CAN OBESITY BE PREVENTED? GABRIEL V. JASUL, JR., MD, FPCP, FPSEM Clinical Associate Professor, UP College of Medicine PASOO President and PSEM Past President “ KNOWING IS NOT ENOUGH; WE MUST APPLY. WILLING IS NOT ENOUGH; WE MUST DO.” This quotation from German writer and statesman, Johann Wolfgang von Goethe, somewhat reflects the current challenges in obesity management and prevention in many countries. Despite the better understanding of the multifactorial nature of obesity and the improved strategies in its management, obesity prevalence rates continue to be high. There are recent reports of some plateauing, or even mild decrease, of overweight rates among children and women in some developed countries. However, the general trend, especially for severe obesity and for men, remains to be on the upward trend. It is estimated that in the US and Canada, 6-7 out of 10 individuals are overweight or obese. In the Philippines, the recent estimate is that 3 of 10 Filipinos are overweight or obese. With all its known complications, obesity thus continues to be a major public health concern globally. Addressing obesity as a public health problem requires public health solutions emphasizing multilevel approaches. Current strategies to treat obesity appear to be inadequate and therefore, it would be rational to adhere to the concept that the best treatment for obesity is PREVENTION. So, can obesity be prevented? There is a growing body of literature supporting the usefulness of preventive strategies in obesity. Definitely, YES, OBESITY CAN BE PREVENTED. The real challenge is finding and implementing the right and the effective interventions. Ecological Levels of Intervention Interventions for a multifactorial condition such as obesity can be categorized according to so-called ecological levels, i.e., downstream, upstream and midstream. Briefly, downstream factors involve individual decision-making that influences personal preferences and habits. Upstream factors, on the other hand, are at the community and national levels that may include infrastructure and community planning that may influence lifestyle (diet, physical activity) in the population. Midstream factors are the remaining components that operate in homes, schools or workplaces. Much of current obesity interventions are downstream, focused on attaining individual desirable weight and often have limited success, are short-term and characterized by relapse to previous weight status. They are also reach fewer numbers of the target population and are hence not cost-effective. Midstream interventions, often family-based, offer some success especially in childhood obesity because they alter the home environment making it conducive for changes in food consumption and physical activity for extended periods of time. Upstream interventions are becoming the preferred solutions for population-based weight management because they influence policies shaping environment conducive for healthier choices for many people. Obesity prevention would be more successful if multilevel interventions, combining programs and approaches from these ecological levels, are utilized. Community-based intervention studies on obesity prevention programs in both adults and children have been reported across continents. Much of the evidence for effective obesity prevention programs is based on studies on childhood obesity. Prioritizing childhood obesity is a logical target since overweight children are more likely to become overweight adults. School-based programs are often the setting for many of the studies but more recently, multilevel programs are gaining ground in childhood obesity prevention programs. Model Community-Based Obesity Prevention Program One of these successful programs is the EPODE, which stands for “Ensemble, Prevenons L’Obesite Des Enfants”, translated as “Together, Let’s Prevent Obesity in Children”. It is a community-based intervention program that was started in a few towns in France in 2004 and involved public-private partnership focusing on healthy nutrition and lifestyle choices. Because of its initial success in France, the program expanded to Belgium and the United Kingdom and in 2011, the EPODE International Network was established, covering 25 programs in over 14 countries in 4 regions (Western Europe, Eastern Europe, South America and Asia Pacific). It is estimated that by 2015, there will be 40 plus EPODE-based community programs involving 400 million individuals. Several outcome parameters are monitored in these programs showing that obesity rates can be reduced especially among children over extended period of time, now about ten years in the original French towns in the program. Collaboration with different agencies, governmental and non-governmental, including commercial companies, contribute to the sustainability of the EPODE programs. Several obesity prevention programs are also underway in many countries and in different populations (e.g., adults, immigrants, etc). and with different approaches. In the Philippines, several programs through the Non-communicable Disease Program of the Department of Health and through private and health organizations are also being implemented. However, outcomes monitoring, sustainability and funding are limiting issues. The PASOO has several childhood obesity programs which are mainly schoolbased and are all continuing projects but their full implementation and expansion to other schools and communities are awaiting reevaluation and additional funding. These include the Whiz Kids Project and the School-based Health Promotion Program. Despite the limitations, these early initiatives of the PASOO have shown results supporting the fact that OBESITY PREVENTION WORKS!
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