Obesity epidemics: simple or simplicistic answers?

Abstract

Among the strategies suggested to face obesity epidemics there is also a mere reduction of only 100-200 kcal day, i.e. less mouthfuls of food and a little more walking every day. Are these proposals "simple and feasible" or, vice versa, "simplicistic and unrealistic" solutions? A possible source of such confusion comes firstly from dietary guidelines: the "food pyramid" may easily lead to misinterpretation as low-fat foods enriched in simple sugars produce similar metabolic abnormalities as saturated fat rich foods. Replacement of fruit derived fructose with other fructose-enriched beverages is not adequately considered. In total, 45-60 min of moderately intense physical activity, instead of "few steps", daily appears a more realistic evaluation of the role of physical activity in energy balance but is still an unrealistic intervention strategy in many obese individuals requiring a long preliminary rehabilitation period. Another complaint is the current poor distinction between "preventive, population oriented" and "therapeutic, clinical" intervention strategies possibly due to the long duration of the latent "preclinical" phase of the disease and the scarcity of safe and effective drugs. Obesity may be considered a "culture-bound" disease and as such it requires a proper cultural, political and educational strategies. The number of obesity clinics worldwide is too limited; educational interventions in the crucial period of the developmental age are lacky. The social science content of medical school curricula, and teaching healthy behaviours, needs to be improved. In conclusion, a deeper reflection from Medical Societies on the relationship between the negative aspects of the "transition diet" and "globalization process" may help to produce really "simple" and more successful strategies against obesity epidemics and its complications.