Glasgow: The growing obesity problem in the UK could bankrupt the state health system, warn doctors in the Britisih Medical Journal.

In the United Kingdom, well over half the population is overweight and more than one in five adults is obese, write Naveed Sattar and colleagues. Obese people are at high risk of multiple health problems, while the cost of obesity to a country’s health service is currently estimated at up to 9%, and the overall social cost of the condition is seen as a major hindrance to economic development.

So, can we reverse the rising trend in the prevalence of obesity, and if so, when?

People clearly have some responsibility for their health, but society and government also have a responsibility to make the preferred, easy choices healthier ones. It is increasingly apparent that most individuals are unable to make enough “proactive” changes to prevent excess weight gain but are simply “reactive” to their environment, say the authors.

What is provided is what is eaten so what is provided has to change, they add. Thus education alone will fail to halt this obesity epidemic, and environmental changes (physical, food, and fiscal policy) are urgently needed.

They believe that prevention is the only economic long term solution to the problem and recommend that:

The food industry needs to take more responsibility for preventing obesity. And governments, as custodians of public health, should create the conditions for this to happen.

The advertising of energy dense foods needs to be substantially curtailed
The basic principles of energy balance should be taught in primary schools, and education should be provided at all levels to change attitudes and behaviour towards diet and physical activity

Obesity health issuesshould be made a core part of all medical training
Public health consequences should be considered for all decisions made in public life

Medical practice must adapt to the current epidemic of obesity and nutrition related diseases, while society must also accept that many people now need drugs (and in some cases, surgery) to cut risks of and disability from obesity, and to limit its progression, they write.

As the prevalence and costs of obesity escalate, the economic argument for giving high priority to obesity and weight management through a dedicated coordinating agency will ultimately become overwhelming. The only question is, will action be taken before it’s too late?

Rochester: One of the main measurements for obesity, the body mass index (BMI) is being called into question by US doctors.

This follows research by the Mayo Clinic in Rochester, Minnesota, which investigated 40 studies involving 250,000 victims of heart disease. As expected it found that severely obese patients had a higher risk of heart-related death.

But would it didn’t expect was that overweight patients, as defined by BMI scores, had better survival and fewer heart problems than those with a normal BMI. In turn, those with normal BMI were less likely to die than those with a low BMI.

They concluded that many of the so-called BMI defined overweight patients actually had more muscle – which actually weighs more than fat – and that BMI failed to identify the difference.

Many experts now want waist circumference or waist to hip ratio, which indicates levels of abdominal fat, adopted as a more accurate guide rather than the method for BMI which is calculated by dividing weight in kilograms by height in metres squared. Someone with a BMI of less than 18.5 is considered underweight, between 18.5 and 24.9 lies within the ‘ normal’ range, and 25 to 29.9 is classified as overweight. Clinical obesity is defined by a BMI of 30 or greater.

A recent international study in 52 countries found waist-to-hip ratio was the most reliable predictor of heart attack risk. As a rough guide to healthy waist circumference, doctors regard over 40 inches for a man and 35 for a woman as danger signs.