Intended for healthcare professionals

Rapid response to:

Practice ABC of obesity

Management: Part I—Behaviour change, diet, and activity

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7571.740 (Published 05 October 2006) Cite this as: BMJ 2006;333:740

Rapid Response:

Re: Rearranging the deck chairs on the Titanic

Andrew Montgomery is expressing an exasperation which is felt
globally. We agree that to expect all individuals to have the self-control
to eat healthily and undertake regular physical activity in the face of an
overwhelmingly hostile environment for these activities is totally
unrealistic. People do not choose to eat more and exercise less to become
overweight; the environment has made it unavoidable for the majority.
Moreover, unlike tobacco or alcohol, food is essential for life and many
in society have lost their ability to control their levels of food intake
to satisfy needs. Indeed, recent scan evidence revealed that the regions
of the brain that controlled satiety were the same as those in drug
addicts craving drugs (1).

The following points, to be repeated in a subsequent paper (2), are
also relevant in response here. A permanent change in the environment is
the best way to ensure sustainable changes in lifestyle. Actions should
focus on (a) enabling people to manage energy balance as far as they are
able in the current environment; (b) modifying the vectors of obesity
(high-energy, high-fat foods, unnecessary energy-saving devices etc), and
(c) changing the current sociopolitical environment, which currently
rewards the manufacturers of products, processes and environments that
contribute to obesity. Effective programmes for obesity prevention
encourage both healthy eating and physical activity (rather than relying
on separate strategies for eating and activity). The true test will be
whether any society is able to make such changes, and make the changes
permanent by environmental modifications. Of interest, New Zealand offers,
perhaps uniquely, a manageable and forward thinking nation which has
considerable control over its own food supply and also a track record of
leading the world with public health initiatives, e.g. banning smoking in
public places. The battle against obesity will not be won by attacking
governments or attacking the food industry. We need to produce the
research evidence that will allow all parties to work together.

Regardless of future interventions to prevent obesity, the medical
profession and allied health professionals have clear contributory roles
to the treatment of obesity and the purpose of paper three (3) in this ABC
series was to outline the current evidence base for lifestyle
modification.

References

1. Wang GJ, Yang J, Volkow ND, Telang F, Ma Y, Zhu W, Wong CT, Tomasi
D, Thanos PK, Fowler JS. Gastric stimulation in obese subjects activates
the hippocampus and other regions involved in brain reward circuitry. Proc
Natl Acad Sci U S A. 2006 Oct 5; [Epub ahead of print]

2. Lean M, Lara J, Hill JO. Strategies for preventing obesity. Brit
Med J (In press)

3. Avenell A, Sattar N, Lean M. ABC of obesity. Management: Part I--
behaviour change, diet, and activity. BMJ. 2006;333:740-3.

Competing interests:
None declared

Competing interests: No competing interests

11 October 2006
Naveed Sattar
Professor of Metabolic Medicine
Alison Avenell, Mike Lean
Glasgow Royal Infirmary, Glasgow, G31 2ER