Helen Walls

Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis

This study examined the relationship between normal weight, overweight and obesity class I and II+, and the risk of disability, which is defined as impairment in activities of daily living (ADL). Systematic searching of the literature identified eight cross‐sectional studies and four longitudinal studies that were comparable for meta‐analysis. An additional four cross‐sectional studies and one longitudinal study were included for qualitative review. Results from the meta‐analysis of cross‐sectional studies revealed a graded increase in the risk of ADL limitations from overweight (1.04, 95% confidence interval [CI] 1.00–1.08), class I obesity (1.16, 95% CI 1.11–1.21) and class II+ obesity (1.76, 95% CI 1.28–2.41), relative to normal weight. Meta‐analyses of longitudinal studies revealed a similar graded relationship; however, the magnitude of this relationship was slightly greater for all body mass index categories. Qualitative analysis of studies that met the inclusion criteria but were not compatible for meta‐analysis supported the pooled results. No studies identified met all of the pre‐defined quality criteria, and subgroup analysis was inhibited due to insufficient comparable studies. We conclude that increasing body weight increases the risk of disability in a graded manner, but also emphasize the need for additional studies using contemporary longitudinal cohorts with large numbers of obese class III individuals, a range of ages and with measured height and weight, and incident ADL questions.

Trade and investment liberalization and Asia’s noncommunicable disease epidemic: a synthesis of data and existing literature

BackgroundTrade and investment liberalization (trade liberalization) can promote or harm health. Undoubtedly it has contributed, although unevenly, to Asia’s social and economic development over recent decades with resultant gains in life expectancy and living standards. In the absence of public health protections, however, it is also a significant upstream driver of non-communicable diseases (NCDs) including cardiovascular disease, cancer and diabetes through facilitating increased consumption of the ‘risk commodities’ tobacco, alcohol and ultra-processed foods, and by constraining access to NCD medicines. In this paper we describe the NCD burden in Asian countries, trends in risk commodity consumption and the processes by which trade liberalization has occurred in the region and contributed to these trends. We further establish pressing questions for future research on strengthening regulatory capacity to address trade liberalization impacts on risk commodity consumption and health.MethodsA semi-structured search of scholarly databases, institutional websites and internet sources for academic and grey literature. Data for descriptive statistics were sourced from Euromonitor International, the World Bank, the World Health Organization, and the World Trade Organization.ResultsConsumption of tobacco, alcohol and ultra-processed foods was prevalent in the region and increasing in many countries. We find that trade liberalization can facilitate increased trade in goods, services and investments in ways that can promote risk commodity consumption, as well as constrain the available resources and capacities of governments to enact policies and programmes to mitigate such consumption. Intellectual property provisions of trade agreements may also constrain access to NCD medicines. Successive layers of the evolving global and regional trade regimes including structural adjustment, multilateral trade agreements, and preferential trade agreements have enabled transnational corporations that manufacture, market and distribute risk commodities to increasingly penetrate and promote consumption in Asian markets.ConclusionsTrade liberalization is a significant driver of the NCD epidemic in Asia. Increased participation in trade agreements requires countries to strengthen regulatory capacity to ensure adequate protections for public health. How best to achieve this through multilateral, regional and unilateral actions is a pressing question for ongoing research.

Why Education and Choice Won't Solve the Obesity Problem

The authors express their opinion that governments must consider the environment that led to the obesity epidemic when proposing obesity prevention measures. They believe that proposals that focus on the willpower, knowledge, or decision-making ability of individuals will not be successful. They note that changing behavior is a challenge and that increasing levels of knowledge and awareness does not always result in change of behavior.

Setting Population Targets for Measuring Successful Obesity Prevention

In 2008, The Council of Australian Governments set a target to increase by 5% the proportion of Australian adults at a healthy body weight by 2017, over a 2009 baseline. Target setting is a critical component of public health policy for obesity prevention; however, there is currently no context within which to choose such targets. We analyzed the changes in current weight gain that would be required to meet Australian targets. By using transition-based multistate life tables to project obesity prevalence, we found that meeting national healthy weight targets by 2017 will require a 75% reduction in current 5-year weight gain. A reliable model of future body weight prevalence is critical to set, evaluate, and monitor national obesity targets.

Global prevention and control of NCDs: Limitations of the standard approach.

The five-target ‘25 × 25’ strategy for tackling the emerging global epidemic of non-communicable diseases (NCDs) focuses on four diseases (CVD, diabetes, cancer, and chronic respiratory disease), four risk factors (tobacco, diet and physical activity, dietary salt, and alcohol), and one cardiovascular preventive drug treatment. The goal is to decrease mortality from NCDs by 25 per cent by the year 2025. The ‘standard approach’ to the ‘25 × 25’ strategy has the benefit of simplicity, but also has major weaknesses. These include lack of recognition of: (i) the fundamental drivers of the NCD epidemic; (ii) the ‘missing NCDs’, which are major causes of morbidity; (iii) the ‘missing causes’ and the ‘causes of the causes’; and (iv) the role of health care and the need for integration of interventions.

Improving regulatory capacity to manage risks associated with trade agreements

Modern trade negotiations have delivered a plethora of bilateral and regional preferential trade agreements (PTAs), which involve considerable risk to public health, thus placing demands on governments to strengthen administrative regulatory capacities in regard to the negotiation, implementation and on-going management of PTAs. In terms of risk management, the administrative regulatory capacity requisite for appropriate negotiation of PTAs is different to that for the implementation or on-going management of PTAs, but at all stages the capacity needed is expensive, skill-intensive and requires considerable infrastructure, which smaller and poorer states especially struggle to find. It is also a task generally underestimated. If states do not find ways to increase their capacities then PTAs are likely to become much greater drivers of health inequities. Developing countries especially struggle to find this capacity. In this article we set out the importance of administrative regulatory capacity and coordination to manage the risks to public health associated with PTAs, and suggest ways countries can improve their capacity.

A conceptual framework for understanding the impacts of agriculture and food system policies on nutrition and health

Agriculture and food systems are important determinants of nutrition and consequent public health. However, an understanding of the links among agriculture, food systems, nutrition, public health and the associated policy levers, is relatively under-developed. A framework conceptualizing these key relationships, relevant to a range of country contexts, would help inform policymakers as to how agriculture and food policy could improve nutrition and public health, particularly in low- and middle-income countries (LMIC). The objectives of this paper are: to present a conceptual framework, relevant to a range of country contexts and focused on the policymaker as the user, which depicts the key relationships among agriculture, the food system, nutrition and public health; and to describe how the framework can be used for understanding the impacts of agriculture and food system policies on nutrition outcomes. Existing conceptual frameworks, highlighting the relationships among agriculture, the food system, nutrition and public health (n = 37) were identified, reviewed and categorized, based on the key themes they address. Building on this analysis and synthesis a conceptual framework was developed that assists in identifying associated policy levers and their effects on elements of the framework. The end product is a conceptual framework that presents key domains linking agriculture and food systems to nutritional outcomes and public health. The framework is relevant to a range of contexts, for example low-, middle- and high-income settings; and to policymakers wishing to examine the potential direct and indirect impacts of agriculture and food system policies.

Towards a comprehensive global approach to prevention and control of NCDs

BackgroundThe “25×25” strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors.DiscussionWe propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal “one-size fits all” approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors.SummaryThe 25×25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.

The impact of drought on the association between food security and mental health in a nationally representative Australian sample

BackgroundThe association between food insecurity and mental health is established. Increasingly, associations between drought and mental health and drought and food insecurity have been observed in a number of countries. The impact of drought on the association between food insecurity and mental health has received little attention.MethodsPopulation-based study using data from a nationally representative panel survey of Australian adults in which participants report behaviour, health, social, economic and demographic information annually. Exposure to drought was modelled using annual rainfall data during Australia’s ‘Big Dry’. Regression modelling examined associations between drought and three indicative measures of food insecurity and mental health, controlling for confounding factors.ResultsPeople who reported missing meals due to financial stress reported borderline moderate/high distress levels. People who consumed below-average levels of core foods reported more distress than those who consumed above the average level, while people consuming discretionary foods above the average level reported greater distress than those consuming below the threshold. In all drought exposure categories, people missing meals due to cost reported higher psychological distress than those not missing meals. Compared to drought-unadjusted psychological distress levels, in most drought categories, people consuming higher-than-average discretionary food levels reported higher levels of distress.ConclusionsExposure to drought moderates the association between measures of food insecurity and psychological distress, generally increasing the distress level. Climate adaptation strategies that consider social, nutrition and health impacts are needed.

Eye Disease Resulting From Increased Use of Fluorescent Lighting as a Climate Change Mitigation Strategy

Increased use of fluorescent lighting as a climate change mitigation strategy may increase eye disease. The safe range of light to avoid exposing the eye to potentially damaging ultraviolet (UV) radiation is 2000 to 3500K and greater than 500 nanometers. Some fluorescent lights fall outside this safe range. Fluorescent lighting may increase UV-related eye diseases by up to 12% and, according to our calculations, may cause an additional 3000 cases of cataracts and 7500 cases of pterygia annually in Australia. Greater control of UV exposure from fluorescent lights is required. This may be of particular concern for aging populations in developed countries and countries in northern latitudes where there is a greater dependence on artificial lighting.