Obesity as a Complex Problem with Simple Solutions - Essay Example

Obesity-A public health crisis: A complex problem with simple solutions As a review Introduction Obesity has become a serious public health issue in the 21st century. Children with obesity grow up to become obese adults. There has been an exorbitant increase in the rate of pediatric obesity along with the parallel rapid increase in the rate of adult obesity. As obese children grow up into adulthood they are faced with several health problems related to obesity at a very young age. The mortality and morbidity rate related to obesity also continues to increase. 1 Obesity is a complex health disorder that can form the basis of several fatal health concerns which can be prevented and cured through simple measures. Obesity and Genetic Interactions Obesity evolves from the imbalance in food consumption and energy expenditure for a certain period of time. The genetic approach in human and animal models relates obesity to body weight regulation. Monogenic type of obesity in man is characterized and emerges from mutation of genes in the central pathways of food consumption regulation. But these types of obesity cases are rare and obesity is normally understood as a complex polygenic health issue that increases interaction between the environment and multiple genes. Several studies including research on children have strived to find the susceptibility genes. Currently, the outcomes of the research are inconclusive because it is highly variable between researches and also due to the risk involved with a specific gene allele obesity is low. Therefore, it is premature to classify obese patients based on genotype for predictive testing. 2 Nutrient gene interaction relates to the differential functional and the subsequent phenotypic effects of various doses of specific ingredients or energy intake together with various gene variants. The gene interaction explains inter individual variations within a species. 3 The effect of gene-gene interaction is found in extreme cases and immune dysfunction in obesity. The interactions between the variants of β-adrenergic receptor genes lead to longitudinal weight differences in Caucasian and African American subjects. The gene-gene three way interactions affect the abdominal fat. 4 Recent Data Like many other diseases, obesity is a genetic health problem. A research using a dense genome scan of DNA specimen from Framingham Heart Study participants was used to find a common genetic variant close to the INSIG2 gene related to obesity. The replication of the findings in four different specimens using participants of African Americans, Western Europe ancestry and children revealed that obesity predisposing genotype was found in ten percent of the individuals. The research reveals that common genetic polymorphism is a significant determinant of obesity.5 An assessment of β2- and β3- adrenergic receptor interactions in abdominal fat in QFS revealed that lipolysis is promoted by ADRB3 activity while it is obstructed by ADRA2. The subjects were genotypes for ADRB3 Trp64Arg polymorphism and ADRA26.7/6.3 KB Dra I RFLP (restriction fragment length polymorphism). A comparison of the carriers or non carriers of both or one of the variant alleles for abdominal fat area (AFT) through scan revealed that carriers of Arg64 and non carriers of 6.3 kb alleles indicated a higher AFT than carriers of 6.3kb and non carriers of Arg64. The findings suggest that ADRA2A and ADRB3 Arg 64 variant alleles have less efficiency in their function to inhibit or induce lipolysis since the amount of fat is higher when Arg64 is present and 6.3 kb is absent. 6 The characterization and identification of monogenic obesity syndrome has paved way for a better understanding of the specific nature of inherited components responsible for severe obesity and has resulted in undoubted medical benefits that dispels the assumption that obesity emerges from a defect in an individuals behavior rather than from biological aspects. People with high risk and complication of obesity can avail rational mechanism based therapies. Congenital leptin deficiency is a disorder that has obtained successful medication. 7 Further genome wide research has found a convincing relationship of genes to obesity risk that includes fat mass, obesity related gene and melanocortin-4 receptor gene. 8 A research on 4500 Caucasian working population in Italy that included obese, non-obese and severely obese individuals to determine 866G/A UCP2 and the Pro12Ala PPARγ2 polymorphisms on genome DNA. It was found that insulin, glucose, BMI or plasma glucose was not significantly varying in non-carriers and carriers of 866G/A variant. There is no relevant association between severe or moderate obesity to 866G/A UCP2 gene polymorphism. The same findings were observed when UCP2 polymorphism was studies in a combination with PPARy2 polymorphisms.9 A research at the Tufts University found a gene diet interaction that influences body weight. A replication of the findings in three other research found that men and women carriers of CC genotype exhibited higher BMI scores and greater incidence of obesity however only if the food intake consisted of high saturated fat. The association between gene and diet is found in (APOA2)apoliprprotein A –II gene. 10 Gene targeted for effect on one strain show varying phenotypes in the background of another strain. Leptin deficiency is caused by the ob mutation of leptin (Lepob) and the cuases deficiency of C57BK/KsJ background leading to hyerglycenia, obesity and severe diabetes. 11 Lipostatic regulation system is a process whereby energy stores develop signals compared to targets encoded in brain. The variation in the signal directs the level of food consumption, resting, activity patterns and active metabolism. Several studies have been made to understand the molecular basis of lipostatic system. The high body mass in certain obese individuals is due to broken lipostats though it is found in a rare minority which indicates that in a major percentage of obese people lipostat is found at inappropriately high amounts. Obesity develops when individuals are exposed to an environment where food is available at low cost. 12 A genetic variation in ApoE (apolipoprotein E) gene and amount of blood cholesterol is observed in studies which suggest that carriers of apolipoprotein E Є4 gene allele shows higher amount of low density lipoprotein cholesterol compared to variants such as Є3 or Є2 allele carriers. However this relationship depends on the consumption of dietary fat. In case dietary fat is reduced Є4 carriers show more decrease in cholesterol levels than Є3 or Є2 allele carriers. 13 ADRB2 (beta2-adrenergic receptor plays a significant part in regulating energy usage by promoting lipid metabolism the adipose tissue. The polymorphism present in ADRB2 gene is related to obesity and other weight related traits though there is little understanding about its effects in ADRB2 gene in childhood obesity. Age based analysis indicated that there is no evidence for genetic relationships in obesity measure during a period of time in females however age based genetic relationship was found in males. The relationship between obesity and Arg16Gly polymorphism becomes stronger with age.14 A research on the presence of Trp64Arg of the ADR3 gene and Pro12Ala of the PPAR2 gene and its association to obese children and adolescents was conducted among Spanish children. A study through psychical activity questionnaire by calculating the metabolic equivalent index revealed that the carriers of polymorphism Pro12Ala of the PPAR2 gene was at a higher risk for obesity than non carriers. Further the rate of obesity risk was higher for children with family history. Therefore obesity is related to polymorphisms ADR3 and PPAR2. There is a synergistic impact between Trp64Arg of the ADR3 gene and Pro12Ala of the PPAR2 gene for risk of obesity. 15 The disagreements among research related to gene nutrient interactions reveal the difficulty in the accurate measurement of precise forms of dietary micro and macro nutrient consumption as well as the assessment of phenotype irrespective of the discrepancies evolved from biological relevance. Successful intervention takes place after the identification of people genetically more probable to respond to a specific dietary change. This assists professionals to design a dietary guidance and weight management program as per the genetic predisposition about obesity.16 A coding variant R125W in TBC1D1 is significantly relates to risk for severe obesity among women. The chromosomes carrying R125W reported major evidence originally associated with 4p15-14 in the disease. The selection of families with R125W generates a significant evidence for obesity predisposition at 4q34-35. This indicates that R125W influences vulnerability to obesity and delimits the location of the gene 4q34-35 that causes obesity. Though the role of TBC1D1 is not known there is a structural similarity of the protein to known controller of insulin mediated Glut4 translocation. 17 Recent literatures suggest that fatty acids, vitamins, minerals and carbohydrates of dietary constituents have a role in the regulation of gene expression. 18 The eating habit of an individual is established very early in life to a great extent. Scientific evidence suggests that early obesity influences the body’s further metabolism and the process in which fat cells are deposited throughout the body.19 Obesity is a nutritional disorder even in nations where deficiency disease is a serious public health problem.20 Data related to gene interactions that stimulate obesity Method Research Gene related to obesity Participants Genome scan of DNA specimen Framingham Heart Study INSIG2 African American, Western Europe ancestry Β2- and β3- adrenergic receptor interactions in abdominal fat in QFS Lipolysis is promoted by ADRB3 activity while it is obstructed by ADRA2 The subjects were genotypes for ADRB3 Trp64Arg polymorphism and ADRA26.7/6.3 KB Dra I RFLP (restriction fragment length polymorphism Determine 866G/A UCP2 and the Pro12Ala pparγ2 polymorphisms on genome DNA Insulin, glucose, BMI or plasma glucose was not significantly varying in non-carriers and carriers of 866G/A variant. There is no relevant association between severe or moderate obesity to 866G/A UCP2 gene polymorphism. The same findings were observed when UCP2 polymorphism was studies in a combination with ppary2 polymorphisms 4500 Caucasian working population in Italy that included obese, non-obese and severely obese individuals Tufts University Carriers of CC genotype exhibited higher BMI scores and greater incidence of obesity Men and women (if the food intake consisted of high saturated fat) Genetic variation in apoe (apolipoprotein E) gene and amount of blood cholesterol Carriers of apolipoprotein E Є4 gene allele shows higher amount of low density lipoprotein cholesterol compared to variants such as Є3 or Є2 allele carriers In samples based on the consumption of dietary fat ADRB2 (beta2-adrenergic receptor) The polymorphism found in ADRB2 is significant for regulating energy usage by promoting lipid metabolism the adipose tissue Trp64Arg of the ADR3 gene and Pro12Ala of the PPAR2 gene The carriers of polymorphism Pro12Ala of the PPAR2 gene was at a higher risk for obesity than non carriers Spanish children R125W in TBC1D1 Chromosomes carrying R125W reported major evidence originally associated with 4p15-14 in the disease. Delimits the location of the gene 4q34-35 that causes obesity Women The role of nutrition to control and regulate obesity and promote good health An analysis of nutrition transition patters during the receding famine period to a period where nutrition related non communicable diseases found that speed of activity and dietary patterns changes is great especially in the developing world with a positive outcome for changes in obesity.21 Cognitive behavioral treatment methods include nutrition, slowing eating, self monitoring, stimulus control and cognitive restructuring and exercise. The short term results from these methods are initial weight loss, portion controlled diets and very low calorie food intake while long term results include obesity treatment and weight management.22 Data related to obesity and health awareness A postal survey using self complete questionnaires by health professional to assess nutrition, obesity and weight management revealed that the professionals had a good understanding of health and nutrition. The research found that there is some knowledge about weight management and nutrition among health professionals but they are unclear about the methods to offer effective weight management support.23 The rapid change in the composition and levels of dietary and inactivity/ activity patterns in transitional culture is related to demographic and socioeconomic changes. A study using activity and diet patterns among people with increased income indicates that urban population consumes diet markedly different from that consumed by rural populations. 24 Research has found insight into physiological reasons for bodyweight regulation. Treatment for childhood obesity continues to be extensively ineffective. The epidemic of childhood obesity is basically attributed to undesirable environmental factors that can be solved through straightforward measures if a political solution is difficult.25 A statement on physical activity, nutrition and metabolism from American Heart Association Council has found the relationship between cardiovascular system and obesity and has assessed the impact of weight loss on coronary heart disease and heart disease risk factors and offers a practical weight management guidelines that lead to the treatment of obesity based coronary heart disease risk that can be used as a primary therapy.27 The proof for potential strategies and aetiological factors that reduce obesity indicates that protective factors against obesity such as high consumption of dietary non starch polysaccharides, regular physical activity, supportive school and home environment for children reduces the incidence. 26 The relationship between depression and obesity reveals that obese women are more depressed than their male counterparts. The result is strong for individuals from various sections of the society based on education, age, marital status, dieting for medical conditions, use of psychiatric medicines, use of alcohol or other substance abuse and cigarette smoking.28There is an increased risk of mortality and morbidity in obese people and a decrease in life expectancy. Medical cost and health service use is also increase dramatically and is expected to be on the higher side. Other than the change in the metabolic profile, a number of alterations and adaptations occur as a result of the excess accumulation of adipose tissue even when co-morbidities are absent.29 The rate of metabolic syndrome among US adults is high and indicates a significant implication for the health care segment.30 Standard mortality rates due to hypertension, diabetes and acute myocardial infarction were researched during 1980 -1998. The use of refined carbohydrates and fat intake has increased mortality due to the absence of physical activity. 31 The incidence of gastric bypass among adolescents for obesity related morbidities has increased though it is an effective measure to reduce weight among morbidly obese teenagers. It is a measure of last resort when behavioral approaches and dietary control become unsuccessful.32 Obesity has a relation to dietary energy density, diet quality and energy costs. Obesity is at high rates among the least educated and among poor populations. Food insecurity and poverty increased obesity because there is less consumption of vegetables, fruits and lower quality food. Since high fat, low cost food is affordable that food like fish and lean meat that lead to the consumption of more fat and sugar that are energy dense. 33 The role of nutrition to correct poor eating patterns References and further reading may be available for this article. To view references and further reading you must purchase this article. A lack of similarity in the eating patterns is related to overweight status in a number of ethnicities. 34 Energy density is the energy content per unit volume of meals, food or diet. Due to the varying effects of satiety and satiation, it is important to consider drinks and solid foods separately.35   Obesity can be prevented by state funded initiatives that recommend people to adopt a healthy life style. The Working Group on Obesity in China is such a group that has issues a cut off point for body mass index for obese and overweight adults in 2002. In 2003 the organization set up guidelines for the control and prevention of obesity among adults in China and the Ministry of Health approved the guidelines. 36 People are interested in eating a variety of high value food which can be eaten in large quantities. Overeating at fast food restaurants is attributed to this craving. Children are convinced to eat food at restaurants when compared to convincing children to eat healthy vegetables. Food companies pose a serious threat to the great threat to the ever increasing problem of overweight and obesity. 37 Nutrition professional must recommend the maintenance of body weight according to body composition to assess energy expenditure rates and determine nutrient requirements to identify and prevent obesity related diseases.38 The measures taken by governments such as the initiative of the American Congress to develop a prevention oriented action to reduce the number of obese children in the United States is a promising approach to prevent efforts with the participation of a number of stakeholders and sectors. 39 Nutrition therapy to effect the reduction of weight includes programs for behavior modification considering the medical history, weight history, eating patterns, usual diet, weight goal, support group intervention and motivation of the individual. 40 New paradigms of nutrition stress measures like maternal nutrition, growth rate, birth weight and body size to promote non-obesity diet based on the genetic potential of a body to control obesity and ensure longevity through preconception.41 Dietitians can play a significant role in improving the quality of life and reduce disability and diseases related to obesity. Educating public about medical assessment and treatment is also a measure to decrease obesity. Dietitian can associate with businesses, organizations and government health agencies in the local and national level to improve data collection and research funding to decrease the rate of obesity. 42 The need for awareness about nutritious food Parental knowledge and skills regarding risk awareness and nutrition of obesity together with governmental nutritional programs that supports physical activity and healthy diet can solve obesity. 43 Appropriate selection of food is essential to ensure that children eat the right food at the growing up stage and therefore decrease the consequences of inadequate food consumption.44 Children and adolescents from low income families should also be educated about physical activity and proper nutrition. 45 Publicizing awareness programs through schools is an effective method to control obesity. 46 Several nutritional disorders are simple to solve or it can be avoided if the public has knowledge about the risks so that they can change their behavior and lifestyle. Mother and caretakers of children must possess more awareness about health risks. 47 A research by Montero and associates in 37 developing countries found that prevalence of obesity increases in developing countries where the GNP is at an intermediate level. 48 Schools must make physical arrangements of space for children that caters to children’s developmental needs.49 Data derived from various research, medical organizations and contemporary lifestyles regarding the measures to curb obesity Method / factors Participants Activity level Inference Postal survey Health care professional Had little understanding about obesity as a disease and the advantages of weigh management with low energy diets Research Activity and diet patterns among people with increased income Urban population consume diet markedly different from that consumed by rural populations American heart association council Offers a practical weight management guidelines that lead to the treatment of obesity based coronary heart disease risk that can be used as a primary therapy Found a relationship between cardiovascular system and obesity Protective factors against obesity High consumption of dietary non starch polysaccharides, regular physical activity, supportive school and home environment for children reduces the incidence Prevalence of obesity is further reduced Strategies like reducing the advertisement of energy dense food, influence food supply to provide healthy options, community wide programme and increased communication about physical activity and healthy eating and manage existing obese or overweight people Food insecurity and poverty Increase obesity because there is less consumption of vegetables, fruits and lower quality food State funded initiatives Obesity can be prevented Nutrition professional Recommend the maintenance of body weight according to body composition to assess energy expenditure rates and determine nutrient requirements to identify and prevent obesity related diseases Nutrition therapy Reduction of weight includes programs for behavior modification considering the medical history, weight history, eating patterns, usual diet, weight goal, support group intervention and motivation of the individual Parental knowledge and skills together with governmental nutritional programs Can solve obesity It may be concluded that there is substantial evidence that obesity is a heritable health disorder. The use of this knowledge in patient care has however been at a slower rate. A proactive initiative to prevent the risk combined with awareness programs to deal with current obese cases is essential to promote a better and healthy body.50 The data from gene interactions reveal that obesity can be predicted to a certain extent by learning the etiology of the disorder or from the history of patients. Environmental factors and gene environment interactions also gives details about the causes of obesity. All these require more research to reach a conclusive action regarding the medication for each type of gene related obesity. However, the data related to nutrition, health awareness and physical activity from a wide number of samples including various ethnicities and regions reveal that obesity is a health disorder which is within the control of individuals unlike any other disease which can be implemented through simple day to measures taken through governmental, non-governmental and corporate agencies. A well designed programme with the support of political system around the world can wipe out obesity which is growing at a rapid rate due to lifestyle changes and changing living environments. Reference 1. Barness LA, Opitz JM, Gilbert-Barness E. 2007 Obesity: Genetic, molecular, and environmental aspects. Am J Med Genet Part A 143A:3016-3034 Available: http://www3.interscience.wiley.com/journal/116843304/abstract?CRETRY=1&SRETRY=0 2. Clément K & Ferré P Genetics and the pathophysiology of obesity Pediatr Res. 2003 May;53(5):721-5. Epub Available: http://www.ncbi.nlm.nih.gov/pubmed/12621112 3. 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