Call for More Countries to Recognize Obesity as Disease

Becky McCall

May 24, 2017

LISBON, Portugal — Experts at two recent endocrinology meetings are calling for more countries to formally recognize obesity as a disease in order to strengthen the fight against this epidemic of the 21st century.

Speakers at the European Congress of Endocrinology (ECE) 2017 and the recent European Congress on Obesity (ECO) 2017 both stressed the fact that recognition of obesity as a disease in Europe remains a much–needed step forward.

Interestingly, Portugal, where the ECE and ECO meetings were both held this year, is currently the only country in Europe that officially classifies obesity as a disease.

"One of the ways in which obesity can receive more attention from politicians, the general public, and healthcare professionals caring for obese patients is for obesity to become formally recognized as a disease. I think politicians should take note of this," said John Wass, MD, professor of endocrinology, University of Oxford, United Kingdom, and lead on obesity at the Royal College of Physicians, London, during a symposium on "childhood globesity" at the ECE meeting.

Obesity is currently recognized as a disease in the United States (by the American Medical Association in 2013), Canada (by the Canadian Medical Association, 2015), the World Health Organization, and most recently by the World Obesity Federation.

"I think this will help the situation in these unfortunate people, who have a genetic problem in 40% to 70% of cases, to be more readily understood and be able to more readily access treatment," added Dr Wass.

Earlier this month, the World Obesity Federation released a position statement recognizing obesity as a "chronic, relapsing, progressive disease process" and emphasized the need for immediate action to prevent and control the global obesity epidemic (Obes Rev. 2017; DOI:10.1111/obr.12551). The statement reflects the position taken by the WHO, back in 1997.

Speaking at the ECE symposium, Tim Lobstein, PhD, director of policy at the World Obesity Federation, stressed that voluntary initiatives would not be enough to bring about change.

"We have to do something at the regulatory level, at a national level." He explained that the cost of obesity is not included in the price of goods — for example, "food companies not having to pay for the cost of selling excess joules and the damage to teeth and weight gain. This justifies market intervention through regulation."

Canada's Experience: Governments Must Recognize Obesity Too

In a session at last week's ECO conference that was dedicated to lessons learned from countries where obesity has been classified as a disease, research was presented that looked at access to various weight-related interventions in Canada.

The Canadian Medical Association declared obesity as a disease requiring enhanced research, treatment, and prevention efforts in 2015.

But despite this, neither the federal government there nor any of the provincial/territorial governments have officially recognized this, which "has a trickle-down effect on access to treatment," said researchers.

And data presented at the meeting show this to be the case: many Canadians who need obesity treatment still have to pay out of pocket for care.

For example, less than 20% of the population with private drug insurance plans have access to antiobesity medication, and these treatments are not covered by any provincial drug-benefits programs, either.

Canadians are also still expected to pay out of pocket for supervised weight-management programs with meal replacement. And bariatric surgery is only available for 0.54% of severely obese individuals in need.

Epidemic Set to Reach Almost 5 Million Obese Children by 2025

In his talk at the ECE meeting, Dr Lobstein ran through a series of slides showing data attesting to the rising obesity in children globally, with a projected 16% overweight, including 5% clinically obese, by 2025. He also highlighted the steep socioeconomic gradient seen in prevalence of obesity from the least deprived to the most deprived children.

Given that obesity-related behavior in the individual child (or adult) is really about consuming more energy than is metabolized, it follows that if dietary patterns and activity are not modified the individual will put on weight, he said.

Overconsumption is made easy by environmental cues, including the price, availability, attractiveness, marketing, and advertising of processed food, and with respect to activity there are multiple inducements to sedentary behavior.

"The environment can be so unhelpful, as is the marketing that uses all the tricks of the trade, including cartoon characters, bright colors, chocolate, biscuits, snack foods, drinks, and especially child-oriented products," he commented.

His talk complemented two other presentations in the session that focused on the genetics of obesity and physical-activity/dietary-treatment programs.

With a nod to his copresenters, Dr Lobstein highlighted: "You can't treat an individual in isolation, because if you put them back into an obesogenic environment, the child will almost certainly put the weight back on."

Greater Transparency Needed From Governments

Dr Lobstein also stressed that the battle against obesity needs leadership and transparency from governments.

At the highest levels in many countries, there is political lobbying from the food industry, he explained.

For instance, in the US Congress, there are 100 senators and 435 representatives. By comparison, US Congress lobbyists total 327 food and beverage industries (in addition there are 256 for alcohol, and 174 for tobacco).

"There's a lot that goes on at government level that you and I have very little knowledge about. What goes on behind the scenes needs to be exposed and made clear that this is undermining our health and the health of our children," stressed Dr Lobstein.

"Lift the lid and increase transparency in how government links with food industry, lobbyists, party donors, and members of parliament," he added.

Mark Petticrew, PhD, professor of public health evaluation and director of the Public Health Research Consortium at the London School of Hygiene and Tropical Medicine, agreed. The evidence from many countries over many decades is clear, he said.

"Unhealthy commodity industries manipulate the evidence, distort the science, and work hard to mislead policymakers and the public. Often it's done covertly via think tanks and front groups who don't declare their funding or other conflicts of interest, which undermines evidence-based policymaking — and of course this is usually the industry's intention."

Echoing the thoughts of Dr Lobstein, he added that there is a need for "much greater transparency, closer public scrutiny, and greater…leadership from the public-health community in this area — not least because industry's back-door promotion of ineffective interventions is a significant threat to public health."

Drs Lobstein, Petticrew, and Wass have declared no relevant financial relationships.

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European Congress of Endocrinology 2017. May 21, 2017; Lisbon, Portugal. Symposium 4.

European Congress on Obesity 2017; May 18, 2017; Porto, Portugal. Session RS8.


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