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Causes of cases versus causes of epidemics
Symposia Abstracts to manage weight-related behaviour of their children will also be explored. http://dx.doi.org/10.1016/j.orcp.2012.08.022 S021 Effects of the global environment Garry Egger The proposed causes of the modern obesity epidemic are many and varied. Most explanations are limited to drivers that are proximal to the problem, which abrogates policy makers from responsibility by putting blame back on the individual. Epidemiological principles suggest a tiered level of causality based around Jeffrey Rose’ famous dictum that we must not just look for the ‘cause’, but for the ‘cause of the cause’. When this is taken to its logical conclusion, it becomes evident that the primary distal driver for obesity, as well as (not unrelated) problems such as climate change, is the modern system of economic growth beyond a ‘sweet spot’, in developing and developed societies. Global figures showing the complex relationship between growth and obesity levels will be presented to suggest that obesity is merely ‘collateral damage in the battle for modernity’ and that no discussion about obesity aetiology should be framed in the absence of the broader social and economic environment. http://dx.doi.org/10.1016/j.orcp.2012.08.023 S022 Causes of cases versus causes of epidemics Alistair Woodward Head, School of Population Health, University of Auckland, New Zealand It is almost 25 years since Geoffrey Rose wrote ‘‘aetiology confronts two distinct issues: the determinants of individual cases and the determinants of incidence’’. Rose’s point has been missed in much that has been written subsequently on the origins of chronic disease. There has been a tendency to confuse causes of individual cases with the ‘‘uber-causes’’ of population epidemics, and this misunderstanding is apparent in the literature on obesity. For example, differences in genotype help explain where individuals lie in the overall distribution of body mass index. But they do not explain why the whole distribution of body mass has shifted upwards so rapidly in many populations. Simple epidemiology provides some powerful messages about the origins of the obesity epidemic. For instance,
11 it is implausible that explanations for the epidemic are to be found early in life. Indeed it is unlikely any factor with a long induction period played a major role in the initiation of the epidemic. Instead, suspicion has to fall on population-wide changes in factors that act rapidly and affect all age groups simultaneously. Examples might include changes in the energy density, quantity and availability of certain foods. What causes epidemics to go away is more complicated than simply reversing what led to their appearance in the first place. But this must be a guiding principle: if we want to substantially reduce the burden of disease attributable to obesity, then preventive efforts have to focus on the determinants of incidence rather than the causes of individual risk. http://dx.doi.org/10.1016/j.orcp.2012.08.024 S023 Sociocultural influences on eating and physical activity: Not as simple as it seems Marita P. McCabe PhD FAPS, Deakin University, Melbourne, Australia During the past 30 years there has been a concerning increase in the prevalence of body image disturbance, eating disorders and obesity. Although there is a clear biological base to many of these disorders, sociocultural influences also play a major role. This paper will examine the evidence for sociocultural influences on these problem areas. Gender differences will be considered as well as cultural differences in the nature of the messages from the sociocultural agents and also the impact of these messages. The major sociocultural influences are the media, family and peers, although the church also plays a role in some societies. In Western societies, and more recently in many other societies, the clear message is that the ideal female body is lean and thin. This ideal is vastly different from the actual body form of most females. The extent to which this ideal body form presents a problem for females at different stages of life is dependent on the nature of the message transmitted, the source of the message, it is importance to the female’s sense of self-worth, her level of self-esteem and negative affect and her current body size. For males, the almost universal ideal portrayed by sociocultural influences is that of a lean, powerful, muscular body. The focus is more on body function than appearance. As for females, the impact of this sociocultural ideal depends on the internalization of this ideal, as well as selfesteem and negative affect. Cultural differences
11 it is implausible that explanations for the epidemic are to be found early in life. Indeed it is unlikely any factor with a long induction period played a major role in the initiation of the epidemic. Instead, suspicion has to fall on population-wide changes in factors that act rapidly and affect all age groups simultaneously. Examples might include changes in the energy density, quantity and availability of certain foods. What causes epidemics to go away is more complicated than simply reversing what led to their appearance in the first place. But this must be a guiding principle: if we want to substantially reduce the burden of disease attributable to obesity, then preventive efforts have to focus on the determinants of incidence rather than the causes of individual risk. http://dx.doi.org/10.1016/j.orcp.2012.08.024 S023 Sociocultural influences on eating and physical activity: Not as simple as it seems Marita P. McCabe PhD FAPS, Deakin University, Melbourne, Australia During the past 30 years there has been a concerning increase in the prevalence of body image disturbance, eating disorders and obesity. Although there is a clear biological base to many of these disorders, sociocultural influences also play a major role. This paper will examine the evidence for sociocultural influences on these problem areas. Gender differences will be considered as well as cultural differences in the nature of the messages from the sociocultural agents and also the impact of these messages. The major sociocultural influences are the media, family and peers, although the church also plays a role in some societies. In Western societies, and more recently in many other societies, the clear message is that the ideal female body is lean and thin. This ideal is vastly different from the actual body form of most females. The extent to which this ideal body form presents a problem for females at different stages of life is dependent on the nature of the message transmitted, the source of the message, it is importance to the female’s sense of self-worth, her level of self-esteem and negative affect and her current body size. For males, the almost universal ideal portrayed by sociocultural influences is that of a lean, powerful, muscular body. The focus is more on body function than appearance. As for females, the impact of this sociocultural ideal depends on the internalization of this ideal, as well as selfesteem and negative affect. Cultural differences