In briefBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4824 (Published 17 July 2012) Cite this as: BMJ 2012;345:e4824
All rapid responses
Response to Dr Anand’s “In brief” re the obesity epidemic.
I wish that the epidemic of obesity in the developed countries were due only to overeating and under-exercising. The issue is much more complex and linked to a combination of early childhood vaccination, paracetamol and antibiotics.
As early as 1978, Hannik and Cohen (1978) (“Changes in plasma insulin concentration and temperature of infants after pertussis vaccination”, Third International Symposium on Pertussis) documented that babies developed a small but significant increase in plasma insulin level within 8 hours of the first DPT and polio vaccination (they only referred to the pertussis component).
Zametkin et al. (1990. New Engl J Med; 323(2): 1361-1366) demonstrated that adults with hyperactivity of childhood onset suffer derangement of cerebral glucose metabolism affecting exactly those parts of the brain which control attention and motor activity – prefrontal cortex and superior prefrontal cortex.
Hyperinsulinism has become a major problem in infancy (Glaser et al. 1992. Persistent hyperinsulinaemic hypoglycaemia of infancy: long-term octreotide treatment without pancreatectomy. J Pediatrics; 123: 644-650).
Hughes et al. (1997. Trends in growth in England and Scotland, 1972-1994. Arch Dis Child; 76: 182-189) monitored the growth of 5 to 11-year old English and Scottish children and demonstrated a significant increase in both the height and weight of these children, and they called for an urgent need to realistic intervention to reduce obesity in the population.
Freedman et al. (1997). Pediatrics; 99(3): 420-426) dealt with secular increases in relative weight and adiposity among children over two decades, from 1973 to 1994, residing in Ward 4 of Washington Parish, Louisiana, a biracial community. They demonstrated increases in means levels of weight and skinfold thickness – approximately two-fold by 1994 and approximately 50% greater than in those born between 1973 and 1982.
Scott et al. (1997. Characteristics of youth-onset of non-insulin dependant diabetes mellitus and insulin-dependant diabetes mellitus at diagnosis (Pediatrics; 100: 84-91) have demonstrated a close connection between obesity and diabetes.
The Royal Australian College of Physicians annual meeting in Wellington (New Zealand; October 2005) was told that the study of nearly 200 children showed that weight problems were significantly associated with sleeping disorders, headaches, musculoskeletal pain, depression, anxiety and bullying (both as perpetrators and on the receiving end).
The association between type 1 diabetes and Hib vaccine is documented by Classen JBV & Classen DC (1999; BMJ; 319; 23 October: 1133) as one potential adverse effect, and exceeding the benefits of preventing seven deaths and 7-26 cases of severe disability/100 000.
Acetaminophen was shown to be hepatotoxic even at therapeutic doses (Weiss 1973. Acetaminophen a potential pediatric hazard. Pediatrics; 52 (6): 883), yet parents are advised to use it “as needed” to alleviate pain after vaccination, and to suppress even a moderate fever, although orthodox medical research warns about the fallacy and dangers of such efforts. Hull (1989) wrote that high body temperature may assist in the rejection of microscopic invaders (“Fever – the fire of life” Arch Dis Child; 64: 1741-1747).
Then it should come as no surprise that, as disclosed by Medical Observer (2005; May 12; “Surprise findings on child obesity fallout”), there are alarming levels of hyperinsulinism, fatty liver, dyslipidaemia and other complications present in Australian primary school children with high body mass index (BMI).
And last but not least, antibiotics are used in animal food industry to enhance the protein (flesh) production and weight in animals. Children develop ear infections and upper and lower respiratory and urinary tracts infections after vaccination (Craighead 1975. “Report of a workshop: Disease accentuation after immunisation with inactivated microbial vaccines”; J Infect Dis; 1312(6): 749-754) and may be given several rounds of antibiotics by the age of one year. It is not difficult to see that these may have the same effect on children as they have on young food animals: antibiotics make them fat and muscular, and, together with paracetamol, may have deleterious effect on their liver and other organs.
The fattening effect of antibiotics was, unwittingly, demonstrated by Garly et al. (1996) in a developing country (“Prophylactic antibiotics to prevent pneumonia and other complications after measles; community based randomised double blind placebo controlled trial in Guinea-Bissau”). They wrote, ”The group that received prophylactic antibiotics had less pneumonia and conjunctivitis and had significantly higher weight gain in the months after inclusion” [into the study.] (BMJ, doi:10.1136/bmj.38989.AE published 23 October 2006).
They also wrote, “In 1987 a project in Senegal implemented routine prophylactic antibiotics (co-trimoxazole for seven days) for all children under 3 years of age seen within the first two weeks after the inset of symptoms of measles…Furthermore, children aged under 3 years who had received prophylactic antibiotics were less likely to have respiratory symptoms on days 8-15 than were children of the same age group who had not received prophylactic antibiotics.” To me, their qualified and specific statement does not demonstrate the healing power of the administered antibiotics. The reduced level of symptoms merely reflects antibiotics’ propensity to suppress symptoms (drying out the mucous membranes and hence stopping the runny nose and cough). Moreover, subsiding symptoms during days 8-15 reflect the dynamics of stress response as documented by my own research (illustrated in the attached figure: Scheibner 2004. Dynamics of critical days as part of the dynamics of non-specific stress syndrome discovered during monitoring with Cotwatch breathing monitor. J ACNEM; 23 (3): 1-5). The symptoms of diseases follow the pattern of critical days with the alleviation of the symptoms on the non-critical days. In reference to Garly et al. (1996), the symptoms could have worsened after the fifteenth day.
Dr Anand is right: bicycling- and running-induced increased respiration cannot be beneficial considering the intense inhalation of car fumes.
Exercising at home, in a park, away from traffic, and even gyms (unless they are well-ventilated) makes more sense.
The unfortunate, and not so rare, trend by doctors and authorities to blame parents for their children’s obesity, even with threats to remove the children from their care, sadly only shows the ignorance of an eminently iatrogenic condition.
Competing interests: No competing interests
Miss Mitchelll cites with approval the increasing numbers of runners and cyclists on the roads and attributes this phenomenon to the Olympics in London. She feels that all this will help tackle obesity.
I ask her:
Would it not be better to eat less so that you do not have to burn the excess calories?
Is pounding the pavements good for your knee joints?
Is the exercise induced increased respiration good for the road runners and cyclists? Do they not inhale traffic fumes and dust unnecessarily?
Do your exercise at home - or in a park, away from traffic - and do not throw your money in to "gyms".
And, by the way, do not celebrate another medal won by Team GB by guzzling yet another pint of bitter.
Competing interests: No competing interests
Anecdotal evidence suggests that the Olympics will bring even more to Great Britain than the £16.5 billion extra it is estimated the economy will generate by 2017. Since the start of the Olympics the UK has seen a phenomenal increase in the numbers of runners and bike riders on the roads, swimming pools and tennis courts have been full, a generation of children have been inspired by Team GB’s success in the athletics.
We must not underestimate the potential impact of the Olympics on the health of the nation. Whilst only a minority of children encouraged to take up sport today will become the gold medal winners of tomorrow, the potential benefit to the health of the rest offers a far more tangible result. Public health initiatives such as “Go london” attempt to harness the sporting enthusiasm generated by the Olympics (1).
Globally, obesity kills more people than underweight; and physical inactivity increases risk of type 2 diabetes, cardiovascular disease and certain cancers (2). In a country where obesity is reaching epidemic rates, doctors need to recognise the health benefits conferred by physical exercise and take active steps to promote it to patients (3). Physical activity can not only prevent disease but also be used in the treatment of active disease and we should applaud and encourage any lifestyle changes inspired by the Olympics.
1. NHS London. Go London! An active and healthy London for 2012 and beyond. 2009. http:www.london.nhs.uk/publications/public-health/ go-london!-an-active-and-healthy-london- for-2012-and-beyond (accessed 4 August 2012)
2. World Health Organization. Global Health Risks. Mortality and burden of disease attributable to selected major risks. WHO Library Cataloguing-in-Publication Data, 2009:10. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_re... (accessed 4 August 2012)
3. Sport and Exercise Medicine Committee Working Party of the Royal College of Physicians. Exercise for life: physical activity in health and disease. Jun 2012 http://www.rcplondon.ac.uk/sites/default/files/documents/exercise-for-li... (accessed 4 August 2012)
Competing interests: No competing interests