Heavyweight problem breaks through the class barriers

Historically, it’s been an issue which effects the poorest in society, rather than the cossetted middle classes. Not any more. Obesity it seems no longer respects the usual class divides, with increasing numbers of high earners faced with growing waistlines.

“Research is now showing obesity is coming up across all the socio-economic statuses, so there are middle to high income earners who have problems,” says Paul Sacher, chief research and development officer and co-founder of MEND, a social enterprise that runs obesity treatment and prevention programmes for families.

“Although it’s still more of a problem in the lower socio-economic groups it is no longer exclusively so. “

According to recently- published NHS data, in the past decade there’s been a substantial rise in the number of hospital admissions for patients whose main diagnosis is obesity, from 1,054 to 11,574.

Experts predict that by 2020 half of UK men could be obese, meaning that life-threatening health problems including type 2 diabetes and heart disease will be prevalent.

“It’s been famously said that obesity is a normal response to an abnormal environment. We’re just responding to the environment we live in a very natural way,” says National Obesity Forum chairman Professor David Haslam. “In an ‘obesogenic’ environment [one that tends to cause obesity], things go wrong.”

As the academics see it, the decision to eat, or overeat, is deeply ingrained.

“Our species has adapted to become fat because in the past, if we didn’t, we’d die out during the next famine,” explains Professor Stephen Bloom of Imperial College, London, a pioneer in the field of obesity and diabetes research, soon to be knighted for services to medical science.

“But then we abolished famine. Therefore it’s natural for people to get fat – and it’s a big strain trying not to. Some people can manage it, and some people can’t.

“So there’s nothing wrong with fat people, they’re just responding how they’re programmed to.”

And as our environment changes, so our perceptions of what’s normal become subverted. “If everyone around you looks the same, you think ‘I don’t have a problem’,” says Paul. “You think ‘I don’t stand out’, or ‘Other people are much bigger than me’. So for those people, obesity only becomes an issue when there is a health problem.”

Unfortunately for those facing the health problems caused by obesity, the solution is not straightforward.

Medication to encourage weight loss has been unsuccessful due to some side-effects. Rimonabant was withdrawn in 2010 because it was linked to serious psychiatric problems, including anxiety and suicidal thoughts. And Alli, which is still available, is reported to cause diarrhoea, nausea and acute allergic reactions in some patients.

“The only effective way of treating obesity at the moment is through surgery, and it doesn’t seem very reasonable to suggest we put a third of the people in the country into surgery in the future,” says Professor Bloom. “Particularly with a death rate of one to two per cent.”

He hopes that medications that mimic the effects of weight loss (bariatric) surgery, such as gastric banding, the removal of a portion of the stomach (sleeve gastrectomy), and re-routing the small intestines to a small stomach pouch, known as gastric bypass surgery, could be less invasive.

“We’ve been researching why the bypass has its magic effects and the reason is the brain thinks there’s something wrong with the gut. So the gut then sends a hormone signal to the brain to stop eating,” he says. “So our current big push is to work out a way to give these hormones safely to obese people.”

Another route is being pursued by MEND. “We work with families and adults and basically teach them how to counteract the environment,” says Sacher.

“Research shows that you don’t have to burn that many fewer calories a day to become overweight. A couple of biscuits a day extra can lead to weight gain.

“So sometimes just by being aware of things and spending time to have some strategies in place can make all the difference, because it’s a small amount that’s causing you to gain weight.”