Men bad for women's waistlines

[dragon wench]

Does anyone have any further information on this? I just came across the piece and was mildly surprised. I mean, some of this does make sense, but how widespread (er..excuse the pun... ) is it?


Men bad for women's waistlines

A UK obesity expert has analysed why it is that women who move in with their man often put on weight as a result.

Eating man-sized portions and indulging in richer foods and wines can lead to weight gain, a review in The Lancet medical journal says.

When you combine that with going on the contraceptive pill or having babies, a woman's waistline can severely suffer, says author Dr David Haslam.

"Men are very bad for women really," he said.

If you are eating with a partner the evening meal is a social event...you may eat more and maybe more extravagant stuff
Dr Haslam

He said research showed women tend to gain weight once they cohabit and begin to share meals with men who intrinsically have higher energy needs and therefore appetites.

"If you are eating with a partner the evening meal is a social event and its no longer just filling a gap. You may eat more and maybe more extravagant stuff."

The weekly shopping list may change from the basic fruit and veg to include indulgent treats.

Couples may go out to restaurants for meals more often.

Women may do less exercise when they are in a relationship, skipping a trip to the gym to spend quality time with their partner.

Multiple insults

The contraceptive they chose to use can also have an impact.

The Pill, taken by 3.5 million British women, has been associated with a slight weight gain among some users, on average 4lb in the first three months.

Repeated pregnancies can also lead to weight gain.

"Each individual factor for weight gain is serious enough but put them all together and you can get a significant increase," said Dr Haslam.

Societal changes mean women may be less physically active than their great-grandmothers were, doing less housework thanks to time-saving gadgets, getting partners to share the load or paying others to do it for them.

Some studies have shown that married couples gain weight while those who divorce lose weight.

Dr Haslam stressed that it was important not to generalise and that being in a relationship had numerous positive influences and gains too.

He said the important thing was for individuals to look at their own lifestyles and make healthy changes if they needed to.

Obesity has been shown to decrease life expectancy by seven years at the age of 40.

Story from BBC NEWS:
http://news.bbc.co.uk/2/hi/health/4339758.stm

[Fiona]

I saw that. Slade and Krunchyfrogg say it is the same for men. Who cares

edit: sorry I didn't mean that to come out the way it did. I just object to the way the media concentrate on this kind of thing for women. I get a bit tired of being chivvied

[dragon wench]

No worries Fiona
I do know what you mean. There is a little too much media fixation on how women look. I have read that anorexia is actually becoming more common amongst men, owing to media imagery of the "perfect male body," but, even so, there still seems to be far more emphasis on the female shape..

The research should look into the effects of couplehood for *both* genders..

[HighLordDave]

It's true, and as you say, not just for women, although it sounds as if the study only looked at women.

Since I got married 7½ years ago, I have put on about 30 pounds.

Part of that is because I've grown out of the super-fast metabolism of my teenage years and early 20s. I still eat like I used to, but my body doesn't go through it as fast anymore.

However, a lot is due to the fact that I'm no longer on the "single guy diet" which generally consisted of one meal a day and a couple of snacks to hold me over. Now that I eat on a regular schedule (and I'm married to a fabulous cook), I take in more calories than I used to, hence the weight increase.

I have also found that my wife and I are generally more sedentary than before we met. I go out less and and so I burn fewer calories.

An increase caloric intake and reducted activity can only lead to weight gain.

I suspect that if you did a study on men, they probably gain more weight (both in terms of straight pounds/kilos and as a percentage of their body mass) than women when they cohabitate as opposed to being single.

[Hill-Shatar]

It's funny for me, really, as we both ended up getting swept up into each other's hobbies...

Repeated pregnancies can also lead to weight gain.

No way, I never knew that! Gosh gee, my world is being turned upside down.

He said the important thing was for individuals to look at their own lifestyles and make healthy changes if they needed to.

Seriously, many people don't already do that? We have been told this since we were five. I know that I feel a little guilty buying a huge chocolate bar, which is not totally healthy (coco butter is good for you and apparently increases your lifespan) but rationalize it anyways.

In my opinion, the article is sprouting a bunch of facts of weight gain for woman through relationships that we have been hearing for years.

It is funny that they don't put down the benefits. Nor do they say what you should do, other than 'continue your healthy lifestyle'. What is the actual point of this article? It was not particularly helpful, I find... more FYI for those who have not heard the entire list of facts IMO. Pretty pointless, if you ask me.

However, I find it kind of insulting that they don't put down anything about obesity and men relating to marriage and relationships...

In hindsight, did they have any links on that page to an actual study?

[HighLordDave]

As an addendum, I wonder if the results would be the same if you studied same-sex partnerships.

If two women lived together, as partners not just as roommates, would they gain weight?

The summary posted here hypothesises that because men eat more and women then eat to keep up with them, they gain weight. But what if two women were cohabitating? I suspect that they would also gain weight.

Or for that matter, based on the hypothesis above, if two men entered into same-sex cohabitation, they would not gain weight. I still think they would gain a few pounds.

[Chimaera182]

[QUOTE=HighLordDave]As an addendum, I wonder if the results would be the same if you studied same-sex partnerships.[/QUOTE]
Oh, I doubt a male couple would gain weight; gay men are Nazis when it comes to body image.

[QUOTE=Fiona]edit: sorry I didn't mean that to come out the way it did. I just object to the way the media concentrate on this kind of thing for women. I get a bit tired of being chivvied[/QUOTE]
Understandable. I've been tired of how everyone concentrates on body image for years. And since it's sooo important women look their best, of course they get focused on intently.

Frankly, I don't see all that much merit in the article. Sure, if a woman moves in with a man (and they're a couple, not just co-habiting or whatever), a woman might gain weight; so might the man. Maybe they've decided, "Oh, I've found someone to spend the rest of my life with, I don't have to work out all the time anymore." After all, if a person is really fastidious in their diet and exercise routine, they're not just going to drop it due to the influence of their SO; they won't just up and change the habits of a lifetime.

[dragon wench]

Beyond the unnecessary focus on women, I guess I'm just having trouble believing the article, period.
It seems... I don't know, there are just so many variables at work when it comes to body weight, and often there many exceptions to the expected as well. Some women, for example, do *not* actually gain weight during pregnancies (nothing beyond what is entirely foetus-related anyway). In fact, I know several women who dramatically lost weight while pregnant, and ended up several sizes smaller postpartum.
Or other people, men and women, have hyper fast metabolisms and can eat highly caloric food while exercising little, and they don't gain a pound.
Stress can have a huge impact as well...either causing binge eating, or an almost complete withdrawal from food.
And, as most people are aware, the type of food consumed makes a difference...

I'm really not sure why co-habitating as a couple should be considered as all that high a factor in weight gain.

And that whole... "Gee, now I've found a life mate so I can eat what I want etc." just strikes me as....odd... and I have trouble relating, I suppose.
Forget about body image and all of that superficial crap; there are very serious health risks associated with obesity. So why endanger yourself just because of a long term relationship? I mean if your spouse is a great cook, or the two of you enjoy cooking together... that is one thing... But to make the conscious decision to no longer care about your health... IMO it is just weird.

[HighLordDave]

[QUOTE=dragon wench]
And that whole... "Gee, now I've found a life mate so I can eat what I want etc." just strikes me as....odd... [/QUOTE]

I don't think it's that people let themselves go (although I know that to be the case for some people), but just eating regularly will cause people to gain weight.

When you're single, you eat when you want to. If you're not hungry, you either eat a package of ramen noodles or pick up a burger/salad/taco/whatever somewhere.

When you get into a steady relationship, assuming that you're on the same schedule, you will probably make time to eat together as a social/domestic activity. Whether you alternate cooking duties or one person does it is irrelevant. You're together and you eat. Not because you're hungry, but because it's 6:00 pm.

I think that has more to do with it than anything else.

[Hill-Shatar]

@DW: My mother lost sixteen pounds have both my twin and I. However, it said repeated pregnancies, and you know that even after one, your body is never quite the same.

I'm really not sure why co-habitating as a couple should be considered as all that high a factor in weight gain.

It certainly isn't for all. In the lab is is usual for people who marry or go into relationships to loose weight. I mentioned before that I did. Before I actually ate my own cooking which I used way to many of my favorite ingredients in, and now I have to compromise some of the dishes I like to make.

[C Elegans]

Haslam DW, James WP. Obesity.
Lancet. 2005 Oct 1;366(9492):1197-209. Review.[/b], you would have found that it contains 122 references to studies of obesity and weight gain, including both genders. You would also have found that the article is a review of disease burden, causes and treatment for obesitas, and that the "couple effect" was mentioned in three lines in this 12-page article. I quote:

The adult phase of weight gain (figure 1) corresponds to a substantial fall in leisure-time sports for men. Women tend to gain weight once they cohabit and begin to share meals with men, who have intrinsically higher energy needs and commonly take more exercise.(72) Oral contraceptives could provide further physiological and social conditions conducive to weight gain; repeated pregnancies certainly do so.(73) The well-documented progressive fall in physical activity with age means that the less effective mechanisms downregulating food intake are under severe strain as energy needs decline. Before major changes occurred in use of cars, mechanical aids, television, and computers in the 1960s to 1980s, the fall in total energy output from age 25 years to 75 years in the Baltimore ageing study(74) amounted in men to 1200 kcal (5·02 MJ) per day.

So the article says that of "lifestyle factors", weight gain in women are more influenced by living in a couple relationship (eating habits, hormonal contraceptives, pregancy) and men are more influenced by decline in exercise. Anecdotal evidence can give examples of the range of variation, but at group level (and in science we have to work at group level and not individual case level, this I am sure you all understand why) the "couple effect" for females are larger and more consistent that than reported for males.

Beyond the unnecessary focus on women, I guess I'm just having trouble believing the article, period.
It seems... I don't know, there are just so many variables at work when it comes to body weight, and often there many exceptions to the expected as well. Some women, for example, do *not* actually gain weight during pregnancies (nothing beyond what is entirely foetus-related anyway). In fact, I know several women who dramatically lost weight while pregnant, and ended up several sizes smaller postpartum.

There are many factors behind weight gain, the review article by Haslam & James go through genetic influence, fetal and childhood nutrition, influence from other disease and social/behavioural factors like individual life-style and factors in society that facilitate overeating.
Body weight, like most other things, are influenced by a lot of factors and that's why large group level studies are needed rather than anecdotal evidence. Claiming that you do not, period, believe in the article because you personally know some women who have not gained weight during cohabitation or pregnancy is analogous to believing that smoking does not cause COL or lung cancer, because you "know some people who smoked all their life and they are 90 years old and healthy".

Humans differ. Individual differences exist in many aspects of human physiology and psychology. In the complex interaction between genes, biology and environment, it would be strange indeed to see 1:1 correlations between anything and anything.

I'm really not sure why co-habitating as a couple should be considered as all that high a factor in weight gain.

I thought Haslam explained that pretty well also in the BBC article? Influence from the male partners larger energy need, eating becomes a social event and therefore you may eat better food and eat out more often, which often means fattier food and larger amount, reduction of exercise, hormonal contraception, pregnancy. He said "Each individual factor for weight gain is serious enough but put them all together and you can get a significant increase".

Overweight has the largest and most expensive burden of disease in the entire Western world, larger than alcohol, smoking, cancer or anything else. It's the 6th most important risk factor contributing to the overall burden of disease worldwide, surpassed by factors like starvation and AIDS!

I quote from Haslem's & James article:

The risks of diabetes, hypertension, and dyslipidaemia increase from a BMI of about 21·0 kg/m2, thereby reducing life expectancy and greatly increasing the health and societal economic burden;5 excess bodyweight is now the sixth most important risk factor contributing to the overall burden of disease worldwide.6

[CM]

Yeah yeah yeah....blame it on men...that is all you women do

[dragon wench]

CE,
I was *not* stating that I disbelieved the article because of personal experience. Perhaps I should have separated those two points into separate paragraphs in order to facillitate your ability to read them.
Moreover, I also stated that part of my scepticism was due to the many variables involved in weight gain. My apologies for the lack of clarity.

@CM.. Well hell yes, of course you men are to blame for everything! I am preparing your personal self-criticism closet as we speak

[Fiona]

[quote="CE]LOL"]

LOL. I didn't. The news article did. Two lines saying some studies show that married couples gain weight does very little to take away from the overwhelming impression of the report that this is a female problem.

The original article does not seem to be available except by subscription, so that is not much help

[dragon wench]

[QUOTE=Fiona]LOL. I didn't. The news article did. Two lines saying some studies show that married couples gain weight does very little to take away from the overwhelming impression of the report that this is a female problem. [/QUOTE]

Indeed, the title alone does so.

Oh good, glad it wasn't just me who had trouble accessing the article.
If it does not infringe on any kind of copyright law, perhaps CE would be so kind as to paste it here for the benefit of us peons? Since she seemingly was able to read it.

IMO, the BBC piece was a very poor extrapolation.

[darkeningfire]

[QUOTE=dragon wench]Does anyone have any further information on this? I just came across the piece and was mildly surprised. I mean, some of this does make sense, but how widespread (er..excuse the pun... ) is it?


Men bad for women's waistlines

A UK obesity expert has analysed why it is that women who move in with their man often put on weight as a result.

Eating man-sized portions and indulging in richer foods and wines can lead to weight gain, a review in The Lancet medical journal says.[/QUOTE]

Hmm. Simple problem. Rule 1: Remove all fat from the varmit before spit-roasting. Rule 2: Drink bourbon (except that foul swill Turkey), not beer. Rule 3: Walk the highway to pick up roadkill. That's good exercise. Rule 4: Don't drink Turkey.

[/QUOTE]When you combine that with going on the contraceptive pill or having babies, a woman's waistline can severely suffer, says author Dr David Haslam. [/QUOTE]

Babies. Breed 'em in an aquarium.

[Xandax]

[QUOTE=CM]Yeah yeah yeah....blame it on men...that is all you women do [/QUOTE]

Which I'd think figure for the fact that expected lifespan for men is lower then for women

[Chimaera182]

[QUOTE=Xandax]Which I'd think figure for the fact that expected lifespan for men is lower then for women [/QUOTE]
Women are to blame for that.

[C Elegans]

I was *not* stating that I disbelieved the article because of personal experience. Perhaps I should have separated those two points into separate paragraphs in order to facillitate your ability to read them.
Moreover, I also stated that part of my scepticism was due to the many variables involved in weight gain. My apologies for the lack of clarity.

I'm sorry if I mistook the anecdotal evidence you presented for personal experience, however, personal experience and anecdotal evidence are equal in their insufficiency when it comes to examining determinant and associated factors of something. Hearsay, personal experience, reading some popular text, "common knowledge" or "common sense" can all give highly biased and skewly selected data. Controlled studies is the only way to analyse what is what.
Furthermore, I don't see a connection between the number of variables determining a phenomenon, and the validity of one of these factors.

Oh good, glad it wasn't just me who had trouble accessing the article.
If it does not infringe on any kind of copyright law, perhaps CE would be so kind as to paste it here for the benefit of us peons?

There is almost always a copyright problem with scientific articles, especially if they are recent, so I can only quote some parts of the article. Otherwise Buck may get the editors, or rather the lawyers, of The Lancet knocking at his door. So I'll post the headers from the article so you get an overview of it's content, and some paragraphs from the parts most relevant for this discussion. My comments are in yellow.

Obesity
Haslam DW, James WP
Lancet. 2005 Oct 1;366(9492):1197-209. Review.

Article Outline

Life expectancy
Disease burden from excess weight in adults
Fat distribution
Hypertension
Coronary artery disease and strokes
Diabetes
Imprinting of metabolic control in fetal life and early childhood
Respiratory effects
Cancers and reproductive abnormalities
Arthritis
Non-alcoholic steatohepatitis
Psychological features of obesity
Weight gain despite good physiological control of intake
Physical inactivity
Changes in daily food intake patterns
Drugs
Assessment and management
Dietary management
Pharmacotherapy and surgery
How are health-care systems going to cope with the obesity epidemic?
Search strategy and selection criteria
References

Hippocrates wrote “Corpulence is not only a disease itself, but the harbinger of others”, recognising that obesity is a medical disorder that also leads to many comorbidities. This association is profoundly important for the affected individuals, but the associated morbidity is also economically damaging for society. The number of deaths per year attributable to obesity is roughly 30 000 in the UK1 and ten times that in the USA,2 where obesity is set to overtake smoking in 2005 as the main preventable cause of illness and premature death.3
WHO4 describes obesity as one of the most blatantly visible, yet most neglected, public-health problems that threatens to overwhelm both more and less developed countries. The problems of overweight and obesity have achieved global recognition only during the past 10 years, in contrast to underweight, malnutrition, and infectious diseases, which have always dominated thinking. WHO now accepts a body-mass index (BMI) of 25•0 kg/m2 or higher as abnormal; the overweight category is classified as obese when the BMI is 30•0 kg/m2 or more. The risks of diabetes, hypertension, and dyslipidaemia increase from a BMI of about 21•0 kg/m2, thereby reducing life expectancy and greatly increasing the health and societal economic burden;5 excess bodyweight is now the sixth most important risk factor contributing to the overall burden of disease worldwide.6
<snip>
this part presents prevalence in different regions
Life expectancy
<snip>

Disease burden from excess weight in adults
<snip>


Fat distribution
<snip>
describes statistics for distribution of the body fat, and goes through mechanisms and causes why obesitas severely increase the risk for development of glucose intolerance, premature type 2 diabetes and inflammatory arterial damage

Hypertension
The risk of hypertension is up to five times higher among obese people than among those of normal weight,29 the variability in response reflecting differential genetic susceptibility as well as dietary factors.
<snip>
describes the relationship between hypertension and obesitas at a molecular level, and at a eating habit-level

Coronary artery disease and strokes
Dyslipidaemia progressively develops as BMI increases from 21 kg/m2 with a rise in proatheromatous, dense, small-particle-sized LDL. This change increases the risk of coronary heart disease by 3•6 times. With low HDL concentrations, as well as high concentrations of triglycerides, CHD risk increases.40
<snip>
describes the relationship between hypertension, cardiovascular disease and obesitas, and present prevalence and relative risk factors

Diabetes
The relation between obesity and type 2 diabetes is so close that Sims and co-workers coined the term “diabesity” in the 1970s, when they showed that in young men with no family history of diabetes who were overfed for 6 months BMI increased to 28•0 kg/m2 and there were reversible rises in fasting concentrations of insulin, glucose, and triglycerides, and impaired glucose tolerance.
<snip>

Imprinting of metabolic control in fetal life and early childhood
<snip>
presents worldwide prevalence of diabetes and ethnic differences associated with eating habits and effect on embryos and children

Respiratory effects
<snip>
describes the relationship between obesitas and sleep disorders related to respiratory problems

Cancers and reproductive abnormalities
Obesity is one of the most important known preventable causes of cancer.
describes the relationship between obesity and various types of cancer, as well as hormone disturbances in obese women that results in decreased fertility and other reproductive problems

Arthritis
<snip>

Non-alcoholic steatohepatitis

The prevalence of non-alcoholic steatohepatitis is increasing rapidly in more developed countries as part of the obesity epidemic. It is set to become one of the most common causes of end-stage liver failure in more developed countries, because it progresses from benign fatty changes to cirrhosis, portal hypertension, and hepatocellular carcinoma.
<snip>

Psychological features of obesity

Obesity was a sign of wealth and wellbeing in the past and still is in many parts of Africa, particularly since the HIV epidemic began. Care is needed to distinguish the social from the pathophysiological consequences of weight gain. In affluent societies and many Asian countries, slenderness is now the ideal, so individuals gaining weight, especially women, feel increasingly unacceptable and become anxious and depressed and can develop obsessive behaviours as they attempt to deal with their excess weight. Discrimination is rampant; obese individuals are less acceptable marriage partners, are handicapped in job promotions, and earn less.67

In US women, obesity increases the risk of being diagnosed with major depression by 37%, whereas obese men have a 37% lower risk of depression than men of normal weight. In men, underweight is associated with significantly higher risks of depression and suicide, although whether the association is causal, or whether depressed men smoke more heavily, for example, is unclear.

Two eating disorders are linked with both depression and obesity: binge eating disorder (a subgroup of bulimia nervosa) and night eating syndrome (panel 1). These disorders affect a substantial proportion of patients attending obesity clinics; recognition of the characteristics is important, because psychological assessment and counselling are essential.

[C Elegans]

part II of the article

Weight gain despite good physiological control of intake

Despite the obesity epidemic, individuals have extraordinarily fine control of their food intake on a weekly if not daily basis. Although there are unpredictable variations in daily intake in response to social events, and smaller fluctuations in energy output from changes in physical activity, body energy stores remain fairly constant. A weight gain of 0•5–1•0 kg in a year amounts to 3500–7000 kcal (14•6–29•3 MJ), implying an error in the regulation of food intake of less than 0•5% of average daily consumption. Subconscious mechanisms, including gastrointestinal hormones, such as ghrelin PYY3–36, gastric inhibitory peptide, and cholecystokinin, and other complex neuroendocrine systems are therefore effective in controlling adjustments to appetite and intake in the short, medium, and long term. These mechanisms are surpassed only by the multi-faceted processes that come into play when people are deprived of food. Those processes enable deliberately overfed young but not older volunteers to return spontaneously to normal bodyweights over a few months.68
In the light of this surprisingly good control of energy balance, why do people become overweight and obese as they become middle aged? Genetic factors are well recognised to influence who gains weight, and the magnitude of weight gain, as shown by overfeeding studies in twins.69 Statistical analyses suggest that 50% or more of the variation between individuals in BMI has a genetic basis,70 but these effects are dominated by polygenic environmental interactions that reflect many genetic influences affecting spontaneous physical activity, twitchiness, basal metabolic rate, propensity to synthesise diurnally lean rather than fat tissues, and appetitive behaviour. Monogenic mutations, of leptin secretion or receptor activity for example, are very rare but single base changes in the gene for the hypothalamic melanocortin receptor, normally involved in appetite suppression, explain about 5% of obesity in children if it is severe early in life.71
These genetic influences cannot explain the population's public-health problem of obesity. The adult phase of weight gain (figure 1) corresponds to a substantial fall in leisure-time sports for men. Women tend to gain weight once they cohabit and begin to share meals with men, who have intrinsically higher energy needs and commonly take more exercise.72 Oral contraceptives could provide further physiological and social conditions conducive to weight gain; repeated pregnancies certainly do so.73 The well-documented progressive fall in physical activity with age means that the less effective mechanisms downregulating food intake are under severe strain as energy needs decline. Before major changes occurred in use of cars, mechanical aids, television, and computers in the 1960s to 1980s, the fall in total energy output from age 25 years to 75 years in the Baltimore ageing study74 amounted in men to 1200 kcal (5•02 MJ) per day. To avoid any gain in body energy would therefore have required a progressive fall in intake of about 270 kcal (1•13 MJ) daily, each decade, throughout adult life. Now the environment is deliberately designed to promote inactivity, even children are sedentary, especially when both parents work and they are confined indoors or at school.
Accompanying the documented secular and age-related declines in physical activity are changes in food habits that might originally have been responses to reduced energy needs. Social historians describe the three or four large meals a day taken by hard-working people, amounting to 3000–4500 kcal (12•5–18•8 MJ) per day to cope with physical demands at work and in the home. As working conditions and household aids apparently improved, meals became smaller; breakfast was omitted or reduced, sandwiches or single, smaller courses were eaten in the middle of the day, and the evening meal became the main meal of the day. In the 1960s and 1970s in more developed countries rates of overweight and obesity were of little immediate concern; however, by 1983 the potential public-health problem of obesity was being highlighted.75 What can explain the huge rise in obesity rates?

Physical inactivity

Many studies have shown the relation between sedentary lifestyle and weight gain, but reliable direct measures of physical activity are only just emerging.76 Nevertheless, the secular decline in physical activity is obvious. Morris and colleagues showed more than 50 years ago77 and 78 that vigorous exercise was crucial to cardiovascular health, but highly sedentary adults now derive benefit from even slight exertion.79 Exercise has many benefits, from psychological to physical, independent of its contribution to weight stability. However, the recent emphasis on weight maintenance has highlighted the importance of total energy output—60–90 min per day of walking,80 10 000 steps monitored on a pedometer, or 15 000 steps in individuals attempting to maintain weight loss. Such activity is difficult nowadays without redesigning cities to necessitate more walking and spontaneous movement. Gyms tend to be attended by more affluent and motivated individuals. Physical activity is helpful in weight loss, and essential for limiting the progressive decline in lean tissues with age, but its main importance in bodyweight is in maintaining rather than increasing a 5–10% weight loss.
Changes in daily food intake patterns

Short-term regulation of food intake is readily overcome by sudden increases in the energy density of food, for example by fat-rich evening meals that allow no compensatory adjustments until the next day.81 Sugar-rich drinks also circumvent the meal-based regulation of appetite.82 Foods with higher energy density—those rich in fats, extracted sugars, and refined starches—are unwittingly consumed in greater amounts, the density rather than the macronutrient content being the determinant of intake.83, 84, 85 and 86 Nevertheless, the urge to eat sugary and salty foods is driven by selective taste buds and neuronal projections to the limbic pleasure centres, and the combination of the fats and sugars, rare and precious in our early evolution, is especially alluring. When displayed in larger portions, the visual impact of food dominates appetitive regulation in adults and children older than about 4 years so they consume more.87 Food companies have long known the commercial benefits of promoting larger portion sizes. Given the fixed energy requirements of a population, the only ways to promote sales involved provision of products with higher content of fats, sugars, and salt, in larger portions, making them available everywhere, and promoting drinking and eating on the move since this distracts the normal appetite regulatory responses.
Eating outside the home also restricts the ability to control the composition and quantity of food. Targeting of children from infancy to generate brand loyalty, which distorts dietary patterns,88 and expansion of sales to the huge potential markets of less developed countries are the only means seen by food companies for maintaining expansion, profits, and shareholder value. Contrary to initial estimates89 that the dominant factor precipitating the obesity epidemic in the UK was a decline in physical activity rather than excessive intake,90 recent evidence from secular trends and obesity rates in 36 countries shows rising intakes.91 Similarly, national studies of BMI of different groups92 show that intake is now the dominant determinant with lower physical activity following, rather than preceding, weight gain in some cases.93 Thus, a decline in activity was probably a particular feature of the 1960s to 1980s, but the transformation of our food habits in response to intense industry competition is now the main amplifier of the epidemic.94

Drugs

An increasing number of drugs are now being documented as causing weight gain (panel 2).95
<snip>


Assessment and management
<snip>
taddresses treatment problems, suggests a program for clinical assessment

Dietary management
<snip>
comment and evaluate dietary factors

Pharmacotherapy and surgery
<snip>
description, effect and evaluation of these two treatment strategies, recommendations of groups of patients where surgery is contraindicated

How are health-care systems going to cope with the obesity epidemic?

No health-service system has yet developed a useful strategy for managing the huge numbers of overweight and obese people in the community. Nursing, dietetic, and physical-activity expertise and collaboration with public and private community slimming groups are needed. The challenge of prevention as well as managing the millions already affected is overwhelming.120 and 121 The challenge to think in novel ways was also emphasised by the new WHO global agreement122 to develop strategies to deal with the burden of cardiovascular disease, cancer, and diabetes now being fuelled by the obesity epidemic.
The medical profession is only now waking up to the political and industrial challenges as well as the medical challenge. The industrial interests, with powers exceeding even those of the tobacco industry, are on the alert and often acting to slow the drive for change, by intense political lobbying at the highest level and by engaging in tactics well rehearsed by the tobacco companies. Our new scientific understanding of obesity is helping to validate a new approach to tackling the problem but the response of the medical profession to both its management and prevention is still at an early stage.

Search strategy and selection criteria
<snip>