The prevention of type 2 diabetes by combating obesity and counteracting a sedentary lifestyle is one of the most important health issues of today, and based on projections of future development the issue will be even more important tomorrow. There is much to indicate that our preventive efforts must be based on a population strategy, engaging different sectors of the society. Having health-promoting legislation and agreements with the food industry go hand in hand with health professionals' ambition to change people's attitudes and lifestyles. However, at the same time, not least for ethical reasons, there must be a concentration of resources within the health care system to treat as effectively as possible those identified to be at highest risk of suffering serious health consequences by their choice of lifestyle (high-risk strategy).
Looking at the association between obesity and type 2 diabetes, many indications suggest that a high-risk strategy may be worthwhile, not only from an individual standpoint, but also from a population perspective. The role of screening programmes is to identify and treat these high-risk individuals. The question from a cost-effective point of view, when screening for obesity, is not how to find these high-risk individuals, whether by using mass screening, opportunistic screening or screening by educating people to seek advice and support from the health care system when BMI or waist circumference is above a certain level. The costs for the detection of obesity in screening programmes will be within reasonable limits, irrespective of screening methods used. A potential danger is that many high-risk individuals from low socioeconomic groups will abandon the screening activities. We must remember that the central issue, with respect to obesity, is to find an acceptble treatment open to all defined as high-risk individuals. In other words to allocate enough resources for the treatment programme.
Selective rather than mass screening programmes have been advocated and exemplified in the second part of this chapter. These screening proposals may be regarded as the first line of screening programmes for obesity, especially in view of the present level of resources for prevention within most health care systems.
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