Mr. Eric Steele for their assistance in the preparation and finalization of the report. This report may be used, in whole or part, for reference purposes. NIEHS/NIH or the Department of Health and Human Services endorsement of such reference may not be stated or implied. NIEHS is one of the 27 Institutes and Centers of the National Institutes of Health whose mission is to reduce the burden of environmentally-associated diseases and dysfunctions by defining: • How environmental agents affect our health; • How individuals differ in their susceptibility to these agents; • How these susceptibilities change over time. The NIEHS achieves its mission through: • Multidisciplinary biomedical research programs; • Prevention and intervention efforts; • Communication efforts that encompass training, education, technology transfer, public information, and community outreach.

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Aboriginal people have a life expectancy 10–14 years shorter than non-Aboriginal Australians, primarily due to cardiovascular disease. Although the 2001 National Health Survey 1 included data on self-reported health behaviours in Indigenous populations by region, there are no detailed data on the patterns of cardiovascular risk in urban Aboriginal populations.

1 summarises succinctly the impact of bariatric (obesity) surgery on morbid obesity (Box 1) and its related comorbidities. The percentage excess weight loss in patients who have had bariatric surgery is reported to be 50%–70%, and “cure ” or significant amelioration of diabetes, hypertension, hyperlipidaemia and obstructive sleep apnoea is experienced by over 80 % of patients, on average, for each condition. The meta-analysis confirms that bariatric surgery is a safe and effective intervention, with positive effects persisting for years or decades. This leads us to consider the current difficulties in providing obesity surgery for Australian patients. Obesity is now epidemic in the Western world, due to a complex range of environmental and genetic factors. 3 The AusDiab survey showed a combined prevalence of overweight and obesity of about 60 % in Australian adults. 4 It would be fair to assume, therefore, that overweight and obesity are now more prevalent risk factors for disease than smoking. Extrapolating from overseas data, the yearly number of deaths in Australia attributable to obesity is in the order of 12 000–17 000. 5,6 Over the past 20 years, the prevalence of both obesity and diabetes in Australia has doubled, 4 and the upward trend is projected to continue. Unfortunately, poor results of non-surgical intervention mean that there is rarely an exit for patients entering the obese cohort. Treatment strategies for obesity have been exhaustively evaluated, both at a primary-care level and as intensive medical therapies instituted for high-risk patients. Primary-care interventions have either been ineffective or of insufficient duration to assess long-term results. 7-9

universal pattern of mortality decline in the G8 countries. Nature 405: 789–92.

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Obesity and health in Europeans aged 50 years and older T. Andreyeva a, , P.-C. Michaud b, A. van Soest c

Five insights that will shape healthcare

persons died and 300,000 were injured. At the time, Haiti had

Background: Obesity is a costly condition that can reduce quality of life and increases the risk for many serious chronic diseases and premature death. The U.S. Surgeon General issued the Call to Action to Prevent and Decrease Overweight and Obesity in 2001, and in 2007, no state had met the Healthy People 2010 objective to reduce obesity prevalence among adults to 15%. Methods: CDC used 2009 Behavioral Risk Factor Surveillance System survey data to update estimates of national and state-specific obesity prevalence. Obesity was calculated based on self-reported weight and height and defined as body mass index (weight [kg] / height [m] 2) ≥30. Results: Overall self-reported obesity prevalence in the United States was 26.7%. Non-Hispanic blacks (36.8%), Hispanics (30.7%), those who did not graduate from high school (32.9%), and persons aged 50–59 years (31.1%) and 60–69 years (30.9%) were disproportionally affected. By state, obesity prevalence ranged from 18.6 % in Colorado to 34.4 % in Mississippi; only Colorado and the District of Columbia (19.7%) had prevalences of <20%; nine states had prevalences of ≥30%. Conclusions: In 2009, no state met the Healthy People 2010 obesity target of 15%, and the self-reported overall prevalence of obesity among U.S. adults had increased 1.1 percentage points from 2007.