One in eight adults obese - global survey

PARIS -- Over one in eight adults are now obese -- a ratio that has more than doubled since 1975 and will swell to one in five by 2025, a major survey reported Friday.

Of about five billion adults alive in 2014, 641 million were obese, the data showed -- and projected the number will balloon past 1.1 billion in just nine years.

The research warned of a looming crisis of "severe obesity" and disease brought on by high-fat, high-sugar diets causing blood pressure and cholesterol to rise.

"There will be health consequences of magnitudes that we do not know," author Majid Ezzati of Imperial College London told AFP.

The survey, published in The Lancet medical journal, claimed to be the most comprehensive of its kind conducted to date.

People are divided into healthy or unhealthy weight categories based on a universally-adopted measure dubbed Body Mass Index -- a ratio of weight-to-height squared.

A healthy BMI ranges from 18.5 to 24.9.

One is considered underweight below 18.5, overweight from 25 up, and obese from 30 -- when the risk of diabetes, stroke, heart disease and some cancers escalates massively.

With a BMI of 35, one is categorized as severely obese, and from 40 upward as morbidly so.

Among men globally, obesity tripled from 3.2 percent of the population in 1975 to 10.8 percent in 2014 (some 266 million), and among women from 6.4 percent to 14.9 percent (375 million), said the survey -- 12.9 percent combined.

This was equivalent to the average adult, 18 and older, being 1.5 kilos (3.3 pounds) heavier every decade.

"If the rate of obesity continues at this pace, by 2025 roughly a fifth of men (18 percent) and women (21 percent) will be obese," according to a statement by The Lancet.

More than six percent of men and nine percent of women will be severely obese.

Weighty flip-flop

The ratio of underweight people in the world declined at a slower rate than obesity grew, said the authors -- from about 13.8 percent in 1975 to 8.8 percent for men, and 14.6 percent to 9.7 percent for women.

"Over the past 40 years, we have changed from a world in which underweight prevalence was more than double that of obesity, to one in which more people are obese than underweight," said Ezzati.

At current rates, more women will be severely obese (a BMI of 35 or more) than underweight by 2025, and the world will miss its stated target of halting obesity at 2010 levels.

In 2014, the world's fattest people lived in the island nations of Polynesia and Micronesia, where 38 percent of men and more than half of women were obese, said the study.

Nearly a fifth of the world's obese adults (118 million) lived in six high-income countries -- the United States, Britain, Ireland, Australia, Canada and New Zealand.

The US was home to one in four severely obese men and almost one in five severely obese women in the world.

Surgery as a solution? 

At the other extreme, the paper said, Timor-Leste, Ethiopia and Eritrea had the lowest BMI numbers in the world, with averages as low as 20.1

More than a fifth of men in India, Bangladesh, Timor-Leste, Afghanistan, Eritrea and Ethiopia, and a quarter of women in Bangladesh and India, were underweight.

"The global focus on the obesity epidemic has largely overshadowed the persistence of underweight in some countries," the research paper said.

"To address this problem will require social and food policies that enhance food security in poor households, but also avoid overconsumption of processed carbohydrates and other unhealthy foods."

Like being underweight, severe and morbid obesity has many health risks.

"We can deal with some of these, like higher cholesterol or blood pressure, through medicines," said Ezzati.

"But for many others, including diabetes, we don't have effective treatment."

The paper says stomach-shrinking bariatric surgery may become the "most effective intervention for weight loss and disease prevention" as waistlines continue expanding.

The data was compiled from 1,698 studies involving 19.2 million adults from 186 countries which are home to 99 percent of the world's population.

Unlike earlier research, studies were only included if the participants' height and weight had been measured -- not self-reported.

The data did not include statistics on children and teenagers.

source: interaksyon.com

Obese cancer patients often shorted on chemo doses

Obese people are less likely to survive cancer, and one reason may be a surprising inequality: The overweight are undertreated.

Doctors often short them on chemotherapy by not basing the dose on size, as they should. They use ideal weight or cap the dose out of fear about how much treatment an obese patient can bear. Yet research shows that bigger people handle chemo better than smaller people do.

Even a little less chemo can mean worse odds of survival, and studies suggest that as many as 40 percent of obese cancer patients have been getting less than 85 percent of the right dose for their size.

Now, the largest organization of doctors who treat cancer, the American Society of Clinical Oncology, aims to change that. The group has adopted guidelines urging full, weight-based doses for the obese.

Don't call it supersizing; it's right-sizing cancer care, said Dr. Gary Lyman, a Duke University oncologist who led the panel that wrote the advice.

"There's little doubt that some degree of undertreatment is contributing to the higher mortality and recurrence rates in obese patients," he said.



The Food and Drug Administration's cancer drug chief, Dr. Richard Pazdur, agrees.

"By minimizing the dose, or capping the dose, we have been undertreating patients," he said.

The dosing issue applies to all types of cancer treated with chemo — breast, colon, lung, ovarian and even blood diseases such as leukemia.

It affects a lot of people. Big isn't healthy but it's the new "normal" — 60 percent of Americans are overweight and more than one-third of them are obese.

Giving too little chemo "could make it as if they didn't even get treated at all ... so they go through the whole ordeal with no benefit, in the extreme case ," said Dr. Jennifer Griggs, a University of Michigan breast cancer specialist who also worked on the guidelines.

So why do doctors limit dose?

Sometimes it's for good reason — the patient has diabetes, heart problems or other illnesses that interfere with how much chemo they can stand. Usually, though, it's because doctors are afraid to follow a standard weight-based formula because the dose seems so huge and they're afraid of harming the heart and blood system, Lyman said.

"You're three times the size of the average person, but it doesn't mean your heart is," Griggs explained.

Yet studies show that heavier patients are less likely to develop dangerous, low blood counts from cancer treatment, and that they clear chemo drugs more quickly from the body than thinner people do.

A paper Lyman published in the journal Nature in August said that a 20 percent reduction in chemo doses lowered remission and cure rates by half in animal experiments and helped the tumors develop resistance to the drugs. Other research in people found lower survival among those getting less chemo as well.

Even if a patient develops a problem from a chemo treatment and doctors have to dial it back, it's important to try a full dose the next time around so the patient gets all the treatment intended, Lyman said.

That happened to Tracy Smith, a 46-year-old Durham, N.C., woman treated at Duke in 2011 for breast cancer that had spread to more than a dozen lymph nodes. Doctors gave her full chemo doses based on her weight, which at 285 pounds classified her as obese.

Three times, high fevers put her in the hospital, and one treatment was cut short because doctors thought it was causing wheezing and possible lung damage. But she resumed and finished the intended treatment and has been cancer-free since then.

After hearing you have cancer, "you're just kind of in a fog" and don't think to ask about doses of the drugs you need, she said. "I trusted my doctor. Doctors should be well aware of what you can tolerate. You should do whatever you can to fight this beast."

Smith's tumor was fueled by estrogen — a hormone made in abundance by fat tissue. Robin McRath, a floral designer who helps run a women's shelter in Ludington, Mich., had the same type.

"It's like a playground, an amusement park, for cancer cells when you're fat," she said. She was only was 41 when her cancer was diagnosed five years ago, and her oncologist, Dr. Carol Peterson, treated her with full doses based on her weight — about 240 pounds, which put her in the obese category.

"We didn't discuss dosage. That didn't matter to me — I just wanted to get it out of my system," she said of the cancer, and praised the treatments to prevent one of chemo's most feared side effects. "There are fantastic anti-nausea medicines. I was never sick one day."

McRath is active in the Obesity Action Coalition, an education and advocacy group. A spokesman said the group was unaware of the dosing issue for obese patients.

Not all doctors are aware either. Luckily for McRath, hers was. Peterson said she uses full doses unless a patient has other health issues.

"If that's their only problem — if they're just overweight or obese — they can do quite well" with full weight-based doses, she said.

Duke's Lyman agreed, and offered this advice to patients: "Ask your doctor how they plan to treat you and whether you're going to get the full dosing. The doctor may have a good reason not to, but you should have that discussion."

source: philstar.com