Despite the successes of GLP-1 medications and bariatric surgery, the obesity epidemic continues as a public health disaster globally. The prevalence of obesity long ago reached alarming levels, needlessly killing 300,000 Americans annually, and leading to appallingly increased morbidity and healthcare costs. If we truly wish to reduce the dreadful increases in stroke, heart attack, and degenerative joint disease obesity has brought us, it is time to recognize the impact of environmental factors, termed obesogenic factors, in driving this epidemic. To combat obesity effectively, we must stop blaming people with the disease and start preventing the disease from occurring. I have written and spoken a lot about the personal steps we can all take to combat obesity and help kids do so, but let us think about this problem on a wider societal level with a focus on prevention.
Understanding Obesogenic Factors
Nearly every policymaker with whom I have spoken over the past 20 years about the obesity epidemic have cited personal behavior as their understanding of the causes: over-eating, poor discipline, too many sweets, not enough exercise, laziness basically. Yet the science shows people are no more or less lazy than we humans were fifty years ago when there were tiny rates of obesity. So, what gives?
Obesogenic factors encompass environmental elements that promote biochemical fat storage and higher blood sugar. In other words, they exert a direct effect upon metabolic processes in our bodies no matter your behavior. Yes, there are also obesogenic factors that promote unhealthy eating habits and sedentary lifestyles. These factors are pervasive and multifaceted, operating at individual, community, and societal levels, things like the ubiquitousness of carbohydrate-rich foods, sedentary lifestyles due to modernization, urbanization, and technological advancements, food marketing practices, increased energy-dense serving sizes, socioeconomic disparities, and limited access to healthy food options, among others. Food science has enabled producers to tickle our brain chemistry and reward centers like never before, inducing cravings we simply must satisfy. And while those factors deserve attention, they also divert attention away from direct chemical effects on the body and its biochemistry coming from compounds in our environment that simply did not exist in quantity before the obesity epidemic.
Is it possible that the problem is more biochemical and less behavioral? As hard a pill as it is to swallow, the truth appears to be that the epidemic stems from changes in our environment, from cereals to pharmaceuticals to the water supply.
In other words, are our kids just being duped into eating more and sitting on the couch more, or are they likely being essentially poisoned into obesity? A closer look at the changes in the chemistry of the environment that correspond to the timing of the obesity epidemic suggests we may soon conclude that the latter plays the larger role.
A Few Possible Culprits
So, what’s happening environmentally? Let’s look at the biggest culprits.
Changes in Cultivars of Agricultural Staples
The agricultural industry has undergone significant changes in recent decades, driven by efforts to increase crop yields, enhance resistance to pests and diseases, and improve marketability. These changes have led to the development of new cultivars of agricultural staples, including grains, fruits, and vegetables. While these cultivars offer benefits, they have altered genomes that may have unintended consequences and exert obesogenic effects. For example, modern wheat and corn varieties bred for high yield, mouth feel, and disease resistance may potentially predispose individuals to higher blood sugar and obesity.
Antibiotics
Antibiotics are commonly used in both pediatric human medical care and in animal agriculture. Research suggests that exposure to antibiotics through direct prescribing, in the food supply or because of antibiotic residues in water sources disrupt the gut microbiome and cause weight gain.
Pharmaceuticals
Several classes of medications cause weight gain, including certain antidepressants, antipsychotics, antibiotics, antihistamines, corticosteroids, insulin, and medications used to treat hypertension. Pharmaceutical compounds also enter water sources through various pathways, including incomplete metabolism and excretion by humans and animals, improper disposal of unused medications, and runoff from agricultural areas where veterinary drugs are used. While conventional water treatment processes can remove many contaminants, certain pharmaceutical compounds persist in water supplies.
Other Chemical Compounds
The modern food production system relies heavily on the use of chemical compounds such as preservatives, additives, and flavor enhancers. Way more study is needed, but some of these compounds have been linked to disruptions in metabolic processes and hormonal regulation, potentially influencing appetite, energy expenditure, and fat storage in the body.
What To Do
We are not going to treat our way out of this pandemic. Millions of children are starting off life on the wrong foot, morbidly obese before they are even teenagers. Addressing the obesity epidemic requires much better science, followed by a concerted effort from policymakers, healthcare professionals, industries, communities, and individuals. By embarking upon evidence-based detective work on the causes of the epidemic, future policy interventions can target obesogenic factors in the environment and create a healthier society by preventing obesity before it begins.
