bmj.com Rapid Responses for Swinburn and Egger, 329 (7468) 736-739

Rapid Responses to:

EDUCATION AND DEBATE:
Boyd Swinburn and Garry Egger
The runaway weight gain train: too many accelerators, not enough brakes
BMJ 2004; 329: 736-739 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Don't forget evolution...: James M. Howard (24 September 2004)

Our body cues are the missing homeostatic element: Debora Burgard, PhD (27 September 2004)

FUEL WATCH: Anil K Chawla (28 September 2004)

FOLDS OF FAT (ADIPOSA EXCESSIVA): Anil K Chawla (28 September 2004)

Obesity and physical inactivity: Ediriweera B.R., Desapriya (4 October 2004)

Don't forget evolution... 24 September 2004

James M. Howard,
independent biologist
1037 North Woolsey Avenue, Fayetteville, Arkansas 72701-2046, U.S.A.
Send response to journal:
Re: Don't forget evolution...

There are a number of "epidemics" currently occurring within our populations. While environmental causes may contribute, I suggest we look elsewhere for real causes. It is my hypothesis that the "secular trend," the increase in size and earlier puberty in our children, is caused by increases in the percentages of individuals of higher testosterone with our populations. This effect would be driven by higher testosterone women increasing in percentage and the effects of their testosterone on their fetuses.
A case may be made for excessive testosterone as a cause in these epidemics, including the current epidemic of obesity. I invite you to read http://www.anthropogeny.com/Obesity%20Epidemic.htm .
Competing interests: None declared

Our body cues are the missing homeostatic element 27 September 2004

Debora Burgard, PhD,
Clinical Psychologist
Los Altos, CA 94022 (USA)
Send response to journal:
Re: Our body cues are the missing homeostatic element

A generation ago, if movie-goers had been presented with wastebasket- sized sodas "for only $.25 more - best value!" they would have thought, "what am I going to do with all this soda?" The comfort of one's own body in consuming this food was much more salient to us. We have to ask, what has made us disregard the strong homeostatic signals that come from our own bodies? Bodies do not like to be uncomfortable - they don't like to go hungry too long and they don't like to get too full. It is all too easy to focus on large serving sizes (the "obesogenic environment") and not on the question of why they are being tolerated by the marketplace.
What is the one environmental change that would make us disregard our own body signals? It is widespread, repeated dieting, and the idea that our minds are a better "brake" on food consumption than our bodies. If you had to design a training course on how to ignore your body, what would be better than the instruction to make all decisions based on external reasons - this amount of food, this type of food, at this time, regardless of hunger or satiety, and to be successful you have to learn to ignore your stomach.
I have not met an infant who has to learn how to tell whether she is hungry - or full. We are born hard-wired with this skill, and dieting teaches us to ignore the cues.
Competing interests: None declared

FUEL WATCH 28 September 2004

Anil K Chawla,
Senior Specialist in Medicine
Royal Hospital, P.O.Box 1331, P.C. 111, Muscat, Oman
Send response to journal:
Re: FUEL WATCH

Ronny was given charge of a machine,
That would take him places, run and swim.
He loved and adored it to a whim,
Always filled its tank to the brim.
Fuel in the machine was always in excess,
His travels consumed so much less.
Extra fuel got stored as lumps and bumps,
His machine became heavy, round and plump.
You know how much Ronny loved his machine,
Took care of it to the extent of a whim.
When he got it, it was sleek and buoyant,
Over the years he made it into a hefty giant.
It does take him places, as well as swim,
But the speed and alacrity is gone to the winds.
Ronny wonders as he looks at his machine,
He loved it so much yet it�s failing him.
One day he met Uncle Quinn in a gym,
Who had kept his machine thin and slim.
�Too much love Son, needn�t mean too much fuel,
Don�t refill till it has consumed the first gruel.�
�Fuel in must be equal to the fuel out,
Don�t overfill now for a future drought!�
Ronny sadly had overfilled all his life,
Now he understood his uncle�s great advice.
He now runs his machine up and down,
Forces out stored fuel as sweat from his crown.
He watches the quantity and quality of fuel in,
He won�t refill till the fuel-out matches fuel-in.
Competing interests: None declared

FOLDS OF FAT (ADIPOSA EXCESSIVA) 28 September 2004

Anil K Chawla,
Senior Specialist in Medicine
Royal Hospital, P.O.Box 1331, P.C. 111, Muscat, Oman
Send response to journal:
Re: FOLDS OF FAT (ADIPOSA EXCESSIVA)

Folds of fat, folds of fat,
Hanging from the chest, the waist and just below that,
Tell me dears, how on earth,
Did you quietly enter all places like that?
Fold of fat, you stores of fat,
Energy stored for a rainy day?
That rain doesn't come the whole life long,
And we carry the extra weight to grave.
Laden with cholesterol and triglycerides,
Bloated become the adipocytes.
From fatty streaks to sclerosed vessel walls,
The organs get pale as the blood supply falls.
Measure it as body mass index or as weight,
In the shape of an apple or the pear shape.
Thickness of the Triceps fold will show,
How much you need to stop to grow.
Lovely, beautiful and well rounded you make,
If in right places and amounts without mistake.
But hanging and bulging at the wrong spots,
You make one a figureless, blob of fat.
Children wonder, adults stare, give a naughty smile,
When the figure they see is elephantine.
The load is so much, the center of gravity shifts,
Keeping balance is hard without a stick.
Giving large surface area, displacing large volume,
You may help a person to float and swim.
But to walk or run on surface land,
Is like climbing Mount Everest without oxygen or wand.
Carrying the load of two or several in one,
The heart weeps silently, the knees cry aloud.
The hips no longer can swing and dance,
To the rhyme and tune of the Song of Swan.
Folds and loads and tiers of fat,
We know your no secret routes and ways.
How easy to get the folds in place,
But how hard to melt you or displace.
Beware, behold, listen one and all,
There's only one way the thief can enter us all.
And rob us slowly but surely of,
Our figure, our shape, our health and smile.
Two sweet lips surround its entry portal and gate,
The mind should guard, but won�t protest the full plate.
The taste of sweets and fat the tongue can�t resist,
The thief enters quietly as the guard sleeps.
Lock your doors, friends, seal them well,
Train your guards of taste and smell.
For poison here is sweet, not bitter;
Too much of a good thing is bad they tell!
Let's gird up our loins and make a resolve,
To watch our figures and keep us smart.
The balance of intake and output must show,
That more doesn't go in than we need to burn and glow.
Shapely figures of the fitness bums,
Envy of young lads and of old dads and mums.
Let's cross the road to the fitness side,
Let others envy us in awe and surprise:
�Wow, how beautiful!�
Competing interests: None declared

Obesity and physical inactivity 4 October 2004

Ediriweera B.R., Desapriya,
Research Associate
Centre for Community Child Health Research, 4480 Oak Street Vancouver BC V6H 3V4
Send response to journal:
Re: Obesity and physical inactivity

The epidemic of overweight and obesity in children, adolescents, and adults in North America and Europe have prompted increased attention from scientists, clinicians, and public health advocates. Prompted in part by the global epidemic of obesity, the World Health Organization (WHO) has advanced recommendations that encourage public policy initiatives to reduce the burden of disease related to diet and physical inactivity (1).
A major goal of this WHO initiative is to guide the development of sustainable actions at the community, national, and global levels. Similarly, multisectoral policies to promote physical activity beginning early in life are advocated. By necessity, these initiatives also target institutional and environmental changes conducive to active lifestyles.
The most probable reason why a child has become obese is that various facets of modern life have conspired to reduce the total daily energy expenditures (even if the energy cost of any given movement rises as a child becomes obese). Sources of inactivity to explore include a reliance on cars rather than physically active means of transportation, long hours of school busing, the time devoted to viewing an ever-increasing number of television channels, addiction to computer games, (2) and the constraints of current urban life (high-rise apartments, a lack of safe space for active games, and a fear of strangers that keeps children indoors) and suburban sprawl (a lack of adequate sidewalks and cycle paths)(3).
Other investigators have blamed the obesity epidemic on an increase in energy intake (4) or a combination of increased food intake and decreased physical activity (5).National surveys also indicate that patterns of dietary intake and physical activity for the majority of children and youth are not meeting current recommendations. (6)
An understanding of the causes of the current obesity epidemic is essential to developing a rational plan of prevention and/or treatment. Management of overweight and obesity currently includes a variety of modalities such as behavioral, lifestyle, pharmacological, and surgical interventions (7).But unless both child and parents are extremely well motivated; treatment of the overweight child remains difficult, time- consuming, and disappointing. One adverse factor predisposing to overeating in current society is the ready availability of high�energy-density snacks: junk foods that are rich in sugar, or more likely in fat (8, 9). In recent years, physical educators have pointed accusingly at a progressive decrease in the physical education requirements of North American schools, (10) and they have argued that many aspects of child health would be enhanced by a restoration of mandatory physical education programs throughout the 13 years of school attendance.
An Australian study that offered 75 minutes of vigorous endurance exercise per day for 14 weeks significantly reduced the skin fold thicknesses of 10-year-old children relative to control students receiving either ordinary or physical education skill-oriented classes (11).Likewise, a two-year program in Japan (20 min/d, 7 d/wk at the blood lactate threshold) substantially reduced the body fat content of obese 11- year-old children without specific dietary intervention (12).
REFERENCES:
(1). World Health Organization. Integrated prevention of noncommunicable disease: draft global strategy on diet, physical activity and health. http://www.who.int/gb/ebwha/pdf_files/EB113/eeb11344.pdf (accessed 2-Oct. 2004)
(2). Hernandez B, Gortmaker SL, Colditz GA, et al. Association of obesity with physical activity, television programs and other forms of video viewing among children in Mexico City. Int J Obes. 1999;23:845�854.
(3). Conn JM, Annest JL, Gilchrist J. Sports and recreational injury episodes in the US population, 1997�1999. Inj Prev. 2003; 9:117�123.
(4). Simmons G, Jackson R, Swinburn B, et al. The increasing prevalence of obesity in New Zealand: is it related to recent trends in smoking and physical activity?N Z Med J. 1996;109:90�92.
(5). Greksa LP. Activity levels and obesity among Samoans. In: deGarine I, Pollock NJ, eds. Social Aspects of Obesity. Amsterdam: Gordon & Breach, Publishers; 1995:253�266
(6). Winkleby MA, Robinson TN, Sundquist J, et al. Ethnic variation in cardiovascular disease risk factors among children and young adults: findings from the Third National Health and Nutrition Examination Survey, 1988�1994. JAMA. 1999;281:1006�1013
(7). Wadden TA, Brownell KD, Foster GD. Obesity: responding to the global epidemic. J Consult Clin Psychol. 2002;70:510�525.
(8). Hill JO, Prentice AM. Sugar and body weight regulation. Am J Clin Nutr. 1995;62(suppl 1):264S�273S.
(9). Lissner L, Heitmann BL. Dietary fat and obesity: evidence from epidemiology. Eur J Clin Nutr. 1995;49:79�90.
(10). US Surgeon General. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 1996
(11). Dwyer T, Coonan WE, Leitch DR, et al. An investigation of the effects of daily physical activity on the health of primary school students. Int J Epidemiol. 1983;12:308�313.
(12). Sazaki J, Shindo M, Tanaka H, et al. A long-term aerobic exercise program decreases the obesity index and increases the high density lipoprotein cholesterol concentration in obese children. Int J Obes. 1987;11:339�345.
Competing interests: None declared