Fat people eat too much ...

What has changed in the West, and in a number of developing countries, is free access to unlimited quantities of high calorie food. The most satisfying hypothesis is that obesity is currently an interaction between susceptibility genes and an environment with unlimited access to calories. There is much we don’t know. Which genes, and what are the environmental interactions? Are particular food types more likely to affect these pathways?

Finally, when we understand all this, are there approaches, most likely pharmacological, to modulating these systems.

Is it likely the solution to the problem in 10 years time will just be specific diets and more exercise? Many think this is unlikely.

Will the solution simply be a series of tablets? Most think this unlikely too.

The solution is likely to involve continuing attempts at dietary restriction, combined with exercise and an appropriate mix of medications. These medications will regulate the function of those genes predisposing to obesity. Will we have these medications within 10 years? Time will tell.

Many have advocated other approaches including; more physical activity training for children, encouraging life long exercise patterns, stricter regulation of food advertising in the media particularly aimed at children, stricter regulation of food outlets, education campaigns, advertising, peer pressure.

Who would argue against some of these sensible approaches? We are all in favour of promoting healthy lifestyles and suggesting people should eat less and exercise more. This approach to lifestyle delivers many important health benefits, and may help slightly overweight people get back to their normal weight. However, it will not cure obesity, no matter how much is spent on advertising.

We should not be too pessimistic however. Can we commence treatment currently? Of course. Appropriate lifestyle and diet, regular exercise, tablets in some, operations in a few. Will these effectively solve the problem? Most do not really believe this.

Fat people do eat too much, otherwise they would lose weight, but there is no point blaming them.