935). Smoking has been estimated to account for 8% of total healthcare costs in the US, 3.8% in Canada, and 3.7% in Germany (Chang et al, 2005, pp. 2122 -2125). Dramatic variations in rates and trends of smoking are evident for specific subpopulations of women in Canada. There has recently been a disturbing trend whereby smoking rates among teenaged girls exceeded smoking rates among teenaged boys for the first time. Among girls aged 15 to 19, 25.1% reported being daily smokers in 1998 - 1999 and 26% in 2001, as compared with 18.5% and 20% respectively for boys in this age group (Chang et al, 2005, pp.2126 -2128). Girls also started smoking at a younger age, 41% of girls aged 15 to 17 reporting having smoked their first cigarette before age 13 as compared with 29% of boys. In the last decade, daily consumption increased for girls aged 15 to 19 from 11.5 cigarettes per day in 1990 to 12.7 cigarettes per day in 1999; this has decreased to 10.8 in 2001 (Statistics Canada, 2000, pp. 238-245). In this paper we would be discussing the two issues faced by the Canadians - Obesity and Smoking.
The simplest definition of obesity is an excessive amount of body fat. It must be distinguished from overweight, which refers to an excess of body weight relative to height. Obesity is probably best assessed by the visual judgment of an experienced observer. If a man, woman, or child looks fat when undressed, he or she is probably obese. Measurement of sub scapular and triceps skin-fold thicknesses with calipers is the simplest objective way to assess body fat.
Data from the 2004 Canadian Community Health Survey (CCHS) indicate an obesity rate for Canada of 23.1% and an overweight rate of 59.1%. U.S. data from the National Health and Nutrition Examination Survey (NHANES) 1999 -2002 show that 65.1% of the American adult population is overweight and 30.4% are obese (Hedley et al, 2004, pp. 2847- 2848). The problem of obesity does not affect all populations equally, particularly in the U.S. The obesity rate in the U.S. is higher for women at 33.2% compared to the rate for men (27.6%). By race, these gender differences are exacerbated. F or example, the obesity rate among non-Hispanic white women is 30.7% compared to a rate of 49% among non-Hispanic black American women, whereas obesity rates across race for men do not differ significantly (Hedley et al, 2004, pp. 2849- 2850). In Canada, obesity rates do not vary substantially by sex (23.2% for women and 22.9% for men). However, obesity rates are higher for white women (24.8%) and white men (25.5%) compared to their non-white counterparts (Hedley et al, 2004, p.2849).
An estimated 80-90% of persons with type 2 diabetes mellitus in the Canadian population are overweight or obese. Obesity is also a growing problem in children with type 1 diabetes (Hypponen et al, 2000, pp.1755-1760). Furthermore, intensive insulin therapy is associated with weight gain. Weight loss has been shown to improve glycemic control by increasing insulin sensitivity and glucose uptake and diminishing hepatic glucose output (Chou et al, 2004, pp. 565-587). The risk of death from all causes, cardiovascular disease (CVD), and some forms of cancer increases with excessive body fat (Calle et al,