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Medical Control of Obesity
The classical interpretation of populations becoming obese, failing to lose weight or recidivism after initial weight-loss, is failure on the part of the individual, weight-loss strategy, or both. However, the problem of rising obesity prevalence does not appear to be owing to a lack of interest by the individuals in the population. On the contrary, in the US, where the increase of obesity-rates is very reliable, there is evidence that the majority of the population are actively trying to control their weight. Recent reviews suggest that the environment in which these individuals make choices on what food to eat and how much to exercise, is necessary to understand and tackle the problem. There is a growing consensus that effective intervention to address the obesity epidemic requires a multi-strategic approach involving all levels of society – both, for the population as a whole and for the individual. This relates to ensuring a balance in intervention strategies along the continuum that stretches from individualized health-care (downstream investments) to the introduction of policy and legislation that affects whole populations on a macro level (upstream investments).
Numerous attempts have been made to control and curb obesity pharmaceutically. However, because these drugs do not produce permanent changes in the physiology or behavior of the person, they are only effective for as long as they are taken. Furthermore, they only produce a modest weight-loss of 3-8%, barely satisfactory for obese patients.
There are, however, numerous risks to obesity therapies:
- Pharmaceutical treatments for obesity carry a substantial list of side-effects: increases in heart-rate and blood-pressure, gastrointestinal pains and symptoms, agitation and nervousness, central nervous system symptoms, parasthesia, insomnia, and others. These drugs have a profound effect on digestion and central nervous system neurotransmitters.
- Many of such drugs, such as Fenfluramine have been pulled from the market due to safety concerns. Others like Phentermine, which has been demonstrated beyond any doubt to cause valvular heart disease in people with no history of cardiac disease, remain on the market.
- Weight-loss at or exceeding 3 pounds per week, dramatically increases the risk of gallstone formation.
- Severe calorie-restriction leads to transitory symptoms of fatigue, hair-loss, and dizziness and may lead to acute gallbladder disease.
- Efforts to lose weight with exercise and diet alone usually result in 1/3 of weight-lost, being regained after 1 year, and almost all of it after 5 years.
Obesity also has a substantial effect on life-expectancy. For white men and women ages 20-30 with severe obesity (BMI > 45), life-expectancy is reduced to between 8 and 13 years. For blacks, such extreme obesity can lead to up to 20 years of lost life-expectancy.
For the first time in US history, children will actually die sooner than their parents.
There are several environmental factors responsible for the prevalence of obesity today. Industrialization and improvement in technology have led to an increasingly sedentary workforce and a greater availability of food. This environment of reduced energy expenditure and increased energy intake is termed as "obesogenic" environment.
People of various ethnic groups respond differently to this obesogenic environment - this is due to the presence or absence of a "thrifty gene". This gene presented an advantage for those groups of people who would frequently experience starvations. However, people like the Pima Indians and Pacific Islanders, both of whom possess this thrifty gene, tend to overreact to the obesogenic environment and very easily become obese.
Human eating-patterns are also influenced by social conditions: the amount of meals eaten in a social setting are 44% greater than meals eaten alone. The more people participate in eating together socially, the longer time they spend on meals and the more food they consume. These correlation increases proportionally for each additional person participating in the group.
Numerous natal factors affect an individual's tendency to excessive weight-gain in childhood, adolescence, and later adulthood. Such factors include:
- Maternal nutrition / undernutrition
- Diabetes, obesity, or excess weight-gain in mother during pregnancy
- Nutrient density of foods consumed in infancy
Obesity has a significant genetic component. Several comprehensive studies suggest that the heritability of BMI and body-fat is between 25% to 40%.
The modern "obesogenic" environment of industrialized countries - specifically increased sedentary lifestyle due to machines and automation, and increased availability of inexpensive food - has led to an explosion of obesity in ethnic groups possessing a "thrifty" gene, such as Pima Indians, Pacific Islanders, Afro-Americans and Hispanic-Americans.
This modern epidemic of obesity is not limited to the United States. Besides having spread throughout all industrialized nations, it also has far-reaching effects in the poorest nations such as Gambia and Polynesia.
The World Health Organization (WHO) Expert Consultation on Obesity held in 1997 warned of an escalating epidemic of obesity that puts most countries' populations at risk of developing noncommunicable diseases (NCDs). A subsequent initiative, the Global Strategy on Diet, Physical Activity and Health noted that 66% of deaths from NCDs were in poor nations, and 33% were in industrialized nations with developed health services.