Obesity - a worldwide problem

The British business magazine "The Economist" presented the topic obesity in an interesting Special Report.

The special issue of "The Economist" from December 2012 discusses the global trends in morbid obesity (adiposity), the food industry and the problem-solving approaches by pharmaceutical companies and governments. The IFB reports about the interesting analysis of the business magazine in this and the next "Current Issue".

Just as the economy the bellies are growing

We are accustomed to the alarming statistics about overweight and obesity. As expected the worst numbers come form the United States: Two thirds of American adults are overweight, 36 percent of them are even obese. According to the most recent study by the Robert Koch Institute (DEGS) 67 percent of men and 53 percent of women in Germany are overweight and 23 percent of both sexes are obese. Furthermore, about 7 percent of children and adolescents are obese. The largest increase of obesity was recorded in the age group of 25 - to 34-year-olds, young people who have grown up with computers and entertainment media. France and Switzerland are slightly slimmer; however, about 25 percent of the UK’s population is obese.

Yet, not only Americans are too big. Studies of 2008 showed that 1.5 billion of the world’s population is overweight or obese. Obesity rates were nearly twice as high as in 1980. By 2030, researchers at Tulane University (USA) expect 3.3 billion people to be overweight worldwide.

Among the world’s obesity-frontrunners are inter alia: the Pacific Islands, Mexico and the Gulf States; Brazil, China and South Africa are catching up quickly. And it is not just the rich world that is getting heavier. In many developing countries, the rate of overweight women is already higher than the rate of underweight females. Particularly striking is the connection between the growing economic strength of a country and an increasing body weight in the population. Notably children of malnourished mothers are prone to develop obesity.

Little success in the treatment of obesity

Evolution has turned humans into beings that are designed to face hunger crisis and bad times by maximally using calories. However, this survival advantage has become a disadvantage and has led to the obesity numbers mentioned. Even a couple of years after somebody succeeded in losing weight, the levels of the hunger-signaling hormone Ghrelin remain high while the level of the satiety hormone Leptin still is low, according to studies of Joseph Proietto of the University of Melbourne (Australia). Thus, the body works hard to make sure that it regains the lost weight. This makes it even harder to fight superfluous pounds. Several genes are designed to store fat for hard times and to defend body weight against falling below a minimum. Aside from biology and evolution several countries show that educated and wealthy people are slimmer. Education increases the chance to stay normal weight. Since an effective treatment of obesity is lacking, education and knowledge about a healthy lifestyle is the biggest key factor that should be supported.

Of course, also pharmaceutical companies have recognized the signs of time. After a long phase without any novel medicine the companies brought two weight loss drugs on the U.S. market in 2012. Only one has managed to get on the German market: the appetite suppressant lorcaserin (Belviq ™). Sure enough, the effect is lowly: According to the product information the weight loss to be expected is about 3 to 4 percent of the body weight. These pills, just as Orlistat, that reduces fat absorption in the intestine, won’t fight the increasing obesity epidemic. The “Economist” also provides a critical view on bariatric surgery and doubts its function in the solution to the obesity crisis.

The authors rather hope for innovative therapeutic approaches, such as the transfer of gut bacteria from slim to obese patients; a method that improves metabolism verifiably.

The IFB itself is currently involved in a research project (MetaCardis), which examines the relationship between gut flora and metabolic health.

Consequences of obesity

The lack of effective treatments still remains and a remedy for the overweight problem is out of sight. Therefore, secondary diseases caused by obesity increase. The World Health Organization (WHO) explains that 44 percent of the diabetes cases and about 40 percent of certain cancers are due to obesity. Thus, obesity causes major health and financial burden for patients and society. The "Economist" assumes that an obese person is responsible for around 40 percent higher health care costs than a normal weight one. The German Adiposity Society (DAG) calculated in 2003 about 85 million Euros direct medical costs for obesity care and 11.3 billion for obesity-associated diseases. The indirect costs, e. g. for non-productive times while staying sick at home, were 1.4 to 1.6 billion Euros.

In threshold countries diseases such as fatty liver, cardiovascular disease, diabetes and high blood pressure can not be adequately identified and treated. The situation there is paradox: Although the increased prosperity altered diet and lifestyle in many places, the lack of health care remains. For China it can be assumed that 40 percent of all diabetes cases have not been discovered yet. However, even if insidious diseases like diabetes were more commonly diagnosed, treatment would be uncertain in many countries.

This is why pharmaceutical companies are most active in China, South Africa and other countries - with all the associated disadvantages as critics notice. Still, money alone doesn’t guarantee the success of obesity treatment and prevention for example the Gulf States show: Countries such as Abu Dhabi invest heavily in prevention and treatment - yet with little success so far.

  In the next "current issue" readers can learn how the "Economist" sees the dichotomy of the food industry and policy in the obesity problem.

Review by Doris Gabel

Keywords: associated diseases, health policy, society & social life