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Population Health > Lecture 24: Epidemiological Research In Action: Obesity > Flashcards

Lecture 24: Epidemiological Research In Action: Obesity Flashcards

1
Q

What are the four key measures in epidemiological research?

A
  1. Descriptive
  2. Predictive
  3. Explanatory
  4. Evaluative
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2
Q

What is descriptive?

A

Current trends and burdens

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3
Q

What is predictive?

A

Future burden

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4
Q

What are explanatory?

A
  1. Changes over time

2. Differences between populations

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5
Q

What is evaluative?

A

The effectiveness of interventions

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6
Q

What countries have highest rates of obesity?

A

Pacific islands, middle eastern, Caribbean

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7
Q

Which countries have lowest obesity rates?

A

Japan
Vietnam
North Korea

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8
Q

Are obesity trends predictable?

A

Yes, often follow state to state etc

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9
Q

Which countries have high child obesity rates?

A

High income countries

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10
Q

Describe the childhood obesity trends in low income countries?

A

They tend to come into the epidemic later, but they rise steeply and often have under-nutrition burden as well

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11
Q

What are the stereotypical obesity trends through a populations?

A

Women then men
Middle-age then children
High SES then low SES
Urban then Rural

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12
Q

What is the relationship between socioeconomic status and obesity in low income countries and women?

A

Strong positive

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13
Q

What is the relationship between socioeconomic status and obesity in low income countries and men?

A

Positive

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14
Q

What is the relationship between socioeconomic status and obesity in low income countries and children?

A

Positive

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15
Q

What is the relationship between socioeconomic status and obesity in high income countries and women?

A

Strong negative

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16
Q

What is the relationship between socioeconomic status and obesity in high income countries and men?

A

Mainly negative

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17
Q

What is the relationship between socioeconomic status and obesity in high income countries and children?

A

Mainly negative

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18
Q

What are some consequences of obesity?

A
  1. Metabolic diseases
  2. Mechanical disorders
  3. Psychological problems
  4. Social consequences
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19
Q

What are some metabolic diseases from obesity?

A

Type 2 diabetes
Cardiovascular diseases
Almost all cancers (esp colon, breast, uterine)
Gallbladder diseases

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20
Q

What are some mechanical disorders from obesity?

A

Arthritis
Back pain
Obstructive sleep apnoea
Skin disorders

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21
Q

What are psychological disorders stemming from obesity?

A

Low self esteem
Reduced quality of life
Depression

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22
Q

What are the social consequences of obesity?

A

Weight bias and discrimination

Reduced life opportunities

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23
Q

What relative risk numbers do we take seriously?

A

2-3 times higher

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24
Q

What are the relative risk increases like for obesity as your BMI increases?

A

As much as 10-20 times if you hit the BMI definition of obesity

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25
Q

Is good data important?

A

YES! You need good monitoring data to see specific trends and details (NZ is bad in this regard- UK is good with monitoring child obesity)

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26
Q

What is data important for?

A

Establishing predictive trends ie working out if it will flatten off etc

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27
Q

What are the differences in child obesity depending on deprivation?

A

Increased obesity in higher deprivation, lower obesity in lower deprivation

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28
Q

What are the benefits of monitoring childhood obesity?

A
  1. Can determine prevalence and trends
  2. Predict future trends
  3. Identify hotspots
  4. Contribute to policy and program evaluation
  5. Screening and feedback
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29
Q

What types of prevalence rates and trends can child obesity monitoring generate?

A

National, regional and local

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30
Q

Why is identify hotspots through childhood obesity important?

A

We can identify areas with low/decreasing obesity vs priority areas with high/increasing obesity

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31
Q

How does monitoring childhood obesity contribute to policy and program evaluation?

A

It’s difficult to measure impact in real world interventions

32
Q

How does screening and feedback relate to childhood obesity monitoring?

A

Given data to parents

Referral systems for children with obesity

33
Q

What are individual questions related to childhood obesity?

A

“Why am I getting fatter?

34
Q

What are population questions to the causes of obesity?

A

Why is this population’s obesity prevalence going up?

Why is this populations obesity prevalence higher/lower than other populations?

35
Q

What do the answer to the cause of obesity depend on?

A

The question

It can be: genetic, metabolic, behavioural, environmental (on individual level) or environments related to food or physical activity (macro/micro in size) and physical, economic, policy, socio-cultural in type.

36
Q

What differences does the answer to what causes obesity attempt to explain? (Example)

A

Obesity in pacific islands

37
Q

What are the determinants of obesity like?

A

Complex, interconnected aspects of society (think the crazy map)

38
Q

Why are all countries increasing in obesity (simultaneous global rise from the 1970s across all high/middle/low income countries)?

A

Global drivers

39
Q

What are the two main global drivers in regards to obesity?

A

Globalised food systems

Progressive reductions in occupational physical activity

40
Q

How does globalised food systems affect global obesity rates?

A
  1. Increasingly processed, affordable, available and promoted tasty food
  2. Push effect from the environment (cheap etc)
  3. Passive consumption by population
41
Q

What is passive overconsumption?

A

Without realising, consuming more calories than necessary

42
Q

What does similar obesity trends across all age groups tell us?

A

It’s an environmental trend (not just a cohort)

43
Q

Describe USA food energy supply 1910-2000?

A

Initially, physical activity decreased and so did energy consumption (as mechanics became more normal eg cars-needed less energy), but then food energy supply began to rise again, demonstrated by increase in food waste

44
Q

Where is there the biggest reduction in physical exercise?

A

In occupational activity (is jobs)

45
Q

What is the biggest plausible reason for the simultaneous global increase in obesity?

A

The changes in global food supply (price, product, placement, promotion) creating population “passive consumption” of energy

46
Q

How is obesity shaped by the economic environment?

A

Income

Income disparities

47
Q

How is obesity shaped by physical environments?

A

Food

Physical exercise

48
Q

How is obesity shaped by socio-cultural environments?

A

Food
Physical activity
Body size

49
Q

How is obesity shaped by policy environments?

A

Market regulation

50
Q

What four types of environments affect obesity levels?

A

Economic environment
Physical environment
Socioeconomic environment
Policy environment

51
Q

What are two contrasting local environments?

A

Japan: social/fashion to be thin, small portions
Pacific islands: love, hospitality shown through big portions

AKA a cultural thing, there was no health promotion in Japan for decreasing obesity in young women

52
Q

What is age distribution in pacific islands of obesity like?

A

Kids are relatively lean until they hit around 20

53
Q

Are there ethnic disparities in NZ childhood obesity?

A

Yes, Pacific Islanders and Maori are more at risk

54
Q

Where are health and social problems worse? (Obesity included as a social problem)

A

In countries with higher inequality (eg income inequality)

55
Q

So, if global drivers are pushing global obesity up, why are there differences between populations?

A

Because different local environments determine the trajectories of obesity in different populations

56
Q

Where is obesity intervention more important and difficult, with more uncertain evidence?

A

At the environmental stage, with policy interventions (before people get disease, at physiology stage interventions won’t help)

57
Q

What are 4 ways obesity can be reversed?

A
  1. Clinics (controlled clinical studies of treatment)
  2. Settings eg school (controlled prevention studies in setting)
  3. Communities (quasi-experimental prevention interventions in communities)
  4. States/countries (natural experiments, understand heterogeneity)
58
Q

What study exemplifies reversing obesity in children?

A

The Cochrane meta-analysis

59
Q

What are three examples of preventions in children?

A

Romp and chomp
Be active be well
It’s your move

(All implemented in schools)

60
Q

Did the healthy eating in schools programme curb obesity in pacific islands?

A

No

61
Q

What are three new system approaches to fighting obesity?

A
  1. Progression of interventions over time
  2. Healthy Together Victoria
  3. Healthy families NZ
62
Q

How does progression of intervention over time work?

A

Generation 1: implement programs and projects
Generation 2: build community capacity
Generation 3: re-orient existing systems

63
Q

What is health together Victoria?

A

Taking a systems approach in 12 local government areas in Victoria

64
Q

What is healthy families NZ?

A

Using htv model
10 sites around NZ
Added dimension of Maori and pacific populations with high obesity prevalence

65
Q

What does the natural experiment of the Cuba economic downturn in the 1990s show?

A

Decrease in population obesity strongly associated with economic crisis, as increased physical activity, less dietary intake. Obesity levels started to rise as Ebonics restabilised

66
Q

Did mortality rates increase or decrease due to the Cuban economic crisis?

A

Decreased, the rose as economics got better

67
Q

What’s the brief timeline of solving obesity epidemic?

A

1980s: scientists identify epidemic
1990s: advocacy to get obesity on public/political agenda
2000s: increased awareness and some action- largely program based
2010: evidence of effectiveness of interventions, plateaus, declines in some populations, increasing battles over food policies

68
Q

What are three environmental determinants for obesity?

A 
Systemic drivers (eg policy and economic enabling/promoting high growth and consumption)
Env drivers (food supply and marketing promoting high energy intake)
Env moderators (socioeconomic/cultural/transport which amplify drivers
69
Q

What are behaviour patterns in the obesity determinant model?

A

High energy intake with low physical activity

70
Q

What is the physiology aspect of the obesity determinant model?

A

Energy imbalance: high total energy intake pushing energy imbalance (hard to fix, only drugs and surgery really)

71
Q

Are upstream obesity determinants easy to change?

A

No, they’re complex, governments don’t want much to do with it etc

72
Q

Does NZ use the WHO definition of obesity?

A

No, so our child obesity rates are probably actually higher

73
Q

What is the BMI classification of obese?

A

30 (and you are 15-20 times for likely to get type 2 diabetes)

74
Q

What are examples of changes in the global food supply?

A

Price
Promotion
Product
Placement

75
Q

What is heterogeneity?

A

A word that signifies diversity

76
Q

What does the Cuban economic decline exemplify?

A

A natural experiment, showing how lack of resources resulted in lower obesity which also correlated with decreased mortality, decreased disease etc obesity and so on, quite quickly

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