Throughout medical history there have been many wonderful discoveries and inventions that have eased the burden of morbidity and mortality and heightened mankind’s collective understanding of biology and disease. The invention of penicillin, anaesthesia, the germ theory, isolation of insulin, covered sewerage, fluoride in drinking water. These discoveries all ameliorated severe scourges on the health of general populations. Obesity is one such scourge which in modern times continues to spread around the globe riding swiftly on the coattails of its sociological gateway; economic development. The question springs to mind, ‘will medical historians look back at one brilliant individual or discovery which brought an end to the morbidity and mortality caused by obesity?’ Based on current knowledge, I personally consider this unlikely, and like the other 
NCDs which are currently endemic it would appear Medicine is in for a war of attrition with obesity.
Why is this? Will there not eventually be a brilliant ‘fat pill’ discovered and distributed, and the 1.5 Billion obese people worldwide systematically returned to good health?
The fact of the matter is that obesity is a completely different beast to historical health problems. It is a psychological disorder, a metabolic disorder, an endocrine disorder and a socioeconomic problem all in one. Add to that the fact that it very rarely causes mortality in and of itself. It merely predisposes individuals to a myriad of other health problems. Oh and one other thing – the cure has already been discovered and is widely available, in developed countries like Australia at least. That’s right; restricting the kilojoules available in one’s diet, eating fresh fruit and vegetables, and exercising regularly will cure all but extreme or extraordinary cases.
With that in mind, how does one approach this problem? Previous post on the topic addressed the socioeconomic side of the issue. In poorer but developing countries, the masses who struggle to get by in relatively low incomes are enticed by cheap, nutritionally unbalanced, calorie-rich foodstuffs. The relationship between socioeconomic status and obesity varies from country to country, with it being an inverse relationship in Australia. So does the solution lie in economic improvement and social equalisation? I haven’t even begun to discuss smaller-scale social influences, such as peer pressure, body image, advertising and lifestyle pressures. How about pharmacological intervention? Surely some clever pharmacist can develop a magical fat-burning pill with negligible side-effects? There are many on the market describing themselves as such, but the proof of the pudding is in the eating, and the fact is obesity rates continue to rise. And besides, if we consider obesity a metabolic or endocrine disorder then pills, like liposurgery, are merely a band-aid solution.
How about the psychological factors? In a country like Australia, almost everyone can afford fresh food and exercise opportunities abound, and millions of taxpayer dollars are spent educating the public about healthy lifestyles. Granted there are time pressures which influence peoples’ lifestyle choices but the fact remains that many people become and remain obese due to laziness and/or apathy. In this regard it could be considered a psychological disorder – perhaps sufferers are addicted to a certain lifestyle just as a smoker is addicted to nicotine. How should health authorities approach this situation? Government health campaigns have led the public to water, but it may not be possible to make people drink.
Many cancer experts say there is no silver bullet for curing cancer because what we call cancer is actually hundreds or thousands of different cellular diseases which manifest a macroscopically similar pattern of symptoms. Likewise obesity is a complex multifaceted health issue facing an increasing proportion of the world’s population. The causes of obesity are not entirely within the realms of Medicine, but the consequences almost exclusively are and it will take many years of multidisciplinary research to gradually break down and reduce the prevalence of this disease.
global health obesity 