Obesity is a multi-factorial condition in which physiological, epigenetic, behavioral, environmental, sociocultural and genetic predisposition may all lead to an imbalance between energy intake and expenditure over long periods of time. Other inevitable factors include older parental age at birth, and intrauterine and intergenerational effects. Scientists and dietary experts have suggested various ways to curb the epidemic of obesity, such as getting adequate sleep, regulating hormones involved with food packaging and appetite, observing time spent in climate-controlled areas, quitting smoking and controlling weight gain.
The global rise in obesity has triggered an immediate need for preventive strategies to resolve future health and economic burdens, which researchers suggest have contributed to the “obesity epidemic”. Many potential health-based strategies have been tested at schools, workplaces and community settings to prevent an increase in BMI (body mass index), but so far these strategies have produced little improvement. Evidence suggesting the role of effective economic policies to control cases of obesity remains limited.
Prevent Obesity: Potential Dietary Interventions
According to a study published by Professor George A Bray and colleagues in The Lancet on Feb 8, 2016, the most commonly suggested strategies for weight loss are dietary interventions. However, several considerations are involved in selecting an appropriate diet for weight loss, such as the following:
- The diet must provide less energy than that required for daily maintenance.
- The diet must be easily to follow in the long-term.
- The diet must provide additional health benefits as well.
The first goal can be fulfilled by a reduction of energy by 500 kcal/day below daily energy requirements, or via a dietary plan that provides 1200–1500 kcal/day for women or 1500–1800 kcal/day for men (increased by a further 300 kcal/day for each gender if their weight exceeds 150 kg).
The current problem is that people start hoping these regimes will ‘magically’ cause weight loss, and help them achieve their ideal weight no matter what or how much they eat. This concept has shifted the focus of various studies to consider the amounts of protein, dietary fiber and carbohydrates in such dietary plans. Diets that are low-fat, low-carbohydrate or high-protein, low glycemic-index and balanced deficit have been summarized in many researches.
- Review Of Relevant Studies Comparing Different Diets
Among the largest studies in this regard entitled the Preventing Overweight Using Novel Dietary Strategies (POUNDS) Lost Study involved 811 overweight or obese patients. The study compared many diets used for weight loss and found that those containing 20 percent or 40 percent fat and 15 percent or 25 percent protein did not produce any significant weight loss after 6 months to 2 years.
A similar review of various studies comparing low-carbohydrate and low-fat diets showed that both regimes were equally effective in weight reduction and improving metabolic risk factors. A systemic review of 17 diets also demonstrated that no particular one was better than the other. These findings show that the best weight-loss diet is one that provides low energy and is likely to be followed by the patient to seek long-term health benefits.
- Mediterranean Style Diet
A somewhat favorable regime seems to be the Mediterranean style diet. Analyzing nine studies in which 1,178 patients used such a diet, the latter were seen to cause a significant decrease in weight, BMI, hemoglobin A 1c, fasting plasma glucose and fasting insulin. Moreover, a slightly different version of this diet could reduce the risk of cardiovascular disease as well.
- Low-glycemic Index or Low-glycemic Load Diets
Evaluating a five-week randomized trial involving low-glycemic index or low-glycemic load diets showed no significant differences between the two with regard to insulin resistance or markers of cardiovascular disease risk. However, a review of 14 studies has raised some concerns. Despite benefits in C-reactive protein and fasting insulin due to low-glycemic diets, the latter also resulted in significant losses of fat-free mass. This aspect has cautioned dieticians who frequently recommend such diets for weight loss.
- Very low-calorie Diets (VLCD) or Very Low-energy Diets
These diets are categorized as those providing 200 and 800 kcal/day and resulting in more rapid weight and body fat loss. Certain studies demonstrate that such an approach can efficiently regularize blood glucose and other risk factors related to type-2 diabetes.
However, other reviews suggest that despite initial rapid weight loss, changes after one year are not much different from other multicomponent and comprehensive approaches. An analysis of medically monitored commercial programs (Health Management Resources, Medifast, and OPTIFAST) shows that VLCD caused 4 percent greater short-term weight loss than counseling, but a reduction in this effect was seen after six months. Thus, their routine use is not recommended unless there is an essential clinical necessity.
Need For Better Understanding Of Obesity Epidemic
Obesity is a detrimental illness and a serious form of malnutrition. The Scientific Report of the 2015 Dietary Guidelines Advisory Committee has observed a significant deficiency of essential nutrients among the US population, namely vitamins A, D, E, and C, folate, calcium, magnesium, fiber, potassium, and iron.
Criticism Of Mediterranean Diet
The private sector, with its ulterior motives reacts only partially to these science-based evidences, and the lack of proper policies gives them a free-hand. Mediterranean style diet emphasized on sugar reduction but evidence-based study is lacking in its credibility.
Ways To Combat Obesity As National Health Emergency
This highlights the urgency of considering obesity as a national health emergency. Potential steps that could lead to improvements include:
- Introducing a sugar tax to reduce the consumption of sugar.
- Establishing comprehensive obesity strategies on a national and global level with the involvement and dedicated participation of relevant government departments.
- Guiding the health sector to focus on education, treatment and prevention as potential strategies to prevent obesity, along with the empowerment of children and young adults with information about food and nutrition and physical activity.
- Ensuring that transport and urban planning departments provide cities with easy access to healthy foods and opportunities for physical activity.
- Including economic, enterprise and business departments in efforts to improve health policies and outcomes.
- Understanding the need for varied health treatments for adults and children, and initiating multifaceted regimes that focus on treating obesity and its consequences, apart from surgical interventions.