Epidemiologic and economic consequences of the global epidemics of

From: "Susanna Bedell
Para: procor@healthnet.org
Assunto: [ProCOR] Epidemiologic and economic consequences of the global epidemics of
[Overweight and obesity were, until recently, diseases of the developed world. A commentary recently published in Nature Medicine discusses the changes in nutrition and physical activity often associated with urbanization that have resulted in a steadily higher prevalence of obesity and its complications in the developing world. Yach and colleagues also raise important questions about the opportunity costs of changing policies.]
Article: Epidemiologic and economic consequences of the global epidemics of obesity and diabetes.
Authors: Derek Yach, David Stuckler, and Kelly D. Brownell
Reference: Nature Medicine January 2006; 12:62-66.
Reviewer: Susanna E. Bedell, MD

Summary: Rates of overweight and obesity are rising dramatically worldwide.
Complications of overweight and obesity are varied and most importantly include diabetes where '60% of all cases of diabetes can be directly attributed to
weight gain.' The worldwide increase in diabetes is expected to rise from 175 million in 2000 to 353 million by 2030. Throughout the developing world,
diabetes will become an increasingly common problem during this time. The largest increases will be in India (25 to 59 million) and China (14-25 million).
This reflects an increase in the rates of diabetes double the rate observed in the USA, currently the country with the highest incidence of diabetes.

Not only has the incidence of diabetes increased, but the distribution of type 2 diabetes has shifted more heavily to children. In China, for example, over 20%
of children in thelargest urban environments are overweight or obese, anincrease from 2% maximum two decades ago.Yach and colleagues suggest that the changing trend in obesity and diabetes canbe linked to changes in lifestyle and economic incentives, in particular:1. Growing labor market for women outside the home2. Increased consumption of food away from home (so called "fast foods")3. Relative cost of healthy vs calorie dense foods4. Overall increase in caloric intake as prices for certain foods decline5. Decreases in physical activity (occupational and as part of daily life).The economic burden of obesity and diabetes on the healthcare system isenormous. The greatest proportion of expenses for diabetes are forcomplications of the disease and hospitalization for CVD, CVA, leg amputationand renal failure. In Latin America, one third of hospital bed-days areassociated with complications of diabetes. Throughout the world, preventive careis suboptimal, and the developing world has followed the US lead in focusing onacute care. The burden of health care costs in the developing world fallsheavily on the individual: "For diabetic individuals in India, 15-25% ofhousehold income is required to cover treatment costs" for diabetes. In additionto direct healthcare expenditures there are other indirect coststo society such as increases in unemployment and early retirement. Yach and colleagues raise important questions about the opportunity costs ofchanging policies; there are many tradeoffs between "immediate gratification"and future benefits for the society. They propose the need for a "roadmap" thatconsiders the "economic, political, social, psychological, and biologicalfactors."Commentary: As Yach and colleagues suggest, there is an urgent need to addressthe global rising prevalence of obesity and diabetes. As suggested above, thesolutions will be more complex than those that so successfully curbed tobaccouse. The absence of an easy solution should not delay our attempts to workwith individuals, communities, and governments to reverse this trend. As ProCORhas done in the past, we need to share strategies to improve the research agendaso that our actions will have the greatest impact with the lowest cost. Newmodels for effective preventive strategies take precedence over the older USmodel of providing for acute care once complications from diabetes haveoccurred.
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