Treating the Obesity Epidemic

Drugmaker Vivus saw its experimental weight-loss medication, Qnexa, pass two Phase III clinical trials C&EN reported on September 10, and the company’s share price skyrocket.

The rewards of developing a safe and effective anti-obesity medication will be in the tens of billions of dollars, according to Bloomberg. Of course, such apparent breakthroughs are going to hit the headlines, big time. After all, who wants to reduce calorie intake and increase exercise levels when popping a pill could solve one’s weight problems?

In the developed world, overweight and obesity (BMI > 30) and other diet-related problems, such as cardiovascular disease, diabetes, and metabolic syndrome, are on the increase. And, while it might be assumed that the billions of people who live in abject poverty with the daily threat of acutely lethal diseases, such as malaria, have other things to worry about, the diseases we commonly associate with the “Western” lifestyle are emerging across the globe. The WHO says that, perhaps with the exception of sub-Saharan Africa, deaths caused by chronic diseases dominate the mortality statistics.

Astoundingly, WHO figures from 2005 suggested that there are more people suffering from overweight-related problems than malnutrition. At the time, globally there were more than 1.6 billion people aged over 15 years who were overweight and 400 million of those were clinically obese, while around 800 million suffered from malnutrition. Those numbers are already changing. The WHO predicts that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese.

The costs in terms of loss of quality of life and impact on healthcare providers in the developed world are likely to be unsustainable in terms of demands on surgical and drug treatments.

While much of the focus on the obesity epidemic is aimed at the US, high rates of cardiovascular disease associated with poor nutritional choices, dietary trends, and exercise issues ring just as true in the UK.

Andreas Anastasiou of the Department of Agricultural and Food Economics at the University of Reading, and a quantitative risk analyst at the Bank of Santander, London, UK and Athanasios Anastasiou a lecturer at the Technological Education Institute of Patras, Greece and an economist at the University of Patras, recently highlighted the sorry state of the British diet and the burden the growing obesity problem will ultimately have on the economy and society as a whole.

Here are just a few of the UK obesity facts and figures cited by the authors:

  • 30,000 – deaths a year
  • 9 years – average life reduction
  • 18 million – working days lost
  • £1 billion – cost to National Health Service
  • £2.5 billion – cost to the economy

Obesity and associated chronic diseases are a serious threat to a nation’s health and well-being, the researchers say. “Their impact on the economy and society as a whole is tremendous exhibiting enormous healthcare costs and losses in working hours and years of life.” They suggest that improvements will happen if long-term changes to food choices and dietary habits are made, whether this should come top down from government and healthcare providers is difficult to say. How ever it is achieved, you can be almost certain that popping a pill will not be the cure all, despite what pharmaceutical share prices might suggest.

Research Blogging Icon Andreas G. Anastasiou, & Athanasios Anastasiou (2009). The effects of current dietary trends and consumption patterns on health: evidence from the UK Int. J. Behavioural and Healthcare Research, 1 (3), 318-333

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21 thoughts on “Treating the Obesity Epidemic”

  1. Great, now our wonderful politicians will become the police of everything we eat. I am sick of the govt and liberals telling me what to eat, how much to eat, when to smoke (even tho I don”t smoke it”s just a reference to big govt), what I can publically say and most of all that I can”t talk about God in schools. People–it”s time to stand up and take back our country from the dems and republicans and start over with the way our founding fathers meant for it to be!!

  2. Vikki,

    I know it seems counter intuitive to increase fat intake to lose weight. But the fact that you have a hunger problem hints at the possibility that your body is starving for materials needed to make hormones, namely cholesterol and certain kinds of fats. Diana Schwarzbein may be able to help you understand the particulars. http://www.youtube.com/watch?v=JLZP8FkgK0U Often, when over weight people add fat to the diet they gain weight initially as the body heals. Then, as the hormone systems become fully functional the body rebuilds muscle tissue, the metabolism ramps up, and weight loss occurs.

  3. I just watched the sugar video.

    I’m NOT going to switch back to a higher fat diet, because low fat is the only thing that has ever worked for me, and I will not risk regaining the weight I’ve kept off for over a year now. Now I am not totally strict about “no” fat as I am doing a little olive oil and the occasional handful of nuts. But I take Alli anytime I have meats or eggs or other undesirable fats, and choose nearly all lower fat meats. But I have not been able to lose any more, as I still have an appetite like a horse and I am eating as healthy as I can stand, and exercising as much as I have time for. So I’m ordering some barley bread products and will do my best to make sure that though I can’t low-carb, I can avoid consuming fructose without plenty of fiber attached to it. You may also want to watch Food, Inc. because they also highlight the role of refined corn products in fattening cattle and other livestock as well as its prevalence as a cheap carbohydrate source in our current food economy.

    As far as helping patients and families with obese chidren – many people with massive sugar soda or juice intake get very ornery when you suggest giving it up for water and low-fat dairy drinks, they can’t imagine life without unlimited sweet drinks – it really does seem like an addiction.

    I did see one problem with the sugar video – early on, these is a slide where BMI increase per extra sugary drink may be as little as 0.1kg/m2 and the odds ratio for obesity is well within the CI (meaning not statisticaly significant.) Also, I thought that modest alcohol intake was overall favroable for lipid profiles, especially HDLs. My LDL runs high and HDL low – even worse on statin, which I actually do not tolerate and will not be taking anyways – and the LDL is the small dense (bad) kind to boot. Any other diet suggestions for me?

  4. I was really surprised when I saw that article on the impact on obesity. In that article you had said all the causes of obesity and the helpful steps of prevention. Childhood obesity is certainly a recognized issue in today’s society. Parents get confused what would they were do when there child were suffering from obesity. We were started a program to educate parents about nutrition for children. We provide a health chart for the daily diet of children.

  5. @Vikki

    Fundamentally, there are no quick fixes to what is essentially a problem of our prehistoric bodies trying to cope with mass-produced food stuffs. To be honest, I don’t think the answers are going to be unique to any individual nor surprising. It’s easy for me to say with my good BMI and my half-decent cholesterol, but the answer lies in not ever getting to the point where people are eating more than they need. Need and want are related but not the same.

    An inability to control one’s appetites may have a genetic, hormonal or other cause, but basically you have to consume more calories than you burn through activities to raise your BMI. So, the converse is equally true. Yes, I know it can be hard, especially if someone has a genetic tendency to accumulate body fat or a leptin problem, but it is an issue of simple calorie calculations at the bottom line.

  6. Arrrgh! Qnexa is just a combo of phentermine and Topamax! I’m not against techonological solutions to a largely technologically-induced problem, but this is NOTHING NEW and probably not a great idea. Had my hopes up for a minute there….

    Topamax, AKA Dopamax to some of docs, does suppress appetite for most people, but esepcially skinny little picky-eater kids who don’t need it. I got ocular and other side effects when I tried it myself as a headache preventive that at least would not make my appetite and weight problems worse. It might have worked but I sure couldn’t stay on it.

    Phentermine may be bad for the lungs. I have a friend who got a big dose of formica dust, and used phentermine for years, now has pulmonary hypertension realted to interstitial lung disease, which is not good. Her family’s obesity genes are worse than mine, apparently, and they all hit the 300-400 lb range without any appetite supressant.

    I think the solutions to obesity are going to be very individualized and very suprising.

    I have actually gone from BMI 34 to BMI 27 on a low fat diet and find that control of appetite is critical for me. I can’t defeat my excess appetite without a modified diet and supplements, which are expensive, especially compared to junk food. I almost gave up trying to reverse my pre-diabetes, because I could not fast and could not low-carb, and thought I was eating healthy. But in fact I was taking in a lot of excess fat…using Alli made me aware of it, and that made all the difference. NO, I was not interested in diet pills that could kill me or make me stupid or depressed. I’m glad to see rimobanant off the table, frankly. But there are some reasonably safe OTCs and dietary manipulations that can work even in the presence of bad genes.

    If you have seen Food Inc. you know that the excess of corn and corn syrup, the emphasis on economics/efficiency over quality of food and of human life as well as the very limited excercise endemic to modern life is the root of the problem from a population perspective. Also, though I do not deny the exisitence of individuals who are lazy, unwilling, and emotional or binge eaters, the vast majority of people are just mismatched by a relatively small but daily amount in terms of intake and expenditure. When I calculate for patients who are gaining weight, it is usually 100-250 calories a day; they find it helpful that someone understands they are not grossly overindulging huge amounts all the time. Exercise alone may not work for most peole (it din’t for me), but it certainly helps avoid muscle loss when you are dieting.

    What’s your take on the artificial sweeteners increasing food intake and obesity, at least in mice?
    I found that was true for me, and avoid them entirely, or make sure I get a little bit of “real” carbs along with the fake ones. There was a sweetener called tagatose that was mismarketed that might have been a real answer, especialy for people with type 2 diabetes issues. They ate trying to revive it essentially as a pharmaceutical. You can get a litlte bit of it in a product called Therasweet, but that has way too much xylitol…frustrating. And not the first time something that could really work – or DID work- went away!

  7. I work in the fitness industry and see first hand the devasting effects of overweight and obesity. No pill can cure this problem! Low fat foods aren’t working – clearly. Messages about exercising aren’t working either. The availability of too much cheap and nasty food is part of the problem and a quick fix mentality. Bring on the pill or the exercise machine that requires no effort and people are happy to give it a go.

    You mention Britain and N America but here in Australia I think we are doing a fine job in growing our girths. I believe we may even have overtaken the States in the “obesity epidemic”. The obvious thing I see regularly is laziness and the Australian lifestyle has encouraged this (so much for a sports mad culture!!!). We are spectators not participants. Coupled with the mind set of an affluent society that expects to have what ever it wants when ever it wants – GREED.

  8. Obesity drug is immoral – -> are additives the cause? –> Don’t try to separate a man from his chips –> aspartame is either bad or two amino acids tacked together, depending on which science you read –> ascorbic acid is in oranges and is not formic acid, which ants release –> formica is a mica substitute –> mica is see-through in thin sheets and is dangerous to the lungs, as was Artex when it contained asbestos.

    All caught up.

  9. hmm! I am not sure how this will affect the obese as in many cases there are dietary and other health issues that may not be addressed if we start fixing things with a pill. In my opinion, these underlying conditions if untreated will ultimately get the best of these individuals with or without pills involved.

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