Michele Cecchini

Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness.

The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.

Improving Lifestyles, Tackling Obesity: The Health and Economic Impact of Prevention Strategies

Overweight and obesity rates have been increasing relentlessly over recent decades in all industrialised countries, as well as in many lower income countries. OECD analyses of trends over time support the grim picture drawn in the international literature and so do projections of overweight and obesity rates over the next ten years. The circumstances in which people have been leading their lives over the past 20-30 years, including physical, social and economic environments, have exerted powerful influences on their overall calorie intake, on the composition of their diets and on the frequency and intensity of physical activity at work, at home and during leisure time. Many countries have been concerned not only about the pace of the increase in overweight and obesity, but also about inequalities in their distribution across social groups, particularly by socio-economic status and by ethnic background. Les taux de surpoids et d’obesite ne cessent d’augmenter depuis plusieurs decennies dans tous les pays industrialises, ainsi que dans beaucoup de pays ayant un revenu plus faible. Les analyses consacrees par l’OCDE aux tendances structurelles confirment le sombre tableau qui a ete brosse dans les publications internationales, tout comme le font les previsions etablies sur les taux de surpoids et d’obesite pour les dix prochaines annees. Les conditions dans lesquelles vivent les individus depuis vingt ou trente ans, notamment sur le plan materiel, social et economique, ont tres fortement influe sur leur ration calorique globale, la composition de leur alimentation, ainsi que la frequence et l’intensite de leur activite physique au travail, a la maison et pendant les loisirs. Beaucoup de pays sont preoccupes non seulement par le rythme auquel progressent le surpoids et l’obesite, mais aussi par le caractere inegal de leur repartition entre les categories sociales, en particulier selon la situation socioeconomique et l’origine ethnique.

European Code against Cancer 4th Edition: Diet and cancer

Lifestyle factors, including diet, have long been recognised as potentially important determinants of cancer risk. In addition to the significant role diet plays in affecting body fatness, a risk factor for several cancers, experimental studies have indicated that diet may influence the cancer process in several ways. Prospective studies have shown that dietary patterns characterised by higher intakes of fruits, vegetables, and whole-grain foods, and lower intakes of red and processed meats and salt, are related to reduced risks of death and cancer, and that a healthy diet can improve overall survival after diagnosis of breast and colorectal cancers. There is evidence that high intakes of fruit and vegetables may reduce the risk of cancers of the aerodigestive tract, and the evidence that dietary fibre protects against colorectal cancer is convincing. Red and processed meats increase the risk of colorectal cancer. Diets rich in high-calorie foods, such as fatty and sugary foods, may lead to increased calorie intake, thereby promoting obesity and leading to an increased risk of cancer. There is some evidence that sugary drinks are related to an increased risk of pancreatic cancer. Taking this evidence into account, the 4th edition of the European Code against Cancer recommends that people have a healthy diet to reduce their risk of cancer: they should eat plenty of whole grains, pulses, vegetables and fruits; limit high-calorie foods (foods high in sugar or fat); avoid sugary drinks and processed meat; and limit red meat and foods high in salt.

European Code against Cancer 4th Edition: Physical activity and cancer.

Physical activity is a complex, multidimensional behavior, the precise measurement of which is challenging in free-living individuals. Nonetheless, representative survey data show that 35% of the European adult population is physically inactive. Inadequate levels of physical activity are disconcerting given substantial epidemiologic evidence showing that physical activity is associated with decreased risks of colon, endometrial, and breast cancers. For example, insufficient physical activity levels are thought to cause 9% of breast cancer cases and 10% of colon cancer cases in Europe. By comparison, the evidence for a beneficial effect of physical activity is less consistent for cancers of the lung, pancreas, ovary, prostate, kidney, and stomach. The biologic pathways underlying the association between physical activity and cancer risk are incompletely defined, but potential etiologic pathways include insulin resistance, growth factors, adipocytokines, steroid hormones, and immune function. In recent years, sedentary behavior has emerged as a potential independent determinant of cancer risk. In cancer survivors, physical activity has shown positive effects on body composition, physical fitness, quality of life, anxiety, and self-esteem. Physical activity may also carry benefits regarding cancer survival, but more evidence linking increased physical activity to prolonged cancer survival is needed. Future studies using new technologies - such as accelerometers and e-tools - will contribute to improved assessments of physical activity. Such advancements in physical activity measurement will help clarify the relationship between physical activity and cancer risk and survival. Taking the overall existing evidence into account, the fourth edition of the European Code against Cancer recommends that people be physically active in everyday life and limit the time spent sitting.

European Code against Cancer 4th Edition: 12 ways to reduce your cancer risk

This overview describes the principles of the 4th edition of the European Code against Cancer and provides an introduction to the 12 recommendations to reduce cancer risk. Among the 504.6 million inhabitants of the member states of the European Union (EU28), there are annually 2.64 million new cancer cases and 1.28 million deaths from cancer. It is estimated that this cancer burden could be reduced by up to one half if scientific knowledge on causes of cancer could be translated into successful prevention. The Code is a preventive tool aimed to reduce the cancer burden by informing people how to avoid or reduce carcinogenic exposures, adopt behaviours to reduce the cancer risk, or to participate in organised intervention programmes. The Code should also form a base to guide national health policies in cancer prevention. The 12 recommendations are: not smoking or using other tobacco products; avoiding second-hand smoke; being a healthy body weight; encouraging physical activity; having a healthy diet; limiting alcohol consumption, with not drinking alcohol being better for cancer prevention; avoiding too much exposure to ultraviolet radiation; avoiding cancer-causing agents at the workplace; reducing exposure to high levels of radon; encouraging breastfeeding; limiting the use of hormone replacement therapy; participating in organised vaccination programmes against hepatitis B for newborns and human papillomavirus for girls; and participating in organised screening programmes for bowel cancer, breast cancer, and cervical cancer.

Education and obesity in four OECD countries

An epidemic of obesity has been developing in virtually all OECD countries over the last 30 years. Existing evidence provides strong suggestions that such epidemic has affected certain social groups more than others. In particular, education appears to be associated with a lower likelihood of obesity, especially among women. A range of analyses of health survey data from Australia, Canada, England and Korea were undertaken with the aim of exploring the relationship between education and obesity. The findings of these analyses show a broadly linear relationship between the number of years spent in full-time education and the probability of obesity, with most educated individuals displaying lower rates of the condition (the only exception being men in Korea). This suggests that marginal returns to education, in terms of reduction in obesity rates, are approximately constant throughout the education spectrum. The findings obtained confirm that the education gradient in obesity is stronger in women than in men. Differences between genders are minor in Australia and Canada, more pronounced in England and major in Korea. The causal nature of the link between education and obesity has not yet been proven with certainty; however, using data from France we were able to ascertain that the direction of causality appears to run mostly from education to obesity, as the strength of the association is only minimally affected when accounting for reduced educational opportunities for those who are obese in young age. Most of the effect of education on obesity is direct. Small components of the overall effect of education on obesity are mediated by an improved socio-economic status linked to higher levels of education, and by a higher level of education of other family members, associated with an individual’s own level of education. The positive effect of education on obesity is likely to be determined by at least three factors: (a) greater access to health-related information and improved ability to handle such information; (b) clearer perception of the risks associated with lifestyle choices; and, (c) improved self-control and consistency of preferences over time. However, it is not just the absolute level of education achieved by an individual that matters, but also how such level of education compares with that of the individual’s peers. The higher the individual’s education relative to his or her peers’, the lower is the probability of the individual being obese.

Preventing Obesity in the USA: Impact on Health Service Utilization and Costs

BackgroundWith more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to ‘bend the curve’ of rising healthcare costs is still an object of debate.ObjectiveThis study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA.Study Design and MethodThe study was carried out as a retrospective evaluation of alternative scenarios compared with a ‘business as usual’ scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997–2010).ResultsIn 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to

Use of seemingly unrelated equations to assess changes in dietary behaviours during the UK's economic crisis

US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits.ConclusionPrevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

Tackling obesity requires efficient government policies.

Abstract Background In 2008, the world economy entered one of the most severe crises ever. Standards of living fell for large parts of the population in many countries. For example, UK families cut their food expenditure by 8·5%. The aim of this study was to assess whether the economic crisis was associated with any dietary change in the UK and other member countries of the Organisation for Economic Co-operation and Development (OECD). Methods A seemingly unrelated regression (SUR) model with random effect estimators was used on a panel dataset that included data between 1999 and 2013 for 21 OECD countries. The dataset included statistics from Euromonitor-Passport, OECD, World Bank, and Eurostat. The three variables of interest were purchase of fruit and vegetables, snack-bars, and snacks. Negative growth in gross domestic product (ie, economic crisis) was the explanatory variable of interest. Foodstuff-specific inflation rates and other key socioeconomic variables (eg, population age) were also included. Compared with standard statistical approaches, SUR models provide more efficient performances when dependent variables can be substituted (eg, fruit and vegetables, snack-bars, and snacks). Findings People living in countries affected by the economic crisis decreased their consumption of fruit and vegetables by 3·64 kg per head per year (95% CI −6·65 to −0·64, p=0·017) which is about one portion per week. At the same time, people slightly increased their consumption of snack-bars (22·6 g per head per year, 95% CI 1·5 to 43·8, p=0·036) and snacks (40·2, −50·5 to 130·9; p=0·385). In the UK, given the levels of consumption of these products, the above mentioned variations indicate that the economic crisis was associated with a 3·5% decrease in purchase of fruit and vegetables and an increased purchase of snack-bars (3·5%) and snacks (0·5%). Interpretation The findings of this study support the hypothesis that tighter food budgets might have led consumers to switch to lower-priced (per calorie) and less healthy food. The economic crisis might have therefore contributed to a further growth in obesity and related chronic diseases. Previous studies suggest that small effects at the population level can mask substantial inequalities across different socioeconomic groups. This study pioneers, in the field of public health, the use of an advanced econometric approach applied to a market information database. Funding This project is partly funded through regular contributions from OECD member countries.

Impacts sur l'économie et la santé des principales mesures possibles en matière d'alcool

Changes in food supply and eating habits, combined with a dramatic fall in physical activity, have made obesity a global epidemic. Across OECD countries, one in two adults is currently overweight and one in six is obese. Children have not been spared, with up to one in three currently overweight. Obese people are more likely to develop diseases such as diabetes, cardiovascular disease, and cancer, and have a shorter life expectancy than people of normal weight. A prevention strategy combining health promotion campaigns, government regulation, counseling of individuals at risk in primary care, and paying special attention to the most vulnerable, would enhance population health at an affordable cost, with likely beneficial effects on health inequalities. Failure to implement such a strategy would impose heavy burdens on future generations. The new IJHPR paper by Ginsberg and Rosenberg illustrates how particular countries can assess alternative strategies for tackling obesity in a rigorous fashion.This is a commentary on http://www.ijhpr.org/content/1/1/17/