The Obesity Epidemic: Looking for the Magic Bullet

Fortunately, not all wars focus on guns, bullets, explosions and minefields nor are they reported in such gruesome manners. Other types of wars exist in which the casualties are reported in epidemiological terms such as “prevalence, incidence, percent increase” and so forth. Such is the case in the present global war against obesity. Marion Nestle and Michael Jackson, writing in Public Health Reports in 2000, cited a 1974 editorial in Lancet that identified obesity as the most important nutritional disease in the affluent countries of
the world. Twenty- five years later, its prevalence had increased sharply among Americans, Europeans, as well as citizens of countries as widely separated as India, and casualties were being counted among children as well as the adults. Mortality was not caused by bullets, but by increasing risk of chronic disease,
its persistence from childhood to adulthood, the paucity of successful treatments, the risks of the available medical treatments and the complexities trying to treat the condition once it was present.

Thoughtful readers might stop at this point and ask for more facts. The facts are as cold and cruel as those that are being reported on a nightly basis on the ten o’clock news. Globally, there are more than one billion obese adults. This translates into every ninth or tenth person all over the world. Obesity levels range from below 5% in China, Japan and certain African nations to over 75% in urban Samoa. Obesity is an independent risk factor for type 2 (adult onset) diabetes, cardiovascular diseases, high blood pressure and stroke. The costs of treating these illnesses are not considered in the budgets of the defense departments
but amounts to more than the present armed conflicts. The key causes are the consumption of energy-dense foods high in saturated fats and natural or substitute sugars and the reduced physical activity that goes along with having enough money to drive to the nearest fast food outlet, the grocery store, or even to buy the morning papers. Other potential causes are environmental factors, as might occur in some of the western states where it is not possible to walk the distances that are necessary to go to school, shop for food and other necessities, and when the job requirements for exercise are essential non-existent, as would be the case if one sat in front of a computer in an office all day. Also implied in some small number of instances are genetic issues but these are clearly not a major international cause.

In recent years, the prevalence of overweight and obesity are commonly assessed by using the so-called Body Mass Index (BMI). This is the number that is derived when one divides the body weight in kilograms by the square of the body height in meters (kg/m2). Whereas such numbers were only reported in nutrition journals as little as ten years ago, they are now common jargon for medical doctors regardless of their specialty and are even to be read in the lay press. According to telephone surveys conducted by the Centers for Disease Control of the United States, using the definition of obesity as a BMI more than 30, the prevalence
obesity rose by 50% between 1991 and 1998 and more recent figures are even more alarming.

Having read the above statistics, our hypothetical reader should now be scratching his or her head and wondering aloud, “What is being done about this?”

Quite a bit, to be truthful. Unfortunately, these efforts are woefully underfunded and thus less than successful, considering the enormous expenditure of the food industry on advertising and promotional activities, which are directed to the consumer to buy the very things that are causing the problem. These amounted to more than 30 billion annually when Nestle and Jacobson wrote in 2000 and are obviously much more in 2007. From 1952 to present, at least 60 policy guidelines have been published by US government agencies and health organizations for the prevention of obesity thru diet and exercise or both. All
together their costs were a mere fraction of the annual expenditure of the other side, namely the food industry. And as well intentioned as they are, they have not turned the tide. One hears repeated calls for decreased energy intake and increase on a national basis, to the point of being deaf to the singing.

It would be a shame to end this article without offering a ray of hope. Happily that is possible due to some long range planning by the pharmaceutical industry, which realized that as the numbers of type 2 diabetics increased, so would their potential market for drugs to combat it. There have been a series of oral medications for this condition for at least twenty years and every now and then a new class of drugs comes onto the market with great expectations. Recently a new group has appeared, the so-called incretin mimetics, which not only appear to be effective for type 2 diabetes but also soon will undergo testing among people who are obese and who do not want to become diabetic. These numbers, as noted above are astronomical worldwide. Like any new medication, this group of agents has side effects, but here one of the side effects is not only wanted but highly desirable. This is weight loss, which comes about by an interesting interplay of complementary actions. Most users say that they do not desire to eat as much as they did previously, feel satisfied with much smaller portions and no longer “crave” sweets. A wise patient may be
tempted to address his or her doctor with the following, “If this is a side effect, let me have a double dose of it.”

Researches postulate that an inherent aspect of the medication group is to send a signal to the brain and tell it that the stomach is full long before it actually is. As the function of sweet deserts is to kill the appetite, one can see the advantage of being full with half a meal. From the patient perspective, this is not bad at all. From a national perspective, this is good news indeed, in that one can suppose that other and more refined products will appear in the next few to several years that will capitalize on this “side effect.” If this is the case, the medical profession would have the magic bullet to win the war against obesity. Let us hope this is so.