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The Obesity Epidemic

The Trials and Tribulations of Obesity

In the past few years researchers have been avidly searching for a cure for the western and increasingly pandemic problem of ‘obesity’, because of all the predisposition for diseases that the condition entails. For example, people who are obese more frequently have high blood pressure (HBP) and coronary diseases related to hardening of the arteries, with blood clots in the heart and the brain, and stroke;¹ plus other related problems including non-insulin dependent diabetes, gallstones, &c.²

Obesity may also increase the risk of some types of cancer. For example, in 2001 French scientists investigated energy intake, a sedentary lifestyle, and high BMI (Body Mass Index) associated with a high risk of cancer itself or large adenomas, which indicate an effect on promotion of colorectal tumours. Their findings suggested that preventive advice regarding these factors should be provided, even late in life, to decrease the risk of colorectal cancer.³ This is important, as in the USA alone, more than 50,000 people die from colorectal cancer annually.⁴ It is the second-leading cause of cancer deaths for men and women combined, and more lives are lost each year to it than to breast cancer and AIDs combined.⁵

Obesity can involve other cancers. Earlier this year, scientists in the Republic of Ireland investigated of 760 patients, taking into account recent evidence linking obesity with the rising incidence of oesophageal adenocarcinoma, which in Ireland between 1995-2004 increased by 38%, coinciding with a 67% increase in the prevalence of obesity. They discovered that the odds ratio for adenocarcinoma of the oesophagus, the oesophago-gastric junction and gastric-cardia rose significantly with increasing BMI. Also, for tumours of the lower oesophagus obesity increased the risk 10.9-fold, but the increased risk was found to be significant in males only.⁶

Internationally, in a large study by Australian researchers, similar observations were made i.e. they observed an increased risk of adenocarcinoma of the lower oesophagus and gastric-cardia associated with increased BMI, central adiposity (fattiness) and the non-fat component of weight, but found no association with non-cardia gastric adenocarcinoma. They concluded that an increasing prevalence of obesity may be associated with the increasing incidence of gastro-oesophageal cancer observed in many populations.⁷

A brand new American study suggests that excess fat may affect tumour biology and that women who are obese get more aggressive ovarian cancers, and are more likely to die from the disease. The lead researcher said: “This study is the first to identify weight as an independent factor in ovarian cancer, in disease progression and overall survival, suggesting that there is an element in the fat tissue itself that influences the outcome of this disease in obese women.”⁸

The study’s authors believe fat cells excrete a hormone or protein that makes ovarian cancer cells grow more aggressively. Other studies have found compounds that may contribute to the ‘aggressive’ aspect of the disease. One called insulin-like growth factor 1 (IGF-1) is more highly expressed in obese people than those who are slimmer, and IGF-1 also correlates with increased breast cancer risk in women. Another is a binding protein for IGF (IGFBP-2) which appears to promote invasion in ovarian cancer.⁹

The study involved looking at the course of the disease in 216 women with epithelial ovarian cancer, the most common type of ovarian tumours, which accounts for 90% of cases. A comparison of the 35 women who were obese with the 108 women who were an ideal weight revealed significant differences in cancer outcomes.¹⁰ Obesity influenced survival rates, shortened the length of time that the cancer recurred after treatment, and lead to an earlier death from cancer.¹¹

This research is exceedingly important, as ovarian cancers are difficult to diagnose and most women are diagnosed with late disease, about 70% of which die within five years of diagnosis, making it one of the most lethal forms of the disease. Annually, approximately 6,800 UK women are diagnosed with ovarian cancer, and whilst it may occur at any age, it is most commonly found after the menopause.¹² Deaths from ovarian cancer accounted for 13,627 deceased reported in the USA in 1999, and the post-diagnosis survival rate, i.e. living for five years, for white and African American people was 52% (1992-1999) alike.¹³

Although obesity as a risk of heart disease is by now well-known, and overweight is associated with increased relative and population risk for hypertension and cardiovascular problems, ¹⁴ there is some concern that its relationship to cancer is little known to the general public.¹⁵

In a current UK survey of public awareness of obesity as a cause of some cancers, polling 4,000 adults, it was discovered that 32% knew weight-loss lowered cancer risk, but almost half 40% thought the major reason to maintain a healthy weight was ‘looking good’; which applied to 48% of the younger more ‘image conscious’, whereas twice as many (67%) realized that losing weight reduced the risk of heart disease.⁵ In the over 65s age group, looking good and cancer risk were equal reasons, 25% listing both. As a result of this ‘lack of awareness’, ‘Cancer Research UK’ has now linked up with the charity ‘Weight Concern’ to offer a simple weight management programme, giving advice about eating a healthy and balanced diet and building regular exercise into daily life.¹⁶    

Perhaps it is even lesser known that obesity can also lead to kidney disease via diabetes and HBP, which are the leading causes of chronic kidney disease, ¹⁷ as well as causing the better known difficulties in mobility and increased risk of mortality.¹⁸

The health implications of obesity are wide and far-reaching. For example, last year the effects of obesity on asthma were investigated by a team of Swedish researchers. They established that in a group of 309 newly-diagnosed asthmatics obesity is ‘a risk factor’ for asthma. The how or why of it was unknown, but their study concluded that in addition to hay fever, a family history of asthma, allergic sensitisation, ex-smoking status, increased body mass index was a significant risk factor for incident asthma, independent of sex and allergic status.¹⁹

Hot on the trail, a few months later Australian researchers discovered obesity is associated with reduced lung volume that is linked with airway narrowing, which in males is greater than that due to reduced lung volume alone.²⁰ The mechanisms causing airway narrowing and sex differences in obesity are as yet unknown,²¹ but the science fraternity are working on it.

Last month, according to UK research, the effect of being obese on net change in diagnosed asthma was greater in women than in men, but for net change in ‘wheeze’ without a cold it was greater in men.²² These results are consistent with asthma being more frequently diagnosed in women, especially obese women, and may help to explain the reportedly stronger association between asthma and obesity in women than in men.²³ It may be concluded that ‘asthma’ must be added to the lengthening list of risk factors of obesity.

There is yet another recently publicized obesity threat; it doubles sight-loss risk and is a factor via other diseases for the onset of ‘blindness’.²⁴  Obese people have double the risk of losing their sight because their weight increases their chance of developing certain conditions.

A Royal National Institute of the Blind (RNIB) report has said that the obese run the risk of developing four main conditions concomitant with sight loss: Age-related macular degeneration (AMD), the UK’s leading cause of sight loss affecting approximately 500,000 people.²⁵ Those with a BMI of over 30, classed as obese, have double the risk of the most common form of the latter condition – dry AMD.²⁶ Plus obesity has been found to increase the rate of progression of wet AMD, which can lead to blindness in as little as three months.²⁷ Those who are genetically predisposed to AMD should be particularly careful about their weight, as the risk of the condition increases in normal weight people from four-fold to eleven-fold in the obese.²⁸

If obese, people also have double the risk of cataracts, linked to 1-in-4 cases of sight loss in the over-75s age group, and also significantly increases the risk of type 2 diabetes, which in turn is linked to diabetic retinopathy.^{29 & 30} The report also states that sight loss risk through diabetes is particularly high in people of Asian, African and Afro-Caribbean extraction, who are 4-5 times more likely to develop diabetes.³¹ There is also a link between being severely overweight and glaucoma, caused by pressure within the eye.³²

Advice to ‘safeguard sight’ given by Barbara McLaughlan, an eye health consultant who wrote the RNIB report, is: (for) “people to maintain a healthy weight, eat lots of fresh fruit and vegetables, take exercise to improve general health, don’t smoke, and most importantly have regular eye tests. Many thousands of people lose their sight each year through conditions that could have been treated if picked up early enough through an eye test.”³³ 

Furthermore, American researchers found a year ago that because obesity has led to a dramatic increase in the incidence of type 2 diabetes (T2DM) among children and adolescents over the past two decades, children and adolescents with T2DM may experience the micro-vascular and macro-vascular complications of this disease at younger ages than individuals who develop diabetes in adulthood.³⁴ These include effects upon cardiovascular disease, stroke, myocardial infarction, and sudden death; renal insufficiency and chronic renal failure; limb-threatening neuropathy and vasculopathy; and retinopathy leading to blindness. The youth of the world is the future, consequently with so much at stake, the researchers recommended that health care professionals are advised to perform the appropriate screening in children at risk for T2DM, to diagnose the condition as early as possible, and provide rigorous management of the disease.³⁵

However, regarding health and disease, it is not a question of solely targeting those who are obese, those who are over-weight should also take heed of their health status. While the link between being overweight and dying prematurely is controversial, according to new American research³⁶ there is little room for complacency. Although obesity is known to contribute to early death, and some experts have argued that a few extra pounds does no harm, this latest research found a few too extra pounds that may not seem significant can be harmful.³⁷ Dr. Michael Thun, chief epidemiologist of the American Cancer Society, who had no role in the research, stated: “Being overweight does increase health risks. It’s not simply a cosmetic or social problem.”³⁸

Involving over half a million people, the American study’s conclusion was grave. It stated that excess body weight during midlife, including overweight, is associated with an increased risk of death.³⁹ Researchers analyzed patients BMI and mortality rate over a 10-year period. Overall, baby boomers that were underweight or obese had increased risk of death compared with normal weight people, but the risk was particularly high for Hispanics, Asians and American Indians than for whites and blacks. The simply overweight had no substantial increased risk, but in a separate analysis of 186,000 healthy people, who had never smoked, overweight people were 20%-40% more likely to die prematurely than normal weight people. The risk increased 2-3-fold for obese people. What happens in the USA today can happen in the UK tomorrow.

To further ram home the message, on the other side of the world a separate large study of 1.2 million Korean patients reached a similar conclusion.⁴⁰ Allowing the association of BMI with death varied according to the cause of death and was modified by age, sex, and smoking history, it concluded that underweight, overweight, and obese men and women had higher rates of death than men and women of normal weight.⁴¹

Such controversy will be up for debate and argument for some time, as is the BMI measurement itself in dispute, ⁴² but it is clear from this latest research that maintaining a normal weight is highly desirable for a healthy life and to avoid a premature death.

Obesity – A Worldwide Issue

Rates of obesity are climbing everywhere. What is particularly ominous is that the percentage of children and adolescents who are obese has doubled in the last 20 years.⁴³  More than half the US population is overweight, at least 1 in 5 children. It is considered an epidemic there and in other developed countries. It is so prevalent that some $45 billion is spent on treating disease associated with obesity, plus businesses carry an estimated loss of $20 billion in productivity each year from absence due to illness caused by obesity.⁴⁴

A new American study of medical records of more than 120,000 children who visited doctors from 1980-2001 found that children under 6 years old in Massachusetts are more likely to be overweight than two decades ago.⁴⁵ “No age group, even infants under 6 months old, was immune from the trend. The results of this study point out very clearly that the origins of overweight are at the origins of human life, even at birth,” according to Dr. Matthew Gillman, senior author of the study and associate professor at Harvard Medical School.⁴⁶ Other studies have shown that accelerated weight gain in a child’s early months can predict weight problems and higher blood pressure later in life.

The prevalence of obesity in England has almost tripled since 1980. In 2001 about a fifth of the population (approx. 60+ million) were obese. Nearly two-thirds of men and half of women in England are either overweight or obese.⁴⁷ It was suggested at that time eating patterns and sedentary lifestyles are the most likely explanation for the upward trend. For example, in a typical week in 1997 four in five young persons aged 4-18 years consumed white bread, chips, savoury snacks, biscuits, chocolate confectionery and boiled, mashed and jacket potatoes.⁴⁸ Children and adolescents from higher socio-economic households were more likely to have eaten raw and salad vegetables, apples, pears and bananas than those from lower socio-economic households,⁴⁹ which also points to ‘family income’ playing a directive role in the diet of low income groups rather than wholly choice.

America may be at the top of the obesity league, but Britain is running a close second. It is sitting on a public health ‘time bomb’. Three years ago just over 9 million adults were classed as obese. But, in accordance with current trends, the latest Government report projects that by 2010 1-in-3 UK adults will be obese.⁵⁰ More than 13-14 million adults and children will be so dangerously fat that they are putting their health at risk.⁵¹ Experts are blaming the phenomenal surge in obesity levels on over-reliance on Junk Food, progressively more sedentary lifestyles; the use of TV and computer games as ‘electronic babysitters’ also intensifies the swell in child ‘couch potatoes’.⁵²

It is also reported that in the UK obesity causes 9,000 deaths every year and an estimated annual cost of up to £1billion to the National Health Services (NHS) in extra treatment.⁵³ The annual cost to the nation as a whole is put at an astounding £7billion,⁵⁴ and the situation looks set to get dramatically worse.

It has also recently been reported, in a special edition of the British Medical Journal, that China has been warned to look to its rising child obesity. People in China are becoming overweight at an alarming rate. According to Chinese Professor Yangfeng Wu from the Chinese Academy of Medical Sciences in Beijing, in the 15 years (1985-2000), the number of overweight and obese children increased 28-fold.⁵⁵ Once a lean nation, today a fifth of the world’s overweight and obese people live in China, and numbers are rising drastically. In big cities like Beijing and Shanghai, there is an average of one obese child in every five.⁵⁶ A range of underlying causes were cited, including changes to traditional diet, reduced levels of exercise, sedentary lifestyle and the rapid increase in car use.⁵⁷

As one Indian newspaper put it, ‘the world is round and so are a growing number of its inhabitants’.⁵⁸ In fact, obesity is spreading at a disturbing speed everywhere, not just in industrialized countries but also in developing countries, where obesity often sits alongside malnutrition. The global ‘fat’ problem is evidenced from China, to Australia, to Egypt, to remote islands of the Pacific, and beyond. In developing countries, it is now estimated that more than 115 million people suffer from obesity-related problems, including Type II diabetes, heart disease and obesity-related cancers.⁵⁹

The problem is now so severe that yesteryear’s British seaside holiday cartoon post-cards’ depictions of ‘fat ladies’ no longer seem so very jolly.  

US & UK Wake-Up Calls

The obesity story will rightly run and run until it is under some kind of control. Nevertheless, there are some signs that this global ‘crisis’ is beginning to be tackled.

Whilst the EU has been busily targeting and putting OTC (over the counter) vitamins and supplements of remedial dosage out of reach of the health-conscious UK public who wish to be more responsible for their own health and well-being, including shunning GM foods, the US appears to have had an obesity ‘wake up’ call. We in the UK may aptly blame America’s Fast Food Empires as a prime cause of overweight and obesity, however the US is at last taking some ‘action’ on its own home-ground.

There is a strong signal of federal commitment to fighting obesity and chronic disease through nutrition. Recently, they have opened up a new $25m laboratory and office building in Davis, California, where the Western Human Nutrition Research Centre (WHNRC) at the University of California-Davis campus will house the US Department of Agriculture’s Agricultural Research Service (ARS).⁶⁰ It is reported that such: “… public research facilities could bring positive spin-off effects for the supplement and functional food industry, as the government aims to stem national health problems at their cause. …”⁶¹ – could that ‘cause’ be interpreted as the modern Junk and Fast Food impoverished diet!

Things are really looking up stateside, the ‘good news’ is WHNRC expertise spans nutrition, exercise physiology, chemistry, immunology and specializes in exploring new and healthful ways to fight obesity.⁶²  Scientists of WHNRC conduct pioneering studies to discover how nutrients and nutrient-like compounds in foods and beverages can help prevent chronic diseases that are among the leading causes of death in America, which include heart disease, stroke and certain kinds of cancer.⁶³ The centre’s research team has increasingly focussed on ‘nutrigenomics’, an emerging field which benefits from still-unfolding discoveries in human genome research, which studies bring the promise of discovering how genes influence the body’s ability to absorb and use essential nutrients.⁶⁴      

In the UK, the “5-a-day” campaign has appeared to have some effect on certain segments of the population, the discerning, those that can afford healthier organic food and/or persuade their offspring to eat fruit and vegetables instead of a regime of cheap Junk Food, snacks and fizzy drinks. Yet press and media repetition of the “5-a-day” campaign, via bill-boards and reiteration of British government rhetoric by the press and media, do not seem to have pricked the ever-inflating obesity balloon – the problem, like the pantomime shows say: “grows bigger and bigger”.

To meet the seeming apathy of the public towards this approach, the government has launched a fresh attempt to tackle obesity in England by appointing a ‘Minster for Fitness’.⁶⁵ The lady minister concerned, Public Health minister Caroline Flint, will be working across all government departments to develop a new fitness strategy to see how to better look at current policies and how money is spent to enable people to improve their health, but no ‘new money’ or a specialized facility was immediately mentioned.

The minister has been given the task of getting people to boost their activity levels. The aim is to get people to build physical activity into their daily routines to create a healthier nation; a ‘carrot’ of encouragement for this ‘stick’ is the run-up to the 2012 iconic image of the Olympics to be hosted in the UK.⁶⁶

Fitness has to be tackled sensibly, for too much or a sudden onslaught of exercise upon a body that is unused to it, or beyond natural endurance, can kill.⁶⁷ If unfit to begin with, before entering into an exercise regime it is wise to get your health status checked out first. Even the very young can have an undetected heart condition, as exemplified by the death of an 11-year-old Lancashire lad who lately collapsed and died on a school cross-country run.⁶⁸ He was indeed an extreme and unusual case, as he was born with a deformed heart. Short of surgery, no scan, X-ray or monitor would have given any indication of his state of health.

According to Olympic pentathlete and researcher Professor Whyte of the British Institute of Sport, those at risk range from ‘couch potatoes’ who suddenly start inappropriate exercise, to top athletes who overdo their training regimes. Sudden unaccustomed surges of exercise can also be dangerous, if otherwise unfit, e.g. for people who suddenly do a spate of ‘weekend’ exercise, such as Sunday football players or the ‘one-off’ untrained charity marathon runner.⁶⁹ It is a matter of moderation in all things. He also recommends doing 30 minutes of exercise five times a week, with activities ranging from brisk walking to dancing and sports.⁷⁰ Dancing is one good fun route to exercise for all age groups, and music can be introduced into many forms of exercise to make it more appealing.

Additionally, this month, the Scottish Education Minister, Peter Peacock, in response to calls for better food and sports facilities in schools, announced that pupils in Scotland are set to benefit from a £30 million investment drive to provide a healthier environment in schools.⁷¹ The funding will be added to the ’Schools Fund’, which helps councils make improvements to schools in their area. Proposed improvements include revamping school canteens, creating better sports facilities and school environments, encouraging use of solar panels and wind power.⁷² With regard to school dinners, the minister said: “Our ‘Hungry for Success’ programme has revolutionized our school meals. We now need to do all we can to encourage as many pupils as possible to stay in school at lunchtime and take them.”⁷³

Earlier this summer in the UK, in an effort to do battle with the bulge, the government launched its ‘Small Change Big Difference’ initiative, encouraging people to make small changes to their lifestyle in order to boost their long-term health.⁷⁴ It may be early days yet, but success of initiatives to date has been remarkably lacking by its absence. Healthy living advice such as: Eat regular, balanced meals. Eat at least five portions of fruit and vegetables a day. Avoid foods that are very high in sugar and/or fat. Eat less than 6g. of salt per day. Drink alcohol in moderation. For adults, take 30 minutes moderate activity (exercise) five times a week, and for children, an hour a day of moderate activity,⁷⁵ are all already well trodden exhortations to the public by the medical profession and government alike. What it will take to get the public to put the words of these crucial mantras ‘into action’ is uncertain, but efforts are at long last being made by the Government.

So far one of the most practical approaches has fallen to the lot of the country’s GP’s to tackle and monitor. Thousands of GPs are set to carry out ‘intensive lifestyle interventions’ after a nationwide study shows they lead to long-term weight loss.⁷⁶ The Department of Health’s new strategy is to make ‘obesity management’ part of the routine work carried out by GPs, according to a report in the doctors’ newspaper ‘Pulse’, in an effort to slow, if not eradicate, the UK obesity epidemic.⁷⁷

This new scheme stems from a nationwide study, a ‘pilot’ plan, of the ‘Counterweight Project’ - a structured general practice programme, and the first large-scale practice nurse-led intervention aimed at improving the management of obesity in primary care, which was guided by a board of consultants from across the UK and facilitated by dieticians, involving 80 general practices and 2,000 patients.⁷⁸

Following health checks, patients were given advice on exercise, diet and calorie control, and where needed drug treatment or dietetic referrals. In 2005, the preliminary results of the project suggested 40% of patients who completed the weight management aspect of the programme achieved and maintained a 5% loss of initial body weight at 12 months.⁷⁹ Based on giving obese patients diet and exercise plans, after GP consultation, requiring attendance of just six fortnightly nurse-supervised appointments for advice on healthy living, obese patients lost up to half a stone (7lbs.) approx. 3 kilos. The results are inspiring, because it was found the Counterweight Project led to sustained reductions in weight, blood pressure and cholesterol.⁸⁰ Howzat for a reward for effort!

It is to be hoped that the importance of the dietary and exercise messages get through, as already in America it has been shown that obesity can interfere with medical care, either the patient may become too fat to fit into X-ray machines or scans are unable to penetrate the excess fat.⁸¹ Too much fat can obscure imaging tests, such as X-rays, CT scans, ultrasound, and magnetic resonance imaging (MRI). For example, in an ultrasound scan, the beam may not be able to get through layers of fat to get an image of an individual’s organs such as appendix, gallbladder, or kidneys.⁸² Too much body fat can make it more difficult for a doctor to make a medical diagnosis and treat a patient. Scans that have to be abandoned could mean a ‘no-’ or ‘mis-diagnosis’ of some life-threatening disease if an obese patient cannot be offered the best possible imaging test because of their weight.   

Reported statistics of the ‘obesity crisis’ may vary, but insufficiently to contradict that there is no room for doubt that a definite critical health predicament to be dealt with. The situation and vital statistics of obesity, when so many are wilfully or inadvertently putting their health and lives at risk, give a whole new meaning to ‘vital statistics’ when they refer to the ‘vital signs of life’.  

Childhood Obesity – Who’s Responsible?

Adults may chose to eat what they want, but children are increasingly at risk. A couple of years ago, a UK survey found that most people think the primary responsibility for improving a child’s diet should rest with the parents (88%) - (See also Herbsphere archived article –‘Food Choice Starts in the Womb’), but 43% thought schools played an important role, followed by food manufacturers and broadcasters.⁸³

However, more and more, the onus for children’s toxic diets is being laid at the door of food and drink companies, whose advertising can hamper well intentioned parents’ influence through the use of celebrity endorsements and the like. The poll, commissioned by the UK Food Standards Agency, resulted in the launch of a public debate on food promotion and advertising. This was ‘good news’ and very much in the public’s interest. Although some progress has been made there is still a great deal more to be done to curb food manufacturing companies’ food content and their ‘marketing’ forces’ influence upon the foods that modern children in general choose to eat.

Regarding food and drink manufacture, ‘toxic diets’ (high-sugar, low-fibre diets) fuel child obesity and cause hormone imbalances.⁸⁴ In the view of American professor Robert Lustig: “Young children are not responsible for food choices at home or at school, and it can hardly be said that pre-school children, in whom obesity is rampant, are in a position to accept personal responsibility”.⁸⁵ He cited food processing changes over the past 30 years, with sugar being added to a wide variety of foods that never used to have it, and fibre being removed from many foods create ‘essentially addictive’ foods.⁸⁶

It is perhaps in the area of food content, sugar, salt and trans fatty acids, (TFAs) - likely to be found in commercially packaged goods that contain ‘partially-hydrogenated vegetable oils’, ‘hydrogenated vegetable oils, or ‘shortening’, that governments can have the most influence on commercial marketing to improve the public diet.

Some messages are getting through to food manufacturers and/or retailers. It is reported that with the scientific evidence associating TFAs intake with an increased risk of coronary heart disease (CHD), the US Food and Drug Administration (FDA) issued a rule that brings in a labelling requirement declaring the amount of TFA present in foods, including dietary supplements, on the nutrition label by 1^st January 2006 - shaming many food manufacturers into taking these fats out of their recipes. ⁸⁷ However, “… there are many issues the FDA has yet to resolve: (i) defining nutrient content claims for “free” and “reduced” levels of trans fat, (ii) placing limits on the amount of RFA in conjunction with saturated fat limits for nutrient content claims, health claims, and disclosure and disqualifying levels, (iii) a daily value, and (iv) a possible footnote or disclosure statement to enhance consumer understanding of cholesterol raising lipids.

The FDA issued an Advanced Notice of Proposed Rulemaking (ANPR) requesting comments on the unresolved issues. FDA will also be conducting consumer research to determine consumer understanding of various TFA labelling possibilities. Comments to the ANPR, results of consumer research and current science will be used by FDA to resolve these issues and to determine future rulemaking for TFA labelling.”

Although ‘Marks & Spencer’ were the first UK supermarket to banish trans fats from their products this year. Further good news is that ‘Sainsbury’s’ has joined the anti-trans fat field. They propose to remove trans fats and all artificial flavour enhancers from their own brand lines by January 2007.⁸⁸ Sainsbury’s decision to eliminate trans fats from 15,000 products follows doctors’ warnings of the dangers of trans fats, which studies have shown raise cholesterol and are linked to heart disease.⁸⁹

Brazilian research (March 2006) states that the consumption of TFAs is larger in the US, Canada, and some European countries than in Japan and Mediterranean countries, and the incidence of coronary heart diseases is higher in countries where the consumption of TFAs is high. “In addition, trans isomeric seems to inhibit the action of desaturase enzymes of essential fatty acids (A5- and A6-desaturase) by holding back the biosynthesis of important fatty acids such as arachidonic acid and docosahexaenoic acid (DHA). With respect to pregnant women’s and infant’s health, concentrations of TFAs ingested by the mother are associated to concentrations found in the maternal milk. Besides the milk, the TFAs can be transferred to the newly born through the placenta. Studies suggest that TFAs can affect intrauterine growth due to the inhibition of the conversion of essential fatty acids by desaturse enzymes. The inhibition of DHA can also cause early atherosclerosis lesion.” ⁹⁰

The major reason for TFA’s existence is that these man-made fats increase products’ shelf-life. Some experts say that trans fats induce arteries to ‘fur up’, and are more harmful than saturated animal fats found in meat and dairy products.⁹¹ The British Medical Journal has very currently called for trans fat ingredients content to be listed on food labels⁹² – some are, on commodities such as biscuits. However, a good deal more needs to be done, but this is another step in the right direction to aid obesity.

One other bit of ‘good news’ is that in the UK Cookery Classes, called ‘Entitlement to learn to cook’ are going to be offered to pupils in secondary schools. It is not compulsory for all boys and girls, which is a pity - boys who leave home to go to university and the like also need to know how to feed themselves properly and not to live out of cans and on ‘take-aways’.⁹³ This is important, because we are now living in an era where many working mothers either never learned to cook or don’t, and older children are unlikely to have or take the leisure time to learn to cook from their grand-parents, even if they are geographically location-wise available.

Putting ‘cookery’ back on the curriculum in secondary schools is part of the drive to encourage healthy eating. The course of 24 lessons is to be launched September 2008 for pupils aged 11-16 who will get the opportunity to earn a ‘Licence to Cook’ certificate to improve their culinary skills, but it will not count towards a formal qualification. The Department for Education and Skills has already asked the Qualifications and Curriculum Authority to put a greater emphasis on cooking in ‘food technology’ lessons, as many of these lessons under the National Curriculum, when ‘Home Economics’ was replaced since 1988 by ‘Food Technology’, focus on design of food packaging and not actual cookery.⁹⁴ In the interim period, there has been a shift to ‘food theory’ instead of ‘hands on’ cooking.

It is also reported that there is to be a formal ‘ban’ starting this autumn term on junk foods, such as chocolates, crisps and fizzy drinks in school vending machines. School lunches will have to include at least two portions of fruit and vegetables per child per day, plenty of oily fish and access to fresh water. Guidelines stipulating vitamin, mineral and nutrient levels will be introduced in primary schools by 2008 and in secondary schools by 2009.⁹⁵

Too little, too late? We live in hope; anything that assists to remedy the obesity state of affairs has got to be good news.

“Cometh the hour, cometh the man”

Certainly, if somewhat lagging behind other western European countries, the British Government and Local Authorities have been given the message that children need decent school meals and more money spent on them, as a direct result of young TV Chef and entrepreneur Jamie Oliver’s startling BBC TV Series on ‘School Dinners’. His campaigning to ban Junk Food and to get fresh, tasty, and above all, nutritious food back on the school dinners’ menu message struck home through media exposure, and garnered a £280m rescue package at the end of March 2005. It’s about of third of what some nutrition experts say is required, in Oliver Twist parlance – “Please sir, we want more,” but it was a brilliant coup and start to a better future.

The elderly in hospitals and nursing homes are also often found to have malnutrition, partly from lack of time to see to individual needs and/or because, again, the food is just not nutrition-wise up to scratch. Where Government funding for healthy food applies a great deal more needs to be done across the entire public spectrum.

However, there are some more improvements on their way for school-children. The Education Secretary, Alan Johnson, announced the first week in September a package of new Government measures to improve school food and fight obesity.⁹⁶ In addition to the £220 million already going to schools and local authorities to support the new nutritional standards at the beginning of the autumn term 2006, the package will include £240 million to continue to subsidize healthy ingredients for school meals until 2011, after the current transitional funds run out in 2007/08. And, as well as the pupils’ new ‘Entitlement to learn to cook’ programme, £2 million for the establishment of a network of regional training kitchens to act as centres of excellence, hosting the area’s school cooks for training on day-release. There is also to be a specific fund for building school kitchens. In addition to the multi-billion pound ‘Building Schools for the Future’ and ‘Primary Capital Programme’; funding will be made available from 2008 to local authorities that have the most need for new kitchens.  

Recently, Jamie Oliver has been somewhat irate and disappointed with parents’ performances in relation to his efforts, i.e. continuing to feed their children ‘rubbish’ in their school lunch-boxes, which is counter-productive to bettered school dinners. So far the worst news reported in the ‘I don’t believe it’ category is, at one school in England, (Rawmarsh Comprehensive, Rotherham, South Yorkshire), a couple of mothers have been taking orders from pupils in break-time for Junk Food ‘take away’ lunches; first off for their own children and their friends, building up to many pupils.⁹⁷ They have been effectively running a lunch-time delivery service through and over the school fence. What is so upsetting about this childish adult rebellion is that the parents in question may not be doing anything actually unlawful, but by such action are interfering with the wishes of other parents and their decisions regarding their off-springs’ diet and health. Such puerile parental behaviour is not just a ‘kick in the teeth’ for Jamie Oliver’s efforts to get the Government to act to help school children fight obesity, it unintentionally demonstrates an even more valid scientific point regarding ‘parental influence’ upon children’s food preferences.

Recent up-to-speed research shows, wilfully or inadvertently, parents really do influence what their children eat.⁹⁸ It  is, of course,  inevitable that mothers get the sharp end of the stick, but the old adage that ‘we make mistakes so we can learn from them’ is the more positive approach.

There are literally well over a hundred research papers on the subject of what influences children’s eating preferences, i.e. ‘nature or nurture’, but this latest research is more definitive in suggesting that parents, especially the mother, have a profound influence on what children will choose to eat.

Getting children to ‘eat their greens’ has not always been such a problem. Those alive now who are WWII babies, experienced food rationing into a period well after the war, well know that ‘greens’ were in short supply for anybody living in a town or city and highly desirable for health; their health suffered from the deficiency of vegetables and fruits in their diets. Many such young urban children did not even see an orange or banana for many years; fruits were either absent from the diet or at a premium. One learned at an early age just how important lack of these types of food, fresh or otherwise, were to the daily diet and good health. After WWII there was little need to adjure children to ‘eat their greens’, except through lack of familiarity, but this does not apply to children or their parents of today.

The Cancer Research UK scientists who carried out this impressive study hope it will shed some constructive and beneficial light upon the modern obesity problem by helping to understand why certain children grow up to have unhealthy diets.⁹⁹ When experts state that 12,000 cases of cancer could be prevented each year in the UK if nobody was overweight, its findings make clear how specially important it is for parents in laying the foundations of diet for their children, and to lessen the risks of cancers, diabetes and heart problems from the word go.

The study is key to understanding if food preference is something genetically inherent ‘nature’ or down to parental influence ‘nurture’, which determines our behaviour regarding food preferences. To this end the research team studied 214 pairs of same-sex twins, 103 pairs of identical twins and 111 pairs of non-identical twins for comparative analysis. Identical twins share the same genes, so any differences that become apparent must be down to ‘nurture’ rather than inherited behaviour.¹⁰⁰ The study was based on children’s like or dislike of 77 foods divided into four categories: vegetables, fruit, desserts, meat and fish.¹⁰¹

In simple terms, the results showed that genes had a strong influence on preference for foods such as meat and fish inherited from the parents, but a liking for vegetables such as broccoli and cabbage, and fruit such as apples, bananas and strawberries is determined by upbringing.¹⁰² The latter also appeared to apply to desserts such as sponge pudding, custard, cakes and pastries. ¹⁰³ 

It is reported that lead researcher Jane Wardle said: “This is the first study to include significant numbers of protein foods and the first to show high heritabilty for these. But it is not clear exactly what environmental factors are influential when it comes to fruit, vegetables or puddings. It might be that children who witness their parents showing enthusiasm or distaste for certain types of vegetables or puddings are likely to follow suit. Or it might be that if a particular food is always available, children learn to like it. For instance, if a fruit bowl is always full of bananas, then children might think of them as being a favourite food.”¹⁰⁴

Children learn by copying, as well as instruction; copying mostly at the early stages of development. So, if you are a ‘chips with everything’ parent, ‘Don’t do as I do, do as I say’ is not a very good maxim for dealing with your children’s diet or encouraging them to get their healthy ‘5-a-day’. Parents are a child’s first and most important role model, but if you cannot bring yourself to ‘lead by example’ through personal dislikes of certain foods, then create an environment to facilitate their learning: e.g. keep the fruit bowl full.

Parental and environmental encouragement to eat vegetables and fruits is very important. Firstly, because children’s food preferences or ‘fussiness’ regarding green leafy vegetables and fruits can compromise their intake of micronutrients such as iron, zinc and iodine from natural dietary sources. Secondly, “the full genetic potential of the child for physical growth and mental development may be compromised due to sub-clinical deficiencies of micronutrients which are commonly referred to as ‘hidden hunger’. Micronutrients are required for the integrity and optimal functioning of the immune system.”^104A If micronutrient deficient, children are more vulnerable to develop frequent and more severe common day-to-day infections.

The research also stated that: “The first 3 years of life are most crucial and vulnerable to the hazards of under-nutrition.” And, “All efforts should be made so that pre-school children are given a balanced and nutritious home-based diet.”^104B Shades of the recent recommendations for children to take cod-liver oil capsules for their physical and mental health – the research also indicated that, where it is not possible to meet 100% requirements of recommended dietary allowances (RDA’s) of micronutrients from dietary sources alone, even pre-school children may need administration of nutritional supplements to optimize their genetic potential for physical growth and mental development.^104C 

For example, natural iodine (iodide) is present in seafoods such as cod, cod-liver oil, haddock, herring, salmon and shrimps, as well as some green leafy vegetables, seaweeds e.g. kelp, and sunflower seeds. It is vital for good thyroid gland function, which affects the role of hormones associated with growth, mental and sexual development. Iodine deficiency during pregnancy and early infancy can result in cretinism (irreversible mental retardation and severe motor impairments).^104D Although only required in minute amounts, as well as for thyroid function, iodine is essential for numerous biochemical processes, such as ‘fat metabolism’. Iodine deficiency has also been linked to coronary heart disease, susceptibility to polio and breast cancer.^104E

What is more, there is a low iodine level in many plant foods that reflects the low iodine levels in the UK soil, due in part to the recent Ice Age. About half the iodine consumption of omnivores in the UK comes from dairy products, such as cow’s milk, yoghurt etc.^104F 

So what else is blocking children from ‘liking’ their greens – anti-greens genes? In an American study last year, researchers stipulated that: “‘flavour’ is the primary dimension by which young children determine food acceptance.”^104G Parental and environmental influences matters here, as children are not merely miniature adults, i.e. their sensory systems mature post-natally.^104H However, their responses to certain tastes differ markedly from adults. Among these differences are heightened preferences for sweet-tasting and greater rejection of sharp or bitter-tasting foods.^104I

Although many bitter or sharp tasting foods contain bitter phytochemials with reputed cancer-protective activity, including flavonoids in citrus fruit, polyphenols in green tea and red wine, glucosinolates in cruciferous vegetables, and isoflavones in soy products, consumer acceptance of these plant-based foods may depend critically on inherited taste factors.^104J Sensitivity to the bitter taste of 6-n-proplthiourcal (PROP) is an inherited trait.^104K Vegetarians may experience difficulties, as certain vegetables, such as cabbage and spinach, can block iodine absorption when eaten raw or unfermented and over-consumption causes problems.^104L So a very early aversion to some green vegetables may in fact help us stay healthy.

The American research hypothesis of last year’s investigated aversion to the ‘bitter’ taste of green leafy vegetables, among others, is based on everyone having two genes that are responsible for developing ‘taste’.^104M Those with a pair of the sensitive to bitterness type disliked vegetables such as broccoli, cabbage and Brussels sprouts finding them extremely bitter; those with two insensitive to bitterness liked these vegetables and enjoyed eating them. Others with one pair of each type of genes fell somewhere between this like and dislike of the vegetables tested.

Nevertheless, back to parental and environmental influences such as school dinners, this does not in any way preclude children from eating a balanced amount of ‘greens’, as the experts believe it is possible for sensitive people to develop a taste for such vegetables as they grow older. All is not lost in a glib convenient haze of ‘I don’t like greens because it’s in my genes not to’ simply won’t wash. Au contraire, the researchers’ concluded that this new knowledge of food likes and dislikes in children, in a generation that will struggle with obesity and diabetes, may suggest strategies to overcome diet-induced diseases.^104N

Fortunately, Jamie Oliver has not abandoned his campaigning and has now taken up the ‘other end of the age scale’ challenge. He is now embarking on a new culinary mission to improve the standard of ‘Meals On Wheels’ for the elderly.¹⁰⁵ At the ‘GQ Man Of The Year’ awards, it is reported that he said: “I will always keep the school dinner campaign going, especially after my TV show on it, but now I want the next challenge. I want to make ‘Meals On Wheels’ ten times better. How can the sick get better when they’re being fed c**p? I also want to see an overhaul of food in hospitals and I will be liaising with the Government officials as I did on the schools campaign.” ¹⁰⁶At a time when confidence in politicians is so low, the country is very lucky to have this young 31-year-old unique and special man batting for the public’s health and well-being. It is indeed a case of ‘Cometh the hour, cometh the man”! ¹⁰⁷ 

Other Influences on Diet

Food Aroma

Taste and colour are not the only aspects of food that dictate choices, our sense of smell can also play an active role. US researchers have investigated how quickly mammals evaluate odours, pushing back the boundaries of understanding smell, and having implications for the food industry.¹⁰⁸

It is estimated that people may make decisions about the identity and perhaps even the hedonic quality of food flavours and aromas more quickly than previously thought.¹⁰⁹ There are no immediate danger signals that very unhealthy foods will suddenly acquire an irresistible aroma, researchers say this may not translate into modification of a consumer’s hedonic response.¹¹⁰ In fact, it is ventured that to control a consumer’s attention to a product would require a highly effective marketing strategy.¹¹¹ Umm! Tell that to a ‘nose-led’ burger devotee or chocoholic!

Food Texture

Food texture also plays its part, the satisfying ‘crunch’ of biscuits and crisps have been seen as the culprit in the downfall of many a dieter. Scientists have found that we get a buzz from simply biting into crunchy foods.¹¹² Experts say each bite creates both a clearly audible ‘crunch’ and a series of powerful ultrasound waves that make the eating experience more appealing.¹¹³The inaudible waves, generated at the sort of frequency that bats, whales and dolphins use for echo-location, trigger a reaction in the brain which causes a sensation of pleasure.¹¹⁴ According to Professor Malcolm Povey, a Leeds University physicist: “Our research shows that the sound and feel of food in the mouth is as important as taste, look and smell in deciding whether we like something or not.”

Apples scored 7.8 out of ten, crisps rated 7.2, biscuits a close runner up at 6.8. He further stated: “It is probable that we are genetically disposed to appreciating crispness as a sign of freshness. Crisper foods tend to be fresher. As rotting sets in and food becomes undesirable it gets softer.”

Aye, the apples have it. It’s one in the eye for crisps and biscuits and an excellent reason for advocating eating more health-giving apples.

On the fragrant upside, there are at least two fresh fruits that smell like they taste; strawberries and cantaloupe melons, both of which are excellent colourful healthful foods.

The sight of food obviously plays its part. However, it is debatable whether those that are not repulsed by the smells of Fast Food outlets are in reality not drawn by hunger, but by their noses i.e. the aroma activates their hunger. If palates have been re-educated to accept certain unhealthy foods since the 1950s, with both senses of smell and taste so closely related, who can say to what extent our choices of food lead us by our noses.

Eating Out

Another change in eating habits that may contribute to our choice of foods is eating out, which has overtaken eating in the home.¹¹⁵ According to the Office of National Statistics, it is a cultural shift that has led to people eating out more regularly and, according to a recent survey, it is suggested that consumers are now ‘eating on the hoof’ more, including junk food, which is widely blamed by nutritionists for increasing obesity levels.¹¹⁶ It is also a habit that is not good for the digestion.

In accordance with the choice of food eaten, the beneficial element is that we enjoy a wider range of cuisine initiated by the change. For example, the introduction of foreign foods such as curries, which contain compounds such as curcumin in turmeric, a curry spice well-known to be advantageous to health. If you think your granny is losing her marbles, it might help to take her for a curry once a week. In July 2006, in cognitive function of the elderly, researchers found that those who ate curry ‘occasionally’ and ‘often or very often’ had significantly better mental state scores than did subjects who ‘never or rarely’ consumed curry.¹¹⁷

There are other aspects of eating together at home as a family that are important to family cohesion. For many cultures dining together is as much a spiritual event as it is a necessity to bodily function. How many people say any form of ‘Grace’ before and after meals nowadays, which is as much a Christian ethic as of any other religion. At a time when the nation seems to have many problems with its youth, there might be some truth in the saying: “The family that eats together stays together.”¹¹⁸

When the UK’s PM put the ‘Respect Agenda’ at the heart of the government’s plan for its third term in an effort to reconcile the problems of the country’s troubled youth, his Home Office minister advised that getting families to eat together was a good starting point.¹¹⁹ Columnists, parenting experts and even government ministers have decried the decline in families sitting down together for a hearty meal and a chat about the day’s events.¹²⁰ Also, various studies have suggested a link between fewer family meals and eating disorders, obesity, drug and alcohol abuse and poor communication skills among young people.¹²¹ For example, in accordance with the Centre for Alcohol and Substance Abuse surveys conducted since 1996, it was found that children who do not eat dinners with their families are 61% more likely to use alcohol, tobacco, or illegal drugs.¹²² Teenagers who eat frequent family dinners were less likely to have sex at young ages, get into fights, or be suspended from school.¹²³

Assumptions that the ‘family meal’ is in decline is debatable to an extent, and such comments are not intended to beat up already hard pressed parents. People lead hard working ‘fast-track’ lives that are not conducive to the togetherness of ‘family meals’, but it serves to draw attention to the need for family meals to play an important part in family life, even if  through work schedules and extra-mural child activities it has to be relegated ‘full on’ only to the weekend.

Concerns have been expressed about a culture of microwave dinners eaten in bedrooms etc., which is taken as a symptom of the fragmentation of modern families and considered to be partly responsible for anti-social behaviour by youths.¹²⁴

It was also reported that mealtimes provide an important ‘slot’ where parents can pass on positive values to their children on a daily basis, because if there is no ‘space and place’ for teenagers to anchor their values, they will turn to their peer group. “If this is a malign influence, then this will have worrying consequences.” ¹²⁵

Childhood Exercise

There is one other often reiterated huge factor that goes hand-in-hand with obesity, i.e. lack of exercise. Perhaps overweight toddlers could be attracted to the need for exercise by gentle parental invocation of the children’s much-loved charming ‘teddy’ Winnie the Pooh’s edict. 

“A bear, however hard he tries, grows tubby without exercise.”

(A. A. Milne, “Winnie the Pooh” from Pooh’s Little Instruction Book.) 

Science has often suggested that the increased prevalence of overweight and obesity among young children and adolescents, as well as among adults, is in part due to television viewing. In our sedentary leisure time video, computer and console games, TV-watching culture, ‘couch potato’ kids may need to be ousted from their loafing spaces to get outside to play in the fresh air.

A new world-wide report, commissioned by ‘Tesco’, signifies that British children are among the laziest in the world.¹²⁶ They may need a lot of parental encouragement to take up physically ‘active’ pursuits; sedentary behaviour is counter-productive to physical fitness, which is important to establishing good overall health. In the survey of 3,500 young people among 10 countries, including the US, Australia and India, Britain came in as the 7^th fittest nation!¹²⁷ Russia and India fared worse, although Australians spent an average of ten hours a week in front of a television or games console, they made up for it by playing far more sport than children from other nations and ranked 1^st, China 2^nd and Germany 3^rd.¹²⁸ The findings from the ‘Tesco Sport Report’ indicate that the average British child, aged 7-16 years old, spends an astounding average of 4,339 hours (half a year) in front of a TV screen or video game. On the upside, the survey also revealed that 94% of children from Britain said they enjoyed taking part in sport; swimming was their favourite.¹² So, it really could be an important case for parental encouragement to get children out there and turn their words into action.

In July this year, a Canadian randomized, controlled trial, found that reductions in ‘sedentary behaviour’ is directly related to reductions in BMI, fat intake, and snack intake while watching television.¹³⁰

To focus on children’s ‘physical fitness’, rather than ‘fatness’ may be the best approach. The Council on Sports Medicine and Fitness and Council on School Health are aware of the problem and that the current widespread inactivity and obesity being driven by multiple factors (societal, technologic, industrial, commercial, financial). It must be addressed on several fronts.¹³¹ They state that: “Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment.”¹³²  

Kids Bad Eating Habits – The Junk Food School Run

There is another difficult area for parents with children to manage, which is fuelled by children’s disposable income, ‘pocket money’, and how they spend it. In the past few years a lot of schools in the US and elsewhere have banned many unhealthy snacks and some fizzy drinks’ vending machines, but this is not sufficient to curb Junk eating.

The British School Food Trust,¹³³ which was set up to improve school meals, released a survey this month demonstrating that children are still being led by their adulterated poor palates. Children are apparently using the journey to and from school to fill up on ‘a secret mountain of junk food’.¹³⁴ Pupils are eating an extra 100,000 calories every year by guzzling snacks and drinks on the school run.¹³⁵ When there are an estimated 2,000,000 overweight and 700,000 obese children in the UK, this is ‘bad news’.¹³⁶

According to the survey, nearly one in three primary school children buy fizzy drinks, crisps and chocolate on their way to or from school.¹³⁷ More than half of secondary school pupils buy ‘treats’ equivalent to 20 blocks of butter weighing 8ozs. each and 11 2lbs. bags of sugar during the course of the academic year.¹³⁸ This is a very thorny situation to tackle, for it was also reported that many parents give their children money specifically to spend on snacks on the way to and from class.¹³⁹

Some parents have obviously not got the obesity message, more than 60% told researchers that nutrition was less important than providing food which their youngsters would like and eat.¹⁴⁰ Whatever, under new rules being introduced this month, September (2006), at the beginning of the school year schools will be required to ‘ban’ all confectionery, such as chocolate, unhealthy savoury snacks like crisps, and fizzy drinks in school canteens, as well as vending machines.¹⁴¹ Also, manufactured meat products would be restricted and would have to meet the standards for minimum meat content.¹⁴²

Under the new rules, school meals will have to include at least two portions of fruit and vegetables per day, oily fish at least once every three weeks and healthier drinks, such as fruit juice and semi-skimmed milk.¹⁴³ This is good strategy and guidelines to enforce for nutritional improvement, contra-overweight and obesity, but what parents may do about children’s ‘out of hours’ home and school mealtimes’ eating is anybody’s guess.

In America the Beverage Guidance Panel, a group of nutrition experts who recently came out with recommendations for beverage consumption in the United States, has been inspired by the panel’s leader, Barry Popkin, Ph.D., at the University of North Carolina School of Public Health, to educate Americans about how beverage consumption has contributed to their obesity epidemic.¹⁴⁴

In contrast to our forebears, Palaeolithic humans drank only breast milk and water, the panel found that most modern-day Americans now consume 150-300 more calories per day than 20 years ago, and about half of these extra calories come from soft drinks and fruit drinks.¹⁴⁵ Americans are also drinking more alcohol and more fancy coffee and tea drinks, which has added lots of sugar and fat to their diets. In fact, about 20% of daily calories are now coming from drinks. The calorically laden drinks do not suppress appetite the way that solid foods do, so people tend to consume more calories per day through drinks.¹⁴⁶ Taking a ‘ball-park’ view, it may not be far off the mark to hazard that, as with obesity itself, the UK is not far behind these figures on calorific drinks.

Exercise – Still going to the Gym?

It could be said that adults should know better by now, no pill or calorie count can replace a sensible diet and reasonable amount of daily exercise to burn off fat and keep the weight level down and stable. Science confirms that exercise appears crucial in the successful maintenance of weight loss and in fostering cardiovascular health in obese patients.¹⁴⁷ The simple advice to ‘use the stairs, not the lift’ is part of the small, but significant, modifications people can add to their lives for daily exercise. Other exertions like cycling and walking are also beneficial to both children and adults – family biking can be fun. Although fresh air and exercise go together, if you are agoraphobic¹⁴⁸ you don’t even have to go outside the door to get exercise. There is a wide choice from Pilates to Yoga, or for the older less mobile person to exercise on Cobble Mats. (See Herbsphere – “Exercise – Cobbles and Sand.”)   

Extraordinarily, at a time when the UK is facing an obesity epidemic, in a survey of health clubs, not public facilities, it is reported that Britons are turning their backs on gymnasiums.¹⁴⁹ This is not good news, the drop in this consumer higher income group leisure spending is said possibly to be due to rising utility bills and bank interest rates! ¹⁵⁰

True, most people who use ‘private’ gyms or personal trainers are in the higher income bracket and can afford to, but others should not feel deprived if they cannot. There are still plenty of small changes to their lifestyle that could help keep them fit. We need the better off ‘business people’ that contribute much to the wealth of the country and provide employment for others to be fit too. As a nation, we need those at the top of the wealth pyramid to be as healthy and functional as those at the bottom, instead of following the old ‘stress’ pattern of dying mostly from heart disease prematurely. Besides, those who followed the trend for personal trainers often admit that to help enforce daily discipline they needed some strategic incentive and ‘time-plan’ for exercise, for without some form of ‘organized’ exercise they were unable to stick to a healthy regime.

Body-weight Attraction

Not all men are obsessed with their ‘six-packs’, nor does every member of the fair sex fancy to become a ‘muscle woman’ like Madonna in her latest self-reinvention. Inherently plump ladies must obviously watch their diet and exercise, but need not despair. Only this week, it was proposed that in the fashion trade the days of the stick-thin, super-skinny, super-models may well be over.¹⁵¹ It looks like ‘Curves R Us’ is on it’s way.

There has been concern for some time that zero-sized supermodels are a bad influence and advertisement for the health of female children and contribute to the cause of eating disorders in their efforts to emulate them. Last week in Madrid, Spain, it was announced that only healthy-looking mannequins would be permitted to strut their stuff at the city’s annual style event.¹⁵² Anyone with a BMI of less than ‘18’ was banned, and five supermodels were barred from taking part. To put the matter into context, a BMI of 18.5 or below is classed as underweight by the World Health Organization (WHO). London Fashion Week, which starts Monday 18^th September, is being urged to do like-wise, to impose similar rules.¹⁵³

It is likely there will be a big row and the fashion industry will fight back, because any fashion designer will tell you that a model requires to be ‘slim’, to be a good ‘clothes hanger’, to show off their designer clothes to best advantage. However, there’s a world of difference between having a healthy slim and curvaceous body than being unhealthily thin and emaciated.

In a bid to better understand obesity and the attractions of body-weight, current UK researchers have found that, although in the West lower female body weights are preferred, the old saying of ‘the way to a man’s heart is through his stomach’ apparently still applies.¹⁵⁴ Predatory women have been described as being ‘man hungry’, but this research puts a new twist on what to expect from a ‘hungry man’ – he may find you scrumptious!

Hungry men are attracted to heavier women - how full a man’s stomach is can dictate the type of women he will fancy.¹⁵⁵ Hungry men rated more heavier women as attractive than men who were replete, which shows how physiology does impact on our perceptions and thought processes.¹⁵⁶ In fact, in times of food scarcity, a heavier women becomes the ideal.¹⁵⁷

This body-size concept may be tied into evolutionary theory, although in the not so distant past, for the Victorians ‘fat’ was a sign of prosperity, which also applied to having a groaning dining table laden with food. Well-off ladies and gentlemen alike were inclined to be fat, whereas the poor, who were both short of money and food, were thin.

Socio-economically, there is something of a reversal in what is happening with regard to over-weight and obesity now, because it is the better-off who are eating healthier food and are slimmer, but the lower income group who are eating plenty of unhealthy food i.e. there is no food shortage, but a difference in the types of food money can buy.

Whatever turns you on! But, to take some form of daily exercise for sound health is required by and a need of everybody of any age. It doesn’t matter what the latest ‘trend’ in taking exercise may be, if a first-rate ‘exercise video’ works for you, use it. To do something as simple as walking to the news-agent to collect the daily newspaper, instead of having it delivered, can help. 

Why Dieter’s Do Not Succeed

Or Why it’s Best Not to Put Weight on in the First Place

Some women, rather than men, seem to spend a lot of their lives dieting, trying one ‘fad’ diet after another. They start off each time with determination, often with remarkable early results, and then become frustrated at a certain point when the pounds they wish to shed suddenly stop to fall away and little, very little, or no further progress is made. They reach a ‘plateau’ of weight loss. Is there an answer to this mystifying puzzlement?

According to Dr Neil King, an expert appetite regulation and energy balance researcher from the Institute of Health and Biomedical Innovation at Australia’s Queensland University of Technology, our bodies have strong mechanisms to defend attempts to lose weight, but very weak mechanisms to prevent weight gain.¹⁵⁸

Why? Our evolutionary responses get in the way. It is thought that evolution has ‘programmed’ the body to cope with ‘famine’ by resisting weight loss, but not how to cope with the high calorie foods and lack of exercise, “the obesogenic environment which enforces inactivity and a plentiful food supply” in modern life.¹⁵⁹

In the first study, 30 obese men and women took part in a 12-week, laboratory-based exercise programme in which they exercised 5-times a week. The second study looked at weight loss in 200 males on a commercial weight loss programme comprising exercise and dietary advice.¹⁶⁰

Dr King said: “In the first study, the subjects’ energy deficit was caused by exercise only, which was fixed and imposed, in contrast to the second study where subjects used diet and exercise to lose weight, but chose how much they did of each. The first group’s weight loss during the first eight weeks averaged 7lbs (3 kg), but it ‘plateaued’ at week-8 and weight loss for the next four weeks was markedly reduced  to 1 ½ lbs. (0.7kg).” ¹⁶¹

The second group had a variable pattern of weight loss, but it too showed a plateau. “There appears to be little at this stage to predict the onset, duration and frequency of the plateau,” Dr King said. “My research now aims to identify and characterize mechanisms responsible for out inbuilt weight loss resistance.” ¹⁶²

So there you have it, homo sapiens’ evolution is extremely slow, our metabolic ‘blue-print’ just cannot cope with the volume and speed of change inflicted upon our daily diets in the past 50-70 years, or in the case of Fast and Junk Foodstuffs over an even shorter period 20-30 years, the results of which are now evident in the epidemic size of the obesity problem.

The Anti-obesity Vaccine

Many treatments of obesity have proved unsuccessful. Even though vaccines traditionally have been used to protect against infectious diseases and, more recently, for unconventional targets such as drug addiction, most recently a vaccine developed by US researchers announced an ‘anti-obesity vaccine’¹⁶³ which prevents weight gain in rats, offering clues about human treatments.¹⁶⁴  

The vaccine prompts the body to produce antibodies against ghrelin, ¹⁶⁵ a hormone produced by stomach cells that is thought to stimulate hunger, which therefore promotes weight gain. The reduction in weight gain occurred despite the rats eating and drinking normally, which indicated that the inhibition of ghrelin was having an effect on the animal’s metabolism. They gained less body weight, with sparing of lean mass and preferential reduction of body fat, consistent with reduced circulating leptin levels. From research to date, it was concluded that vaccination against the endogenous hormone grehlin can slow weight gain (in rats) by decreasing feed efficiency.

In pursuit of the lucrative ‘holy grail’ of dieters, pharmaceutical companies’ researchers have been looking for methods and techniques to block the action of ghrelin without success; nothing has proved effective. However, it is early days for this latest vaccine discovery and there are problems. An independent opinion suggests the experiment is an important proof of principle, and the study is useful, but as yet unsafe. ”… if you develop antibodies against something you can’t get rid of them very easily, so if there’s anything bad you can’t undo it. … Since grehlin is present in the brain you might start an immune system response against the brain. It’s not necessarily a very safe thing to do – I wouldn’t want to be a volunteer.”¹⁶⁶ The research on the vaccine has a long way to go, but it looks as if ‘the jury it out’ on this one.

The cause(s) of obesity are complex and not as yet well understood. Other than the obvious ones such as over-eating, which may be exacerbated psychologically by depression and/or ‘comfort eating’, eating unhealthy foods, lack of exercise and a sedentary lifestyle. However, a great many people do not like the idea of taking drugs for obesity. So what’s the alternative?

Firstly, heed the messages and remember ‘prevention is better than cure’ and, when it comes to eating a definition of insanity is: ‘to repeat the same mistake expecting a different result’.

References:

1.              Obesity – Health Central - http://www.healthcentral.com/ency/408/003101.html

2.              Ibid.

    3.        ‘Energy intake, body mass index, physical activity, and the colorectal adenoma-carcinoma sequence.’ Boutron-Ruault, et al. Registre Bourguifnon des cancers difestifs, Faculte de Medecine, Dijon, France. Nutr Cancer. 2001; 39(1): 50-7.

Adenoma: a benign epithelial tumour of glandular origin. Epithelial/Epithelium: Epithelium lines both the outside skin and the inside cavities and lumen (the cavity or channel within a tubular structure) of bodies. Epithelial cells line the insides of the lungs, the gastrointestinal tract, the reproductive and urinary tracts, and make up the exocrine and endocrine glands.

        4.        Colorectal Cancer Death Statistics for the U.S. -

                http://coloncancer.about.com/od/cancerstatistics/a/US_Death_CRC.htm

        5.             Ibid.

        6.        ‘Adenocarcinoma of the oesphagus and gastric cardia: male preponderance in association with obesity.’ Ryan AM, et al. Uv. Department of ClinicalSurgery, Trinity Centre for Health Sciences, St James’s Hospital/Trinity College Dublin, Dublin, Republic of Ireland. Eur J Cancer. 2006 May; 42(8):1151-8. [Epub April 19^th 2006]

Adenocarcinoma: This term is applied to a malignant tumour originating in glandular tissue. It is a cancer that develops in the lining or inner surface of an organ, e.g. most pancreatic cancer and prostate cancer are adenocarcinoma.

Gastric cardia: The gastric cardia is the uppermost part of the stomach that connects the bottom of the oesophagus to the stomach.

Oesophagus: the passage between the pharynx and the stomach.

Pharynx: the passage to the stomach and lungs.    

7.                    ‘Body size and composition and the risk of gastric and oesophageal adenocarinoma.’ MacInnis RJ, et al. Cancer Epidemiology Centre, The Cancer Council Victoria, and Centre of Molecular, Environmental, Genetic and Analytic Epidemiology, Uv. of  Melbourne, Victoria, Australia. Int J Cancer. 2006 May 15; 118(10):2628-31.

5.                    ‘Obesity – ‘worsens ovarian cancer’ BBC News Online UK 28^th August 2006.  & ‘Obesity leads to more aggressive ovarian cancer, Cedars-Sinai research shows.’ Los Angeles, CA (Press Release 28^th August 2006) 

                ‘Effect of Obesity on Survival in Epithelial Ovarian Cancer.’ Li AJ, et al. Cedars-Sinai Medical Centre, Los Angeles, CA, USA. Pub. online American Cancer Society’s journal 28.8.2006.

6.             Ibid.

7.             Ibid.

8.             Ibid.

9.             Ibid.

10.           Ibid.

11.           Ibid.

12.           Ibid.

13.        ‘Deaths from Ovarian Cancer’: 13,627 deaths reported in USA 1999 (NVSR Sep 2001)

http://www.wrongdiagnosis.com/o/ovarian_cancer/deaths.htm

14.                 E.g. ‘Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.’ Wilson PW, et al. Boston Uv. School of Medicine, Evans, Boston, MA, USA. Arch Intern Med. 2002 Sept. 9; 162(16): 1867-72.

15.                 “Obesity Link to cancer ‘unknown’.  BBC News Online 8^th August, 2006.

16.                 Ibid.

17.                 Obesity and Your Health – National Kidney Foundation - http://www.kidney.org/news/newsroom/fsitem.cfm?id=23

18.                 Obesity information - http://www.medicineonline.com/encyclopedia/O/Obesity and http://www.healthcentral.com/ency/408/003101.html

19.                 ‘The effects of body weight on airway calibre.’ King GG, et al. Woolcock Institute of Medical Research, Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.  Eur Respir J. 2005 May; 25(5):896-901.

20.                 Ibid.

21.                 ‘Incidence of asthma and net change in symptoms in relation to changes in obesity.’ Chinn W, et al. King’s College London, Capital House, London, UK. Eur Respir J. 2006 Jul 26; [Epub ahead of print]

22.                 Ibid.

23.                 ‘Obesity increases the risk of incident asthma among adults.’ Ronmark E, et al. The Obstructive Lung in Northern Sweden Studies, Dept. of Medicine, Sunderby Central Hospital of Norrbotten, Lulea, Sweden. Eur Respir J. 2005 Feb; 25(2): 282-8.

24.                 Obesity ‘doubles sight-loss risk’ – BBC News Online 5^th September 2006 & ‘Obese people are twice as likely to go blind.’ by Emily Cook, D. Mail 6^th September 2006. 

‘Obesity is a risk factor for eye diseases’ Habot-Wilner Z, Belkin M. Goldschleger Eye Institute, Sheba Medical Centre, Tel Aviv Uv., Tel Hashomer, Israel. [Article in Hewbrew] Harefuah. 2005 Nov; 144(11):8805-9, 821.

        26.           Ibid. & ‘A study of the relation between body mass index and the incidence of age related macular degeneration.’ Moeini HA, Masoudpour H, Ghanbari H. Feiz Hospital, Opthamolgy Department, Isfahan, Uv. Of Medical Sciences, Islamic Republic of Iran. Br. J. Ophthalmol. 2005 Aug; 89(8):964-6.

        27.        Obesity ‘doubles sight-loss risk’ – BBC News Online 5^th September 2006 & ‘Obese people are twice as likely to go blind.’ by Emily Cook, D. Mail 6^th September 2006. 

‘Obesity is a risk factor for eye diseases’ Habot-Wilner Z, Belkin M. Goldschleger Eye Institute, Sheba Medical Centre, Tel Aviv Uv., Tel Hashomer, Israel. [Article in Hebrew] Harefuah. 2005 Nov; 144(11):8805-9, 821.

        28.           Ibid

        29.           Ibid.

        30.           Ibid.

        31.        Retinopathy: degeneration of the retina caused by a decrease in blood supply.

        32.        Obesity ‘doubles sight-loss risk’ – BBC News Online 5^th September 2006 & ‘Obese people are twice as likely to go blind.’ by Emily Cook, D. Mail 6^th September 2006. 

‘Obesity is a risk factor for eye diseases’ Habot-Wilner Z, Belkin M. Goldschleger Eye Institute, Sheba Medical Centre, Tel Aviv Uv., Tel Hashomer, Israel. [Article in Hebrew] Harefuah. 2005 Nov; 144(11):8805-9, 821.

32.                 Ibid.

33.                 Ibid.

34.                 Ibid. ‘Childhood obesity and Type 2 diabetes mellitus.’ Hannon TS, Rao G, Arslanian SA. Division of Weight Management and Wellness, Uv. of Pittsburgh School of Medicine, Children’s Hospital Pittsburgh, Pittsburgh, Pennsylvania, USA. Pediatrics. 2005 Aug; 116(2):473-80.

35.                 Ibid.

36.                 ‘Study: Even a few extra pounds risky’ by Alicia Chang, AP Science Writer, 23^rd August 2006.

37.                 Ibid.

38.                 Ibid.

39.                 ‘Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old.’ Adams KF, et al. National Cancer Institute participating in a research project by the National Institute of Health and AARP, formerly known as the American Association of Retired Persons, N Engl J Med. 2006 Aug 22; [Epub ahead of print]

40.                 ‘Body-Mass Index and Mortality in Korean Men and Women.’ Lee SH, et al. Yonsei Uv. South Korea & Johns Hopkins Uv. Bloomberg School of Public Health, N Engl J Med. 2006 Aug 22; [Epub ahead of print]

41.                 Ibid.

42.                 ‘Survival of the fattest.’ – BMI measure is called into doubt as ‘overweight’ heart patients live longer’ by Jenny Hope, Medical Correspondent, Daily Mail, 18^th August, 2006.

43.                 ‘Massachusetts infants growing more overweight.’ By Melissa Trujillo, Associated Press Writer, 9^th August 2006. Study published in Journal of Obesity, 9^th August 2006.

44.                 Ibid.

45.                 ‘More babies becoming overweight’ BBC News Online 10^th August 2006.

46.                 Ibid.

47.                 ‘Tackling Obesity in England’ Report by The Comptroller and Auditor General –HC 220 Session 2000-2001: 15 February 2001. http://66.102.9.104/search?q=cache:3EqGYooBBooJ:www.nao.gov.uk/publications/nao_reports/00-01/0001220.pdf+Office+of+National+Statistics+Obesity+UK&hl=en&gl=uk&ct=clnk&cd=3

48.                 Obesity – The Office of National Statistics UK - http://www.statistics.gov.uk/cci/nugget.asp?id=718

49.                 Ibid.

50.                 ‘One in three adults ‘will be dangerously obese by 2010’ by Emily Cook, Health Reporter, Daily Mail, 21^st August 2006 - Research reported by the Independent on Sunday.

51.                 Ibid.

52.                 Ibid.

53.                 Ibid.

54.                 Ibid.

55.                 ‘China warned over rising obesity’ by Jill McGivering, BBC News Online 18^th August 2006 - ‘China Follows the West to Becoming Obese’ Editorial: Overweight and obesity in China BMJ Vol. 333, pp 362-3 August 2006.

56.                 Ibid.

57.                 ‘Obesity: A Worldwide Issue – Beijing Xinhua News Agency (government owned): http://www.worldpress.org/Africa/1961.cfm

58.                 Ibid. – Chennai The Hindu (independent)

59.                 Ibid.

60.                 ‘USDA plus $25m into nutrition research facility.’ by Staff Reporter, Nutraingredients USA 21^st August, 2006 - http://www.nutraingredients-usa.com/news/ng.asp?n=69994&m=2NIU823&c=zvcdgfpbnucfltc

61.                 Ibid.

62.                 Ibid.

63.                 Ibid.

64.                 Ibid.

65.                 ‘Minister for fitness’ appointed – UK, BBC News Online, 23^rd August 2006.

66.                 Ibid.

67.                 ‘When fitness can be fatal … ‘ by Fiona MacRae, Science Reporter Daily Mail, 7^th September 2006.

‘Cardiac drift during prolonged exercise with echocardiographic evidence of reduced diastolic function of the heart.’ Dawson EA, Whyte G, et al. Centre for Clinical and Biophysical Research in Human Movement, Manchester Metropolitan Uv., Alsager, UK. Eur J Appl Physiol. 2005 Jun; 94(3):305-9 Epub 2005 Mar. 12.

68.                 ‘Heart defect killed young runner’ – BBC News Online, 14^th September 2006.

69.                 ‘When fitness can be fatal … ‘ by Fiona MacRae, Science Reporter Daily Mail, 7^th September 2006.

70.                 Ibid.

71.                 ‘Schools set for £30m health kick’ BBC News Online 8^th September 2006.

72.                 Ibid.

73.                 Ibid.