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The effects on health of the dramatic increase of overweight and obesity which occurred in many countries in the last decades were controversial until short time ago. In the present paper therefore the results of the in 2009 published great international metaanalysis of the Prospective Studies Collaboration about the main associations between the body mass index (BMI) and the overall and the cause-specific mortality is presented which brought firm insights on this field. In men the mortality in relation to a specific BMI was found double as high as in women. In both sexes mortality was lowest at a BMI of about 22.5-25 kg/m 2. Each 5 kg/m 2 higher BMI was on average associated with about 30% higher overall mortality, 40% higher for vascular mortality, 60-120% higher for diabetic, renal and hepatic mortality, 10% higher for neoplastic mortality and 20% higher for respiratory and all other mortality. The study shows that BMI in itself is a strong predictor for overall mortality above and below an apparent optimum of about 22.5-25 kg/m 2. The increase of mortality above this range is due mainly to vascular diseases and is probably largely causal. At 30-35 kg/m 2 median survival is reduced to 2-4 years and at 40-45 kg/m 2 to 8-10 years which is comparable with the effect of smoking. In men and women the combined risk of a specific BMI and smoking was almost doubled and caused a loss up to 20 years. In the discussion the authors criticize some views which relativise the unfavourable effects of overweight and obesity on health. In contrary to these positions the results of the metaanalysis of the Prospective Studies Collaboration show that adult obese people pay a high price and would gain much by a weight reduction. At last it is emphasized that a successful therapy of obesity besides a traditional nutrition consultation needs at its best a regular motivation in the medical practise, as is shown in two actual randomized intervention trials a short time ago. Source


The effects on health of the dramatic increase of overweight and obesity which occurred in many countries in the last decades were controversial until short time ago. In the present paper therefore the results of the in 2009 published great international metaanalysis of the Prospective Studies Collaboration about the main associations between the body mass index (BMI) and the overall and the cause-specific mortality is presented which brought firm insights on this field. In men the mortality in relation to a specific BMI was found double as high as in women. In both sexes mortality was lowest at a BMI of about 22.5-25 kg/m2. Each 5 kg/m2 higher BMI was on average associated with about 30% higher overall mortality, 40% higher for vascular mortality, 60-120% higher for diabetic, renal and hepatic mortality, 10% higher for neoplastic mortality and 20% higher for respiratory and all other mortality. The study shows that BMI in itself is a strong predictor for overall mortality above and below an apparent optimum of about 22.5-25 kg/m 2. The increase of mortality above this range is due mainly to vascular diseases and is probably largely causal. At 30-35 kg/m2 median survival is reduced to 2-4 years and at 40-45 kg/m2 to 8-10 years which is comparable with the effect of smoking. In men and women the combined risk of a specific BMI and smoking was almost doubled and caused a loss up to 20 years. In the discussion the authors criticize some views which relativise the unfavourable effects of overweight and obesity on health. In contrary to these positions the results of the metaanalysis of the Prospective Studies Collaboration show that adult obese people pay a high price and would gain much by a weight reduction. At last it is emphasized that a successful therapy of obesity besides a traditional nutrition consultation needs at its best a regular motivation in the medical practise, as is shown in two actual randomized intervention trials a short time ago. Source


2004 a sensational study in the USA found out that avoidable causes of death are responsible for almost half of the annual cases of death. On the top of the causes of death stand smoking and obesity in combination with lack of exercise. The WHO speaks in this context of the deadly quartet to whom also alcohol abuse belongs. These dramatic results take place, because smoking and obesity in combination with lack of exercise promote the occurrence of many non transferable chronic diseases, e.g. coronary heart disease with myocardial infarction, essential hypertension, cerebral ischemia with cerebral infarction, adult-onset diabetes, chronic obstructive lung disease and the most frequent cancer diseases. In Germany there are 10-20 million people, who suffer from at least one of the announced chronic diseases. tial for diminishing the number of chronic diseases. Convincing examples for this are the adultonset diabetes and the essential hypertension. These diseases are not only improved but often are healed by a long lasting loss of weight in obese people. The research during the last decades has shown that non transferable chronic diseases are found more often in people with lower income than in those of the middle and upper classes. This social difference obviously cannot be reconciled by means of the established ambulatory and stationary medical care, but requires more efforts in the field of prevention and health care. Measures of prevention must promote the selfresponsibility. This means that a single person actively takes care of its health. During the last years this term unfortunately is used as an argument for a stronger orientation of health care on profit interests, because this aim is combined inevitably with a reduction of solitary achievements of our social system. Concerning prevention there is a difference between behavioural and social prevention. Behavioural prevention is a task of the health profession, especially the physicians. In the meantime there exist some effective measures of behavioural prevention which are useful to be carried out in a medical practice, e.g. measures for smoking cessation, obesity therapy and primary prevention of the adult-onset diabetes. Lifestyle changes as cessation of smoking, a healthy nutrition and regular exercise can avoid 80-90% of these chronic diseases or can improve its course. Concerning lifestyle changes you can differentiate between measures of primary prevention with the aim to prevent the occurrence of chronic diseases and measures of secondary prevention with the aim to influence favourably the progression of existing chronic diseases or to stop them. According to the motto to prevent a disease is better than to heal it, the priority belongs to primary prevention of non transferable chronic diseases. Nevertheless, it is important, that to be ill does not mean automatically that you must be ill for your whole life. It must be understood that also secondary prevention bears an enormous poten- If measures of behavioural prevention will be popular, it must be completed with measures of social prevention. The latter are part of the frame conditions of our life and therefore firstly a task for politics. On the field of tobacco control a law for public non smoking without any exception belongs to it and in the field of obesity control the labelling of food according to an ample-system. These and more measures can only be achieved if the public interest of health is attached a greater value than the private interest of profit of particular industries, which live from a disease promoting behaviour of our population. Source


2004 a sensational study in the USA found out that avoidable causes of death are responsible for almost half of the annual cases of death. On the top of the causes of death stand smoking and obesity in combination with lack of exercise. The WHO speaks in this context of the deadly quartet to whom also alcohol abuse belongs. These dramatic results take place, because smoking and obesity in combination with lack of exercise promote the occurrence of many non transferable chronic diseases, e.g. coronary heart disease with myocardial infarction, essential hypertension, cerebral ischemia with cerebral infarction, adult-onset diabetes, chronic obstructive lung disease and the most frequent cancer diseases. In Germany there are 10-20 million people, who suffer from at least one of the announced chronic diseases. Lifestyle changes as cessation of smoking, a healthy nutrition and regular exercise can avoid 80-90% of these chronic diseases or can improve its course. Concerning lifestyle changes you can differentiate between measures of primary prevention with the aim to prevent the occurrence of chronic diseases and measures of secondary prevention with the aim to influence favourably the progression of existing chronic diseases or to stop them. According to the motto to prevent a disease is better than to heal it, the priority belongs to primary prevention of non transferable chronic diseases. Nevertheless, it is important, that to be ill does not mean automatically that you must be ill for your whole life. It must be understood that also secondary prevention bears an enormous potential for diminishing the number of chronic diseases. Convincing examples for this are the adultonset diabetes and the essential hypertension. These diseases are not only improved but often are healed by a long lasting loss of weight in obese people. The research during the last decades has shown that non transferable chronic diseases are found more often in people with lower income than in those of the middle and upper classes. This social difference obviously cannot be reconciled by means of the established ambulatory and stationary medical care, but requires more efforts in the field of prevention and health care. Measures of prevention must promote the selfresponsibility. This means that a single person actively takes care of its health. During the last years this term unfortunately is used as an argument for a stronger orientation of health care on profit interests, because this aim is combined inevitably with a reduction of solitary achievements of our social system. Concerning prevention there is a difference between behavioural and social prevention. Behavioural prevention is a task of the health profession, especially the physicians. In the meantime there exist some effective measures of behavioural prevention which are useful to be carried out in a medical practice, e.g. measures for smoking cessation, obesity therapy and primary prevention of the adult-onset diabetes. If measures of behavioural prevention will be popular, it must be completed with measures of social prevention. The latter are part of the frame conditions of our life and therefore firstly a task for politics. On the field of tobacco control a law for public non smoking without any exception belongs to it and in the field of obesity control the labelling of food according to an ample-system. These and more measures can only be achieved if the public interest of health is attached a greater value than the private interest of profit of particular industries, which live from a disease promoting behaviour of our population. Source


In the introduction it is explained that health care in Germany is in realty a «disease care». In spite of different statements, the prevention of lifestyle caused chronic diseases does not play any important role. The first part deals with the topic «Social inequality and diseases». The main focus of the investigations of the British epidemiologists WILKINSON and PICKETT are described in their book «The spirit level». The authors have explored the statistics of the rich industrial societies and have searched for correlations between social inequality expressed in income distribution patterns and the amount of health and social problems. The book shows that most of the problems are not correlated to the average income level but to the grade of social inequality in the countries which are compared. That is also valid for obesity which is, besides smoking, the most important factor for lifestyle caused chronic diseases. Many peoples in the lower but also in the middle and upper classes are affected by this. It is probably a causal relationship form which is well founded by the actual scientific literature in the field of sociology. The conclusion is: that all measures to lower social inequality work as well for health and social prevention. In the middle of part two, the prevention of lifestyle caused chronic diseases is described. In the rich countries the far greatest part of annual cases of deaths is caused by lifestyle-caused chronic diseases. That includes e.g. coronary heart disease and myocardial infarction, cerebral ischemia and infarction, essential hypertension, obesity and adult-onset diabetes, chronic obstructive lung disease and most frequent cancer diseases. According to the WHO priority should be given to the prevention of the deadly quartet. It consists of the risk factors smoking, obesity in combination with lack of exercises and alcohol abuse. About 40 percent of all cases of death are linked to it and about 70 percent are closely connected with it. The prevention of lifestyle caused chronic diseases is a duty of the whole society. It only functions as a unity of behavioural prevention in the form of primary prevention, e. g. in kindergartens, schools and companies, and secondary prevention, e.g. in doctor's offices, in combination with social prevention. In part three, the national health insurance (GKV) is confronted with the private health insurance (PKV). The main problem of the GKV is that its income is dropping because the income of the employees during the last decades is stagnating or falling and the payments of the employers are frozen (abolition of equal financing of health insurance between employees and employers). As a result, the amount the employees pay is increasing, the national health insurance must get higher grants from taxes, the catalogue of services is reduced or questioned, and the extra charges have increased. In addition, there is a growing tendency towards a two-class-medical system. Therefore, I am pleading for strengthening the principles of solidarity by creating a united form of health insurance for all citizens, the re-establishment of equal financing of health care, a creation of fair fees based on income and a step by step increase of the income threshold. It is the further development of a health insurance system based on solidarity for all citizens in which there is still much support in the German population today. Source

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