MAIN SESSION
Obesity as a global risk factor
for cardiovascular disease
Stockholm, 5 September 2005 This main session was chaired by P.A. Poole-Wilson (London, UK) and E. Escobar (Santiago, Columbia) and was an initiative of both the European Society of Cardiology (ESC) and the World Heart Federation
(WHF). The first speaker, S. Rossner (Stockholm, Sweden) demonstrated that the prevalence of obesity has increased enormously during the past two decades. Countries with the highest prevalence of obesity are Greece and many east-European countries. However, no country is spared. Women show a higher percentage of obesity compared with men. Obesity leads to a spectrum of complications from type II diabetes mellitus (DM) to arthrosis. Obesity as a risk factor for many diseases is becoming a greater problem than smoking. A BMI of 35 is associated with an 80-fold increase in developing type II DM in women. The presenter gave ten reasons for emotional overeating: anxiety, anger, guilt, depression, frustration, boredom, failure, self-pity, joy and avoidance. Nine out of these ten reasons were negative and lead to a negative cycle. Men tend to stop eating when there is no more food and the main reasons to stop eating for women are tasteless food, others quit eating or they had their share. Prevention of obesity would be an ideal approach; however it is not easy. Prevention is difficult and slow because obesity has a multicausal aetiology, diet has a low compliance, the risk of obesity needs more evidence, and due to economic priorities and an information overload. Current approaches to prevent obesity are diet, increased physical exercise and behavioural modification. Sweden has introduced an Internet weight club that reaches people all over the world and offers help with their obesity problems. In summary, obesity is a global problem. Prevention is desirable, but difficult. Children form a new major concern. New technology and pharmacotherapy is in development and seems promising.
P.S. Monraats Leiden University Medical Center, Leiden E-mail: [email protected]
18
The second speaker, S.C. Smith (Chapel Hill, US) presented data on diet and nutrition in the Americas. Hypertension, smoking and high cholesterol are risk factors that have shown a decrease in prevalence in recent years. However, the prevalence of obesity has been rising since 1980. Obesity is defined as a BMI of 30 or more. Obesity is an important problem in America, parallel to DM. The prevalence has doubled in the last ten years, both in men and women. The risk of an event in type II DM patients without a prior MI is similar to the risk in nondiabetic patients with a prior MI. Obesity emerges as the leading cause of preventable deaths eclipsing smoking. Nowadays it has proven important to look beyond only LDL. Therefore, the term metabolic syndrome was introduced, which is defined by high fasting glucose, high blood pressure, low HDL cholesterol, high triglycerides, and abdominal obesity. The reasons for the increasing prevalence of obesity are a rise in the number ofeating occasions, sizes of meals have increased, people eat more away from home and meals contain more refined carbohydrates and calories. In children consumption offruit and soft drinks form an important problem. Since 1988 the prevalence ofoverweight children has doubled, especially in African Americans and Hispanics. A website (Mypyramid.com) has now been developed that provides recommendation on nutrition. K.S. Woo (Shatin, Hong Kong) presented the situation on obesity in China. People in China also show a strong increase in CAD, DM, hypertension and osteoarthritis. The prevalence of obesity in adults in mainland China was 10% in 1982 and is already 15% in 1992; Beijing also shows a strong increase in the prevalence of obesity. This increase was seen in both men and women. The risk ofstroke showed a positive relation with BMI. The modernisation in the Far East leads to changing habits and an increase in the
prevalence of obesity. Different food intake and job stress all cause more obesity. The overall prevalence in children aged 3 to 18 years is now 10.1% in Hong Kong. Obesity has an effect on endothelial function. Exercise next to a diet is more important in changing endothelial function than diet alone. Sustained improvement ofendothelial function can only be reached Netherlands Heart Journal, Volume
13, Supplemcnt 2, November 2005
C(PC
27th Congress of the European Society of Cardiology
with sustained exercise. In conclusion reducing BMI to a normal range (
Obesity as a global risk factor
for cardiovascular disease
Stockholm, 5 September 2005 This main session was chaired by P.A. Poole-Wilson (London, UK) and E. Escobar (Santiago, Columbia) and was an initiative of both the European Society of Cardiology (ESC) and the World Heart Federation
(WHF). The first speaker, S. Rossner (Stockholm, Sweden) demonstrated that the prevalence of obesity has increased enormously during the past two decades. Countries with the highest prevalence of obesity are Greece and many east-European countries. However, no country is spared. Women show a higher percentage of obesity compared with men. Obesity leads to a spectrum of complications from type II diabetes mellitus (DM) to arthrosis. Obesity as a risk factor for many diseases is becoming a greater problem than smoking. A BMI of 35 is associated with an 80-fold increase in developing type II DM in women. The presenter gave ten reasons for emotional overeating: anxiety, anger, guilt, depression, frustration, boredom, failure, self-pity, joy and avoidance. Nine out of these ten reasons were negative and lead to a negative cycle. Men tend to stop eating when there is no more food and the main reasons to stop eating for women are tasteless food, others quit eating or they had their share. Prevention of obesity would be an ideal approach; however it is not easy. Prevention is difficult and slow because obesity has a multicausal aetiology, diet has a low compliance, the risk of obesity needs more evidence, and due to economic priorities and an information overload. Current approaches to prevent obesity are diet, increased physical exercise and behavioural modification. Sweden has introduced an Internet weight club that reaches people all over the world and offers help with their obesity problems. In summary, obesity is a global problem. Prevention is desirable, but difficult. Children form a new major concern. New technology and pharmacotherapy is in development and seems promising.
P.S. Monraats Leiden University Medical Center, Leiden E-mail: [email protected]
18
The second speaker, S.C. Smith (Chapel Hill, US) presented data on diet and nutrition in the Americas. Hypertension, smoking and high cholesterol are risk factors that have shown a decrease in prevalence in recent years. However, the prevalence of obesity has been rising since 1980. Obesity is defined as a BMI of 30 or more. Obesity is an important problem in America, parallel to DM. The prevalence has doubled in the last ten years, both in men and women. The risk of an event in type II DM patients without a prior MI is similar to the risk in nondiabetic patients with a prior MI. Obesity emerges as the leading cause of preventable deaths eclipsing smoking. Nowadays it has proven important to look beyond only LDL. Therefore, the term metabolic syndrome was introduced, which is defined by high fasting glucose, high blood pressure, low HDL cholesterol, high triglycerides, and abdominal obesity. The reasons for the increasing prevalence of obesity are a rise in the number ofeating occasions, sizes of meals have increased, people eat more away from home and meals contain more refined carbohydrates and calories. In children consumption offruit and soft drinks form an important problem. Since 1988 the prevalence ofoverweight children has doubled, especially in African Americans and Hispanics. A website (Mypyramid.com) has now been developed that provides recommendation on nutrition. K.S. Woo (Shatin, Hong Kong) presented the situation on obesity in China. People in China also show a strong increase in CAD, DM, hypertension and osteoarthritis. The prevalence of obesity in adults in mainland China was 10% in 1982 and is already 15% in 1992; Beijing also shows a strong increase in the prevalence of obesity. This increase was seen in both men and women. The risk ofstroke showed a positive relation with BMI. The modernisation in the Far East leads to changing habits and an increase in the
prevalence of obesity. Different food intake and job stress all cause more obesity. The overall prevalence in children aged 3 to 18 years is now 10.1% in Hong Kong. Obesity has an effect on endothelial function. Exercise next to a diet is more important in changing endothelial function than diet alone. Sustained improvement ofendothelial function can only be reached Netherlands Heart Journal, Volume
13, Supplemcnt 2, November 2005
C(PC
27th Congress of the European Society of Cardiology
with sustained exercise. In conclusion reducing BMI to a normal range (
