Enjoy the holidays!

Dear readers

It’s been a busy end to the autumn and it’s time for some relaxation. I will be posting again after Christmas, a very challenging period for many people but also a happy time to enjoy with family and friends. Make sure you get out to enjoy whatever sunlight you can get during these very short days (at least here at 60 degrees north).

I have a sneaky feeling 2015 will be a very interesting year indeed for obesity research. Make sure you check back before New Years Eve for a special 2015 prediction list of what I think will happen next year.

Happy Christmas!

Erik

Interesting developments in research on body weight regulation

I have had many interesting meetings this year, including trips to Melbourne to meet with professor Helen Skouteris and her team at Deakin university, New York for the American Psychiatric Association meeting, Boston for the massive Obesity Week meeting, and finally Copenhagen last week to meet with professors Thorkild Sorensen and Berit Heitmann.

Having met so many leading obesity experts this year, it feels safe to say that we are making massive strides in obesity research, even though this will not be very apparent to lay people, who are still very much bombarded by advice on the latest fad diet.

For me, the biggest progress is happening in the field of body weight regulation, i.e. understanding more about why excess fat is stored in some people but not in others, even though they are eating and exercising the same amounts. This is also so much more complex than mere calories or genetics, it goes into a range of factors that can trigger weight gain. Much more information about this is coming in future posts.

Once we understand body weight regulation a bit better, and we identify the causes of weight gain, we could be getting quite close to making some real progress in both treatment and prevention of obesity. We have to understand that there are always reasons the body stores extra body fat, it is certainly not a random process.

Christmas is coming up and my plan is to post a bit more frequently during this festive but also rather challenging period for many people.

Erik

The obesity and poverty paradox

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The recent TOS obesity congress in Boston was an excellent opportunity to catch up with the latest research. While it is interesting to hear about what other people are working on, it is also interesting to note what isn’t trending so much.

Many areas of research have obviously come and gone from the limelight as we naturally go through cycles and phases in research, with some topics having considerably more longevity than others.

Short-lived topics with rapid cycles of boom and bust include things like new diets or exercise fads, something many (if not most) obesity experts got fed up with a long time ago. The basic rule here is that the more extreme the new diets are, the more volatile the cycle. Such strategies rarely make sense if you are genuinely concerned about obesity, even though they can stir remarkable amounts of curiosity in the short term. The science eventually catches up.

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Obesity research is inevitably a mix of trending topics with shorter cycles, and less trendy but enduring topics that have withstood considerable scientific scrutiny over decades. While these long-lasting areas of research might not always be the most exciting for lay people, they arguably have a more robust potential for providing effective solutions.

For me, there was one such long-lasting topic I had hoped to hear much more about in Boston, namely the negative influence of low socioeconomic status. Obesity and poverty may appear to be a paradox but it was a long time ago, at least in developed nations, that obesity was a condition among the wealthy.

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It is now well established that obesity is much more common in individuals at the bottom of the socioeconomic pyramid, and rare towards the top. This particular association is also noted for its strength and consistency across populations in developed nations. Since such associations are rare in obesity research, socioeconomic adversity could well be the strongest risk factor we have for obesity development, hence its long-lasting appeal to researchers.

When we investigate causes behind the obesity epidemic we can obviously point to the junk food invasion and increasingly sedentary lifestyles, for example, but we also need to be aware of the quite dramatic changes in wealth distribution, with financial inequality now at its highest level in seven decades.

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So, since socioeconomic adversity is so well established as an obesity risk factor, the topic I wanted to hear much more about in Boston was why this association is so strong. In other words, what is it about being at the bottom of the socioeconomic pyramid that increases the risk of obesity so drastically?

While there were very interesting studies in Boston that touched upon the potential mechanisms, such as food insecurity, stress, junk food, mental health issues, addiction, lack of sleep, and malnutrition, I would have liked to have seen much more.

This is clearly an area where we can find many interesting pieces of the obesity puzzle and really develop our understanding of weight gain and body weight regulation. This work clearly needs to be multifactorial in nature and not just include experts on socioeconomics, but also experts on social interaction/family dynamics, psychology, emotion regulation, behaviour and lifestyle, diet and nutrition, sleep, fitness, metabolism, endocrinology, immunology, inflammation, genetics, epigenetics, and so on.

Once we start to identify the drivers of weight gain among the socioeconomically disadvantaged, the road to some much needed progress in terms of both treatment and prevention of obesity should be considerably wider.

Erik Hemmingsson

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

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