Obesity Treatment and Prevention: New Directions

Description

Obesity continues to be a major problem for global public health, affecting not only adults, but increasingly also adolescents and even young children. Moreover, obesity and diabetes are no longer limited to wealthy societies: rates are also rising in low- and middle-income countries.Summarizing some of the key issues in obesity treatment and prevention, this publication promotes novel and interdisciplinary approaches and explores cutting-edge ideas that span child development, nutrition, behavioral sciences, economics, geography and public health.Contributions suggest a sequence of steps that may result in new ways to address obesity at the personal as well as at the population level: First, a clear understanding of who becomes obese, where, and for what reason is needed. Second, the likely contributions to overeating by the brain, biology, economics and the environment need to be identified. Then, based on the understanding of disease etiology and its distribution by geography and by social strata, targeted yet comprehensive strategies for obesity prevention and treatment for both individuals and groups need to be developed.

Informations

• Publié par: S. Karger AG
• Date de parution: 26 octobre 2012
• Nombre de lectures: 2
• EAN13: 9783318021165
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Obesity Treatment and Prevention: New Directions
Nestlé Nutrition Institute Workshop Series
Vol. 73
 
Obesity Treatment and Prevention: New Directions
Editors
Adam Drewnowski   Seattle, WA, USA
Barbara J. Rolls   University Park, PA, USA
Nestec Ltd., 55 Avenue Nestlé, CH-1800 Vevey (Switzerland)
S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) www.karger.com
Library of Congress Cataloging-in-Publication Data
Nestlé Nutrition Workshop (73rd: 2011: San Diego, Calif.)
Obesity treatment and prevention: new directions / editors, Adam Drewnowski, Barbara J. Rolls.
p. ; cm. -- (Nestlé Nutrition Institute workshop series, ISSN 1664-2147; vol. 73)
Includes bibliographical references and index.
ISBN 978-3-318-02115-8 (hard cover: alk. paper) -- ISBN 978-3-318-02116-5 (e-ISBN)
I. Drewnowski, Adam. II. Rolls, Barbara J. III. Nestlé Nutrition Institute. IV. Title. V. Series: Nestlé Nutrition Institute workshop series ; v. 73. 1664-2147
[DNLM: 1. Obesity--therapy--Congresses. 2. Obesity--prevention & control--Congresses. W1 NE228D v.73 2012/ WD 210]
616.3’98--dc23
2012034925
The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived.
Great care has been taken to maintain the accuracy of the information contained in the volume. However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for any consequences arising from the use of the information contained herein.
© 2012 Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher.
Printed on acid-free and non-aging paper
ISBN 978–3–318–02115–8
e-ISBN 978–3–318–02116–5
ISSN 1664–2147
e-ISSN 1664–2155
 
Contents
Preface
Foreword
Contributors
Obesity Treatment: Challenges and Opportunities
Brain Reorganization following Weight Loss
Rosenbaum, M.; Leibel, R.L. (USA)
Physical Activity and Weight Loss
Jakicic, J.M. (USA)
Dietary Strategies for Weight Management
Rolls, B. J. (USA)
Targeting Adipose Tissue Inflammation to Treat the Underlying Basis of the Metabolic Complications of Obesity
Goran, M.I.; Alderete, T.L. (USA)
Summary Discussion on Obesity Treatment: Challenges and Opportunities
New Directions for Prevention
The Gut Microbiome and Obesity
Hullar, M.A. J.;Lampe, J.W. (USA)
Starting Early: Obesity Prevention during Infancy
Birch, L.L.; Anzman-Frasca, S.; Paul, I.M. (USA)
The Economics of Food Choice Behavior: Why Poverty and Obesity Are Linked
Drewnowski, A. (USA)
The Importance of the Food and Physical Activity Environments
Oppert, J.-M.; Charreire, H. (France)
The Importance of Systems Thinking to Address Obesity
Finegood, D.T. (Canada)
Summary Discussion on New Directions for Prevention
 
Concluding Remarks
Subject Index
For more information on related publications, please consult the NNI website: www.nestlenutrition–institute.org
 
Preface
Obesity continues to be a major problem for global public health. Despite best efforts by health care providers, public health agencies, and the private sector, few prevention efforts have been effective. As a result, bodyweights have continued their upward surge, contributing to ill-health among both children and adults. Although many treatment programs are available, few can boast of longterm success, with minimal risk of relapse and weight regain.
One glimmer of hope has been the recent leveling off in obesity rates in the US and in European countries. Whether temporary or permanent, it provides a much-needed breathing space. This is the opportunity to regroup, reexamine past approaches, assess relative success rates, and point to new directions for the future. Those new directions can be global in their reach. Obesity and diabetes are no longer limited to wealthy societies. Their rates in developing countries, while still relatively low, are on the rise.
Clearly, obesity treatment and prevention can benefit from a major paradigm shift. The standard advice to eat less and exercise more is both simplistic and often ineffective. The science presented at this workshop suggested a sequence of steps that could result in new ways to address obesity at the personal as well as at the population level. First, we need to achieve a clear understanding of who becomes obese, where, and for what reason. Second, we need to parse out the likely contributions to overeating by the brain, biology, economics, and the environment. Then, based on our understanding of disease etiology and its distribution by geography and by social strata, we need to develop targeted yet comprehensive strategies for obesity prevention and treatment for both individuals and groups.
The conventional disease model of obesity, built around the individual patient, needs to be reconciled with some of the contemporary thinking about obesity in its social and environmental context. That may require a shift of emphasis from the individual to the group and a full consideration of the biological as well as the social and economic determinants of health.
One issue that deserves serious study is the observed social gradient in obesity. Obesity rates, especially for women, are strongly influenced by the social and economic environments. In developing countries, it is the more affluent urban women who are gaining weight. In developed countries, higher rates of obesity are observed in relatively more deprived areas. In both cases, women's bodyweights are affected by the changing social conditions more than bodyweights of men. The global obesity epidemic can thus be viewed through the prism of social disadvantage and women's health.
Clear thinking about the biological and social determinants of weight and health is essential to the success of any intervention, whether at the individual or population level. Few studies have examined the success of prevention or treatment strategies across different socioeconomic strata. Little is known about social and economic barriers to the adoption of lower energy density diets and more active lifestyles. If the reasons why some women gain weight and others do not are either misunderstood or ignored altogether, then the proposed prevention plans will fail. If the reasons why some people stay with a diet regime whereas others fail are unclear, then the treatment plans will be ineffective in the long-term. Barriers to treatment success may be inherent in the brain, the biology, or the environment.
Current advances in research – discussed here – have the power to change our thinking. The traditional disease model holds that people become obese through a combination of genetic predisposition, faulty metabolism, and acquired bad habits. The new emphasis must move beyond a focus on personal responsibility, calorie counting, and the macronutrient composition of the diet. We need a greater understanding of behaviors determining food intake and physical activity and how environmental and biological influences combine to determine food choices, amounts consumed, and activity levels. Appeals to individual motivation need to be tempered by the recognition that food-seeking behaviors are bound by biological, economic, social and environmental constraints.
Our thinking about the role of the adipose tissue has also undergone a paradigm shift. Formerly viewed as a passive fat repository, the adipose tissue is now regarded as an active neuroendocrine organ functioning in concert with body physiology. Similarly, the obese person is often thought of as the victim of passive overeating. Our thinking about obesity could benefit from a broader integrative approach that places more emphasis on how obese people behave and function within the surrounding food environment. On one hand, food choices and dietary behaviors are driven by biology and the brain. On the other hand, access to healthy foods and opportunities for physical activity can be limited by material resources, transportation, and the built environment. New studies on spatial epidemiology and behavioral economics provide a contextual framework for cutting-edge research on biology, human development and behavior.
The chief aim of this workshop was to summarize some of the key issues in obesity treatment and prevention in order to promote novel and interdisciplinary approaches and to explore cutting-edge ideas that spanned child development, nutrition, behavioral sciences, economics, geography and public health. We discussed a variety of approaches and disciplines, ranging from molecular biology to ethnographic research and public health policy and practice. With each topic, it was important to consider both personal and public health. On one hand, individual decisions, choices, and behaviors that lead to overeating and weight gain remain important and cannot be overlooked. On the other hand, food systems, food cultures and food environments are of critical importance. It is those systems, not human physiology, that have undergone dramatic changes over the past few decades. Should we try to influence the person or improve the food environment? New strategies should demand that we do both.
Adam Drewnowski
Barbara J. Rolls