Obesity Poses Complex Problem

May 25,2015

For the last 15 years, Plymouth, England has held a symposium on obesity. It’s estimated that more than half the city’s adults are overweight or obese. The rest of Britain is not fairing much better. But what’s happening in the U.K. can also be seen the U.S. and many Western countries and a growing number of developing nations. One obesity expert said it’s a long term problem that is very difficult to solve

Professor Jonathan Pinkney said, “No one health issue has the most impact on human health, or engenders more debate about how to tackle it, than obesity.” Pinkney - a professor of Endocrinology and Diabetes – took part in the annual Plymouth Symposium on Obesity, Diabetes and Metabolic Syndrome on May 21st.

He said obesity is a complex issue that involves more than calorie intake.

“I personally feel that this is such a wide field. There are so many issues. There’s politics. There’s biology. There’s everything you can imagine. There’s the food industry. And I think that sometimes we’re all a bit guilty of just maybe concentrating on one of those areas. And you can go to a conference anywhere in the world where they spend days just talking about bariatric surgery or fizzy drinks. So, I think it’s right to talk about everything under one umbrella.”

Bariatric surgery restricts how much food a person can eat, sharply reducing caloric intake.

Obesity Poses Complex Problem
In this Sept. 4, 2014, file photo, an overweight man rests on a bench in Jackson, Miss. Rising numbers of American adults have the most dangerous kind of obesity, belly fat, despite evidence that overall obesity rates may have plateaued, government data shows. Abdominal obesity affects 54 percent of U.S. adults, versus 46 percent in 1999-2000, and the average waist size crept up an inch, too, according to the most recent statistics. (AP Photo/Rogelio V. Solis, File)

The professor gave his definition of obesity as “when body size becomes so huge that it impairs people’s day to day function and quality of life and well-being and personal relationships. Yeah, that’s kind of devastating. That tends to occur at a higher level of body weight.”

However, Pinkney said those not considered technically obese are also at high risk for poor health.

“That’s the more important point for the health of the population. You know, all the diabetes and heart attacks and cancers and things. I mean that’s really caused by lower levels of weight gain. As you can see, it’s just the average weight of the population drifting up because we’re just sort of eating the wrong things and not really sufficiently active,” he said.

The Plymouth symposium showed that much is known about the biology of the brain and appetite control. But Pinkney said, as one speaker pointed out, knowledge is not enough.

“That is completely overridden by things going on around us in the environment: food advertising – food Industry -- the way that it’s all marketed to everybody, including children. And I think the simple fact of the matter is, you know, our bodies are very smart and beautifully built. But it’s just that the biological systems that would keep us slim are just completely swept away by the pressure from the things going on around us,” he said.

And he said it’s difficult to do anything about it whether in Britain, the U.S. or developing countries that have adopted a Western diet heavy in sugar, salt and fat.

“There’s a multinational food industry and there’s huge vested interest in selling a lot of the stuff. I can’t give you a magic word as to how you crack this, but we’ve got exactly the same problem here. And I think you can prescribe all the drugs you want. You can do all the bariatric surgery you could manage to fund, but it’s not going to crack the problem unless you stop the development of the epidemic at source,” said Pinkney.

Going to the source means how eating habits are formed. Poor eating habits can be a learned behavior passed down by parents to their children.

“I think a lot of things start very early in life. You know, it’s difficult to break the habits of a lifetime, isn’t it? I think we all find that. But I think our health and our prospects for the future are kind of laid down fairly early. And I think that’s not surprising. Big kids often have big parents. I think they learn this at an early stage,” he said.

Solving the problem, he said, is a lot harder than simply trying to encourage prevention.

“There isn’t a kind of medical way to prevent the problem. It really does look as if it’s down to politics, policy, marketing, food industry and preventing children from being exposed to all of this. And I think that’s the toughest thing that we face in the world. It’s very, very difficult.”

Professor Pinkney said too many unrefined carbohydrates – sugars – are to blame for much of the obesity epidemic. He said that they don’t satisfy a person’s hunger for long and people eat their next meal sooner.

“Commercially produced processed food with large amounts of carbohydrate – sweeteners, short acting carbohydrate – and it just sets us up to fail. And I think there are big problems with carbohydrate in the Western diet,” he said.

While it may be difficult to foster better eating habits, Pinkney said there is precedent for large scale behavior change.

“Other things have changed. I mean one really interesting thing, I think, was what’s happened over cigarette smoking. And how people complained about not being able to smoke in pubs and restaurants and have to go outside. But it didn’t take very long for that to translate into clear health benefit. So, you know, maybe you can get these things through in time, little by little,” he said.

Some lessons, he said, can be learned from our hunter-gatherer ancestors.

“The hunter-gatherers going right back to last Ice Age and before that would have had a diet that was rich in complex, sort of, fiber kind of carbohydrate. There would be protein in it now and again. But it didn’t have all the sugar. So, the diet that is, of course, followed by traditional peoples is radically different.”

He said studies of indigenous peoples, who returned to their traditional diets, “took a step back from modern health problems.” Pinkney says a combination of prevention methods, medical interventions and political will be needed to stop the obesity epidemic.

In the U.S. the Centers for Disease Control and Prevention reported over 35 percent of adults – or nearly 79 million people – are obese. More 17 million children were obese. The annual medical cost of obesity in the U.S. is nearly $200 million.