Obesity is now so common within the world's population that it is beginning to replace undernutrition and infectious diseases as the most significant contributor to ill health. In particular, obesity is associated with diabetes mellitus, coronary heart disease, certain forms of cancer, and sleep-breathing disorders. Obesity is defined by a body-mass index (weight divided by square of the height) of 30 kg m(-2) or greater, but this does not take into account the morbidity and mortality associated with more modest degrees of overweight, nor the detrimental effect of intra-abdominal fat. The global epidemic of obesity results from a combination of genetic susceptibility, increased availability of high-energy foods and decreased requirement for physical activity in modern society. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals, but an epidemic that threatens global well being.

Obesity as a medical problem

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease. Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological, and structural parameters. Studies in humans have shown that men and women whose birth weights were at the lower end of the normal range, who were thin or short at birth, or who were small in relation to placental size have increased rates of coronary heart disease. We are beginning to understand something of the mechanisms underlying these associations. The programming of blood pressure, insulin responses to glucose, cholesterol metabolism, blood coagulation, and hormonal settings are all areas of active research.

Fetal origins of coronary heart disease

In this contribution we put forward a novel hypothesis concerning the aetiology of Type 2 (non-insulin dependent) diabetes mellitus. The concept underlying our hypothesis is that poor foetal and early post-natal nutrition imposes mechanisms of nutritional thrift upon the growing individual. We propose that one of the major long-term consequences of inadequate early nutrition is impaired development of the endocrine pancreas and a greatly increased susceptibility to the development of Type 2 diabetes. In the first section we outline our research which has led to this hypothesis. We will then review the relevant literature. Finally we show that the hypothesis suggests a reinterpretation of some findings and an explanation of others which are at present not easy to understand.

/pdf/type-2-non-insulin-dependent-diabetes-mellitus-the-thrifty-wkzyogfl8p.pdf

Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis.

Objective: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the lifelong influences on the development of disease. Design: A computer search of the relevant literature was done using Medline-‘life cycle’ and ‘nutrition’ and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using ‘life cycle’, ‘nutrition’ and ‘noncommunicable disease’ (NCD), and ‘life course’. Several published and unpublished WHO reports were key in developing the background and arguments. Setting: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. Results of review: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition. Conclusions: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

/pdf/a-life-course-approach-to-diet-nutrition-and-the-prevention-1smoo3dz1o.pdf

A life course approach to diet, nutrition and the prevention of chronic diseases.

Studies have shown that long-term alcohol abuse produces serious, harmful effects on a variety of the body’s organ systems. Parts of the human body most affected include the liver and the immune, cardiovascular, and skeletal systems. Current research has examined some of these effects in an effort to better understand the medical consequences of alcohol use and abuse and to ultimately develop more effective treatments for responding to alcohol-induced bodily damage. This article discusses some of those findings.

Medical consequences of alcohol abuse

intravenous and oral acetazolamide, topical steroids, and mydriatics. Radiographical examination excluded any orbital fracture. Over the next 48 hours blood in the anterior chamber had cleared sufficiently to allow fundal views: there was vitreous haemorrhage in the left eye and bilateral commotio retinae. The visual acuity in the right eye returned to 6/5 within 72 hours, and re-examination showed no abnormality apart from residual traumatic mydriasis. Topical timolol was required to control persistently raised intraocular pressure in the left eye. After four weeks the visual acuity was still reduced at 6/18 with peripapillary subretinal haemorrhage, oedema at the posterior pole, and peripheral pigmentary retinal degeneration.

https://www.bmj.com/content/bmj/294/6570/482.full.pdf

Pulsatility of luteinising hormone in men with chronic renal failure: abnormal rather than absent.

Matrix effects in clinical analysis: commutability of control materials between the Ektachem, Beckman and SMA 1260 glucose and urea methods

In recent years, the development of dry reagent tests has made it possible for many clinical laboratory tests to be performed not only in the laboratory but also elsewhere. Some of the factors influencing the applications and use of one such system, the Ames Seralyzer, have been studied. Sample volume and the timing of analysis were critical, and poor precision was obtained by an inexperienced operator. The calibrators and reagent strips were stable when stored as recommended by the manufacturer, and calibration was stable for 24 hours. The implications of these findings as well as the problems of method comparison and quality control are discussed, particularly in relation to the use of the instrument outside the laboratory. More generally, this study illustrates several problems with the use of dry reagent, thin films and associated instrumentation that must be considered during evaluations.

https://journals.sagepub.com/doi/pdf/10.1177/000456328302000402

Potential applications and pitfalls of dry reagent tests. An evaluation of the Ames Seralyzer.

BackgroundSince more than 90% of cortisol is bound to protein, serum free cortisol (SFC) may be a more appropriate marker of adrenal status than total cortisol. However, measurement of SFC is techn...

https://journals.sagepub.com/doi/pdf/10.1258/acb.2010.009246

Penelope M.S. Clark

Papers

Medical consequences of alcohol abuse

Pulsatility of luteinising hormone in men with chronic renal failure: abnormal rather than absent.

Matrix effects in clinical analysis: commutability of control materials between the Ektachem, Beckman and SMA 1260 glucose and urea methods

Potential applications and pitfalls of dry reagent tests. An evaluation of the Ames Seralyzer.

An evaluation of measured and calculated serum free cortisol in a group of patients with known adrenal suppression