Czechs fight the flab as obesity rates soar

01-03-2004

Czech doctors have declared war on obesity. With six percent of children and almost a quarter of the adult population obese, the Czech Republic follows countries such as the USA, Greece, Ireland and Portugal as the nation with the highest percentage of obese people. WHO, the World Health Organisation, considers obesity one of the ten main health threats for the 21st century.

Dr. Marie Kunesova is from the Czech Obesity Management Centre in Prague:

"Obesity prevalence in the Czech Republic is increasing. About twelve to fourteen years ago, it was about sixteen percent in men and twenty percent in women. What is causing it is the increasing food intake and the decreasing physical activity and energy expenditure."

What's shocking is the fact that in the last ten years, the number of obese children in the Czech Republic has increased twofold. A nationwide study in 2001 showed that six percent of children between the ages of 9 and 11 years were obese; the percentage of overweight children is believed to lie between fifteen and twenty percent. The country's paediatricians have been demanding special weight management programmes for children, since the numerous obesity centres and clinics around the country are mainly equipped to help adults. In February, the Czech weight-watcher organisation STOB, answered their call and began offering special management courses to help children change their eating habits. Iva Malkova is a psychiatrist at STOB:

"A one-time consultation session would not have any effect at all, so it's important to follow a systematic twelve-week plan in which they get together once a week for three hours. The three hours consist of a sixty-minute exercise class and a programme that teaches them to change their eating habits. So, it's not primarily a weight-loss programme but rather a course that helps children eat differently and only when they are hungry and not when they are stimulated by something else. Parents have to take part in the courses because they are those in control and often play the biggest role."

The main factor responsible for the Czech population getting fatter is the lack of exercise. Less people work in factories and more have jobs at which they sit in front of a computer all day long. Czechs now drive or use public transport to get around; a decade ago many would walk. In their free time, they much prefer to watch TV or read a book. Children, play computer games after doing their homework. The Czech way of life has become a life of comfort, which doctors warn could result in alarmingly large cases of diabetes and heart disease.

"Children are exposed to what they call a toxic environment. In the United States, for example, they found that a child is attacked by ten thousand TV advertisements for unhealthy food a year. That's certainly a strong influence! But it's not just television ads that are the problem. There are other stimuli that make children eat more. One is the large portions they get in restaurants. Children then don't eat because they are hungry but only because their taste buds are stimulated."

And of course, some Czechs argue that it is much easier and cheaper to get the good old pork, dumplings, and sauerkraut in restaurants and fast-food in shops than the healthy stuff doctors order. But Dr. Marie Kunesova disagrees:

"I have been working with obese patients for years and I don't think it would be much more expensive for people to buy healthy food. It's the problem of preferences what they are used to eating. But we see that young people are able to eat healthy food more often, than the older generation. They are interested in healthy food and they look for it and buy it. They also accept more healthy eating habits. Health insurance covers the care of obese patients from the point of view of visits to the doctors. Of course, the care in weight reduction clubs is paid for by the patients. The drugs for obesity treatment are covered for just a specific group of patients."

And while the country's population has all it needs to lose weight and change its eating habits, Czech doctors are busy researching obesity in co-operation with their colleagues from the French National Institute for Health (INSERM) at Central Europe's only obesity laboratory. Doctor Vladimir Stich heads the recently established lab, which is located in Prague:

"As you know, obesity is increasing very much in many countries in the world and the other problem which is more important is that obesity is associated with the diseases such as diabetes, hypertension, and ultimately cardio-vascular diseases that are really dangerous to our health. We are interested in why obesity develops in a certain individual, i.e. the pathogenesis of obesity, and we are even more interested in why an obese person is more susceptible to the development of cardio-vascular diseases, diabetes, etc. In fact, up to now, we do not know the mechanism."

What exactly is an obesity lab? Do you have samples of fat and put them under the microscope, what exactly does your research entail?

"We do believe that the core problem is the excess of adipose tissue. So, the attention of our laboratory is on the study of adipose tissue and on its characteristics. We have the instruments to measure energy metabolism, how much energy we need in order to function. But because we are interested mainly in adipose tissue, we do exactly what you said. We take samples of fat, usually subcutaneous fat, from obese individuals by a so-called needle biopsy and study this fat using the techniques and methodology of molecular biology. So, we are looking at the genes which are expressed in that fat and we see how these genes are changed in obese individuals or how they are altered when we change the nutrition or physical activity of these persons."

How many people work in the lab or do the research?

"We have just two doctors and three post-graduate students, who are doctors or persons from the natural science faculties, and we have one and a half lab technicians."

What or who exactly is half-a technician? [laughing]

"You would think a small technician [laughing] but he's a technician who is working here on a part-time basis."

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