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Rapid Responses: Rapid Responses published:
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Causes of Obesity - from evolution to industrial profiteering.
- Anne-Thea McGill (19 November 2006)
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Increase awareness
- Amitabh Parashar, Roanoke,VA 24033 (20 November 2006)
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Re: Causes of Obesity - from evolution to industrial profiteering.
- Alan Williams (24 November 2006)
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obesity epidemic
- edwin n wardle (28 November 2006)
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Time For Action
- ANDREW MONTGOMERY (29 November 2006)
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Nutrition Mantra?
- Carrie H Ruxton (29 November 2006)
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Calls for drastic action
- Joan McClusky (30 November 2006)
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Commercial pressure,socialisation and obesity
- David J Evans (7 December 2006)
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Evolution of Obesity Pandemic?....in two generations?
- Bruce M Gray (11 December 2006)
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Anne-Thea McGill, Senior Lecturer/Medical Obesity Consultant Human Nutriton Unit/General Practice
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Dear Editor
It is disappointing to read the platitudes of governments, industry, and sadly, intellectuals and to hear them blaming individuals and families for the problem of obesity. It is not as simple as just ‘eating less and exercising more’ as T Groves in a BMJ editorial reiterates 1. The large human brain consumes approximately 23% of our energy, a relativity very high amount compared to other mammals 2. This means that we have highly-attuned energy-dense food-seeking appetite pathways, which, interestingly, include brain cell receptors involved in substance addiction 3. Additionally, it appears that we have also evolved to conserve energy for our brain by inhibiting pathways for the synthesis of a number of vitamins and cofactors. In Palaeolithic times these nutrients were consumed in our whole food diets, 72% of which we no longer consume 4. Thus, we naturally love the high energy, processed food combinations, complete with taste additives. We find such over-palatable food hard to resist and we cannot regulate the volume when compared to whole foods. Unfortunately, we do not consciously miss the micronutrients which have been refined out of our diets. In fact scientists don’t even know what all the useful, if not necessary-for-good-health micronutrients in foods are, even in common foods such as apples. Mechanisms of how the myriads of plant food chemicals tend to reduce the neoplasia associated with obesity are not yet certain 5. We do know our unbalanced, high-energy diets tend to direct fat to our upper body; thus upper body or central obesity develops. The problem is further increased as most of us individuals who are not talented sportspersons naturally inherit a tendency limit use of our limb muscles, unless absolutely necessary. Physical activity both utilizes a modest amount of energy, and muscle work stimulates healthy metabolism6. Failure to balance our nutrient and energy intake with energy output results in fat being stored firstly, and safely, into fats cells under the skin around the hip and thigh area, as seen in some obese, ‘pear-shaped’ women. If energy overload continues and particularly in combination with 1) a relative lack of whole food micronutrients and 2) minimal safe storage fat cells depots (as seen in ‘apple-shaped’ men and women) fat is forced into cells where it is toxic7. Such tissue includes that of the upper body deep sub cutaneous, then peri-visceral, adipose and finally organs such as liver, pancreas and muscle. This condition, the metabolic syndrome, is well known to increase our risk for high blood pressure, abnormal cholesterol, chronic immune problems, type II diabetes, heart disease, stroke and cancers. If any government wants to make real changes to reduce obesity, hard economic decisions need to be made. The cost of the average consumer’s health has been eclipsed by our admiration and tolerance of profiteering, but exploitative food processing, electronic gaming and advertising industries. These industries affect and cost the whole of society, directly and indirectly. It is time to admit these facts and stop allowing the government and social and medical scientists to keep writing that they expect ‘individual responsibility’ and a slight reduction in fast food advertising to children on television, for example, to solve the problem. We know it is not working for enough people, and it is highly likely it will never work. Public health measures to regulate industry are imperative. Practical incentives for good quality whole food (including low additive preserved whole food – frozen, dried, tinned/bottled), and disincentives for degraded, refined food, production and distribution, need to be designed and enforced. Physical activity and environmental improvement are promoted simultaneously if personal and goods transport by cars and lorries, is discouraged. It is well known that the provision of efficient public electric rail transport and appropriate urban and rural planning is successful in inducing more walking or ‘active transport’. In many localities these developments have been sidelined by pressure from the fossil-fuel industry. Over all, this will require support for whole food production (as opposed to subsidies for fruit, vegetable and fish destruction when prices are low) and reduction of invisible subsidies for processed food (no tax breaks for advertising, no subsidies for large scale food and fuel processing, and paying real costs of transport and packaging), for example8. Reigning in the huge transport fossil-fuel lobby and influence, by legislative, change is long overdue. Let’s stop the platitudes, put the evolutionary, genetic, environmental, metabolic and socio-economic stories (research) together, make sense of them, and start the real work on preventing the obesity that is otherwise destined to affect generations. Anne-Thea McGill BSc MBChB FRNZCGP
1. Groves T. Pandemic obesity in Europe. BMJ 2006:bmj.39038.449769.BE. 2. Cunnane SC, Crawford MA. Survival of the fattest: fat babies were the key to evolution of the large human brain. Comparative Biochemistry & Physiology 2003;Part A, Molecular & Integrative Physiology. 136(1):17-26. 3. Kelley AE, Schiltz CA, Landry CF. Neural systems recruited by drug- and food-related cues: Studies of gene activation in corticolimbic regions. Physiology & Behavior 2005;86(1-2):11-14. 4. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, et al. Origins and evolution of the Western diet: health implications for the 21st century. American Journal of Clinical Nutrition 2005;81(2):341-54. 5. Barth SW, Fahndrich C, Bub A, Dietrich H, Watzl B, Will F, et al. Cloudy apple juice decreases DNA damage, hyperproliferation and aberrant crypt foci development in the distal colon of DMH-initiated rats. Carcinogenesis 2005;26(8):1414-1421. 6. Schimmack G, DeFronzo RA, Musi N. AMP-activated protein kinase: role in metabolism and therapeutic implications. Diabetes, Obesity and Metabolism 2006;8(6):591-602. 7. Unger RH. Minireview: weapons of lean body mass destruction: the role of ectopic lipids in the metabolic syndrome. Endocrinology 2003;144(12):5159-65. 8. Lobstein T. Suppose we all ate a healthy diet… …could our food supplies cope? Obesity Reviews 2006;7(s2):1-34. Competing interests: None declared |
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Amitabh Parashar, Internal Medicine Resident UVA Roanoke Salem Program, Roanoke,VA 24033
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This obesity initiative of WHO european chapter is timely and laudable. I think spreading awareness in the general population is very vital in countering any public health problem. Awareness can be increased by involving print and electronic media, appropriate introduction of the issue in school curricullum and involving the food industry. Restaraunts, for example, should be encouraged to divulge the nutritional value/calorie counts of specific items and give some idea to consumers regarding the time one will have to spend on the treadmill to wear these calories off. Competing interests: None declared |
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Alan Williams, Strategy consultant to biotechnology sector CB1 8SH
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Anna-Thea McGill begins her comments with the statement "It is not as simple as just ‘eating less and exercising more’" Some lines later she says "Failure to balance our nutrient and energy intake with energy output results in fat being stored ....". Precisely! It is interesting to note how few overweight people (let alone obese) are found in Cambridge colleges, Silicon Valley start-ups, Wall St, London financial markets or Sydney legal firms. In other parts of the same cities, among different economic and ethnic groupings, obesity may be as high as 40%. People make choices about their diets; today the thinner ones (apart from models) have tended to make wise choices and recognised the fundamental equation Anna-Thea confirms. The obese have not. That is an incontrovertible fact. The question is what influences them. Raising awareness is a valid role for government, not least through schools. On the whole legislation to drag an industry into line is inappropriate. Industry is generally sensitive to the public mood and may even take initiatives. The Sainsbury's "Taste the Difference" and "Be Good to Yourself" ranges may be useful steps taken without government coercion. Competing interests: As an independent consultant I work with clients that require my services. I have not worked for a food or retail company in the last ten years. |
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edwin n wardle, retired physician SG7 6SY
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It is not so helpful to suggest that persons move more and eat less. Teenage girls follow their mothers and seldom respond,and unfortunately that now applies to many men too. Drastic measures are needed, because the NHS will not be able to afford the consequences of the current trend.The DTI(department of Trade and Industry) should close the super-markets on Sundays.The shock will mean that people will have to take stock of what they are doing. Those who feel strongly about this should write to Alistair Darling MP or to the Response Unit, DTI,V LG84, 1 Victoria St, London SW1H 0ET or e-mail correspond@dti.gsi.gov.uk.E Nigel Wardle MD Competing interests: None declared |
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ANDREW MONTGOMERY, locum Auckland
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The solutions to this epidemic require doctors, politicians and laypeople to recognise that they are operating from a fundamentally flawed understanding of human behaviour. "free will" is 99% fantasy and 1% fact - ie the human cerebral cortex allows us the fantasy but not the reality of true choice. A simple thought experiment should illustrate this point to the sceptic. Firstly I invite those who do not believe me to be in a good mood rather than a bad mood, to decide to like coffee instead of tea, Beethoven instead of U2 and so on. The human brain is simply incapable of true choice in the sense that many believe it is - and this is because almost all our behaviour is genetically prescribed and modified by early environmental influence. "Personal responsibility" is of course a conditioned state - nothing more and nothing less. For these reasons the only way to stop this epidemic is via absolutely draconian legislation and taxation - which I have been advocating for years. Nothing else has worked - and nor will it. Human beings are just animals reacting to their environment - genetically programmed to maximise input and minimise output. I have considerable experience in treating Polynesian folk with obesity. I have read widely on the subject. We really are facing a disaster in New Zealand. ' Competing interests: None declared |
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Carrie H Ruxton, Freelance Dietitian Cupar KY15 4EA
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Every time WHO publishes a nutrition-related strategy, whether it be for cardiovascular disease, obesity, or general health, there are calls to reduce "fat, sugar and salt". As far as I am aware, there is no relationship between salt and obesity aetiology, prevention or treatment. This makes me wonder whether the ideas in the new obesity Charter are evidence-based or just another mantra. As usual, there are many regulatory initiatives aimed at the multinational food companies and few at the day-to-day drivers of our obesogenic lifestyle e.g. fast food outlets (most of which are not chain stores), burger/chip vans (particularly those parked outside schools every lunchtime), out-of-town shopping, low cost home entertainment, lack of cooking skills amongst young people, unsafe open spaces for play and recreation, long working hours, lack of showers and bicycle parking, unimaginative school PE, low cost and readily available alcohol, insufficient NHS obesity services (particularly for children). It is nice that European governments agree on obesity action. However, I am concerned that European charters focus too much attention on headline-grabbing initiatives aimed at industry - an easy target since many health professionals and public interest groups feel uncomfortable about profit - and too little attention on all the other drivers of obesity, especially those experienced by lower income people who are most at risk from obesity. Competing interests: I consult to the NHS (I write obesity strategies) and to the food industry |
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Joan McClusky, medical writer New York, NY 10003
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Yesterday, just reading the newspaper and a magazine, I was told to do a number of things, including creating a living will "just in case," investigating and updating my credit ratings, and to stop drinking alcohol because all women are now presumed to be "prepregnant." I have 3 telephones--a landline, a private cell phone, and a business cell phone, and 2 email accounts--private and business. A visit to the doctor last week yielded referrals to a dermatologist for a spot on my leg, a clinic for a mammogram, and a schedule for a PAP smear. My dentist wants me to use a special rinse and device for removing plaque. And these are the ancillary demands on my time--not work specifically, or family, or friends. The list is endless, and I live a relatively peaceful existence. I can only imagine how grueling and demanding it is to try to eke out a living on a less than living wage. Yet this is the population that is largely obese. The problem with every solution to the obesity problem is that those calling for drastic action are employed, with health insurance, and some control over their lives. And their solution is to demand that those already in a position of powerlessness--who, like all of us, are being told to do things on almost a minute by minute basis for ourselves, our families, our employers, and the public good--are now being told that they must take drastic steps in one of the few areas that they probably still control and that might give them some comfort--their diets. Curing the obesity epidemic begins with asking the obese why they eat what they eat and don't exercise, and working with them to come up with effective ways to improve their health. It does not begin with arrogantly demanding that they "change their ways." Competing interests: None declared |
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David J Evans, Emeritus Professor of Histopathology Imperial College W12 0HS
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It is in the interest s of the food/drink industry to sell as much as possible and to maximise profits. Their strategy starts with convenience food for weanlings which are designed to appeal more to infantile tastes than the foods consumed by adults (which they would formerly have been given minced or mashed) A similar taste spectrum is then provided by fast foods/snacks/sweetened drinks through childhood and the manufacturers hope that their customers will continue to buy “convenience” food or fast food throughout their lives. In the adult world there has been a substantial inflation of portion size. Whereas a glass of wine used to be 125ml, now small glasses are 175ml and large glasses 250ml. It is not only McDonalds who offer supersize meals. Many restaurants and some pub chains advertise buffets with “as much as you can eat”, and in the USA many restaurants specifically forbid portion sharing. Clearly gluttony has disappeared as a sin. Socialising children into sensible eating habits in the face of commercial and peer pressure is well nigh impossible especially for a generation who “Can’t cook, won’t cook” and who know little about proper nutrition. Somehow we have to do better for the next generation while avoiding the usual parrot cry of “Health fascists”. Competing interests: None declared |
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Bruce M Gray, Physiotherapist & Physiologist Brisbane, Australia
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I don't agree that the cause of the obesity pandemic rests mostly outside of individual, family unit, or sub cultural choice. A choice between a healthy and unhealthy diet exists in developed nations. Fruit and vege are more plentiful now than 50 years ago, when obesity was not a pandemic. Just look at any historical photos of large public gatherings previous to the 1970s, and play spot the obese people. They are very few. It is erroneous to up play the role of genetics and evolutionary pressure, and downplay the role of subcultural values that have traditionally moulded individual values and behavioural patterning. Making healthier choices would not be so hard if the conditioning of individual, family unit, and subculture had not been apathetically surrendered. The heads of each family unit and each subculture need to rediscover a sense of duty and responsibility. If they don't then anything will and has occupied that vacuum, especially the highly motivated and unconscionable profit beast. Competing interests: None declared |
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