ICO president interview

Interview with Prof Bernard Guy-Grand

President of the 8th International Congress on Obesity

Paris-CNIT Convention Centre August 29th - September 3rd 1998-07-23

1 - What have been the most striking developments since the last congress four years ago?

The obesity field has developed considerably and there have been a number of discoveries of major importance. Even if they have not produced immediate practical results, we do hope that this greater understanding will result in improvements in treatment.

The discovery of leptin. A newly identified hormone secreted by adipose tissue that informs the brain of the amount of fat stored. It represents a major link that was previously unknown. It is part of the mechanism which controls the amount of fat stored by its effect on food intake and energy expenditure. Its absence, or in rare cases the absence of its receptor, may provoke severe obesity with eating disorders and pituitary hormone deficits.

It is still too soon to know if leptin will be for obesity what insulin is for diabetes. The results of experiments in leptin therapy will be presented at the congress, but a lot remains to be done to understand the function of leptin in normal people and the role it plays in weight gain.

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Genetic research. If it has not allowed us to find the very hypothetical "obesity gene" yet, research has identified a number of predisposing genetic factors. It has confirmed the importance of genetic predisposition (one cannot control obesity at will!) and their diversity (obesity is multifactorial). It is possible that in the future different types of obesity may be identified according to their genetic characteristics and this will lead to new diagnostic tools, which will allow new individualised therapeutic strategies to be established. We also believe this research is helping to decrease the guilt of a number of obese people and the stigma of obesity.

Together with the progress made in fundamental research, and partly thanks to it, obesity is gaining more and more attention in the scientific community. A lot has been learned about its clinical aspects. Well designed epidemiological studies have appeared, including several in France, where the proportion of obese (BMI>30) in the population is ranging from five to 18 per cent depending on regional factors, age, sex and social class. These studies have confirmed the increase in occurrence of obesity that is becoming a real public health problem everywhere in the world. The complications and risks linked to obesity, as well as the forms of obesity which pose greater risks, and the way of recognizing them are better identified now even if there is still debate. Similarly as the mechanisms of resistance of the body to weight loss are becoming better known, most of the therapeutic objectives have been rethought. In particular the concept of an "ideal body weight" has been abandoned.

Particular emphasis should be placed upon prevention of weight gain (whatever the weight of the subject). That is nowadays closely linked to maintaining an adequate level of physical activity, and a healthy diet in terms of quantity, quality and pattern.

2 What are the main themes to be discussed at the ICO 98 and what can we learn from them?

At this congress the main themes will emerge from the discoveries I have already mentioned which will be examined in detail with the presentation of results from the latest studies. Different therapeutic approaches will be compared, but this is a difficult subject. Psychological and social aspects of obesity will also be discussed.

A particularly outstanding moment will be the discussions on the World Health Organization report "Obesity; preventing and managing the global epidemic", which illustrates how ideas in the obesity field have developed. This report is an event in itself as it is the first complete report on that subject written by this international body. The report is based on the synthesis done by the International Obesity Task Force (IOTF), which brings together specialists from all over the world on behalf of the International Association for the Study of Obesity (IASO). This congress is the official IASO congress.

During the congress a joint recommendation will be made by the Association Francaise pour 'Etude et la Recherche sur l'Obesité, the Societé de Nutrition et de Diététique de Langue Francaise, and the Association de Langue Francaise pour l'Etude du Diabète et des Maladies Métaboliques, for the diagnosis, prevention and treatment of obesity adapted for the French situtation. It will show how the entire health professional community as well as the educational and industrial world, and the population as a whole should be concerned.

The development of new treatments will also be mentioned. Their effect, and what can be expected from them (certainly not "miracles"), their potential contra-indications and indications, mainly long-term ones, will be presented, especially by the pharmaceutical firms that have discovered them and the experts who have tested them. Some directions for the future will also be examined.

3 In many countries overweight and obesity are becoming a more critical problem. Is this due to a failure of medicine?

Medical science should have had more clear ideas on this subject and should not have taken so long a time before to start dealing with the problem seriously. On the other hand, medicine cannot be expected to have an answer for everything. The scientific aspects of obesity must not overshadow the role of modern society and lifestyles nor indeed individual responsibility. The major concern on a population level is general prevention of weight gain. Indeed medical science is getting better at identifying the mechanisms of individual predisposition as well as the situations which put people are risk. It is improving treatments and eventually may be able to provide biological and bio-technological solutions.

Part of the answer however - and probably the most important one t present - depends upon on the modification of lifestyle that in many respects flies in the face of economic and social development models (which paradoxically promote slenderness as an ideal). It isn't by chance that the prevalence of obesity is increasing more rapidly in countries in which lifestyles are being "modernised" most quickly. Escalators, cars, television, food advertising in children's programmes....have nothing to do with medicine, but are a public health concern.

On the other hand, it is imperative to differentiate obesity from cosmetics. In many respects it must be considered as a disease (even if this does not apply to all cases) and this involved efforts of research, teaching and a suitable attitude towards caring.

4 Without speaking of an "ideal" plan for prevention and treatment, are there some exemplary leads which may serve as models for care?

A thorough scientific reflection on this was undertaken at the time of the drafting of the IOTF and WHO report. It seems that no country has succeeded yet in establishing a system of prevention and treatment which nears the ideal, and the prevalence of obesity is growing almost everywhere in the world. On the other hand, each country has its own care system and cultural traditions concerning health and dietary habits.

So it is a question of adapting policies and practices to each country's context in order to promote a healthier diet and an increase in physical activity. But, amongst other plans, this will happen by a policy of training, starting with health care professionals (doctors, nurses, dieticians etc) by the introduction of nutrition courses in schools (as in Canada), by the creation of therapeutic networks at the primary care level (as is happening in Sweden or in certain East European countries), by the assumption of payment of costs associated with the treatment of obesity (which occurs only partially in France), by the encouragement of physical exercise (for example the role of the bicycle in the Netherlands).

None of these actions taken in isolation has any chance of being effective. What is required is a co-ordinated, multi-pronged campaign against what has become a world-wide pandemic.

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