Population Nutrition. Module 4: Metabolic Disease Epidemic

HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 1 MODULE 4 Metabolic Disease Epidemic Contents Introduction 1 Objectives 2 Facts, figures and defin" rel="nofollow">initions 2 Burden of Disease attributable to Non-communicable Disease 4 Factors contributin" rel="nofollow">ing to obesity and metabolic disease 5 Approaches to obesity prevention 9 Obesity prevention and the nutrition transition 12 Summary of key poin" rel="nofollow">ints 14 Conclusion 14 References 15 Introduction This module will consider the prevalence, causes, and potential public health actions to address the metabolic disease epidemic, which is occurrin" rel="nofollow">ing in" rel="nofollow">in Australia and in" rel="nofollow">internationally. The term ‘metabolic disease’ refers to diseases that have in" rel="nofollow">interrupted normal metabolic function, and in" rel="nofollow">includes obesity, particularly abdomin" rel="nofollow">inal obesity, impaired glucose tolerance, in" rel="nofollow">insulin" rel="nofollow">in resistance, type 2 diabetes, and altered lipid profiles known to be associated with in" rel="nofollow">increased vessel damage. The metabolic disease epidemic is an important current issue in" rel="nofollow">in public health nutrition due to the high prevalence in" rel="nofollow">in developed countries, the in" rel="nofollow">increasin" rel="nofollow">ing prevalence associated with the Nutrition Transition in" rel="nofollow">in developin" rel="nofollow">ing countries, and the challenges associated with addressin" rel="nofollow">ing the issues. These diseases place enormous economic costs on the health care systems of all countries, and are among the greatest contributors to global morbidity and mortality. HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 2 Objectives When you have completed this module, you should be able to: • Discuss why the metabolic disease epidemic is a public health nutrition priority, • Describe and assess what contributes to the development of metabolic disease at a population level and groups most at risk, and • Discuss what public health approaches can and should be undertaken to reduce the risin" rel="nofollow">ing prevalence of metabolic disease across the population. Facts, figures and defin" rel="nofollow">initions The terms described below are relevant to understandin" rel="nofollow">ing the metabolic disease epidemic. The Deakin" rel="nofollow">in university unit ‘Diet and Disease’ (HSN301 or HSN703) provides more detail on the conditions outlin" rel="nofollow">ined below – if you have undertaken one of those units then this first section (two pages) should serve to refresh your knowledge, and if you have not then you are encouraged to read some of the references in" rel="nofollow">in more detail. •A term used to describe the series of demographic, social and economic changes occurrin" rel="nofollow">ing in" rel="nofollow">in low and middle in" rel="nofollow">income countries, which result in" rel="nofollow">in rapid shifts in" rel="nofollow">in dietary patterns and lifestyles. In countries undergoin" rel="nofollow">ing nutrition transition, communicable diseases and under-nutrition co-exist with an in" rel="nofollow">increasin" rel="nofollow">ing prevalence of non-communicable and metabolic diseases and over-nutrition -the worst of both worlds. The nutrition transition is discussed in" rel="nofollow">in further detail later in" rel="nofollow">in this module. Nutrition transition •Metabolic conditions which are non-in" rel="nofollow">infectious and non-transmittable (as opposed to communicable diseases, which are in" rel="nofollow">infectious). This term refers to similar states of ill health as the term ‘metabolic disease’, but also in" rel="nofollow">includes Cardiovascular Disease (CVD), cancers and respiratory disease. Non communicable diseases are usually chronic in" rel="nofollow">in nature (long duration) and most are lin" rel="nofollow">inked to obesity. These health issues are estimated to be the leadin" rel="nofollow">ing cause of death in" rel="nofollow">in the world, representin" rel="nofollow">ing 63% of deaths annually, with 80% of these occurrin" rel="nofollow">ing in" rel="nofollow">in low-and middle-in" rel="nofollow">income countries (WHO). Non communicable diseases (NCDs) •Obesity is typically defin" rel="nofollow">ined as a Body Mass Index (BMI) = 30, though some defin" rel="nofollow">initions also in" rel="nofollow">incorporate other measures such as waist circumference (in" rel="nofollow">indicatin" rel="nofollow">ing abdomin" rel="nofollow">inal obesity) and percentage body fat. People who are obese, or overweight (BMI 25-29.9), are at higher risk of Type 2 Diabetes, cardiovascular disease, cancer, join" rel="nofollow">int problems, respiratory problems and some psycho-social issues. Accordin" rel="nofollow">ing to the World Health Organisation (2014) there are around 2 billion adults overweight, of those 768 million are obese.It is also estimated that over 200 million school-age children are overweight, makin" rel="nofollow">ing this generation the first predicted to have a shorter lifespan than their parents (World Obesity). Obesity HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 3 Accordin" rel="nofollow">ing to the 2011-12 Australian Health Survey, In these Australian data overweight/obesity rates varied across different population groups. The rate was higher for men (70.3%) than women (56.2%), and higher for older people (74.7% of adults aged 65-74) than younger people (38.4% of adults aged 18-24) in" rel="nofollow">in the 2011-12 survey. Additionally, accordin" rel="nofollow">ing to previous data, a third of Australian adults livin" rel="nofollow">ing in" rel="nofollow">in areas of most disadvantage were obese (33%), which is almost double that of people in" rel="nofollow">in areas of least disadvantage (17%). Where people lived also in" rel="nofollow">influenced prevalence with more adults in" rel="nofollow">in outer regional and remote Australia bein" rel="nofollow">ing obese (31%) than those in" rel="nofollow">in major cities (23%). These figures reflect some of the greater health risks seen for disadvantaged groups, as discussed in" rel="nofollow">in Module 3. Figure 1: Overweight/Obesity rates across different population groups in" rel="nofollow">in Australia Older people -65-74 years (74.7%) Younger people -18-24 years (38.4%) Men (70.3%) Women (56.2%) Outer regional and rural areas (31%) Major Australian cities (23%) Most disadvantaged (33%) Least disadvantaged (17%) “In 2011-12, 63.4% of Australians aged 18 years and over were overweight or obese, comprised of 35.0% overweight and 28.3% obese. A further 35.2% were of normal weight and 1.5% were underweight”. “Prevalence of overweight and obesity in" rel="nofollow">in adults aged 18 years and over has contin" rel="nofollow">inued to rise to 63.4% in" rel="nofollow">in 2011-12 from 61.2% in" rel="nofollow">in 2007-08 and 56.3% in" rel="nofollow">in 1995. However the prevalence of overweight and obesity in" rel="nofollow">in children aged 5-17 has remain" rel="nofollow">ined stable at 25.3% in" rel="nofollow">in 2011-12.” (ABS) HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 4 Burden of Disease attributable to Non-communicable Disease The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is a large and detailed collection and representation of data to quantify levels and trends in" rel="nofollow">in health. The GBD provides a tool to quantify health loss from hundreds of diseases, in" rel="nofollow">injuries, and risk factors. GBD research in" rel="nofollow">incorporates both the “prevalence” of a disease or risk factor and the “relative harm” it causes. The Australian data in" rel="nofollow">indicates that: • Non-communicable diseases are the leadin" rel="nofollow">ing contributors to burden of disease • High body mass in" rel="nofollow">index and dietary risks now both out-rank tobacco smokin" rel="nofollow">ing as the top risk factors contributin" rel="nofollow">ing to the burden of disease • Go here to view the Australian data and here to look at the whole GBD program and compare with other countries. •Diabetesis diagnosed when a person’s in" rel="nofollow">insulin" rel="nofollow">in response to carbohydrate in" rel="nofollow">ingestion is significantly impaired.Globally there are 374 million people livin" rel="nofollow">ing with diabetes, with an estimated further 50% undiagnosed. Most of these cases are type 2 diabetes, which is caused by ‘lifestyle factors’ in" rel="nofollow">includin" rel="nofollow">ing physical in" rel="nofollow">inactivity, unhealthy diet, and overweight/obesity.People with diabetes are at higher risk of health conditions such as cardiovascular disease, kidney failure and eye disease. In Australia, diabetes is the 6thleadin" rel="nofollow">ing cause of death and contributes 10% to all deaths. Those livin" rel="nofollow">ing in" rel="nofollow">in disadvantaged areas are twice as likely to have diabetes as those livin" rel="nofollow">ing in" rel="nofollow">in least disadvantaged areas. For further in" rel="nofollow">information on diabetes in" rel="nofollow">in Australia, please see the Diabetes Australia website (https://www.diabetesaustralia.com.au/diabetes-in" rel="nofollow">in-australia). Diabetes •Cardiovascular disease comprises diseases and conditions of the heart and blood vessels. Globally, it is estimated that 17.3 million people died from CVD in" rel="nofollow">in 2008, with a projected figure for 2030 of 23.6 million. Given CVD is known as a disease of affluence it is perhaps surprisin" rel="nofollow">ing to fin" rel="nofollow">ind that the majority of deaths (80%) are seen in" rel="nofollow">in lower to middle in" rel="nofollow">income countries. (WHO: http://www.who.in" rel="nofollow">int/cardiovascular_diseases/en/). In Australia, accordin" rel="nofollow">ing to the 2011-12 Australian Health Survey, 1 million people (4.7%) reported havin" rel="nofollow">ing CVD. Cardiovascular disease (CVD) HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 5 Essential Task 4.1: Read Read Nader P, et al. 2012, Next Steps in" rel="nofollow">in Obesity Prevention: Alterin" rel="nofollow">ing Early Life Systems to Support Healthy Parents, Infant and Toddlers, Childhood Obesity, vol. 8, no. 3. pp. 195-204. This paper should firstly rein" rel="nofollow">inforce and extend your knowledge from Module 1 regardin" rel="nofollow">ing the importance of early in" rel="nofollow">influences across the lifecourse, and developmental and in" rel="nofollow">intergenerational effects. Take note of any new in" rel="nofollow">information about the lifestages considered most important for obesity prevention. Followin" rel="nofollow">ing this, you are encouraged to consider: - What are some key features of a systems approach? - Look at the model (figure also shown below), and take note particularly of the two way (bidirectional) arrow between the in" rel="nofollow">individual/family and social and physical environment support. - What are some relevant/useful examples of systems in" rel="nofollow">interactions for nutrition promotion and obesity prevention? Factors contributin" rel="nofollow">ing to obesity and metabolic disease This in" rel="nofollow">infographic from the Institute of Medicin" rel="nofollow">ine titled Obesity: complex but conquerable presents some key facts and figures on obesity, particularly on five contributin" rel="nofollow">ing factors - suggested as areas which need improvement. Another in" rel="nofollow">infographic from the Obesity Society titled Potential Contributors to Obesity illustrates the complexity of the determin" rel="nofollow">inants of obesity and presents a more detailed lsit of factors that have been raised in" rel="nofollow">in the literature as potential contributors. This complexity of the genesis of obesity is nicely summarised by Deakin" rel="nofollow">in’s Head of the School of Exercise and Nutrition Sciences Professor David Crawford: “The obesity epidemic is a complex phenomenon (and) this complexity exists at a number of levels... The underlyin" rel="nofollow">ing in" rel="nofollow">influences on our eatin" rel="nofollow">ing and physical activity are not straightforward, in" rel="nofollow">involvin" rel="nofollow">ing a range of personal, social and structural factors that are likely to vary in" rel="nofollow">in their relative importance for different populations and for different sub-groups within" rel="nofollow">in the same population. In addition, there are powerful global commercial and political in" rel="nofollow">interests at stake.” (Crawford et al, 2010.) The complexity referred to has been operationalised by many researchers (if you are in" rel="nofollow">interested in" rel="nofollow">in this topic for postgraduate study, a potential unit of in" rel="nofollow">interest is HSN734 Obesity Prevention). In the followin" rel="nofollow">ing readin" rel="nofollow">ing you’ll fin" rel="nofollow">ind both a discussion around a focus for obesity prevention but also an example of a model that could be applied to ensure obesity and its sequelae might be addressed. HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 6 Essential Task 4.2: Read Please read this paper by Giskes et al, an in" rel="nofollow">interestin" rel="nofollow">ing systematic review lookin" rel="nofollow">ing at which environmental factors significantly contribute to the development of overweight/obesity. Please note which ones were the strongest drivers for obesity. Giskes K et al. 2011, A systematic review of environmental factors and obesogenic dietary in" rel="nofollow">intakes among adults: are we gettin" rel="nofollow">ing closer to understandin" rel="nofollow">ing obesogenic environments? Obesity Reviews, vol. 12, no. 5. e95-e106. A community systems framework of early in" rel="nofollow">intervention of childhood obesity with feedbacks between in" rel="nofollow">individuals and the environment (Nader et al. 2012). The complexity referred to by Crawford above has also been operationalised by Davidson and Birch’s socio-ecological model (figure shown below). The socio-ecological model highlights a similar but slightly different conception of causality suggestin" rel="nofollow">ing that obesity and metabolic disease will be affected by in" rel="nofollow">individual, in" rel="nofollow">interpersonal, and environmental factors. The figure below focusses HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 7 Supplementary Task: Read This paper provides a fascin" rel="nofollow">inatin" rel="nofollow">ing in" rel="nofollow">insight in" rel="nofollow">into a key element of the food environment: ultra-processed foods. Monteiro C et al. 2013, Ultra-processed products are becomin" rel="nofollow">ing domin" rel="nofollow">inant in" rel="nofollow">in the global food system, Obesity Reviews, vol. 13, no. S2, pp. 21-28. The discussion of the spread of these foods to middle-in" rel="nofollow">income countries is lin" rel="nofollow">inked to the discussion of the nutrition transition at the end of this module. on how these different levels can in" rel="nofollow">influence the weight status of a child, but a similar model can be applied to a variety of health outcomes and life stages. The environmental or ecological drivers affectin" rel="nofollow">ing food choice and physical activity can in" rel="nofollow">include: The food environment in" rel="nofollow">includes the type of food that is available, the cost of food, how it is marketed, and policies regulatin" rel="nofollow">ing the food supply. The food environment is becomin" rel="nofollow">ing in" rel="nofollow">increasin" rel="nofollow">ingly globalised, with highly processed foods transported around the world and often available for relatively low prices. The in" rel="nofollow">international nature of the food environment makes regulation challengin" rel="nofollow">ing because of differences between countries, and because trade agreements related to food are usually focused on economic and political rationale, thus unrelated to nutrition. The built environment in" rel="nofollow">includes the type of buildin" rel="nofollow">ings, neighbourhoods, transportation systems, and other man-made features of the landscape e.g. roads, pavements, buildin" rel="nofollow">ings, sports facilities, parks, escalators/stairs. These features affect people’s ability to participate in" rel="nofollow">in physical activity (eg. Source: Davison KK, Birch LL. Childhood overweight: a contextual model and recommendations for future research. Obes Rev. 2001;2:159–71 HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 8 Supplementary Task: Watch You might fin" rel="nofollow">ind it in" rel="nofollow">interestin" rel="nofollow">ing to watch this short (~10 min" rel="nofollow">inute) video with Dr William (Bill) Dietz, discussin" rel="nofollow">ing the issue of obesity in" rel="nofollow">in the United States – in" rel="nofollow">in particular issues related to in" rel="nofollow">inequalities, the likely key dietary factors contributin" rel="nofollow">ing to the issue of obesity, and some examples of strategies to address these. If there are no safe, well-lit footpaths it is difficult to walk anywhere), as well as the ability of people to access food (eg. If there is no reliable transport to shoppin" rel="nofollow">ing centres, people may rely on convenience food stores closer to home). This cartoon is an amusin" rel="nofollow">ing remin" rel="nofollow">inder with a serious message about the obesity-promotin" rel="nofollow">ing nature of the current environment. Source: The Age newspaper, 2012 In addition to environmental factors which affect food choice and physical activity, the socio-ecological model also shows that in" rel="nofollow">interpersonal and in" rel="nofollow">individual factors are likely to be important. The skills, knowledge, perceptions and attitudes of in" rel="nofollow">individuals, and those of their friends and family, will shape the way a person eats. For example, if a parent has a high level of nutrition knowledge, cookin" rel="nofollow">ing skills, and self-efficacy to eat well, then they are likely to have a good quality diet and consequently be a healthy weight. Also, if the parent models healthy eatin" rel="nofollow">ing and eats with the child, uses appropriate feedin" rel="nofollow">ing practices, and has healthy foods available in" rel="nofollow">in the home, then their child is also likely to eat and enjoy healthy foods throughout their life (Spence et al., 2010). Conversely, there are many in" rel="nofollow">individual and in" rel="nofollow">interpersonal factors which do not promote healthy eatin" rel="nofollow">ing and are therefore associated with obesity. Many people have limited knowledge and skills of how to prepare tasty and nutritious meals. Lack of time, fin" rel="nofollow">inancial difficulties, stress, and lack of motivation to eat well and promote health are all common reasons for people to regularly eat unhealthy, processed foods. Considerin" rel="nofollow">ing ways to address these factors at a population level is another important aspect of public health nutrition. HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 9 Approaches to obesity prevention If preventin" rel="nofollow">ing obesity were easy we’d have prevented the obesity epidemic we currently face. Clearly, and as this module highlights, preventin" rel="nofollow">ing population obesity is not simple and there is much to be done. In this section we consider a number of approaches to obesity prevention, with a focus on complex systems thin" rel="nofollow">inkin" rel="nofollow">ing. The over-ridin" rel="nofollow">ing philosophy remain" rel="nofollow">ins that complex problems will require complex solutions with co-ordin" rel="nofollow">inated action occurrin" rel="nofollow">ing at multiple levels. This section discusses some examples of current strategies – as with all the issues presented in" rel="nofollow">in this unit, a variety of strategies is required to address the variety of issues across different populations, and different experts have different views about which approaches are “best”. You can use these activities to in" rel="nofollow">inform your own viewpoin" rel="nofollow">int about the most useful strategies (and as an opportunity for you to consider whether any of these areas might appeal to you as career, advocacy or research options in" rel="nofollow">in future). Examples of settin" rel="nofollow">ings and strategies for nutrition promotion for obesity prevention are listed below, and then some are discussed in" rel="nofollow">in more detail with further examples. Please note this is by no means a fin" rel="nofollow">inite list, and there are many other types of strategies and settin" rel="nofollow">ings – you might like to add to this list with other examples that you know of. Type of strategy/settin" rel="nofollow">ing Example of nutrition promotion in" rel="nofollow">in action Poin" rel="nofollow">int-of-sale in" rel="nofollow">information and availability Traffic-light labellin" rel="nofollow">ing Health star ratin" rel="nofollow">ing system (some commentary here) Fin" rel="nofollow">inancial in" rel="nofollow">incentives and pricin" rel="nofollow">ing strategies Mexican tax on sugar sweetened beverages ‘Fat tax’ as per Smed & Robin" rel="nofollow">inson readin" rel="nofollow">ing task 4.8 below Community-based programs Bell et al. Preventin" rel="nofollow">ing childhood obesity: the sentin" rel="nofollow">inel site for obesity prevention in" rel="nofollow">in Victoria, Australia, HPI. Healthy Together Victoria Schools Healthy Kids Eat Well Get Active Sports clubs Be the in" rel="nofollow">influence Government resources Healthy Weight Guide Mass media campaigns See essential task 4.7 below Some strategies are implemented within" rel="nofollow">in a sin" rel="nofollow">ingle organisation, while others are implemented systematically through a particular sector. The National Healthy School Canteens Project is an example of a strategy with the potential for wide reach across the nation. While such a strategy does not necessarily mean that all schools immediately follow new healthy food and drin" rel="nofollow">ink HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 10 Essential Task 4.3: Read and thin" rel="nofollow">ink Please read this short article discussin" rel="nofollow">ing and comparin" rel="nofollow">ing nutrition promotion strategies which rely on educatin" rel="nofollow">ing and upskillin" rel="nofollow">ing the in" rel="nofollow">individual to make changes, versus strategies which change the environment. Adams et al. Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency, PLOS Medicin" rel="nofollow">ine 2016. Create a list of the pros and cons of in" rel="nofollow">interventions requirin" rel="nofollow">ing more agency (in" rel="nofollow">individual responsibility) versus less agency (use the paper as a startin" rel="nofollow">ing poin" rel="nofollow">int, but add to your list with your own experiences and knowledge and opin" rel="nofollow">inions). Then, while you are workin" rel="nofollow">ing through all the remain" rel="nofollow">inin" rel="nofollow">ing tasks in" rel="nofollow">in this section, thin" rel="nofollow">ink about how much agency (in" rel="nofollow">individual responsibility) is required for each of the very different in" rel="nofollow">initiatives discussed to be effective. Essential Task 4.4: Read and thin" rel="nofollow">ink Access this 2016 report of the Commission on Endin" rel="nofollow">ing Childhood Obesity. Open the report and read the Executive Summary, pages VI to XI (8 -13 in" rel="nofollow">in your PDF viewer). Despite the complexities of the issue of obesity discussed earlier, you will note that this report has managed to defin" rel="nofollow">ine a list of very specific suggested strategies, which have the strongest evidence base to support reductions in" rel="nofollow">in childhood obesity. As you are readin" rel="nofollow">ing (particularly pages VIII & X related to nutrition strategies), consider how easy or difficult it might be to implement each strategy. For example, consider: • Who might some of the stakeholders be, and are they likely to agree on strategies (especially when food in" rel="nofollow">industry is in" rel="nofollow">involved)? • How many different settin" rel="nofollow">ings and systems would be in" rel="nofollow">involved to implement the strategy? • How expensive would it be? Who would pay? • How popular would it be? • How far removed is this from current practice? In Australia and in" rel="nofollow">internationally? guidelin" rel="nofollow">ines, it does give impetus and start the process of improvements. Where such strategies are supported by appropriate resources from the government, there is potential for benefit across the population of school-aged children. You might like to discuss your responses to this activity on the CloudDeakin" rel="nofollow">in discussion HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 11 Essential Task 4.8: Read and Thin" rel="nofollow">ink Please read the short, 2 page article by Smed & Robin" rel="nofollow">inson 2012 which discusses the implementation of a ‘fax tax’ in" rel="nofollow">in Denmark. Smed, S, & Robin" rel="nofollow">inson, A,(2012 ) ‘Are taxes on fatty foods havin" rel="nofollow">ing their desired effects on health?’, British Medical Journal, 2012, vol. 345: e6885. This tax was implemented in" rel="nofollow">in 2011, and then abolished in" rel="nofollow">in 2012 - you may wish to look at some of the commentaries and viewpoin" rel="nofollow">ints available about this issue onlin" rel="nofollow">ine. Write down some pros and cons for usin" rel="nofollow">ing a tax on some foods in" rel="nofollow">in Australia as a public health nutrition strategy. Essential Task 4.6: Watch Please watch the video with A/P Karen Campbell for a description of why early childhood is a particularly important stage to target for obesity prevention. Karen will also discuss the Infant Program, an example of a community-based in" rel="nofollow">intervention targetin" rel="nofollow">ing in" rel="nofollow">individual and in" rel="nofollow">interpersonal in" rel="nofollow">influences on obesity at this life stage. Essential Task 4.5: Healthy Together Victoria View: Revisit the Healthy Together Victoria: Complex Systems Thin" rel="nofollow">inkin" rel="nofollow">ing video, approx. 3 min" rel="nofollow">ins. Visit: Healthy Together Victoria home page and take a good look around and consider the complexity of the response to obesity prevention in" rel="nofollow">in Victoria in" rel="nofollow">in 2013-2015. View: Please watch this video in" rel="nofollow">interview with Debbie Leslie, about her experience workin" rel="nofollow">ing in" rel="nofollow">in health and nutrition promotion in" rel="nofollow">in Whittlesea, and the Healthy Together Victoria in" rel="nofollow">initiative. Future thoughts: Evaluation of the Healthy Together Victoria program is currently takin" rel="nofollow">ing place. Look out for these results in" rel="nofollow">in comin" rel="nofollow">ing years, which will be in" rel="nofollow">informative for future systems health promotion efforts. Essential Task 4.7: Watch and thin" rel="nofollow">ink Briefly review strategies such as the Live Lighter campaign, and ads to Reduce soft drin" rel="nofollow">ink consumption:and Set a better example. These promote in" rel="nofollow">individuals to modify behaviours such as reduce their portion sizes and spend more time in" rel="nofollow">in active outdoor pursuits. What do you thin" rel="nofollow">ink are some strengths and limitations of such in" rel="nofollow">initiatives? What are they likely to achieve (effect, target audience reach, would you change your behaviour after seein" rel="nofollow">ing one of these ads?) How do they compare to some of the other strategies mentioned below? Debbie is another Deakin" rel="nofollow">in alumni, who shares with us her experiences in" rel="nofollow">in the health promotion field at an early stage of her career. You might like to discuss your responses to this activity on the CloudDeakin" rel="nofollow">in discussion board. HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 12 Supplementary Task: Onlin" rel="nofollow">ine If you are in" rel="nofollow">interested in" rel="nofollow">in further in" rel="nofollow">information on food policies, there is a great 17 min" rel="nofollow">inute audio clip of an in" rel="nofollow">interview between Kelly Brownell and Jane Martin" rel="nofollow">in (Obesity Policy Coalition Australia) onlin" rel="nofollow">ine, see: https://itunes.apple.com/itunes-u/the-rudd-report/id341653648#ls=1 (click on ‘Pricin" rel="nofollow">ing and Food Marketin" rel="nofollow">ing in" rel="nofollow">in Australia’ number 41 on the list). There are also other units offered by Deakin" rel="nofollow">in University focused entirely on food policy, which you might consider studyin" rel="nofollow">ing – HSN706 (postgraduate) and HSN309 (undergraduate). Supplementary Task: Onlin" rel="nofollow">ine Visit some websites to fin" rel="nofollow">ind about more about obesity prevention advocacy in" rel="nofollow">in Australia. For example: • Parents’ Voice • Obesity Policy Coalition • Public Health Association of Australia Supplementary Task: Onlin" rel="nofollow">ine Swin" rel="nofollow">inburn B, Wood A 2013, Progress on obesity prevention over 20 years in" rel="nofollow">in Australia and New Zealand, Obesity Reviews, vol. 14, no. 2, pp. 60-68 – this paper discusses lessons learned from over 20 years of obesity prevention efforts in" rel="nofollow">in Australia and New Zealand, and suggests directions for future efforts. Obesity prevention and the nutrition transition Obesity and its consequent diseases affect most countries around the world. Stunnin" rel="nofollow">ingly, countries such as Mexico, where stuntin" rel="nofollow">ing and malnutrition remain" rel="nofollow">in prevalent are also showin" rel="nofollow">ing some of the highest rates of obesity in" rel="nofollow">in the world. This paradoxical situation, seen in" rel="nofollow">in many poorer countries has come to be known as the nutrition transition. Professor Barry Popkin" rel="nofollow">in in" rel="nofollow">introduced this notion to the world and his work is profiled in" rel="nofollow">in the Globesity documentary recommended below. In low- and middle-in" rel="nofollow">income countries experiencin" rel="nofollow">ing an in" rel="nofollow">increase in" rel="nofollow">in wealth, obesity tends to occur firstly in" rel="nofollow">in women before men, and in" rel="nofollow">in those of middle age before younger people and children. It is first predomin" rel="nofollow">inant in" rel="nofollow">in people livin" rel="nofollow">ing in" rel="nofollow">in urban areas of higher socio-economic position. Over time, as economic development contin" rel="nofollow">inues in" rel="nofollow">in these countries, the proportion of people who are underweight decreases, and the proportion of overweight in" rel="nofollow">increases. As the nutrition transition contin" rel="nofollow">inues, overweight and underweight often coexist together, before obesity eventually becomes more common in" rel="nofollow">in the lower socio-economic population groups. HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 13 Supplementary Tasks Read: Popkin" rel="nofollow">in B, Adair L and Ng S. 2012 Global nutrition transition and the pandemic of obesity in" rel="nofollow">in developin" rel="nofollow">ing countries. Nutr Rev.70(1):3-21, for a summary of this issue by expert Barry Popkin" rel="nofollow">in. Read: Kelishadi R, 2007, Childhood overweight, obesity and the metabolic syndrome in" rel="nofollow">in developin" rel="nofollow">ing countries, Epidemiological Reviews, vol. 29, pp. 62-76, for a discussion of the impacts of the nutrition transition on children’s health. View: Globesity – Fat’s New Frontier, Foreign Correspondent, ABC, 1hr. View: BBC documentary Horizons program via EduTV, ‘The nin" rel="nofollow">ine months that made you’, 52 min" rel="nofollow">ins. Reflect: What stays with you after viewin" rel="nofollow">ing these videos? What are the take home Essential task 4.11: Thin" rel="nofollow">ink Consider how your learnin" rel="nofollow">ings from this module in" rel="nofollow">intersect, align with, or oppose, your learnin" rel="nofollow">ings from the other modules studied in" rel="nofollow">in this unit so far. As some prompts: - Why is in" rel="nofollow">investigation of the nutrition transition important, even if obesity rates in" rel="nofollow">in many mid- or low-in" rel="nofollow">income countries are not as high as those in" rel="nofollow">in developed countries? - How can nutrition promotion messages regardin" rel="nofollow">ing all the topics studied so far (food sustain" rel="nofollow">inability, food security and obesity) all align? Essential task 4.10: View and thin" rel="nofollow">ink Look at this WHO website which hosts data regardin" rel="nofollow">ing global obesity rates. Explore the functions available. Suggest which countries may be goin" rel="nofollow">ing through nutrition transition. (This website allows you to map both underweight and overweight/obesity. Note not only the prevalence, but also which countries do not have sufficient data for in" rel="nofollow">inclusion.) Essential task 4.9: Read 1. A special edition on the nutrition transition was published in" rel="nofollow">in the journal Public Health Nutrition in" rel="nofollow">in 2013. Please ensure you read the short editorial: The nutrition transition: the same, but different. You are also encouraged to view the full table of contents for this issue, and read any of the further papers mentioned in" rel="nofollow">in the editorial which are of in" rel="nofollow">interest. 2. Read: Rivera J et al. 2013, Childhood and adolescent overweight and obesity in" rel="nofollow">in Latin" rel="nofollow">in America: a systematic review, Review, vol. 2, published onlin" rel="nofollow">ine December 13, 2013. The authors state: “Policies in" rel="nofollow">in most countries favour prevention of undernutrition” - while readin" rel="nofollow">ing this paper consider some of the reasons WHY this might be the case. Let’s discuss your responses to this task in" rel="nofollow">in the module 4 onlin" rel="nofollow">ine tutorial in" rel="nofollow">in week 8. HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 14 Summary of key poin" rel="nofollow">ints The metabolic disease epidemic is an important current issue in" rel="nofollow">in public health nutrition due to the high prevalence in" rel="nofollow">in developed countries, the in" rel="nofollow">increasin" rel="nofollow">ing prevalence associated with the nutrition transition in" rel="nofollow">in developin" rel="nofollow">ing countries, and the challenges associated with addressin" rel="nofollow">ing the issues. Obesity rates vary across different population groups, and are higher in" rel="nofollow">in more disadvantaged groups, highlightin" rel="nofollow">ing the need for considerations of equity when addressin" rel="nofollow">ing this issue. Factors contributin" rel="nofollow">ing to obesity and metabolic disease are complex – it is important to understand these in" rel="nofollow">in order to propose appropriate in" rel="nofollow">interventions to address the issue(s) Solutions and in" rel="nofollow">interventions to address metabolic disease are therefore also often complex – action is probably needed in" rel="nofollow">in a variety of sectors usin" rel="nofollow">ing a variety of strategies. It is important to be aware of some of the opportunities and evidence-based suggestions for action, and to consider the amount of personal or public responsibility, and ‘agency’ required for the various in" rel="nofollow">intervention types to be effective. Obesity and its consequent diseases affect most countries around the world. Some countries where stuntin" rel="nofollow">ing and malnutrition remain" rel="nofollow">in prevalent are also showin" rel="nofollow">ing some of the highest rates of obesity in" rel="nofollow">in the world. This paradoxical situation, seen in" rel="nofollow">in many poorer countries has come to be known as the nutrition transition, and is a key current issue in" rel="nofollow">in public health nutrition. Conclusion Metabolic disease is a major contributor to global disease burden, and is in" rel="nofollow">in large part a consequence of poor nutrition. There are many complex and in" rel="nofollow">interconnected factors which contribute to the current metabolic disease epidemic. It is an important current issue in" rel="nofollow">in public health nutrition due to the high prevalence in" rel="nofollow">in developed countries, the in" rel="nofollow">increasin" rel="nofollow">ing prevalence associated with the nutrition transition in" rel="nofollow">in developin" rel="nofollow">ing countries, and the challenges associated with addressin" rel="nofollow">ing the issues. Public health nutritionists must work with other sectors, utilise available examples and evidence, and apply complex systems theories to understand and address the multifaceted and in" rel="nofollow">interconnected factors that in" rel="nofollow">influence dietary in" rel="nofollow">intake. HSN302: Population Nutrition. Module 4: Metabolic Disease Epidemic 15 References Australian Bureau of Statistics: http://www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.001Chapter4002011-12 Australian Institute of Health and Welfare. Public health expenditure in" rel="nofollow">in Australia, 2008-9. Accessed 22/02/13 from www.aihw.gov.au/public-health-expenditure/ Campbell, K., et al. The Infant Feedin" rel="nofollow">ing Activity and Nutrition Trial (INFANT) an early in" rel="nofollow">intervention to prevent childhood obesity: Cluster randomised controlled trial. BMC Public Health, 2008; 8: 103. Clark R, Armstrong R and Waters E. Local government and obesity prevention: An evidence resource. Interventions to prevent obesity in" rel="nofollow">in early years settin" rel="nofollow">ings; tacklin" rel="nofollow">ing food in" rel="nofollow">insecurity and built environment changes to support physical activity. 2010; CO-OPS Secretariat, Deakin" rel="nofollow">in University, Geelong. Crawford D., Ball K., Jeffery RW., and Brug J. P445 from: Obesity epidemiology, from aetiology to public health, second edition, Oxford University Press, 2010. International Obesity Taskforce 2010. Accessed 22/02/12 from http://www.iaso.org/iotf/obesity/obesitytheglobalepidemic/ Spence A., Campbell, K., Hesketh, K. Parental correlates of young children’s dietary in" rel="nofollow">intakes: a review. Australasian Epidemiologist, 2010; 17(1): 17-20. World Health Organization. Accessed 22/02/13 from http://www.who.in" rel="nofollow">int/features/factfiles/noncommunicable_diseases/en/