Day 3 of ICO: The Future of Obesity Epidemiology, and the Future as Life Course Interventions

Opening Plenary

 

Dr. Anna Peeters accepted her award with a talk on her winding path, imbued with a love of ideas, an ongoing desire to make a positive contribution, and shared enthusiasm with her colleagues. She gained from her early work at Monash University the value of non-traditional backgrounds and approaches. This took her to the Erasmus Medical Center in the Netherlands, where she did a post-doc learning more about cardiovascular disease treatment, prevention, and mortality, eventually leading her to obesity. She learned here the value of a creative, supportive environment that encourages critical thinking. She there thought to apply the techniques of measuring life expectancy with cardiovascular disease to obesity. To do this she used the well-known Framingham Heart Study, translating relative risk predicated on BMI to life expectancy differences. She realized at this point that the enjoyed working on tools that can inform public health, integrating health risks associated with obesity, population distribution trends, equity implications, and health benefits associated with intervention. All of this led her to work on “obesity duration,” providing a rationale for early intervention approaches. She then spoke about the complexities of setting population targets for obesity prevention, noting that even optimistic projections fail to reach 2005 obesity prevalence by 2025. All of this is to say, Dr. Peeters argues, that we need to think about how we define success. With a nod to the future, she sees obesity epidemiology moving in the direction of bringing inequalities to the fore, developing a greater understanding of the combined effect of interventions, and building a more sophisticated view of evidence.

 

Afternoon Plenary

 

Professor Mark Hanson of the University of Southampton begin his talk asking and answering a question on the minds of many conference attendees: “Why are we losing the war against obesity? Because we intervene too late.” He proceeded to characterize the current vogue in obesity thinking: large agreement on the etiological roles of genetics and lifestyle, combined with the immovability of genetic traits, builds a preemptive consensus for lifestyle intervention. It is the lifestyle intervention, Professor Hanson argues, that leads to the unnecessary guilting of individuals, and later on, exasperated calls for drugs and surgery. He then provides an alternative paradigm, one that move beyond the genotype and lifestyle to consider the role of epigenetics. This paradigm, known as the “life course” approach recognizes that risk increases exponential through the progression of life. In some emerging cases, he demonstrated findings suggesting that more than 70% of the variably methylated regions (VMRs) in one gene associated with later adiposity could be attributable to genotype-perinatal environment interactions. What this means is that interventions can target the pre-conception period and display their efficacy within five years. Professor Hanson himself is collaborating on a project (Jom Mama) with the Malaysian Ministry of Healthy and other academic and industry partners to provide health promotion services to newly married couples soon to conceive their first child. Adding to the lifestyle, pharmacological, and surgical options for obesity intervention, the life course approach offers a compelling set of tools.