The obesogenic environment. Jean-Philippe Chaput, PhD

Transcription

1 The obesogenic environment Jean-Philippe Chaput, PhD

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3 Obesity prevalence and obesity publications Obesity prevalence (%) Obesity-related publications (*100) Years

4 One explanation may be that obesity, like all health conditions that are primarily socially determined, resists durable solutions until there is a change in societal norms and the values underlying those norms Whitaker. Arch Pediatr Adolesc Med (2011)

5 Why are we becoming fatter?

6 Obes Rev (2010) Int J Pediatr Obes (2011)

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8 George Bray Our genes load the gun but our environment pulls the trigger

9 Factors causing weight gain and obesity SES Lack of time Gene s Drugs causing weight gain Sedentariness (TV - Computers) Chemical pollutants Meal size Lack of habitual physical activity Lack of vitamins? Birth weight Mental health Sleep/stress Energy density

10 Do we focus too much on the Big Two? What about non-caloric factors?

11 Odds ratio Risk factors for childhood overweight and obesity: the Québec en Forme Project Low familial income Low parental education Parental obesity Physical inactivity Watching TV Short sleep duration Chaput et al. Int J Obes (2006)

12 Adjusted OR Risk factors for adult overweight and obesity: the Quebec Family Study High alcohol intake Non-consumption of vitamins No vigorous physical activity Low calcium intake Short sleep duration High lipid intake High restraint behaviour High hunger behaviour High disinhibition behaviour Chaput et al. Obesity (2009)

13 n = 634,511 participants Sleep (2008) Adults sleeping 5 h/night were 55% more likely to be obese than those sleeping >5 h/night Children sleeping <10 h/night were 89% more likely to be obese than those sleeping 10 h/night

14 Desire to eat Energy intake Opportunities for eating Insufficient sleep Altered thermoregulation Fatigue Energy expenditure Obesity

15 A good night s sleep for promoting fat loss?

16 Change in fat mass (kg ) A good night s sleep for preventing weight gain? Control group Increased sleep Maintained short sleep Sleep-duration groups * *P<0.05 vs. other groups Chaput et al. Int J Obes (2012)

17 From labourer man to thinking man

18 Energy expenditure (kcal/45 min) Energy intake (kcal) Intellectual work induces excessive calorie intake * kj kj Rest Computing Rest Computing 0 Balance: +946 kj Chaput and Tremblay. Physiol Behav (2007)

19 Computer-related activities are: Metabolically stressful May impair satiety signal capacity Deserve to be counterbalanced by an adequate physical activity regimen Tremblay, Mathieu, Chaput. Obesity (2009)

20 Energy intake (kj) Video game playing increases food intake = 335 kj 5000 * Control Video Game 1 2 Chaput et al. Am J Clin Nutr (2011)

21 Endocrine disruptors

22 We should ask the why and not the what Obesity is a sign Overeating and lack of PA are symptoms Sharma and Padwal. Obes Rev (2010)

23 Obesity is not a choice! Complex causation (genetic, physiological, lifestyle, environmental, etc) The underlying causes and paths to obesity are manifold no one is immune Examples: Change in economic status Reduced activity due to injury or illness Introduction to an obesogenic drug Moving to a less walkable community

24 Obesity prevention: a complex issue Living in an obesogenic environment makes achieving a healthy lifestyle close to impossible Strong evidence showing that a change in the environment and conditions of poverty is truly what is needed to tackle obesity at the population level

25 Obesity, economic growth and social inequality

26 Mean Body Mass Index BMI and Gross Domestic Product Sweet Spot Columbia HIGH INEQUALITY ( Hard Capitalism ) S. Africa USA NZ * Australia Can UK Switzerland Sweden Italy Belgium France Norway China Namibia LOW INEQUALITY ( Soft capitalism ) 21 Senegal Ethiopia Increasing returns on GDP growth Diminishing returns on GDP growth $5000 $20,000 $50000 GDP Per capita ($US; 2000)

27 What can we do? Promote evidence-based population approaches Mozaffarian et al. Circulation (2012) Lau et al. CMAJ (2007) Wilson et al. McMaster Health Forum (2012)

28 A very complex and difficult task in the current obesogenic environment No program to date has proven to be effective in reversing the trend of childhood and adulthood obesity We need to target all levels (individual, family, neighborhood, policy) in order to make the healthy choice the normal one

29 Country Province Region City Neighborhood Family Individual

30 Are we leaders in Canada? Cycling rate of 37%!!! Since 2003

31 What is a healthy body weight? A body weight: Associated with healthy lifestyle habits Not associated with health problems In which eating is still a pleasure Not necessarily a BMI in the normal range!!!

32 Psychobiological vulnerability The good compromise Appetite Energy expenditure Fat oxidation Mild hypoglycemia Chemical pollutants Depression symptoms Metabolic syndrome Healthy zone Body weight Chaput et al. Obes Rev (2012)

33 A weight focus as an indicator of success Ineffective Increases food and body preoccupation Increases yo-yo Reduces self-esteem Increases eating disorders Increases weight stigmatization and discrimination Bacon and Aphramor. Nutr J (2011)

34 Psychological health and obesogenic lifestyles For many, eating is the easiest and most affordable means of coping with stress, anxiety, depression, boredom, loneliness, isolation, abuse, despair and frustration Macht. Appetite (2008)

35 Benefits of being physically active regardless of weight loss Improves sleep quality Improves management of stress Improves brain function (learning, memory, etc) Improves cardiometabolic risk profile Prevention of stroke, some forms of cancer, type 2 diabetes, osteoporosis, sarcopenia, loss of function and autonomy Improves wellness

36 Is it possible that the body says NO? Tremblay et al. Future Lipidol (2007)

37 The take-home message To promote good practices, including physical activity, healthy diet, good sleep hygiene and wellness, and let the body decides where a new body weight set point will be fixed

38 We need many sandbags to build a levee

39 Concluding remarks Multiple drivers to weight gain There are no simple solutions Any intervention taken in isolation is expected to be small Action is urgently needed to create supportive environments At-risk populations should be prioritized

40 Thank you!!! ICO Meeting, Stockholm, Sweden, 2010