Should we worry about obesity?

Background

According to the World Health Organisation (WHO) (2016) nutrition is food intake based on the body’s dietary needs which varies through lifecourse. A balanced diet is ideally composed of essential nutrients consisting of balanced large amounts of macronutrients which can act as energy sources namely carbohydrates, fats and proteins and micronutrients in smaller amounts of vitamins and minerals (Sharma, 2016) (The Nutrition Society, 2011) (Patton & Thibodeau, 2016). Individual food choice is governed by physiological factors like hunger and satiety reflexes which can be overridden by psychological factors like appetite, aversion, preference and emotions (Sharma, 2016). External factors affecting food choice include culture both overtly and subtly, religion, ethical decisions, economic factors, social norms and media and advertising (Sharma, 2016). In an effort to protect and improve national health through nutrition, the United Kingdom (UK) government has launched the Eatwell guide (Department of Health, 2016). The relationship between diet and chronic disease has long been documented (WHO, 2016). Nutritional status is clinically assessed using the body mass index (BMI) (Fruhbeck, 2013; Patton & Thibodeau, 2016). A body mass index (BMI) of less than 18.5 is deemed as underweight, while 25 to 29.9 is pre-obese and above 30 deemed obese (WHO, 2004).

2016-2026 have been declared the “United Nations decade of action on nutrition” (Food & Agriculture Organisation & WHO, 2016) and acknowledges the “double burden” of malnutrition where undernutrition coexists with its extreme - over-nutrition. This duality is evidenced in 2014 with 462 million adults underweight whilst 1.9 billion were overweight and 600 million obese, translating to 39% and 13% of the global population, respectively (WHO, 2016). Since 1980 the global prevalence of obesity has doubled in adults, the aforementioned 2014 obesity figures are consistent with the WHO projection set in 2005 which envisaged 2.3 billion by 2015 (WHO, 2016). In the UK 63% of the adult population was overweight and 28% obese (International Food Policy Institute, 2014). The obesity epidemic is proclaimed to be the largest global adult chronic health condition and more serious than under-nutrition (Fruhbeck, 2013) and likened to smoking (Wanless, 2004). Costs of overweight and obesity are estimated to soar to £9.7 billion by 2050 for the National Health Service (NHS), with wider costs to society estimated to reach £49.9 billion per year. From April 2013 primary care trusts (PCTs) were absolved from the sole responsibility of preventing and managing obesity with realisation that wider resources from local authorities were required (Public Health England, 2016) including the need for broader community-based interventions (Foresight, 2007; National Institute of Health and Care Excellence, 2006).

Obesity

Obesity is derived from Latin, “ob” means ‘because of’ and ‘esum’ is ‘having eaten’, illustrating the ancient association between over-nutrition and obesity in relation to perceived individual lack of willpower (Fruhbeck, 2013; Foresight, 2007). Obesity results from an energy imbalance where intake exceeds expenditure yielding a positive balance which is stored as fat (Bandini, et al., 2011; Sharma, 2016). Obesity is classically defined as excess body fat and not body weight (WHO, 2016), in particular central/truncal adiposity (Sharma, 2016; National Obesity Observatory, 2009). Central obesity is associated with chronic disease like diabetes mellitus, cardiovascular disease, cancer, hormonal dysfunction, musculoskeletal conditions like osteoarthritis, hormonal dysfunction, respiratory difficulties (Sharma, 2016). However Kushner, Lawrence and Kumar (2013) posit that obesity is more complex than calorific restriction and adopting active lifestyles – obesity is multifactorial, encompassing genetics, physiological control mechanisms, behavioural, metabolic, psychosocial, ethnicity, food availability, both food quantity and quality and societal factors (Sharma, 2016). Mechanisation and the modern lifestyle are said to be creating an “obesogenic environment” (Sharma, 2016; Foresight, 2007) (Kushner, et al., 2013). Bandini, Flynn and Scampini (2011) state that obesity ranges vary according to ethnicity, as ethnic minorities were considered clinically obese at lower ranges as compared to white British subjects. Women are more vulnerable as there is a strong correlation between lower socio-economic status and obesity risk, and obesity is more prevalent in Black African women (Willis, 2014).