Is There Hope For Obesity and Diabetes Prevention?Wednesday, December 7, 2011
This morning, at the World Congress on Diabetes, I attended a talk by Paul Zimmet, professor emeritus from Melbourne’s Baker Institute, on ‘diabesity’ as a global threat to health and economies.
Zimmet reminded us that in 2030 almost 500 million people will be living with type 2 diabetes, two-thirds of these in the developing world. This increase, largely driven by increasing obesity rates, is almost directly proportional to economic development in these countries.
So while it there is no doubt that this burden of disease will significantly impact global health and economies, Zimmet also spoke out against the often proposed ‘simplistic’ notions that simply banning or taxing sugar soft drinks or imposing bans on food advertising, which are unlikely to have major impacts on these numbers.
As Zimmet points out, even a cursory glance at the Foresight map should make it immediately evident that such simplistic (and populistic?) approaches discount the remarkably interconnected ‘tangled’ complexity of the problem.
Indeed, there are unfortunately currently no ‘proven’ population approaches to preventing or reducing obesity – a real challenge for ‘public’ health efforts.
Thus, although there is general acceptance that prevention is better than treatment – there is no consensus or hard evidence that any such approaches are actually effective beyond rather rare instances of isolated ‘anecdotal’ examples in communities or populations, that are generally not transferable or scalable enough to impact a relevant proportion of the global at-risk population. There is also very limited evidence on the long-term impact of such ‘successful’ interventions.
This, of course poses a major dilemma for a prevention approaches to obesity or diabetes. Especially, when, as Zimmet points out, we consider the role of biological drivers of the epidemic (such as epigenetic modification), it is not really clear how this global ‘diabesity’ epidemic could indeed be reversed in the foreseeable future.
So while in the end, one certainly will require population- or societal-wide prevention efforts, where exactly these should begin and how effective these will be remains anyone’s guess.
Certainly not a happy or optimistic picture of the future of global health.
Certainly a lot of food for thought (pun intended) – but no immediately obvious solutions to the problem.
Wednesday, December 7, 2011
Your pessimism about making the fat people – a significant percentage of the populations of developed countries – into thin people is probably justified. Don’t get me wrong. I don’t think that long term weight loss is impossible for everyone. I just think that for the majority of fat people, it’s not worth the price. That’s why so few of us succeed at it.
However, I’m not sure that your pessimism about the health of populations is as justified. I understand that if you believe that fat people are innately unhealthy, that’s the conclusion you’d come to. However, in reality BMI is just a risk factor and fat people can be healthy; we often live just long and as well as smaller people. Instead of trying to figure out how to turn fat people into thin people, what if you were to try to figure out how to make fat people healthier?
When fat people have health problems, we tend to be blamed for them. When we stay healthy for decades and decades, people tend to attribute it to luck or heredity. In reality, luck and heredity always play a role, but I suspect that habits do as well. That’s why so many studies show improvements in health with only a modest weight loss, or before any weight loss has occurred. It’s the habits that really matter. That 10% weight loss that seems to have a beneficial effect on health is a side effect, not the main event. And the health improvements will probably happen with an improvement in habits with or without that small, aesthetically insignificant weight loss.
When you make the good habits all about weight loss, people won’t keep them up if they don’t end up noticeably thinner. And before anyone asks, one of those habits is definitely regular physical activity. I’m less sure about the effect of eating habits, although obviously it’s a good idea to eat a regular meals with a variety of foods.
I do know that maintaining a large weight loss is uncomfortable and difficult for most people, while eating healthy food and having active hobbies is much more pleasant and has many rewards that have nothing to do with body size: improved mood, improved strength, stamina and flexibility, higher energy level, opportunities for friendship, better posture, and on and on.
People in western countries have been getting heavier, on average, pretty much since the economic recovery after WWII. However, our life expectancies keep increasing. Is it really so crazy to think that people can be healthy without being thin, and that doctors should support them in that; treat health problems without demanding weight loss, provide positive reinforcement for healthy habits independent of the patient’s body size, and only address weight in the context of a patient’s weight history?
Wednesday, December 7, 2011
There is hope on the horizon. A few days ago Medicare, the US federal health insurance plan, approved lifestyle and weight management counseling for obese individuals. Although it is limited to persons enrolled in Medicare, it provides one session per week for up to 9 months. Research proves that counseling can be effective for up to 10% weight loss over 6 months. This is not only a big step forward, but usually the large private insurers such as Blue Cross and State insurance carriers typically follow Medicare. Just maybe…..
Thursday, December 8, 2011
Do you know the European program : EPODE ?
Isn’t it a preventive population approach ?
Thursday, December 8, 2011
@Thoelen: I am well aware of EPODE and it certainly appears promising – however, it is still being evaluated and we have yet to see long-term results and outcomes – let’s hope the original findings are transferable, scalable, cost-effective and sustainable in the long-term. I guess time will tell.
Tuesday, April 15, 2014
I am with DeeLeigh on this. I have yo-yoed for years dieting and never kept the weight off for any significant amount of time. I have been the least healthy when I was dieting because I did not get as much physical exercise as I was getting when I was obese. I weighed three hundred pounds but was swimming a hard mile every morning in 50 minutes. I felt great, but I was embarrassed by my size. I lost 50 pounds when I went on Medifast, felt great, but was in terrible shape because I could not keep up the exercise on that kind of diet regime. I am back up to 300 pounds again, and am beginning to swim, but I can only go a very difficult and laborious half mile so far. I should have kept swimming and to hell with Medifast. The key is to stay healthy, eat healthy, and I if you are obese, se la vie. Don’t let the bastids get keep you down. And all you fat girls out there. I think you’re beautiful!