but very few are listening….
Obesity has been described by the World Health Organisation as the largest health threat facing mankind.
This is terrifying. Two thirds of the UK adult population are overweight or obese.
Nearly one in five of the under-fives are overweight.
Adolescent obesity has increased more than ten-fold in the last few decades.
Unfortunately, obese children tend to become obese adults.
The Health Foundation Report 2023 makes for depressing reading.
1 in 5 UK adults are expected to be living with major illness by 2040, an increase of more than a third.
The average health span (complete physical, mental & social wellbeing without disease or disability) in 2040 will be 44 years out of an average life span of 83 years. That means 39 years will be spent with some degree of illness.
There will be millions of new cases of:
Diabetes up 49%
Dementia up 45%
Heart failure up 92%
Atrial fibrillation up 51%
Cancer up 31%
All associated with obesity.
How do we measure risk?
- BMI isn’t a good measurement to be guided by.
Waist circumference, which is simple to perform, would identify even more at risk. Normal waist circumference: Females less than 80cms
Males less than 94cms (for Caucasians.)
- Electrical impedance scales send a weak electric current through the body to determine tissue composition. These should ideally be in all medical establishments as they can be used to identify visceral obesity (inflammatory fat that affects liver, kidneys, pancreas & heart) plus muscle quality important in identifying Sarcopenia (age-related progressive loss of muscle mass strength and function)
Severe obesity (BMI> 40) is, for most, a relapsing, deadly, incurable disease (only around 5% of dieters remain lean after five years). Those with a BMI of greater than 45, only 1 in 1700 will manage to attain leanness by lifestyle changes alone.
Obesity acts as the gateway to the pandemic of metabolic diseases that destroy lives prematurely. Cardiovascular disease (heart attack, stroke, peripheral vascular disease and heart failure) remains the biggest killer worldwide.
Type 2 Diabetes isn’t a mild disease and 90% of sufferers are obese. Only 50% of obesity-induced diabetes survive 10 years (for breast cancer it is 80%).
Thirteen cancers are related to obesity (an additional five newly associated cancers are now recognised in the young obese). There is also an increased risk of dementia, fatty liver disease, sleep apnoea etc. etc. There are over two hundred conditions associated with obesity and none of them are fun!
Prevention is essential. You don’t suddenly wake up 20kgs heavier than when you went to bed!
Obesity has a genetic element but may be prevented for most by adopting a healthier lifestyle, eating real unprocessed food, not too much, nor too often, moving more than currently, avoiding stress (not easy!) and having a good night’s sleep!
This must be maintained lifelong.
Unfortunately, the social determinants of health: poverty, food insecurity & lack of health education, identifies a large group for whom obesity is now the norm. Overconsumption is probably more important than reduced activity. Although movement is miraculous for health, large amounts are needed to prevent regaining lost weight after lifestyle changes. Subconsciously the body tries to restore weight loss by increasing appetite but also reducing metabolic rate and spontaneous activity.
What causes Obesity?
It’s complicated. The average adult consumes around a million calories each year and it is only in the last few decades that weight stability has been lost. Prior to the 1970’s an average adult’s weight remained incredibly stable, without calorie counting or consciously trying to balance dietary intake with energy expenditure.
Theories abound, there isn’t a single answer.
A couple of contenders!
1. Ultra-processed, industrially pre-chewed junk food
Most of us adore the variety of manufactured tastes, the low cost & the long shelf-life. The industrial processing (mechanical chewing) makes it “melt in the mouth” and does virtually nothing to relieve the rapid return of hunger after a huge meal.
Why are they so addictive? Perhaps the combination of sugar, fat, and salt is like the only food that humans had to adore throughout evolution to survive:- breast milk!
The reward element of food is vastly reduced in the obese so that the child-size cone of Hockings Ice Cream (a fabulous North Devon creation!) that satisfies the lean, may require a two-litre tub to provide the same pleasure for the obese.
Apart from obesity, ultra-processed food additives themselves increase the risk of cancer, impair mental health, increase the risk of dementia and inflammatory bowel disease!
2. Obese Parents
Obesity & pregnancy are the perfect metabolic storm.
Virtually every complication of pregnancy, delivery and the postpartum period are increased in the obese woman, including miscarriage, hypertension (pre-eclampsia), pre-term delivery and gestational diabetes.
Unfortunately, longer-term outcomes for the mother include increasing weight retention exacerbating the huge list of associated metabolic diseases.
The foetus has increased risk of stillbirth, congenital malformations and tend to be large for gestational age producing increased mechanical delivery problems and a higher level of Caesarean delivery.
Health problems for the child extend into adulthood (Developmental Origin of Health & Disease / Maternal Resources Hypothesis) which includes a long list of metabolic diseases. Obesity, type 2 diabetes, cardiovascular disease, anxiety and depression, and behavioural problems such as ADHD and autism.
An obese father’s sperm at conception exacerbates virtually all the problems usually assigned to a weight challenged mother.
Game changing drugs?
Can the incoming “tides” cure the Obesity crisis?
Will Liraglutide, Semaglutide plus the soon to be available Tizepatide or Retatrutide solve this countries weight problem?
For first time there are a group of drugs that result in dramatic weight loss, approaching that seen following bariatric surgery.
These drugs mimic the hormones transiently produced by the gut & pancreas after eating. Currently the majority require a weekly injection, but oral preparations (Orforglipron) are in development.
Dark side of Drug Therapy
For most, once started they must be continued life-long to avoid weight regain.
Side effects are frequent & mostly related to the gut with nausea, vomiting & diarrhoea predominating even when the dosage is slowly increased to reach therapeutic levels. The weight loss includes lean tissue especially muscle which is not desirable.
The huge current cost will reduce substantially when they become available in a generic form, but can the NHS afford to treat millions for what should be a preventable disease?
How do they work?
Probably by increasing the feeling of fullness after eating & slowing gastric emptying although perhaps a major effect is on the brain causing the addictive appeal of calorie dense ultra-processed foods to disappear.
The Energy Balance model jostles with the Carbohydrate Insulin model that denies the Protein Leverage theory and ignores the Constraint model of exercise. Do we have a set point, a settling point or is the dual intervention theory the answer? Do we have a fat threshold and is the microbiome involved? What about Food addiction / binge eating disorder etc.
If this all sounds like gobbledygook perhaps a visit to The Woodland Clinic might help you understand the complexity of appetite control and develop a sensible approach to weight management.
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