Philip McTernan, Associate Professor, Warwick Medical School
Published January 2014
Obesity per se can often be a difficult subject to tackle. Currently 19.2 per cent of children in Year Six (those aged 10-11 in the UK) are obese and a further 14.7 per cent are overweight. Obesity is a complex disease. Even though it is the single biggest risk factor for diabetes and cardiovascular disease (CVD), it attracts limited research funding from government and charitable donations given the amount of people it affects. Often the perception from society is that adults with obesity are lazy and this can transfer, by association, to their children. There is a notion that they have brought it upon themselves along with their families. Add to this the reoccurring debate of whether or not we should treat people with obesity and we appear to have an ethical judgement presented to us. These debates and discussion about obese people being lazy are, however, complete moralistic nonsense.
Obesity is a complex multifactorial disease. I use the phrase disease because it carries the symptoms and pathology of being a disease. Weight gain can lead to a vast number of health conditions such as;
- Pulmonary diseases (obstructive sleep apnoea)
- Non-alcoholic fatty liver disease
- Gall bladder disease
- Gynaecologic abnormalities such as infertility, polycystic ovary syndrome [PCOS]
- Osteoarthritis, skin complaints
- Breast cancer
- Uterus cancer
- Cervix cancer
- Colon cancer
- Pancreas cancer
- Prostate cancer
- Kidney cancer
- Oesophagus cancer
- Cardiovascular disease
- Coronary heart disease
- Intracranial hypertension
Do we stop treating these conditions because someone has put on weight?
These health conditions are not only confined to adults – they affect children as well. Studies within Warwick Medical School have identified that children with obesity appear to carry the same cardiovascular injury markers noted in middle aged adults with cardiovascular disease. This suggests that a child with obesity will have a very much reduced early onset of cardiovascular disease affecting their life expectancy.
The increase in childhood obesity is dependent upon multiple environmental factors, global work shifting patterns, changing population habits and lifestyle, global food production economics, media, shifting dietary habits and the developing disconnect between food and its nutritional contents. This is even before we get to our own genetic make-up which is heavily influenced by the environmental pressures. These environmental pressures have meant that not only our children but our society as a whole is putting on much more weight.
Children with obesity appear to carry the same cardiovascular injury markers noted in middle aged adults with cardiovascular disease
As an average adult we are going to consume around 800,000 kcals a year. Our body’s fat stores are, remarkably, able to keep us on track considering how much we consume each year. Although even a five per cent increase in those calories over that year could equate to five kilograms of extra weight, compounded by a ten year period this could be as much as 50 kilograms or 7.87 stone! Amazingly, though, we don’t see that happen very often.
Most people don’t see the slow increase in their weight but see the final result and a number of factors affect children differently. For example, a child eating the same meal as another will put on more weight than that other child of equivalent weight due to their genetic make-up. Also the timings of the meals and type will also affect how many extra calories that child may intake. Add all these elements together and you could have a child that puts on more weight, subtly and slowly over time.
Whilst childhood obesity appears to be a modern phenomenon, curiously it could be why, as a species, we are all still here today. Our ancestors would have no doubt battled with periods of hunger as they spread across the globe; the capability to store body fat in lean times would have conferred a tremendous selective survival trait. Our successful ancestors therefore could have combined their intellectual skills with their capability to store fat to ensure their survival. Whilst we don't appear to need this trait today in many places, we in part owe our success as a species to these traits. So the next time someone makes an ill-informed remark around childhood obesity, inform them, and let them know where it stems from.
Obesity is on the increase worldwide and in the majority of cases this increase will lead to type 2 diabetes. At present, 50 per cent of the UK population is overweight and this percentage is set to increase.
Dr Philip McTernan is part of a team, at Warwick Medical School, which works on several of these factors to examine how they impact on the progression of the disease and its complications, such as hypertension and the risk of heart disease. The team performs both clinical and laboratory patient-based studies, assessing the effects of risk factors on fat as well as the role of drug treatment on reducing pathogenic factors produced by fat.
The studies aim to provide a deeper understanding of how present drug and or diet intervention impact on our health with particular emphasis of how human fat cells may contribute to this risk. The team looks into ways to decrease risk imposed by obesity and type 2 diabetes. The multidisciplinary team works across several cross-clinical specialisms and academic departments (Biology, Chemistry, Maths and Systems Biology). Key research includes studies into the role of inflammation in the progression of obesity and Type 2 Diabetes Mellitus; how our gut flora may impact on our health and the influence of both medication and inflammatory factors impact on human fat cell metabolism.
Illustration by Joel Santana/Dribbble