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Obesity Surgery, 14, 869-870

The past 50 years have witnessed a rise in obesity, whichhas become almost universal. This initially occurredinsidiously, until obesity, rather than famine, has becomethe most common form of malnutrition. The world has aproblem, and it is getting worse.

In the 1980s, particularly because of studies on identi-cal twins reared apart, I was of the opinion that the majorcause of fatness was genetic.1 However, as the problemadvanced rapidly,2,3 it became obvious that the gain inadipose tissue must be largely related to lifestyle anddietary changes.

In the 1950s, in the period between medical school andmy summer job, I traveled with two classmates across theU.S.A. on a low budget. In each city, we stayed at theYMCA – these functioned mainly as hostels for men atthe time. Now, these institutions function as a mainsource of exercise for much of North America. A newfeature commenced in the 1960s and 70s, and has contin-ued – the recreation industry for “working out”. Also, tocombat obesity, a host of diets, diet books, diet pills, low-calorie foods, psychotherapy, home exercise equipment,recent labeling of food contents, etc. have evolved. TheMetropolitan Life “ideal” weights for survival of 19834

were higher than the “desirable” weights of the 1950s,and this was attributed to increased muscle mass from thepush for physical fitness. However, we continue to losethe battle.

The incidence of overweight and obesity in the U.S.A.and Canada has doubled in the past 25 years, now involv-ing more than 50% of the population, with a resultinghuge increase in the co-morbidities, medical-care costs,and absenteeism from work.5 Europe is not far behind –the greatest incidence of obesity being in the oldYugoslavia, followed by Greece, the UK, with the othercountries close behind.6 Greece is of interest, because inthe past, Greece was lauded for its simple salads witholive oil (unsaturated fat).7 South America is right in thethick (not a pun) of the excess adiposity. Brazil has morethan 600 bariatric surgeons. With the rise in obesity nowoccurring in the huge populations of China, India and therest of Asia, the World Health Organization estimates thatoverweight and obesity involve more than 1.7 billion peo-ple worldwide.8 The problem is that Asians are vulnera-ble to obesity-related diseases at a BMI of only 23.

It seems that everyone has an explanation for this‘globesity’ epidemic. We have become sedentary. Wedrive – to the corner. We press a button to lift the garagedoor. We take the elevator for only three flights of stairs.We watch TV. We sit at a computer. Fast food is cheap

and super-sized. Women are also now breadwinners; they are at work to

pay for a second car, a third TV, and the other currentnecessities of life, so that there is no one at home to pre-pare food for the children. The children eat calorie-denselow-nutrient fast food at Mc-stores or from schoolmachines. Studies show that 40% of children age 1 to 4of low-income families in the U.S. already have a TV intheir bedroom.12 Inactive adolescents are manifesting analarming increase in the associated impaired glucose tol-erance, cardiac and lipid disorders of obese adults.13,14

The effect of a high-fat “Anglo” diet and decreased phys-ical acitivity is particularly exemplified by the PimaIndians of Arizona who were traditionally fit, but with anunderlying genetic susceptibility, type 2 diabetes, heartdisease, gallstones and the other sequelae of obesity havebecome common.15 Trans (hydrogenated, saturated) fatsas a food preservative in marketed baked goods, saladdressings, processed cheese, margarine, etc. add to thedisorders,7,16 as likely does an increase in tranquilizingdrugs in a fast-paced society. As obesity increases, sodoes the advancement to the severe form – morbid obe-sity.

Where is this all going to end? I hate to think!Meanwhile, governments and the medical professionhave to mount an ongoing attack on this menace.17-19 Weneed education of children and proper foods in theschools. We need fresh fruits and vegetables, wholegrains, protein without binding of fat, removal of high-calorie soda-pop, and reasonable nutritious low-calorieportions. We need an awareness of our BMI (fatness),daily exercise, formal exercise 30-60 minutes 3 times aweek, and participation in sporting activities. Cigarettesmoking was the major cause of unnecessary disease, butthe International Tobacco Treaty of the WHO guidelines(education, prevention of enticing ads and sponsorship ofsports events, cautions by the manufacturers, non-smok-ing laws, and substantial taxes on cigarettes) has reducedsmoking and also the effects of second-hand smoke. Toconfront obesity, the WHO has been trying to set upguidelines for cooperating governments20 – education inchildhood, healthy menus and food selections, lowerintake of sugar, smaller portions, restriction of fast-foodadvertising, possibly taxing some foods and subsidizingothers, and particularly integration of physical acitivityinto daily life. As medical practitioners, we share theresponsibility to research, advise, confront and thwartthis international challenge.

M. Deitel, MD, Editor, Toronto, Canada

Editorial

It’s a Fat, Fat, Fat, Fat World!

References

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4. 1983 Metropolitan Height and Weight Tables. MetropolitanLife Foundation, Statistical Bull 1983; 64 (1); 2-9.

5. The cost and health effects of obesity. Washington BusinessGroup on Health. http://www.wbgh.org/healthy/about.cfm

6. UK Parliament Health Select Committee Third Report onObesity, May 27, 2004. www.parliament.the-stationery-office.co.uk/pa/cm/cmhealth.htm

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13. Kopelman PG. Obesity as a medical problem. Nature 2000;404: 635-43.

14. The Bogalusa Heart Study. www.som.tulane.edu/cardiohealth/bog.htm

15. Williams DE, Knowler WC, Smith CJ et al. The effect ofIndian or Anglo dietary preference on the incidence of dia-betes in Pima Indians. Diabetes Care 2001; 24: 811-6.

16. Cuchel M, Schwab US, Jones PJH et al. Impact of hydro-genated fat consumption on endogenous cholesterol synthe-sis and susceptibility of low-density lipoprotein to oxida-tion in moderately hypercholesterolemic individuals.Metabo-lism 1996; 45: 241-7.

17. Stubbs RS, Wickremesekera SK. Insulin resistance in theseverely obese and links with metabolic co-morbidities.Obes Surg 2002; 12: 343-8.

18. Laaksonen DE, Lakka H-M, Salonen JT et al. Low levels ofleisure-time physical activity and cardiorespiratory fitnesspredict development of the metabolic syndrome. DiabetesCare 2002; 25: 1612-8.

19. Deitel M. The Surgeon-General’s call to action to preventan increase in overweight and obesity. Released Dec. 13,2001. Obes Surg 2002; 12: 3-4.

20. Fifty-seventh World Health Assembly resolution WHA57.17, May 22, 2004. www.who.int/hpr/global.strategy.shtml

Deitel M

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