University of Health Sciences, Cambodia

Sickle Cell Disease (SCD) Visits to Emergency Departments (ED)

mozachsz — Tue, 21 Sep 2010 09:55:27 GMT

FROM: http://www.cdc.gov/Features/dsSickleCell_ED_Visits/

Between 1999 and 2007, approximately 197,333 sickle cell disease ED visits occurred each year.

Sickle cell disease (SCD) is an inherited blood disorder characterized by the production of an altered type of hemoglobin by those affected by the disease. When sickle cell hemoglobin deoxygenates while passing through blood vessels, it polymerizes and becomes fibrous-like causing the red blood cell to become rigid and change shape, appearing sickle shaped. The altered red blood cells can clog blood vessels resulting in lack of oxygen to tissues and causing pain. Repeated, unpredictable episodes of acute pain are a complication of sickle cell disease that affect a substantial number of patients with the disease.

Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a survey of hospital ED and outpatient visits, for the years 1999–2007 revealed estimates of approximately 1,475,000 (95% CI = 1,214,000, 1,736,000) and 1,776,000 (95% CI = 1,484,000, 2,068,000) emergency department visits made by patients with a primary or any diagnosis of SCD, respectively. The estimated yearly average number of emergency department visits by patients with any diagnosis of SCD was 197,333. ED visits by patients with SCD were identified using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes, and nationally weighted estimates were calculated.

Reasons for ED Visits

Reasons for ED visits included chest pain (11%*), other pain or unspecified pain (67%), fever/infection (6%), and shortness of breath/breathing problem/cough (5%) among other reasons. Substantial numbers of ED visits occur among persons with SCD. The most common reason for the ED visits is pain symptoms. The findings of this study can help to improve health services delivery and utilization among patients with SCD.

Characteristics of ED Visits

The mode of arrival for most emergency department visits by patients with SCD was walk-in (79%), followed by ambulance (14%; Table 1). The mode of arrival was walk-in for 87% of visits by patients aged 0–19 years, and 76% of visits by patients aged ≥20 years. The age groups with largest percentage of ED visits were 20-29 years and 30-45 years, and the age group with the fewest visits was >45 years.

The expected source of payment for emergency department visits by patients with SCD was private insurance, Medicaid/State Children's Health Insurance Program (SCHIP), Medicare, and other or unknown for 14%, 58%, 14%, and 15% of visits, respectively. Among visits by patients aged 0 –19 years, the expected source of payment was private insurance for 20% and Medicaid or SCHIP for 70%. Among visits by patients aged20 years, the expected source of payment was private insurance for 11%, Medicare for 19%, and Medicaid for 53%.

The percentage of visits indicated to be initial visit, follow-up visit, and unknown as to the episode of care were 66%, 23%, and 11%, respectively (Table 1). Among visits by patients aged ≥20 years, the episode of care was indicated as a follow-up visit for 27% of the visits. Approximately 29% of emergency department visits by patients with SCD resulted in hospital admission. This was 37% among visits by patients aged 0–19 years, and 26% among visits by patients aged ≥20 years. The difference by age group in the percentage admitted to the hospital came close to but did not reach significance (p=0.059).

*All statistics listed in this feature under Reasons for ED Visits and Characteristics of ED Visits have been rounded to the nearest whole number. Co statistics can be found in the charts on this page.

Data Source

Yusuf HR, Atrash HK, Grosse SD, Parker CS, Grant AM. Emergency Department visits made by patients with sickle cell disease: a descriptive study, 1999-2007 [PDF - 100 KB]. Am J Prev Med 2010;38(4S):S536–S541.

Attention Deficit Hyperactivity Disorder: What Is ADHD?

mozachsz — Tue, 21 Sep 2010 09:47:12 GMT

FROM: http://www.webmd.com/add-adhd/guide/attention-deficit-hyperactivity-disorder-adhd

Attention-deficit/hyperactivity disorder (ADHD) is also known as hyperactivity or attention deficit disorder (ADD). ADHD is a common condition that affects children and adolescents, while ADD is more common in adults.

The National Institute of Mental Health (NIMH) estimates that 3% to 5% of children have ADHD. Some experts, though, says ADHD may occurs in 8% to 10% of school age children. Experts also question whether kids really outgrow ADHD. What that means is that this disorder may be more common in adults than previously thought.

Children with ADHD generally have problems paying attention or concentrating. They can't seem to follow directions and are easily bored or frustrated with tasks. They also tend to move constantly and are impulsive, not stopping to think before they act. These behaviors are generally common in children. But they occur more often than usual and are more severe in a child with ADHD.

The behaviors that are common with ADHD interfere with a child's ability to function at school and at home.

Adults with ADHD may have difficulty with time management, organizational skills, goal setting, and employment. They may also have problems with relationships, self-esteem, and addictions.

What are ADHD symptoms in children?

Symptoms of ADHD in children are generally grouped into three categories: inattention, hyperactivity, and impulsiveness.

Inattention -- A child with ADHD:

is easily distracted
does not follow directions or finish tasks
does not appear to be listening when someone is speaking
does not pay attention and makes careless mistakes
is forgetful about daily activities
has problems organizing daily tasks
avoids or dislikes activities that require sitting still or a sustained effort
often loses things, including personal items
has a tendency to daydream

Hyperactivity -- A child with ADHD:

often squirms, fidgets, or bounces when sitting
does not stay seated as expected
has difficulty playing quietly
is always moving, such as running or climbing on things (In teens and adults, this is more commonly described as a sense of restlessness)
talks excessively

Impulsivity -- A child with ADHD:

has difficulty waiting for his or her turn
blurts out answers before the question has been completed
often interrupts others

For in depth information, see WebMD's ADHD in Children.

What are ADHD symptoms in adults?

Adult ADHD symptoms may be different than the symptoms in children. In addition, they may stem directly from ADHD or may be the result of behavioral issues. Symptoms include:

chronic lateness and forgetfulness
anxiety
low self-esteem
employment problems
difficulty controlling anger
impulsiveness
substance abuse or addiction
poor organization skills
procrastination
low frustration tolerance
chronic boredom
difficulty concentrating when reading
mood swings
depression
relationship problems

For in depth information, see WebMD's Adult ADHD.

What causes ADHD?

The exact cause of ADHD is not known, although researchers continue to study the brain for clues. They suspect that there are several factors that may contribute to the condition, including:

Heredity: The fact that ADHD tends to run in families suggests that children may inherit a tendency to develop ADHD from their parents.
Chemical imbalance: Experts believe an imbalance of brain chemicals (neurotransmitters) that transmit nerve impulses may be a factor in the development of ADHD symptoms.
Brain changes: Areas of the brain that control attention are less active in children with ADHD than in children without ADHD.
Head injury:There are reports of children with head injuries, particularly with concussions, developing behavioral problems that may mimic ADHD.
Poor nutrition, infections, and substance abuse (including cigarette and alcohol use) during pregnancy may be contributing factors. That's because they can affect the development of the baby's brain.
Exposure to toxins, such as lead or PCBs, in early childhood can also affect brain development.
Injury to the brain or a brain disorder may play a part in the development of ADHD.

Eating too much sugar does not cause a child to develop ADHD. A proper diet is essential, though, for normal development in children. ADHD is also not caused by watching too much TV, a poor home life, poor schools, or food allergies.

How common is ADHD?

ADHD is the most commonly diagnosed mental disorder of children and is more common in boys than in girls. It most often is discovered during the early school years, when a child begins to have problems paying attention. ADHD can continue into the teen years and on into adulthood.

How is ADHD diagnosed?

If symptoms are present, the doctor will begin an evaluation by taking a complete medical history and doing a physical examination. There are no laboratory tests for ADHD. The doctor, though, may use various tests -- such as X-rays and blood tests -- to determine if there is a physical disorder or other problem causing the symptoms.

Certain mental illnesses, such as depression and anxiety disorders, have some symptoms that are similar to those of ADHD. For that reason, a complete psychiatric assessment is needed to accurately diagnosis ADHD.

If no physical disorder is found, the child may be referred to a specialist in childhood development disorders. That may be a child and adolescent psychiatrist or psychologist, a pediatric neurologist, a developmental pediatrician, or another health professional. It should be someone specially trained to diagnose and treat ADHD. The doctor bases his or her diagnosis on the child's symptoms and behavior. The doctor may ask for input from the child's parents, teachers, and other adults who are familiar with the child's symptoms.

Researchers all agree that ADHD is not an adult-onset disorder. To be ADHD, it must be verified as being present from childhood. Adults who are thought to have ADHD will be asked questions about their childhood. In particular, they will be asked about such things as:

behavior
development
relationships
achievement
grades

The answers will help the doctor make an accurate ADHD diagnosis.

For in depth information, see WebMD's ADHD Diagnosis.

What is the treatment for ADHD?

ADHD cannot be cured. But many of the symptoms that interfere with functioning and cause distress can be controlled. Treatment for ADHD often includes a combination of medication and various psychosocial therapies.

Medication: Certain medications called stimulants may be used to help control hyperactivity and impulsive behavior and increase attention span. Commonly used stimulants include:

Concerta
Dexedrine
Focalin
Metadate
Methylin
Ritalin
Vyvanse

Some children with ADHD respond to antidepressant medications such as Wellbutrin.

Sometime stimulant drugs have worrisome side effects for children. In that case, non stimulant medications such as Strattera may be prescribed for children with ADHD who are older than 6. Strattera is a selective norepinephrine reuptake inhibitor.

Psychosocial therapies: These are treatment approaches that focus on the behavioral, psychological, social, and work/school problems associated with the illness. Psychosocial therapies that may be used for ADHD include:

Special education: Special education is a type of education that is structured to meet a child's unique educational needs. Children with ADHD generally benefit most from a highly structured environment and use of routines.
Behavior modification: Behavior modification includes strategies for supporting good behavior and decreasing a child's problem behavior.
Psychotherapy (counseling): Psychotherapy can help a child or adult with ADHD learn better ways to handle their emotions and frustration. It can also help improve their self-esteem. Counseling may help family members better understand the child or adult with ADHD.
Social skills training: Social skills training can help a child learn new behaviors, such as taking turns and sharing. This will enable the child to better function in social situations.
Support groups: Support groups are generally made up of people with similar problems and needs. This can help with acceptance and support. Groups also can provide a forum for learning more about a disorder and the latest approaches to treatment. These groups are helpful for adults with ADHD or parents of children with ADHD.

For in depth information, see WebMD's ADHD Treatment.

What is the outlook for children and adults with ADHD?

It is very important for children and adults with symptoms of ADHD to seek professional care. Without treatment, ADHD can interfere with a child's performance in school as well as the child's ability to make and keep friends. This can have a negative impact on the child's self-esteem.

In addition, children with ADHD are at risk for developing conduct disorder, depression, or an anxiety disorder. They are also more likely to have a learning disorder. Teens with ADHD are at greater risk for car accidents, early pregnancy, and tobacco and alcohol use. Adults with ADHD have difficulty with time management, employment, and relationships.

But, when treated, most people with ADHD -- between 70% and 80% -- experience at least some relief of symptoms. Many of the symptoms of ADHD diminish by early adulthood. However, up to 50% of people with ADHD as children continue to have problems as adults.

Is there a way to prevent ADHD?

ADHD cannot be prevented or cured. However, early identification and diagnosis, as well as a carefully designed treatment and education plan, can help a child or adult with ADHD adjust to the disorder. Many people with ADHD learn to focus their attention, develop their personal strengths, minimize disruptive behavior, and become productive and successful.

Cambodia opens first methadone clinic for heroin users

mozachsz — Tue, 21 Sep 2010 09:15:06 GMT

FROM: http://www.bbc.co.uk/news/world-asia-pacific-11310931

By Guy De Launey BBC News, Phnom Penh

Methadone is a heroin substitute used to treat withdrawal symptoms

Cambodia has launched the country's first methadone-treatment programme, in a new approach to help heroin users.

The World Health Organization (WHO) told the BBC that addiction was widely viewed in Cambodia as a social problem, rather than a health issue.

Until now the government has favoured treatment centres which emphasise hard work and exercise.

But health workers and human rights groups have criticised the facilities, describing them as "labour camps".

The opening of the methadone clinic is the culmination of years of gentle persuasion by organisations which work with drug users.

Ongoing concerns

The methadone programme will be strictly voluntary. Methadone is a heroin substitute used to treat withdrawal symptoms.

Two organisations which run outreach programmes for drug users will identify candidates for treatment.

If they're willing, they will be taken to the clinic for an assessment based on international standards. While the facility is supported by the WHO, it is run by the Ministry of Health inside a public hospital.

But while international health workers are delighted with the new approach, they are still concerned about the existing drug treatment facilities.

The government has no plans to close the centres which it says are voluntary, but which the UN has described as compulsory.

Some residents have complained of being held against their will - and forced to take experimental herbal remedies.

Health Inequity Slows Decline in Child Mortality

mozachsz — Tue, 21 Sep 2010 09:04:38 GMT

FROM: http://ipsnews.net/news.asp?idnews=52908

By Marwaan Macan-Markar

BANGKOK, Sep 21 , 2010 (IPS) - Cambodia’s partial success in reducing child mortality rates has exposed a fault line of inequity, one that underscores the advantage that the country’s urban population has had over the rural poor.

Yet the South-east Asian kingdom, 35 percent of whose 14 million population live below the poverty line, is not alone in having this mixed record of reducing child mortality, say child rights experts.

Some of the other countries in the region reflect a similar trend 10 years after world leaders committed to meet a set of eight targets to help the world’s poor by 2015. The fourth of the eight U.N. Millennium Development Goals (MDGs) seeks to achieve a two-thirds reduction in child mortality rates by 2015.

"To be fair to governments in South-east Asia, child mortality rates are going down everywhere," said Ben Phillips, director of strategy at the Asia office of Save the Children, a British-based humanitarian organisation. "But the rate of decline is less than the rate they committed in 2000."

"In South-east Asia, child mortality rates have almost halved from 2000 levels," he told IPS. "But the region is substantially behind from meeting the two-thirds target, which is five years away."

A recent report by Save the Children, entitled ‘A Fair Chance At Life’, shows that Cambodia has seen a 32 percent drop in child mortality figures among the country’s "richest 20 percent", but only an 18 percent reduction in child mortality among the "poorest 20 percent".

Indonesia, the region’s giant where 16 percent of its 225 million people live below the poverty line, has recorded "equitable progress," noted the 37-page report. The poorest 20 percent has seen child mortality figures drop by 29 percent, while the richest 20 percent has witnessed a nine percent decline.

Military-ruled Burma, also known as Myanmar, lags behind all with the worst child mortality figures. It reportedly has 104 children under five years dying for every 1,000 live births. Cambodia, by contrast, has 82 deaths of children under five years of age per 1,000 live births. Laos, the third of this region’s poorest countries, has 75 deaths per 1,000 live births.

Child rights groups have hailed Thailand, Malaysia and Vietnam as being well on course to meeting the 2015 targets. The region’s richest country, the city-state of Singapore, has been singled out in a study by ‘The Lancet’, a British medical journal, as leading all countries in the world in child mortality rates, having reduced it by 75 percent since 1990.

The inequity in child mortality rates in countries like Cambodia and the Philippines, which has 32 deaths per 1,000 live births, is "partly an urban-rural divide," said Phillips. "There is no conscious discrimination, but a natural tendency for nurses and doctors to work in cities."

At times, the distance to a health care is a day away, making it costly and time consuming for a family to take a newborn to treat illnesses that lead to child deaths, such as pneumonia, diarrhoea and sepsis.

"If you live more distant from a health centre, you will be reached later unlike those who live closer to health care workers," said Basil Rodriques, regional adviser for your child survival and development at the Asia office of the United Nations Children’s Fund (UNICEF). "The MDGs saw the ‘low hanging fruits’ reached first."

To address this trend, countries in the region are being urged to strengthen community health initiatives in rural areas, including by tapping trained midwives who live in the villages they grew up in. "This is what is going to make the difference," Rodriques said in an interview. "Governments are looking at how to train workers who grow up and return to live in their communities."

Early diagnosis of diseases like pneumonia is key to saving a child’s life, adds Rodriques, pointing to achievements in Indonesia. "There is a growing recognition of a community-focused approach, since community health workers are trained to see the problem and offer prompt care."

Vietnam’s success with a similar community health care programme across its rural regions is also being held up as another model for the region. Its record of child mortality is 17 deaths for 1,000 live births.

"It is really hard to divorce equity from the development paradigm," said Rodriques. "The MDGs have, in a sense, acted as accelerator for governments in South-east Asia to invest more."

Save the Children’s Phillips estimates that the entire Asian region needs two million health workers, ranging from midwives, nurses and obstetricians, to meet the 2015 targets on child mortality. "India will need one million of them and South-east Asia will need a third," he said.

"This requires a dramatic shift in policy and resources made available to strengthen rural health care systems," he explained. "If you are not focused on equity, the outcome will be inequitable."

"Health workers don’t just cure; they also prevent," he said. "Governments need to be putting more people through nursing schools." (END)

WHO warns countries to act against drug-resistant bacteria

mozachsz — Tue, 21 Sep 2010 09:00:31 GMT

FROM: http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/aug/20/drug-resistance-infectiousdiseases

Drug-resistance could put an end to the antibiotic era. The World Health Organisation today tells all countries they must act on hygiene and infection control

Scanning electron micrograph of Escherichia coli bacteria (E. coli). Photograph: S. Lowry/University of Ulster/Getty

The World Health Organisation is today urging countries to take action against the spread of drug-resistant bacteria, which threaten to deprive us of antibiotics which once seemed miracle cures for infectious diseases.

The WHO is speaking out following a Lancet paper written by Professor Tim Walsh in the UK and colleagues in India, which warned of the spread of bacteria carrying a new gene, which they called NDM 1. These bacteria become resistant to almost all the antibiotics designed to fight them. The main piece I wrote about it, called "Are you ready for a world without antibiotics?" can be found here.

Unfortunately, the Indian government reacted badly to the Lancet paper, which suggested that one of the factors behind the spread of NDM 1 could be medical tourism. Among those in the UK and elsewhere in Europe who were found to have these drug-resistant bacterial infections were people who had traveled to India for necessary surgery or cosmetic treatment.

An Indian government press release on August 12 said that

the conclusions are loaded with inference that these resistance genes/organism possibly originated in India and it may not be safe for the UK patients to opt for surgery in India. Concluding sentence presents a frightening picture which is not supported by any scientific data....such organisms may be circulating more commonly in the world due to international travel but to link this with the safety of surgery hospitals in India and citing isolated examples to show that due to presence of such organism in Indian environment, India is not a safe place to visit is wrong.

India has a lot to lose. Medical tourism is a boom industry, growing at 30% a year. It would be unfair to single it out, because NDM 1 will be elsewhere too. Scientists only know it is in India because they have been able to look.

But the point the WHO is making today is that no country is any more an island. All need to look to their infection control and guard against the wrong and cavalier use of antibiotics, such as their sale on the streets without prescription, because drug-resistance knows no frontier posts. This is what it says:

Those called upon to be alert to the problem of antimicrobial resistance and take appropriate action include consumers, prescribers and dispensers, veterinarians, managers of hospitals and diagnostic laboratories, patients and visitors to healthcare facilities, as well as national governments, the pharmaceutical industry, professional societies, and international agencies.
WHO strongly recommends that governments focus control and prevention efforts in four main areas:
* surveillance for antimicrobial resistance;
* rational antibiotic use, including education of healthcare workers and the public in the appropriate use of antibiotics;
* introducing or enforcing legislation related to stopping the selling of antibiotics without prescription; and
* strict adherence to infection prevention and control measures, including the use of hand-washing measures, particularly in healthcare facilities.

It ends on a hopeful note:

Successful control of multidrug-resistant microorganisms has been documented in many countries, and the existing and well-known infection prevention and control measures can effectively reduce transmission of multi-drug resistant organisms if rigorously and systematically implemented.

But it's clear that pretending there is no problem or sitting on our hands is asking for disaster.

A slice of life

mozachsz — Tue, 21 Sep 2010 08:51:16 GMT

FROM: http://www.guardian.co.uk/science/blog/2010/sep/16/molecular-complexity-la-rna

The La molecule shows that the deeper you look, the more complicated life becomes

Stephen Curry is a professor of structural biology at Imperial College and writes a regular blog at Reciprocal Space

N-terminal domain of La complexed with AUUUU RNA. Illustration: Stephen Curry

Please don't be alarmed gentle reader, but I am here to tell you that you are an abominable monster. And I have made it my job, like an inverse Dr Frankenstein, to dismantle you. The work is exacting, but we have to find out what makes you tick, my fearsome friend.

This news may come as a shock, but if you don't believe me, take a look above.

Appalled at yourself? You should be. Your complexity is monstrous. And that is just one molecule plucked from among thousands in your body. It goes by the disarmingly simple name of La.

If you have ever peered into the crowded innards of a computer and recoiled in horror or wonder (the two are not so different), you will have some small sense of the task of working out the secrets of life. For the intricacies found in human artefacts cannot compare to the morass of molecules within each one of the trillions of cells in your body. Somehow, this crazy jumble of proteins, fats, carbohydrates and nucleic acids (DNA and its sibling, RNA) is keeping you alive.

Fortunately, we scientists are the monster's friend. And we are a dogged lot, not put off by the unnerving confusion of living things, though we often have to focus on the small details to make any headway.

My particular task, as a structural biologist, is to uncover the atomic architecture – seen in the image above – of the proteins and other molecules that work together inside you to sustain life. It is slow, painstaking work. I was reminded of this at a conference last week when I stood up to tell the audience about our research into the structure of La, which had started more than 10 years ago.

La caught my eye back then because of reports of its seizure by some viruses, such as hepatitis C virus, which force this innocent protein to co-operate with infection. We wanted to find out how that happens and, at the same time, to learn more about how the protein operates in healthy cells.

La is a tiny cog in the apparatus of life but has an important role in the process of translation that uses the information in our genes to make the proteins, the molecular contraptions that keep your cells alive and communicating with one another.

The mechanism of translation uses molecules of RNA – called tRNA – that are directly involved in the conversion of the DNA sequence of your genes into the chains of amino acids that fold into working proteins. The job of La is to ensure that these tRNA molecules are themselves built correctly. During tRNA synthesis, La holds on to one end the molecule to prevent it becoming damaged by accidental encounters with rogue proteins in the cell.

All of this we know by indirect methods, feeling blindly with measurements of the strength of the interaction between the protein and the RNA. But humans are visual creatures. To understand exactly how La embraces a tRNA molecule and how it might be ensnared by viral RNA, we have to see the structure of the protein.

Our work with La started by transferring the DNA for its gene into bacteria that are easily cultured in litres of nutritious soup. This genetic trick made it relatively easy to produce large quantities of La protein in the lab, entire milligrams of the stuff.

But we then had to spend a long time poking and dissecting the protein, testing its solubility, checking that it was folded properly, cutting and trimming to find a manageable fragment that might be induced to line up in orderly ranks to form a crystal, the shining jewel we needed to reveal the structure. After many trials and errors (and the distractions of securing funding and teaching duties), tiny crystals emerged from our experiments. They were 100th of a millimetre thick.

At the Diamond synchrotron near Oxford we took measurements as the crystals scattered the high-energy beam of X-rays in multiple directions, producing patterns of spots on the detector. Thanks to the mathematical techniques developed in the19th century by Joseph Fourier (who was grappling with the unrelated problem of heat flow – the connections in science are always unpredictable), we were able to use the spot pattern to calculate the three-dimensional structure of La, in all its atomic glory.

It took years of work, but finally we could unveil how part of La (our fragment is just half of the protein) grapples with one end of a tRNA molecule.

We have shown how two parts of two of the cogs of life fit together. In the grand scheme of things, it is just one small step forward, but it is nevertheless an important step, one that shows how the protein recognises – by feel, not sight – and protects the tRNA. Thus ensuring that the machinery of life keeps ticking over.

This long story is still incomplete. There are the remaining portions of La and the tRNA to consider. How do they contribute to the protective embrace between these two molecules? And is this embrace the same forceful grip by which the RNA of hepatitis C virus compels La to sabotage liver cells? To tackle these questions we've got to spend more years in the lab.

But just for a moment, let us pause to admire the horrific complexity of your La molecule in action by rendering the protein and RNA chains as friendly coils:

You may be monstrous, dear reader, but I never said you were ugly.

Stephen Curry is a professor of structural biology at Imperial College and writes a regular blog at Reciprocal Space. His work on La is a long-standing collaboration with Dr Maria Conte at King's College London

Obesity crisis 'cannot be solved by exercise alone'

mozachsz — Tue, 21 Sep 2010 08:47:52 GMT

FROM: http://www.guardian.co.uk/society/2010/sep/15/obesity-crisis-cannot-solved-exercise

Study urges severely obese to eat more healthily, finding that forgoing a small sandwich is as effective as a one-hour run

Ian Sample, science correspondent
guardian.co.uk, Wednesday 15 September 2010 20.24 BST
Article history

The obesity crisis will not be solved by exercise alone, according to a new study from Aberdeen University. Photograph: Jose Luis Pelaez/Getty Images/Blend Images

The obesity epidemic will not be reversed by urging people to exercise more, because they have too little time to spare, researchers claim.

To make an impact on levels of obesity, severely overweight people would have to exercise for several hours a day, when they could find it easier to lose the weight by eating less, they said.

An obese person with a body mass index of 35 could reach a more healthy weight and BMI of 22 by reducing their calorie intake by one third. "That is equivalent to exercising for around five hours a day. That is not realistic," said Professor John Speakman of the energetics research group at Aberdeen University.

A study by Speakman's group found that contrary to popular belief, our lives have not become more sedentary in recent decades. Physical activity has remained the same for at least the past 25 years, while obesity rates have soared.

Since 1985, the typical man in Britain has burned off 1,380 calories a day through exercise, compared with 950 calories for women. The cause of rising obesity is linked to the population eating more high-calorie food than exercising less, Speakman said.

"Promoting exercise is a good idea, but if you want to tackle the obesity epidemic it is not the solution. Weight loss is not a key benefit from exercise," he said. Foregoing a small sandwich was as effective as a one-hour run, he added.

About a quarter of British adults and a fifth of children are obese and this figure is rising. An estimated 30,000 people die prematurely across the country from obesity-related illnesses each year.

"You cannot exercise your way out of the obesity epidemic. It would take an enormous intervention in physical exercise," Speakman said.

"It is important for policymakers to realise that if they want to promote weight loss in overweight and obese people, the most effective way is through healthy eating and diets."

However, the report says exercise protects against heart disease, type 2 diabetes, osteoporosis and high blood pressure.