Causes and Solutions to the Obesity Epidemic

Poor eating habits and the physical health of 21st century human beings has become the centre of worldwide discussions. It is far more complex than merely understanding and using the nutritional information available. A mixture of an individual’s financial position, geographical location and will power are to blame but it seems as if unethical scientific studies, uninformed decisions by members of government and the availability of false information are major contributing factors to the status quo. However, it is evident that healthy people are less of a burden on society than those who overeat and do not partake in regular exercise.

Obesity is an epidemic defined as the abnormal or excessive fat accumulation of which millions of individuals around the world have fallen victim to. The disease is preventable but more than 65% of the world’s population live in areas where overweight and obesity kills more than underweight, 10% of the world’s adult population is clinically obese and 40 million children under the age of 5 are classified as being overweight. The statistics are horrifying but the effects are evident particularly in the United States of America where its affects are seen in every state.

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The obesity statistics in South Africa are no better. Currently 29% of men and 56% of women are classified as being overweight or obese and of those individuals 71% have never tried to cut down and 78% think that they are perfectly healthy. The blame seems to be on Westernisation and Urbanisation as well as the fact that we are among the highest consumers of alcohol in the World.

Obesity has doubled since 1980 and it is currently the 5th leading cause of death. The fix is near impossible especially with the current nonchalant attitude with regard to the addressing of the disease. The lack of urgency towards addressing the problem is evident worldwide, particularly in the United Arab Emirates where type-2 diabetes is now seen in children as young as the age of 10.

It appears that in affluent countries such as the UAE-where people are spoiled by higher incomes-that overeating rather than the sedentary lifestyle is to blame for the poor health statistics. The rapidity of the problem took hold half a century back where their lifestyle changed as a result of population growth and urbanisation. The UAE staple diet now consists mainly of rice, bread and sweet fruits and the sudden explosion of delivery services and restaurants has compiled the problem. According to Dr Kazem Behbehani, “We need to invest heavily in nutrition,” and so the UAE draft strategy was implemented. The aim is to educate the public with regard to health and nutrition and also target the manufacturing sector where it will emphasise ethical marketing and labelling strategies.

The epidemic can be reduced through a combined effort by the individual, society and the food industry. The individual has the responsibility to limit energy intake and partake in regular physical activity. Society must show its sustained political commitment and make pursuing a life of health, affordable and easily accessible. The biggest responsibility lies with the food industry as they are the ones that should provide healthy and nutritious choices and ensure responsible marketing.

Another factor to consider with regard to the poor health of individuals around the world is the fast food industry. According to the Huffington post about 50% of all meals consumed daily are away from home and one in five breakfasts is eaten from McDonalds. The calorie intake has surged since 1980 from 3200 calories per day to a whopping 3900 and can be seen by looking at figure 14 that shows the changes of calorie intake over the past 40 years. The fact that there are over half a million fast food restaurants staking their claim around the world is a concern as it shows the demand for them outweighs the supply. McDonalds alone feeds 68 million people per day and is the largest toy distributer in the world which explains why children develop such resilient reliance and trust with McDonalds at a very young age.

Calorie intake varies according to gender, age and height. There are, however, calorie intake guidelines for adults. The recommended calorie intake per day for sedentary males and females is 2,000 to 2,600 and 1,600 to 2,000 respectively. If an individual is active these amounts increase, for males it is 2,400 to 3,000 and for females it is 2,000 to 2,400 calories per day. What many people do not realise is how many calories are in the food they consume particularly in fast food.

If we compare the amount of calories in a fast food meal (regular burger, fries and a milkshake) from the three major fast food chains around the world, namely KFC, Burger King and McDonalds one will notice that an individual would have almost expended their daily calorie intake in one meal.

•McDonalds (Big Mac, Regular Fries and a Chocolate Milkshake) = 1780

•KFC (Burger, Regular Fries and a Crusher)= 1125

•Burger King (Whopper, Regular fries and a Chocolate Milkshake)= 1750

As a result of the Patient Protection and Affordable Care Act all restaurant chains with 20 or more locations in the United States are now required to post the calorie contents of their products on menus or boards. The calorie information is relatively easy to find but whether or not people use them is debatable but a study conducted by NYU Langone confirms that the posting of nutritional information at fast food chains does not influence an individual’s choice in product consumption. As a result it has no effect on the amount of calories consumed, “10 percent of the respondents in our study said that calorie labels at fast-food chains resulted in them choosing fewer calories.”

A comprehensive study conducted in Boston and Philadelphia by Bryan Bollinger, Phillip Leslie, Alan Sorensen and their team found that, “Mandatory calorie posting does influence consumer behaviour at Starbucks, causing average calories per transaction to decrease by 6%.” But the effect is insignificant when you look at figure 12.4 where calorie posting before and after produced practically identical graphs of calorie consumption. They also note that, “Calorie posting did not cause any statistically significant change in Starbucks revenue overall.”

If calorie posting does not affect a company’s overall revenue one wonders why every fast food chain does not partake in global calorie posting. Whether or not the effects on weight loss are statistically significant or not calorie posting should become the norm. Society needs to be constantly exposed to calorie posting if the effects on an individual’s health are to be meaningful.

Bryan Bollinger makes an interesting comment. It seems only reasonable to assume that the providing of nutrition information to consumers would assist them in purchasing healthier products. The idea is that consumers would be shocked to realise how many calories are in the beverage and/or food that they consume. However, it appears that consumers at chain stores are more concerned about convenience, price and taste, rather than the nutrition information. And those who do care about nutrition information and calories either do not go to fast food chains in the first place and/or are already well-informed because the information is easily accessible on company websites.

If nutritional information were going to make a difference it would appear at chain stores, however, if they assume that the calorie consumption for all chain stores was reduced by 6% then, “It would imply a decrease in total calorie consumption on the order of 1.5%” This amounts to a mere 30 calories and if it was going to have any meaningful effect on weight loss it would have to be between 500-1000 calories per day.

The paper suggests that mandatory calorie posting is only an acceptable policy if the benefits outweigh the costs. If anything they hope that calorie posting will encourage companies to offer more low-calorie items and that the consumer’s exposure to this information will make them more aware of the nutritional value of the foods they eat. They conclude that, “Our back-of-the-envelope calculation suggests that average reductions resulting from calorie posting in chain restaurants will not by themselves have a major impact on obesity.”

The study does have its shortfalls and the effects of calorie posting may have been understated as they acknowledge in the paper:

1.The study assumed that the calorie intake of every individual was 2000 calories per day. They comment that it may be higher and this would mean that the reduction of calories per day could be much higher.

2.The study was only taken from Starbucks and this could understate the impact of nutrition information at other chain stores. In their study they found that consumers were more sensitive to calories ingested from food and not beverages which means that the effects of nutrition posting could be higher at other chain stores.

3.The impact of nutrition posting could be much higher chain stores promoted tasty, low-priced, low-calorie products.

The single most significant factor on the state of an individual’s health and eating habit is their diet. A diet is a concept whereby an individual eats food in a regulated fashion with the aim to either maintain, increase or decrease their current weight. It is often used in combination with exercise but studies by the APA journal (among others) have found that the majority of individuals regain all weight irrespective whether or not they maintain diet and exercise.

There are a variety of diets that either restrict calorie intake or a particular macronutrient but meta-analysis of randomised controls found no difference in weight loss. It appears that as long as calories are reduced weight will be lost but it is also evident that the restriction of certain macronutrients such as carbohydrates results in fast weight loss over a shorter period of time.

Diets appear to arise as a result of an individual’s own miraculous weight loss and William Banting is no exception. In his Letter on Corpulence that he wrote in 1863 he describes his low-calorie and low-carb diet. Banting was morbidly obese and he blamed it on his love for farinaceous foods such as, “Bread, milk, butter, sugar and potatoes […] these, said my excellent advisor, contain starch and saccharine matter, tending to create fat.”

Many individuals-like Banting and others-do not realise that their daily eating habits have a detrimental effect on their health. Generally poor eating habits result in a poor state of heath.

•Drinking alcohol: Increases ones insulin resistance which results in the storage of excess carbohydrates in the form of fat and hinders its use as fuel.

•Compulsive snacking and food binging: Eating large amounts of food (often driven by emotions) results in eating beyond the point of being full.

•Skipping breakfast: It is by far the most important meal of the day and failing to eat at this time results in an energy drain, disruption of metabolism, reduction in the amount of carbohydrates burned and increases likelihood of snacking.

•Eating heavy meals before bed: Your body fails to burn and digest the carbohydrates as fuel and as a result the body stores it as fat.

Dieting is not as simple as it is made out to be as many individuals have realised. However, Tim Noakes believes that the current poor health of individuals around the world is the result of an unethical study conducted by Ancel Keys that has resulted in decades of individuals failing to lose weight.

The ‘Seven-Countries Study’ conducted by Keys is considered a case of manipulated bias. The study was published in 1953 by Keys who was already a well-respected American biochemist. In the publication he drew a comparison to the cholesterol levels in individuals and the amount of fat that one consumed. Despite having enough statistics from 22 countries he only selected 7 of them that supported his theory. The countries that were omitted did not support his hypothesis such as Holland and Norway whose diets comprised of large amounts of fat but who had some of the lowest cases of heart disease. Conversely there were cases where fat consumption was low but heart disease was high such as in Chile.

There were many flaws in Keys work:

1.The data came from 7 of the 22 countries that suited his theory.

2.He failed to use randomised controlled clinical trials and only ever reported observational studies. As a result he could not prove his theory unequivocally.

3.He never considered other variables that could explain the relationship explored in his theory such as the growth in cigarette consumption.

4.He was not a clinician and had never treated a patient that suffered from the disease.

Political events such as the desperate need to bring down the food price and increase the wealth of US farmers allowed for the global exploitation of Keys false theory. Senator George McGovern wanted to restrict the intake of saturate fats and eggs by implementing the United States Dietary Goals for Americans (USDGA). The guidelines for the USDGA were compiled by Nick Mottern who had no formal training in nutrition science and now the American diet was based on 8-12 servings of grains and cereals a day so that they could successfully implement industrial scale production of corn and soy.

US government agencies such as the National Institute of Health used research budget to prove that people that follow the guidelines will become immune to diabetes, heart disease and obesity. They spent over $700 million promoting the Food Pyramid but could not prove that a dietary change would produce significant health benefits. Figure 2 shows that the sudden increase of obesity since the 1980s is as a result of the USDGA. The stimulatory effect of carbohydrates on hunger results in the increase in calorie consumption and figure 5 shows that the increased consumption of calories from carbohydrates matches exactly the increasing rates of obesity from the beginning of the 1980s.

What many people do not know is that out of all the macronutrients (fat, protein and carbohydrates) available the one that our body can do without are carbohydrates. Humans have the ability to obtain their energy requirements from proteins and fats-a process called gluconeogenesis-and there are no scientific studies that show that avoiding carbohydrates have short or long term effects on humans. There are, however, studies that support the Low-Carb, High-Fat diet (LCHF) promoted by Noakes and his team as a more suitable means of weight loss as opposed to other diets. A study conducted by the New England Journal of Medicine in 2003 found statistically no difference over a period of 12 months but low-carb diets are a more effective means of weight loss over a shorter period of time when compared to low-fat diets.

History shows that ancient humans such as the Egyptians suffered from severe tooth decay, bone fractures, high blood pressure, diabetes and obesity. These are symptoms similar to those that we now see in many individuals today. It is believed that the Egyptians diet, like ours, comprised mainly of refined carbohydrates. As Michael Eades says in his book Protein Power if such is the ultimately health diet, “Rich in all foods believed to promote health and almost devoid of saturated fat and cholesterol […] then ancient Egyptians should have lived forever.”

There are many shortcomings to the LCHF diet promoted by Professor Tim Noakes as explained by Christopher Gardner in a presentation presented at the Stanford University. One cannot confirm if it is the reduction of carbohydrates or the increase of fat in an individual’s diet that is behind the miraculous weight loss. The mere fact that you are restricting your carbohydrate intake to extremely low levels means that you immediately reduce calorie intake and despite having the ability to eat copious amounts of fat one cannot eat a tub of butter without bread to put it on. The result of the LCHF diet means your stomach shrinks and you have the ability to go without feeling hungry for 6-12 hours.

There is also the important issue of fat loss versus muscle loss. Weight loss typically involves loss of fat, water and muscle. The aim of weight loss is to reduce the percentage of body fat. Muscle tissue, however, is denser than fat and a mere 10% reduction can have a dramatic effect on the shape of the body.

The fact that muscle loss occurs is based on our Basic Metabolic Rate (BMR). This is the amount of calories the body requires when at rest and is influenced by the weight and muscle mass of an individual. More muscle means more calories without any ‘weight’ gain. In order to lose fat one must have a daily caloric intake that is greater than or equal to the BMR. Muscle and fat loss occurs when the daily caloric intake is less than or equal to the BMR.

Maintaining muscle whilst losing fat is difficult but muscle loss can be restricted by regular lifting of weights and sufficient protein intake.

There are many other diets such as the famous Atkins diet but a more recent diet based on the idea that no two humans are the same and that means one should eat according to their genetic make-up. The diet is as a result of Dr Peter D’Adamo’s work that certain foods are beneficial to certain blood types where others are harmful.

It is evident that there is just far too much information out there surrounding proper dieting and nutrition. Individuals are bombarded with information that could possibly be false and based on no scientific studies but even those that are could not work for some individuals. It comes down to will power. If one partakes in regular exercise, follows an eating plan that contains sufficient nutrients and stays committed then I believe that anyone has the ability to live a healthy lifestyle.

Finally the effect of obesity on the modern world is a financial one. It costs the United States government $190 billion a year in treatments alone and it is expected to rise to $344 billion by 2018. This means that the obesity-related treatments make up 10% of the annual medical spending. On average obese people spend 42 percent more on healthcare costs than healthy-weight people and obesity-related job absenteeism costs $4.3 billion annually.

In closing poor eating habits and the physical health of human beings is only partly dependent on the availability and the understanding of nutritional information as the issue is far more complex. Individuals are bombarded with information (correct or not) and are far more concerned with price and taste rather than their well-being. Simplistically, the more educated we are in nutritional information the more informed we can be as individuals to take responsibility for our own health. It is however clear that healthy people are less of a burden on society.