Intended for healthcare professionals

Rapid response to:


“Tsunami of obesity” threatens all regions of world, researchers find

BMJ 2011; 342 doi: (Published 04 February 2011) Cite this as: BMJ 2011;342:d772

Rapid Response:

Tsunami of obesity--- The toll due to our negligence may be unprecedented!!!

We read the current BMJ news with anxiety (1).In recent years,
obesity is posing as a major challenge to modern cardiovascular medicine
in the developed and developing countries alike, not only because of the
enhanced individual risk but also because of its epidemiological
importance. In industrialized countries 15% to 25% of the adult population
are obese. According to estimates by the WHO in the year 2000, there are
more than 300 million obese individuals worldwide. This number is
considerably higher than the 1995 estimate, indicating that we currently
face an explosion of this health problem. Since genetic predisposition
does not change rapidly, environmental factors including eating behavior
and reduced physical activity are likely to play a major role in the
increased prevalence of obesity (2).
The impact of obesity is so diverse and extreme that it should now be
regarded as one of the greatest neglected public health problems of our
time with an impact on health which may well prove to be as great as that
of smoking. Earlier, we critically reviewed a number of researchers' study
reports and concluded that one can have normal BMI and yet carry unseen
excess fat causing masked obesity which is not at all free from fatal
cancer risk (3).
In the recent past, a large number of researchers described that for
younger men, obesity, independent of fat distribution, is a strong risk
factor for coronary heart disease. For older men, measures of fat
distribution may be better than body mass index at predicting risk of
coronary disease. Moreover, the coexistence of systemic hypertension and
central obesity imparts a double burden on the heart due to a simultaneous
increase in afterload and preload.
There is substantial evidence that obesity also serves as an independent
risk factor for coronary atherosclerosis. A variety of thrombogenic
factors have been associated with central obesity including elevated
plasma fibrinogen levels, impaired fibrinolysis, increased factor VII and
VIIc activity, and increased plasminogen activator inhibitor levels.
Plasma homocysteine concentrations are higher in centrally obese than in
lean patients. Lipoprotein(a) may also be elevated in obesity. Plasma
leptin, which correlates positively with fat mass, was recently identified
as an independent cardiovascular risk factor. Obesity has been associated
with endothelial dysfunction, an early stage of coronary atherosclerosis
The accumulation of visceral fat, which is a hallmark of aging, is
hypothesized to pose a greater risk for the development of insulin
resistance and other features of the metabolic syndrome than other fat
depots due to its anatomical location, high lipolytic rate and secretion
of inflammatory adipokines which may initiate hepatocellular
The long-term consequence of VF-induced metabolic decline includes
enhanced risk for several age-related diseases such as CVD, T2DM,
Alzheimer's disease and certain cancers. Therefore, VF accumulation would
be expected to increase mortality risk and reduce lifespan.
Until recently, little was known of the feedback loops which ensure whole-
body energy homeostasis and avoid excess proliferation of adipose tissue.
During recent years exciting new observations on the crosstalk between
adipose tissue and the brain have been reported which presents the
regulatory mechanisms of energy storage in peripheral tissues.
Given the hazards of VF accumulation on health, treatment strategies aimed
at selectively depleting VF should be considered as a viable tool to
effectively reduce disease risk.
Therefore, currently recommended list of treatment strategies that
includes leptin and Beta-3-agonist administration,11-Beta-Hydroxysteroid
Dehydrogenase inhibitors, prevention of systemic inflammation may be
evaluated in large clinical trials (5).
The alarm raised by Wise J, that tsunami of obesity is spreading from the
developed countries to developing countries at an accelerated rate, is
It is the high time to equip our health care providers and state
leaderships with advanced treatment modalities, long term management and
meticulous prevention strategies like our war strategies against the
menace of smoking.If we ignore this alarm,the toll due to our negligence
may be unprecedented!!!

1. Jacqui Wise: "Tsunami of obesity" threatens all regions of world,
researchers find: BMJ 2011 342:d772; doi:10.1136/bmj.d772
2. Obesity epidemic puts millions at risk from related diseases [press
release]. Geneva: World Health Organization; June 12, 1997. No. 46.
3. Ren Lerch: Obesity - a modifiable risk factor:
4. Jogenananda Pramanik, Tanu Pramanik: A point of view: Hidden fat--A
matter of our concern:
5. Derek M. Huffman and Nir Barzilai: Review-Role of visceral adipose
tissue in aging:
Biochimica et Biophysica Acta (BBA) - General Subjects: Volume 1790, Issue
10, October 2009, Pages 1117-1123.

Competing interests: The first author is an editorial board member of International Peer Reviewed Journals: Lab Medicine(ASCP)Journal and Hektoen International Journal,Chicago,USA and Social Science & Medicine,UK etc.

14 February 2011
Jogenananda Pramanik MD
Professor & Head of Biioheochemistry and Director of International Relations
Tanu Pramanik,BSc (Cal) MA (Sociology) PG Dip(Clinical Ethics)
Allianze College of Medical Sciences,Waziria Medical Square, Penang-13200,Malaysia.