THE “OBESITY GENE” NEED NOT BE A LIFE SENTENCE
Genes influence every aspect of human make-up and development – Obesity is no exception1
Obesity can affect every aspect of a person’s health and can result in a range of illnesses, many of which are debilitating or life-threatening2. Excess weight also brings on mechanical stress, affects hormonal and metabolic function and causes emotional distress as a result of discrimination and low self-esteem2.
For many years obesity was not given the attention it desperately needed, mostly because of stigma with many people believing that obesity was simply a direct consequence of a lack of will power and exercise3. Evidence now shows that when it comes to obesity, an individual’s genetic make-up can play a role in determining our relationship with food and the effect it has on our bodies1,4.
“There is definitely evidence that there is a genetic component to obesity. This presents itself either in the phenotype of the individual, i.e. the shape and distribution of fat in a person’s body and this will determine their appearance. Otherwise it presents purely as generalized obesity. However it is very important to note that the suddenness of the obesity prevalence cannot be blamed solely on a genetic causation,” says Dr Rosetta Guidozzi, a General Practitioner from Johannesburg4.
Although there is evidence that genetics does play a role in obesity, it is only one component of “Globesity” – a word coined by the World Health Organisation to describe this very visible, yet neglected worldwide problem5. Alarmingly, in 2016, more than 1.9 billion adults over the age of 18 were overweight. Of these, over 650 million were obese6.
“It is important to stress that it has been the combination of environmental and behaviour changes that have evolved in our social evolution that have allowed for the underlying genes to express or manifest themselves. Decreases in activity levels, changes in diet, especially fats and carbohydrates, as well as shifts in the behaviour of eating patterns have all contributed to the rise in obesity,” Dr Guidozzi explains
Can we defy our genetic predisposition when it comes to obesity? Dr Guidozzi, who has a special interest in weight management, says that it is indeed possible by understanding the way that the genes express themselves and trying to implement the necessary and appropriate actions to prevent the expression of these genes, until such time that we are able to manipulate genes directly.
“Therefore in families or ethnic groups or societies where the prevalence of obesity is higher, diets, behaviour and physical levels will need to be addressed early to prevent obesity from being ‘”inherited” and thus to break the cycle,” she says4.
“Nutritional behaviour is a learnt entity and here the parents and close families have the biggest role. Not only are the habits associated with foods learnt, but the tastes for these foods are acquired as well. Further, it is important to stress that the culture around food is sometimes the most difficult element to change or to influence. The culture, the food, the flavours, the patterns become part of an individual’s identity and to change these factors is very difficult once they have been entrenched. Society plays a big role in influencing our choices and patterns because as people we want to belong, Dr Guidozzi4.
The good news for anyone struggling with obesity is that it is preventable6 and it only takes losing 5-10 % of one’s bodyweight for significant health benefits to be seen7.
Dr Guidozzi stressed that like with any other health condition; treatment needs to be addressed holistically as there are many factors that need to be taken into consideration. She also believes that healthcare professionals should be including a patient’s weight and BMI as part of their medical examination, and need to offer advice in the same way they would for cholesterol, blood sugar or any other medical condition. “Patients need to be informed that their weight needs to be attended to in the same way that any other problem would be attended to and be treated – for health reasons,” she says4.
Waist circumference is also an important and useful measuring tool to assess obesity, with the criteria for clinical obesity being a waist circumference of more than 90cm in men and 85cm in women8.
When an individual makes the decision to do something about their weight problem, the myriad of information and options can be overwhelming. There are numerous diets available, many of which promise tempting quick-fix solutions and immediate results. Some of these “fad diets” might work temporarily but can be detrimental to your health as well as trigger further weight gain9.
“Initially I believe that patients need to make their own choices and these choices must be aligned with their lifestyle, culture and preferences. As a healthcare professional, I can advise on what would be the most suitable and what would be the “‘healthier'” options; however the patient must remain autonomous in their decision making and they need to understand that they are responsible,” Dr Guidozzi says4.
A doctor may choose to prescribe a specific appetite suppressant when improved control over eating habits and cravings are required. “Some of the most successful behavioural diet programs exhibit relapse of 56% of the participants according to a medical report on obesity in 2016,” says Dr Riekie Smit, an Aesthetic and Sports Practitioner from Pretoria. “This is where prescription agents have shown to be effective in reducing these relapses”10.
For more information, speak to your healthcare professional. Further information is available on request from iNova Pharmaceuticals. Name and business address: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07. 15E Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. IN2770/18
References: 1. Genes are not destiny. Obesity-promoting genes in an obesity-promoting world. Harvard School of Public Health. (https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/genes-and-obesity). Website accessed 20 August 2018. 2. Consequences of Obesity. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). ( http://www.ifso.com/consequences/). Website accessed 20 August 2018. 3. Puhl, RM & Heuer, CA. Obesity Stigma: Important Considerations for Public Health. June 2010. US National Library of Medicine National Institutes of Health. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/) Website accessed 20 August 2018. 4. Q&A with Dr Guidozzi – 12 August 2018. 5. Controlling the global obesity epidemic. The World Health Organisation. 23 April 2003. (http://www.who.int/nutrition/topics/obesity/en/) Website accessed 20 August 2018. 6. Obesity and Overweight. World Health Organisation. February 2018 (http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight) Website accessed 20 August 2018. 7. Pietrzykowska, NB. MD, FACP. Benefits of 5-10 Percent Weight-loss. Obesity Action Coalition. (Accessed on 15 August 2017). 8. Kim HO, et al. Postmarketing Surveillance Study of the Efficacy and Safety of Phentermine in Patients with Obesity. Korean J Fam Med 2013;34:298-306