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Rapid Responses: Rapid Responses published:
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Removing European subsidies may widen inequalities in developing countries.
- Kelechi E Nnoaham (2 December 2005)
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The Scenario in Sri Lanka
- A.A.W. Amarasinghe,MD, (2 December 2005)
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Subsidies may be irrelevant
- Dr D Mark Jackson (3 December 2005)
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Agricultural subsidies and obesity-how strong is the link?
- Dr.SUSHMA RAO (7 December 2005)
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Obesity - an ongoing controversy
- Dr. Rajesh Chauhan, Sandeepa Chauhan, Shruti Chauhan, Shivendra Pratap Singh Chauhan, Apurva Chauhan, Aakriti Chauhan. (12 December 2005)
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Re: Obesity - an ongoing controversy
- Nils O Carlin (18 December 2005)
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Kelechi E Nnoaham, Specialist Registrar in Public Health North Oxfordshire PCT, Adderbury, OX17 3NS
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Editor, Elinder does well to put into perspective European agricultural policy and its public health consequences. There is intuitve appeal in suggesting that excess food production in Europe has resulted in inability of developing country farmers to compete in the international agricultural market. However, the more important question arising from this fact is how this failure to compete has influenced the life of the ordinary developing country farmer or citizen. Most inhabitants of developing nations are rural dwellers. For example, over 70% of Nigeria's population live in a rural area (US Library of Congress, 2005). Most of these people are subsistence farmers who produce foods for family and local market consumption. They have never traded internationally and may never do so. On the other hand, a few urban dwellers are professional farmers practising medium- to large-scale mechanised farming. These are the few who have been unable to compete. Their food productions never served the needs of the larger population. Therefore, while the suggested changes in the European agricultural policy might improve the outlook for obesity and healthy nutrition in developing countries, it is likely to widen inequalities in developing countries by favouring the already favoured mechanised farmers. What is needed more urgently as far as developing countries are concerned is increased national political committment to stimulating growth through sound national social and economic policy. If, for example, African leaders incentivised and subsidised rural agriculture, growth in that sector, as well as eradication of poverty and hunger, would necessarily follow in spite of European agricultural policy. Reference 1. US Library of Congress. Nigeria. Avialble at http://countrystudies.us/nigeria/34.htm. Accessed 2nd November 2005. Competing interests: None declared |
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A.A.W. Amarasinghe,MD,, Consultant Physician 102 Bayberry Hills, McDonough, Georgia 30253 USA
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Being an ex-patriate professional, I regularly visit my stunningly beautiful home country Sri Lanka. In the urban areas, I increasingly encounter big 'M's, 'KFC' Colonels, pizza parlors, saree wrapped barrels in chauffeur driven autos and third trimester looking politicos. Bill boards blaring, "GYM" attract your attention. In the rural areas, among coconut groves, paddy fields, tea gardens etc. poverty and poor nutrition frame the picture. Lines of pregnant mothers carrying their sick pot bellied malnourished children and sheltering the latter with the short saree tail from the hot sun, waiting patiently at the free government clinics are there to be seen. It is obvious that in Sri Lanka, over nutrition and under nutrition run parallel with the economy. Corrective measures call for collective, creative efforts. Competing interests: None declared |
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Dr D Mark Jackson, Consultant Anaesthetist Great Western Hospital, Swindon
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Professor Elinder is probably right to suggest that agricultural subsidies are currently distorting the production and supply of food for the World's population, but in the face of French obduracy or American self-interest,for example, it is inconceivable that much will be done about it. Fortunately, she can allay her worries about obesity by being a little more critical of the FAO's unbelievable prediction that per capita dietary energy supplies will grow for the next 25 years. China's grain production has decreased for 4 out of the last 5 years, a deficit which is equal to the whole of Canada's surplus production. The increasing population of the USA will soon consume their surpluses and water supply and degradation of agricultural land will impair food production there and in many other countries. World oil production is due to peak within the next 15 years and cheap energy, on which the 'green revolution' has depended, will be a thing of the past sooner than most people realise. Yet, at the same time, the World population is expected to increase by 50% to 9bn by 2050. If the members of the FAO really believe that per capita dietary energy supply is going to increase, it makes you wonder what else they believe. Yours sincerely, Dr D M Jackson. Competing interests: None declared |
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Dr.SUSHMA RAO, SHO in Learning Disabilities Monkwearmouth Hospital,Newcastle road ,Sunderland SR5 1NB
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Obesity is now being considered as becoming a pandemic in many of the developed nations. In the United Kingdom 22% of men and 24% of women are obese* according to WHO criteria for obesity [BMI >30 kg/m2] With Obesity comes the risk of various non communicable diseases like type 2 Diabetes Mellitus, cardiovascular complications, hypertension, ischemic stroke etc. Obesity itself can lead on to other problems like depression, unemployment and various socio economic problems associated with it. The factors contributing to obesity include decreased physical activity, sedentary lifestyle which is facilitated by activities like watching television and playing computer games, consumption of energy dense food, lack of knowledge about nutritious food and the ill effects of consuming junk food. Another factor in the modern society is the prevalence of nuclear families where both partners are working leaving less time to cook at home, instead rely on ready to eat meals. As mentioned in the article, agricultural subsidies in the developed countries affecting obesity is an interesting aspect to think about. However more studies are required to establish the extent to which agricultural subsidies are contributing to obesity and whether it is statistically significant taking into account the effect of confounding factors like decreased physical activity, personal choice of food, genetic influence etc. Another aspect which needs to be studied is the time frame. Agricultural subsidies have been present since many decades. But obesity is a more recent problem. It is important to find out if there is a significant co relation between the two with regards to the time frame. The practical steps that can be taken to prevent obesity include: 1.Research into the above aspects.
As far as the effect on the developing countries is concerned, a cut in the agricultural subsidies in the developed countries can have a beneficial effect .Many countries whose main source of income is agriculture will be benefited if there is demand for exports to developed countries. But this will again need attention to trade policies internationally. Reference: *Obesity costs UK economy 2bn pounds sterling a year. BMJ 2003; 327:1308 (6 December), Competing interests: None declared |
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Dr. Rajesh Chauhan, Consultant, Family Medicine & Communicable Diseases 309/9 A.V. Colony, Sikandra, Agra -282007. INDIA, Sandeepa Chauhan, Shruti Chauhan, Shivendra Pratap Singh Chauhan, Apurva Chauhan, Aakriti Chauhan.
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Dear Editor, The development of obesity is mired with controversies and all possible reasons are being searched and correlated by researchers around the globe. These controversies take us to preconception stages, and then marches ahead, while halting at every known stage of development – pregnancy, breast feeding, milk-food, infancy, being big and growing fast, catching up, school age, adolescents etc. The controversies continue with play, watching TV, particular diets, hormones, familial trait, genetics, agriculture subsidy, etc [1]. Why can’t we simply just say obesity is a manifest discrepancy between total energy intake and output, while certain factors help in promoting/aggravating the problem (if provided a free hand) and that these factors may start to influence from preconception stages of an individual [2]. To control, one has to balance the energy intake with the required output plus some extra that is essential for body requirements and growth, and let the obese not hide behind a “valid” and “insolvent reason”. Christmas and the forthcoming New Year celebrations is a time to watch out, whether bestowed with agriculture subsidies or not. Reference: 1. Elinder LS. Obesity, hunger, and agriculture: the damaging role of subsidies. BMJ 2005; 331: 1333-1336 2. Chauhan R, Chauhan S, Chauhan S, Chauhan SPS. Obesity: the new "raja" or just fetal origins? BMJ 14 June 2005. http://bmj.bmjjournals.com/cgi/eletters/330/7504/1348-a#109580 Competing interests: None declared |
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Nils O Carlin, Radiologist 271 82 Ystad, Sweden
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Dr Chauhan asks: "Why can’t we simply just say obesity is a manifest discrepancy between total energy intake and output" One important reason is that saying so leads us into the logical trap of assuming that moderating the energy (calorie) content of food would help in combating obesity, regardless of macronutrient composition. Instead, I suggest we could say obesity is a manifest discrepancy between the amount of fat stored within the body and the amount of fat removed from the stores to be metabolised. Would anybody find this incorrect or misleading? The big difference is of course that this would focus on the mechanisms that govern fat storage, and how they can be modulated by the composition of the food eaten - or other factors that may be effective. By now, we know only too well that attempts to lower calorie intake as such will only have transient effects in the majority of subjects. It does not seem very reasonable to me that fat stores would not be hormonally/neurally regulated as homeostatic mechanisms in general are. We know that both appetite and metabolism are strongly affected by the macronutrient distribution even in isolcaloric amounts. One possible mediator is insulin - in just about any study that determines insulin, lowering of fasting insulin or increased insulin sensitivity go hand in hand with fat loss. But the obvious conclusion is usually not drawn.... Be that as it may (and why not find out?), fat loss with any diet (if corrected for changes in muscle weight and changes in glycogen/water stores) means net expenditure of energy corresponding to the fat energy. This is of course so, regardless of the nutritional density or caloric contents of the food eaten. Competing interests: None declared |
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