Obesity In Australia Research Articles

Healthcare utilisation and costs attributable to severe obesity in Australia

Healthcare utilisation and costs attributable to severe obesity in Australia

Projected progression of the prevalence of obesity in Australia

Several country-specific and global projections of the future obesity prevalence have been conducted. However, these projections are obtained by extrapolating past prevalence of obesity or distributions of body weight. More accurate would be to base estimates on the most recent measures of weight change. Using measures of overweight and obesity incidence from a national, longitudinal study, we estimated the future obesity prevalence in Australian adults. Participants were adults aged ≥25 years in 2000 participating in the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study (baseline 2000, follow-up 2005). In this population, approximately one-fifth of those with normal weight or overweight progressed to a higher weight category within 5 years. Between 2000 and 2025, the adult prevalence of normal weight was estimated to decrease from 40.6 to 28.1% and the prevalence of obesity to increase from 20.5 to 33.9%. By the time, those people aged 25–29 in 2000 reach 60–64 years, 22.1% will be normal weight, and 42.4% will be obese. On average, normal-weight females aged 25–29 years in 2000 will live another 56.2 years: 26.6 years with normal weight, 15.6 years with overweight, and 14.0 years with obesity. Normal-weight males aged 25–29 years in 2000 will live another 51.5 years: 21.6 years with normal weight, 21.1 years with overweight, and 8.8 years with obesity. If the rates of weight gain observed in the first 5 years of this decade are maintained, our findings suggest that normal-weight adults will constitute less than a third of the population by 2025, and the obesity prevalence will have increased by 65%.

Obesity in Australia: People, politics and prevention

Obesity in Australia: People, politics and prevention

Endoscopic Repair of Gastrocutaneous Fistula: 2010 Presidential Poster

Purpose: Laparoscopic adjustable gastric banding (LAGB) is one of the most frequently performed surgical procedures for the treatment of obesity in Australia, Europe, and the USA. It is considered to be the least invasive of bariatric procedures. Complications such as esophagitis, infection, gastric necrosis, band migration, and gastric fistulas have been reported. We report a case of gastrocutaneous fistula caused by laparoscopic band removal, which was successfully closed using endoclips and bioglue. A 58 year old woman with a history of LAGB performed 20 years previously presented with a foul discharge from the epigastric region two days after removal of her gastric lap band. Endoscopy identified a gastrocutaneous fistula initiating within the gastric antrum and four endoscopic clips were deployed to approximate the edges of the fistula (Figure 1). The epigastric discharge decreased transiently only to increase again. Interventional Radiology subsequently injected bioglue into the fistulous tract which did not resolve the drainage. A combined procedure with injection of bioglue and simultaneous endoclip placement was performed. Drainage ceased within 3 days and the patient has remained well. Bariatric surgery is increasingly utilized as a treatment for obesity. Complication rates over 10 years in two large studies were 20 to 50%; with serious complication rates of only 1.2%. Serious complication rates decline as experience increases, but cumulative long term complication rates increase as the length of follow up increases. Endoscopic clipping appears to be a safe technique for closure of gastrocutaneous fistulae. Our case is the first described of gastrocutaneous fistula closure utilizing bioglue and clipping after laparoscopic band removal.Figure 1: Left side: Gastrocutaneous fistula from endoscopy views. Top right: Endoclips approximating the gastrocutaneous fistula.

Framing the mother: childhood obesity, maternal responsibility and care

Currently in developed nations, childhood obesity is generating widespread concern and prompting social and institutional responses. Obesity is constructed as a broad public health crisis, but individuals are constructed as responsible for their own bodies and body sizes within this crisis. We are particularly interested in two aspects that focus on women as central to this phenomenon; the first is the imputation of maternal responsibility for the weight of children and the second is the role that specific fears about flesh and women's bodies play in how childhood obesity is represented. We analyse media representations of childhood obesity in Australia and draw out the discourses of maternal responsibility and the intertwining of mothers and children's bodies. We frame the childhood obesity crisis within a broader discussion of women, care and responsibility, suggesting that childhood obesity offers another embodied location to reinforce and extend women's roles and responsibilities as mothers, in response to changing patterns of work and care.

Trends in BMI, diet and lifestyle between 1976 and 2005 in North Sydney.

Although the prevalence of overweight and obesity in Australia has increased during the past 30 years, little is known about the dietary and behavioural antecedents of body mass index (BMI). We examined changes in mean BMI, diet, and other lifestyle behaviours between 1976 and 2005 and described the cross-sectional associations between these factors and BMI. A series of biennial biomedical surveys by Sydney Adventist Hospital from 1976 to 2005 allowed examination of BMI trends, while the selection of three surveys enabled detailed examination of likely dietary and lifestyle associations. Subjects included in this study were: 384 men and 338 women in 1976; 160 men and 146 women in 1978; 166 men and 141 women in 1980; 164 men and 142 women in 1982; 177 men and 13 women in 1984; 239 men and 227 women in 1986; 210 men and 225 women in 1988; 165 men and 148 women in 1990; 138 men and 167 women in 1992 and 270 men and 62 women in 2005. Height and weight were measured by hospital staff. Mean BMI increased in the early 1990s. Salt, coffee, cola, alcohol and meat consumption, dieting to lose weight and eating between meals were positively associated with BMI while physical activity, food variety, large breakfasts and consumption of spreads were negatively associated. Food consumption and daily activities have important associations with BMI, though their specific associations differ by sex. "Affluent" lifestyle patterns appear to contribute to higher BMI, while a more "prudent" lifestyle seems to protect from such increases.

Trends in anthropometry and severity of sleep‐disordered breathing over two decades of diagnostic sleep studies in an Australian adult sleep laboratory

To document trends in subject demographics, anthropometry and sleep disorder severity over 21 years of diagnostic sleep studies. A retrospective observational study of consecutive subjects undergoing initial diagnostic polysomnography for investigation of possible sleep disorders in a university-affiliated tertiary public metropolitan hospital in the Hunter New England region of New South Wales between 1987 and 2007. Body weight, body mass index (BMI) and severity of sleep-related breathing disorders (apnoea-hypopnoea index [AHI]). Between 1987 and 2007, 14 648 new diagnostic sleep studies were performed. The median age of subjects (51 years; interquartile range, 41-61 years) did not change over time and the proportion of women increased from 20% to 39%. Median body weight increased from 89 kg to 99 kg for men (11%) and from 73 kg to 85 kg for women (16%), equating to a yearly increase in median BMI of 0.15 kg/m(2) for men and 0.14 kg/m(2) for women. The proportion of subjects who were morbidly obese (BMI > or = 40) increased from 3% in 1987 to 16% in 2007. Median AHI progressively increased from 1992-1995 to 2004-2007 (from 6.5 events/h to 14.3 events/h; P < 0.001), indicating increasing disease severity. Over the same period, for every unit increase in BMI, AHI increased by 5.5 events/h for men and by 2.8 events/h for women. About 80% of the observed variance in AHI over this period was attributable to variance in BMI. There is a continuing trend towards increasing body weight and BMI in people undergoing diagnostic sleep studies. Our data do not support the hypothesis that increased accessibility to diagnostic services and increased awareness of sleep disorders are resulting in a decline in disease severity. These findings are consistent with the premise that worsening severity in sleep-disordered breathing is primarily attributable to increasing obesity.

Breakfast size is related to body mass index for men, but not women

The objective of this study was to examine the effect of self-reported breakfast size, daily eating, and other health habits on body mass index (BMI). We hypothesized that a consumption of a substantial breakfast compared with skipping or small breakfasts would be associated with lower BMI. Three independent, cross-sectional, screening surveys were conducted by Sydney Adventist Hospital in 1976, 1986, and 2005 in the surrounding community. The archived survey forms of 384 men and 338 women in 1976, 244 men and 229 women in 1986, and 270 men and 62 women in 2005 were randomly selected. Body mass index was determined from height and weight measured by hospital staff. The reported amount consumed at breakfast was one of several eating habits that predicted BMI for men but not women. It explained 5% to 6% of the variance in male BMI in all 3 years examined. As the reported breakfast amount increased, men's BMI decreased. Lifestyle confounders including vegetarianism and physical activity did not affect this relationship. However, the consumption of breakfast was significantly positively associated with consumption of cereals, bread, fruit, and spreads, while coffee consumption was significantly associated with smaller breakfasts or breakfast skipping. The consumption of relatively large breakfasts may influence BMI in men, and its promotion may help reduce the prevalence of obesity in Australia and elsewhere.

The cost of overweight and obesity in Australia

To assess and compare health care costs for normal-weight, overweight and obese Australians. Analysis of 5-year follow-up data from the Australian Diabetes, Obesity and Lifestyle study, collected in 2004-2005. Data were available for 6140 participants aged >or= 25 years at baseline. Direct health care cost, direct non-health care cost and government subsidies associated with overweight and obesity, defined by both body mass index (BMI) and waist circumference (WC). The annual total direct cost (health care and non-health care) per person increased from $1472 (95% CI, $1204-$1740) for those of normal weight to $2788 (95% CI, $2542-$3035) for the obese, however defined (by BMI, WC or both). In 2005, the total direct cost for Australians aged >or= 30 years was $6.5 billion (95% CI, $5.8-$7.3 billion) for overweight and $14.5 billion (95% CI, $13.2-$15.7 billion) for obesity. The total excess annual direct cost due to overweight and obesity (above the cost for normal-weight individuals) was $10.7 billion. Overweight and obese individuals also received $35.6 billion (95% CI, $33.4-$38.0 billion) in government subsidies. Comparing costs by weight change since 1999-2000, those who remained obese in 2004-2005 had the highest annual total direct cost. Cost was lower in overweight or obese people who lost weight or reduced WC compared with those who progressed to becoming, or remained, obese. The total annual direct cost of overweight and obesity in Australia in 2005 was $21 billion, substantially higher than previous estimates. There is financial incentive at both individual and societal levels for overweight and obese people to lose weight and/or reduce WC.

Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008

Popular media, health experts and researchers talk about a paediatric 'obesity epidemic' with exponentially increasing rates of obesity and overweight. However, some recent reports suggest that prevalence may have plateaued. This study examined trends in the prevalence of Australian childhood overweight and obesity since 1985. Specifically, it aimed to determine whether there have been (a) overall increases in average body mass index (BMI), (b) differential patterns of change within age groups and (c) increases in BMI within each weight-status category. Forty-one Australian studies of childhood weight status conducted between 1985 and 2008 were reviewed. The studies included data on 264 905 Australians aged 2-18 years, with raw data being available on 70 758 children (27%). Children were classified as overweight or obese based on BMI using the criteria of Cole et al. (BMJ, 2000). The prevalence estimates were adjusted for age and sex, and plotted against measurement year using Lowess plots and two-linear-segment models. Where raw data were available, BMI z-scores (UK 1990 standard) were plotted against measurement year for all children and children in various age groups. Lowess plots and two-linear-segment models were used to assess secular trends in BMI z-scores pre- and post-1996 within age, gender and weight-status categories. There has been a plateau, or only slight increase, in the percentage of boys and girls classified as overweight or obese, with almost no change over the last 10 years. In boys and girls, prevalence rates have settled around 21-25% for overweight and obesity together, and 5-6% for obesity alone. Similar trends were found for BMI z-scores. These patterns were fairly consistent across the age span. Within each weight-status category, average BMI has not increased. Although levels of Australian paediatric overweight remain high, the prevalence of overweight and obesity seems to have flattened and has not followed the anticipated exponential trajectory.

Health and mortality consequences of abdominal obesity: evidence from the AusDiab study

To provide an estimate of the morbidity and mortality resulting from abdominal overweight and obesity in the Australian population. Prospective, national, population-based study (the Australian Diabetes, Obesity and Lifestyle [AusDiab] study). 6072 men and women aged>or=25 years at study entry between May 1999 and December 2000, and aged<or=75 years, not pregnant and for whom there were waist circumference data at the follow-up survey between June 2004 and December 2005. Incident health outcomes (type 2 diabetes, hypertension, dyslipidaemia, the metabolic syndrome and cardiovascular diseases) at 5 years and mortality at 8 years. Comparison of outcome measures between those classified as abdominally overweight or obese and those with a normal waist circumference at baseline, and across quintiles of waist circumference, and (for mortality only) waist-to-hip ratio. Abdominal obesity was associated with odds ratios of between 2 and 5 for incident type 2 diabetes, dyslipidaemia, hypertension and the metabolic syndrome. The risk of myocardial infarction among obese participants was similarly increased in men (hazard ratio [HR], 2.75; 95% CI, 1.08-7.03), but not women (HR, 1.43; 95% CI, 0.37-5.50). Abdominal obesity-related population attributable fractions for these outcomes ranged from 13% to 47%, and were highest for type 2 diabetes. No significant associations were observed between all-cause mortality and increasing quintiles of abdominal obesity. Our findings confirm that abdominal obesity confers a considerably heightened risk for type 2 diabetes, the metabolic syndrome (as well as its components) and cardiovascular disease, and they provide important information that enables a more precise estimate of the burden of disease attributable to obesity in Australia.

Childhood obesity in Australia remains a widespread health concern that warrants population‐wide prevention programs

Childhood obesity in Australia remains a widespread health concern that warrants population‐wide prevention programs

Childhood obesity in Australia remains a widespread health concern that warrants population‐wide prevention programs

Childhood obesity in Australia remains a widespread health concern that warrants population‐wide prevention programs

Who will take responsibility for obesity in Australia?

Obesity is increasing throughout the world. With its strong links to many health problems, the costs associated with obesity will strain future health budgets. Urgent action on obesity is needed and this needs to extend beyond treatment. Diets may work in the short term but their long-term success is poor. Bariatric surgery can be effective, but it is expensive and its long-term effects are unknown. Common sense dictates that attention should be focused on preventing obesity. Experience with other public health measures, such as reducing cigarette smoking, indicates that government intervention will be essential for success in preventing obesity. In practice, however, governments are reluctant to take responsibility for this multi-factorial problem that is exacerbated by modern lifestyles because it involves standing up to vested interests. The real need is to take action to alter food consumption patterns, change transport options and reform urban planning (including housing and workplace environments), so that healthy choices are easy and physical activity returns to being a normal part of everyday life.

Childhood obesity in Australia remains a widespread health concern that warrants population‐wide prevention programs

Recent reports have suggested that the problem of childhood and adolescent obesity has been exaggerated in Australia, and that community-wide obesity prevention initiatives are not warranted; we argue that this is not an accurate reflection of the situation. Available data indicate that obesity affects 6%-8% of Australian schoolchildren, and that the proportion has continued to increase in recent years. Childhood and adolescent obesity is associated with a wide range of immediate health concerns, as well as increasing the risk of disease in adulthood. Some weight-related health problems are also found in overweight children. A range of strategies, including whole-of-community obesity prevention programs, will be required to tackle this problem. Concerns about disordered eating in children and adolescents should not preclude appropriate action on childhood obesity.

Estimating equations to correct self‐reported height and weight: implications for prevalence of overweight and obesity in Australia

To derive correction equations based on nationally representative data, for the error associated with self-reported height and weight and to apply these to recent estimates of overweight and obesity in the Australian adult population. Linear regression was used to derive correction equations to predict reporting error on height, weight and body mass index (BMI) for 8,435 adults, aged 20 and over, who had their height and weight accurately measured as participants of the 1995 National Nutrition Survey (NNS) and who had also supplied self-reported information within the 1995 National Health Survey (NHS). Evaluation of different correction algorithms suggests that simple correction equations for height and weight (each with one independent variable) are the most useful in the prediction of corrected prevalence of overweight and obesity. Applying these equations to nationally representative data suggests that the prevalence of overweight and obesity (BMI > or = 25) in Australia in 2004/05 was 66% compared with the value of 54% determined from self-reported data. We present a simple and reliable method for correcting true prevalence of overweight and obesity from self-reported data. In order to get realistic estimates of overweight and obesity in Australia, either measured height and weight data should be collected directly, or equations to correct for self report error should be used.

Being ‘fat’ in today’s world: a qualitative study of the lived experiences of people with obesity in Australia

To develop an in-depth picture of both lived experience of obesity and the impact of socio-cultural factors on people living with obesity. Qualitative methodology, utilizing in-depth semi-structured interviews with a community sample of obese adults (body mass index >or=30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included. Seventy-six individuals (aged 16-72) were interviewed. Most had struggled with their weight for most of their lives (n=45). Almost all had experienced stigma and discrimination in childhood (n=36), as adolescents (n=41) or as adults (n=72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of 'blame' against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight. There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.

Cancer adds further urgency to prioritising obesity control

he increasing incidence of obesity in Australia is set to impose a major additional cancer burden at a time when population ageing alone is projected to cause unprecedented growth in cancer incidence. While obesity is frequently associated with type 2 diabetes, hypertension, lipid abnormalities and death from heart disease and stroke, there is growing evidence for its role in causing cancer. A systematic review and meta-analysis, which included the Million Women Study, investigated the link between body mass index (BMI; calculated by dividing weight in kilograms by height in metres squared) and types of cancer. 1,2 In men, a 5k g/m 2 increase in BMI was strongly associated with adenocarcinoma of the oesophagus, and thyroid, colon and renal cancers, and in women with adenocarcinoma of the oesophagus, and endometrial, gallbladder and renal cancers. There were weaker associations for melanoma and rectal cancer in men, and postmenopausal breast, thyroid and colon cancer in women. Leukaemia, myeloma and Hodgkin disease were associated in both sexes. One postulated mechanism for the link between obesity and cancer is that chronic hyperinsulinaemia results in raised levels of free IGF-I (insulin-like growth factor), with higher mean concentrations in men compared with women. This alters the environment of cells to favour cancers developing. 3 In adipocytes, androgens are converted to oestradiol, and chronic hyperinsulinaemia also reduces sex-hormone-binding globulin, leaving more oestrogen to impact on oestrogen-sensitive tissues. Further, adiponectin, a protein hormone secreted by adipocytes, is an insulin-sensitising agent that is anti-angiogenic and antiinflammatory, inversely correlated with BMI, found in higher concentrations in men than in women and, in some studies, its level is inversely associated with cancer risk. 4 Obesity is linked to 11% of colon cancers and 9% of postmenopausal breast cancers 5 — both increasingly common tumour types in Australia as a result of population ageing. With high percentages of endometrial cancer (39%), oesophageal adenocarcinoma (37%), kidney cancer (25%) and gallbladder cancer (24%) attributed to obesity and overweight, these rarer cancers may become more common as Australia’s obese population ages. 5 The risk of an obesity-related increase in cancer burden in this country is amplified, with the link between BMI and cancer compounded by a 50% increase in the number of obese or overweight Australians over the past 15 years. An estimated 7.4 million Australians are obese or overweight, including a quarter of children aged between 5 and 16 years. 6

Overweight and obesity in Australia

Medical Journal of AustraliaVolume 188, Issue 11 p. 678-679 Letter Overweight and obesity in Australia Douglas G Travis, Corresponding Author Douglas G Travis President dgtravis@bigpond.net.au Australian Medical Association Victoria, Melbourne, VIC.Correspondence: dgtravis@bigpond.net.auSearch for more papers by this author Douglas G Travis, Corresponding Author Douglas G Travis President dgtravis@bigpond.net.au Australian Medical Association Victoria, Melbourne, VIC.Correspondence: dgtravis@bigpond.net.auSearch for more papers by this author First published: 02 June 2008 https://doi.org/10.5694/j.1326-5377.2008.tb01836.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume188, Issue11June 2008Pages 678-679 RelatedInformation

Overweight and obesity in Australia

Overweight and obesity in Australia