Availability of warm clothing and central heating so that
energy expenditure on keeping warm is reduced;
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
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.
Having obese parents resulting in a metabolic programming
Migration from country areas to cities and replacement of
manual work by sedentary work;
Use of private and public transport rather than walking;
Director of Metabolic Research and Head of Medical School
University of Buckingham
te l :
+44 (0)1280 email@example.com www.buckingham.ac.uk/bitm
The Buckingham Institute of Translational Medicine
The University of Buckingham