Obesity And Its Expensive Relationship WIth The NHS...

Recently, the NHS chief executive Simon Stevens issued a statement to the public at the Public Health England conference in Coventry, which is held each year. In the light of an on-going obesity epidemic, he believes that "Obesity is the new smoking". Describing the disease as a "slow-motion car crash", he, along with thousands across the country, recognise that the costs involved in treating obesity has risen year on year to a point where it'll become unsustainable without raises taxes.

Basic statistics reveal how vast the problem is: 25% of adults and over 20% of children are considered obese. I encourage you to see my other article, 'Fat!', for more interesting statistics.

By many, obesity is considered a disease of all age groups, which makes the numbers affected much larger. Tackling the issue therefore proves an expensive task, as currently the government spends around £9bn every year on treatments.

Stevens added that Britain would be 'piling on the pounds in terms of future taxes'.

Percentage of men and women obese from 1993 - 2009 (BBC article)

However its important to appreciate that obesity isn't just an isolated disease. In the majority of cases, obesity will inevitably lead onto other complications including cancer, diabetes and heart disease. Treating people for these additional problems will only increase the overall cost of treatment. At present, the most common direct treatment for obesity (especially those morbidly or severely obese) is bariatric surgery. There are two main types - gastric band and gastric bypass. A gastric band uses a restriction of stomach size, so than when food is ingested, less is required to make you feel 'full'. The alternative method is a gastric bypass, 'where your digestive system is re-routed past most of your stomach'. This gives the effect of digesting less food, having a similar psychological effect to a gastric band. Despite the obvious benefits, patients are always made aware of the potential complications to their health post-surgery. Internal bleeding or deep vein thrombosis (DVT) are just a named couple. Generally however, patients are enrolled onto a 'rigourous and lifelong plan', including regular exercise and a monitored diet, according to NHS Choices.

However this measure may only be considered suitable for those whose life is at risk and require emergency intervention. Those who register as 'overweight' on the BMI scale, are currently not legible for bariatric surgery.

But how can the nationwide problem be tackled? According to the BBC, one of the future proposals would be to increase spending on 'lifestyle intervention programmes' rather than bariatric and similar surgery. This will be a step forward in combating obesity in the long term. Surgery could be considered a relatively short-term solution. 

Credit to Nick Triggle, BBC Health correspondent, for his article published which can be read here. Also the full speech by CEO Simon Stevens can be read here.

Fat!

One of the major health issues facing our world, the western world especially, is obesity. In fact, it is estimated that there are over 1.4 billion people overweight with over 500 million obese. These figures are expect to rise. In 1971, it was estimated that in North America, 14.5% of the population were obese. Now, the figure is over double at 30.9%. These figures were taken from the Biological Sciences Review article 'Lifestyle and Cardiovascular Disease', Volume 26, Number 2. Britain, despite it's small land mass, is considered the second 'fattest' country in the world - in reference to it's people that is. It is not only to do with the fact our country is now becoming overcrowded, our very habits, morals, behaviour and eating patterns have contributed to a dramatic increase in cases of obesity in the last couple of decades. To many people, carbohydrates contribute to the base of a diet. However in many cases an imbalance of this food group inevitably leads to weight gain and the formation of excess fat (adipose) tissue. How does this mechanism work? Well, central to this question is respiration, adipocytes (fat cells) and of course the different types of fat. Here, I want to explain how a weight gain is achieved, even right down to the molecular level.

Firstly, we need to understand that the molecule glucose makes up the vast majority of carbohydrate-based foods. Glucose is essential to our well being, in particular being vital to the function of our nervous system and our muscular system. It's uptake by our many billions of cells initiate the start of the production of the 'energy' molecule ATP, or Adenosine Triphosphate. It is a continuous process, however once our cells are content with the amount of glucose needed to produce ATP, glucose is transported and stored in various tissues of the body.

Adipocytes

Usually, glucose can be converted into glycogen via glycogenesis for "short-term" storage in muscles and the liver. Glycogen can be easily hydrolysed back into glucose for ease of access to body cells and tissues. However alternatively, glucose can be stored as part of fat molecules called triglycerides. These molecules comprise of a glycerol backbone with three attached hydrocarbon chains. These chains were originally carboxylic acids, better known as fatty acids - they take part in a condensation reaction to release three water molecules in forming a triglyceride. The main site in the body in which we would find triglycerides is in adipocytes. However triglycerides can also be utilised by muscle cells in the release of energy if needed. Fats are generally considered a second source of energy after carbohydrates. As well as the storage of glucose, triglycerides can also be formed from the digestion of fatty foods into the base components glycerol and fatty acids before subsequent absorption.

So how exactly is fat managed?

Well, to start with there are two different kinds of adipocytes, white and brown. It is important to distinguish between these two cell types as they have very contrasting roles. When fat is said to be 'stored', it is held within the white adipocytes of the body. When these cells are content with the amount of glucose needed to carry out respiration to yield the maximum number of ATP's, excess glucose is converted into fat here. The receptor that recognises this and promotes the storage of fat is called PPARγ. Conversely, brown adipocytes are considered extremely 'energy ineffecient', "burning" up triglycerides and storing very little, if any, of them. The result is that much heat is produced, a consequence of the many mitochondria this cell has. In fact, it has the most of any cell in the human body. This was once considered a survival mechanism for newborn infants as they had brown adipocytes in large numbers - the heat generated helps to protect the child from comparatively cold conditions to the womb. New research has found that adults posses these exact same cell types, 'roughly 60g in the neck region'. These cells adjust their calorie-burni ctivity in accordance with food intake and external temperature just to name a couple.

Now here is the intriguing part. Recent experiments in mice have shown that an increase in brown adipocytes 'help protect against diet-induced obesity and type 2 diabetes by preventing the build-up of triglycerides in other cell types, such as those in the liver and muscle'.

So what are the potentials of brown adipocytes?

In my view, adipocytes quite fasdcinate me now I've read a lot more into the subject. In cellular respiration, glucose is commonly processed through a series of step-by-step exothermic reactions. However in brown adipocytes, the stage that normally produces the largest number of ATP's is halted. It is known as oxidative phosphorylation. This means rather than using the energy released form the exothermic reactions to produce ATP, it is dissipated as heat energy - usually regardedas very inefficient!

Scientists have spent years of research trying to suggest new methods to combat the ever-pressing problem of obesity. Novel resserach into a particluar protein found in adipocytes called sirtuin has sparked a glimmer of hope. Sirtuin has been found to be associated with 'calorfic restriction' where life expectancy has increased with decreasing the number of calories in the diet gradually over a prolonged period of time. As sirtuin is commonly found in metabolising brown fat cells, there may be potential for sirtuin to be stimulated in white fat cells in combating weight gain. The experiments that scientists carried out confimred that with an increased presence of sirtuin, white fat cells started to show some of the characteristsc of brown fat cells, i.e. genes were becoming switched on that were analogous to brown fat cells. Parallel to this, other genes in the white fat cells were becoming switched off, again the same ones that are switched off in normal brown fat cells.

This phenomenal "growing" effect of white fat cells has significant potential. It is down to the protein sirtuin, how this works requires a little more understanding. Sirtuin is found to bind to the PPARγ receptor and modifies it. This receptor is found on the nucleus of white adipocytes. Therefore this receptor doesn't resume in normal function - instead it 'activates a transcription factor called Prdm16 that stwiches on a set of genes necessary for using up chemical energy to produce heat'.

Another plus side of the 'browning' of white adipocytes is that, in diabetic mice, their responsiveness  to insulin increased.

Is it all too good to be true? Well, not exactly. You see, sirtuin is found in many different types of cell throughout the body, not just adipocytes. This would imply that adjusting concentrations of sirtuin will have additional, even unwanted effects to the body. These problems will need to be investigated further by researchers in the future.


Credit to Joseph Robertson, who writes for the Biological Sciences Review (Volume 26, Number 2), for his article "Fighting the Flab" which was published.

The Complications of Obesity And Their Devastating Effects

What is becoming increasingly common in western countries such as the UK is the onset of obesity. Some would say that it has dominated health related news for the last few years. Following this, increasing numbers are likely to result in increasing concerns. What many people associate with obesity is the increasing risk of developing heart related diseases and the early development of diabetes. However what many people fail to realise is that obesity is becoming increasingly related to many different cancers. Although all these diseases could be considered equally devastating, the spread of cancer and it's effects is the cause of many funded research projects throughout the world. It is indeed of the worlds emergencies.

According to an article published in the Lancet medical journal, obesity has the potential to put people 'at greater risk of developing 10 of the most common cancers'. The study has arrived at this link through investigating the health of 5 million people which is an incredible number for a study. Additionally these people were monitored over an extended period of 7 years, which is very comprehensive in my opinion. It follows that I have increased confidence in the findings due to the sheer scale of the study - however it is always important to understand the study holistically before drawing conclusions.

It is fair to say that obesity can increase the risk of developing cancer in general with age. However what was unique about this study was that the size of a risk is dependent on the type of tumour. For example, the study found that cancer of the uterus carried the biggest risk when an individual becomes obese. Conversely leukaemia carried the lowest relative risk. Obviously men will not suffer from cancer of the uterus, so the biggest risk that is posed to obese men is gallbladder cancer, according to the study.  Scientists from the London School of Tropical Medicine found that 'each 13-16 kg of extra weight an average adult gained was linked firmly and linearly to a greater risk of six cancers'.

Furthermore, a high Body Mass Index (BMI) has been linked to higher risk of the incidence of cancer of the liver, colon and ovaries just to name a few. However what was very peculiar is that the researchers found that an increased BMI seemed to be linked with a decreased risk in prostate cancer. Of course, this only displays a correlation which doesn't always necessarily indicate a causal link, nevertheless this statistic is intriguing. Despite the links to risks with BMI, one may assume these links are sufficiently linear. But according to Dr Krishnan Bhaskaran who led the research team, "There was a lot of variation in the effect of BMI on different cancers". An example he described was that the risk of cancer of the uterus increased 'substantially' with increased BMI however this link proved more 'modest' when looking at other tumour types.

So it is evident that scientists will need to investigate the causal mechanism behind the differences in increased risk. Dr Bhaskaran suggests that "BMI must affect cancer risk through a number of different processes, depending on cancer type". Although quite vague, this statement enforces that cancer is an area of research that will need to be fully understood in the coming years in order to cause medical advances in the scientific world.



Credit to Smitha Mundasad, BBC News Health Reporter for the original article. Read more on the subject here.