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Weighing In On Obesity

As waistlines continue to expand at an alarming rate, how do we begin to tackle the weight-gain pandemic?

Dr. Samuel Klein takes obesity every seriously. And he should. After all, it’s his job and main focus 24/7.

As the director of the Center for Human Nutrition at Washington University School of Medicine, he is a leading researcher on obesity. And there is, no doubt, plenty of research to be done. Unfortunately, we don’t yet have a clear understanding of this disease, so that can make it difficult to treat.

Sadly, obesity has become one of the top public health issues facing the nation and the world today. In fact, this year, obesity was designated as a chronic disease by the American Medical Association.

Vivian Wang, President, Lifescan EMEA

Likewise, diabetes is on the rise. Why? “More people are getting diagnosed,” said Vivian Wang, president of Lifescan EMA. “As countries become more wealthy, a more Westernized diet becomes available and people become more sedentary.”

With that said, it comes as no surprise that diabetes is the main driver of health care costs in the U.S. In fact, the total cost is a whopping 234 billion, according to Wang. And more than a third of American adults and nearly one child in five are now obese, according to the Centers for Disease Control and Prevention. What’s frustrating, though, is that “95 percent of Type 2 diabetes is preventable by practicing healthy eating habits,” Wang said.

“We are experiencing a pandemic of obesity,” said Dr. Daniel Kelly, Sanford-Burnham’s scientific director at last month’s Lake Nona Impact Forum held in Orlando. “It’s a lethal problem in that it’s driving Type 2 diabetes.”

What’s worse, is that is has now moved into the pediatric population. “We’re seeing children with not Type 1 but Type 2,” Kelly said.

Clearly, it will take a multidisciplinary approach to solve the massive problem.

On a positive note, though, “we are starting to understand the behavioral aspects of diabetes,” said John Brooks, president and CEO of Joslin Diabetes Center. “Having that kind of understanding is going to be critical.”

How did we become so fat?

To fully comprehend what comes next, we must first look at the past and how we got where we are.

One problem is the fact that it doesn’t take very much to become obese in the first place. The environment we live in, for starters, makes it very easy. We are all genetically predisposed to become obese. We were geared to be in a very harsh environment.

Sam Klein, MD Danforth Professor of Medicine, Washington University School of Medicine

“We are eating more refined foods,” said Klein. “And food portions have become much larger.”

“There is some data to suggest food intake has changed, particularly snack foods,” Klein said. “The ingestion of snack foods has really increased, which has contributed a lot to the caloric intake. Whereas physical activity has gone down a little bit, but not so much as we think.”

And it’s not just Americans. More than 100 million people in China now have Type 2 diabetes, according to a comprehensive survey published in the Journal of the American Medical Association. This means diabetes is now more prevalent in China than in the U.S.

But if you glance back at China a few generations ago, that didn’t exist. As they move toward an urban society, there have been changes in their eating habits.

It truly is a global issue.

However, we are starting to see people taking action. New York, for example, has continued to try and ban large, non-diet sugary beverages.

How do we fight back?

“While obesity itself may not be lethal, the complications that it drives truly are lethal,” said Kelly. It is now, in fact, the leading cause of preventable death.

One reason for this is because it drives heart failure and numerous other conditions ranging from stroke and hypertension to osteoarthritis and sleep apnea.

“We clearly don’t understand this disease,” Kelly said. “Complex diseases have a very significant environmental and lifestyle component. And the genetic variation evolves over millions of years.”

Daniel Kelly, MD Distinguished Professor & Scientific Director, Sanford Burnham Medical Research Institute

So where does that lead us? Could we harness the power of the genome to help solve this problem? Could gene discoveries help us to take actions that would reduce Type 2 diabetes in the population?

That remains to be seen.

One thing we do know is that objective monitoring and positive feedback play a key role in the grand scheme of things. Whether it’s the genome or the metabolome, to learn more would allow the patient to get the feedback that they need. And many experts agree that this could have potential for behavioral modification and weight loss.

“We have CEOs of companies who walk through walls to get objectives done, they can solve anything, but they are unable to make that small lifestyle change in order to lose weight,” said Klein. “They control their environment – they schedule the lunches, they schedule the dinners – but they are unable to make that change.”

It’s a very complex problem, indeed.

There are many irons in the fire because we know it’s an extremely complicated disease. While it’s crucial that we continue to focus on the science of the matter, it’s equally important for physicians to have a clearer understanding of obesity, too, so they can counsel patients on ways to lose weight. Oftentimes, physicians are not trained in the treatment of obesity. However, they essentially are the quarterbacks for Type 2 diabetes.

Take the cell phone, for example. In many parts of the world it could, in fact, be a great diabetes management device. The key is: How do we use it to reinforce good behaviors?

At the end of the day, of course, there aren’t any silver bullets. It’s a multi-factorial problem. And sometimes it boils down to simple programs. For instance, how do we get people to take the medications that have been given to them? And, more importantly, do we know which medications are the right ones?

We’re going to have to tackle a lot of these issues just given the magnitude of the problem.

“What we do know is how individualized things have become,” said Wang. “We definitely see that with people who have diabetes or people who are prone or predisposed. It’s very individualized as to what they are able to overcome or change or not.”

Looking into the future, it’s important to really understand what causes people to adopt certain behaviors. This is really where the solution’s going to be.

How exactly do we tackle this across the board? How do we come up with better ways to prevent or treat obesity and obesity-related diseases?

Many agree that a widespread campaign could help change behaviors.

Think about what helped drive smoking rates down from 40 percent to 20 percent. Remember when the government banned tobacco ads from television in the 70s? After that, tobacco taxes hiked up. The nicotine patch eventually was created and smoking was banned in many public places.

Just like it took decades for smoking rates to go down, obesity cannot be cured overnight. But there is certainly hope in the long run. There is such a huge focus on this issue right now that we’re bound to make strides at some point.

In other words: “This will actually be a very exciting time to be obese,” said Klein.