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

 

 

3 Comments

  • Srikanth

    Ramki, Please accept my sincere appreciation on starting the blog . You blog is detailed , informative and educational to me.
    How much do you think stress at work and home contributes to NCD ? The working culture has changed with meeting deadlines , targets and long hours at work have not helped the work life balance in the present day.I think this is a major cause for seeing patients in 40 s in my practice who come with a cardiac event .
    Look forward for your comments

    • Ramki

      Dear Srikanth

      Thanks for your comments. Nice to see that the Blog is useful.

      Yes – you are correct. Stress is seem as one of the major contributors to NCDs (some if not all)

      I will cover Stress in detail in a future post but would like to give you an idea in a few pointers here.

      1. I believe Humans have evolved to manage stress extremely well but on an acute basis not on a chronic basis (which is perhaps what you are referring to)
      2. As you will see in future posts – Obesity, Diabetes etc. and some of the other disorders are more hormonal disturbances and metabolic disorders than anything else
      3. Stress is meant to play havoc with the hormonal mechanisms involving Cortisol, Adrenal and Serotonin etc. e.g. – Insomnia (as a result of stress) is being mentioned quite a bit these days in the media
      4. Malcolm Kendrick is his book “The Great Cholesterol Con” (which I highly recommend) talks about the Hypothalamic-pituitary-adrenal (HPA) Axis and its impact on Cardio-Vascular-Diseases (CVD)
      5. Malcolm Kendrick also has an interesting theory – that stress related to dislocation (and migration to other places) is a major problem and can cause CVD. There is evidence to suggest that he is perhaps right – CVD is (was) high in populations that have been mass evacuated during Second World War, in Glasgow (as part of a government move), very high in Japanese who have moved to the US, Polynesian Islanders moving to New Zealand and Asians in the US and UK.

      The Blog is titled Diet, Exercise and Yoga and the third element Yoga is meant to provide some thoughts and suggestions around managing stress (apart from other things). But I will try to do so in a non-denominational or non-religious manner (meaning you don’t need to know Hinduism or Buddhism to do whatever is suggested).

      Have a good day

      Ramki

  • Amal El-sharkawy

    Health education and changing life style are the corner stones for preventing and treating diabetes . More efforts should be done by doctors towards the community. I am a family practitioner working in primary health care center in kuwait, with special interest in diabetes.kuwait proved to be in the top list countries worldwide in diabetes and obesity so you can imagine how much these informations is going to help us in our practice thanks alot

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