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Research:
Tazeen H. Jafar, Nish Chaturvedi, and Gregory Pappas
Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population
CMAJ 2006; 175: 1071-1077 [Abstract] [Full text] [PDF]
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[Read eLetter] OVERWEIGHT AND OBESITY IN PAKISTAN: ADDITIONAL EVIDENCE
Debra Nanan   (1 November 2006)

OVERWEIGHT AND OBESITY IN PAKISTAN: ADDITIONAL EVIDENCE 1 November 2006
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Debra Nanan
Pacific Health & Development Sciences Inc.

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Re: OVERWEIGHT AND OBESITY IN PAKISTAN: ADDITIONAL EVIDENCE

dnanan.pacificsci{at}shaw.ca Debra Nanan

Jafar, Chaturvedi and Pappas (CMAJ October 24, 2006) estimated the prevalence of overweight and obesity in Pakistan, using lowered BMI thresholds compared to those for western populations (1). They also studied optimal BMI cutoff values for association with hypertension and diabetes mellitus; their findings support using lowered definitions for overweight and obesity in this population. Currently, the recommended definitions for overweight and obesity in Asian populations are BMI =>23 and =>25, respectively (2). Curiously, while the authors cite these values, they used BMI =>23 for overweight, but BMI =>27 for obesity; their reasons behind this latter choice are not given, and most of their findings are related to BMI =>23.

Further, while we concur generally with their findings, the statement that "Estimates of the prevalence of overweight in Indo-Asian countries ... based on these cut-off values have not been reported" is not strictly correct. Similar findings and discussion points were published independently in 2002 (3) utilizing the same data source (National Health Survey of Pakistan 1990-94). Prevalence estimates were derived for BMI =>25 (in particular re: age, sex and residence), and discussion focused on how measurement tools (specifically BMI) may need adaptation depending on the context (South Asia). That work formed the basis for the section on obesity and overweight in the National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan; this document is arguably one of the best disease prevention and control policy frameworks to have emerged from a developing country (4).

Regarding the accompanying Commentary by Anand (5), while the interventions suggested may be ideal in a developed country, these may not be the most appropriate in Pakistan. A major consideration is the direct relationship with socioeconomic status and overweight/obesity in developing countries, the opposite of that in developed countries. We also urge caution in extrapolating work in populations to immigrants, a selective subset of their countries of origin, keeping in mind the critical contributions of nature and nurture.

Debra Nanan, Pacific Health & Development Sciences Inc., Victoria BC. <dnanan.pacificsci@shaw.ca> Formerly Lecturer, Epidemiology & Biostatistics, Aga Khan University, Karachi, Pakistan.

Franklin White, Pacific Health & Development Sciences Inc., Victoria BC. <fwhite.pacificsci@shaw.ca> Honorary Adjunct Professor, Community Health & Epidemiology, Dalhousie University, Halifax NS. Formerly Chair & Professor, Community Health Sciences, Aga Khan University, Karachi, Pakistan.

References 1) Jafar TH, Chaturvedi N, Pappas G. Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo- Asian population. Can Med Assoc J. 2006. 175; 9: 1071-7. 2) World Health Organization, Western Pacific Region. The International Association for the Study of Obesity and the International Task Force. The Asia-Pacific Perspective: redefining obesity and its treatment. Sydney, Australia: Health Communications Australia Pty Limited; 2000. Available: www.diabetes.com.au/pdf/obesity_report.pdf (accessed 2006, Oct 30). 3) Nanan DJ. The obesity epidemic - implications for Pakistan. J Pak Med Assoc. 2002. 52, 8: 342-346. 4) National Action Plan for Non-Communicable Disease Prevention and Health Promotion in Pakistan. Islamabad, Pakistan. 2004. Available from: URL: http://heartfile.org/napdoc.pdf. 5) Anand S. Obesity: the emerging cost of economic prosperity. Commentary. Can Med Assoc J. Can Med Assoc J. 2006. 175; 9: 1081-2.

Conflict of Interest:

None declared