WHO (Western Pacific Region) and IASO/IOTF

Until recently, obesity has not been high on the public health agenda in Asia as the prevalence (defined by the standard WHO classification of BMI>30) appeared very low and governments and health agencies focused attention on eradicating undernutrition. However the release of more detailed regional assessments of weight status has highlighted the rapid rise in the average body weights of countries within the Asian region (even though undernutrition persists) and the consequent upsurge in rates of metabolic disease such as diabetes, hypertension and coronary heart disease. New research has also indicated that Asians are more pre-disposed to visceral obesity than those of European origin and that the health risks of obesity occur at a much lower level of body mass index in Asian populations. In contrast, Pacific Island populations are more muscular and their risk of ill health starts at a much higher level of BMI, although they are also particularly prone to diabetes with weight gain.

These observations suggested that it may not be appropriate to apply directly the general guidelines for the classification and management of obesity produced at the 1997 WHO Consultation on Obesity to all Asian and Pacific Island populations. To respond to this issue, a committee was established under the joint auspices of the World Health Organization (Western Pacific
 

Region) and the Asia and Oceania region of IASO. The committee examined the available information about weight status throughout the region and the association between BMI and level of weight-related ill health. The resulting document presents a regional perspective on these issues and proposes specific diagnostic criteria to define overweight and obesity in Asians using BMI and waist circumference which reflects the increased risk of disease at lower levels of body fatness. It also proposes that a separate classification system be developed for Pacific Islanders, but it was felt that insufficient evidence was available at this time to define the criteria.

In addition to redefining the diagnosis of obesity in the region, the document provides useful guidance on assessment procedures and appropriate prevention and treatment strategies based on the special needs of the region. It identifies the regional factors contributing to the rapid rise in body weights, indicates the social and economic consequences of this rapid change and highlights the specific cultural issues that impact upon attempts to control obesity in the region. It also proposes future research.

The report draws very heavily on the work of the 1997 WHO Consultation on Obesity, but interprets the guidelines agreed at that meeting for use within Asia-Pacific. It is not meant to replace national guidelines, where they already exist, but it is intended that the document be used to encourage and guide the development of further programs and policies for the prevention and management of obesity. Due to the cultural, genetic and geographical heterogeneity of the region it would be difficult to produce very specific guidelines suitable for the whole region.

The committee was chaired by Prof Shuji Inoue from Japan and Prof Paul Zimmet from Australia. The production of the report was coordinated through the International Diabetes Institute in Melbourne with an educational grant from Knoll. It presents a wealth of regional data and makes an important contribution to the body of evidence urging immediate action to tackle this important health issue.

The report was released at a press conference and workshop in Hong Kong in February. Copies will be circulated to governments and key health policy agencies throughout the region. The full version is available to download from the internet on:

http://www.idi.org.au/obesity_report.htm.

Ian Caterson, IASO/IOTF Australia and Tim Gill, IOTF Regional Co-ordinator, Asia-Pacific