The Obesity Epidemic: New Research, New Solutions?
It’s no secret that obesity is one of the most serious public health concerns in North America. In fact, rates of obesity have more than doubled in the last 50 years, according to the Centers for Disease Control and Prevention. But while researchers know that obesity is a deadly problem, they are less certain when it comes to the major causes - and the solutions.
Research presented at a media workshop by the Canadian Institutes of Health Research in mid-March highlighted the need for more insight into obesity and its roots. Experts at the presentation said that the problem is not a genetic one alone, nor can it be blamed entirely on environments or learned behaviors. Instead, they emphasized the variety of factors that can play a role in leading to obesity.
“Obesity’s not rocket science,” said Dr. Diane Finegood, director of CIHR’s Institute for Nutrition, Metabolism and Diabetes. “It’s a lot more complex.”
Biological factors like genetics or diet do play a major role. Genetics help to determine where we gain weight, said Dr. Jean-Pierre Despres, a professor at Universite Laval in Quebec. And where our genes tell our body to store fat—whether we’re an apple shape that stores it on our stomachs or a pear shape that stores it on our hips—is an important factor for determining our cardiovascular risk, he said.
In one major study spanning 63 countries, done by Despres and colleagues, researchers found higher rates of diabetes in those with the highest waist measurements, whether or not their body mass index classified them as overweight or obese. “This is really making the point that private care physicians, when they are told and shown how to measure waist circumference, are not measuring noise,” he said.
For someone who discovers that his or her waist is too large, and wants to lose weight to reduce the measurement, the solution would seem to be easy: eat less and move more. “Obesity is the outcome of a positive energy balance,” said Dr. Angelo Trembley, a professor at Universite Laval. But research done by Trembley and others has shown that it may not be that simple. A variety of biological factors that wouldn’t automatically occur to us may also be contributing to the dramatic rise in obesity rates, he said.
New evidence also suggests that micronutrients may affect fat loss or gain. A study led by Trembley found that subjects in a placebo group couldn’t achieve significant weight loss, despite a carefully restricted diet, while those who took a calcium supplement had better results.
“We cannot exclude the possibility at this time that some individuals might gain some weight due to deficiencies in some vitamins and minerals,” he said.
Poor sleep is another factor that may affect the body’s ability to control appetite. A lack of sleep can increase levels of ghrelin and decrease levels of leptin, which results in increased hunger and appetite. The Quebec Family Study showed that short-sleepers were more likely to be heavier, with more body fat and a larger waist circumference.
Data collected by Dr. Gillian Booth, and other researchers at Toronto’s St. Michael’s Hospital, showed that it is not just individual lifestyle choices that are contributing to obesity, but environments, cultures and political landscapes as well.
North America is facing an epidemic of diabetes due to increases in obesity rates, Booth said, and her report on diabetes in Toronto showed that diabetes rates in the city were highest in areas found to be less friendly to healthy choices - fewer sidewalks and bike paths, less access to fresh fruits and vegetables, fewer parks, and fewer physicians taking new patients. Diabetes rates also showed strong correlations to ethnicity - many non-white ethnic groups have higher diabetes rates than Caucasians.
So, if we know that there are a confluence of factors, from genetics to lifestyle, how do we fight the epidemic? Researchers said that attacking obesity “from all sides” was the best solution. For changes to make a difference in people’s behavior, and then in their health, they must be comprehensive, addressing the physical, economic, sociocultural and political environment people live in.
For example, research done at the University of Alberta found that the city of Edmonton had 61 supermarkets, but 761 fast food outlets, many of which were concentrated in poorer neighborhoods. There were 2.7 times the number of fast food restaurants in poorer neighborhoods than in middle-class or high-income neighborhoods, and a similar ratio has been found in the United States. A promotional campaign endorsing fresh fruits and vegetables will have little effect if people cannot easily find those items close to home.
While new research doesn’t offer a key to one, overarching solution, it is a step in the right direction. Pointing out that more than one change is necessary, and then taking action to make transformations to multiple areas of lifestyle and environment, seems like the best, and most comprehensive, line of attack.
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