As Professor Rossner’s eloquent editorial demonstrates,obesity is fast becoming a major global pandemic withlethal consequences. While we may view this as apreventative, public health problem, as members of theworldwide diabetes care team the implications of this, as asource of an ever-increasing supply of diabetic patients,on our ability to provide adequate care are clear.

In the next few issues of Practical Diabetes Internationalwe are going to publish a number of articles on obesity inan attempt to awaken our readers’ interest. In this issueJohn Wilding from Liverpool writes about the causes, andJonathan Webber from Nottingham about thecomorbidities of obesity, including diabetes. There will befurther articles on the treatment of obesity by diet, drugsand surgery as well as possible arrangements which mightbe made to treat obesity in the NHS. However there arepractical procedures we as individuals could consider: forexample, limiting the time spent by our children in frontof any screen, computer or TV, to two hours per day,protesting to local councils when they close leisurefacilities and to local schools who do not providedomestic science teaching to boys and girls or sell offplaying fields for housing because the government tellsthem to balance their books.

However as Professor Rossner points out there doesappear to be something of a sea change in attitudes tooverweight and obesity with more articles in newspapers,on radio and television. While governments are always

The king of Tonga in the Pacific recently became one ofthe most successful members of the Australian Gutbusterprogram. Two things were remarkable about his success:(1) he lost about 100 kg from a starting point of about226 kg and (2) this at an age of 86! Success stories of thiskind are much needed these days, since we have nowreached a global situation when more people in our worlddie of overnutrition than starvation. The incidence ofobesity and type 2 diabetes is accelerating throughout theworld. The WHO consultation on obesity1 has recentlysummarised prevalence data for weight development andfound an acceleration, not only in the Western part of theworld, but also in all other regions.

Of particular concern is the fact that the prevalence ofobesity is accelerating already in childhood, again also

‘If you think diabetes care has problems. . .’apprehensive of the costs of the prevention and treatmentof long term conditions such as obesity (and, for thatmatter, diabetes) drug companies have no suchapprehensions, particularly when it is rumoured that thetwo years of the Fen-Fen anti-obesity regime in the UScreated an eight billion dollar market before it waswithdrawn for safety considerations. No such market canbe ignored. It does not seem accidental that the drugindustry’s interest in obesity has been re-awoken. Thenext ten years in the field of obesity may well prove to bequite exciting, with an expansion in our understanding ofthe causes and treatment of the condition, with hopefullya big spin-off for diabetes care.

However the scale of the problem is immense. In theUK there may well be three million diabetic patients by2010 but there are just short of ten million obese patientsalready and the number is steadily increasing. You maythink that diabetes care has problems with caseload: theseare minor compared to those involved in the care ofobese patients.

And so, readers, peruse these articles and cogitate;better still read them while you are eating less andexercising more.

John K WalesEditorPractical Diabetes International

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particularly in Southeast Asia.1 In countries such as theUnited States type 2 diabetes associated with early andsevere obesity has become almost as common as type 1diabetes in adolescents.

Genes change slowly but this epidemic has explodedover a few decades. Although obesity and type 2 diabetescan to a certain extent be explained by genetic factors,this rapid increase over the last few years indicates thatthe environment, rather than changes in our geneticmake-up, explains the increase. One genetic explanationmay still be important to recognise: selective mating,meaning that individuals of similar body size are attractedto each other selectively, remains a possibility, which isactually supported by some studies.2 Birds of a featherstick together.

Obesity and type 2 diabetes