

  • half a pint of ordinary strength beer, lager or cider (3-4% alcohol by volume); or
  • a small pub measure (25 ml) of spirits (40% alcohol by volume); or
  • a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume)

There are one and a half units of alcohol in:

  • a small glass (125 ml) of ordinary strength wine (12% alcohol by volume); or
  • a standard pub measure (35 ml) of spirits (40% alcohol by volume)

(from Recommended Safe Limits for Alcohol – Patient.co.uk )

                                                                                         Continued in part 2

 

 

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