Obesity – Genetic or Environmental?

Obesity has become part of a serious blame culture. “Just eat less and exercise more”, seems to be the simplistic argument these days. Social media is full of ‘fat shaming’ and the public opinion has shifted much more towards it being people’s own fault if they are fat – “they should just make better choices and take more responsibility for themselves”. It makes sense right? People just need to be a whole lot less greedy and a whole lot more restrained…..Well – just for a minute, let’s suspend our judgements, put away our pointing fingers or indeed, our shame and let’s examine the evidence….and then maybe we can have a much better and kinder conversation about the obesity epidemic we’re in and what might need to change.

 

A few weeks ago, I listened to the excellent Prof Sandro Galea, Knox Professor of Epidemiology at Boston State University, give an excellent lecture on: “What Do Obesity, Opioids and Guns all Have in Common?” the answer: They are all really complex and hugely important! I am shamelessly going to use his slides from that lecture to explore the issue of obesity in this blog, which Sandro has kindly shared with me.

 


If we take any given population, let’s start by asking this question: What percentage of obesity is determined by genetics, compared to the environment? Go, on, give it a go – write a figure down, or make a mental note of what you currently presume!

 

 

 

 

In any give population, there will be a percentage of people who have a higher genetic risk of becoming obese. In the diagrams which follow, these, dark grey represents those with a high genetic risk.

 

 

 


 

There will be some people who will be obese, with or without a genetic risk. In the following diagrams, these people are represented in red/pink.

 

 


The environment is represented in green. everything that is not ‘genetic’ is considered to be environmental. This includes, air pollution, adverse childhood experiences, advertising, sugar in products, transportation, access to shops, types of shop available, family income, affordability of food, use of food banks, etc etc. The more green there is, the less healthy the environment represented.

 

So…….if we take a population with the same genetic risk factors and number of obese people, let’s see what happens to those people with a higher risk of becoming obese, when the environment is less than ideal, e.g. high stress, poor air quality, high index of deprivation, low educational opportunities, high unemployment, poor access to shops, poor transport links, high numbers of junk food outlets…….etc – here is the population in a poor environment and those with a genetic risk factor are marked with grey dots:

Look at what happens to the obesity rate in that population!! All of those with a genetic risk factor become obese! The odds are stacked against them, because their choices are significantly reduced!

But take the scenario, with the same population in an environment which is much more positive, where there is less sugar in foods, where there are more healthy opportunities for good eating and exercise, where there is no need for food banks because employment is high, jobs are well paid and the welfare state is functioning appropriately.

In this scenario – the odds are in favour of those genetically more likely to become obese – BIGTIME! Obesity rates are far less and overall the population is much more physically healthy. People who are genetically at risk of becoming obese have far less chance of actually becoming obese!

What was your answer to the percentage question at the start? It was a trick question! the worse your environment is, the more your genetics come into play! So, now there’s a complex argument about who is responsible for the environments in which we live and who creates an atmosphere of choice!

 

If we take the food industry to start with, just look at what has happened to the calorie intake of foods sold in fast food outlets over the last 20 years. If you want French Fries now, you’re eating triple the calories that you were 20 years ago, due to larger portion sizes – always upsold in McDonalds (and other like minded companies)!! TRIPLE the calories! Who’s fault is that?! A turkey sandwich, which some might consider a ‘healthy option’ is now packed with more than DOUBLE the calories that were in that same sandwich just 20 years ago! Do the maths! The way this has been allowed to happen is appalling. The government, so keen on not being a ‘nanny state’ have allowed a deregulated ‘nanny food industry’ to lovingly shove calories down our throats without most of us even realising! Prof Susan Jebb, one of the leading experts in this field, globally is really clear – if we taxed cakes and biscuits and made healthy food more affordable, we would be in half the mess we’re in.

 

The same is true of exercise, and so opportunities to exercise, created by culture and environment are really important:

If you look at how much the advertising industry is spending on obesogenic foods, or you examine where junk food cafes are placed (disproportionately higher in our most deprived communities); if you consider the profound effect of adverse childhood experiences on our eating habits or look at the affordability of health food for low income families, as shown by the food foundation, then you begin to see that this over simplistic argument that people ‘should just take more responsibility for their own health’ is total nonsense. We need to take an altogether more kind and considered view to what is an incredibly complex situation.

 

Sandro Galea talks powerfully about this principle: Small changes in ubiquitous causes may result in more substantial change in the health of populations than larger changes in rarer causes.

You can feed your goldfish the best food, ensure they swim their mile a day, help them practice mindfulness every morning and decrease the amount of time they spend on screens……but if you don’t care for the quality of the water – they will die!

 

Health inequality between the rich and poor in the UK is worsening. Health inequality between the north and south is worsening. Life expectancy overall and healthy life expectancy are both beginning to fall. Our mental health crisis is deepening. Now is not the time for loads more programmes that benefit the already healthy and make the inequalities even worse. Now is the time to ask some fundamentally deeper and more difficult questions about what we have built our society on, what the point of the government is and how, together, we might work for a future that is better for everyone. Unless we do so, the NHS continues to stare into an abyss, as indeed do all our public services.

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Making a Key Distinction in the NHS

There are two different narratives that are shaping the debate around the NHS at present. They are different stories, but they are becoming dangerously intertwined. I want to highlight the two stories and make a clear distinction between the two.

 

The first story is that there are some ways in which the NHS needs to be more efficient, work more smartly, integrate its services more effectively, cut some unnecessary waste, be more collaborative and ensure that the service it provides is as affordable as possible in a manner that is safe, learning, compassionate and continually improving. Some of this involves working with communities to help us live in a way (individually and corporately) that helps us to be more healthy and well, taking some strain from the system. It also involves some restructuring and rearranging of services to enable them to deliver care in a more streamlined way. This is a true story.

 

There is another story that is told that sounds like it has some similarities, but it is not the same story. This is the story that tells us the NHS is unaffordable, that it is failing and that we need parts of it to be privatized for it to survive. This is based on an idea that we have to balance our books, cut our cloth, tighten our belts and ‘live within our means’. This story is not true. It is not true because no country has ever lived within its means. Countries are nothing like households. Households are very simple. The economies of nation states are not. Households do not have banks in their back gardens that print money when things go wrong. Households do not give special privileges to rich friends, making life easier for them, whilst treating poorer friends like servants, taking away things they need and telling them are lazy and need to work harder, whilst blaming their problems on other friends who have moved into the area aka immigrants. Cutting public services and seeing the gap between the rich and poor grow ever wider whilst taking away the welfare that helps families in genuine need, cutting the services available to help them (pretending these are efficiency savings and not cuts) is a choice being made by our politicians. We are told there is no other choice, but this is not a true story. The NHS could be better funded (it is currently one of the most under funded health care systems in the entire developed world) and we could choose to manage the money of the country in an altogether different way! The NHS is affordable and the first story is helping to make this more true, but it needs greater investment, not the removal of vital services. Do not confuse the two stories.

 

 

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The Nazi Dog Experiment

Tweet Do you know the story of the Nazi Dog Experiment? The Nazis found that if they inflicted a group of dogs with pain through electrocution, 1/3 of them would lie down hopelessly and do what they were told. 1/3 would keep a fighting spirit no matter how much pain they were put under. The [Continue Reading …]

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