Where and why did the obesity epidemic start?

World-wide epidemic

Obesity has definitely gone global. Although it will be difficult to prove using scientific methods, which can be pretty blunt for this type of investigation, I have no doubt that the epidemic started in the US around 1950-1960. This is the era that saw the rise of the junk food industry, mechanized transport, more stress, increasing social disconnection, more aggressive marketing, and changed consumer habits. But the main change was undoubtedly the junk food invasion.

It did not happen overnight, and the epidemic did not get its breakthrough until around 1980. Like a snowball rolling down the hill, the epidemic was now fuelled even more by other changes to society. Both Reagan and Thatcher, for example, started to gradually dismantle the welfare system during this period, meaning that poor people got pushed over the edge financially and had no choice but to eat cheap junk food. The rise and rise of junk food marketing also reached new levels through TV, and use of colorful images and messages. We were told to consume and consume we did.

Trends in obesity, US

 

If you walk around major cities in Europe and the US today it is quite staggering how much food, transport, lifestyle, family, working hours, stress, etc has occurred during the decades when the epidemic really took off. There has also been a large disconnect from nature and a more balanced lifestyle through massive urbanization and who knows how much toxicity we are exposed to today in the cities compared to the days before the epidemic as a result of pollution, pesticides, steroids and antibiotics in our food. Children have also increasingly been growing up in environments where they see less and less of their parents, who both work full time to pay their mortgage. The increased stress levels is certainly a major factor that fuels the the epidemic more and more.

We are suckers for these types of very gradual changes, and the prize for this lack of vigilance is that one day we find ourselves in a hole that we struggle to get out of. And as always in epidemiology, it is the combination of causal factors that tip us over the edge. And those environmental changes I have mentioned as causal obviously also play a very prominent role in many other health epidemics, such as diabetes, cancer, heart disease, and depression. How much more of this will it take before we take action and get back to a more balanced lifestyle?

Why this blog?

Bild 2013-05-31 kl. 09.27 #2

I guess it’s part excitement and part frustration behind my decision to start communicating much more directly with real people interested in obesity and weight loss, and not just other academics and media. Let’s start with the frustration and then round off with the happy bits.

The lack of progress in both prevention and treatment outcomes is quite frankly staggering. Sure, the epidemic appears to be slowing down in more affluent segments of the population, but it is still more or less a runaway train in poorer areas of the US and Europe, and this also goes for countries in the middle of the nutrition transition, such as China and India. There are in fact very few places in the world where the epidemic is not doing very well. This is a public health failure of monumental proportions.

Despite this, most of the obesity experts continue to advocate more of the same tired old strategies, i.e. increased dietary control and exercise, and the outcomes are very predictable: more failure.

Then the experts seemingly got desperate and started to drastically scale up the use of bariatric surgery with minimal follow-up afterwards, as a kind of advanced quick fix. This very large increase in bariatric surgery volumes is a bomb waiting to explode if you ask me, since the safety of such drastic procedures are far from fully understood. A review I am working on with former student Filippa Juul has so far identified 32 separate nutritional deficiencies after bariatric surgery, some of them quite serious. And this is just one type of safety concern.

Another major source of frustration is the almost total lack of balance in the media. Every day they keep pumping out the same tired fad diets, or similarly ineffective measures. And on the next page you can read up on recipes for all kinds cakes and sweets, complete with glossy photographs and smiling photoshopped models. It’s quite absurd, but we apparently fall for it, and so they keep doing it.

The media is nothing if not cynical when it comes to weight loss, and it has now basically gotten to the point where public health nutrition and lifestyle advice is largely controlled by the media. These are some of the biggest frustrations for me as an obesity academic.

So, what are the happy bits? Well, just over a year ago, I started to become very interested in some of the deeper underlying psychological and emotional reasons behind overweight and obesity. And what I have discovered so far has got me pretty excited. I guess I feel a little like Howard Carter when he was exploring the unknown parts of the pyramids.

If you are anxious to read more in-depth information right now you can read a conceptual review paper I just published (Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obesity Reviews, 2014, epub 16 June).

I am expecting to publish many posts on the topics covered in the review, for example how the very earliest years of our lives continue to affect our health as adults. I genuinely think that this type of information can be a concrete help for anyone wanting to lose weight permanently.

I actually think we are getting close to a genuine breakthrough in how we help people lose weight that actually works long term, and also in terms of preventing new cases of overweight and obesity. Sure, much more research needs to happen before the epidemic is confined to the history books. And that is why I go to work each day. Stay tuned of you want to find out more.

 

Sincerely,

Erik Hemmingsson

Welcome to Holistic Obesity

Hi

Welcome to Holistic Obesity, a popular science blog about how we can solve one of the greatest health challenges of the 21 century: obesity. As scientists we have failed miserably with both treating and preventing obesity for many decades now, and things need to change. It’s time to stop scratching the surface and delve deeper into the many psychological and emotional aspects of weight control, that we are only just starting to understand. We need a holistic approach to achieve lasting weight loss, or I believe we will continue to fail.

During the last 12-18 months, I have been fortunate to gain some insight into this fascinating new area of obesity research, and this is why I decided to start this blog. I want to share these new insights with the world, and with you. My hope is that this will not only improve quality of care for overweight individuals, but also help relieve some of the stigma, shame and discrimation. Welcome.

Dr Erik Hemmingsson, Obesity researcher, Stockholm, Sweden