Is being overweight good for you?

On November 2 I participated in a radio debate organised by radio Netherlands, the Dutch world service (http://www.radionetherlands.nl/features/amsterdamforum/071102af). The debate was inspired by a book called 'Diet Nation: exposing the obesity crusade' (http://www.socialaffairsunit.org.uk/pub/001269.php). The first author of the book, Patrick Basham (http://www.cato.org/people/basham.html), participated in the debate, and he claims that the danger of being overweight is wildly over-estimated. According to Basham, the present “hysteria” about fatness is the result of alarmist lobby groups and bad science. He provides evidence indicating that people who are thin have lower life expectancy than people who are overweight.
Basham is right in claiming that being a bit overweight is not that bad for health. But obesity, i.e. being grossly overweight is, and on the road to obesity one passes through different stages of being a bit, than a bit more, and more and more extra bodyweight. Time trend research shows that people generally gain between 0.5 and 1 kg per year, and over the course of a few decades this does lead to health-threatening levels of obesity.
Basham claims that lobby groups, including the dieting industry, exaggerate the dangers of being overweight. Although I am sure that the lobby of the food industry to encourage people to eat more than they need is much stronger than the weight-loss industry, it is true that most dieting/weight loss strategies that are commercially marketed do not work in the long run. Almost all diets do lead to weight loss if people comply to the rules and regulations prescribed, but most diets are hard to maintain and such diets are often not well-varied and maintenance is therefore too difficult and if maintained such diets may lead to unhealthy nutrition. People who do loose weight generally regain the kilos soon enough when they stop dieting and start eating their ‘normal’ diet again. In order to curb the obesity epidemic we should therefore not focus on promoting weight loss among people who are somewhat overweight. We should focus on promotion of health eating and plenty of physical activity to help to prevent further weight gain and to promote physical fitness. It is better to be fit and somewhat overweight than unfit and lean. The HOPE project (Health promotion through Obesity Prevention in Europe) is dedicated to informing obesity prevention efforts: http://www.hopeproject.eu/

Body@Work and a new professor of occupational health.

On Thursday November 8, Dr. Allard van der Beek held his inaugural address to accept his chair in occupational health. His address was preceded by a symposium reporting on the Body@Work project (http://www.bodyatwork.nl/), a collaboration between the EMGO institute (http://www.emgo.nl/) and TNO Quality of Life (http://www.tno.nl/content.cfm?context=overtno&content=overtnosub&laag1=32&item_id=59) to support an conduct research on physical activity, work and health.
Professor Allard van der Beek argued in favour of carefully planned and evaluated preventive occupational health care in order to develop better interventions and improve evidence-based practice. He further argued that such research to develop preventive occupational health interventions should be especially focussed on opening the ‘epidemiological black box’, i.e. to gain better understanding on why and how certain behaviours are associated with work disability, and on intervention mapping (http://www.interventionmapping.nl/), i.e. to carefully tailor interventions to specific needs and characteristics of the target population. Such research is dependent on multidisciplinary collaborations.Allard also completed his first marathon recently… http://evenementen.uitslagen.nl/2007/amsterdammarathon/details.php?t=nl&s=5002

Towards an interfaculty research institute for health and care research.

Yesterday the senior staff of EMGO research institute (see http://www.emgo.nl/) met to discuss plans to reform our institute into a so-called interfaculty research institute. Our mission is to encourage, initiate, conduct, and publish excellent research of international standing to improve public and occupational health, primary care, rehabilitation, and long-term care.
The main challenges in these research fields all require interdisciplinary research, involving medical doctors as well as health scientists, psychologists et cetera. This asks for close collaborations between experts from different university faculties.
Our policy day was focussed on exactly that: what are the strengths, weaknesses, opprtunities and threats related to forming a formal interfaculty research institute, involving the VU University Medical Center (www.VUMC.nl), the Institute for Health Sciences (http://www.falw.vu.nl/Onderzoeksinstituten/index.cfm) of the faculty of earth and life sciences and the faculty of psychology and education (http://www.psy.vu.nl/fpp.php/research/). Other collaborations are with the faculty of Social Sciences (http://english.fsw.vu.nl/home/index.cfm) and the faculty of Law http://www.rechten.vu.nl/).
Important examples of ongoing interfaculty collaboration include the Netherlands Study on Depression and Anxiety NESDA (http://www.nesda.nl/site_en.php) as well as the longitudinal Aging Study Amsterdam (http://www.lasa-vu.nl/).

Nutrition and cancer?

This week the new report from the World Cancer Research Fund on the association between nutrition, physical activity and cancer will be published (see http://www.wcrf.org/). This report is the result of one of the most comprehensive series of systematic reviews and meta analyses. The title of the new report is Food, Nutrition, Physical Activity and the Prevention of Cancer.

In a process that has taken five years, an expert panel of 21 renowned scientists from around the world reviewed and assessed the body of research on the relationship between food, nutrition (including obesity) physical activity and cancer risk. The expert panel has drawn conclusions based on this evidence and developed 10 health recommendations for the prevention of cancer.

Based on early ecological studies and case-control studies it was hypothesized that nutritional factors such as fat intake, fiber intake and fruit and vegetable consumption were strong determinants of risk for certain cancers.
In the last decades more and more longitudinal cohort studies have become available, and these studies show that the association between diet and cancer risk appears to be much weaker than was believed from the earlier weaker designed investigations.

However, the WCRF reviews will probably also make clear that obesity is a major risk factor for certain cancers, such as breast cancer.

Registration for the meeting where the new report will be launched is still possible…http://www.wcrf.org/launchconference/registration.lasso

Be Active 07: Physical activity research conference in Adelaide Australia.

The last few days I attended the Be Active 07 conference in Adelaide (http://www.sma.org.au/ACSMS/2007/). This conference was in fact a combination of several conferences, sports medicine, injury prevention, and physical activity, with the possibility of attending sessions in each and a few joint sessions. I was invited to speak in the physical activity part on environmental determinants of physical activity. The short version of my talk is that physical activity is certainly not only influenced by physical environmental factors. Personal factors like motivation and abilities and social environmental factors like social support and positive examples of others, are of great importance, and are supported by stronger scientific evidence. In short, physical activity is a result of motivation, ability, opportunity and support. People will be most likely to be active if the are motivated to do so, if the have the right abilities, if their environment offers good opportunities and if the get support from relevant others. A short interview in the Herald Sun exaggerated my point a bit…(see http://www.smh.com.au/news/national/example-the-key-in-battle-of-the-bulge/2007/10/13/1191696235688.html).
Steve Blair gave a very entertaining keynote on the ‘fit and fat’ message (see for example http://suewidemark.com/fat-fit-new.htm, http://www.sph.sc.edu/news/blair.htm). He presented convincing evidence that physical activity has strong health benefits, also independent of weight loss, and that people who are fat but fit are much better of health-wise that lean but unfit people. He also presented nice research showing that physical activity is a more effective and less expensive treatment of conditions such as metabolic syndrome and hypertension that most other usual treatments. So why is it that physical activity support is not part of treatment programs and often not covered by health insurance?
Part of the program focussed on sedentary behaviours. Earlier studies have indicated that sedentary behaviour and physical activity are rather independent, i.e. people who are active may also engage in much sedentary behaviours. Earlier studies have also indicated that sedentary behaviour is an independent and maybe even more important determinants of conditions such as obesity and metabolic syndrome. Now some evidence was presented that just getting people out of their seats for a little while during their sedentary days may have a significant impact on prevention of such chronic conditions.

Visiting C-PAN at Deakin University, Melbourne Australia

This week I am a guest at the Behavioural Epidemiology group of the Centre for Physical Activity and Nutrition Research (C-PAN; please see www.deakin.edu.au/hmnbs/cpan/be.php), Deakin University, Melbourne Australia. This group really does work of great interest to ring behavioural nutrition and physical activity research a few steps further. In their work on explaining and promoting healthful nutrition and physical activity behaviours, they have adopted a social ecological perspective, and a main focus is on social and physical environmental determinants of these behaviours. Socio-economic differences in these behaviours is another topic that they excel in. Their studies include children and adults, observational and intervention studies. Productive as they are, they appear rather relaxed, taking plenty of time to discuss their work, but also making sure that I am well-fed and that I have a bike during my stay to attend to my cycling addiction. The groups is led by professor David Crawford and Drs. Jo Salmon, Kylie Ball and Anna Timperio. You should check out their work, for example via pubmed (see www.ncbi.nlm.gov/sites/entrez/ ).
Although you see quite some cyclists in Melbourne, I suspect that these are the really dedicated few. The cycling infrastructure is not that good. There are some very nice bike routes, especially the main Yarra trail, along the Yarra river, but cycling for transport is something else. Not many designated bike lanes, and if you do encounter one, they are often used to park cars…See http://www.whitehat.com.au/Melbourne/Activities/Cycling.asp and http://www.melbourne.vic.gov.au/info.cfm?top=140&pa=1196&pg=1200 for more information on cycling in Melbourne and the Melbourne city bike plan.

A new chair in epidemiology of common mental disorders

On Friday October 5, Professor Brenda Penninx gave her inaugural address for her new position as professor of epidemiology of common mental disorders. Professor Penninx coordinates the Netherlands Study of Depression and Anxiety disorders, a large-scale and unique longitudinal study primarily focussed on two of the most common mental disorders: depression and anxiety disorders. During her address, Brenda Penninx provided a clear overview of some recent results from this ongoing study and her plans for further research in the years to come. She touched upon her research showing the associations between these mental disorders and other important burdens of disease, such as cardiovascular conditions, as well as with lifestyle determinants such as nutrition, physical activity and smoking habits. A few years ago she received a VIDI grant for her work from the Netherlands organisation for Scientific Research, NWO, one of the most prestigious grants available (see http://www.nesda.nl/pdf/artikel%20ad%20valvas.pdf) and se is also a member of the ‘Young Academy of the Netherlands Academy of the Royal Dutch Academy of Arts and Sciences (see http://www.knaw.nl/english/index.html and http://www.knaw.nl/cfdata/nieuws/nieuws_detail.cfm?nieuws__id=392). Professor Penninx work is part of the Common Mental Disorders program of the EMGO Institute, and her work illustrates very nicely the fruitful interdisciplinary and interfaculty collaboration within our institute. She works with colleagues from the Psychiatry, Clinical Psychology and General Practitioners departments in mapping causes and effects of common mental disorders, and in exploring and evaluating ways for prevention and early treatment.