Do overweight and obesity prevalence rates converge in Europe?

We exploit recently published data to evaluate the long-run evolution of overweight and obesity rates among European economies between 1975 and 2016. We find that overweight rates for both females and males converge in Europe. In particular, the convergence is driven by the nations in the EU. This fact is consistent with food patterns as well as trade, agricultural, and health policies that are common among EU members. Across our model specifications, the steady-state average overweight rate ranges between 60% and 77% for European female individuals and lies above 82% for their male counterparts. Confidence intervals suggest that such gender differences are statistically significant. In the EU, the point estimates of these rates are 62% and 91%, respectively. Obesity prevalence in Europe would reach long-term rates of 39% and 45% for females and males respectively, whereas these rates would be similar in the EU (approximately 28%).     

Where can obesity management policy make the largest impact? Evaluating sub-populations through a microsimulation approach

Background: There is a critical need to focus limited resources on sub-groups of patients with obesity where we expect the largest return on investment. This paper identifies patient sub-groups where an investment may result in larger positive economic and health outcomes.

Methods: The baseline population with obesity was derived from a public survey database and divided into sub-populations defined by demographics and disease status. In 2016, a validated model was used to simulate the incidence of diabetes, absenteeism, and direct medical cost in five care settings. Research findings were derived from the difference in population outcomes with and without weight loss over 15 years. Modeled weight loss scenarios included initial 5% or 12% reduction in body mass index followed by a gradual weight regain. Additional simulations were conducted to show alternative outcomes from different time courses and maintenance scenarios.

Results: Univariate analyses showed that age 45–64, pre-diabetes, female, or obesity class III are independently predictive of larger savings. After considering the correlation between these factors, multivariate analyses projected young females with obesity class I as the optimal sub-group to control obesity-related medical expenditures. In contrast, the population aged 20–35 with obesity class III will yield the best health outcomes. Also, the sub-group aged 45–54 with obesity class I will produce the biggest productivity improvement. Each additional year of weight loss maintained showed increased financial benefits.

Conclusions: This paper studied the heterogeneity between many sub-populations affected by obesity and recommended different priorities for decision-makers in economic, productivity, and health realms.     

Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States

Abstract

Objective:

This study estimated the economic burden of obesity-related comorbidities (ORCs) in the US, at both the person and population levels.     

Tackling the new materialities: Modern food and counter-movements in Ecuador

Faced with rising non-communicable diseases (NCDs), the Ecuadorian Government has proposed a model health program targeting individual and environmental level determinants. Drawing on cosmopolitan social theory, the experiences of counter-movements and concerns over food policy, the authors explore how mass pesticide poisoning and obesity can be viewed as the product of the ‘success’ of the modernization policy as well as a specific range of global phenomena configuring civic activity and policy situations. Through the study of NCDs as an emergent social field, the authors examine historical developments and heterogeneity in peoples’ practices for insights on more practical and effective public policy responses. The rise of the consumer–citizen in counter-movements represents a paradoxical, but promising dynamic capable of reconstituting economies, culture, and society. In Ecuador, social action appears to be a largely neglected and under-utilized resource for tackling NCDs and perhaps other highly pressing and seemingly intractable food policy concerns.     

Cultural resistance to fast‐food consumption? A study of youth in North Eastern Thailand

Increased intake of saturated fat and refined sugars underlies much of the problem of emerging obesity all over the world. This includes middle-income countries like Thailand, which are subject to successful marketing of Western fast foods especially targeted at adolescents. In this study we explore the socio-cultural influences on fast-food intake for non-metropolitan (rural and urban) adolescents in North East Thailand (Isan). Our questionnaire sample included 634 persons aged 15-19 years who are in and out of formal schooling and who are randomly representing upper, central and lower Isan. All were asked about their knowledge of fast-food health risks and their attitudes towards, and consumption of, fast food and traditional food. As well, we used several focus groups to obtain qualitative data to complement the information derived from the questionnaire. Some three quarters of sampled youth were aware that fast food causes obesity and half knew of the link to heart disease. About half consumed fast food regularly, induced by the appeal of 'modern' lifestyles, social events and marketing, as well as by the convenience, speed and taste. Nearly two-thirds thought that local foods should be more popular and these beliefs were more likely to be found among children from educated and urban families. Local foods already constitute a cultural resistance to fast-food uptake. We propose several methods to boost this resistance and protect the youth of Thailand against fast food and its many adverse health consequences.     

奥利司他与二甲双胍联用对肥胖型2型糖尿病患者的疗效及对体重指数、胰岛β细胞功能指数、胰岛素抵抗指数水平的影响

目的探讨奥利司他与二甲双胍联用对肥胖型2型糖尿病(T2DM)患者的疗效及对体重指数(BMI)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)水平的影响。方法选取2018年2月至2020年2月大连市第四人民医院收治的肥胖型T2DM患者83例作为研究对象,按随机数字表法分为联合组41例与对照组42例。对照组予以盐酸二甲双胍片治疗,联合组则在对照组的基础上增用奥利司他胶囊治疗。两组进行为期3个月的治疗,比较两组临床疗效,治疗前后BMI、HOMA-β、HOMA-IR水平,微炎症状态变化情况,药物不良反应发生情况。结果治疗后联合组空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)水平明显低于对照组(P<0.05)。治疗后联合组BMI以及HOMA-IR明显低于对照组,而HOMA-β明显高于对照组,差异有统计学意义(P<0.05)。治疗后联合组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平明显低于对照组(P<0.05)。两组头痛、低血糖、腹泻以及胃肠胀气发生率比较差异无统计学意义(P>0.05)。结论奥利司他与...     

Barriers and potential facilitators to the implementation of government policies on front-of-pack food labeling and restriction of unhealthy food advertising in Thailand

Thailand is experiencing an increasing burden of obesity and diet-related non-communicable diseases. The Thai government has responded by developing a number of policies to protect and promote healthy eating. In particular, in 2008, the Thai Government passed a regulation to restrict unhealthy radio and television food advertising to children (RTA). In the following year, a voluntary front-of-pack nutrition labeling policy to promote those products that had reduced their sugar, fat and/or sodium content by at least 25% (25% SFS) was passed. However, the extent of implementation of both of these policies has been poor to date. The aim of this study was to identify barriers and potential facilitators to the implementation of both the RTA and 25% SFS policies. Semi-structured interviews were conducted with 28 participants holding senior positions in government, industry and civil society organizations closely involved in the implementation of these policies. The interview data were analyzed using the thematic framework analysis approach. The major barriers to policy implementation perceived by participants were a lack of a monitoring and evaluation system, a lack of organization knowledge regarding skills required for implementation, poor governance system, lack of funding and resources, lack of effective multi-sectoral platforms, influence of the food industry, lack of clear policy content, organizational culture and structure, and changes in policy priorities. Factors that potentially facilitated implementation of these policies, as identified by participants, were policy being compatible to implementer’s context, individual support from government officials, good financial management mechanisms, inter-organization networks, and personal motivation to implementing policy. The successful implementation of policies to create healthy food environments in Thailand will likely require attention towards improving the capacity and authority of government agencies, infrastructure to support multi-sectoral platforms and inter-organizational networks, and adequate resources.     

“I am so ashamed of my body”: Obese guests’ experiences in hotels

The hotel experience of obese people is examined in this exploratory study, addressing a segment of the population thus far ignored by hospitality scholars. The findings are based on 32 semi-structured interviews with American obese men and women living in the Virginia area. The results revealed that almost all participants’ hotel experience was affected by constraints arising from the physical environment, but more so, from other guests gazing at them. The thematic analysis of the experiences of obese hotel guests suggest that two relevant spaces in the hotel can be distinguished: the guest room and the public space accessible to all guests. These spaces differ in the difficulties experienced as well as the emotions that evoked among those guests. Overall, the findings indicate that people’s body and its image is crucial for the understanding of the hotel experience, as lookism is a critical barrier obese people face.     

“I have to go the extra mile”. How fat female employees manage their stigmatized identity at work

This study explores how fat female employees engage in identity work to manage stigmatizing expectations grounded in healthism and obesity discourse that construct fat people as unhealthy, stupid, unprofessional, and lazy. We interviewed 22 women who self-identified as fat, full-figured or obese. Our analysis reveals how our participants engaged in identity work strategies in order to project a professional appearance and highlight their work performances. Many strategies reproduced dominant notions about fatness such as ‘smartening up’, ‘distracting’, ‘hiding’, ‘concealing’, ‘humour’, ‘compensating’, ‘explaining’ and ‘defensive Othering’. Yet at times some participants also used strategies that challenged dominant discourses about size, such as ‘flaunting’, ‘irony’ and ‘self-acceptance’. The identity work strategies our participants engaged in were not just narrative; many involved what they did with their bodies. We therefore argue the need for further theorizing embodied identity work, specifically with regards to how size matters in the context of employment.