Obesity is at an all-time high. Humans throughout the world are consuming more calories than they expend, and BMIs continue to rise. Medically this is not good news as there are virtually no benefits from being overweight - and considerable risks.
Obesity is linked to risks of cardiovascular disease, metabolic disorders, cancer incidence, increased mortality and, in women, reproductive dysfunction. Science has produced evidence of the risks and no-one in the developed world can claim ignorance of the dangers of obesity.
Socially, some developing cultures perceive obesity as a marker of success or status but the ample figure is not admired or respected in Western culture. Over the last half century, affluence seems to have changed our views and being overweight has become a feature of society. Whether it has become socially acceptable or not is a sociological question, but medically it simply increases the burden of disease.
The aesthetics are in the eye of the beholder.
Premenopausal women are traditionally figure-conscious, and diets feature in conversations, magazines and respected medical journals. Arguments about diets will continue as “easier” ways to lose weight are touted by the popular press. But is there science to back one diet against another?
Gardner et al from California (JAMA 2007;297:969-77) explored the relative merits of diets that varied in their carbohydrate components. They diligently followed four groups of women in their forties over one year who were randomly allocated to the following diets - Atkins (very low carbo), Zone (low carbo), LEARN (moderate carbo) and Ornish (very high carbo). They looked at metabolic effects and gave the women every incentive - including a modest financial stipend - to stick to their regimens.
The Atkins diet gave the best results biochemically and cardiovascularly and in terms of sustained weight loss compared to the three others which were equally inferior. However, the overall results were only modest, with the Atkins diet women losing about 4.5kg and the others about 2kg over the year.
Since their mean weight at the start was 85kg, the reward for these women's efforts was small and the drop-out rates not insignificant. Obesity is a problem of lifestyle and the individual effects are there for everyone to ponder. Medicine can highlight what each person can eat for optimal health and emphasise through large studies how our society is slumping into soft-option acceptance of unhealthy food consumption.
