We are discussing how to include obesity or overweight rates in the America's Health Rankings here at the annual meeting of the Scientific Advisory Committee. Jonathan Fielding, Leah Devlin, Glen Mays, Steve Teutsch, Marthe Gold, and others are pitching in to the discussion. The French have largely avoided the trend toward greater obesity rates. Why is this?
Antoine Flahault, Dean of the École des Hautes Études en Santé Publique (EHESP) commented on this recently in his blog on the EHESP web site. Here's a translation.
Among the 30 OECD countries, France is the seventh from the bottom in rates of obesity. How did France get to this point with the fattest national diet in Europe (42% of food energy in France comes from fat). France is the largest sugar producer of Europe and the largest consumer of bread and cheese, the two largest providers of salt in food today.
Could it be that the French exercise? This is unlikely; we have the second worst place in terms of proportion of adults exercising at a recommended level in Europe (less than 25%, compared to an EU average above 30% with the Netherland at the top at 41%). It is probably not the "genetics" of the French; it must be heterogeneous. It is almost impossible to believe that it is the consumption of wine, which has steadily decreased since 1960, parallel to the decrease in cardiovascular disease.
Determinants of control of obesity in France might be essentially cultural: we are one of the few European countries to continue to have three meals a day and eat nothing (or almost nothing) between meals. Our children continue, for the most part are raised this way. Thus it would seem that even with a diet with the worst possible nutritional composition, if it is small (the new French cuisine providing the model), and if it is eaten only three times a day, it is not easy to get obese. Obesity rates in French children are the lowest in Europe and did not tend to increase in last decade. There are a few studies (North American) showing the link between regular family meals, exposure to television screens and video games for less than two hours a day associated with a low prevalence of obesity. As long as the French retain that cultural advantage, they may be protected against the obesity epidemic across our borders and almost everywhere else in the world.
Friday, March 30, 2012
Friday, March 9, 2012
AFSSAPS now ANSM as Mediator scandal slowly resolves.
The French equivalent of the FDA was reorganized and renamed in what the French government hopes will be the final chapter of the Mediator scandal.
AFSSAPS, the Agence Française de Securité Sanitaire des Produits de Santé, was found lax in not removing the drug benfluorex (Mediator®) from the market for many years despite strong evidence that it caused harm. The drug likely caused 500 deaths and at least 3500 hospitalizations related to valvular heart disease in France between 1979 and 2007 when it was finally removed from sale.
The French Parliament passed a law in December 2011 that establishes a new agency, the National Agency for Medicines and Health Products Safety (Agence Nationale de Securité du Médicament (ANSM). The new agency is headed by Dominique Maraninchi who was moved to AFSSAPS in the middle of 2011 from the French National Cancer Institute.
The drug is closely related to one that has been used to treat obesity and diabetes (benfuorex is related to fenfluramine, known more widely as one of the Fen-Phen pair).
The "Mediator scandal" occupied the front pages of French newspapers for much of 2011 after the government auditing agency, IGAS released "A devastating 244-page report on the affair … (and) accused the pharmaceutical company Servier, headquartered in the suburbs of Paris, of misleading authorities about the true nature of benfluorex, which was sold under the brand name Mediator."
The first case of valvulopathy due to Médiator in France was reported in 1999, but no action was taken. The first Spanish case of valvulopathy was reported in 2003, prompting the drug to be banned there in 2005. The US FDA removed fenfluramine from the market in the fall of 1997. The manufacturer of two marketed products derived from the compound, Redux and Pondamin, Wyeth, was the target of a class action lawsuit that may lead to them paying up to $5 billion for damages.
AFSSAPS, the Agence Française de Securité Sanitaire des Produits de Santé, was found lax in not removing the drug benfluorex (Mediator®) from the market for many years despite strong evidence that it caused harm. The drug likely caused 500 deaths and at least 3500 hospitalizations related to valvular heart disease in France between 1979 and 2007 when it was finally removed from sale.
The French Parliament passed a law in December 2011 that establishes a new agency, the National Agency for Medicines and Health Products Safety (Agence Nationale de Securité du Médicament (ANSM). The new agency is headed by Dominique Maraninchi who was moved to AFSSAPS in the middle of 2011 from the French National Cancer Institute.
The drug is closely related to one that has been used to treat obesity and diabetes (benfuorex is related to fenfluramine, known more widely as one of the Fen-Phen pair).
The "Mediator scandal" occupied the front pages of French newspapers for much of 2011 after the government auditing agency, IGAS released "A devastating 244-page report on the affair … (and) accused the pharmaceutical company Servier, headquartered in the suburbs of Paris, of misleading authorities about the true nature of benfluorex, which was sold under the brand name Mediator."
The first case of valvulopathy due to Médiator in France was reported in 1999, but no action was taken. The first Spanish case of valvulopathy was reported in 2003, prompting the drug to be banned there in 2005. The US FDA removed fenfluramine from the market in the fall of 1997. The manufacturer of two marketed products derived from the compound, Redux and Pondamin, Wyeth, was the target of a class action lawsuit that may lead to them paying up to $5 billion for damages.
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