Globesity and the Permacrisis

Back in 2014, The Lancet reported that despite raised awareness of global obesity, the numbers from 188 countries indicated that “no national success stories have been reported in the past 33 years,” and that urgent action and leadership would be needed.

A Commission on Ending Childhood Obesity was established to develop a set of recommendations. In 2016, the Commission’s final report noted that progress had been “slow and inconsistent” and called for the implementation of several recommendations, involving healthy foods, physical activity, preconception and pregnancy care, and weight management. It also said,

Driven by globalization and urbanization, exposure to unhealthy (obesogneic) environments is increasing in high-, middle- and low-income countries and across all socioeconomic groups. The marketing of unhealthy foods and non-alcoholic beverages was identified as a major factor in the increase in numbers of children being overweight and obese, particularly in the developing world.

Earlier this week Dr. Hans Henri P. Kluge, the World Health Organization’s Regional Director for Europe, summed up the current situation. He first noted that for at least a century, Europe has “grappled with multiple, momentous crises.” One feature of what some call the “permacrisis” is that its pace has been accelerating. Climate change brings catastrophic weather events, wildfires, unbearable heat, drought, desperate water shortages, crop failure, and hunger. Then, there are the wars, the most noticeable in recent months being the one in Ukraine.

Infectious diseases rampage through populations. Much as we might wish to forget about COVID-19, it has not forgotten us, and in fact, seems likely to become a permanent feature of the world health-scape. Then, there are monkeypox and polio. One effect of the COVID pandemic years has been the closure of, in some countries, up to 50% of HIV testing services.

Noncommunicable diseases are also destroying the health and ending the lives of millions of people, and among those morbidities Dr. Kluge names “cancer, heart disease, alcohol- and tobacco-related disease, and the epidemic of obesity.” He goes on to say,

One out of every four children in primary school in our region is living with overweight or obesity.

A ray of hope is that WHO is setting up a Pan-European Summit of First Ladies and First Gentlemen to tackle childhood obesity, whose first session will meet next year in Croatia. Dr. Kluge says of the whole permacrisis situation that it demands a dual-track response, as spelled out below:

On one hand, we must urgently prepare for health emergencies like pandemics, climate-related crises and conflicts. On the other hand, we must urgently strengthen our current health systems and essential services to address the permacrisis of noncommunicable diseases and HIV. One cannot be sacrificed for the other. It requires investment in the health workforce and mental health.

Your responses and feedback are welcome!

Source: “Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013,” TheLancet.com, 05/28/14
Source: “Commission presents its final report, calling for high-level action to address major health challenge,” WHO.int, 01/26/16
Source: “Statement: The European Region is in a ‘permacrisis’ that stretches well beyond the pandemic, climate change and war,” WHO.int. 09/17/22
Image by Sébastien Bertrand/CC BY 2.0

Dental Health Awareness is Crucial — United Kingdom

The USA is not the only nation whose military leaders are concerned about the problem described in the previous post. As one typical example, the French Military Health Service reported that dental emergencies accounted for 24.2% of all medical evacuations during an operation in Mali.

Childhood Obesity News has previously discussed dental health in the United Kingdom, but not in relation to military readiness, and the situation only worsens over time. As of a 2018 report, during the pertinent year more than 26,000 children ages five to nine were treated in hospitals because of rotten teeth. Note: These were only 5- to 9-year-olds.

The United Kingdom Armed Forces, just like their American counterparts, take dental health very seriously. A report on defense dentistry notes that “the impact of oral disease on service personnel serving on operations has been well documented and can substantially disrupt operational capability.” The authors back up this assertion with six footnotes, and many more references would no doubt be available, had they chosen to cite them also.

The U.K. has developed a preventive-focused, holistic program that addresses alcohol, tobacco, diet, and weight management. Of course, obesity and dental disease often coexist in the same individuals, and just like the U.S., Britain’s realm is eminently interested in sustaining operational capability and maximizing effectiveness.

This means minimizing dental morbidity. The details state that clinical decision-making is…

[…] focused on the patient’s occupational role and the environment in which they will operate. Considers factors such as the duration, remoteness and austerity of the deployment. A responsive uniformed dental workforce with strong individual and collective leadership ethos […] can move assets between locations and adapt quickly to rapidly changing situations in both UK and overseas bases and in operational environments.

The officers in charge have to consider what conditions the patient will be living in, and whether they will be able to keep up correct oral hygiene, and/or aftercare appropriate to any dental work that has been done. If an emergency flared up, how long would the service member be away from their post to receive the needed care, and who would fill their role in the military operation? How would they be transported, and what would be the risks to both the patient and the mission? What effect would any prescribed medications have on the patient’s ability to function effectively?

The relevance of dental problems, of course, is that they so often coexist with obesity, creating a two-faceted health dilemma for large numbers of both civilian and military personnel.

Your responses and feedback are welcome!

Source: “Britain’s sugar obsession sees number of children going to hospital with rotten teeth rise to 26,000,” DailyMail.co.uk, 09/25/18
Source: “Defence dentistry: an occupationally focused health service with worldwide deployable capability,” NIH.gov, 2021
Image by NATO/CC BY-SA 2.0

Dental Health Awareness Is Crucial — USA

This post dives a little deeper into the topic of childhood obesity in relation to a country’s military preparedness.

Obviously, juvenile obesity too often develops into adult obesity. Another aspect is very much worth exploring. Obesity and poor dental health walk hand-in-hand. They have a reciprocal relationship. Each causes, and is caused by, the other.

Even when a tooth remains present in the mouth, a crack, cavity, or infection may render it useless, along with all the other teeth on that side. A person might go for years, doing all their chewing on the “good side,” which is not beneficial to the good teeth on the bad side, which do not get enough stimulation to keep their blood supply flowing properly. As time goes by, one-sided chewing can lead to disorder of the temporomandibular joint, and other jaw malfunctions.

The past

A poor diet with a lot of sugar can cause teeth to fall out or to need removal. This in turn causes
more deplorable dietary habits like a preference for fizzy sweet beverages, yogurt, and ice cream. Many hyperpalatable, high-calorie foods are easy to ingest with minimal teeth. But it is very difficult to gain sustenance from the most health-retaining foods with painful or missing teeth.

Tooth loss does not favor the ingestion of most meats, for instance. It destroys the ability to bite into an apple or crunch a carrot. Lettuce is a struggle, and celery is impossible. Even if a recruit loses weight and stays fit, the damage to teeth remains and worsens. How does this impact the individual’s fitness for military service? If the enlisted person or officer is stationed in the field, doing an essential job, and an urgent medical condition arises so that they need to be med-evaced, that will divert considerable resources from the mission.

In the USA, candidates are ineligible for military service if they fail to meet certain educational standards, are involved in crime, or are physically unfit. Even more than a decade ago, Mission: Readiness announced that every year, about 15,000 potential recruits failed entrance physicals because of excess body fat.

Unfortunately, many young Americans who want to join cannot. Startling statistics released by the Pentagon show that 75 percent of young people ages 17 to 24 are currently unable to enlist in the United States military.

And, 27 of those percentage points are accounted for by overweight individuals. Others are rejected because of “other medical problems that would disqualify them even if they were to lose enough weight.” One of those others is unacceptable dental health. The report also mentioned that 20% of Army reservists arrived at their appointed mobilization sites with “dental conditions that made them non-deployable.” Difficulty working is of course the most serious case, but difficulty in relaxing or sleeping also impacts the person’s ability to do their job.

The military keeps very close track of the problems that interfere with accomplishing the mission, and sorts its human resources into four categories:

DRC 1 — do not require dental treatment or re-evaluation — worldwide deployable
DRC 2 — require nonurgent dental treatment that could wait at least a year — worldwide deployable.
DRC 3 — require urgent or emergent dental treatment — not worldwide deployable
DRC 4 — require periodic dental examinations; or dental classification is unknown — not worldwide deployable

The armed forces require annual “dental readiness” assessments, after which DRC3 and DRC4 conditions must be immediately corrected.

Your responses and feedback are welcome!

Source: “Ready, Willing, And Unable To Serve,” missionreadiness.org, 2009
Source: “Dental Classification Fitness and How it Relates to the Operational Force,” fdiworlddental.org, 09/21/21
Image by Army Medicine/CC BY 2.0

Globesity Awareness, Be Raised More!

As we learned from the massive report called “Reframing Childhood Obesity: Cultural Insights on Nutrition, Weight, and Food Systems,” Japan requires adults to be measured yearly, and refers people with too-large waistlines to lifestyle intervention classes.

If the situation in a district is unacceptable, the local branch of government may be fined, and so may the company that a person or a relative of theirs works for. These institutions try to prevent such penalties by offering counseling, nutrition classes, and free exercise programs. There is also a cultural element that probably helps:

Rather than using the word “obesity,” which has negative connotations, the Japanese refer to “metabolic syndrome…” The general view is that speaking about fighting “metabo” seems much less offensive to individuals than speaking about fighting obesity, as it re-frames the focus to a health perspective, rather than openly criticizing the aesthetics of someone’s body.

Probably a lot of the credit for Japanese fitness belongs to the school lunches which, to quote teacher Jessica Korteman’s, are “awesome.” Elementary school children have a hot lunch for the equivalent of about $2.50 per day. The illustration on this page, though a cold brought-from-home meal, is similar to the variety and nutrition found in a typical school lunch. But equally important is the way things are done. Korteman’s very explicit article is highly recommended.

Cultural dynamics

France seems to have devised a way to combine school lunches (which after all, need to be pretty standardized) with a certain amount of joie de vivre. In some places, the authorities do not simply ask skinny people what is wrong with the status quo, or how it should be changed. They also listen to people who are “living in large bodies,” as the genteel phrase has it.

Brazil’s policies are quite sensitive to such matters as fat shaming, weight bias, stigma, and discrimination, and try hard to move things in another direction. The country’s Values-Based Nutritional Guidelines comprise 10 principles. Among other cultural mores, fresh foods and foods that have undergone minimal processing are preferred.

Similarly, Chile has used labeling laws and taxation to resist the ultra-processing trend that cranks out hyper-palatable products. To take such a stand is difficult, because the global corporations that make the stuff pretty much have their own way in everything.

In the Netherlands, one area of focus seems to be communication, specifically between government agencies, the private sector (meaning business), and the civilians who bear the consequences of both of their impetuous blunders. In New Zealand, with its fraught history of colonialism and racism, the philosophical ground is shaky. But things like this are happening:

Māori Systems Thinking Public health efforts have built on Māori systems thinking, introducing a holistic and collective approach to community interventions.

Your responses and feedback are welcome!

Source: “Reframing Childhood Obesity: Cultural Insights on Nutrition, Weight, and Food Systems,” Vanderbilt.edu, 2022
Image by Maria/CC BY 2.0

Globesity Awareness, Be Raised!

Here are the credits of a very timely report with five primary authors and 28 expert consultants from around the world, which looks at global childhood obesity from some angles that are not often considered:

With funding from the Robert Wood Johnson Foundation and in collaboration with WHO/Europe’s Behavioral and Cultural Insights Unit, the Vanderbilt Cultural Contexts of Health and Wellbeing Initiative uses cultural insights to help improve public health policy and healthcare delivery.

This 52-page document dives into various aspects of a problem that seems all too familiar. At the same time, it holds some lesser-known secrets whose exploration could make a significant difference. Over the last 40-plus years, “the prevalence of children classified as overweight or living with obesity based on BMI increased more than four-fold, from 4% to 18% globally.”

And yet, many professionals in the field now believe that Body Mass Index is not a good predictor of metabolic health for the individual. Japanese authorities have demoted BMI to only one risk factor among several. Since 2008, the “Metabo-Law” has required the waistlines of all adults over 40 and under 74 years of age should be measured annually. If the number does not fall within strict parameters, the people are referred to programs designed to help.

As of 2022, Japan is one of the 10 least obese countries in the world, with only less than 5% of its adults being defined as obese.

Heart of the matter

The core proposition of cultural awareness goes like this:

[R]ather than focusing on particular nutrients, acknowledge food as embedded in cultural contexts, allowing for creative adaptation to local circumstances…

It is hoped that consensus may emerge, regarding “the need to look beyond individual choices to address upstream cultural, commercial, and structural factors that produce obesogenic environments…” Cultural traditions are very stubborn, and if their energy and creativity can be captured:

We show how public health programs can work with, not against, cultural traditions and norms — harnessing local creativity to change nutritional outcomes.

Some societal norms probably have very little to do with culture or tradition, and increasing numbers of thoughtful individuals turn against the norms that have become destructive. Many of the earth’s people agree that children need to be protected from the marketing of ultra-processed foods with ultra-low nutritional value.

In South Africa, for example, the administration and the food corporations have worked out some limits and restrictions. In Mexico, reducing soda consumption is a major goal. Labeling guidelines and taxation are employed, along with regulations about marketing to children in school environments.

Your responses and feedback are welcome!

Source: “Reframing Childhood Obesity: Cultural Insights on Nutrition, Weight, and Food Systems,” Vanderbilt.edu, 2022
Source: “Obesity Rates by Country 2022,” WorldPopulationReview.com, undated
Image by Mark Licht/CC BY 2.0