Obesity - An ongoing pandemic - Louise Mercieca

 

It was World Digestive Health Day on 29th May.  This is a day celebrated by the World Gastroenterology Organisation (WGO) annually to focus on the research and progress they have made into  specific digestive diseases and their associated prevalence, prevention and treatment.  Each year the day explores a specific digestive problem and previous topics have included IBS, gut microbes and environmental factors. This year, the WGO teamed up with the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) to focus on Obesity: an ongoing pandemic. They state;


The goal for WDHD 2021 is to raise awareness of obesity and the impact on the development of comorbidities and subsequently the effect on life expectancy, which is as devastating as any infectious pandemic


The use of the word ‘pandemic’ catches our attention because we are all currently living through one, and the global impact of the Covid-19 pandemic will certainly be felt for years to come.  Perhaps, because we usually associate a pandemic with an infectious disease such as Covid-19 it’s hard to relate it to a condition such as obesity, but as the World Gastroenterology Organisation (WGO) states ‘obesity is as devastating as any infectious disease’.  


The stigma around obesity


Obesity is a sensitive subject., Even as a Nutritional Therapist I have been guilty of feeling embarrassed for using the word obesity. I worry that by saying the word I may cause offence and feel this is because obesity is often misrepresented and misunderstood.  If we treated obesity as a metabolic condition linked to a combination of emotional and biological factors, then we may feel more comfortable discussing it.  Often, however, it is portrayed as something to be ashamed of or in a way that makes individuals feel guilty.  The result of this shame or stigma is that people can become unwilling to seek help and instead may attempt fad-diets, for example, to attempt to manage the problem behind closed doors.  


On this topic, a piece published in The Independent (July 2019) entitled Obesity should be recognised as a disease, stated:


“John Wilding, professor of medicine at the institute of ageing and chronic disease at the University of Liverpool, and Vicki Mooney, executive director of the European Coalition for People living with Obesity (EASO), argue that the view obesity is “self-inflicted and that it is the individual’s responsibility to do something about it, is “inaccurate” and reinforces stigma around being overweight.”



It’s clear to me that, just as mental health awareness aims to tackle stigma to enable people to feel less ashamed and more confident in seeking help, the same kind of awareness programmes should be carried out to tackle stigma around weight and obesity.


After all, if we look at the work of the World Gastroenterology Organisation (WGO) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). We can see that there’s far more to obesity than simply eating too much.


To understand obesity and to take a stand against it we have to appreciate the significant toll it places on our health and the health of future generations. Here are some statistics around that:

  • Worldwide obesity has nearly tripled since 1975.

  • In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.

  • 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.

  • Most of the world's population live in countries where overweight and obesity kills more people than underweight.

  • Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

  • Obesity is preventable.


So what is obesity?


The World Health Organization's definition of obesity is having a Body Mass Index (BMI) greater than or equal to 30. The BMI is the most often used measure for adults in the UK - but it isn’t entirely accurate as it measures only weight and height rather than the composition of the weight (i.e. muscle or fat).  To define obesity as a number on a scale is, in my opinion. downplaying the complexity of the condition


A more detailed definition which I feel describes the complex nature of obesity more accurately comes from the Obesity Medicine Association: -


“The Obesity Medicine Association's definition of obesity is “a chronic, relapsing, multifactorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences”



Whilst we know and can appreciate the fact that obesity is a global health concern, there are plenty of statistics around to further evidence this.  In many ways, the Covid pandemic makes it seem that we have gone backwards, and that more people than ever are struggling with obesity following lockdown. However, another way to look at this is to consider that Covid-19 highlighted issues which individuals had perhaps always struggled with behind closed doors.


Emotional eating 


I know many people who have admitted turning to ‘comfort foods’ as a way to counter stress throughout the pandemic and the associated lockdowns.  Because everyone seemed to be doing this, it became ok to talk about it - celebrities were even referring to their ‘lockdown weight and eating habits’. So, whilst it wasn’t a healthy approach to stress, at least it challenged the stigma around how we sometimes use food by raising awareness of it and starting conversations.


Our emotional attachment to food is perhaps the biggest single influencing factor in obesity.  Yes, there are many biological considerations of obesity but if we emotionally eat in any situation of stress, anxiety, boredom, grief, fear, isolation - even happiness - then we are constantly and habitually turning to foods to ‘fix our emotions’.   As humans our emotions naturally fluctuate, particularly in times of stress, so to link this with food is particularly damaging for two reasons: -


1. Comfort eating foods – usually the foods we crave in these situations are high-fat and/or high-sugar items.  We crave these because they are;

 

  • Highly palatable

  • Addictive

  • Convenient 

  • Habit-forming

  • Nutrient devoid (so they don’t make you feel full)

  • Often linked to ‘food memories’ where we may think we have felt happy due to eating that item


Additionally, when we are tired and/or stressed, we have elevated levels of the hunger hormone Ghrelin. Ghrelin literally craves these kinds of foods, so our body is biologically asking for these items. 

2. The biological response – often people feel ‘out of control’ when it comes to their food intake.  When you seek to understand the biology behind this, you can see why it is happening.  Before we look at that, I would like to add that, whenever I talk to individuals about this, the first thing I say is “to remove the blame, the guilt and the shame”.  This is because you are caught up in a cycle that your body is controlling. This is very hard to break, however, once you can see how the biology is controlling you, you can start to work on habits, foods and behaviours that enable you to regain control.  Understanding that the foods you crave are not down to you being greedy or lazy with food choices but down to the biological cycle you are caught in can help you feel more able to address the situation.  


How food types influence emotional eating


When high sugar/high fat foods are consumed the body creates the neurotransmitter, dopamine, in the brain. Dopamine is associated with pleasure and reward through short term blood sugar spikes and short term mood and/or energy surges.  


As sugar energy diminishes, no Leptin is produced (the hormone that tells you that you are full), meaning that your mood can dip and your, cravings return. This results in you reaching for even more food, creating more dopamine. However, this time, to get the same ‘feel good’ response produced by the dopamine, you need to eat a bit more, and so on. It becomes a vicious cycle resulting in the desire for more and more food.


Hopefully, from this whistle-stop journey through the way the body reacts to food you can see how you are constantly working against the biology - you are not over-eating because you are greedy but because you are out of kilter with your biology. 


Taking back control of your biology


Unfortunately, this is easier said than done – although it is of course very possible.  Conversely, there is a link to another important matter on the subject of obesity and digestive health – the fact that within the same populations people are often both obese and malnourished simultaneously. 


According to the Global Nutrition report 2016: 44% of countries were experiencing under-nutrition and obesity within the same populations.  The report suggests that hundreds of millions of people are malnourished because they are overweight, as well as having too much sugar, salt or cholesterol in their blood.


Within the report, one statement said the study “redefined what the world thinks of as being malnourished”.  Malnutrition literally means bad nutrition – that’s anyone who isn’t adequately nourished, not exclusively people who are literally starving.


To take back control we must first understand the true nature of different types of food and what they do for our health.


Processed foods – these tend to be linked to the cravings mentioned above. They are easily available, often cheap, nearly always devoid of nutrients such as fibre, quality protein, essential fats, vitamins and minerals.  Predominantly ‘simple/white’ carbohydrates or those which enter the blood stream quickly causing fluctuating blood sugar levels.  These foods contribute to metabolic diseases such as obesity and Type 2 diabetes and create the issue of ‘malnutrition’.  It isn’t a lack of food it’s a lack of nourishment from the food.


Real foods – this is basically anything that isn’t processed! Real foods include Protein such as lean fish and meat, plant-based proteins, lentils, beans, fruit and vegetables, ‘complex/wholegrain’ carbohydrates.  These foods create a natural emotional balance via the production of neurotransmitters coupled with a stable release of energy from slow-release carbohydrates enabling us to feel more satisfied from our foods and significantly reducing cravings.  As these foods contain fibre and quality proteins, we produce Leptin (the hormone that tells us we are full).  Thee foods also contain vitamins, minerals, antioxidants and phytochemicals which promote a healthy gut microbiome, healthy immune system, better blood sugar regulation, healthier fat detoxification, energy transfer and mood.  


Conclusion

There’s enough information in the statistics mentioned early on in this article to give us cause for concern. However,  to fully move forwards we need to remove the blame, tackle the stigma and give obesity the ‘disease credibility’ of a serious condition rather than viewing it simply as a dress/trouser size or BMI reading.  We have seen the impact of an infectious virus causing a global pandemic, yet perhaps we have not seen or fully appreciatedthe pandemic that has been creeping up on us gradually but consistently over the last 40 years.  Due to changes in lifestyle trends and within the food landscape, this is only set to get worse. Our children are expected to become overweight as adults and, as we know it isn’t just our weight that’s at stake, it’s our health and quality of life too.

For more information on the work that is taking place for World Digestive Health Day (WDHD) 2021 take a look here 


https://www.worldgastroenterology.org/wgo-foundation/wdhd/wdhd-2021/wdhd-2021