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Dr. Slama: I have two points to make. One I don't know if it is a joke or a philosophical question, and the second one is much more serious. My first point is that if you say that 20 years from now 100% of the people will be fat, then what will be the definition of normal? Will we be normal, or will they be abnormal? Do we say that elephants are too fat? So 20 years from now we will all be normal. My serious question is that I read in the newspaper that for the first time in the history the increase in life expectancy is leveling off and even now slightly decreasing. Might it be that we are now paying the price for our very recent lifestyle?
Dr. Foreyt: I will answer your second question first. That came out of a paper just published by Olshansky et al.  in the New England Journal of Medicine. What they did was take all the data and show that this extended life expectancy is starting to level off, and they think now it is going to start decreasing because of obesity. They particularly show data, especially in children who are developing adult risk factors earlier and earlier, that this generation of children will die before their parents do. So according to Olshansky et al. this extending lifestyle is ending. Regarding your first point about 100% of Americans being obese or overweight by 2040; as you know obesity itself is excess body fat not weight. So the body mass index doesn't fit for everybody, but the average man in the United States has about 20% body fat, the average woman has about 25% body fat. With a body mass index of 30 a woman has about 37% body fat, and a man has about 25% body fat. So that equates very well if we look at body fat in men and women and look at that with respect to when this is going to happen, and it looks as though it is going to happen by 2040 in all of us in the United States, but all the other countries are catching up quickly. That curve is not starting to level off yet in any of the countries. The International Obesity Task Force data show that the lines are going up in all countries. I have not yet seen a country where it is leveling off or going down; not pessimistic, realistic.
Dr. Eshki: I want to make a recommendation. When looking at diseases in the past century, we see that the major killers, such as heart disease, cancer, stroke, and diabetes, are on the rise. Yet there is a lot of money being spent on research and health care. Looking at the preceding theory which focuses on the predisposing, reinforcing and enabling factors, I see the enabling factors as a major player when fighting this battle. Health professionals and the public seem to be fighting this battle alone. The government and industrial sectors seem to be watching this battle take place and don't seem to know that their intervention would make a difference. For instance, in Saudi Arabia there is a city called Medina where the governor issued a law banning smoking there. Furthermore, there are billboards in the streets around the city which are intended to educate the public about the dangers of smoking. As a result of this in the past 2 years health professionals have witnessed a dramatic reduction in the prevalence of lung cancer. So do you think the other two sectors should join the battle or should we continue to spend more money and lives, and hope for a happy ending?
Dr. Foreyt: That is a great question and it is being debated over and over; at every meeting I go to that is the major focus of the meeting. I think it has to do with personal responsibility. There is a role for communities, a role for local governments, and there is a role for the federal government. What that role should be is being debated now. But ultimately it has got to do with each individual; we all have to play a part.
1 Olshansky SJ, Passaro DJ, Hershow RC, et al: A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005;352:1138-1145.
Bantle JP, Slama G (eds): Nutritional Management of Diabetes Mellitus and Dysmetabolic Syndrome. Nestlé Nutr Workshop Ser Clin Perform Program, vol 11, pp 207-218, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2006.
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