Editorial
Obesity, the epidemic that CAN be stopped? Obesity is associated with ill-health and is the leading preventable cause of death worldwide. In 2013, the American Medical Association recognized obesity as a disease in its own right (Tucker 2014). For healthcare professionals working in the acute or community setting, obesity is commonly encountered and the majority of the work relates to treating and managing the related chronic conditions such as diabetes, heart disease and stroke, respiratory and renal disease and sleep apnoea. The main causes of obesity and these associated illnesses are predominantly lifestyle related: diets high in saturated fats and dense calories, lack of physical activity, cigarette smoking, excess alcohol and stress (NHS Choices 2011). It is not unusual for patients with obesity to have several of these long-term conditions. Obesity is seen as a ‘modern’ phenomenon but there is evidence that obesity has been around for thousands of years starting with the Neolithic era 8000–5500 BC (Bray 2009). In terms of medical literature describing the condition, one text ‘Cursory remarks on corpulence or obesity’ provides an excellent historical overview of the life-style related affliction. It was written by a surgeon William Wadd and published in 1816. The ill-effects of obesity are presented in a case study of a 30-year old: ‘Indeed inactivity, somnolency, depression of spirits and inaptitude for study, were symptoms suffered to produce anxiety.’ Although the language is archaic, the signs and symptoms in those with obesity are familiar and unsurprisingly, the ‘cure’ of his ills, also familiar: ‘by an abstentious mode of living, and a vegetable diet, he became lighter, more capable of mental exertion and in every aspect improved his health.’ Unlike 200 years ago, we now have sophisticated modelling methods to predict future healthcare issues and the modelling on obesity linked to poor health behaviour is quite startling. Wang et al. predict an extra 11 million people with obesity in the UK by 2030 accounting for nearly half the population (26 million) (Wang et al. 2011). In terms of healthcare needs, they have equated this obesity pandemic with additional cases of diabetes (6–85 million cases), heart disease and stroke (57–73 million cases) and new cases of cancer
© 2014 John Wiley & Sons Ltd
(492,000–669,000). The cost of treating these largely preventable conditions is estimated to be £19–2 billion per year. Wadd’s solution Wadd 1816 was quite simple: eat less and exercise more. Despite our technological advancements over the past two centuries, we appear to be no closer to solving the age-old problem of obesity. The advice healthcare professionals impart to with lifestyle related conditions would be: stop smoking, increase physical activity, lose weight and eat healthily. It could be said that we don’t need ‘miracle drugs’ but good healthy living. And this is where the humble healthcare professional can assist. Healthcare changes led by a nurse or similar practitioner can assess, monitor and manage those with chronic diseases and there is now a growing body of work on the effectiveness of healthcare intervention programmes. The detrimental effects of sitting all day has also been identified (Van der Ploeg et al. 2012). Simple advice such as establishing standing desks for those with office jobs and encouraging sedentary people to use stairs instead of lifts and regularly stand and walk during their working day. If we can encourage exercise, improve patients’ diets and assist individuals to stop smoking, the benefits to patients are profound with weight loss, reduced blood pressure and plasma cholesterol, controlled diabetes, reduction/prevention in cardiovascular diseases and cancers. The simple advice of eat less and exercise more and the role of nurses in managing obesity by these means has recently been highlighted (Deck et al. 2014). However, there is a need to acknowledge the local environments and the issue of socioeconomic deprivation when tackling chronic conditions (Lee & Carrington 2007, Swinburn et al. 2011). The issue of obesity is not just an individual fight but a societal one that is affecting high and low income countries alike. The moral of the cursory remarks nearly 200 years after it was published is telling with the case study. . .’ whenever he resumed his former habits, his complaints returned in full force. ‘The advice is simple and succinct ‘keep the eyes open and the mouth shut’. It may really be that simple but the proof will be in NOT eating the pudding and getting off the sofa. Geraldine Lee
1971
Editorial
Geraldine Lee Lecturer Florence Nightingale Faculty of Nursing & Midwifery, Kings College London, UK E-mail: [email protected]
References Bray G.A. (2009) History of obesity. In Obesity: Science to Practice (Williams G. & Fruhbeck G., eds), J Wiley & Sons, London, pp. 3–18. Deck K.M., Haney B., Fitzpatrick C.F., Phillips S.J. & Tiso S.M. (2014) Prescription for obesity: eat less and move more. Is it really that simple? Open Journal of Nursing 4, 656–662. Lee G. & Carrington M. (2007) Tackling heart disease and poverty. Nursing and Health Sciences 9(4), 290–294. NHS Choices (2011) Half of UK obese by 2030. Retrieved from http://www.nhs.uk/news/2011/08August/Pages/half-of-uk-predictedto-be-obese-by-2030.aspx on 20 October 2014.
1972
Swinburn B.A., Sacks G., Hall K.D., McPherson K., Finegood D.T., Moodie M.L. & Gortmaker S.L. (2011) The global obesity pandemic: shaped by global drivers and local environments. The Lancet 378(9793), 804–814. Tucker M.E. (2014) With Obesity Now Defined as Illness, AACE Takes Next Steps. Retrieved from http://www.medscape.com/ viewarticle/822573 on 26 October 2014. Van der Ploeg H., Chey T., Korda R.J., Banks E. & Baumann A. (2012) Sitting time and all-cause mortality risk in 222 497 Australian adults. Archives of Internal Medicine 172(6), 494–500. Wadd W. (1816) Cursory Remarks on Corpulence; or Obesity Considered as a Disease with a Critical Examination of Ancient and Modern Opinions Relative to the Causes and Cure. J Callow, London. Wang Y.C., McPherson K., Marsh T., Gortmaker S.L. & Brown M. (2011) Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet 378(9793), 815–825.
© 2014 John Wiley & Sons Ltd
Obesity, the epidemic that CAN be stopped? Obesity is associated with ill-health and is the leading preventable cause of death worldwide. In 2013, the American Medical Association recognized obesity as a disease in its own right (Tucker 2014). For healthcare professionals working in the acute or community setting, obesity is commonly encountered and the majority of the work relates to treating and managing the related chronic conditions such as diabetes, heart disease and stroke, respiratory and renal disease and sleep apnoea. The main causes of obesity and these associated illnesses are predominantly lifestyle related: diets high in saturated fats and dense calories, lack of physical activity, cigarette smoking, excess alcohol and stress (NHS Choices 2011). It is not unusual for patients with obesity to have several of these long-term conditions. Obesity is seen as a ‘modern’ phenomenon but there is evidence that obesity has been around for thousands of years starting with the Neolithic era 8000–5500 BC (Bray 2009). In terms of medical literature describing the condition, one text ‘Cursory remarks on corpulence or obesity’ provides an excellent historical overview of the life-style related affliction. It was written by a surgeon William Wadd and published in 1816. The ill-effects of obesity are presented in a case study of a 30-year old: ‘Indeed inactivity, somnolency, depression of spirits and inaptitude for study, were symptoms suffered to produce anxiety.’ Although the language is archaic, the signs and symptoms in those with obesity are familiar and unsurprisingly, the ‘cure’ of his ills, also familiar: ‘by an abstentious mode of living, and a vegetable diet, he became lighter, more capable of mental exertion and in every aspect improved his health.’ Unlike 200 years ago, we now have sophisticated modelling methods to predict future healthcare issues and the modelling on obesity linked to poor health behaviour is quite startling. Wang et al. predict an extra 11 million people with obesity in the UK by 2030 accounting for nearly half the population (26 million) (Wang et al. 2011). In terms of healthcare needs, they have equated this obesity pandemic with additional cases of diabetes (6–85 million cases), heart disease and stroke (57–73 million cases) and new cases of cancer
© 2014 John Wiley & Sons Ltd
(492,000–669,000). The cost of treating these largely preventable conditions is estimated to be £19–2 billion per year. Wadd’s solution Wadd 1816 was quite simple: eat less and exercise more. Despite our technological advancements over the past two centuries, we appear to be no closer to solving the age-old problem of obesity. The advice healthcare professionals impart to with lifestyle related conditions would be: stop smoking, increase physical activity, lose weight and eat healthily. It could be said that we don’t need ‘miracle drugs’ but good healthy living. And this is where the humble healthcare professional can assist. Healthcare changes led by a nurse or similar practitioner can assess, monitor and manage those with chronic diseases and there is now a growing body of work on the effectiveness of healthcare intervention programmes. The detrimental effects of sitting all day has also been identified (Van der Ploeg et al. 2012). Simple advice such as establishing standing desks for those with office jobs and encouraging sedentary people to use stairs instead of lifts and regularly stand and walk during their working day. If we can encourage exercise, improve patients’ diets and assist individuals to stop smoking, the benefits to patients are profound with weight loss, reduced blood pressure and plasma cholesterol, controlled diabetes, reduction/prevention in cardiovascular diseases and cancers. The simple advice of eat less and exercise more and the role of nurses in managing obesity by these means has recently been highlighted (Deck et al. 2014). However, there is a need to acknowledge the local environments and the issue of socioeconomic deprivation when tackling chronic conditions (Lee & Carrington 2007, Swinburn et al. 2011). The issue of obesity is not just an individual fight but a societal one that is affecting high and low income countries alike. The moral of the cursory remarks nearly 200 years after it was published is telling with the case study. . .’ whenever he resumed his former habits, his complaints returned in full force. ‘The advice is simple and succinct ‘keep the eyes open and the mouth shut’. It may really be that simple but the proof will be in NOT eating the pudding and getting off the sofa. Geraldine Lee
1971
Editorial
Geraldine Lee Lecturer Florence Nightingale Faculty of Nursing & Midwifery, Kings College London, UK E-mail: [email protected]
References Bray G.A. (2009) History of obesity. In Obesity: Science to Practice (Williams G. & Fruhbeck G., eds), J Wiley & Sons, London, pp. 3–18. Deck K.M., Haney B., Fitzpatrick C.F., Phillips S.J. & Tiso S.M. (2014) Prescription for obesity: eat less and move more. Is it really that simple? Open Journal of Nursing 4, 656–662. Lee G. & Carrington M. (2007) Tackling heart disease and poverty. Nursing and Health Sciences 9(4), 290–294. NHS Choices (2011) Half of UK obese by 2030. Retrieved from http://www.nhs.uk/news/2011/08August/Pages/half-of-uk-predictedto-be-obese-by-2030.aspx on 20 October 2014.
1972
Swinburn B.A., Sacks G., Hall K.D., McPherson K., Finegood D.T., Moodie M.L. & Gortmaker S.L. (2011) The global obesity pandemic: shaped by global drivers and local environments. The Lancet 378(9793), 804–814. Tucker M.E. (2014) With Obesity Now Defined as Illness, AACE Takes Next Steps. Retrieved from http://www.medscape.com/ viewarticle/822573 on 26 October 2014. Van der Ploeg H., Chey T., Korda R.J., Banks E. & Baumann A. (2012) Sitting time and all-cause mortality risk in 222 497 Australian adults. Archives of Internal Medicine 172(6), 494–500. Wadd W. (1816) Cursory Remarks on Corpulence; or Obesity Considered as a Disease with a Critical Examination of Ancient and Modern Opinions Relative to the Causes and Cure. J Callow, London. Wang Y.C., McPherson K., Marsh T., Gortmaker S.L. & Brown M. (2011) Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet 378(9793), 815–825.
© 2014 John Wiley & Sons Ltd
