Latest news with #LancetCommission
News24
6 days ago
- Health
- News24
Rates of obesity are soaring worldwide. Have we been misunderstanding the problem?
Obesity affects more than 1 billion people worldwide yet there isn't really a conclusive definition of the condition. A Lancet Commission argue that obesity should not just be seen as a risk factor for other diseases – but in some cases, should be seen as a disease itself. In the first of this two-part Spotlight series, we break down the debate around the issue, and its implications for health policy. In 1990, just 2% of all young people around the world aged 5 to 24 were living with obesity. By 2021, this figure had more than tripled to over 6%. This is according to a recent study, which relied on Body Mass Index (BMI) data from 180 countries and territories around the world. It estimates that the rise in obesity among children and young people will only continue in the coming decades. South Africa certainly isn't immune to the crisis. A survey conducted in 2021/2022 found that 16% of all children aged 6 to 18 were 'severely overweight'. Meanwhile, World Health Organization (WHO) data suggests that about 30% of all adults in South Africa are living with obesity, meaning a BMI of over 30, which is almost double the global level. BMI, which simply looks at a person's weight in relation to their height, is a crude measure of obesity. For instance, a person may have a high BMI simply because they have a lot of muscle rather than fat. But while it is agreed that BMI is a flawed indicator at the individual level, many experts recommend using it as a rough proxy for ' health risk at a population level '. For instance, a study which collected data on nearly three million people found that those who had very high BMI levels were, on average, more likely to die at an early age. The study also found that this was true of people with very low BMI levels (those who were underweight). In this context, the above figures paint a concerning picture. Given the rising rates, experts argue that we need health systems to be able to track and respond to obesity urgently. But, according to a Lancet Commission published in January, health systems around the world may struggle to do this, because of a failure to accurately conceptualise and measure what obesity actually is. READ | SA plastic surgery trends: From lip fillers to facelifts, what each generation wants done The Lancet commission was developed by 58 experts from different medical specialties and though it has been the subject of debate, it has since been widely endorsed as a new way to understand obesity. Spotlight takes a look at what it concluded. Delaying treatment for no reason Obesity is often regarded as a risk factor for other diseases, for instance, type 2 diabetes. But according to the commission, there are certain cases in which obesity is not just a risk factor, but a disease itself – one that should be immediately treated. One of the reasons for this is that obesity not only contributes to the emergence of other conditions but sometimes leads to clinical symptoms directly. For example, the cartilage that protects the joints in a person's knees can sometimes become eroded when adults carry too much weight. In this case, a person could suffer from joint pain, stiffness and reduced mobility where obesity is clearly the cause. Take another example. If fat deposits build up in the abdomen, this may limit how much the lungs can expand, causing breathlessness. Similarly, a build-up of fat around the neck can narrow a person's upper airways, which can cause sleep apnoea. Thus, obesity is not simply something which increases the risk of developing a separate disease in the future - but something which can directly (and presently) affect the functioning of organs. More broadly, the commission argues that by hindering a person's 'mobility, balance and range of motion' obesity can in certain cases 'restrict routine activities of daily living'. In these instances, obesity is a disease by definition, according to the commission. This is given that it defines disease as a 'harmful deviation from the normal structural or functional state of an organism, associated with specific signs and symptoms and limitations of daily activities'. But why does this conceptual debate matter? Because at present, people often have to wait for other diseases to crop up before insurers or public health systems cover them for weight loss drugs or bariatric surgery - a procedure to help with weight loss and improve obesity-related health conditions. And when they do cover these services, it is often only after severe delay. Because obesity is only considered to be a risk factor, it isn't typically treated with the same urgency as life-threatening diseases, according to the authors of the commission. Professor Frances Rubino, the lead author of the commission, details how this problem manifests in the healthcare system. 'I've been doing bariatric surgery for 25 years in four different countries; in America, Italy, France and the UK,' he tells Spotlight, 'In all of those countries, to meet the criteria for surgery people very often have to undergo six to 12 months of weight monitoring before their surgery is covered. So systematically you delay treatment'. He continues: 'Someone who has clinical obesity and has heart failure as a result of it is waiting for a year for what reason? That condition will only worsen and if the patient is still alive, the treatment [is] going to cost the same amount to the payer but it's going to be less effective.' Can't people just diet? One of the reasons that some academics have historically been reluctant to classify obesity as a disease is because of a fear that this may reduce people's agency - instead of taking proactive steps to diet and exercise, people with obesity may simply view themselves as afflicted by a disease. The belief that people with obesity can simply diet their way out of their situation is in fact partially why Rubino's patients were forced to wait long periods of time before receiving bariatric surgery. Rubino explains: 'In America, many private payers [i.e. medical insurance schemes] have required weight monitoring programmes, where patients do nothing else other than see a dietician for 12 months, and if they skip one appointment, they have to start all over again. I think that in some cases, this has been misguided by the idea that you want to see if obesity can be reversed by somebody going on a diet.' This, according to him, is a 'misconception', arguing that if someone faces such severe levels of obesity that they require surgery, diet is unlikely to offer a solution. Indeed, research has shown that it's very rare for people with obesity to lose large amounts of weight quickly without surgery or medication. For instance, a study on over 176 000 patients in the UK found that among men with 'simply obesity' or a BMI of 30-34.9, only 1 in 210 were able to achieve a 'normal' weight level within a year. Among men with morbid obesity or BMI of 35 or more, the chance was less than 1 than in 1 000. Chances for women were roughly twice as good as men's - so still exceedingly small. READ | Closed doors, open hearts: The activists filling the gaps in Southern African sexual healthcare Thus, if someone is severely obese and their excess weight is causing life-threatening symptoms, putting them on a diet for a year is unlikely to result in the urgent changes that may be required for them to get better. In fact, Rubino argues that they may simply die of their condition in the interim. Taking a medical approach more quickly is easier now than ever before due to the regulatory approval of GLP-1 agonists like semaglutide and tirzepatide – Spotlight previously reported on the availability of these new diabetes and weight loss medicines in South Africa. An article by WHO officials from December states that because of the approval of these medicines '[h]ealth systems across the globe now may be able to offer a treatment response integrated with lifestyle changes that opens the possibility of an end to the obesity pandemic'. Not all people with obesity are ill There is a more scientific argument against categorising obesity as a disease. This is that while obesity can sometimes result in the negative health symptoms discussed above (like respiratory issues or reduced mobility) it doesn't always do this. In fact, the commission acknowledges that some people with obesity 'appear to be able to live a relatively healthy life for many years, or even a lifetime'. One of the reasons for this is that excess fat may be stored in areas that don't surround vital organs. For instance, if fat is stored in the limbs, hips, or buttocks, then this may cause less harm than if it is stored in the stomach. Since obesity doesn't always cause health problems, it isn't always a disease. In order to deal with this conceptual hurdle, the commission classifies obesity into two categories - clinical and preclinical obesity. If a person has pre-clinical obesity, this means they have a lot of excess fat, but no obvious health problems that have emerged as a result. In this case, obesity is not classified as a disease, though it may still increase the chance of future health problems (depending on a range of factors, like family history). For a person to have clinical obesity, they must have a lot of excess fat as well as health problems that have already been directly caused by this. It is this that the commission defines as a disease. This classification system, according to Rubino, ensures not only that we urgently treat people living with clinical obesity, but also that we don't overtreat people - since if a person falls into the pre-clinically obese group, then they may not need treatment. But if we're going to treat clinical obesity as a disease, we'll need clear methods of diagnosing people. Since BMI is deeply flawed and provides little information about whether a person is ill at the individual level, health systems will need something else. In part 2 of this Spotlight special series, we'll discuss the options offered by the commission, and how this all relates to the situation in South Africa.
Daily Maverick
7 days ago
- Health
- Daily Maverick
The way we understand obesity is changing — What does it mean for SA?
Health workers have long relied on Body Mass Index to gauge whether people are within a healthy weight range. Now, top researchers have made the case for a new way to understand and diagnose obesity. In part two of this special Spotlight series, we take a look at what this new framing might mean for South Africa. If we are going to tackle the global rise in obesity, our understanding of the condition needs to change. That is according to a Lancet Commission convened by a global group of 58 experts from different medical specialties. While we have historically thought of obesity as a risk factor for other diseases such as diabetes, the commission's recent report published in the journal Lancet Diabetes and Endocrinology concludes that obesity is sometimes better thought of as a disease itself – one that can directly cause severe health symptoms (see part one of this series for a detailed discussion of this argument). By categorising obesity as a disease, public health systems and medical aid schemes around the world would be more likely to cover people for weight-loss drugs or weight-loss surgery, according to the report. At present, these services are often only financed if a patient's obesity has already led to other diseases. This is given that obesity is not viewed as a stand-alone chronic illness. But if we're going to redefine obesity as a disease, or at least some forms of it, then we need good clinical definitions and ways to measure it. For a long time, this has posed challenges, according to the Lancet report. The perils of BMI At present, health workers often rely on Body Mass Index (BMI) to gauge whether a patient is within a healthy weight range. BMI is measured by taking a person's weight in kilograms and dividing it by their height in metres squared. A healthy weight is typically considered to be between 18.5 and 25. A person whose BMI is between 25 and 30 is considered to be overweight, while someone with a BMI of over 30 is considered to have obesity. But according to the Lancet report, this is a crude measure, and one which provides very little information about whether a person is actually ill. One basic issue is that a person can have a high BMI even if they don't have a lot of excess fat. Instead, they may simply have a lot of muscle or bone. Indeed, the report notes that some athletes are in the obese BMI range. Even when a high BMI does indicate that a person has obesity, it still doesn't tell us where a person's fat is stored and this is vital medical information. If excess fat is stored in the stomach and chest, then it poses more severe health risks than when it is stored in the limbs or thighs. This is because excess fat will do more harm if it surrounds vital organs. The lead author of the Lancet report, Professor Frances Rubino, says the pitfalls of BMI have long been understood, but practitioners have continued to use it. 'BMI is still by and large the most used approach everywhere, even though medical organisations have [raised issues] for quite some time,' he tells Spotlight. 'The problem is that even when we as individuals or organisations say BMI is no good, we haven't provided an alternative. And so, inevitably, the ease of calculating BMI and the uncertainties about alternatives makes you default back to BMI.' To deal with this problem, the report advocates for several alternative techniques for measuring obesity which offer more precision. The first option is to use tools that directly measure body composition such as a DEXA scanner. This is a sophisticated x-ray machine which can be used to distinguish between fat, bone and muscle. It can also be used to determine where fat is concentrated. It's thus a very precise measurement tool, but the machines are expensive, and the scans can be time-consuming. Alternatively, the report recommends using BMI in combination with another measure like waist-to-hip ratio, waist-to-height ratio or simply waist circumference. If two of these alternative measures are used, then BMI can be removed from the picture. These additional metrics are clinically useful because they provide information about where fat is stored. For instance, a larger waistline inevitably indicates a larger stomach. Indeed, studies have found that above a certain level, a larger waist circumference is linked to a higher chance of dying early, even when looking at people with the same BMI. The report thus offers a more accurate way to measure obesity in the clinical setting. But its authors argue that this is only the first step when making a diagnosis. The second is to look at whether a patient's obesity has actually caused health problems as this isn't automatically the case. They acknowledge for instance that there are some people with obesity who 'appear to be able to live a relatively healthy life for many years, or even a lifetime'. The report refers to these cases as 'preclinical obesity'. Such patients don't have a disease as such, according to the report, but still have an increased risk of facing health issues in the future. As such, the report's authors argue that they should be monitored and sometimes even treated, depending on factors like family history. By contrast, cases of obesity which have directly caused health problems are referred to as 'clinical obesity'. These cases, according to the report, should be treated immediately just like any other serious disease. It lists a series of medical symptoms associated with clinical obesity that would allow health workers to make an appropriate diagnosis. The recommendation is thus for health workers to determine whether a person has obesity through the metrics listed above, and then to determine whether it is clinical or preclinical by evaluating a patient's symptoms. This will inevitably guide the treatment plan. How does this relate to SA? Professor Francois Venter, who runs the Ezintsha research centre at Wits university, says the Lancet report offers a good starting point for South Africa, but it has to be adapted for our own needs and context. 'It's a big step forward from BMI, which grossly underdiagnoses and overdiagnoses obesity,' says Venter, who adds that additional metrics like waist circumference are a 'welcome addition'. The view that clinical obesity is a disease that needs to be immediately treated is also correct, according to Venter. Though he adds that the public health system in South Africa is not in a financial position to start handing out weight-loss medicine to everyone who needs it. 'The drugs are hugely expensive,' says Venter, 'and they have side effects, so you need a lot of resources to support people taking them.' But while it may not yet be feasible to treat all cases of clinical obesity in South Africa, Venter believes we should use the diagnostic model offered by the Lancet Commission to begin identifying at least some people with clinical obesity so that they can begin treatment. 'You have to start somewhere, and for that, you need a good staging system,' he says. 'Let's use the Lancet Commission and start to see if we can identify a few priority people and screen them and start to work on the drug delivery system.' Yet while Venter believes that the commission makes important contributions, he also cautions that we need more data on obesity in Africa before we can apply all of its conclusions to our own context. 'If you go to the supplement of the Lancet Commission, there's not a single African study there. It all comes from Europe, North America and Asia. It's not the commission's fault but [there is a lack of data on Africa].' This is important as findings that apply to European or Asian populations may not necessarily hold for others. Consider the following case. As noted, the commission states that BMI is not sufficient to determine whether someone is overweight and must therefore be complemented with other measures. But it states that if someone's BMI is above 40 (way above the current threshold for obesity), then this can 'pragmatically be assumed' without the need for further measures. But this may not hold in Africa, says Venter. 'The commission says that if your BMI is over 40, which is very big, you can infer that this person has got obesity, and they are sick and need to lose weight. I don't know if we can say that in Africa, where we often have patients who are huge, and yet they are very active, and when you [look at] their blood pressure and all their metabolics, they're actually pretty healthy,' he notes. 'So, I think they're sometimes jumping to conclusions about African populations that we don't have data on,' adds Venter. Is South Africa ready to move past BMI? Another concern is that while the Lancet Commission may offer useful recommendations for advanced economies, its starting assumptions may not be as relevant for countries like South Africa. For instance, while specialists agree that BMI is a crude measure of obesity, direct measures like DEXA scans are 'out of our reach economically', according to Professor Susan Goldstein, who leads Priceless-SA, a health economics unit at the South African Medical Research Council. And while supplementing BMI with the other metrics such as waist circumference may be doable, health experts told Spotlight that at present healthcare workers in South Africa aren't even measuring BMI alone. Dr Yogan Pillay, a former deputy director-general at the national health department who now runs TB and HIV delivery at the Gates Foundation, told Spotlight: 'I can't tell you how few people in the public sector have their BMI monitored at all. Community health workers are supposed to be going out and measuring BMI, but even that's not happening'. Goldstein also suggests that the monitoring of BMI in South Africa is limited. 'If you go into the clinic for your blood pressure, do they say: 'How's your BMI?' No, I doubt that,' says Goldstein. 'It's just not one of the measures that [gets done].' She adds that South Africa could introduce the combination of metrics proposed by the commission, like waist circumference combined with BMI, but says it would simply require 'a lot of re-education of health workers'. Prevention vs treatment For Goldstein, the commission is correct to regard clinical obesity as a disease which needs to be treated, but we also shouldn't view medication as the only way forward. 'We have to remember that prevention is very important,' says Goldstein. 'We have to focus on food control, we have to look at ultra-processed foods, and unless we do that as well [in addition to medication] we are going to lose this battle.' The National Health Department already has a strategy document for preventing obesity, but some of its recommendations have been critiqued for focusing on the wrong problems. For instance, to prevent childhood obesity, the strategy document recommends reforming the Life Orientation curriculum and educating tuckshop vendors so that both students and food sellers have more information about healthy eating. But as Spotlight previously reported, there are no recommendations to subsidise healthy foods or to increase their availability in poor areas, which several experts believe is more important than educational initiatives. Venter also highlights the importance of obesity prevention, though he emphasises that this shouldn't be in conflict with a treatment approach – instead, we need to push for both. 'The [prevention] we need to do is fix the food supply… and the only way you do that is to decrease the cost of unprocessed food.' But while this may help prevent future cases of obesity, it doesn't help people who are already suffering from obesity, says Venter. And since such people comprise such a large share of the population, we can't simply ignore them, he says. 'Even if you fix the entire food industry tomorrow, those [people who are already obese] are going to remain where they are because simply changing your diet isn't going to do diddly squat [when you already have obesity],' he adds. (Part 1 discusses this in more detail). Goldstein adds that increasing access to treatment would also inevitably reduce the costs of 'hypertension, diabetes, osteoarthritis, and a whole range of other illnesses if it's properly managed'. One way to advance access to medication would be for the government to negotiate reduced prices of GLP-1 drugs, she says. (Spotlight previously reported on the prices and availability of these medicines in South Africa here.) Funding A final concern that has been raised about the commission is about its source of funding. 'I don't know how one gets around this,' says Goldstein, 'but there were 58 experts on the commission, 47 declared conflicts of interest.' Indeed, the section of the commission that lists conflicts of interest spans more than 2,000 words (roughly the size of this article). This includes research grants and consulting fees from companies like Novo Nordisk and Eli Lilly, which produce anti-obesity drugs. In response, Rubino told Spotlight that 'people who work in the medical profession obviously work and consult, and the more expertise they have, the more likely they are to be asked by somebody to advise. So sometimes people have contracts to consult a company – but that doesn't mean that they necessarily make revenue if the company has better sales. You get paid fees for your services as a consultant.' Rubino says this still has to be declared as it may result in some bias, even if it is unconscious, but 'if you wanted to have experts who had zero relationship [to companies] of any sort then you might have to wonder if there is expertise available there… the nature of any medical professional is that the more expertise they have, the more likely that they have engaged in work with multiple stakeholders'. For Venter, there is some truth to this. 'It's very difficult to find people in the obesity field that aren't sponsored by a drug company,' he says. 'Governments don't fund research… and everyone else doesn't fund research. Researchers go where the research is funded.' This doesn't actually solve the problem, says Venter, as financing from drug companies can always influence the conclusions of researchers. It simply suggests that the problem is bigger than the commission. Ultimately, he argues that the authors should at least be applauded for providing such granular details about conflicts of interest. Rubino adds that while researchers on the commission may have historically received money from drug companies for separate research studies or consulting activities, none of them received money for their work on the commission itself. 'This commission has been working for more than four years since conception… An estimate of how many meetings we had is north of 700, and none of us have received a single penny [for doing this],' he says. DM
Eyewitness News
11-06-2025
- Health
- Eyewitness News
The way we understand obesity is changing: What does it mean for South Africa?
If we are going to tackle the global rise in obesity, our understanding of the condition needs to change. That is according to a Lancet Commission convened by a global group of 58 experts from different medical specialties. While we have historically thought of obesity as a risk factor for other diseases like diabetes, the commission's recent report published in the journal Lancet Diabetes and Endocrinology concludes that obesity is sometimes better thought of as a disease itself – one that can directly cause severe health symptoms (see part one of this series for a detailed discussion of this argument). By categorising obesity as a disease, public health systems and medical aid schemes around the world would be more likely to cover people for weight-loss drugs or weight-loss surgery, according to the report. At present, these services are often only financed if a patient's obesity has already led to other diseases. This is given that obesity is not viewed as a stand-alone chronic illness. But if we're going to redefine obesity as a disease, or at least some forms of it, then we need good clinical definitions and ways to measure it. For a long time, this has posed challenges, according to the Lancet report. THE PERILS OF BMI At present, health workers often rely on Body Mass Index (BMI) to gauge whether a patient is within a healthy weight range. BMI is measured by taking a person's weight in kilograms and dividing it by their height in meters squared. A healthy weight is typically considered to be between 18.5 and 25. A person whose BMI is between 25 and 30 is considered to be overweight, while someone with a BMI of over 30 is considered to have obesity. But according to the Lancet report, this is a crude measure, and one which provides very little information about whether a person is actually ill. One basic issue is that a person can have a high BMI even if they don't have a lot of excess fat. Instead, they may simply have a lot of muscle or bone. Indeed, the report notes that some athletes are in the obese BMI range. Even when a high BMI does indicate that a person has obesity, it still doesn't tell us where a person's fat is stored and this is vital medical information. If excess fat is stored in the stomach and chest, then it poses more severe health risks than when it is stored in the limbs or thighs. This is because excess fat will do more harm if it surrounds vital organs. The lead author of the Lancet report, Professor Frances Rubino, says that the pitfalls of BMI have long been understood, but practitioners have continued to use it. 'BMI is still by and large the most used approach everywhere, even though medical organisations have [raised issues] for quite some time,' he tells Spotlight. To deal with this problem, the report advocates for several alternative techniques for measuring obesity which offer more precision. The first option is to use tools that directly measure body composition like a DEXA scanner. This is a sophisticated x-ray machine which can be used to distinguish between fat, bone and muscle. It can also be used to determine where fat is concentrated. It's thus a very precise measurement tool, but the machines are expensive and the scans can be time-consuming. Alternatively, the report recommends using BMI in combination with another measure like waist-to-hip ratio, waist-to-height ratio or simply waist circumference. If two of these alternative measures are used, then BMI can be removed from the picture. These additional metrics are clinically useful because they provide information about where fat is stored. For instance, a larger waistline inevitably indicates a larger stomach. Indeed, studies have found that above a certain level, a larger waist circumference is linked to a higher chance of dying early, even when looking at people with the same BMI. Related Posts The report thus offers a more accurate way to measure obesity in the clinical setting. But its authors argue that this is only the first step when making a diagnosis. The second is to look at whether a patient's obesity has actually caused health problems as this isn't automatically the case. They acknowledge for instance that there are some people with obesity who 'appear to be able to live a relatively healthy life for many years, or even a lifetime'. The report refers to these cases as 'preclinical obesity'. Such patients don't have a disease as such, according to the report, but still have an increased risk of facing health issues in the future. As such, the report's authors argue that they should be monitored and sometimes even treated, depending on factors like family history. By contrast, cases of obesity which have directly caused health problems are referred to as 'clinical obesity'. These cases, according to the report, should be treated immediately just like any other serious disease. It lists a series of medical symptoms associated with clinical obesity that would allow health workers to make an appropriate diagnosis. The recommendation is thus for health workers to determine whether a person has obesity through the metrics listed above, and then to determine whether it is clinical or preclinical by evaluating a patient's symptoms. This will inevitably guide the treatment plan. HOW DOES THIS RELATE TO SOUTH AFRICA? Professor Francois Venter, who runs the Ezintsha research centre at WITS university, says the Lancet report offers a good starting point for South Africa, but it has to be adapted for our own needs and context. 'It's a big step forward from BMI which grossly underdiagnoses and overdiagnoses obesity,' says Venter, who adds that additional metrics like waist circumference are a 'welcome addition'. The view that clinical obesity is a disease that needs to be immediately treated is also correct, according to Venter. Though he adds that the public health system in South Africa is not in a financial position to start handing out weight-loss medicine to everyone who needs it. 'The drugs are hugely expensive,' says Venter, 'and they have side effects, so you need a lot of resources to support people taking them.' But while it may not yet be feasible to treat all cases of clinical obesity in South Africa, Venter believes we should use the diagnostic model offered by the Lancet Commission to begin identifying at least some people with clinical obesity so that they can begin treatment. 'You have to start somewhere, and for that you need a good staging system,' he says. 'Let's use the Lancet Commission and start to see if we can identify a few priority people and screen them and start to work on the drug delivery system.' Yet while Venter believes that the commission makes important contributions, he also cautions that we need more data on obesity in Africa before we can apply all of its conclusions to our own context. 'If you go to the supplement of the Lancet Commission, there's not a single African study there. It all comes from Europe, North America and Asia. It's not the commission's fault but [there is a lack of data on Africa].' This is important as findings that apply to European or Asian populations may not necessarily hold for others. Consider the following case. As noted, the commission states that BMI is not sufficient to determine whether someone is overweight and must therefore be complemented with other measures. But it states that if someone's BMI is above 40 (way above the current threshold for obesity), then this can 'pragmatically be assumed' without the need for further measures. But this may not hold in Africa, says Venter. 'The commission says that if your BMI is over 40, which is very big, you can infer that this person has got obesity and they are sick and need to lose weight. I don't know if we can say that in Africa, where we often have patients who are huge, and yet they are very active, and when you [look at] their blood pressure and all their metabolics, they're actually pretty healthy,' he notes. 'So, I think they're sometimes jumping to conclusions about African populations that we don't have data on,' adds Venter. IS SOUTH AFRICA READY TO MOVE PAST BMI? Another concern is that while the Lancet Commission may offer useful recommendations for advanced economies, its starting assumptions may not be as relevant for countries like South Africa. For instance, while specialists agree that BMI is a crude measure of obesity, direct measures like DEXA scans are 'out of our reach economically', according to Professor Susan Goldstein, who leads PRICELESS-SA, a health economics unit at the South African Medical Research Council. And while supplementing BMI with the other metrics like waist circumference may be doable, health experts told Spotlight that at present healthcare workers in South Africa aren't even measuring BMI alone. Dr Yogan Pillay, a former deputy director-general at the national health department who now runs TB and HIV delivery at the Gates Foundation, told Spotlight: 'I can't tell you how few people in the public sector have their BMI monitored at all. Community health workers are supposed to be going out and measuring BMI, but even that's not happening'. Goldstein also suggests that the monitoring of BMI in South Africa is limited. 'If you go into the clinic for your blood pressure, do they say: 'How's your BMI?' No, I doubt that,' says Goldstein. 'It's just not one of the measures that [gets done].' She adds that South Africa could introduce the combination of metrics proposed by the commission, like waist circumference combined with BMI, but says it would simply require 'a lot of re-education of health workers'. PREVENTION VS TREATMENT For Goldstein, the commission is correct to regard clinical obesity as a disease which needs to be treated, but we also shouldn't view medication as the only way forward. 'We have to remember that prevention is very important,' says Goldstein. 'We have to focus on food control, we have to look at ultra-processed foods, and unless we do that as well [in addition to medication] we are going to lose this battle.' The National Health Department already has a strategy document for preventing obesity, but some of its recommendations have been critiqued for focusing on the wrong problems. For instance, to prevent childhood obesity, the strategy document recommends reforming the Life Orientation curriculum and educating tuck shop vendors so that both students and food sellers have more information about healthy eating. But as Spotlight previously reported, there are no recommendations to subsidise healthy foods or to increase their availability in poor areas, which several experts believe is more important than educational initiatives. Venter also highlights the importance of obesity prevention, though he emphasises that this shouldn't be in conflict with a treatment approach – instead, we need to push for both. 'The [prevention] we need to do is fix the food supply… and the only way you do that is to decrease the cost of unprocessed food.' But while this may help prevent future cases of obesity, it doesn't help people who are already suffering from obesity, says Venter. And since such people comprise such a large share of the population, we can't simply ignore them, he says. 'Even if you fix the entire food industry tomorrow, those [people who are already obese] are going to remain where they are because simply changing your diet isn't going to do diddly squat [when you already have obesity],' he adds. (Part 1 discusses this in more detail). Goldstein adds that increasing access to treatment would also inevitably reduce the costs of 'hypertension, diabetes, osteoarthritis, and a whole range of other illnesses if it's properly managed'. One way to advance access to medication would be for the government to negotiate reduced prices of GLP-1 drugs, she says. (Spotlight previously reported on the prices and availability of these medicines in South Africa here.) FUNDING A final concern that has been raised about the Lancet commission is about its source of funding. 'I don't know how one gets around this,' says Goldstein, 'but there were 58 experts on the commission, 47 declared conflicts of interest.' Indeed, the section of the commission that lists conflicts of interest spans over 2 000 words (roughly the size of this article). This includes research grants and consulting fees from companies like Novo Nordisk and Eli Lilly, which produce anti-obesity drugs. In response, Rubino told Spotlight that 'people who work in the medical profession obviously work and consult, and the more expertise they have, the more likely they are to be asked by somebody to advise. So sometimes people have contracts to consult a company – but that doesn't mean that they necessarily make revenue if the company has better sales. You get paid fees for your services as a consultant'. Rubino says this still has to be declared as it may result in some bias, even if it is unconscious, but 'if you wanted to have experts who had zero relationship [to companies] of any sort then you might have to wonder if there is expertise available there… the nature of any medical professional is that the more expertise they have, the more likely that they have engaged in work with multiple stakeholders'. For Venter, there is some truth to this. 'It's very difficult to find people in the obesity field that aren't sponsored by a drug company,' he says. 'Governments don't fund research… and everyone else doesn't fund research. Researchers go where the research is funded.' This doesn't actually solve the problem, says Venter, as financing from drug companies can always influence the conclusions of researchers. It simply suggests that the problem is bigger than the commission. Ultimately, he argues that the authors should at least be applauded for providing such granular details about conflicts of interest. Rubino adds that while researchers on the commission may have historically received money from drug companies for separate research studies or consulting activities, none of them received money for their work on the commission itself. 'This commission has been working for more than four years since conception… An estimate of how many meetings we had is north of 700, and none of us have received a single penny [for doing this],' he says. Disclosure: The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council. This article first appeared on Spotlight. Read the original article here.
Irish Daily Mirror
05-06-2025
- Health
- Irish Daily Mirror
Top doc recommends getting rid of everyday tool to reduce risk of Alzheimer's
There is "such positivity" in Alzheimer's research at the moment, says top immunologist Luke O'Neill. A drug that slows down the disease was recently approved by the European Medicines Agency (EMA), and it is hoped that it will be available in Ireland soon. However, the expert stresses that lifestyle changes can help lower a person's chance of developing the disease. Alzheimer's is the most common form of dementia, which is the umbrella term for memory loss and other cognitive abilities that are serious enough to interfere with daily life. It is primarily caused by the build-up of protein deposits in the brain that eventually kills brain cells. While the exact cause of Alzheimer's is unknown, scientists believe that for most people it is caused by a combination of genetic, lifestyle and environmental factors. In July 2024, the Lancet Commission reported that 45 per cent of dementia cases could be prevented by fully addressing 14 lifestyle factors. Here are Luke O'Neill's and the Lancet's lifestyle recommendations on reducing the risk of Alzheimer's- and it includes ditching a tool most of us use daily. Google Maps is a tool that many of us use daily, however, studies suggest that keeping our brains as active as we can can reduces the risk of Alzheimer's. This can be done by learning a new language, doing puzzles, taking part in quizzes and also by navigating new areas and figuring out directions ourselves. A study published in The BMJ in December 2024 found that taxi drivers and ambulance drivers have the lowest rates of death due to Alzheimer's. Other drivers such as airline pilots or bus drivers - those that have predefined routes - did not have a lower risk of developing the disease. This suggests that occupations requiring frequent navigational and spatial processing could offer some protection against Alzheimer's. Social interaction is a great way to keep the mind active, and scientists have identified social isolation as a risk factor for not only Alzheimer's but hypertension and coronary heart disease. Loneliness can be associated with decreased cognitive activity, which can accelerate cognitive decline and poor mood. Professor O'Neill told the Irish Mirror: "A big one is loneliness, that is a risk factor for developing Alzheimer's and Dementia. We have to mind older people, many older people get isolated and with some encouragement we can hopefully diminish the loneliness epidemic that's there." Studies strongly suggest a link between hearing loss and a higher risk of developing dementia. One found that with every 10-dB decrease in hearing ability, there is a 4 per cent to 24 per cent higher risk of developing dementia. Professor O'Neill encourages everyone to be conscious of their hearing and get it checked if they believe it might be declining. He added: "With a hearing aid you can stave that off, so the big message that's been given in the last while is if you are having trouble hearing go and get a hearing aid because it's a risk of getting Alzheimer's. "These are things we can all do at decreasing our own risk of getting it, and they are very optimistic on that front." The newest Lancet Commission study on dementia reported that high LDL cholesterol is associated with a higher risk of dementia. LDL is commonly known as "bad cholesterol", it's a condition where there's excessive amount of LDL cholesterol in the bloodstream. This is usually checked during a routine bloods appointment, often in a GP office. Luckily, much can be done to reduce LDL cholesterol including a balanced diet low in saturated and trans fats. This is usually found in foods like red meat, full-fat dairy, fried foods and processed snacks. Lifelong learning is associated with improved brain health, with higher levels of cognitive activity. This doesn't mean you have to enroll in a degree programme, but learning a new language or taking up a new skill, even casually, can improve brain health. The Lancet Commission found that those who did not complete secondary school education were more at-risk of developing Alzheimer's. Being active is important for a healthier life, and it has been cited as one of the 14 factors that could reduce the risk of dementia. Physical activity can benefit brain health by reducing chronic inflammation, improving blood flow and increasing the release of protein that is good for brain cells. The World Health Organisation recommends that adults get between 150 and 300 minutes of moderate-intensity aerobic physical activity a week. This would include walking briskly, biking, swimming or dancing. It also recommends that on top of this adults should partake in muscle strengthening activities two times a week. Obesity is also a risk factor for developing Alzheimer's disease. However, it's important to note that BMI is not definitive in diagnosing obesity- as some people can have a high percentage of muscle mass. Calculating body fat percentage, or measuring waist-to-hip ratio can be used to determine a healthy body. An analysis published in the National Library of Medicine with over five million people found that those with higher central obesity - measured by waist-to-hip ratio- was associated with a greater risk of cognitive impairment and dementia.
The Hindu
30-05-2025
- Health
- The Hindu
Watch: Covid cases rise, adolescent health, skin care and more
We address the elephant in the room – COVID cases are rising. There is a palpable sense of panic. Is it a pandemic? Should we take precautions? In the US, health secretary Robert F Kennedy Jnr has said Covid boosters are not to be given to pregnant women and children, with experts already questioning this move. We also talk about the Lancet Commission report on adolescent health and childhood obesity, and the installation of sugar boards in CBSE schools. Back to the US, legendary musician Billy Joel has cancelled his concerts due to an illness called NPS. What is it all about? In our expert segment, we speak to Dr. Monisha Madhumita, Assistant Professor at the Department of Dermatology, in Chennai's Saveetha Medical College. Dr Madhumita talks about skin care routines in this varying climate of blazing sunshine followed by rains, skin pigmentation issues and more. Presentation: Ramya Kannan and Zubeda Hamid Editing: Thamodharan B. Videography: Thamodharan B. and Shiva Raj
