Is this what the solution for obesity looks like?

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Obesity has been a major medical, psychosocial and economical problem for decades. It really took off in the US in the 1950-60 and went from there all over the world, and now the problems are stacking up all over the world. I just read a report saying that Kuwait now the world leader in obesity prevalence:

But the rest of the world is obviously not very far behind the Arab countries, and I have yet to see any major breakthroughs in either prevention or treatment of obesity worldwide. That’s not to say that everything is gloomy: there are some encouraging signs that obesity prevalance rates are starting to level off in places. But it does appear as if the levels of obesity are quite high (around 30-40% but this probably depends on how obesogenic the environment is) before the curve starts to flatten. In short, we have not coped very well with obesity, and I haven’t really seen much that could start to reverse this trend.

We obviously need some major reforms to the way we live if we want to get rid of obesity, so what do we need to do? What does the solution for obesity look like?

Firstly, we need to drastically reduce stress levels. This means a major reform of the economy, so that we eradicate poverty and make sure that everyone enjoys a much greater measure of abundance and freedom. Contrary to what most of the media is telling us, I actually don’t think that there is a shortage of money, it’s just that the distribution of money is mind-bogglingly skew, leading to stress and other problems.

Getting rid of fiat currency, and reintroducing a gold standard will help to stabilize the economy and reduce rampant corruption. It would also help if our politicians realized that war never solves anything, and spent our taxes on rebuilding our societies instead. This would undoubtedly create a more stable, prosperous and harmonious living environment, as opposed to a society burdened by increasing debt levels, conflict and corruption, where many (if not most) are more or less in survival mode on a regular basis.

Personally I would also reform the school system, which seems eerily set up like a factory to create obedient worker bees. All children needs to be given much greater freedom and opportunity to cultivate their own unique talents and interests. Teachers’ principle assignment should be to inspire their students, as opposed to constantly pressuring them with never ending exams and grades from increasingly younger ages.

Improved nutrition for everyone is a no-brainer in this context, including a ban on many (if not all) of the current pesticides, steroids, preservatives and other toxins that we regularly consume. Processed junk food likewise needs to be seriously reduced, and hopefully people will not be drawn to this type of food once stress levels are lower. Nutritious food should be cheap and affordable for everyone, whereas junk food should be expensive, not the other way around.

Increased physical activity is likewise a no-brainer, and includes measures like more parks and play areas, and more bike lanes and less cars in our cities. We would also reform our school and workplaces so that we are more physically active during the day.

The list of possible solutions could go on, but I stop there for now. If you think that this list is completely unrealistic, I would encourage you to think about what the prize of obesity now (and the prize for other obesity comorbidities like diabetes, arthritis and depression) and is likely to be in the future.

Let me know what else you would like to see introduced as a solution to obesity. We can’t afford not to act.

Erik Hemmingsson

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Why are we not doing more to prevent obesity?

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In many ways, obesity is a very complex disease, and it’s likely to remain so for many years. You can always go deeper down the rabbit hole, regardless of whether you are researching fat cells, metabolism, eating psychology or socioeconomics. Researchers are usually very happy to do this, it’s what we trained for.

There comes a point, however, when new studies do not add very much to what is needed in order to bring about a certain outcome, such as prevention of obesity. It’s true that we need much more research, for example on obesity etiology, but do we really need more evidence to tell us that junk food and inequality/poverty (this latter risk factor only applies to countries that have already made the nutrition transition from natural food to junk food, such as Europe and North America) are major causal factors? I think not.

Indeed, we can and should act now to reduce both, and in so doing, we would very likely help to prevent new cases of obesity and probably many other diseases that are also linked to both risk factors, such as depression, arthritis, diabetes and heart disease.

Apart from getting rid of junk food and lowering rates of poverty, we should also be promoting healthy nutrition across the lifespan, where the food contains minimal quantities of pesticides, preservatives, sugar, salt, unhealthy fats, steroids, and antibiotics – just plain natural food, it’s simple. We should also be doing things like promoting physically active transport, and reducing sitting time at work and at home. Healthy eating and regular physical activity will not get rid of obesity, but they can probably go some way in lowering the obesity incidence rates at the very least.

And while messages to promote healthy eating and physical activity can be helpful, we have to be much more comprehensive in how we change the environment. Indeed, the food environment has become so toxic that it feels like we almost have to completely rethink how we produce food. Junk food simply has no place in a society where we value and place emphasis on prevention on chronic disease. Reducing poverty will also require much more than pretty messages, it requires major political decisions and pressure from voters. Bear in mind that the difference between the rich and the poor is at its widest in over 7 decades.

There will always be times when we have to do more research in order to understand more about a particular disease or problem, but if we are talking about obesity prevention, this is probably not that time. This is the time for action, like what is happening in Mexico (see my previous post), where they are successfully working to reduce their more or less catastrophic childhood obesity rates, for example by taxing soda, during very challenging conditions.

Actually, if there is one thing that we should do more research on, it would be to find out why we are not implementing much more serious obesity prevention programs and why we have let mega food corporations take over close to our entire food supply. And while we try to find answers to those two question, there is nothing stopping us from implementing healthy nutrition and physical activity habits for everyone, especially for children in socioeconomically challenged areas.

If you have an answer as to why we are not doing more to prevent obesity, I would love to hear from you. Please share.

Erik Hemmingsson

TOS 2014 summary: It’s good to connect

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It’s been a week since I came back from Boston and it’s time to summarize my impressions. I would say there were fewer outstanding presentations this year compared to last year in Atlanta, but I would also say that there was a greater number of really good presentations.

My favorite this year was Richard Atkinson who gave a very honest and wide-ranging talk when he accepted his Mickey Stunkard award on where we are at the moment, and why we have largely failed to improve much on treatment and prevention outcomes. First of all, it’s good to hear when presenters are truly honest and not just telling everyone that things are great when they clearly are not. I also appreciate it when presenters go out on a limb a little more than usual and really provide some speculation about what we can do in the future to improve on those less than perfect outcomes. Even though I did not entirely agree on how to best go about doing this (more basic science and epigenetics), it is still very much appreciated when informed individuals speak their minds, so well done Dr Atkinson.

The best overall seminar was the one on obesity prevention in Mexico. Mexico has sky-high rates of childhood obesity, even higher that in the US, and a very high consumption of soda. The presenters pained a very interesting picture of how to coordinate a very thoughtful and effective campaign to reduce childhood obesity rates and taxing sugary drinks in a very challenging environment. The opposition they faced from those who wish to keep the status quo, such as Big Soda, was quite formidable, yet they were able to make considerable inroads. This serves as a positive example to us all who think that prevention of childhood obesity is a big ask. It certainly is, but by no means impossible as the team in Mexico clearly demonstrated, inspirational stuff.

But for me, the main positive was meeting up with other researchers who are pursuing similar lines of inquiry as myself, such as the influence of childhood adversity, socioeconomics, stigma and discrimination, and psychological and emotional aspects of weight control. It’s when we connect like this that I believe we take those significant leaps forward and really get somewhere. Conversely, it is when we argue and become divided that our egos get in the way of making those significant leaps forward. Regardless of our personal opinions, we can gain so much more from connecting with each other as opposed to arguing about who is right.

Were you in Boston, or did you read the updates? Please let me know what you think by leaving a comment.

Erik Hemmingsson

Obesity before the age 5 TOS seminar

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This is my last post from Boston, the meeting is winding down. Thank you to everyone who has been part of making this a really great gathering!

Dr Kirsten Davison: New avenues in the treatment of obesity before age 5 in families are being discovered. Intervening early is a key strategy for achieving long-term reductions in BMI, and there is rapidly expanding interest in this very promising area. A key strategy is the promotion of healthy lifestyles (limit added sugars, limit TV time and so on), as is parenting skills, and interventions that target broader family aspects, such as reducing stress and disharmony. The greatest intervention effects were seen in socioeconomically challenged families, for example where there is parental mental health issues and financial strain.

Dr Cynthia Ogden: epidemiology of obesity in children 2-5 year old with data from NHANES. 7-8% of US toddlers have obesity, with huge ethnic disparities (lowest in whites and highest in Hispanic children). There are no major difference between boys and girls. The increase in excess weight really increases rapidly with age. Obesity rates have levelled off since 2003-2004, and could even be declining. Extreme obesity, however, has increased from 3.6% in 2000 to 5.4% in 2012, which is reflected in the distribution histogram for BMI with a much longer right hand tail. No increase in obesity in children <24 months. Energy intake in 2-5 year olds has been stable in both boys and girls. As children grow older, their intake of added sugars increases. Strikingly, for any given day, 15% of 2-5 year old US toddlers will consume a pizza.

Food insecurity and eating disorders in obese children

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Today Dr June Tester presented the first qualitative study I have seen at Obesity Week ever, on the very interesting topic of disordered eating in children growing up with food insecurity. There is quite a marked association between food insecurity and obesity, which may seem paradoxical, but makes perfect sense to me. Subjects were 47 focus groups from a paediatric weight management clinic. Grounded theory was used to describe themes surrounding food insecurity and eating problems in the children.

There was a lot of secretive eating practices and food hiding, as one would expect. There was also a high frequency of hidden candy wrappers in the children’s rooms. Likewise, food insecure parents also hid food, i.e. fending for themselves: “Otherwise I don’t get any”. It was striking to me the low quality of food that these very poor families can afford to buy. All members of the family tend to binge eat food when there is food insecurity. Parents describe how they want to put locks on their fridges or anywhere there is food. These behaviors certainly complicate treatment of obesity.

Given the marked association between socioeconomics and obesity, we could certainly do with more of this type of studies.