Once considered an aesthetic rather than a medical problem, obesity is now officially recognised as a major public health problem. No longer the lifestyle disease of the affluent west, it is growing at an alarming rate both in the industrialised countries and the developing world. The World Health Organisation (WHO) terms it a « rising epidemic ».

Unless steps are taken to deal with the increase in obesity, it could double early in the next millennium. Obesity is the result of multiple factors. These include eating more than is necessary, insufficient physical activity, a genetic disposition, endocrine abnormalities and a medical condition. The progress made in fundamental research of obesity was highlighted at the 8th International Congress which took place in Paris between 29 August and 3 September this year. Professor Bernard Guy-Grand, (Hotel Dieu Paris) chairman of the congress said, « The complications and risks linked to obesity, as well as the forms of obesity which pose greater risks, and the way of recognising them are better identified now even if there is still debate ». Treating obesity and its side effects - coronary heart disease, strokes, diabetes and osteoarthritis is starting to consume more and more of national health budgets in industrialised countries.

The need to encourage global action is now crucial to any future strategies in combating this disease. Meanwhile, discoveries in research will improve the treatment of obesity:

• Scientists have discovered leptin, a hormone secreted by adipose (fatty) tissue which informs the brain of the amount of fat stored. Its absence may provoke severe obesity with eating disorders and pituitary hormone deficits. In the future, leptin may be for obesity what insulin is for diabetes but a lot more research remains to be done.
• New uncoupling proteins have been found in humans. They are related to those already discovered in specific fatty tissue in rodents. Uncoupling proteins disperse energy in the form of heat rather than muscular activity or storing it. Variations in these proteins may explain the difference in weight gain between people with the same nutritional intake. What may be true for some mice might also apply to humans. Research is continuing in this area.
• Knowledge about the complexity of substances implicated in the control of food intake is increasing. The role of substances called monoamines and some peptides are already known. Now that the discovery of new peptide agents, agouti protein or orexins, whose mechanisms of action are being specified, they offer the basis for the development of new medicines.
• While the hypothetical « obesity gene » remains elusive as ever, research has identified a number of predisposing and diverse genetic factors. Future research may identify different types of obesity according to their genetic characteristics. This will eventually lead to new diagnostic tools and individualised therapeutic strategies.

And while scientists are working on new treatments for obesity, The International Association for the Study of Obesity's (IASO) International Obesity Task Force (IOTF) is working with WHO on a three year action programme to sensitise governments to the growing epidemic. The emphasis is now on weight management rather than on short term extreme weight loss. Professor Stephan Rossner from the Karolinska Institute in Stockholm and president-elect of the IASO says, "We are emphasising the need to begin tackling the problem earlier, to deal with childhood weight problems and to completely rethink the way we approach physical activity and diet to ensure a healthy, active lifestyle". Eating a balanced diet and becoming physically active are the first steps in combating obesity.

FOOD TODAY 12/1998