Global obesity: It's not a small world after all

ORLANDO, Fla. — It may be a small world, but it's getting bigger.

And bigger. And bigger.

Although Americans have become accustomed to health experts railing about the nation's obesity epidemic, the problem is not confined to American shores.

The world is rapidly becoming a fatter place.

"It's a very different world than it was a while back," said Dr. Barry Popkin, director of the University of North Carolina's Interdisciplinary Obesity Center. "The bulk of the world is fat."

Even the Mediterranean diet isn't stopping Europeans' expanding waistlines. In Italy, 42 percent of adults are overweight and 9 percent are obese, according to the World Health Organization. In France, 41 percent of adults are overweight; 11 percent obese.

So what is causing the fat boom?

Some scientists blame the changes in our diet. In developing countries such as China, lower prices for cooking oil have led to more fried foods. At the same time, food prices are declining, and people around the world are picking up Americans' bad habits: consuming fast food, sodas and other high-calorie snacks and drinks.

"Frankly, it's very hard to work off a Coke," Popkin said.

While the obesity epidemic has exploded, some scientists have been frantically trying to find a drug that will curb appetites. The answer, some say, may be a "drug cocktail," a combination of medications that doctors would prescribe before patients become obese.

In the United States, West Virginia and Mississippi have the nation's highest obesity rates.

You have to exercise

If anyone knows how difficult it is to lose weight, it's Matt Owen. For most of his adult life, Owen, an Orlando, Fla., software developer, has battled his weight.

Three years ago, however, Matt and his wife, Heather, joined Weight Watchers. Through diet and exercise, Matt lost almost 70 pounds. Once at 260 pounds, he now weighs 193.

To keep the weight off, he gave up his usual lunch of a sandwich and cookies and began packing four servings of fruits and vegetables, along with yogurt. Instead of dining out three or four times a week, he and Heather now eat out only once a week.

Matt is also exercising, the one thing many scientists think is the only way to keep off weight. Once an occasional exerciser, Matt now walks three or four nights a week on his treadmill and often goes for a 20-minute walk during his lunch break.

"I think exercise is the real key to keeping it off," said James Hill, a University of Colorado nutrition professor who runs the National Weight Control Registry, which tracks the habits of people who have successfully lost weight and kept it off for more than a year.

"One of the biggest lessons I've learned is that losing weight is a whole different process than keeping it off," Hill said. "We found very little similarity in how they lost weight and a fair amount of similarity in how to keep it off."

Nearly all successful dieters eat a low-fat diet, weigh themselves almost every day, eat breakfast daily and exercise an average of 60 to 90 minutes a day.

Though some experts blame America's obesity problem on soft drinks or the use of high-fructose corn syrup as a sweetener, Hill says the problem goes much deeper.

"I think we've created a culture that encourages overeating and discourages physical activity," Hill said.

If obesity trends continue, researchers at Johns Hopkins University estimate, 75 percent of American adults will be overweight or obese in just eight years, 41 percent will be obese, and nearly 25 percent of children will be overweight or obese.

While the world's girth has grown, a small community of obesity researchers has been trying to understand the complicated network of hormones that seem to trigger overeating.

"One of the problems in obesity research has been that there are so many dead ends," said Dr. Louis J. Aronne, clinical professor of medicine at Cornell University and former president of the Obesity Society, an organization of obesity researchers. "It's a very complex system with many overlapping mechanisms."

The problem, Aronne says, is like an ever-changing puzzle. Whenever scientists think they have found a drug that will block hunger or create a feeling of fullness, the body adapts — and its survival mechanism kicks in. So far, prescription diet drugs have had limited effect, enabling dieters to lose 5 percent to 10 percent of their body weight.

"You do one thing, and your body compensates for that. So that means combination therapies are going to be the way to go," Aronne said.

That's where the drug cocktail comes in.

Linked to 53 diseases

Because obesity has been linked to 53 diseases, including diabetes, heart disease, stroke and cancer, Aronne thinks insurance companies will pay for drugs, rather than pay far more to treat the diseases that obesity causes.

"I'm not suggesting that everybody in the country should be on medication," he said. "I see it as an alternative pathway of helping people who are ill. But it's going to turn out to be a cost-effective way of managing these problems."

Meanwhile, look for governments to take action. It won't be long, Popkin said, before some countries intervene.

"The costs of obesity are huge," Popkin said. "In places like Mexico, Brazil and China, it's too big a part of their budget. It's scaring them."

Can you imagine, asked Hill, what will happen to China, a nation with 1.3 billion people, when diabetes becomes epidemic in that country?

Governments from Scotland to China are already debating how to tackle the issue. China has begun mandatory dance classes. Among other possibilities: taxing sodas and sugary drinks, revamping agricultural subsidies to make fruits and vegetables cheaper, banning junk-food ads on children's television, and demanding equal advertising time for healthy food.

"The steps have to be big, bold, national steps, like taxation and regulation. It needs the same kind of big change that this country took in regards to tobacco, fluoridated water, seat belts," Popkin said. "We're going to have to do things like that. If we do anything less, it will get us nowhere."