Читать книгу Clinical Obesity in Adults and Children - Группа авторов - Страница 15

W. Philip T. James1 and Tim Gill2

¹ Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

² Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia

Obesity is a complex condition and, although much remains to be elucidated, our understanding of the many facets of overweight and obesity has advanced greatly over the last few decades. Current research is often focussed on the genetic and molecular patho‐physiological drivers which derange energy balance and lead to excess body fat, but it is important that clinicians have an appreciation of the history and context of these findings and an awareness of the significant challenges created by the different features of obesity that continue to be revealed. Different patterns of obesity emerging across the world may also have different impacts on the public health burden and may require a different approach to the development of prevention and treatment strategies.

The condition of obesity has been recognized for millennia, and its historical context was described in detail by George Bray [1], who highlighted the representation of obesity in images and figurines produced in Europe about 23,000–25,000 years ago. These ancient individuals may well have had a severe form of genetic obesity, and Bray suggests that they may have been considered deities – this would not have seemed unreasonable in societies constantly striving to avoid food shortages. This predicament might still have applied to the general population in the early agricultural period 5000–6000 years BC in Mesopotamia and later in Egypt, but by then, with greater food availability, obesity was particularly seen in the ruling classes. However, Bray points out that by then, obesity was considered objectionable rather than reflecting a remarkable and unusual status akin to that of a deity. These individuals most likely suffered from not only the common problems of backache and arthritis but also the impact of comorbidities such as diabetes. Chinese and Indian medicine also dealt with obesity as a problem condition, and the particular propensities for Asians and the people of the Middle East to display ill health on weight gain are discussed later. Further on the Roman Galen distinguished between “moderate” and “immoderate” obesity, so in a European rather than an Asian or Middle Eastern context, there may have been a sizable number of overweight individuals with few complications, whereas others were handicapped by their adiposity without this automatically being a reflection of the degree of obesity.

In this ancient literature, it was clear that obesity was considered a clinically unusual event, and so it is little wonder that the original classification of diseases being steadily developed in France during the 19th century included obesity along with other clearly identified clinical abnormalities, some of which were only really apparent on postmortem examination. This classification of diseases was taken over by the World Health Organization (WHO) on its formation in 1948, so in practice, WHO recognized obesity as a disease entity from its inception. However, at this stage, WHO’s primary focus was public health with a heavy emphasis on the poorer countries of the world at a time when obesity was not a problem in lower‐income countries.