The obesity epidemic in the United Kingdom is out of control, and none of the measures being undertaken show signs of halting the problem, let alone reversing the trend. The United States is about 10 years ahead in terms of its obesity problem, and it has an epidemic of type 2 diabetes with obesity levels that are rocketing. Obesity is a global problem—levels are rising all over the world. Moreover, certain ethnic groups seem to be more sensitive than others to the adverse metabolic effects of obesity. For example, high levels of diabetes and related diseases are found in South Asian and Arab populations. Although most of the medical complications and costs of obesity are found in adults, obesity levels are also rising in children in the UK and elsewhere.Limited time to act Obesity can be dealt with using three expensive options: x Treat an almost exponential rise in secondary clinical consequences of obesity x Treat the underlying obesity in a soaring number of people to prevent secondary clinical complications x Reverse the societal and commercial changes of the past 200 years, which have conspired with our genes to make overweight or obesity more normal. Sheaves of evidence based guidelines give advice on the treatment of all the medical consequences of obesity, and an evidence base for identifying and treating obesity is accumulating.
Although the principles of achieving energy balance are known, an evidence base of effective measures for preventing obesity does not exist. The methods of randomised clinical trials are inappropriate, and so some form of continuous improvement methodology is needed. In the United Kingdom, even if preventive measures against obesity were successful immediately (so that not one more person became obese) and people who are obese do not gain weight, there would still be an epidemic of diabetes and its complications within 1020 years. This is because so many young people are already in the clinically “latent” phase of obesity, before the clinical complications present. Treatment of obesity must be prioritised alongside prevention. It will take an unprecedented degree of cooperation between government departments; schools; food, retail, and advertising industries; architects and town planners; and other groups to improve our “toxic” environment. Meanwhile, in their clinics, doctors have to deal with the obesity epidemic one person at a time—a daunting role.