It’s a Fat, Fat, Fat, Fat World!

Deitel Evolution obesity

The past 50 years have witnessed a rise in obesity, which has become almost universal. This initially occurred insidiously, until obesity, rather than famine, has become the most common form of malnutrition. The world has a problem, and it is getting worse.

In the 1980s, particularly because of studies on identical twins reared apart, I was of the opinion that the major cause of fatness was genetic. However, as the problem advanced rapidly it became obvious that the gain in adipose tissue must be largely related to lifestyle and dietary changesIn the 1950s, in the period between medical school and my summer job, I traveled with two classmates across the U.S.A. on a low budget. In each city, we stayed at the YMCA – these functioned mainly as hostels for men at the time. Now. these institutions function as a main source of exercise for much of North America. A new feature commenced in the 1960s and 70s. and has continued the recreation industry for “working out”. Also, to combat obesity, a host of diets, diet books, diet pills, low-calorie foods, psychotherapy, home exercise equipment. recent labeling of food contents, etc. have evolved. The Metropolitan Life “ideal” weights for survival of 1983 were higher than the “desirable” weights of the 1950s, and this was attributed to increased muscle mass from the push for physical fitness. However, we continue to lose the battle.

The incidence of overweight and obesity in the U.S.A. and Canada has doubled in the past 25 years, now involving more than 50% of the population, with a resulting huge increase in the co-morbidities, medical-care costs, and absenteeism from work. Europe is not far behind – the greatest incidence of obesity being in the old Yugoslavia, followed by Greece, the UK, with the other countries close behind. Greece is of interest because in the past, Greece was lauded for its simple salads with olive oil (monounsaturated fat). South America is right in the thick (not a pun) of the excess adiposity. Brazil has more than 600 bariatric surgeons. With the rise in obesity now occuring in the huge populations of China, lndia and the rest of Asia, the World Health Organization estimates that overweight and obesity involve more than 1.7 billion people worldwide. The problem is that Asians are vulnerable to obesity-related diseases at a BMI of only 23.

It seems that everyone has an explanation for this ‘globesity’ epidemic. We have become sedentary. We drive – to the corner. We press a button to lift the garage door. We take the elevator for only three flights of stairs. We watch TV. We sit at a computer. Fast food is cheap and super-sized.

Women are also now breadwinners; they are at work to pay for a second car, a third TV and the other current necessities of life, so that there is no one at home to prepare food for the children. The children eat calorie-dense low-nutrient fast food at Mc-stores or from school machines. Studies show that 40% of children age 1 to 4 of low-income families in the U.S. already have a TV in their bedroom. Inactive adolescents are manifesting an alarming increase in the associated impaired glucose tolerance, cardiac and lipid disorders of obese adults. The effect of a high-fat “Anglo” diet and decreased physical activity is particularly exemplified by the Pima Indians of Arizona who were traditionally fit, but with an underlying genetic susceptibility, type 2 diabetes, heart disease, gallstones and the other sequelae of obesity have become common. Trans (hydrogenated, saturated) fats as a food preservative in marketed baked goods, salad dressings, processed cheese, margarine, etc. add to the disorders as likely does an increase in tranquilizing drugs in a fast-paced society. As obesity increases, so does the advancement to the severe form – morbid obesity.

Where is this all going to end? I hate to think! Meanwhile, governments and the medical profession have to mount an ongoing attack on this menace. We need education of children and proper foods in the schools. We need fresh fruits and vegetables, whole grains, protein without binding of fat, removal of high-calorie soda-pop, and reasonable nutritious low-calorie portions. We need an awareness of our BMI (fatness), daily exercise, formal exercise 30-60 minutes 3 times a week, and participation in sporting activities. Cigarette smoking was the major cause of unnecessary disease, but the International Tobacco Treaty of the WHO guidelines (education, prevention of enticing ads and sponsorship of sports events, cautions by the manufacturers, non-smoking laws, and substantial taxes on cigarettes has reduced smoking and also the effects of second-hand smoke. To confront obesity, the WHO has been trying to set up guidelines for cooperating governments – education in childhood, healthy menus and food selections, lower intake of sugar, smaller portions, restriction of fast-food advertising, possibly taxing some foods and subsidizing others, and particularly integration of physical activity into daily life. As medical practitioners, we share the responsibility to research, advise, confront and thwart this international challenge.

  • Balasubramanian Ramana

    A movement to go back to traditional cultures would be each society’s way of getting out of this mess. This is largely focused on eating the traditional way, rather than the modern way, with its obscene portion sizes. Physical culture could be revived. An airy, meaningless wish?? As a doctor/surgeon, how many prescribe vegetables and fruits in diet (specific recommendations) and exercise? I do. If every one of us in IBC give time to counsel our patients in these matters, we would have made a small but important move in fighting obesity.

    • Tomasz Rogula

      Excellent comment, i totally agree. Bariatric professional should take a leading role in public education. Fellow and other trainees should spend more time learning about diet and healthy life style and then pass it to their patients. We sometimes focus too much on treatment, rather then prevention.

  • Arun Prasad

    India has the world’s largest number of malnourished ( 20 billion obese and 45 billion undernourished ). We need to address this double health whammy on an urgent basis. The morbidity due to obesity is multiplied by many other factors like diabetes ( 80 million in India ), hypertriglyceridemia, waist circumference etc.
    The traditional high calorie high carbohydrate Indian snacks and food are equally to be blamed as the western diet ( read McDonald ).
    Bariatric surgeons in India have the best understanding of this problem and have to take responsibility to educate and campaign against this ‘mamoth’ endemic.

  • Beth Janssen

    I have worked bariatric patients for quite awhile and truly believe education is the key to not only diet changes but lifestyle as well- without the expert disciplines to help educate the patient this message will be lost- it also helps that those who are sending the message are living the proposed life style


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