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Obesity and the Global Burden of Disease

Last week, The Lancet published the first part of a monumental effort to describe the global burden of disease – I have not read the report.

But, from what I can garner by a cursory look at the abstracts and the many news articles, deaths from starvation are down, whereas deaths from obesity are up (the ratio apparently is now one to three – at least according to some media reports).

I cannot say that I am in any way surprised, not should any one else be.

It is also not surprising that when obesity rates increase hand-in-hand with increases in life-expectancy, then more people will be living longer with obesity related health problems (see my previous post on this).

While the report is descriptive and can neither make nor claim insights into what drives all of this, the warnings for our health systems and policy makers are clear – ignore obesity at your own risk.

In the same manner that obesity did not appear overnight, no public health measures can be expected to make it disappear any time soon (some predict this may be take several decades short of catastrophic and disruptive global events).

Over the last 50 years, we have made considerable strides in our ability to treat diabetes, hypertension, dyslipidemia, heart disease, and other obesity related health problems – one reason why people with these conditions live so much longer today than ever before.

The biology of glucose homeostasis is complex – yet we have effective treatments for diabetes.

The biology of blood pressure regulation is complex – yet we have effective treatments for hypertension.

The biology of cholesterol synthesis is complex – yet we have effective treatments for dyslipidemia.

The biology of coagulation is complex – yet we have effective treatments for blood clots.

The biology of energy homeostasis is complex – why do we not have effective treatments for obesity?

Is it because we simply don’t like fat people and think they deserve less?

Edmonton, Alberta


  1. “The biology of energy homeostasis is complex – why do we not have effective treatments for obesity?

    Is it because we simply don’t like fat people and think they deserve less?”

    Yes, the stigma towards fat people has affected the science and research.

    “When I looked into this stuff, this was the late 90s, I couldn’t find ONE study that had taken the severely obese over 400-500lbs and actually seriously studied them. Ok, there may be some limits, they are immobile, often ill with co-morbs galore, but every other condition is studied in it’s most extreme forms why not obesity? Could some of you please study us with the motive to help the severely obese?

    Sometimes I want to ask, do obesity researchers really want to help people or is all the research now financed to feed the belly of the diet-industry complex? Am I going into conspiracy land to ask this? It kind of bugs me when I see so much of the research for a new product or related to weight loss surgery. I know one has to get funding for research but could someone please think outside the box for once. Is the future of treatment for obesity restricted to risky weight loss surgery?

    More and more I think fat people [especially super obese] are physiologically different but this is horribly denied. Diet, exercise and lose weight and supposely the formula applies to EVERYONE. Sorry guys, but it is failing. This tells me more research needs done. Back in the 1800s, they used to admit that people had different metabolisms, some even far lower then others, what happened to that? Can any of you admit these physiological differences? Maybe some of you already have, but it’s not affecting society much. They still expect all bodies to function the exact same.”

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  2. With all the hysteria over obesity, it is very difficult for a non-expert to really understand the significance of articles reporting on “deaths from obesity.”

    We have trouble assessing what number or proportion of deaths are a) clearly related via a causal path to obesity, and which are b) merely deaths from conditions associated with obesity, for which no strong evidence causal path from obesity has been established (biological pathways to disease being of more interest, but also acknowledging social pathways such as stigma and medical neglect).

    Then, for any deaths in the “a” category above — those clearly caused by high BMI/obesity — for which of these do we have good evidence that they could be averted by a BMI/obesity-reducing intervention?

    If you have references to any suggested high-quality papers on this, they would be greatly appreciated. Thanks.

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  3. It’s because most people are 100 percent sure that going hungry as a therapeutic strategy is (1) benign and (2) effective. It is the opposite of benign and the opposite of effective. Until there is a well-publicised formal retraction of the historically common-place government, agency and medical advice to “just put up with hunger” as a valid approach to weight loss, progress will be stymied (and all heck will continue to break loose).

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