Obesity is a global public health problem, what regarding France?
A. F. : Between 1997 and 2012, the Roche laboratory funded obesity monitoring with a survey every three years. It was important to take stock of the evolution of this disease. In 2020, with 9,598 participants over the age of 18, a new survey was conducted. We find that 30.3% of people are overweight, that is to say a body mass index (or BMI, which is equal to the weight in kilograms divided by the height in meters squared) between 25 and 30 Obesity, with a BMI > 30, affects 17% of respondents.
While the proportion of overweight people has remained stable since 2012, obesity is on the rise. It was 8.5% in 1997 and 15% in 2012. Almost all age groups are affected. It should be noted that among 18-24 year olds, it rose from 2.1% to 9.2% between 1997 and 2020.
How to explain this evolution ?
A. F. : Our lifestyles have changed considerably, particularly in terms of food and physical activity. We are much more sedentary and we spend a significant amount of time in front of screens. We also note that obesity affects more strongly the underprivileged social strata, probably once once more because the most affordable food is of lower quality. If diet and physical activity are two important factors, there are many other dimensions. This problem is multifactorial.
K. C. : Indeed, obesity is a very complex disease and it cannot be reduced to “eating too much and not exercising”. This simplistic summary is harmful. It has a stigmatizing effect for people who suffer from it. To the list of causes of this pathology, we can add stress, not getting enough sleep, being exposed to pollutants, including endocrine disruptors. There are also genetic factors that we are beginning to understand well.
What are the risks of obesity?
A. F. : Obesity is associated with many comorbidities and high mortality. There is an increase in the risks of cardiovascular disease, diabetes or certain forms of cancer (colon, breast, etc.).
What regarding treatments?
K. C. : The answer is multiple and must be adapted to the patient. In any case, the cooperation of several caregivers is often beneficial; nutritionists, dieticians, sports coaches and sometimes psychologists. For the most severe cases, there is bariatric surgery (which changes the anatomy of the digestive system). But we have been without a drug solution for a long time. It’s changing.
In the 1960s and 1970s and until the mid-1990s, certain molecules were used. They targeted the serotonin or dopamine pathway in the brain, influencing the feeling of hunger or the reward circuitry. But these approaches had serious side effects, cardiovascular or neuropsychiatric.
In the late 1990s, researchers using the gut hormone GLP1 to treat diabetes found that it had other interesting effects that led to weight loss. Since then, treatments, by weekly injection, have been put on the market. A weight loss of up to 10% is observed in one year. Other treatments are in the test phase where a GLP1 type molecule is combined with other hormones. Data suggests weight loss can be as high as 20%. It is good news to see the arrival of different therapeutic approaches. It should be emphasized that these treatments involve monitoring and it is imperative to properly train caregivers in these new approaches.
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