Carbohydrates and Obesity
Obesity and diabetes are diseases that are not restricted to national boundaries or culture today. These health threats are universal. In the United Kingdom recent reports put the percentage of men that are either overweight or obese at 67%, and the percentage of overweight or obese women is an estimated 57% (Boseley, 2014). Recent data shows that about one-fourth of the entire population in the United Kingdom is obese (Boseley, 2014). The Global Burden of Disease study reflects that around the globe an estimated 26% of boys and 20% of girls are either overweight or obese, Boseley writes in The Guardian.
The number of overweight and obese people in the world has “surged in the past three decades,” Boseley explains; to put this surge into perspective, about 2.1 billion people on the planet are either overweight or obese — and that is almost a third of the human population. Because of this continuing growth of health-related weight problems, the risks for humans who are overweight or obese are significant: rates of diabetes, heart disease, and cancer are increasing at dangerous levels (Boseley, p. 1). Over one-half of the world’s 671 million obese people live in these ten populous countries (ranked from the largest number to the lease number): U.S., China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia (Boseley, p. 2).
Doctor Christopher Murray, who directs the Institute of Health Metrics and Evaluation in Seattle and who was co-founder of the Global Burden of Disease study claims that over the past three decades “…not one country has achieved success in reducing obesity rates,” and it is expected that the rates will “rise steadily as incomes rise in low-and-middle income countries” (Boseley, p. 1). The UK only “lags behind Iceland” (74% of men and 61% of women are overweight or obese) and Malta (74% and 58% respectively) when it comes to weight problems (Boseley, p. 2).
Purpose of this Research
There is a strong link between the world’s obesity pandemic — and the scourge of Type II diabetes — and the intake of carbohydrates and of high fructose corn syrup. This paper uses scholarly resources to critique and review the treatment and management needed vis-a-vis the problems associated with carbohydrates and with fructose. The research will also put forward what the peer-reviewed research is reporting vis-a-vis carbohydrates and the treatment of diabetes and obesity.
Early Life Impacts — Obesity
In a peer-reviewed editorial in the journal Frontiers in Physiology the authors point out that the “…rapidly changing incidence of obesity cannot be explained in terms of genetic changes” and hence, other answers must be approached (Pico, 2013). In fact what previous studies have shown is that nutritional dynamics “during critical stages of development” do impact a person’s health later in life. And poor nutritional intake on the mother’s part — while the unborn child has no alternative but to use the nutrition from its mother — can and does lead to the possibility of the unborn child suffering from “chronic diseases in adulthood.”
Those diseases include obesity, type II diabetes, cardiovascular disease, and osteoporosis, Pico explains (1). The authors point out that during the critical stages of development undernutrition and over-nutrition can both lead to serious problems later in life; moreover, ironically, malnutrition during prenatal periods can result in obesity for the growing child due to the “catch-up growth” an infant goes through in its early life.
A study referencing how effective a low-carbohydrate diet (low & high-fat) — versus a high-carbohydrate low-fat diet — reports that “…apparently” low-carbohydrate diets have “no advantage over high-carbohydrate low-fat diets” (Demol, et al., 2008). This study was in reference to the high number of children who are obese, because this problem during childhood can produce “metabolic syndrome” along with related conditions (Demol, 346). The problem of obesity in childhood, as has been mentioned earlier in this paper, is very serious; in this article the authors say there is a “70% likelihood of obesity or overweight in adulthood” (Demol, 346).
Interventions to reduce the amount of weight a child is carrying include: a) psychological and family interventions; b) “lifestyle modifications”; c) changes in behavior, more physical activity and diet” (Demol, 346).
The study consisted of 55 obese patients between 12 and 18 years of age. They all had a body mass index (BMI) of greater than “…the 95th percentile for age and gender” (the Centers for Disease Control and Prevention sets the BMI charts) (Demol, 347). The participants in this study were allocated to one of three diet groups:
Group one (low-carbohydrate, low-fat, protein-rich diet containing 1,200 to 1,500 calories daily; 60 g carbohydrates (up to 20%), 30% fats and 50% proteins). Group Two (low-carbohydrate, high-fat diet containing 1,200 to 1,500 calories daily; 60g carbohydrates (up to 20%), 60% fats and 20% proteins). Group Three (High-carbohydrate, low-fat diet containing 1,200 to 1,500 calories a day; 50-60% carbohydrates, 30% fats and 20% proteins) (Demol, 347).
In the Discussion and Conclusions portion of this peer-reviewed research article the authors report that in terms of weight loss there was “no advantage of low-carbohydrate diets over a high-carbohydrate / low-fat diet” (Demol, 349). At the end of the nine-month and at the end of the twelve-month period the findings were “similar”; given that the same caloric amount was included in each of the three groups this is significant for doctors and other healthcare professionals researching weight loss vis-a-vis high-carbohydrate / low fat diet compared with a low-carbohydrate / low-fat and low-carbohydrate high fat diets (Demol, 349).
As an option for obese young people that have not lost weight on high-carbohydrate hypocaloric diets would be to embrace the low-carbohydrate diet without strict caloric limitations, Demol explains on 350.
Maternal Obesity — Impacts on the Child
Recent statistics show that an obese pregnancy has been known to “negatively impact” the future health outcomes of children (Stachowiak, et al., 2013). The research in this article reflected that an obese mother during pregnancy could have a negative impact on the “developmental program of specific fetal brain cell-networks”; the failure of fully healthy fetal brain cell networks suggests the possibility of “some neurological disorders in the offspring at a later age” (Stachowiak, 96). This is a highly technical article based on results in lab tests of high carbohydrate (HC) intake in rats.
The Discussion narrative covers the results of previous studies, which reported that when working with humans, “All HC fetuses (irrespective of gender differences) demonstrated incr4eased body weights gains in the post-weaning period,” and obesity in the adult (later in life) was commonplace. But, the Stachowiak research also posits that an obese pregnancy could also lead to more than obesity; it could lead to “neurological disorders” as well (101). This research article does not suggest a way of treating the child once it is born in regards to slowing down the arrival of child obesity. However, the obvious remedy for this kind of unhealthy result from pregnancy is to perform an intervention on the overweight mother — reducing her intake of carbohydrates — before she is well into her first trimester.
The UK Government Response to Obesity Report
At the top of the list of recommendations (in response to the House of Commons Health Committee Report) by the UK government, is that a “Food Survey” be commissioned with “urgency” in order to accurately reflect the “total calorie intake” of the population. No specific mention of carbohydrates is present in the report, but a “consistent, effective and defined strategy” should be undertaken to find a solution to the obesity problem in the UK. Because there are no “simple, short-term solutions” for preventing or reducing obesity, the strategy should be developed around the following measures: a) launch a campaign on obesity; b) make access to healthy foods easier; c) urge physical exercise for all citizens and improve access to physical activity; d) “restrict the promotion of unhealthy foods to children”; e) boost nutritional information in schools; f) “procurement guidance on food for public bodies”; g) develop a “model for prevention and treatment” of obesity; and h) support training for National Health Service staff.
Reaching the population with useful information is part of the solution, the report emphasizes. Nongovernmental groups like the British Heart Foundation, Cancer Research UK and Age Concern must help promote the idea of healthier living for all citizens, the report continues. The response to the report also asks that industry help by labeling food packaging that helps consumers see the value in certain food products, and the response suggests soccer teams and other pro-sports could help promote positive attitudes about nutrition. Individual sports activities (walking, cycling, and fitness centers) are to be promoted as well.
The UK response to the health report also asks that there be data to identify the “key barriers to choosing a better diet, including environmental factors”; local authorities need to participate in the campaign for healthier available foods in the sense of reducing obesity and the diseases that are linked to obesity.
The drugs / practices involved in treating / preventing diabetes
An article in PLOS ONE, published in 2014, reports that treatment options for Type II over the last several years have included glitazones, glinides and insulin analogues,” and these are drugs that enrich treatment options for doctors (Tamayo, et al., 2014). However, while the drug of choice tends to be metformin (biguanides) when it comes to Type II diabetes, there is not enough known about socioeconomic differences in the history or prescriptions of newer anti-hyperflycemic drugs (Tamayo, 1).
The authors mention a Canadian study — the only one they could find that related to socioeconomics when considering that drugs are given for Type II diabetes — that noted people with higher incomes were able to be treated with thiazolidinediones (TZDs) (2). And it is also true in Germany that while about 90% of the population receives “statutory health insurance” not all doctors will prescribe TZDs because they are more expensive, Tamayo explains. Those with Type II diabetes among 10% of the public in Germany with private health insurance likely will not have a problem paying for TZDs, which in a way is an unfair situation for lower income patients with Type II diabetes.
On the subject of thiazolidinediones in the treatment of “insulin resistance and type II diabetes,” the National Institutes of Health in the U.S. reports that while most patients to eventually experience “reduced responsiveness” to insulin, using thiazolidinediones can help to “enhance the actions of insulin” (Salitiel, et al., 1996). How does this drug actually kick-start the potency of insulin? Salitiel explains that the TZDs actually increase “insulin-dependent glucose disposal” and the TZDs also reduce “hepatic glucose output” (Salitiel, p. 1). Moreover, since this article was published in 1996, it would appear that the TZDs have been around for awhile and the prime reason is they represent a “safe and effective” treatment for Type II diabetes (Salitiel, p. 1).
Treating obesity and Type II diabetes
A 2014 article in the peer-reviewed journal Practice Nurse points out that recently the drug “Victosa” (liraglutide) — in combination with good diet and exercise — has been found to help achieve glycaemic control for the Type II diabetes sufferer (Bostock-Cox, 2014). In the big picture healthcare professionals are trying to reduce the risk of cardiovascular complications, and the use of liraglutide not only treats diabetes, it may have a role in “treating obesity in people without a history of diabetes” (Bostock-Cox, p. 1).
Bostock-Cox reminds readers of what is already well-known — that overweight and obese people are at “…an increased risk of developing type 2 diabetes”; moreover, once a person has been diagnosed with diabetes, and that person is overweight, this increases the risk of “poor control and future complications” (Bostock-Cox, p. 1-2).
What follows in this sentence is the most pertinent, most important passage about prevention of Type II diabetes: “Management of obesity is therefore central to the prevention of diabetes and its complications” (Bostock-Cox, p. 2). Some studies have shown that when a diabetes patient loses significant amounts of weight and lives on a “low calorie diet” (about 600 calories a day) for a period of time may lead to remission of the condition. In addition, even modest weight losses (around 5 to 10% loss of initial weight) have been known to “improve glycaemic control” and to greatly reduce the risk of developing diabetes in the first place (Bostock-Cox, p. 2).
The dangers of weight loss medications
When it comes to weight loss in a person that understands the danger of obesity leading to diabetes, Bostock-Cox explains that many drug options for weight loss have been tried over the years “…but many have been withdrawn from the market due to “unacceptable adverse drug reactions.” One weight loss drug in particular turned out to be a disaster; it was Fen-Phen, which acted as “speed” and was withdrawn from the market because it weakened the major arteries leading in and out of the human heart — and a number of patients died after taking the diet drug.
“Doctors had submitted new data” to the FDA that showed Fen-Phen “…may cause heart valve defects in as many as a third of patients” (Kolata, 1997). The drug seemed at first to be a “magic pill for the national epidemic of obesity,” became very popular as up to six million Americans took the medication (most, but not all, were women, and not all were obese) (Kolata, p. 1).
Meanwhile, the FDA explains that when heart valves are weakened, as Fen-Phen caused in perhaps hundreds of thousands of users, there is a “backflow of blood” which can be severe because it makes the heart work harder leading to heart disease (FDA). The additional danger in the use of Fen-Phen is that the patient seems to have no symptoms albeit a doctor can hear an “abnormal sound as the blood flows over a valve” (that abnormal sound is a “heart murmur”), and if the damage is significant enough, the only remedy is to replace the valves “surgically” (FDA).
Meanwhile, Bostock-Cox suggests that “rimonabant” was used as a diet drug but was taken off the market when it led to “psychiatric side effects such as depression” (p. 2). The only drug used contemporarily that helps people lose weight is “orlistat” and may in time “offer another tool in the armoury against obesity” (Bostock-Cos, p. 2).
Fructose — should the public worry?
According to an article in the peer-reviewed International Journal of Obesity, while some people are obese because of genetic defects or because of “leptin deficiency,” the majority of people who are obese got that way from “highly palatable foods” including those foods that are fat, and from “sweetened beverages” (Bray, 2008). In fact, the increase in obesity over the last 35 years had “paralleled the increasing use of high-fructose corn syrup (HFCS) (Bray, S127). The product is not expensive, and hence it is used in huge quantities because consumers like their beverages sweet, but the sweetness in high-fructose corn syrup “may underlie the relation of obesity to soft drink consumption” (Bray). Hence, for those individuals that would like to take some weight off, or abstain from products that put weight on, avoiding high-fructose corn syrup is a smart choice.
Conclusion
In conclusion, this paper provides recent scholarly information regarding the reasons people are obese — including why unborn children may become obese and suffer from diabetes in their adult lives — and how Type II diabetes relates to obesity. There are no safe diet drugs on the market so the way people can lose weight (even if they have diabetes) is by following carefully crafted diets (low in carbohydrates and fat and high in fruits and vegetables) and getting adequate exercise. Also, part of the reason adults and young people gain weight related to the fructose in soft drinks. The obesity pandemic is not limited to any nation or region, and the information in this paper points to the universality of people who are overweight and/or obese.
Works Cited
Boseley, Sarah. “UK among worst in western Europe for level of overweight and obese people.” The Guardian. Retrieved November 17, 2014, from http://www.theguardian.com. 2014.
Bostock-Cox, Beverley. “Obesity and diabetes: a different perspective.” Practice Nurse,
44.8, 1-5, 2014.
Bray, G.A. ” Fructose: should we worry?.” International Journal of Obesity, vol. 32, S127-
S131, 2008.
Demol, S., Yackovovitch-Gavan, M., Shalitin, S., Nagelberg, N., Gillion-Keren, M., and Phillip, M. “Low-Carbohydrate (low & high-fat) versus high-carbohydrate low-fat diets in the treatment of obesity of adolescents.” Acta Paediatrica, ISSN 0803-5253. 2009.
Food & Drug Administration (FDA). “Questions and Answers about Withdrawal of Fenfluramine (Pondimin) and Dexfenfluramine (Redux).” Retrieved November 17, 2014,
from http://www.fda.gov. 1997.
Kolata, Gina. “How Fen-Phen,, A Diet ‘Miracle,’ Rose and Fell. The New York Times.
Retrieved November 17, 2014, from http://www.nytimes.com. 1997.
Pico, Catalina, and Palou, Andreu. “Perinatal programming of obesity: an introduction to the Topic. Frontiers in Physiology, volume 4. 1-2. 2013.
Stachowiak, Ewa K, Oommen, Saji, Vasu, Vihas T., Srinivasn, Malathi, Stachowaik, Michel,
Gohil, Kishorchandra, and Patel, Mulchand S. “Maternal obesity affects gene expression and Cellular development in fetal brains.” Nutritional Neuroscience, 16.3, 96-103. 2009.
Salitiel, A.R., and Olefsky, J.M. “Thiazolidinediones in the treatment of insulin resistance
and type II diabetes.” PubMed / NCBI. Retrieved November 17, 2014, from http://www.ncbi.nim.nih.gov. 1997.
Tamayo, Teresa, Claessen, Heiner, Ruckert, Ina-Maria, Maier, Werner, Schunk, Michaela,
Meisinger, Christine (and 13 more). “Treatment Pattern of Type 2 Diabetes Differs in Two
German Regions and with Patients’ Socioeconomic Position.” PLOS ONE, 9.6, 1-6. 2014.
UK Government. “Government Response to the Health Select Committee’s Report on Obesity.” Retrieved November 17, 2014, from http://www.publications.parliament.uk. 2004.
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