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The objective of this study was to develop cut-off values and evaluate the accuracy of body mass index (BMI) in the definition of obesity in the Thai population. A cross-sectional, epidemiologic study in 340 men and 507 women aged 50 +/- 16 yr (mean +/- SD; range: 20-84 yr), were sampled by stratified clustering sampling method. Body composition, including percentage body fat (%BF), was measured by dual energy X-ray absorptiometry (GE Lunar Corp, Madison, WI). BMI was obtained by dividing weight (in kg) by height (in m2). The "golden standard "for defining obesity was %BF > or =25% in men and %BF > or =35% in women. The %BF-based prevalence of obesity in men and women was 18.8% and 39.5%, respectively. However, using the BMI cut-off of > or =30, only 2.9% of men and 8.9% of women were classified as obese. In the cubic regression model, BMI was a significant predictor of %BF, such that in men a BMI of 27 kg/m2 would predict a %BF of 25%, and in women a BMI of 25 kg/m2 would correspond to a %BF of 35%. The area under the receiver operating characteristic curve for BMI was approximately 0.87 (95% CI: 0.82-0.92) and 0.86 (95% CI: 0.83-0.90) in men and women, respectively. In conclusion, for the Thai population, BMI is a reasonably useful indicator of obesity; however, the cut-off values of BMI for diagnosing obesity should be lowered to 27 kg/m2 in men and 25 kg/m2 in women.
Asia Pac J Clin Nutr 2006
PMID:Defining obesity by body mass index in the Thai population: an epidemiologic study. 1683 20

The Asia-Pacific region contributes more than half the world population and includes some of the world richest and most developed countries alongside some of the world's poorest and least developed countries. Despite persisting levels of underweight in some countries, overweight and obesity have become a major public health concern for almost the entire region. Official levels of obesity ranges from over 80 % of the entire adult population of some Pacific nations to less than 3 % in the Philippines. There remains much debate about the most appropriate BMI cut points to define the overweight and obesity in Asian populations and thus the true levels of obesity are likely to higher in most Asian countries. The causes of this rapid increase in overweight within the region are likely to be complex. However, rapid development leading to a shift away from traditional diets to an eating pattern containing more high fat, high energy foods and drinks together with a significant reduction in physical activity through shifts in occupational and recreational patterns is likely to be major contributors to the problem. This weight gain has been associated with an epidemic of chronic diseases such diabetes, cardiovascular disease and cancers which is threatening to overwhelm the health care systems of less developed countries and results in an enormous, health, social and economic burden to the region.
Asia Pac J Clin Nutr 2006
PMID:Epidemiology and health impact of obesity: an Asia Pacific perspective. 1692 56

The global obesity pandemic has been well-documented and widely discussed by the public, the media, health officials, the food industry and academic researchers. While the problem is widely recognised, the potential solutions are far less clear. There is only limited evidence to guide decisions as to how best to manage obesity in individuals and in populations. While widely viewed as a clinical and public health problem in developed countries, it is now clear that many developing countries also have to grapple with this problem or face the crippling healthcare costs resulting from obesity-related morbidity. There is also abundant evidence that obesity is socio-economically distributed. In developed countries persons of lower socio-economic position are more likely to be affected, while in developing countries, it is often those of higher socio-economic position who are overweight or obese. The aim of this paper is to briefly review the evidence that links socio-economic position and obesity, to discuss what is known about underlying mechanisms, and to consider the role of social, physical, policy and cultural environments in explaining the relationships between socio-economic position and obesity. We introduce the concept of 'resilience' as a potential theoretical construct to guide research efforts aimed at understanding how some socio-economically disadvantaged individuals manage to avoid obesity. We conclude by considering an agenda to guide future research and programs focused on understanding and reducing obesity among those of low socio-economic position.
Asia Pac J Clin Nutr 2006
PMID:Socio-economic factors in obesity: a case of slim chance in a fat world? 1692 57

Obesity is a global and preventable epidemic with serious health consequences for individuals worldwide, particularly for those in developed countries. The World Health Organization estimates that at least 1 billion people worldwide are overweight, and 300 million are obese. Research has demonstrated that weight losses as small as 7-10% of initial weight produce significant health benefits. These include reducing the risk of heart disease, stroke, and some cancers. This paper describes behavioural methods to modify maladaptive eating and activity habits to achieve a healthy weight. It also examines the short- and long-term results of behavioural treatment for obesity and methods to improve long-term weight control.
Asia Pac J Clin Nutr 2006
PMID:State of the science: behavioural treatment of obesity. 1692 59

Diet, exercise, behavioural support and for some obese individuals, pharmacotherapy, represent the set of lifestyle factors necessary for effective management of obesity. An on-going challenge in the prevention, treatment and management of obesity is to arm health professionals in particular, with the necessary knowledge and understanding and time to engage in meaningful weight management counseling. Despite the many barriers to effective management such as lack of relevant education in nutrition and physical activity, perceived patient non-compliance, perceived inability to change patient behaviours, and the cost of specialist behavioural support, there is increasing evidence of the value of behaviour modification techniques to both dietary and exercise counseling, particularly when focusing on current behaviour. Behavioural counseling addresses the barriers to compliance with diet and physical activity goals and also equips the individual with practical strategies and motivation to be more self-responsible. Commonly employed behavioural interventions include stimulus control, reinforcement techniques, self-monitoring, behavioural contracting, and social support programs. This paper addresses one of the key behavioural components in the treatment and management of obesity - physical activity. Higher levels of energy expenditure through increased physical activity are central to successful weight loss and long-term weight maintenance. The specific value derived from physical activity in the context of weight management for the overweight and obese is in large part associated with an appreciation of the role of both physical activity promotion and exercise prescription.
Asia Pac J Clin Nutr 2006
PMID:State of the science: a focus on physical activity. 1692 60

The global obesity epidemic is causing much concern among health professionals due to the major health risks associated with obesity. Excess weight, particularly abdominal obesity, elevates multiple cardiovascular and metabolic risk factors, including Type 2 diabetes, hypertension, dyslipidaemia and cardiovascular disease. Thus obesity management goals should encompass health improvement and cardiometabolic risk reduction as well as weight loss. While lifestyle and diet modification form the basis of all effective strategies for weight reduction, some individuals may need additional intervention. About one in four people with BMI >27 kg/m(2) (those who have weight-related morbidity and who have been unsuccessful losing weight in standard ways) may require adjunctive therapy such as pharmacotherapy, very low energy diets/meal replacements, or bariatric surgery. This review focuses on appropriate use of pharmacotherapy for obesity and cardiometabolic risk. Sibutramine and orlistat are currently available for use in Australia. Rimonabant has been approved for use in the European Union, and is being considered for regulatory approval in the USA and Australia. The efficacy and safety of these three agents are examined. In addition, several novel pharmacotherapy agents in development are discussed.
Asia Pac J Clin Nutr 2006
PMID:Emerging pharmacotherapy for treating obesity and associated cardiometabolic risk. 1692 62

Obesity is a chronic relapsing disease requiring a similar long term approach to management as that of other chronic conditions. Management needs to be multifaceted aiming to achieve sustainable behavioural changes to physical activity and diet to alter the patient and family microenvironment to one favouring better weight control. A range of therapies including specific diets, calorie counting, meal replacements, very low calorie diets, pharmacotherapy, intragastric balloons and surgery can provide very useful additional benefit. Use of these should be guided by the extent of weight loss required to reduce BMI to an acceptable level with regard to the patient's ethnicity, risk and comorbid conditions. Patients need to set goals that are optimistic, but realistic, and understand the benefits of sustained modest weight loss and the likelihood of weight regain requiring repeat episodes of weight loss. Practitioners need to be informed about the efficacy of current therapies and their combinations to enhance choice of suitable methods for achieving the optimal weight loss required by the patient. They will also need to anticipate trigger points for renewed periods of weight loss in the event of weight regain, as relapse is likely but not a reason for abandoning the battle.
Asia Pac J Clin Nutr 2006
PMID:Combined strategies in the management of obesity. 1692 63

The Weight Management Code of Practice Australia provides a framework for the diversity of players in the weight management industry. In the current worldwide epidemic of overweight and obesity, the potential for the industry to 'do the right thing', comply with the Weight Management Code of Practice Australia, and assist people with long-term weight loss, is far reaching. The Weight Management Code of Practice in Australia is managed by the Weight Management Council Australia Limited. There are many players in the weight management industry, not all will be eligible for membership of Council but there are many who could be eligible. Ideally, all centres, programs and professionals in the industry should have in place business practices and regimens that comply with the Code. The more members of this industry who are willing to modify their business practices and regimens to comply with the Code, the more accountable the industry will be and the better the products and services will be for consumers. The Code has the potential to be implemented in other countries. The Australian Weight Management Code of Practice can be a model for the rest of the world to establish standards by which this huge industry can be governed.
Asia Pac J Clin Nutr 2006
PMID:The Weight Management Code of Practice of Australia as a framework for the commercial weight management sector. 1692 64

Over the past twenty years, obesity has become a major topic of concern. In particular, this paper estimates that the number of obese adults has risen from around 2.0 million in 1992/93 to about 3.1 million in 2005. With the prevalence of obesity on the rise, the associated economic cost is also increasing significantly. The annual cost of obesity in 1992-93 was estimated at around 840 million dollars per year. This paper shows that the annual cost of obesity in Australia could now be as high as 1,721 million dollars. With the cost of obesity rising, the ability to assess and compare alternative programs for reducing the current prevalence of obesity is very important. This involves weighing up the costs and benefits of the different strategies. So, in addition to providing an updated estimate of the potential cost of obesity in Australia, this paper uses a weight management program to illustrate the methodology used in assessing alternative intervention programs. For illustration, the expected benefit per enrollment in a weight loss program was calculated at 690 dollars. The associated cost of the program was 202 dollars per enrollment. It should be noted that the estimate of the cost is more precise than the broad estimate of the average benefit. Nevertheless, the average benefit outweighs the cost by an overwhelming ratio of over three-to-one. So a more detailed analysis is unlikely to overturn the general conclusion that the average benefit clearly outweighs the cost, even if the precise ratio of benefits to costs is likely to change.
Asia Pac J Clin Nutr 2006
PMID:A cost benefit analysis of weight management strategies. 1692 65

There is a pressing need in Australia and other countries to develop systems for monitoring secular trends in childhood obesity and related behavioural and environmental determinants. Energy from foods and beverages consumed at school is an accessible indicator of children's eating patterns and we have developed a school food checklist (SFC) to measure this. The SFC records the number of serves and source (home, canteen, vending machine) of 20 food and beverage categories. This study aims to assess the accuracy and to calibrate the SFC by comparing it to a weighed record (WR) and to evaluate inter-recorder reliability. Participants were 910 primary school children aged 5 to 12 years from a rural township in Victoria, Australia. WR were collected from a non-random sub-sample of 106 and a second sub-sample (n=46) had intake measured twice using the SFC to assess inter-recorder reliability. Mean energy values were 2992 kJ +/- 924 and 3008 kJ +/- 952 for the SFC and WR respectively and the correlation coefficient was strong (Pearson r = 0.77). The mean difference between the WR and SFC methods was 15 kJ (95% CI, -107 kJ to 138 kJ) and the limits of agreement (+2 standard deviations) were +/- 1270 kJ. The SFC overestimated the energy/serve of breads and fruit drinks and under-estimated energy/serve from fat spreads, biscuits/crackers, muesli/fruit bars and fruit. Inter-recorder reliability was good (kappa 0.51). The SFC was designed to measure energy from food and beverages in schools. It has good accuracy and reliability and the revised version should further improve accuracy of the instrument.
Asia Pac J Clin Nutr 2006
PMID:Calibration and reliability of a school food checklist: a new tool for assessing school food and beverage consumption. 1707 61


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