The obesity epidemic

Of late there has been a flurry of publication about obesity, both in the scientific as well as the popular press. Either way you look at it, with 34% obesity rates and overweight rates at around 68% in the United States, the numbers aren’t pretty.

What this epidemic of over-nutrition is leading us into though, is outright ugly.

First the problem was seen to be one of the rich world.  In developing countries, obesity had always been thought to  be a disease of the urban affluent; in developed countries the opposite was held to be true. However, as recent research shows, both points of view are crumbling over their own weight.

In low and middle income countries, it still is a disease of the wealthy, especially wealthy middle aged women, but it is now percolating down to the poor people are well.

In rich countries the problem was thought to be largely concentrated among the urban poor, where lack of proper food choices and inappropriate personal choices were said to drive the epidemic; however when 68% of the people are considered to be overweight, the problem is not only in the urban ghettos, but is also right in the middle of the affluent suburbia. In the developed countries no one in really immune any more, and there aren’t just a few easy explanations of poor choices and poverty to explain the epidemic.

The drivers of this epidemic are far more complicated than was previously believed. A four part series on obesity in the Lancet, offers an incisive analysis of the causes and consequences of the obesity epidemic.

Which brings us to the second part of the problem: the consequences. As such obesity has already overrun tobacco as the greatest modifiable threat to public health in many parts of the world. A case in point: tobacco is an addiction in close to a billion people in the world and will contribute to their death in some way or the other in at least one half of them.

As the global burden of morbidity and mortality, shifts from communicable to non-communicable causes, obesity alone can cause already unsustainable health care costs to sky rocket. If current trends continue, in the US and the UK alone, 65 million additional people could be obese by the year 2030, leading to more than 5 million additional cases of diabetes. A roughly  equal number  of additional heart diseases and half a million cancers are also predicted. Year on year additional health expenses in the US alone are expected to be around 50 billion dollars.

A sad truth is despite universal head scratching, we have not really been able to implement strategies to fight off obesity at a population scale. Strategies have been suggested, however conflicting interest groups make it close to impossible to implement strategies that could lead to the reversal of such an epidemic. Furthermore, to complicate matters, we don’t have a single mass scale field-tested  epidemiological intervention that we can pull from and emulate elsewhere that we can use to fight off obesity.

Our gains in health care over the next several decade will largely depend upon how well we are able to mount population level interventions against risk factors such as  obesity. Ingenious research, adept interventions,  forceful advocacy and implementation of population scale strategies will be required to make any dent in the epidemic of obesity.

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