Fat, Fate, and Disease : Why we are losing the war against obesity and chronic disease (38 page)

And we are frustrated that the current strategy seems to be based on the operation of individual choice, which proved to be successful in the compaign against smoking. But does the little girl force-fed before marriage in rural Mauritania have any choice in her life? Does the 12-year-old child bride in rural India have any choice when she becomes pregnant and drops out of school? Does the little toddler in Detroit have any choice when his mother feeds him French fries? Does the little boy from Tonga whose mother had diabetes in pregnancy have any choice about developing obesity? Does the little boy in Beijing have any choice in being an only child? And yet every one of these scenarios, and many more, sets that little child up with a greater risk of becoming obese and suffering from a non-communicable disease. They are all matters beyond their control.

Obesity, diabetes, and cardiovascular disease are not the same thing. There are individual and population differences in the relationships between them and that complicates matters too, biologically and psychologically. But one thing is common to them all. They are all very slowly developing conditions, and so subtle changes in their development can nonetheless have substantial effects on health later. The early life changes can be so subtle that we may not know when they start, but that does not diminish their importance.

When does the problem go from being one of prevention to one of treatment? Pondering this, we start to get excited because our new scientific understanding reveals that what makes us what we are is a combination of our genes, how we developed from a single egg and sperm, and how we live in the modern world. This realization has been slow to be incorporated into the general scientific framework, impeded as it has been by the focus on the gene—but it is now undeniable. It is an exciting time for medical science.

Within this conceptual framework we are starting to uncover many things that will give us new tactics and strategies for the war against obesity and non-communicable disease, and so we are hopeful. We now know that we will have to give much greater attention to the mother and unborn child. We may well have to focus on the lifestyle of the father as well. And most importantly of all, we are starting to realize that behaviours such as the propensity to exercise, which we previously thought were based on individual choice, have a large constitutional component—based in part on inherited genes, in part on epigenetic changes to gene function in response to the developmental environment, and in part through early learning.

We now face a world where more people suffer from apparent over-nutrition rather than under-nutrition. But paradoxically both can lead to chronic disease. It may be better to think of it as unbalanced nutrition—nutrition mismatched to our evolved biology—affecting much of the world’s population. These issues are growing in the developing world. When combined with climate change, issues of
water, food, and energy security, changes in life expectancy and family size, as well as many other factors, the burden of non-communicable disease will truly add to the ‘perfect storm’ that we mentioned at the start of the book. We see the clouds gathering. Weathering this storm will require the combined effort of governments, agencies, foundations, and the private sector.

The world of the vain emperor, whose sycophantic advisers had assured him that his clothes were too fine to be seen, changed when the little boy exclaimed that the emperor had no clothes. Medicine changed when the significance of Semmelweis’ work was eventually recognized. Across the world, we have not been well served by the current initiatives to prevent non-communicable disease. We are getting fat and we are dreadfully unhealthy. It is apparent that new strategies are needed if we are all to take the pathways to healthier lives. It is in the interests of all of us to listen to the little boy’s cry.

A

Adaptation 25, 182

as an approach to climate change and obesity 223

see also
Predictive adaptive responses

Adipocytes
see
Fat, white

Adiposity 27–8, 156, 176

at birth 27, 41–2

Africa 62–3

dairying 207

human evolution 27, 91, 126, 150, 157

see also
Sub-Saharan Africa

Age at first birth 131

Ageing 42, 53, 130, 174

Agriculture 48, 91, 127

Allen, Twink 154

Ancestry 58, 239

Appetite 30–1, 37, 112, 141, 145–6, 198–9

Atkins diet 54

Australia 133, 176, 254

B

Bachelet, Michelle 273

Ban Ki-moon 63

Barker, David 138–9, 216

Bateson, William 204

Beddington, John 2

Bee 163, 209–10

Bill and Melinda Gates Foundation 16–7, 190, 229, 245, 255–7

Bipedalism 150

Birth weight 123

and deprivation 131

and early life undernutrition 144–7

and graded risk of disease 139

and maternal constraint 157

and menarche 133

and pregnancy weight gain 148–9

and stunting 155

as an indicator of disease risk 18–9, 133–4, 138–9, 147

growth retardation 155

in first-borns 155

in twins 110

Blame 88–9, 169, 187, 193, 235–7, 258–9, 267

Blood vessels 32–3, 36–7, 57, 75, 105–6, 154, 159, 174–5, 251

Bloomfield, Frank 125

Boas, Franz 109

Body Mass Index 24, 42–3

Body temperature 29, 34–5

Body image 40–1, 77–8, 81–2, 270

Bottle feeding
see
Infant formula

Bouchard, Claude 110–1

Brain 36, 73, 156, 198–9, 275

and hormones 30–1, 143

and undernutrition 195

energy dependency at birth 28

epigenetic change 164

growth 42, 123, 151, 156, 173, 181

Brazil 43, 150

Breast milk 33, 146, 197–8

compared to infant formula 157, 183, 197

Breastfeeding 131, 183, 195, 198–9, 229, 234, 239, 275

Brown, Sarah 190

Bruce, Kim 172

Burdge, Graham 140, 164

Burt, Cyril 208

Butterfly 142

Butz, Earl 271

Byrne, Christopher 172

C

Cagampang, Felino 172

Calorie 26–7, 29, 49, 52, 68, 88

high-calorie animal diet 140

Canada 110, 178

Cancer 4, 6, 54, 130

and obesity 6, 24, 38

cervical 224

in larger babies 134

lung 104, 224, 254

Carbohydrate 26, 45–7, 81, 164

intake during pregnancy 147, 167

Cardiovascular disease 4–5, 9, 56, 60–3, 75, 138, 147

Cardiovascular function 106

Cell membrane 36–7, 182

Chan, Margaret 192, 230, 236

Childhood adiposity 166–7

Childhood obesity 9, 18, 185

China 275

diabetes 43, 57

famine 114

first-borns 149

gestational diabetes 62, 177

infant formula 183

nutritional education 252–3

smoking 73

Choice 71–2, 74, 235–6, 250, 268, 276

women’s rights 242

Cholesterol 33, 36, 38

Chromosome 91–2, 94, 163

Climate change 2, 222–3, 231, 260

Cognitive skills 200

Colostrum 181, 197

Constraint
see
Maternal constraint

Copy number variation 96

Cortisol 124

Costello, Anthony 241

Cultural issues 81, 83, 191, 219, 239–40

Cystic fibrosis 98

D

Darwin, Charles 90–1

Darwinian selection 97

Development

and epigenetics 163–5

and evolution 137

as a continuum 134

disruption 123, 134

fetal 121

study of 119

in biomedicine 136–7

Developmental plasticity 122, 126, 135, 163, 237

DHA
see
omega-3 fat

DNA 91–2, 97, 162–3, 166

‘junk’ 92

methylation 162–3, 167, 210

source 166, 213

Diabetes

blood vessels 159

complications of 37, 61, 75, 159

earlier onset of 25, 44, 61, 63

gut bacteria 197–8

in pregnancy
see
Gestational diabetes

population differences 101

surgery 75–6

type 1 4, 56

type 2 4, 56, 61

worldwide prevalence 9, 63

Diet

modern 45, 50, 63–4

Palaeolithic 47

Dieting 28, 78, 84–5, 101, 232

see also
Weight loss

Douglas, Heather 260

Duan, Tony 252

E

Eating disorders 41, 133

Eating habits 275

Economic transition 63, 149

Elahi, Maqsood 172

Embryo transfer 154

Energy balance 28, 76, 110, 253

Engagement between scientists and public 248–9

Environment 99–100, 109, 210, 269

developmental 123–4, 135, 168, 274

see also
Prediction

Environmental change 44, 98–100, 122, 128

Environmental match and mismatch 90, 107, 147

Epidemiology 215

Epigenetics 163, 210

and developmental plasticity 163

and maternal care 164

and pregnancy diet 164–5, 167

determination of disease risk 166–8, 212

implications and interventions 168–9, 213–4, 225, 239

intergenerational transmission 170, 177, 194

markers 195–6, 211

mechanisms 163

paternal influence 169–170

profiles 163, 167, 211–2, 238

reversibility 212–3

see also
DNA methylation

Ethical issues 238–9

Ethiopia 152–3

Evidence-based medicine 103–4

Evolution 44–5, 53, 79–80, 90–1, 106–8, 126, 137, 141–2, 155, 187

Evolutionary medicine 106

Evolutionary novelty 99–100, 175

Exercise 68, 277

in children 50–2

F

Family

diet 80, 86–7

size 131, 149, 243–4

poverty 158

Famine

birth weight 144–5, 147

China 114

Dutch Hunger Winter 81–2, 114, 146, 165

fetal growth 146

Jamaica 144–6

The Gambia 113–4

Fat

abdominal 32, 61, 101

as an adaptation 25

biochemical structure 32

body 26, 29, 40–2, 54, 150, 174, 225

brown 33–4

calories 26

cells 116–7, 174, 181–2

saturated 36, 46

trans- 38, 46

visceral 32, 36–7, 76, 161, 269

white 33–4, 116–7

Fatness
see
Adiposity

Female circumcision 152, 191

Feminist issues 77–8, 242

see also
Women’s empowerment

Fertilization 109

Fertility

and nutrition 41

and age 129, 155

and body fat 41, 156

body shape 31, 40, 81

Fidgeting 52

First-born 19, 149–50, 155, 176, 200, 244

Fistula 152

Fitness 126, 137, 168

Folic acid 46, 164, 214

Food labelling 87–8, 217–8, 232, 271

Food industry 88–9, 217–8

engagement with 89, 218, 233, 236, 252–3, 270–1

Food preferences 198–9

Food security 12, 89, 252

Forrester, Terrence 143–5

Fowden, Abigail 154

Fraud 203–9

Free radicals 174

Fructose 49, 172, 180

G

Gambia, The 113–4, 134

Gastric banding 75–6

Gastric bypass 75–6

Gene 91–2, 97

FTO
95

switches 92, 110, 162–3

thrifty 93, 95, 98

Gene therapy 96

Genetic screening 239

Genetic variation 90–2, 94–6, 98, 202

Gennser, Gerhard 138

Geopolitical consequences 10–1, 258

Gestational diabetes 177–81

evolutionary explanation 181

fetal consequences 177–8

intergenerational passage of risk 178, 185–6

risk factors 180

Ghrelin 30–1

Global warming
see
Climate change

Glycaemic index 46–7, 54, 63, 200

Gluckman, Peter 70–1

Glucose 179

after birth 181

blood 36–7, 46

fetal exposure 177–80

maternal levels during pregnancy 180

‘Gluttony and sloth’ 8, 45, 74, 84, 172, 187, 219, 235, 248, 259

Godfrey, Keith 147, 150

Gregg, Norman 208

Grandmother effect 108

Gross obesity 25, 35, 40–1, 149

Guppy 128

Gut bacteria 197–8

H

Hamlin, Catherine and Reginald 152

Hammond, John 153–4

Hanson, Mark 70–1

Harvest/hungry season 113–4

Haugen, Guttorm 161

HDL
see
Cholesterol

Headstart programme 201

Health literacy 241, 250

Heart disease
see
Cardiovascular disease

Heckman, James 200–1

Height 109

as a continuous measure 58–9

High fat diet 63, 173–4, 180

in animals 140, 143, 165, 172

Histones 162

HIV-AIDS 6, 16, 62, 241, 258, 266

Hong Kong 177–8

Horse 153–4

Human Genome Project 94–7, 201–2

Hume, Thomas 208

Hunter-gatherer 47, 49, 98, 127–9

see also
Palaeolithic

Huxley, Thomas 145

Hwang Woo Suk 206

I

India 159–61

birth weight 155, 160

diabetes 44, 63, 160

fetal growth constraint 275

life expectancy 53

obesity 43

Individual differences 17–8, 26, 39, 70–1, 83, 89, 94, 100–2, 112, 212

in twins 110–2

see also
Genetic variation

Industrial revolution 12, 48, 91

Infant formula 157, 183, 192, 195, 198, 217, 234

Inflammation 37–8

Inheritance 203–4, 208

gene 90, 95, 153, 162, 277

Inskip, Hazel 147

Insulin 30, 36–7, 45, 162, 174

resistance 68, 92–3, 111, 138, 140, 179, 181–2, 194

Interventions 21, 83, 225, 228, 234, 261, 269

adult 254

early 172, 194–5, 201, 213, 226–7, 235, 239

lifestyle 269

state 71–4, 86–7, 231, 236–7, 250, 267–8