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Availability of warm clothing and central heating so that

energy expenditure on keeping warm is reduced;

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Availability of a wide variety of cheap foods, many with hidden

sugar and fat. People respond to a variety of foods available

by consuming more; and

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Motorcars have made roads unsafe for young children, so

children are kept indoors and develop a television viewing habit.

Breaking the obesogenic diabesity cycle

It seems self-evident that this cycle must be broken, but it needs

to be addressed at many levels. There is not one simple solution.

A major factor has to be education and that should start at a

young age. Mothers need to be helped more with dietary

information and weight targets of babies. If all mothers try to

bring their offspring to the 90th percentile, then clearly target

weights will increase year on year.

Schools could ban soft drinks, including fruit juice, from the

premises, and compulsory nutritional advice, including the

potential consequences of being obese, could become part of

the school syllabus. After-school games and exercise

programmes could be more supported.

Food companies and restaurants could be forced to provide

understandable nutritional information so that this becomes part

of people’s choice mechanism. Government could impose a tax

on sucrose and fructose-containing drinks. Supersizing and all-

you-can-eat restaurants could be outlawed. Whilst libertarian

principles suggest that people should have a free choice of what

they do, historically (e.g. smoking, car seat belts, motorcycle

helmets, telephone use whilst driving) changes that people

generally perceive to be for a person’s good have only been

successful following legislation.

Obesity and its prevention need to be treated seriously, as do the

potential consequences of diabetes, cardiovascular disease and

cancer. Research is needed to better identify the molecular

mechanisms leading to obesity and the development of the

diabesity syndrome, and to find drugs that will reverse/prevent

obesity and its consequences.

time fructose was used in many products for diabetics as a

sucrose replacement – thankfully no more.) Fructose, unlike

glucose, has no rate-limiting steps on its metabolism. Fructose is

generally metabolised in the liver, leading to fatty liver and

excessive inflammatory cytokine production.

Are governments and the World Bank to blame?

In the early 1980s high-fructose corn syrup replaced sucrose in

soft drinks. Agricultural policies in the US by subsidy payments

have skewed markets to the overproduction of commodities that

are the ingredients of energy dense foods. These commodities

include high fructose corn syrup and soya bean oil.

The palm oil industry is an important driver of economic growth in

SE Asia and central and western Africa and is the most important

tropical vegetable oil in the global oils and fat industry. It is the

cheapest major vegetable oil and hence it is the most commonly

used by poorer households. Whilst originally used as cooking oil,

it is increasingly being used in packaged foods such as

margarine, ice-cream, cakes, biscuits and chocolates. The global

demand for palm oil rose from less than five million tonnes in

1970 to over 50 million tonnes in 2010. The production of palm

oil provides income for poor farmers and workers in many

countries and is actively supported by the World Bank. However, is

diabesity the unintended consequence of an abundance of palm

oil in everyday foods? The cheapness of the oil means that its

intake is likely to be highest in the lower social economic classes.

Are food manufacturers to blame?

There has been a dramatic move over the last two decades from

using basic ingredients in the preparation of meals to pre-

packaged meals. A consequence of this is people are not really

aware of what they are eating. Labelling of the pre-packed meals

is often poor and in small print on the underside of the pack.

Food composition only usually gives broad data such as fat,

protein and carbohydrate content with perhaps salt content and

is given per 100g, ignoring the pack size. Sometimes

carbohydrates will be split into simple sugars and

polysaccharides and fats into saturated and unsaturated, but

detailed composition is not given.

Of course, even if the food industry was forced to give the details,

would they be understood by the general public? But surely the

general public would know if on an iced fruit cup drink it said

‘contains the equivalent of 28 lumps of sugar’ and that a burger

and fries contains the equivalent of nine teaspoons of oil.

Is the individual to blame?

The simple answer is yes, but it is clearly a complex issue, with

many adverse factors supporting an obesogenic environment.

These include:

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Having obese parents resulting in a metabolic programming

towards obesity;

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Migration from country areas to cities and replacement of

manual work by sedentary work;

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Use of private and public transport rather than walking;

Mike Cawthorne

Director of Metabolic Research and Head of Medical School

Clore Laboratory

University of Buckingham

te l :

+44 (0)1280 820309

mike.cawthorne@buckingham.ac.uk www.buckingham.ac.uk/bitm

The Buckingham Institute of Translational Medicine

The University of Buckingham