Obesity has been recognised as an important contributing factor in the development of various diseases, but comparative data on this condition are limited. We therefore aimed to identify and discuss current epidemiological data on the prevalence of obesity in European countries. We identified relevant published studies by means of a MEDLINE search (1990–2008) supplemented by information obtained from regulatory agencies. We only included surveys that used direct measures of weight and height and were representative of each country's overall population. In Europe, the prevalence of obesity (body mass index ≥ 30 kg/m2) in men ranged from 4.0% to 28.3% and in women from 6.2% to 36.5%. We observed considerable geographic variation, with prevalence rates in Central, Eastern, and Southern Europe being higher than those in Western and Northern Europe. In Europe, obesity has reached epidemic proportions. The data presented in our review emphasise the need for effective therapeutic and preventive strategies.

http://ernaehrungsdenkwerkstatt.de/fileadmin/user_upload/EDWText/TextElemente/PHN-Texte/Adipositas-UEbergewicht/Obesity_Prevalence_Europe_Berghoefer_BMC_Public_Health_8_200_2008.pdf

Obesity prevalence from a European perspective: a systematic review

Until quite recently, there has been a widespread belief in the popular media and scientific literature that the prevalence of childhood obesity is rapidly increasing However, high quality evidence has emerged from several countries suggesting that the rise in the prevalence has slowed appreciably, or even plateaued This review brings together such data from nine countries (Australia, China, England, France, Netherlands, New Zealand, Sweden, Switzerland and USA), with data from 467,294 children aged 2-19 years The mean unweighted rate of change in prevalence of overweight and obesity was +000 (049)% per year across all age ×sex groups and all countries between 1995 and 2008 For overweight alone, the figure was +001 (056)%, and for obesity alone -001 (024)% Rates of change differed by sex, age, socioeconomic status and ethnicity While the prevalence of overweight and obesity appears to be stabilizing at different levels in different countries, it remains high, and a significant public health issue Possible reasons for the apparent flattening are hypothesised

Evidence that the prevalence of childhood overweight is plateauing: Data from nine countries

Numerous techniques are available to estimate body composition and fat distribution, and the method to use will depend on the aim of the study, economic resources, availability, time, and sample size. 6–8 Multi-compartment models, such as underwater weighing, dilution techniques and dual-energy X-ray absorptiometry (DXA) are all reliable methods to obtain accurate measures of total body fat. However, because of their costs in terms of time andmoney, thesemethods are not practical in large epidemiological studies and for routine clinical use. In these situations, body mass index (BMI) is often used and assumed to represent the degree of body fat. BMI, however, does not distinguish between fat mass and lean (non-fat) mass. For example, well-trained body builders have a very low percentage of body fat, but their BMI may be in the overweight range because of their large lean (muscle) mass. In addition, in the elderly and non-Caucasian populations, the relationship between BMI and body fatness may be different as compared with younger Caucasian populations. 9–14 Another potential limitation of the BMI is that the distribution of fat over the body is not captured. Many studies have shown that an abdominal fat distribution, independent of overall obesity, is associated with metabolic disturbances and increased disease risk. 15–23 An increased abdominal fat accumulation is largely caused by the accumulation of visceral (or intraabdominal) fat (for distinction of these fat depots, see Figure 1). Owing tometabolic differences between different fat depots, they differ in their role of predicting metabolic disturbances and diseases. Table 1 summarizes the capability of the most commonly used methods to assess total adiposity and fat distribution. Abdominal obesity is usually assessed by the easily measured waist circumference, the waist-to-hip circumference ratio (WHR), or the less-commonly used sagittal abdominal diameter (SAD). By the use of sophisticated imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), different fat depots can be distinguished at the waist level, and it has been shown that in particular the visceral fat depot is associated with metabolic disease risk. 24–30 Because the SAD or waist circumference alone are more strongly correlated with visceral fat than the WHR, 31–35 guidelines tend to focus onwaist circumference to estimate disease risk as suggested by Lean et al. 36 These widely used cut-points (i.e. 102 cm formen and 88 cm for women) were originally based on a replacement of the classification of BMI, 36 but other cut-points have also been suggested on the basis of relationships with visceral fat area. 37

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What aspects of body fat are particularly hazardous and how do we measure them

This review examines sex differences in health and survival, with a focus on the Nordic countries. There is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women: the so-called male-female health-survival paradox. A number of proposed explanations for this paradox are rooted in biological, social, and psychological interpretations. It is likely to be due to multiple causes that include fundamental biological differences between the sexes such as genetic factors, immune system responses, hormones, and disease patterns. Behavioral differences such as risk-taking and reluctance to seek and comply with medical treatment may also play a role. Another consideration is that part of the difference may be due to methodological challenges, such as selective non-participation and under-reporting of health problems, and delayed seeking of treatment by men. The Nordic countries provide a unique opportunity for such studies, as they have good-quality data in their national health registers, which cover the whole population, and a long tradition of high participation rates in surveys.

Men: good health and high mortality. Sex differences in health and aging*

Pulmonary function measures reflect respiratory health and are used in the diagnosis of chronic obstructive pulmonary disease. We tested genome-wide association with forced expiratory volume in 1 second and the ratio of forced expiratory volume in 1 second to forced vital capacity in 48,201 individuals of European ancestry with follow up of the top associations in up to an additional 46,411 individuals. We identified new regions showing association (combined P < 5 × 10(-8)) with pulmonary function in or near MFAP2, TGFB2, HDAC4, RARB, MECOM (also known as EVI1), SPATA9, ARMC2, NCR3, ZKSCAN3, CDC123, C10orf11, LRP1, CCDC38, MMP15, CFDP1 and KCNE2. Identification of these 16 new loci may provide insight into the molecular mechanisms regulating pulmonary function and into molecular targets for future therapy to alleviate reduced lung function.

/pdf/genome-wide-association-and-large-scale-follow-up-identifies-539xx570iv.pdf

Genome-wide association and large-scale follow up identifies 16 new loci influencing lung function

OBJECTIVE: To study secular trends in overweight and selected correlates in men and women in Goteborg, Sweden. DESIGN: Cross-sequential population-based surveys. SUBJECTS: A total of 2931 female and 2691 male subjects aged 25-64 y participated in WHO MONICA surveys (1985, 1990, 1995) and the INTERGENE study (2002). MEASUREMENTS: Body mass index (BMI), waist-to-hip ratio (WHR), prevalence of overweight (BMI> or =25 kg/m(2)), and obesity (BMI> or =30 kg/m(2)). RESULTS: Mean body weight increased by 3.3 kg for women and 5 kg for men, with a significant upward trend for BMI in men but not women over the 17-y observation period. The prevalence of overweight and obesity increased significantly in both sexes over the period. The largest increase was observed in men, and in women aged 25-34 y. In 2002, the prevalence of overweight was 38% in women and 58% in men, and the prevalence of obesity was 11% in women and 15% in men. No significant secular trends were observed for WHR, but there was an upward trend in prevalence of WHR>0.85 in women. A decreased prevalence of smoking in both sexes was observed together with an increase in reported leisure time physical activity. No significant secular trends were observed in rates of self-reported diabetes, although the risk of diabetes attributable to obesity was 24%. CONCLUSION: The results indicate that 25-64-y-olds in the recent survey were more overweight and obese than earlier studied MONICA participants. The increase in BMI was more pronounced in men while abdominal obesity increased principally in women. Although obesity and overweight are clearly important risk factors for type 2 diabetes, the number of diabetics remains low and any secular increase is not yet apparent.

Georg Lappas

Papers

Trends in overweight and obesity from 1985 to 2002 in Göteborg, West Sweden.