The World Health Organization estimates that global levels of obesity have doubled since 1980. In 2012, more than 40 million children under the age of 5 were estimated to be overweight or obese, which is an issue of serious concern as excess body weight is believed to be the driver of many non-communicable diseases, namely type 2 diabetes, cardiovascular disease and some types of cancer.
To tackle what is, in most cases, a preventable condition, there is increasing focus on research into understanding the mechanisms behind obesity, including our genetics and the influence of lifestyle and the environment. There is also now increased focus on introducing public health initiatives to aid long-term weight loss, which range from improving public, patient and healthcare provider education to policy reform regarding the sale of pre-packaged and processed foods.
To focus on these issues, BMC Medicine has launched an article collection that aims to explore the main contributing factors and possible solutions to tackle the worldwide impact of obesity.
Which are the culprits – sugars, starches or fats?
How much of what we eat makes us fat? This is an ongoing debate, fuelled most recently byRobert Lustig and his focus on sugar. On the question of sugar, a further debate arises – is itsucrose or fructose that has the most impact on obesity?
In an editorial to introduce the article collection in BMC Medicine, Jack Winkler, former Professor of Nutrition Policy at London Metropolitan University, and currently Director of Food & Health Research, discusses why it is so hard to measure which food components are associated with obesity.
Prof Winkler explains one of the many problems with this field is that data derived from large-scale studies depends on reliable and consistent reporting. However, this is a limiting factor simply because these studies rely on self-reported energy intake surveys, and as Prof Winkler reminds us, people are good at lying about how much they are actually eating.
“The lies people tell about their food may be white lies, but they are large lies….. In one study of soft drinks, subjects in the National Diet and Nutrition Survey claimed to be drinking barely a quarter of the products that manufacturers reported they were selling”
The consequences of obesity
There is no question that obesity places a burden on healthcare services. Earlier this year,Gillian Reeves and colleagues showed that elevated body mass index (BMI) in UK women is associated with increased hospital admissions equating to around 420,000 extra admissions annually, indicating that current obesity levels are directly impacting UK healthcare services.
Primary care physicians are usually the first in line to treat patients with obesity related diseases, although patients may not be visiting their GP to directly ‘treat’ their obesity. As David Haslam, a GP and physician specializing in obesity at the Centre for Obesity research explains, the role of primary care in managing obesity is complicated in the UK by ineffective or contradictory policies. In his commentary published as part of this article collection, Prof Haslam starkly points out:
“Obesity prevention has failed. If nobody in the UK gains another single ounce, there are enough already obese people to make epidemics of diabetes, then heart disease then premature death inevitable.”
Prof Haslam, who also serves as Chair of the National Obesity Forum, highlights that obesity can be most effectively managed by individualization of care, which should be implemented through effective screening and risk management. After all, not all patients will benefit from weight loss. Prof Haslam discusses the obesity paradox in his commentary, and recent evidence on this includes a meta-analysis we published this year by Wie Nie and colleagues, showing that an obesity paradox exists for pneumonia – i.e. obese individuals have an increased risk of pneumonia but a decreased risk of pneumonia mortality, indicating a survival advantage for obese individuals.
However, in most cases, obesity and diet are considered as a causal risk factor for chronic diseases such as type 2 diabetes. Recently, Elin Hall and colleagues showed that exposing pancreatic islet cells to the free fatty acid palmitate results in differential gene expression and epigenetic modifications, which may influence type 2 diabetes risk through impaired insulin secretion in these treated cells.
In an Opinion article, Naveed Sattar and Jason Gill discuss the plausible link between type 2 diabetes and ectopic fat around organs such as the liver and pancreas. In their article, they explain that studies have shown accumulation of ectopic fat around the liver leads to insulin resistance, and they also hypothesize that fat around the pancreas could lead to β-cell dysfunction. Prof Sattar and Dr Gill ask a very provocative question: can type 2 diabetes be reversed by loss of ectopic fat around key organs?
Taking action on obesity
So, what should be done about the rising levels of obesity? One of the physicians leading the issue is John Wass, a consultant physician and endocrinologist, and also Chair of the Working Party for Action on Obesity.
I interviewed Prof Wass about the goals of the working party, which aims to tackle the rise of obesity in the UK by filling current gaps in knowledge and support within the healthcare and medical education systems. Prof Wass highlights that educating the public about healthy eating, and collaborations with the food industry on how to responsibly sell and label foods, is key to improving public health.
There is also ongoing debate about whether or not obesity should be considered as a disease. On this, Prof Wass explains that as obesity is a condition that needs to be actively managed it can be labelled as a disease, and unless it is recognized as such, prevention and management strategies will not be taken seriously.
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El artículo en general nos habla de como se produce la obesidad, del problema que ésta causa a la persona y la sociedad, y de que ha sido un problema que podiamos haber manejado mejor desde un principio, pero dado que no le prestamos la suficiente atención a llegado a un punto crítico que hay que resolver.
ResponderEliminarLo hace analizando 3 referencias, otros 3 artículos, cada uno con una tematica específica, dividiendo la obesidad en causas, consecuencias y manejo.
El texto es muy importante ya que nos afronta a la realidad que es la obesidad, y que debe ser manejada, bajo guias estrictas pero basadas a la personalización del tratamiento, ya que entre más personal sea el manejo que demos el paciente tendra mayor oportunidad para solucionar o mejorar su estado e incluso en etapas tempranas evitar todas las consecuencias de la obesidad.
Todo artículo es favorecedor si lo sabemos interpretar, pero los relacionados a problemas que afrontaremos durante toda la carrera, y la vida profesional son de mayor importancia, y más cuando vivimos en una población con altos niveles de obesidad y sus asociados.
Como bien se menciona la Obesidad es una enfermedad crónico- degenerativa resultante de la interacción deletérea entre nuestra genética, la influencia del estilo de vida y el medio ambiente; caracterizado por un aumento generalizado de la grasa corporal que se asocia a co-morbilidades que deterioran la calidad y reducen las expectativas de vida. Es decir la susceptibilidad para desarrollar obesidad está genéticamente determinada y es algo que no podemos cambiar, sin embargo las expresiones fenotípicas están determinadas por las condiciones del medio ambiente y estas últimas son la clave si la padecemos o no, depende de cada uno de nosotros. También como ya se sabe el sobrepeso y la obesidad son factores de riesgo para numerosas enfermedades crónicas, entre las que se incluyen la diabetes, las enfermedades cardiovasculares y el cáncer, pero al contraer estas co-morbilidades, está comprobado que ya no son reversibles, aunque sí son controlables con el tratamiento adecuado, aunque existan teorías acerca de su reversibilidad, solo nos ayudan a comprender mejor la fisiopatógenia de la enfermedad. Sin embargo existen paradojas en las que la obesidad es una ventaja un ejemplo de ello es la osteoporosis, sin embargo como nos los reitera la definición de obesidad de la OMS, la obesidad es perjudicial para la salud, a pesar de lo anterior, existe tratamiento que nos ayuda a combatir contra la obesidad, pero la piedra angular es cambios en el estilo de vida (dieta y actividad física), donde los medicamentos solo son un coadyuvante y no la clave de la resolución de la enfermedad.
ResponderEliminarLa obesidad es un problema de salud mundial, definida por la OMS como la acumulación excesiva o anormal de grasa. Conlleva a otros procesos crónicos degenerativos como los son la resistencia a la insulina, la diabetes, dislipidemias, hipertensin arterial, englobados en lo que se conoce como síndrome metabólico.
ResponderEliminarEn México, de acuerdo a estadísticas del ENSANUT, la obesidad infantil ha crecido a razón del 1.1% anual, pasando del 18.4% en 1999 al 26.2% en 2006. Un niño se considera obeso cuando supera el 20% de su peso ideal. Además, por estadística, cerca del 80% de los niños que llegan a ser obesos en su infancia, la llegan a mantener en su adultez.
Se ha convertido por lo tanto, en un importante problea de salud pública por lo antes mencionado. La composición de los factores que la integran cuentan con la genética (en un porcentaje que ha sido observado en estudios hasta de un 80%), el estilo de vida y el ambiente.
Lo multifactorial de la patología nos lleva a entender los procesos fisiopatológicos inmersos en su desarrollo, los genes involucrados así como su interacción y mecanismos implicados con el estilo de vida y el ambiente.
La obesidad es algo de llamarse la atención no solo en México, si no en todo el mundo, si bien es cierto que muchos genes pueden estar involucrados y en cierto modo evolucionamos a esto, es cierto que el indice de obesidad que nuestros antepasados, y de muchas poblaciones aun hoy en día en el mundo es bajisimo, mientras mas avancemos en cuanto a fisiopatológica y genomica de la obesidad mas podremos ayudar a controlar las personas que padecen este trastorno mas mi opinión considero que no es el camino verdadero del problema, para mi la obesidad puede tener su componente genético, pero el ambiental es el detonante y mas importante de todos, por lo que se debe hacer prevención en contra de la obesidad y reducirla de la forma mas natural posible y no "solapar" esto, de forma que es un gran avance pero de seguir así nunca se solucionara el problema.
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