How will the World Health Assembly meet its 2025 targets?
Author: Dr Tim Lobstein
Director of Policy, World Obesity Federation
*The following blog first appeared on International Diabetes Federation's (IDF) website in support of World Obesity Day.
The launch of the first World Obesity Day (October 11th) also marks the first five years of the fifteen years that world governments have given themselves to tackle obesity and reduce chronic disease.
At the World Health Assembly in May 2012 governments gave themselves a target of a 25% reduction in premature mortality from non-communicable diseases from their 2010 levels, along with a target of ‘no increase in obesity or diabetes levels’ from 2010 levels. The targets were to be met by 2025.
It was perhaps rather rash of the Assembly to aim for a major decline in non-communicable disease while not aiming for any decline in either diabetes of obesity, given the role that both these conditions have in raising the likelihood of premature death, including from cardiovascular diseases, certain cancers and liver disease. But that aside, what are the chances of even meeting the apparently modest target of ‘no increase’ from 2010 levels?
At the World Obesity Federation, we have been assessing the changes in obesity prevalence in the last few years and asking whether the trends are going in the direction of meeting the World Health Assembly targets. Sadly, the figures do not look good.
The World Health Organization recently published estimates for overweight and obesity prevalence for 2014. Whereas in 2010 obesity prevalence stood at 11.5% of adults – equivalent to some 565 million people – by 2014 the figures had increased to 13%, or some 670 million people.
This is not a hopeful sign. If nothing is done, and these trends continue at the same rate, the targets simply cannot be met. The World Obesity Federation predicts the numbers will rise to 17% of all adults, or some 995 million people. If you add in the number who are overweight but not obese, the total is 2.7 billion adults with excess weight by 2025, up from 2.0 billion in 2014.
Worse, the numbers of adults with severe obesity – with a BMI of 35 kg/m2 or higher and meriting immediate medical attention – is also rising significantly. The numbers of adults with severe obesity may more than double between 2010 and 2025, rising from 1.49% of all adults to more than 3.0% on current trends. With rising population numbers, this equates to a rise from 73 million adults in 2010 to an extraordinary 177 million in 2025.
Can the health services of the world cope with this number of severely obese people? How will the services in emerging economies cope, where much of this severe obesity will occur? Left untreated, the chance of comorbidities, including of course diabetes, are very high: the relative risk of diabetes in adults with severe obesity compared with adults of normal weight is some 40-fold for men, and 90-fold for women.
Health services have a limited range of treatment options available: ‘lifestyle’ changes, which require levels of willpower and access to assets which few people possess; pharmaceutical interventions which are capable of only limited weight loss effects; and surgical interventions, which assume the operating theatres, surgical staff and follow-up facilities and professional support exist.
In all cases, patients treated for obesity return to the obesogenic environments from which they came – the environments which encourage sedentary behaviour and the consumption of excess highly processed foods, the very factors which helped put them in the clinic in the first place. Until these environmental drivers of weight gain are fully acknowledged and policies developed to tackle them, obesity treatment will be substantially undermined, and obesity prevention will fail.
To meet its targets, the World Health Assembly needs to act, and act rapidly. Even getting obesity and diabetes back down to 2010 levels will be a mammoth task. We hope that World Obesity Day will help to keep the targets at the forefront of government policies.