Rose revisited: A "middle road" prevention strategy to reduce noncommunicable chronic disease risk

[Extract]
In light of worldwide concern about the obesity crisis and prevention of noncommunicable chronic disease, it is timely to revisit the principles advocated by Geoffrey Rose. The essential tenet of his work is that while strategies that focus on high-risk individuals (for example, weight-loss clinics for obese people) may help these people reduce their risk of chronic disease, the impact on the total burden of disease at the population level may be disappointing. This is because numerous cases of risk-factor-related health problems may arise among the many people who are in the middle of the risk distribution. In contrast, by lowering the risk across the whole population, the numbers of attributable cases of disease are significantly reduced.

Although this principle is well documented for conditions like hypertension, which have a relatively direct or linear relationship with risk factors such as body mass index (BMI), it is unclear for conditions like diabetes, where incidence rises sharply among people who are in the overweight and obese categories of BMI. To explore this issue, we used data from eight years’ follow-up of middle-aged women in the Australian Longitudinal Study on Women’s Health2 to estimate the reductions in incidence of hypertension and diabetes that would result if the BMI distribution were shifted to the left in various ways.