I am bemused when the sins that we recognized in the past are now being redefined by the modern world.

Greed, of course, is behind our “addiction” to oil, the war in the Middle East (no blood for oil”)  and the manipulation  of the stock market.

Lust however is still being touted by the NYTimes as good for you, although the medical profession is busy caring for all the disease and social side effects of that behavior, and even the Washington Post had the courage to print someone who points out that infidelity is still a big no no for most Americans.

And then there is gluttony.

I  used to tease my smoking patients that not only was smoking not good for you, but it was the only “sin” in the modern world.

Well, maybe not. Gluttony seems to be  the new “evil” that will have to be fought by huge government programs that tell us what to eat.

From today’s news: a writer in JAMA (the Journal of the American Medical Association) wants parent of obese children to lose custody.

Yes, bad parents. Or maybe not. Most kids, given unlimited access to food, don’t become 400 pound giants, so maybe the problem is a bit more complicated. Why are they obese? Genes?

Or something else?From MedicalXPressNews:

A new study that looks at weight change over decades finds  that the obesity epidemic in teens and young adults has its roots in  the late 1990s and early 2000s, when body weights began to rise. But not  everyone was affected equally.“Females are at greater risk than males, and black females are  at greatest risk,” said study co-author Kathleen Mullan Harris, adding  that young adults seem vulnerable to gain. “There need to be preventive messages focused on this period.”

Hmm…epidemic started less than 20 years ago (and is only in it’s early stages here in Asia). But Gluttony has been around awhile….so who do they blame?

TV that keeps kids from exercizing,  and fast foods, of course.

Yet TV has been around for 60 years, school bussing started  in the 1970’s, crime that discouraged jogging is now better than 20 years ago…and even kids eating fast foods because mom works outside the home and doesn’t cook started back in the 1980’s.

True, mild to moderate obesity does result from unlimited food, especially high calorie fat containing food, but there is no proof that simple gluttony results in 500 pound kids.

Could it be a problem with leptin?

Experiment one:

Researchers at Duke University Medical Center, in Durham, N.C., studied strains of mice that were unable to make and respond to the hormone leptin, which controls appetite. The animals were given unlimited food and water, and with no brake on their hunger, these leptin-deficient mice quickly gained weight, becoming three times the weight of normal mice, with 10 times as much body fat.

Wikipedia on Leptin:

Leptin (Greek leptos meaning thin) is a 16 kDa protein hormone that plays a key role in regulating energy intake and energy expenditure, including appetite and metabolism.

In the obese, they have lots of leptin but their body doesn’t respond to it as well (similar to the problem of insulin resistance in pre diabetic metabolic syndrome).

so where does fast food come into all of this?

A different form of leptin resistance (in combination with insulin resistance and weight gain) easily arises in laboratory animals (such as rats), as soon as they are given unlimited (ad libitum) access to palatable, energy dense foods,[61] and it is reversed when these animals are put back on low energy-density chow.[62]
So eat your fruits and veggies, kids.

Ah, but the bad news: Fructose induces leptin resistance.
Sources of fructose? Fruits and veggies…and sugar of all sorts…especially beverages with high fructose corn syrup.

We analyzed food consumption patterns by using US Department of Agriculture food consumption tables from 1967 to 2000. The consumption of HFCS increased > 1000% between 1970 and 1990, far exceeding the changes in intake of any other food or food group. HFCS now represents > 40% of caloric sweeteners added to foods and beverages and is the sole caloric sweetener in soft drinks in the United States.

Yet obesity isn’t the only question associated with a diet full of fructose containing sweeteners:  a lot of docs wonder if the present day epidemic of fatty liver disease might be due to the increase fructose in the diet. Yes, we have long known that it is associated with metabolic syndrome and diabetes, but now we are seeing it in obese kids.

Another possible cause of the obesity is chemicals. Some plastics and pesticides are known to mimic estrogen (phytoestrogens) and some of these disrupt the endocrine cycle causing infertility and increasing metabolic syndrome.

Pesticides are one problem.

Another is bisphenol A, which is in a lot of plastics, and can leach out into your food especially if you heat the food in the plastic container.

and not just artificial chemicals:  There is a soy connection that is being investigated. Does soy formula make your baby fat?

Then there is a question if the obesity problem is worse in some (but not all) women due to certain hormonal contraceptives. 

Lots of stuff about this on conspiracy and diet webpages, but , and some have been associated with metabolic syndrome (where some have a genetic tendency to be insulin resistant, put on weight, and get diabetes).

from Science daily:

mice exposed to endocrine disrupting chemicals during pregnancy – at levels either comparable to or approaching those that humans are exposed to – produced offspring that became fat as adults and had altered gene and metabolic functions involved in regulating weight…

One of the chemicals under scrutiny is Bisphenol A, or BPA, an ingredient in polycarbonate plastics. Past research has found evidence that it leaches from plastic food containers and bottles, from plastic wrap and from the resin that lines food cans.

I should point out that the FDA says that the level of the chemical for the average American is a lot less than the toxic one, so maybe the worry is overblown. But it might make you stop heating your kid’s milk or food in one of these plastic containers.

Yet this should give you pause:

Experiment two:

Higher BPA concentration was also associated with abdominal obesity (quartile 2 OR: 1.62, 95% CI: 1.11, 2.36; quartile 3 OR: 1.39, 95% CI: 1.02–1.90; quartile 4 OR: 1.58, 95% CI: 1.03–2.42).

Conclusions

Higher BPA exposure is associated with general and central obesity in the general adult population of the United States. Reverse causation is of concern due to the cross-sectional nature of this study; longitudinal studies are needed to clarify the direction of the association.

Eliminating plastic bottles is one thing: glass an non toxic plastic are easy alternatives.

But what about pesticides? Pesticide exposure is also suspected as inducing metabolic syndrome.

Yet when a million folks die of malaria every year, and when more food is needed to feed a growing population, eliminating pesticide would kill a lot more folks than it would save.

There is one way to figure out this dagner: there is an ongoing experiment in high tech/high pesticide food cultivation in China, and  some Chinese foods contain many chemicals that were used to increase productivity. And yes, we are seeing more obesity here in the Philippines, but not among those who eat the cheap Chinese imports, but in our middle class kids. (fast foods and softdrinks).

One of the hardest things to change is the diet of people. Yet it can be done by a multi pronged approach.

I am leery about expensive things like posting calories (no proof that works) or forbiding the bad food of the month from restaurants or your kid’s school lunches..food fads come and go, but the knowledge of a good diet hasn’t changed much since the days of Hippocrates..

On the other hand, public pressure and making it “in” to eat well is a good way to go. Fads do work to change behavior.

So congratulations to Mrs. Obama for promoting healthy eating.

And let’s hope her husband works to eliminate the more worrisome part of the obesity epidemic, first by promoting more studies on what causes the problem, and second, by limiting the use of dangerous chemicals that are scientifically proven to be a problem (and that includes increased checking food imports for chemicals and contamination).

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Nancy Reyes is a physician living in the rural Philippines. Part of this essay was posted on her HeyDoc Xanga blog.

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