'Obesity is a Disease'

Athens News

The government has a responsibility
to both treat and prevent Greece's ballooning weight
problem, says obesity expert Professor Constantine Tsigos

By Cordelia Madden

With GREECE'S women and children
among the fattest in Europe and the men
not far
behind, obesity is becoming
something of a
national epidemic. And with
approximately 60 percent of the population
living in urban areas, where there are few
places to enjoy outdoor activities, and with
schools cutting back on physical education
and proffering high­calorie snacks at the
canteens, the forecast is for an even fatter

Statistics released by the International
Obesity Task Force (IOTF) in March show
that Greeks surpass even the supersized
Americans on the scaIes, with 38 percent
of Greek women
obese or overweight,
compared to 34 percent in the US, and over
75 percent of Greek men above the age of
30 overweight, in comparison with 67
percent of overweight or obese males in
ca. Meanwhile, local surveys have
shown that 40 percent of Greek children
aged between 9 and 18 are overweight,
with boys in that age group weighing in
at 15 kilos heavier than their counterparts
of 20 years ago. The IOTF reports that the
number of overweight children in the EU
rises by 400,000 each year.

Children in Rome enjoy a gelato or three.
Italian and Greek choldren are among
the fattest in Europe, as they desert the
traditional Mediterranean diet in favour
of more fatty, dairy- and -meat -rich
western foods
Professor Constantine Tsigos, an endocrinologist and diabetologist who is the current chairman of the obesity management task force of the European Association for the Study of Obesity and Association for the Study of Obesity and a member of the Specialist Certification for Obesity Professionals in Europe (SCOPE) committee, says that although Greek governments have made some attempts to address the issue, there needs to be a much more concerted effort at both governmental and community levels to address what he calls the "disease" of obesity.

''The prevention of obesity needs to target children," he tells the Athens News in a November 10 interview. "The rule is that an obese child or adolescent will grow into an obese adult, with all the health consequences. We already have the first instances of Type 2 Diabetes in children - the diabetes that is not due to a lack of insulin but to a resistance to insulin action, caused by obesity and we know that childhood obesity predisposes to very high risks of developing heart diseases, strokes, cancer of the breast or colon, atherosclerosis, hypertension, pulmonary. problems and muscular and skeletal problems."

For many reasons we are gaining weight worldwide. We are consuming more calories than we expend not only due to the abundance of high-calorie foods available but also because of our sedentary lifestyle. "The strongest association between children and obesity relates to the number of cars in the household and the number of TV -viewing hours," reports Tsigos. But looking specifically at the obesity problem in Greece, he says that one of the key factors has been the very rapid change from the classic Mediterranean diet, with its emphasis on fruit, vegetables, legumes and olive oil, to a more westernised diet high in animal fats.

One way the government could take action to try and combat this problem would be to enforce laws that govern what snacks are available at schools. Although Tsigos says that there have been efforts to crack down on what is offered at school canteens, a November 13 report on national television showed that healthy options are still rarely available in tuck shops, which mostly sell a preponderance of greasy pizzas, cheese pies, chocolate-filled croissants and chocolate-flavoured milk.

Tsigos notes that families might be more enticed to eat less fat at home if the supermarket and grocery prices were regulated so that low-calorie alternatives such as skimmed milk or low-fat yoghurt were at least not more expensive than hyper-calorific foods.

'We'll never go hungry again'

Another factor behind Greece's weight problem - and one that government interference can do little to alter- is that fat babies and children are still seen as being more desirable than lean ones. This, explains Tsigos, is an idea from the past that is perpetuated by the older generation who suffered acute deprivations both during and after the Second World War and who still believe that being overweight is a sign of health. Since many Greek parents still rely on their parents for childminding duties, at home the kids are being urged to overeat, while outside the home they are tempted by an array of 'cool', massively advertised, high-calorie snacks and sweets.

Floundering in a quagmire of calories, Greece's children desperately need exercise. But the schools don't offer more than a few hours of sport per week, and open spaces where children can safely play are few and far between in urban areas. "We have to intervene at school level, and we must improve our environment," stresses Tsigos. While Scandinavian countries have seen "impressive results" in reducing the prevalence of obesity by initiating countrywide cycling and walking programmes, Tsigos says that "Athens has only recently obtained pedestrian/cycling areas; in most places the risks actually don't allow us to walk - especially the children and the elderly, who have particular needs".

But it's not just about too much food and too little exercise. Tsigos says that socio-economic stress is emerging as a major factor in obesity, particularly in 'android obesity' (in which fat gathers around the stomach making an 'apple' shape, as opposed to 'gynaecoid obesity', which results in the more classic pear shape), the type most commonly associated with dangerous complications. "Chronic, insidious, uncontrollable socio-economic stress can actually cause growing elevations of cortisone levels, which fuel the fat tissue, particularly of the abdomen, and can cause both obesity and a tendency to atherosclerosis and the complications of that," Tsigos explains.

Obesity needs to be recognised as a disease that needs medical treatment, says Tsigos. Spending national health budgets on the overweight might sound like a waste of money, but he notes that it could actually be more cost, effective. The costs of treating the complications, ranging from diabetes to heart disease, are exorbitant. Markos Kyprianou, European health commissioner, said in September that up to 8 percent of all current healthcare costs in the EU can be attributed to the effects of being overweight.

"Many doctors still refuse to treat obesity," says Tsigos, "believing that it is up to the willpower of the patient. But that's a big mistake. Patients are not responsible for their own obesity, and we should not incriminate them. We need to take the burden off the patient's shoulders and try to work together towards a solution, to overcome the difficulties that have led that person to obesity."

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