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Are the causes of obesity primarily environmental? Yes
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BMJ
2012;345:e5843
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29 September 2012
John Wilding states that “changes to the environment will be essential if we are to tackle the current epidemic” of obesity. 1 In 2011 the UK Department of Health launched the Responsibility Deal programme in which organisations pledged to provide calorie labelling on their products.2 In September 2012, for a medical student project, we conducted a confidential questionnaire survey of customers sitting in Eddie Wilson’s café at St. George’s, University of London to investigate whether their choices of cold drinks were influenced by calorie labelling.
The response rate was 92% (92/100). The mean age of participants was 25 years (range 18 to 54) and 60% were female. They describe their ethnicity as white 55%, asian 27%, black 11% or other ethnic group 7%. On average the 37% (34/92) of responders who said they read the calorie content chose a lower calorie drink than those who didn’t : mean (SD) calorie content 62.3kcal (85.70) versus 103.2kcal (83.7), p=0.03. The 26% (24/92) of people who said they were influenced by the labelling chose even lower calorie options, often diet drinks or water: mean 27.3kcal (55.31). On average women chose lower calorie drinks than men: 71.5kcal (83.23) versus 112.8kcal (85.48), p=0.02. However there were no differences between the calorie content of drinks in people with BMI ≤25 and >25 (based on reported height and weight).
A recent study suggested that in New York a policy of banning supersized sugar-sweetened drinks (>16 fl oz) in fast-food restaurants could reduce calorie consumption per consumer by 63kcal (95% CI 61 to 66).3 Similarly in England, enforcing a minimum price per unit of alcohol could help to reduce alcohol consumption. Although around a third of respondents from our health education institution said they read the calorie labelling, we agree with Timothy Frayling that changes in government policy may be more likely to be successful in tackling the obesity epidemic than increasing awareness through education.4
Yours sincerely
Christianne Monica Dominise, medical student
St George’s, University of London, London SW17 ORE
Abirami Rajamanoharan, medical student
St George’s, University of London, London SW17 ORE
Pippa Oakeshott, reader in general practice
Population Health Sciences and Education
St George’s, University of London, London SW17 ORE
Correspondence: Christianne Monica Dominise m0901443@sgul.ac.uk
References
1 Wilding, J. Are the causes of obesity primarily environmental? Yes. BMJ 2012; 345(7875):24-25
2 Dumanovsky T, Huang CY, Nonas CA et al. Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys. BMJ 2011;343 (7818): 299
3 Elbel B, Cantor J and Mijanovich T. Potential Effect of the New York City Policy Regarding Sugared Beverages. The New England Journal of Medicine 2012; 367(7): 680-681
4 Frayling, T. M. Are the causes of obesity primarily environmental? No. BMJ 2012; 345(7875):24-25
Competing interests: None declared
St. George's, University of London, 16 Penrith Crescent, Rainham, Essex, RM13 7QB
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17 September 2012
While John Wilding and Timothy Frayling disagree on whether the environment or genetics is the predominant factor driving the modern epidemic of obesity they both agree that the solution lies in changing that nutritional environment (1).
Treating obesity generally achieves only modest results that are usually only temporary so the only realistic strategy is prevention . The most cost effective preventive strategy is taxing obesogenic foods (2,3) such as sugary drinks and subsidising healthy foods such as vegetables and whole grain foods.
While physical activity has declined in Western countries since 1900 the substantial increase in the prevalence of obesity did not begin in the United States until after 1960 (4). It was from that date that per capita consumption of sugary drinks (5) and French fries and similar deep fried carbohydrate foods increased by about 400%.
Obesity is now also increasing in developing countries as these countries replace traditional foods of low palatability and high roughage content with processed Western foods and beverages of high palatability and energy density.
Thus It is time to employ the simple and cost effective strategy of targeted taxation to combat the obesity epidemic.
Patrick J Bradley
Lakeside Medical Practice, Warilla, NSW 2528, Australia.
1.
BMJ 2012;345:e5843 and e5844
2.
Bradley P. Diet composition and obesity. Lancet 2012; 379:1100.
3.
Swinburn BA, Hall KD. Diet composition and obesity – Author’s reply. Lancet 2012; 379:1100-01
4.
Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011; 378:804-14.
5.
Vartanian LR, Schartz MB, Brownell K. Effects of soft drink consumption on nutrition and health; a systematic review and meta-analysis. Am J Public Health 2007; 97:667-75.
Competing interests: None declared
Lakeside Medical Practice, Warilla , NSW 2528, Australia
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17 September 2012
The question whether the causes of obesity are primarily environmental itself invites a negative answer. Yes it is true environmental factors do influence and possibly cause obesity. We do not yet have a single gene hypothesis to say that possibly a defect in the obesity gene is responsible for making a person obese. Adipose tissue is a complex organ which seems to play a role in storing excess fat, releasing adipocytokines to regulate energy balance, control appetite, promote positive synergism between hormones and influence liver function. When excess energy exceeds its capacity to balance homeostasis adiposity becomes a measure of obesity.
A complex interaction of hepato-adipo-neural factors cause metabolic stress, which brings about an imbalance between extracellular and intracellular regulatory factors to transform obesity into a pathophysiological phenomenon. The extent to which obesity can influence a person's health may depend upon the genetic constitution as well as the body habitus of the individual concerned or the community affected. Local lifestyle and possibly dietary habits could create a phenotype suited to the environment that a community lives in. A sudden shift in the dietary habits and life style that is not in tune with the culture and environment could transform benign adiposity to say morbid obesity.
Competing interests: None declared
Faculty of Medicine, Benghazi University, Benghazi, Libya
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13 September 2012
Of course, the environmental factor is the major cause of obesity. Eat as usual, weight present. Lifestyle modification is the key to successful obesity therapy. Setting realistic goals before beginning treatment is necessary because unrealistic expectations regarding weight loss frequently result in a failure to manage weight. [1] Laser acupuncture was found to exert a therapeutic effect on simple obesity by reducing both body weight and body mass index. The subjects showed good compliance with this comfortable and non-restrictive diet protocol. Women were maintained on a normal diet and were recommended to achieve a daily energy intake calculated by the following formula: (height in cm – 70) × 0.6 × 30 kcal. The recommended daily energy intake for men was calculated as follows: (height in cm – 80) × 0.7 × 30 kcal. [2]
[1] Hainer V, Toplak H, Mitrakou A. Treatment modalities of obesity, what fits whom? Diabetes Care 2008;31(Suppl. 2):S269–S77.
[2] Hu WL, Chang CH, Hung YC. Clinical Observations on Laser Acupuncture in Simple Obesity Therapy. Am J Chin Med. 2010;38(5):861-7.
Competing interests: None declared
Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong District, Kaohsiung City 833, Taiwan
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