Obesity – Victims of our own success?

By Matt James, Senior Researcher at 2020health

In the previous blog post we saw how human biology, our new lifestyles and the modern food supply has helped to contribute to the rise in obesity. Addressing the complex interplay of evolutionary, historical, scientific, environmental, social and individual factors which arise which help shape our response to the challenges of an obese nation.

Consisting of refined vegetable oils and trans fats, refined sugars and cereals, alcohol & dairy products, increased sodium concentrations, decreased fibre and processed and ultra-processed foods, (Carrera-Bostos et al, 2011, Pokin et al, 2011), the western diet is a product of human nature interacting with various factors including agriculture, industrialisation, the environment, access to wealth, technology and medical development. The manifestation of this style of eating has been many thousands of years in the making. The last two centuries and most rapidly in the last four decades our food and home environments have dramatically changed (St-Onge et al, 2003), this has seen rise to the obsegenic environment in which we live and the subsequent obesity epidemic.

Agriculture
Agriculture and animal husbandry were first introduced around 11,000 years ago (Carrera-Bastos et al, 2011). This instigated the initial shift of the Homo sapien diet away from minimally processed wild plant and animal foods (Cordain et al, 2005).

Industralisation
The industrial revolution saw a rapid acceleration of the process, this has transpired in the last 200 years (Cordain et al, 2005). It was the agricultural and industrial revolution that first propagated the key changes in dietary constructs that we see in the western diet including: Glycaemic load, fatty acid composition, nutrient composition and sodium content (Cordain et al, 2005). This has resulted from changes in food production methods and the ability of the food industry to cater to intrinsic human flavour profile desires.

The introduction of the supermarket pioneered the 20th century food revolution in which food availability increased. The introduction of the Agricultural Act in 1947 was the first UK policy to encourage and subsidise mass food production. This saw rise to the current over abundant food supply.

Whilst the food industry has effectively responded to consumer demands for a safe food supply (Popkin et al, 2006), it has also propagated increased consumption of processed and ultra-processed foods, typically high in fat and sugar and low in fibre. Foods of this nature commonly have poor satiating qualities and increase overall calorie consumption beyond the caloric load of the food itself (St Onge et al, 2006).

Environmental factors
The link between ‘fast food’ consumption and weight gain is well known. The characteristics of the neighbourhoods in which people live can encourage weight gain (Pruncho et al, 2014). Increased density of fast food outlets in communities is associated with unhealthier lifestyles, poor psychosocial profiles and increased risk of obesity (Li et al, 2009). This tends to be true of low socio-economic areas, supporting the socio-economic paradigm of obesity as a ‘poor person’s disease’.

Food
Over time the increased availability of relatively cheap, calorically dense foods has encouraged excess consumption of calories (Bogart 2013: 38). Alongside this has emerged advertising which has helped brand consumption of food with recreational and entertainment activities such as large sport events, trips to the cinema and music festivals. Together this has helped create a sense of consumption as a pastime.

Proliferation of T.V ownership and the introduction of daytime television characterised the 1980s. Increased television viewing is linked with increased BMI, unhealthy diets, decreased physical activity and increased exposure to food advertising. Watching television while eating increases energy consumption (Braude L, Stevenson, RJ. 2014).

Community architecture
A further environmental influence is the design and make up of the communities we live in; what could be termed community architecture. Increasing the built environment in which we live does not encourage or promote physical activity. While this is beginning to show signs of change, to date design and planning have tended to encourage a reliance on the use of cars and not prioritised large open spaces and parks.

Schools and work place culture have also emphasised maximising time and effectiveness to the detriment of giving time to relax, move about and engage in physical activity. Break times in schools have often been reduced in duration and many employees claimed to working through lunch breaks or never taking a proper lunch break. A study of about 2,000 people by the Chartered Society of Physiotherapy has found that one in five employees worked through their lunch. Half of those who did manage to take a break ate at their desk, one in five went outside and 3 percent went to the gym (BBC News Online 2014). Instead of taking a break to refuel, workers turn to chocolates and sweets and caffeinated drinks to get them through the day (Bupa 2013). This helps to create a population who live an increasingly sedentary lifestyle.

Social contagion
Research studies point to the fact that people are connected by health. Due to the breadth and depth of its database, the Framingham Heart Study, a longitudinal study started in 1948 and follows over fifteen thousands individuals, has been used to track developments in individuals other than those related to heart disease. Whilst the accuracy of some of its findings have been called into question, a general trend that has been noted is one referred to as social contagion: good behaviours are passed from friend to friend (Bogart 2013: 39). When an individual becomes obese, friends of that one individual were 57 percent more likely to become obese (Bogart 2013: 39).

Technology
The end of the Second World War saw an increase in technology and a decrease in incidental activity; subsequently energy expenditure began to decrease. This marked the beginning of the trend we observe in modern society.

Technology has almost eliminated the need for physical activity. Modern conveniences and mechanisation have culminated in decreased physical activity and energy expenditure (Pontzer et al, 2012). We see evidence in all facets of modern life from work and travel to leisure activities and time spent in the home (Pokin et al, 2006). Reduced physical activity and energy expenditure can contribute to a positive energy balance associated with weight gain.

Access to wealth
Recent years have also see rise to the number of double income families in which the wife and or mother works outside of the home. This is associated with time constraints and influences food choices towards convenient alternatives. The food industry responded with increased production of convenience and processed food (St Onge et al, 2003).

An increase in consumption of food outside the home particularly in neighbourhoods with high densities of fast food outlets (Li et al, 2009 & Pruchno et al, 2014), culminates in direct increase in consumption of processed food (St Onge et al, 2003). Restaurant meals can have up 65 percent more energy than home

cooked alternatives (Prentice and Jebb 2003). This is associated with one of two phenomenon: proportional decrease in healthy food alternatives, or consumption of these foods in addition to a ‘healthy diet’. Both are associated with excess energy consumption (St Onge et al, 2003). We also observe increased portion sizes in recipe books, restaurants, fast food outlets and within the food industry. Contributing further to the calorific load of the western diet.

Medicalisation
We also observe huge advancements in medical technologies. The implications of this are three fold.

* BMI tends to increase with age (with 45-65 year olds most at risk of being overweight or obese (Puncho et al, 2014). Medical advances are seeing rise to ageing populations;

* Medical advancements have seen rise to improved healthcare provisions and treatment options that did not previously exists. People are surviving conditions that were previously fatal. This increases the percentage of the population living with chronic conditions including those directly associated with obesity, exacerbating the strain of medical costs on society (Li et al, 2009);

* Some medications are associated with increased appetite and decreased satiety attributing to excess weight gain: Steroids, anti-depressants, anti-psychotics and hormone therapies.

Responding to the challenge of obesity is a complex issue, but this should be no excuse for either doing nothing or too little. Denial is certainly the worst possible course of action, but there are no quick fixes either.

The ‘time bomb’ of obesity poses a significant threat on several different fronts: individual and community health as well as financial implications of days lost in work, mounting health costs and impact on society as a whole. As such it requires a complete package of measures. What might this package of measures look like? This will be a question addressed in our next blog.

References:

BBC News Online. 2014. Employers urged to encourage lunch breaks for staff. http://www.bbc.co.uk/news/uk-27726859

Bogart, W.A. 2013. Regulation Obesity? Government, Society & Questions of Health. Oxford: Oxford University Press.

Braude, L., Stevenson, RJ. 2014. Watching television while eating increases energy intake. Examining the mechanisms in female participants. Appetite. 2014 May;76:9-16. doi: 10.1016/j.appet.2014.01.005. Epub 2014 Jan 22.

Bupa. 2014. Working through lunch costs UK businesses almost £50million. http://www.bupa.co.uk/reclaim-lunch

Camera-Bostos P, Fontes-Villalba M, O’Keefe JH, Lindeberg S, Cordain L. 2011. The western diet and diseases of civilisation. Research reports in clinical cardiology. 2: 15-35

Cordain L, Boyd-Eaton S, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’keefe JH, Brand-Miller J. 2005. Origins and evolution of the western diet: health implications of the 21st century. Am J Nutr. 81: 341-54

Li F, Harmer P, Cardinal BJ, Bossworth M, Johnson-Shelton D. 2009. Obesity and the built environment: does density of neighbourhood fast food outlets matter? The science of health promotion. 23(3) 203-9

Pontzer H, Raichlen DA, Wood BM, Mabulla AZP, Racette SB, Marlowe FW. 2012. Hunter gatherer energetics and human ovesity. Plos one

Pokin BM, Adair LS, Ng SW. 2011. Global nutrition transition and the pandemic of obesity in developing countries. Nutrition reviews. 70(1): 3-21

Popkin BM. 2006. Global nutrition dynamics: The world is shifting rapidly towards a diet linked with non-communicable disease. Am J Clin Nutr. 84: 289-98

Prentice, A.M. and Jebb, S.A. (2003). Fast Foods, Energy Density and Obesity: A Possible Mechanistic Link. Obesity Reviews, 4:187–194.

Pruchnon R, Wilson-Genderson M, Gupta AK. 2014. Neighbourhood food environment in community-dwelling older adults individual and neighbourhood effects. American journal of public health. 104(3): 924-9

St-Onge MP, Keller KL, Heymfield SB. 2003. Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr. 78: 1068-73