9 NON-CLINICAL SETTING: PUBLIC HEALTH


of overweight and obese children can be found in low- and middle-income countries.


So what causes obesity? Medically speaking the


fundamental cause is an energy imbalance between calories consumed on the one hand and calories expended on the other hand. On a global level there has been a shift in diet towards the intake of what we consider energy-dense foods – in other words foodstuffs that are high in fat and sugar and low in vitamins, minerals and other micronutrients. Equally, intake of nutritional foodstuffs is falling. Coupled with this is the trend away from physical activity and the increasingly sedentary nature of our work. We can add to that greater reliance on modes of transport – as opposed to walking or cycling – and urbanization, i.e., the move away from the countryside into towns and cities.


Another major point is the related health risks


that obese people run; in other words the consequences of obesity. It’s probably fair to say that obesity as well as its related chronic diseases are largely preventable. And the risks people run are fairly well known. Common consequences of obesity include cardiovascular disease (strokes, heart attacks) which is the world’s premier cause of death; over 7 million die of coronary heart disease worldwide. Also Type II diabetes – the WHO predicts diabetes-related deaths will rise by more than 50% in the next ten years. Other possible risks are osteoarthritis as a result of carrying excess weight. Other musculoskeletal disorders are also common, as are certain types of cancer – cancer of the colon, even breast cancer. People suffering from obesity also run the risk of suffering from respiratory problems and sleep apnoea. When it comes to clinically obese children, premature death and disability in adulthood are the long-term risks.


And now we come to the real question, which is


what exactly are nations doing to reduce levels of obesity in their particular country? It’s true to say that this epidemic extends beyond the medical sphere or even the educational sphere. We must accept that changes in policies in areas such as agriculture, food processing, marketing and distribution also play a significant role. From the point of view of the food industry as a whole, its contribution towards the eradication of obesity in children is crucial. Reducing the marketing of non- nutritious foods to children would be a huge step forward. Children under the age of eight are generally unable to understand the persuasive intent of advertising, and are not capable of viewing it critically. Instead they take it at face value. Research by the Institute of Medicine in the USA has shown that such marketing shapes their eating habits – habits that then last a lifetime.


149 Exercise C


1 Tell students to divide up a page of their notebooks into the three sections of the Cornell system. They should try to take notes in the Notes section as they listen. Warn them that they may not be able to complete their notes while writing so they should leave spaces which then can fill later.


Play Part 2 straight through. Then put students in pairs to complete any gaps in their notes. Feed back with the whole class. Build up a set of notes on the board.


2/3 Set students to work in pairs to complete the Review questions and the Summary. Feed back with the whole class.


4 Discuss with the class the extent to which their pre- questions in Exercise A have been answered.


So it should be clear that while public health authorities do have a role to play in attempting to eradicate this world phenomenon, regulating strategies aimed at improving consumer information and environmental influences also need to be understood and implemented appropriately. In an article by Mello et al, the authors decry the means employed by the US to date in this area. Crucially, they cite the results of previous public health victories, for example a reduction in the number of smokers, increased vaccinations and motor vehicle safety. These so-called victories had all been as a result of tighter public health legislation. I think this is a very interesting topic and definitely one that we can explore more later on. But now I want to turn now to climate change and the impact it is having on our health …


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