Obesity Treatment and Prevention: New Directions

Transcription

1 Obesity Treatment and Prevention: New Directions

2 Nestlé Nutrition Institute Workshop Series Vol. 73

3 Obesity Treatment and Prevention: New Directions Editors Adam Drewnowski Seattle, WA, USA Barbara J. Rolls University Park, PA, USA

4 Nestec Ltd., 55 Avenue Nestlé, CH 1800 Vevey (Switzerland) S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) 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 ; vol. 73) Includes bibliographical references and index. ISBN (hard cover : alk. paper) -- ISBN (e-isbn) I. Drewnowski, Adam. II. Rolls, Barbara J. III. Nestlé Nutrition Institute. IV. Title. V. Series: Nestlé Nutrition Institute workshop series ; v [DNLM: 1. Obesity--therapy--Congresses. 2. Obesity--prevention & control--congresses. W1 NE228D v / WD 210] 616.3'98--dc The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived.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 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 e-isbn ISSN e-issn Basel Freiburg Paris London New York New Delhi Bangkok Beijing Tokyo Kuala Lumpur Singapore Sydney

5 Contents VII Preface XI Foreword XV Contributors Obesity Treatment: Challenges and Opportunities 1 Brain Reorganization following Weight Loss Rosenbaum, M.; Leibel, R.L. (USA) 21 Physical Activity and Weight Loss Jakicic, J.M. (USA) 37 Dietary Strategies for Weight Management Rolls, B.J. (USA) 49 Targeting Adipose Tissue Inflammation to Treat the Underlying Basis of the Metabolic Complications of Obesity Goran, M.I.; Alderete, T.L. (USA) 61 Summary Discussion on Obesity Treatment: Challenges and Opportunities New Directions for Prevention 67 The Gut Microbiome and Obesity Hullar, M.A.J.; Lampe, J.W. (USA) 81 Starting Early: Obesity Prevention during Infancy Birch, L.L.; Anzman-Frasca, S.; Paul, I.M. (USA) 95 The Economics of Food Choice Behavior: Why Poverty and Obesity Are Linked Drewnowski, A. (USA) 113 The Importance of the Food and Physical Activity Environments Oppert, J.-M.; Charreire, H. (France) V

6 123 The Importance of Systems Thinking to Address Obesity Finegood, D.T. (Canada) 139 Summary Discussion on New Directions for Prevention 143 Concluding Remarks 147 Subject Index For more information on related publications, please consult the NNI website: institute.org VI Contents

7 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 VII

8 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. VIII Drewnowski Rolls

9 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 Preface IX

10 Foreword A fifth of all global deaths today can be attributed to overweight or obesity. At least 2.8 million adults die each year as a result of being overweight or obese; according to the WHO report (May 2012), 44% of the diabetes burden, 23% of the ischemic heart disease burden and between 7 and 41% of certain cancer burdens are attributable to overweight and obesity; moreover, as reported by the WHO, the obesity epidemic is spreading widely by 2002 the number of people in the world who were overweight or obese had exceeded the number of people who were undernourished. And this is not only a problem in adults. It affects adolescents and young children too, taking its burden into the future. In 2010, around 43 million children under 5 years were overweight ( en/). Having been previously considered a problem restricted to high-income countries, overweight and obesity rates are now also rising in low- and middleincome countries. Close to 35 million overweight children under 5 years are living in developing countries and 8 million in developed countries. Indeed, developing countries now suffer from a dual burden of disease obesity and undernutrition. Unacceptably high rates of obesity, diabetes and metabolic syndrome in developing countries may well become a global health problem in the near future. Overweight and obesity, as well as their related noncommunicable diseases, have become a burden for the society due to a decrease in the physical nature of work and the increase in morbidity and mortality rates in obese people; but this is largely preventable. While obesity management and prevention certainly require an effort by individuals, the problem should also be a key area of focus for public health systems and services and governments. Thus, this 73rd Nestlé Nutrition Institute Workshop has been dedicated to epidemiology and strategies to prevent obesity, treatment strategies, clinical outcome, and future trends in scientific research. In addition, genetic and epigenetic aspects were considered. The discussions held focused on the day-to-day challenges and opportunities in obesity treatment, and when and how to start preventive measures. XI

11 We highly appreciate the renowned chairpersons Prof. Barbara Rolls and Prof. Adam Drewnowski who prepared such a high level of scientific program and brought together distinguished world experts in the area of obesity. Finally, we would like to acknowledge the great work and organization of Laura Taylor and her team from Jenny Craig, thanks to which we could enjoy the scientific discussions in SanDiego, Calif. Prof. Ferdinand Haschke, MD, PhD Head of Nestlé Nutrition Institute Vevey, Switzerland Natalia Wagemans, MD, PhD Global Medical Advisor Nestlé Nutrition Institute Vevey, Switzerland XII Haschke Wagemans

12 73rd Nestlé Nutrition Institute Workshop Carlsbad, CA September 22 24, 2011

13 Contributors Chairpersons & Speakers Prof. Leann Birch 129 Noll Laboratory The Pennsylvania State University University Park, PA USA Prof. Adam Drewnowski University of Washington Box Nutritional Sciences Raitt Hall 305E Seattle, WA USA Prof. Diane Finegood Simon Fraser University Vancouver 8888 University Drive Burnaby, BC V5A 1S6 Canada Prof. Michael I. Goran Keck School of Medicine University of Southern California 2250 Alcazar, CSC Bldg #212 Los Angeles, CA USA Prof. John Jakicic School of Education University of Pittsburgh 600 BIRM Pittsburgh, PA USA Prof. Johanna Lampe Fred Hutchinson Cancer Research Center 1100 Fairview Ave N., M4 B402 PO Box Seattle, WA USA Prof. Jean-Michel Oppert University Pierre and Marie Curie Department of Nutrition Pitié-Salpêtrière Hospital (AP-HP) 83 boulevard de l'hôpital Paris France Prof. Barbara J. Rolls The Pennsylvania State University 226 Henderson Building University Park, PA USA XV

14 Prof. Michael Rosenbaum Columbia University Medical Center Division of Molecular Genetics Department of Pediatrics Russ Berrie Pavilion 1150 St. Nicholas Avenue, Rm 620 New York, NY USA Attendees Denis Barclay/Switzerland Ferdinand Haschke/Switzerland Petra Klassen/Switzerland Laura Taylor/Switzerland Jamy Ard/USA Molly Bray/USA Anne Dattilo/USA Denise Deming/USA Llona Fordham/USA Chavanne Hanson/USA Linda Hsieh/USA Maureen Huhmann/USA Wendy Johnson-Askew/USA Bill Kesting/USA Jennifer Lovejoy/USA Lauren McDonnell/USA Juan Ochoa/USA Elizabeth Roark/USA Sachiko T. St. Jeor/USA Heidi Storm/USA Roland Sturm/USA Lisa Talamini/USA Molly Wangsgaard/USA Hope Warshaw/USA Christine Zoumas/USA XVI Contributors