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

Obesity prevention: what on earth are we waiting for?

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Please allow me to start with a little name dropping here (sorry): my PhD opponent was professor Steven Blair from the Cooper institute in Dallas, notably of fitness/fatness fame, and his really groundbreaking research on fitness and numerous health outcomes. I am sure Steve’s work has helped to save countless lives and will continue to do so. Anyway, one of the things I clearly remember Steve saying was how we (in medical science) have all been led to worship at the shrine of the randomized controlled trial. And if your research is not founded on a randomized controlled trial then work is so flawed, so biased, that you may as well quit and do something else entirely.

His point was very clear: it is far too easy to discredit sound studies that do not use a randomized design. Most people who critique or even completely discard science have never done any science themselves, let alone a randomized controlled trial, and are employed as full time bureaucrats, or work for big pharma, and so they lack the understanding that such evidence is often utopian and oftentimes makes very little sense. In other words, good science is many times discredited for very petty reasons.

But here is my point: we can easily become very stupid if we insist on scientifically proving everything that we want to do. Not only is it utopian for many reasons such as cost and time, it’s often completely unnecessary. We don’t need, for example, a randomized trial to prove beyond any meaningful doubt, that certain things are either good or bad for us such as exercise, junk food or stress.

So far there are very few examples of obesity prevention programs that have been scientifically proven to be effective. That does not mean that we should refrain from very commendable initiatives such as building more parks and bike lanes, taxing junk food much more severely, banning junk food marketing, reducing harmful chemicals from our food such as steroids, preservatives and antibiotics, etc. There is no need to validate all these preventative measures in a gargantuan randomized controlled trial that will take years, if not a decade, to design, fund, carry out, analyze and publish.

The burocrats can always find things to nitpick at if they so wish (they usually do) and use this as an excuse for their inertia. Everyone should know, however, that science is never perfect. We have to trust and use our common sense when it comes to tackling the epidemic, just as much as we have to let good science guide us when we design programs that reduce obesity.

So what are we waiting for? Why is there so little action to prevent obesity? The numbers are getting worse by the day it seems, partly because we are in fact allowing the epidemic to run around more or less unchecked. It’s time to get serious about prevention, and do all these things that can start to slow it down, and don’t sit around waiting for the perfect study to show us exactly what to do, because that could be decades. We can’t afford to sit around any longer hoping that someone else is going to solve this for us.

Erik Hemmingsson

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Polarity abounds and why it’s time for a new way of doing things

It appears to be a human condition to react very slowly, if at all, to adverse changes that happen very gradually (think the obesity epidemic). If bad things happen very quickly, then we have no problem mobilizing at all, such as what happened during the SARS outbreak just over a decade ago. Moreover, the factors that are feeding the obesity epidemic, such as processed junk food, stress, and socioeconomic adversity, have changed steadily but very gradually as well, making for one gigantic slippery slope that we have apparent problems reacting to.

It seems as if many things in society, including the drivers of the obesity epidemic, are now reaching some kind of peak polarity, i.e. you are either very poor or very rich, you either eat only nutritious organic food or only junk food, and you either exercise 7 times per week according to the latest hype, or you refuse to exercise at all. In terms of socioeconomics the middle class is disappearing fast, and the 1% seemingly flourishes at the expense of the rest of society.

Polarities abound in the present time, and this makes it very difficult to make any inroads into creating the conditions we need in order to produce successful obesity prevention and treatment programs. In short, it is very difficult to separate the fortunes of the individual from the rest of society, and society is not in a happy place right now.

http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph

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Politically, there is much current upheaval in the world, possibly with some kind of peak fear with war in the middle east, ebola outbreaks, water shortages, extreme weather, and an economy in tailspin – can it get any worse?

The good news is that more and more people are waking up to the fact that the current systems, i.e. politics, finance, food environment, lifestyles, etc, are obviously in need of major reform. Maybe we are even getting close to some kind of breaking point for the current dysfunctional way of doing things. I thick that we are, and when enough people wake up to this reality, that is when we can create the conditions we need for preventing obesity globally.

Do we, for example, want to keep eating junk food when it is abundantly clear that such food is very harmful to our health, do we want to keep the current financial system that only seems to work for the 1%, and do we want politicians that are heavily influenced by corporate interests. Or do we want something better? It’s not as utopian as many people think that it is.

 

Erik Hemmingsson

 

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