Prevention of non-communicable diseases

Last week, my column detailed the impressive increase in life expectancy around the globe. As reported in the National Institute on Aging, “The dramatic increase in average life expectancy during the 20^th century ranks as one of society’s greatest achievements. Although most babies born in 1900 did not live past age 50, life expectancy at birth now exceeds 83 years in Japan — the current leader in life expectancy — and is at least 81 years in several other countries.”

However, in 2015 the overall U.S. death rate increased for the first time in a decade, leading to a drop in overall life expectancy for the first time since 1993, particularly among people younger than 65.

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Health experts cite an unexpected increase in mortality from heart disease and stroke, after declining for years. Deaths from Alzheimer’s disease, respiratory disease, kidney disease and diabetes are also up.

What do these diseases all have in common? As reported in the American Journal of Clinical Nutrition, researchers are finding that obesity plays a pivotal role in inflammation throughout the body. Fat cells are not just “storage reservoirs” for excess fat, but are endocrine organs in their own right. Obesity is linked to chronic inflammation and resultant increased risk for diseases ranging from diabetes to depression. Read more here.

The World Health Organization (WHO) reports that non-communicable diseases (NCD) are, today, the leading cause of death in industrialized countries including the U.S., the U.K., and in Ecuador.

The WHO defines a communicable disease as a … “medical condition or disease that is not caused by infectious agents… also known as chronic diseases, these type of “diseases” tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviors factors.”

Cardiovascular disease (including heart attacks and stroke), cancers, chronic respiratory diseases (COPD, asthma) and diabetes are considered NCDs.   They share an important primary risk factor — obesity.

Researchers analyzed data from similar studies from the National Cancer Institute, and found that obese people have more than double the risk for premature death compared to people who maintain a healthy weight for their height.

A contributing factor associated with obesity is lack of physical activity. As reported in the Harvard Health Letter, physical activity levels are declining all over the world, not only in wealthy countries like the U.S., but also in low-and-middle-income countries like China.

Between 1950 and 2000, the number of Americans who worked in high-activity occupations dropped from 30% to 22%. In 1969, 40% of kids walked or rode their bikes to school, dropping to 13% by 2001.

In China, a country formerly plagued by malnutrition, lack of physical activity is one of the most significant behaviors related to obesity and increased rate of non-communicable diseases (others include diet, smoking, and alcohol use.)  According to a report released by the World Obesity Federation, if trends continue, Mainland China will have 48.5 million overweight children in 2025, more than the entire population of Spain.

Childhood obesity: An “exploding nightmare” 

In 2015, the World Health Organization warned of the international epidemic of obese and overweight kids, noting that at least 41 million children under five years old are obese or overweight.  The CDC reports that the percentage of obese kids in the U.S. has more than tripled since the 1970s, and today one in five school-aged children (ages 6-19) is obese.

The WHO notes that in wealthier countries, poorer children are more likely to be obese because of the affordability of fatty fast food and high-sugar snacks.

However, in poorer countries, children from wealthier families are more likely to be obese, especially in cultures where “an overweight child is often considered to be healthy.”

The WHO writes, “Childhood obesity is associated with a higher chance of premature death and disability in adulthood. Overweight and obese children are more likely to stay obese into adulthood and to develop noncommunicable diseases like diabetes and cardiovascular diseases at a younger age.”

Obese kids are also at higher risk for musculoskeletal disorders, especially osteoarthritis, and for certain cancers, including endometrial, breast and colon. The CDC also reports that obese kids are more likely to be bullied and teased, which could lead to social isolation, depression, and lower self-esteem.

Is Unhealthy Behavior Contagious?

Research shows that unhealthy behaviors such as smoking, lack of physical activity and obesity may be socially contagious.

Friends, family members and colleagues of smokers or obese individuals are more likely to smoke or to be obese themselves. These lifestyle habits are spread through social ties.

The obesity epidemic contributes to most of the deadly diseases killing people around the world, including Ecuador, whose obesity rate is growing faster than at any time in history. Far more people around the world are affected by obesity than any other communicable diseases.

We’ve made progress in conquering and preventing infectious and communicable diseases, but how are we addressing the epidemic of obesity? “Non-communicable” sounds somewhat benign. Maybe we should address obesity as we would a virus?

As noted by Margaret Wootan and Katherine Bishop of the Center for Science in the Public Interest, obesity is as deadly as any communicable disease, and prevention programs should be funded as such. Obesity is a major societal problem, deserving of research and programs that any epidemic deserves.

They write, “You can bet that if 86 million Americans contracted some rare flu, and 300,000 of them died from it each year, the country would be fully mobilized to prevent that disease.”

Your Personal Prescription for Healthy Living

Regarding your weight, studies show that it’s more important where you carry your weight than how much you weigh.  If you are an “apple” and carry weight in your belly you may be at higher risk for heart disease and diabetes compared to overweight “pears.”

But weight is just a number on the scale, and doesn’t indicate how much of your weight is muscle mass.  As noted by NPR, if BMI were the test of health, many, including pro athletes, would flunk.  Their muscle mass can boost them into the obese range, even though they’re healthy and fit.

These are the numbers to pay attention to:

Waist size: men 40” or less (101.6 cm); women 35” or less (88.9 cm)

Blood glucose (fasting): less than 100 mg/dL

Blood pressure: 120/80 without medication although at 8,300 feet your BP may be higher

… And there’s something that isn’t easily measured…your energy level.  On a scale from 1-10, with 1 being least energetic, and 10 being most energetic, are you consistently feeling like a “10”, or are you dragging, down in the ‘2s’ and ‘3s’? Energy level is a very important indication of your health, regardless if the scale says “normal weight” or not.

Get to your healthy weight without “dieting”, but instead, eat to live. Fuel your body with foods designed to give you energy. A Mediterranean style of living describes the types of foods to eat most frequently.

Ecuador’s mercados offer an alternative to the SAD diet.

You’re living in Ecuador, so ditch the SAD diet (Standard American Diet) full of butter, fatty meats, hydrogenated fats, deep-fried and processed foods.  Eating a Mediterranean-type diet means enjoying fresh vegetables, fruits and whole grains, some dairy, lots of legumes and dried beans, seeds and nuts, and all types of fish, most days of the week.  If you do eat meat, it’s not a huge hunk, and more typically poultry, lamb or goat rather than beef or pork. Wine may complement the diet, but it’s designed to be part of the meal.

Read the latest research that concludes that the Mediterranean-type diet can also be preventative against atherosclerosis, the metabolic syndrome, type 2 diabetes, some cancers and neurogenerative diseases.

Maybe you feel as lucky as I do, because living in Ecuador, I find it easy to eat healthfully, although there are plenty of SAD foods to be found.

In North America, it’s more expensive to eat the variety of fresh produce that is easily found here in our local mercados and from local growers daily.  Not to mention whole grains such as barley and quinoa, and legumes, fresh fish, avocado, potatoes, and healthy oils.  The Latin Mediterranean Diet!  Buen Provecho!

Sources

American Journal of Clinical Nutrition.  Obesity and the role of adipose tissue in inflammation and metabolism. http://www.andf.com.br/assets/obesity-and-the-role-of-adipose-tissue-in-inflammation-and-metabolism.pdf

Centers for Disease Control & Prevention. Childhood Obesity Facts. https://www.cdc.gov/healthyschools/obesity/facts.htm

Mediators of Inflammation. Chronic Inflammation in Obesity and the Metabolic Syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913796/

National Institute on Aging. Living Longer. https://www.nia.nih.gov/research/publication/global-health-and-aging/living-longer

NIH: National Heart, Lung, and Blood Institute.  Assessing Your Weight and Health Risk. https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm

Pan American Journal of Public Health. Emerging patterns in overweight and obesity in Ecuador. https://www.researchgate.net/publication/23231248_Emerging_patterns_in_overweight_and_obesity_in_Ecuador

PLOS Medicine.  Association between Class III Obesity (BMI of 40-59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001673

PLOS One. Effects of Insufficient Physical Activity on Mortality and Life Expectancy in Jiangxi Province of China 2007-2010. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109826

SecondNatureNutrition.com. Mediterranean Diet: Tastes Great, Great For You! http://secondnaturenutrition.com/mediterranean-diet-tastes-great-great-for-you/

South China Morning Post. China on track to top the world in childhood obesity. http://www.scmp.com/news/china/policies-politics/article/2026185/china-track-top-world-childhood-obesity

The Conversation. Beware; a ‘non-communicable’ disease may be socially infectious.   http://theconversation.com/beware-a-non-communicable-disease-may-be-socially-infectious-36477

The Hill. Obesity: A communicable disease? http://thehill.com/blogs/congress-blog/healthcare/309185-obesity-a-communicable-disease

World Health Organization. Childhood overweight and obesity. http://www.who.int/dietphysicalactivity/childhood/en/

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