Obesity Treatment and Prevention: New Directions (Nestlé Nutrition Institute Workshop Series)

Then, based on the understanding of disease etiology and its distribution by geography and by social strata, targeted yet comprehensive strategies for obesity prevention and treatment for both individuals and groups need to be developed. Read more Read less. Here's how restrictions apply. Karger; 1 edition October 26, Language: Be the first to review this item Amazon Best Sellers Rank: Start reading Obesity Treatment and Prevention on your Kindle in under a minute.

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73rd Nestlé Nutrition Institute Workshop: Obesity Treatment and Prevention - New Directions

The prevalence of obesity has increased throughout the last three decades due to genetic, metabolic, behavioral, and environmental factors [1]. Obesity in turn increases risk for a number of metabolic diseases including type 2 diabetes, cardiovascular disease, fatty liver disease and some forms of cancer [1]. Despite the well-known link between obesity and increased morbidity, the mechanism of this remains elusive.

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By understanding the underlying basis of obesity-associated metabolic diseases, different therapies could be designed to target relevant pathways. Although we lack a full understanding of the underlying mechanisms that result in disease, several putative explanations exist for why fat affects metabolic health.

One such theory is based on the anatomic location of fat deposition and ectopic fat accumulation [2]. Specifically, current literature suggests that visceral, liver and skeletal fat accumulation affects organ function and contributes to the development of insulin resistance, fatty liver, and the metabolic syndrome [3].

However, even in individuals matched for body fat and fat distribution, significant differences can exist in metabolic outcomes, and the phenomenon of metabolically healthy obese has been well described [4].

More recent data suggest the alternative hypothesis relating excess adipose tissue to disease risk based on the metabolic function and morphological properties of adipose tissue. In this paper, we will review the hypothesis linking excess adipose tissue to increased disease risk through adipose tissue inflammation.

The composition of the gut microbiome is hypothesized to be an environmental factor that contributes to obesity. Results of several human studies suggest that obesity is associated with differences in the gut microbiota composition, reduced bacterial diversity, and altered representation of bacterial metabolic pathways. The obese phenotype is associated with increased microbial fermentation and energy extraction from non- digestible food components; however, until recently it was not clear how relatively small increases in energy extraction could contribute to the large and rapid weight gain observed in the animal studies.

Mechanisms by which the gut microbiome may influence metabolism and energy homeostasis include regulation of energy uptake from diet, interaction with signaling molecules involved in host metabolism, modification of gut permeability, release of gut hormones, and low- grade, chronic inflammation, the latter being a hallmark of obesity- related diseases. Fortunately, infancy is a period of great behavioral and metabolic plasticity offering numerous targets for preventive interventions. Modifiable factors that may affect early rapid weight gain and obesity risk include infant sleep duration, feeding to soothe infant distress, and the introduction of solid foods and transitional feeding.

For example, in a recent pilot intervention, we focused on helping new mothers address three areas of infant behavior hypothesized to affect weight gain and early obesity risk: The interventions were delivered via home visits and showed positive effects on infant behaviors and weight outcomes at 1 year. Based on evidence from such pilot interventions, we assess the plausibility of targeting behavioral factors in infancy and suggest next steps for early prevention research. Obesity in the United States does not affect all segments of the population equally.

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It is more prevalent in deprived neighborhoods and among groups with lower education and incomes. Inequitable access to healthy foods is one mechanism by which socioeconomic factors can influence food choice behaviors, overall diet quality, and bodyweight. Having a supermarket in the immediate neighborhood has been linked to better diets and to lower obesity rates. However, the affordability of healthy foods may have more of an impact on food patterns than does distance to the nearest store. Grains, added sugars, and added fats are inexpensive, good- tasting, and convenient.

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Their consumption has been linked to lower quality diets, lower diet costs, and lower socioeconomic status. By contrast, the recommended healthier diets not only cost more but were consumed by more affluent groups. New techniques of spatial analysis are a promising approach to mapping obesity rates and linking them with measures of socioeconomic status based on diverse social and economic aspects of the built environment.

Low residential property values predicted bodyweights of women better than did either education or incomes. Shopping in low- cost supermarkets was another powerful predictor of bodyweight. Bodyweight gain may be best predicted not by any one nutrient, food or beverage but by low diet cost. Higher obesity rates in poor neighborhoods may be the toxic consequence of economic insecurity.

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Alleviating poverty may be the best, if not the only, way to stop the obesity epidemic. There is increasing interest in identifying characteristics of neighborhood environments physical, social, economical that might favor unhealthy dietary and physical activity patterns leading to excess weight at population level.

Measurement of characteristics of the physical environment in relation to food and physical activity has greatly improved in recent years. Methods based on assessment of perceptions by residents of their neighborhood or on objective assessment of the actual built environment such as provided by Geographic Information Systems tools would benefit to be combined.

A number of recent systematic reviews have updated our knowledge on relationships of food and physical activity environments with relevant behaviors and obesity. In contrast, built environment characteristics related to food habits accessibility to different types of food outlets, availability of healthy foods. The need for data from different countries and cultures is emphasized, as much as the importance of transdisciplinary research efforts for translation of these findings into our living environment.

Obesity is clearly a complex problem for both the individual and for society. As such they require solutions appropriate for complex problems, rather than a reductionist search for the causes.

The systems that give rise to the obesity epidemic function at multiple levels, and there are important interactions between these levels.