Obesity in Estonia worse than feared

Ülikooli kliinikumi endokrinoloogi Triin Egliti doktoritööst selgub, et eestlaste hulgas on rasvunuid palju rohkem kui arvatud: enam kui kolmandik täiskasvanud eestlastest on rasvunud. See tähendab, et nende kehamassiindeks on üle kolmekümne.

PHOTO: Margus Ansu

Just a year ago, National Institute for Health Development (TAI) told us that in Estonia, every second adult is either overweight or obese. At that, the former were much more numerous than the latter: obesity, they thought, was the lot of every fifth. According to a Doctoral thesis recently defended at University of Tartu, it’s actually every third of us that is obese.

Fat, and fatter yet. Putting it plainly, this is what the overweight and obese might mean. In medicine, they tell the difference according to body mass index (BMI), which is calculated as a person’s weight in kilograms divided by the square of his height in metres.

Should the result be from 25 to 30, the person is overweight. As indicated in her Doctoral thesis, however, endocrinologist Triin Eglit, 32 percent of adults in Estonia, BMI is 30 and beyond. Meaning: they’re obese.

Unexpectedly fat

«The percentage is substantially higher than assessed earlier. Nearly twice,» said Ms Eglit.

Ms Eglit was referring to TAI data: in their adult health behaviour study published last year, TAI said 19 percent were obese of men and women in Estonia. In  2008, when Triin Eglit begun her study of obesity and related diseases in Estonia, the same indicator was lower by one percent only.

«The TAI data are very good, having been calculated on basis of a large group of people. But their research has been done via postal polls. Several studies reveal that, as compared to what people report, their BMI might prove bigger at objective measuring. Many, especially the older people, may not clearly remember their height and weight. In polls conducted by mail, it may also happen that overweight people are more reluctant to answer. Also, the difference in data may be explained by the people group studied by TAI being a bit younger as compared to ours,» said Ms Eglit.

Ms Eglit invited people in Tartu, Viljandi and Põlva Counties to participate according to random selection. After that, she travelled the counties with a tape measure and all else, making analysis and measuring the people personally.

In Ms Eglit’s study, done in cooperation with family doctors Maiu Lõhmus, Elve Lillemägi, Merle Raidoja and Diana Kirss, involved half a thousand people – a cross-section of Estonian population both gender- and age-wise. Their health data may be generally applied to the entire population. Never before has obesity and related sicknesses studied like this, in Estonia.

As underlined by Triin Eglit, her data is comparable to recent data published in other European nations.  

Obese plagued by problems

The study also revealed negative health data as related to obesity. For instance: 20 per cent of Estonians i.e. every fifth has glucose regulation disorders. «At that, five percent of these had impaired fasting glucose and eight percent had impaired glucose tolerance. Both equal prediabetes,» said Ms Eglit.

People with prediabetes may avoid or postpone type 2 diabetes by adopting a healthier lifestyle and diet, and by weight loss. According to the fresh thesis supervised by Margus Lember and Tarvo Rajasalu, seven percent of Estonians suffer from type 3 glucose regulation disorder i.e. diabetes.

As also revealed by the study, a quarter of adult Estonians have metabolic syndrome, the risk of which increases due to obesity and a «seated» lifestyle.  

«With people suffering from metabolic syndrome, the risk of type 2 diabetes if five times higher, and risk of cardiovascular diseases at least twice as high,» said Ms Eglit.

Metabolic syndrome is diagnosed with people who have at least three of the following five criteria: too wide waistline, low level of good cholesterol, high blood pressure, high level of triglyceride (a type of blood fat – edit), and diabetes or high blood sugar at empty stomach.  

All obese not sick

Even with the strong correlation between obesity and the aforementioned sicknesses, not all obese are plagued by these.

Possibly, these people should thank their high levels of a «good» fatty tissue hormone, the adiponectin. «As opposed to other hormones produced in fatty tissue, adiponectin provides protection both against diabetes and metabolic syndrome,» explained Triin Eglit.

There are 12 percent of such «healthy obese» among adults of Estonia. «They are obese and yet totally healthy metabolically. That had no disorders whatsoever,» said the doctor. «Interestingly, their adiponectin level resembled that of people with normal weight, and was higher that with the sick obese,» said Ms Eglit.

«Still, with obesity there are substantial risks of sleep apnea and osteoarthritis, for instance – thus, it is advisable to even the metabolically healthy obese to try and lose weight,» said Ms Eglit.

Triin Eglit was also interested in possible gender-specific nuances of correlations between adiponectin and metabolic risk factors. 

Turns out, males aged 20 to 44, in Estonia, have a substantially higher percentage of metabolic syndrome that women of the same age.

Even with various correlations found by Ms Eglit regarding links between good fat hormones and various metabolic risk factors, it provided no answers for causes thereof.

While there have been studies conducted elsewhere in the world regarding links between adiponectin and sickness with the obese, research had never been conducted regarding adiponectin of high-molecular weight and metabolic syndrome.

«I am not saying that a new medicine may be developed on basis of my thesis. We did not conduct lab tests, you see. But surely this is a starting point for further research, possibly explaining causes and effects of the lings so far discovered,» said Triin Eglit.

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Obesity and overweight

•    Since 1980, obesity has almost doubled in the whole world.

•    In 2008, 1.4 billion adults (aged 20 and above) were overweight. Of these, 200 million men and close to 300 million women were obese.

•    In 2008, 35 percent of adults were overweight and 11 percent obese.

•    65 per cent of world population live in countries where overweight and obesity kill more people than underweight.

•    In 2011, there were over 40 million overweight children, aged under 5, in the world.

•    Obesity can be prevented.

Studies link overweight with various factors:

•    Low physical activity, much time spent watching TV and using computer. While, a hundred years ago, a person may have used close to 3,000 kcal, doing hard physical work and using up the energy. Basic human metabolism consumes 1,500–1,600 kcal a day. Today, a working age person’s physical load averages 400–1,200 kcal a day. Thus, the daily food energy ought to be 1,900–2,800 kcal, depending on work.

•    Eating out often, excessive consumption of fast food. Developing a habit of eating out, people lose control of nutritional value of food consumed. 

•    Skipping meals. To achieve and maintain normal body weight, regular eating is vital. Overly long intervals cause feeling of hunger.

•    Lower level of education. Those more educated usually are more aware of healthy eating. Also, they have better options to buy food with higher nutritional value.

•    Increased wealth among the poorer strata of society. Having had austerity for a long time and now more money to spare, they want to make up lost time and try everything they’ve been deprived of.

•    Sleep disorders. Studies show too short sleep limits levels of leptine, a hormone creating the feeling of a full stomach, thus affecting metabolism. Hence, increased risk of overweight.   

•    Mother being overweight during pregnancy, baby’s excessive birth weight. Both increase overweight risk with the child.

•    Genetic inclination – on very rare occasions. In majority of cases, it’s the eating habits at home.

Source: toitumine.ee, TAI

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