Hostname: page-component-6bf8c574d5-685pp Total loading time: 0 Render date: 2025-03-05T18:41:14.014Z Has data issue: false hasContentIssue false
  • English
  • Français

Healthy lifestyles in Europe: prevention of obesity and type II diabetes by diet and physical activity

Published online by Cambridge University Press:  27 September 2007

Arne Astrup
Arne Astrup*
Affiliation:
Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Denmark
*
*Corresponding author: Email ast@kvl.dk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The prevalence of obesity is increasing rapidly in all age groups in most EU-countries and is one of the fastest growing epidemics, now affecting 10–40% of the adult population. Obesity increases the risk of serious co-morbidities such as type 2 diabetes, cardiovascular disease, certain cancers and reduced life expectancy, and these complications may account for 5–10% of all health costs in EU countries. The risk of diabetes is particularly increased by obesity, and 80–95% of the increase in diabetes can be attributed to obesity and overweight with abdominal fat distribution. There is robust evidence from cross-sectional and longitudinal studies to support that an energy-dense, high fat diet and physical inactivity are independent risk factors for weight gain and obesity. Furthermore, interaction between dietary fat and physical fitness determine fat balance, so that the obesity promoting effect of a high fat diet is enhanced in susceptible subjects, particularly in sedentary individuals with a genetic predisposition to obesity.

Ad libitum consumption of diets low in fat and high in protein and complex carbohydrates, with a low glycaemic index, contributes to the prevention of weight gain in normal weight subjects. It also causes a spontaneous weight loss of 3–4 kg in overweight subjects, and has beneficial effects on risk factors for diabetes and CVD. To prevent obesity and diabetes there are grounds for recommending the combination of increasing daily physical activity level to a PAL-value of at least 1.8 and reducing dietary fat content to 20–25 energy-% in sedentary subjects, and to 25–35% in more physically active individuals.

Keywords

ObesityType II diabetesDietPhysical activityGeneticsPrevention
Type
Research Article
Information
Public Health Nutrition , Volume 4 , Issue 2b , April 2001 , pp. 499 - 515
Copyright
Copyright © CABI Publishing 2001

References

1Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity, Geneva 3–5 June 1997. Geneva: WHO Publications, 1997.Google Scholar
2Prevention of diabetes mellitus. Report of a WHO study group. WHO Technical Report Series, No. 844, 1994.Google Scholar
3Astrup, A, Finer, N.Redefining type 2 diabetes: ‘Diabesity’ or ‘Obesity Dependent Diabetes Mellitus’? Obes. Rev. 2000; in press.CrossRefGoogle ScholarPubMed
4Colditz, GA, Willett, WC, Rotnitzky, A, Manson, JAE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann. Intern. Med. 1995; 122: 481–6.CrossRefGoogle ScholarPubMed
5Sjöström, CD, Lissner, L, Wedel, H, Sjöström, L.Reduction of incidence in diabetes, herpertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes. Res. 1999; 7: 477–84.CrossRefGoogle Scholar
6Sjöström, L.Obesity, diabetes and other cardiovascular risk factors. Lessons from SOS. Int. J. Obes. 2000; 24(Suppl. 1): S7 (Abs 14).Google Scholar
7Heymsfield, SB, Segal, KR, Hauptman, J, Lucas, CP, Boldrin, MN, Rissanen, A, Wilding, JPH, Sjöström, L.Effect of weight loss with Orlistat on glucose tolerance and progression to type 2 diabetes in obese adults. Arch. Intern. Med. 2000; 160: 1312–6.CrossRefGoogle ScholarPubMed
8Williamson, DF, Pamuk, E, Thun, M, Flanders, D, Byers, T, Health, C.Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40–64. Am. J. Epidemiol. 1995; 141: 1128–41.CrossRefGoogle ScholarPubMed
9King, H, Aubert, RE, Herman, WH. Global burden of diabetes 1995–2025. Diabetes Care 1998; 21: 1414–1431.CrossRefGoogle ScholarPubMed
10Astrup, A.Macronutrient balances and obesity: the role of diet and physical activity. Pub. Health Nutr. 1999; 2: 341–7.CrossRefGoogle ScholarPubMed
11James, WPT, Ralph, A.Implementing dietary change: theory and practice. Obesity. New understanding in obesity research. Proc. Nutr. Soc. 1999; 58: 385–93.CrossRefGoogle Scholar
12Blundell, JE, Cooling, J.Routes to obesity: phenotypes, food choices and activity. Br. J. Nutr. 2000; 83: S33–8.Google Scholar
13Bray, GA, Popkin, BM. Dietary fat intake does affect obesity. Am. J. Clin. Nutr. 1998; 68: 1157–73.CrossRefGoogle ScholarPubMed
14Astrup, A, Ryan, L, Grunwald, G, Storgaard, M, Saris, W, Hill, JO. Ad libitum low-fat diets and body fatness: A meta-analysis of intervention studies. Br. J. Nutr. 2000; 83(suppl 1): S25–32.CrossRefGoogle ScholarPubMed
15Goris, AHC, Westerterp-Plantenga, MS, Westerterp, KR. Undereating and underrecording of habitual food intake in obese men: selective underreporting of fat intake. Am. J. Clin. Nutr. 2000; 71: 130–4.Google Scholar
16Harnack, LJ, Jeffrey, RW, Boutelle, KN. Temporal trends in energy intake in the United States: an ecological perspective. Am. J. Clin. Nutri. 2000; 71: 1478–84.CrossRefGoogle Scholar
17Willet, WC. Is dietary fat a major determinant of body fat? Am. J. Clin. Nutr. 1998; 67: 556S–62S.CrossRefGoogle Scholar
18Yu-Poth, S, Zhao, G, Etherton, T, Naglak, M, Jonnalagadda, S, Kris-Etherton PM. Effects of the national cholesterol education program's step I and step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am. J. Clin. Nutr. 1999; 69: 632–46.CrossRefGoogle ScholarPubMed
19 Food and Agricultural Organization of the United Nations. Get the best from your food. 1992.Google Scholar
20Ludwig, DS, Majzoub, JA, Al-Zahrani, A, Dallal, GE, Blanco, I, Roberts, SB. High glycemic index foods, overeating, and obesity. Pediatrics 1999; 103: 26.Google Scholar
21Bolton-Smith, C, Woodward, M.Dietary composition and fat to sugar ratios in relation to obesity. Int. J. Obes. 1994; 18: 820–8.Google Scholar
22Raben, A, Macdonald, I, Astrup, A.Replacement of dietary fat by sucrose or starch: Effects on 14 days' ad libitum energy intake, energy expenditure and body weight in formerly obese and neverobese subjects. Int. J. Obes. 1997; 21: 846–59.CrossRefGoogle ScholarPubMed
23Saris, WHM, Astrup, A, Prentice, AM, Zunft, FHJ, Formiguera, X, Verboeket-van de Venne, WPHG, Raben, A, Poppitt, SD, Seppelt, B, Johnston, S, Vasilaras, TH, Keogh, G.Randomised controlled trial on changes in dietary carbohydrate/fat ratio and simple vs. complex carbohydrates on body weight and blood lipids: the CARMEN study. Int. J. Obes. 2000; in press.CrossRefGoogle ScholarPubMed
24Salmeron, J, Manson, JE, Stampfer, MJ, Colditz, GA, Wing, AL, Willett, WC. Dietary fiber, glycemic load, and risk of non-insulin –dependent diabetes mellitus in women. JAMA 1997; 277: 472–7.CrossRefGoogle ScholarPubMed
25Salmeron, J, Ascherio, A, Rimm, EB, et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997; 20: 545–50.CrossRefGoogle ScholarPubMed
26Schaefer, EJ, Lichtenstein, AH, Lamon-Fava, S, McNamara, JR, Schaefer, MM, Rasmussen, H, et al. Body weight and low-density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet. JAMA 1995; 274: 1450–5.CrossRefGoogle ScholarPubMed
27Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – The Evidence Report. Obes. Res. 1998; 6(suppl.2): 51S–210S.Google Scholar
28Frost, G, Leeds, AA, Doré, CJ, Madeiros, S, Brading, S, Dornhorst, A.Glycaemic index as a determinant of serum HDL-cholesterol concentration. Lancet 1999; 353: 1045–8.CrossRefGoogle ScholarPubMed
29 Nordiska Ministerråd. Nordiska näringsrekommendationer 1996. Copenhagen, 1996.Google Scholar
30Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy, The Department of Health. Dietary reference values for food energy and nutrients for the United Kingdom. HMSO, London, 1991.Google Scholar
31Ha, TKK, Lean, MEJ. Recommendations for the nutritional management of patients with diabetes mellitus. Eur. J. Clin. Nutr. 1998; 52: 467–81.Google Scholar
32Roland-Cachera, MF, Deheeger, M.Nutrient balance and android body fat distribution: why not a role for protein? Am. J. Clin. Nutr. 1996; 61: S960–7.Google Scholar
33Skov, AR, Toubro, S, Rønn, B, Holm, L, Astrup, A.Randomized trial on protein versus carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int. J. Obes. 1999; 23: 528–36.CrossRefGoogle Scholar
34Hill, MJ. Meat and colo-rectal cancer. Proc. Nutr. Soc. 1999; 58: 261–4.CrossRefGoogle ScholarPubMed
35Bingham, SA. High-meat diets and cancer risk. Proc. Nutr. Soc. 1999; 58: 243–8.CrossRefGoogle ScholarPubMed
36Dulloo, AG, Mensi, N, Seydoux, J, Girardier, L.Differential effects of high-fat diets varying in fatty acid composition on the efficiency of lean and fat tissue deposition during weight recovery after low food intake. Metabolism 1995; 44: 273–9.CrossRefGoogle ScholarPubMed
37Doucet, E, Ameréras, N, White, MD, Despreés, J-P, Bouchard, C, Tremblay, A.Dietary fat composition and human adiposity. Eur. J. Clin. Nutr. 1998; 52: 2–6.CrossRefGoogle ScholarPubMed
38Lawton, CL, Delary, HJ, Brockman, J, Smith, FC, Blundell, JE. The degree of saturation of fatty acids influences post-ingestive satiety. Br. J. Nutr. 2000; 83: 473–82.CrossRefGoogle ScholarPubMed
39Prentice, AM. Alcohol and obesity. Int. J. Obes. 1995; 19(suppl. 5): S44–50.Google ScholarPubMed
40Fogelholm, M, Kukkonen-Harjula, K.Does physical activity prevent weight gain – a systematic review. Obes. Rev. 2000; in press.CrossRefGoogle ScholarPubMed
41Prentice, AM, Jebb, SA. Obesity in Britain: Gluttony or sloth? Br. Med. J. 1995; 311: 437–9.CrossRefGoogle ScholarPubMed
42Schoeller, DA, Shay, K, Kushner, RF. How much physical activity is needed to minimize weight gain in previously obese women? Am. J. Clin. Nutr. 1997; 66: 551–6.Google Scholar
43Ferro-Luzzi, A, Martino, L. Obesity and physical activity. The origins and consequences of obesity, CIBA Foundation Symposium 201. Chichester: John Wiley & Sons, 1996.Google Scholar
44Nagle, DL, McGrail, SH, Vitale, J, Woolf, EA, Dussault, BJ, DiRocco, L, et al. The mahogany protein is a receptor involved in suppression of obesity. Nature 1999; 398: 148–52.CrossRefGoogle ScholarPubMed
45Zhang, Y, Proenca, R, Maffei, M, Barone, M, Leopold, L, Friedman, JM. Positional cloning of the obese mouse gene and its human homologue. Nature 1994; 372: 425–32.CrossRefGoogle ScholarPubMed
46Farooqi, IS, Jebb, SA, Langmark, G, Lawrence, E, Cheetham, CH, Prentice, AM, Hughes, IA, McCamish, MA, O'Rahilly, S.Effects of reombinant leptin therapy in a child with congenital leptin deficiency. N. Engl. J. Med. 1999; 341(12): 879–84.CrossRefGoogle Scholar
47Von Kries, R, Koletzko, B, Sauerwald, T, von Mutius, E, Barnert, D, Grunert, V, von Voss, H.Breast feeding and obesity: cross sectional study. Brit. Med. J. 1999; 319: 147–50.CrossRefGoogle ScholarPubMed
48Meirhaeghe, A, Helbecque, N, Cottel, D, Amouyel, P.β2-adrenoceptor gene polymorphism, body weight and physical activity. Lancet 1999; 353: 896.CrossRefGoogle ScholarPubMed
49Astrup, A, Flatt, JP. Metabolic determinants of body weight regulation. In: Bouchard, C, Bray, GA, eds. Regulation of Body Weight, Biological and Behavioral Mechanisms – Dahlem Workshop. Report LS 57. Chichester: John Wiley & Sons, pp. 193–210, 1996.Google Scholar
50Astrup, A, Raben, A, Buemann, B, Toubro, S.Fat metabolism in the predisposition to obesity. Ann. NY. Acad. Sci. 1997; 827: 427–33.CrossRefGoogle ScholarPubMed
51Astrup, A, Lundsgaard, C, Stock, MJ. Is obesity contagious? Int. J. Obes. 1998; 22: 375–6.CrossRefGoogle ScholarPubMed
52Stubbs, RJ, Harbron, CG, Murgatroyd, PR, Prentice, AM. Covert manipulation of dietary fat and energy density: effect on substrate flux and food intake in men eating ad libitum. Am. J. Clin. Nutr. 1995; 62: 316–29.CrossRefGoogle ScholarPubMed
53Stubbs, RJ, Ritz, P, Coward, WA, Prentice, AM. Covert manipulation of the dietary fat to carbohydrate ratio and energy density: effect on food intake and energy balance in free-living men, feeding ad libitum. Am. J. Clin. Nutr. 1995; 62: 330–7.CrossRefGoogle ScholarPubMed
54Lissner, L, Heitmann, BL, Bengtsson, C.Low-fat diets may prevent weight gain in sedentary women: Prospective observations from the population study of women in Gothenburg, Sweden. Obes. Res. 1997; 5(1): 43–8.CrossRefGoogle ScholarPubMed
55Manios, Y, Moschandreas, J, Hatzis, C, Kafatos, A.Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period. Prev. Med. 1999; 28: 149–59.CrossRefGoogle Scholar
56Kumanyika, S, Jeffery, R, Ritenbaugh, C, Morabia, A, Antipatis, V. Causal Web of Societal influences on obesity prevalence. www.iotf.org/groups/phapo (1999).Google Scholar