No abstract

PurposeThe aim of this paper is to review the evidence of the association between energy balance and obesity.MethodsIn December 2015, the International Agency for Research on Cancer (IARC), Lyon, France convened a Working Group of international experts to review the evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries (LMIC).ResultsThe global epidemic of obesity and the double burden, in LMICs, of malnutrition (coexistence of undernutrition and overnutrition) are both related to poor quality diet and unbalanced energy intake. Dietary patterns consistent with a traditional Mediterranean diet and other measures of diet quality can contribute to long-term weight control. Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control. Genetic factors alone cannot explain the global epidemic of obesity. However, genetic, epigenetic factors and the microbiota could influence individual responses to diet and physical activity.ConclusionEnergy intake that exceeds energy expenditure is the main driver of weight gain. The quality of the diet may exert its effect on energy balance through complex hormonal and neurological pathways that influence satiety and possibly through other mechanisms. The food environment, marketing of unhealthy foods and urbanization, and reduction in sedentary behaviors and physical activity play important roles. Most of the evidence comes from High Income Countries and more research is needed in LMICs.

A World Health Organization (WHO) Expert Consultation on Waist Circumference (WC) and Waist-Hip Ratio (WHR) was convened in Geneva from 8 to 11 December 2008 to consider approaches to developing international guidelines for indices and action levels in order to characterize health risks associated with these measures of body fat distribution-alternative or complementary to the existing WHO guidelines for assessments of generalized obesity on the basis of body mass index. Six background papers prepared for the Consultation are compiled in this issue. These six papers examine a range of health outcomes and issues, including whether there is a basis for choosing WC over WHR and whether different action levels by gender, age, ethnicity, country or region are warranted. Although guidelines involving WC and WHR are potentially useful and clearly required, the challenges in identifying cutoffs for international guidelines should not be underestimated or oversimplified. The final report and outcomes of the Expert Consultation will be published by WHO. European Journal of Clinical Nutrition IntroductionChronic noncommunicable diseases (NCDs), such as heart disease, hypertension and stroke, diabetes mellitus, as well as various forms of cancer, are significant causes of disability, premature death, impaired quality of life and increasing health-care costs, in low-and middle-income, as well as in high-income countries (WHO, 2000a(WHO, , 2004(WHO, , 2008. Obesityreflecting the accumulation of a potentially harmful level of excess body fat-is a major contributor to the development of NCDs (WHO, 2000b), and has become a global epidemic affecting children and adults alike. Addressing obesity through population-level strategies that promote optimal nutrition, such as appropriate dietary intake and physical activity, is a major focus of the Global Strategy and Action Plan of the World Health Organization (WHO) for the Prevention and Control of Noncommunicable Diseases (NCDs) (WHO, 2000a(WHO, , 2004(WHO, , 2008, complementary to strategies developed to address other aspects of dietary quality, tobacco use and harmful use of alcohol.Surveillance to quantify and track NCDs and their risk factors is a key component of the NCD Action Plan (WHO, 2008), which requires clearly specified diagnostic criteria and classifications. Diagnostic criteria and classifications for obesity potentially relate to both generalized obesity and also to obesity subtypes defined by the distribution of body fat, such as abdominal or central obesity. With respect to generalized obesity in adults, reports of the 1993 WHO Expert Committee (WHO, 1995) kilograms divided by the square of height in metres (kg/m 2 ): overweight (BMI of X25.0) and obesity (BMI of X30), with further gradations of obesity defined by BMI ranges of 30.0-34.9, 35.0-39.9 and X40 based on the severity of the associated risk of comorbidities. These BMI cutoff points were recommended for international use with awareness that the risks are graded along a continuum, and that the risk ...

Objective: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the lifelong influences on the development of disease. Design: A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments. Setting: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. Results of review:There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under-and over-nutrition. Conclusions: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

No abstract