How to fight against obesity in France today?

Interview of Professor Serge Hercberg, Director of Research at Inserm

Beginning in October 2009, Nicolas Sarkozy created the Commission for the prevention and management of obesity *. Faced with this public health issue, we interviewed Professor Serge Hercberg, forerunner of the famous National Health and Nutrition Program (PNNS). Causes of overweight junk food through advertising in children's programming, he answered our questions.

Is there an epidemic of overweight and obesity in France?

Professor Serge Hercberg, ** Research Director at Inserm and professor of nutrition at the Medical University Paris 13: In France, between 1980 and 2000, we saw significantly increase the frequency of overweight and obesity in the adults and especially among children. Therefore, sometimes called an epidemic. But since What was put in place public health nutrition policy in 2000, there is a favorable situation.

For cons, the incidence of obesity continues to increase among the poorest people ... There is a kind of social disparity, a fracture nutrition in France. This shows that today, we must refocus nutrition policies taking into account the specific economic, social and cultural.

What are the causes of this increase in overweight?

Professor Serge Hercberg: There are multiple factors that may explain this extremely unfavorable evolution of the frequency of overweight and obesity: the evolution of the food supply that offers more and more products, the breakdown of meals, loss of a number of benchmarks concerning food, the increase in consumption of fatty and sugary foods in particular, physical inactivity, lack of physical activity ...

Today, we try to reframe the situation through information and communication to adults, children and even children, but also playing on the food supply.

Finally, let us remember that nutrition is what comes in, food is also what comes out, physical activity. The balance between the two that allows today to fight against overweight and obesity.

But eating well is expensive. How to improve the situation?

Professor Serge Hercberg: On one hand, the Communication aims to provide practical advice, tips and tricks for eating well and not too expensive. On the other hand, it plays on the food supply so that the cheapest products, are of the highest quality nutrition possible.

It also provides practical recommendations. For example, when you say "eat fruits and vegetables" is of course fees if you can do, but canned or frozen. The nutritional quality is the same and cheaper and therefore more accessible.

It also intends to collaborate with industry, particularly in the context of charter commitment. Industrialists have enough leeway today to offer products of excellent gastronomic quality and are a little less bold, a little less sweet and less salty.

The ban on advertising in children's programming may be effective?

Professor Serge Hercberg: The ban on advertising in TV programs for children may not be fully effective measure alone. However, it is completely legitimate to give coherence to all the messages and even essential to have a real public health policy.

It is clear that this type of measure, as often in public health, is fraught with interest, the economic stakes. Therefore lobbying succeeded so far to block the measure, which, inevitably, will emerge.

I think it will be beneficial for everyone and especially for our children, that this is under the form of mandatory regulation.

Eight years after its launch, what is balance PNNS?

Professor Serge Hercberg: We found that there has been progress in some areas, particularly in the consumption of fruit and vegetables. The goal we had set, namely to increase by 25% the percentage of consumers with an adequate intake of fruits and vegetables has been achieved in adults.

Unfortunately, it has not been in childhood and it has not even been in all walks of life ... The balance sheet is relatively mixed, with real progress on the consumption of fruit and vegetables and salt sometimes favorably on some populations but not all. Unfortunately, there is still much work to do.

Director Florence Lemaire, Yamina Saïdj, September 29, 2009

* Chaired by Anne Danne, currently general delegate of the Wyeth Foundation for the health of children and adolescents, the Commission is addressing a genuine public health problem: there are between 13 and 17% of people obese in France. A decision welcomed by the French Society of Public Health, which has 17 priority projects to this Committee, projects that will complement the many actions conducted for several years under the National Health and Nutrition Program (PNNS).

** Professor of Nutrition at the Medical University Paris 13, Prof. Serge Hercberg was flying NutriNet-Health. This study, which aims to recruit 500,000 volunteers over 5 years, is the largest nutritional study ever conducted. It aims to study the eating habits of the French both for better understanding but also and especially to establish clear links between nutrition and health.

How to fight against childhood obesity?

For a child too big, it does not advocate a diet but changing eating habits and other lifestyle ...

If you believe the medical evidence and nutrition surveys, children today have a much lower calorie diet a few decades ago ... and yet they are increasingly likely to be too big.

Childhood obesity

This paradox is only apparent. For an excess weight gain is necessarily linked to an imbalance between revenues (what we eat) and energy expenditure (including those related to physical activity). The average food energy intake may have decreased in children ... although many of them, confectionery and other snacks in addition to the rest of the food! But maybe they eat too compared to their caloric needs. Indeed, they spend less, they spend much time watching TV or playing video games, they walk little, use the elevator ... In short, one or two generations, their physical activity was significantly reduced, and their average energy expenditures have diminished. The result is a significant risk of overweight ... especially if one has a good appetite!
How to prevent obesity in children, or fight against overweight installed?

* First rule: when a child is overweight, do not lose weight ...

Surprising, but logical! For just leave an obese child to continue to grow, ensuring that it does not take the weight (or whatever it takes much), he is gradually returning to an acceptable weight for its size ... And this without ever having to lose weight in itself! Therefore it is important to react early enough in case of excess weight in childhood, to enjoy the dynamics of the organization during this period of growth.

Childhood Obesity

Issues of early detection of obesity

A child whose obesity is diagnosed and treated before puberty sees the risk of being obese in adulthood decrease significantly.

Define an ideal weight is very difficult in children and adolescents, given the important physiological changes in fat mass during growth. For the same reasons, it is difficult to specify a single reference value for obesity.
However, the "rebound corpulence (or adiposity rebound) matches between 1 and 6 years, with weight loss followed by re-increasing girth to 6 years, can identify children at risk in two criteria:

* If the bounce is too corpulent early (before age 6 years), it seems to be predictive of future obesity;
* If the child is fat, or at least at higher weight curves after the rebound of body size, it will be difficult to find a weight "normal".

Since 1995, the Ministry of Health and WHO were incorporated into the Book of Child Health corpulence curve where the measurement of body mass index is shown as a function of the age of the child.

Most obesity settle between 2 and 6 years. Regular measurement and the postponement of the values on this curve are fundamental elements of identification of overweight.
Expert groups recommend that children whose curve crosses stout up the reference curves of Health record, are considered at-risk children and advocate the establishment of medical monitoring.

Given the psychological consequences and risks of discrimination, obese children may enter into a logic of devaluation of the person. At the first signs of overweight or obesity emerging, it is essential to consult a doctor. A U.S. study has highlighted the danger of schemes undertaken and abandoned in a haphazard way by the children themselves.

During adolescence, body and personality are undergoing major changes. The significant increase in fat mass and size of the young leads to increased caloric needs which can lead to slippage and the importance of maintaining a healthy diet and regular physical activity.

Oxidative Stress

Overweight, obesity and oxidative stress (or oxidant), are closely linked.

In "oxidative stress" the word "stress" is not the same meaning as the mental or psychosocial stress, it is an aggression, an oxidation of constituents of our body due to an excess of molecules that are particularly harmful called free radicals that come from the oxygen we breathe to live.
This oxidation alters our proteins, our lipids, sugars and even our DNA, and thus our cells and our cell membranes.
Oxidative stress is implicated in many diseases, and the phenomena of aging.

Food helps develop health problems more prevalent. Overeating and obesity induce an oxidative stress could represent a pathogenic factor leading to insulin resistance, type 2 diabetes and cardiovascular complications.

By itself, oxidative stress is an independent factor of cardiovascular risk, in addition to other risk factors, particularly overweight and obesity.

Dietary advice "antioxidants" based on a diet rich in fruits and vegetables, but also the importance of low GI foods. They join the classic advice of any scheme "slimming".

If the diet prescribed in the supported weight problems are based on calorie restriction, recent studies show the importance of calories "rich" or "dense" calories compared to "poor".

The term "calorie dense" food of those who make more energy are also rich in nutrients especially antioxidants.

Finally, it has been demonstrated very recently as the metabolic syndrome, characterized by an increase in other waist circumference (abdominal obesity), antioxidant defenses of the body was more affected that the syndrome was important.

In the January 10 issue of the Journal of Clinical Investigation, researchers showed in animal mitochondrial dysfunction that does not precede the onset of insulin resistance and seemed in fact the consequence of oxidative stress associated with muscle hyperglycemia and hyperlipidemia. These results, confirmed in vitro in human muscle cells, make oxidative stress a new target to improve the oxidative capacity in muscle of obese patients with type 2 diabetes.

In conclusion, there are many arguments more convincing to associate with the management of obesity and especially the prevention of cardiovascular and metabolic complications an effective fight against oxidative stress.

Respiratory complications

The majority of obese people show alterations of respiratory functions. The accumulation of fat in the ribs and diaphragm abdominal discomfort expansion of the rib cage. This results in a decrease in the volume of the atonement and a drop of oxygen in arterial blood.



Sleep Apnea Syndrome (SAS)

A significant portion of the population snores (50% to 50 years), but only 10% of snorers are sleep apnea. The signs are suggestive:

* A constant tiredness;
* Episodes of falling asleep the day;
* Irritability.

Often associated with snoring, sleep apnea syndrome, or SAS, the cause of heart attacks or strokes, can be detected. The SAS is the most severe complication of chronic snoring.

The significance of the risk posed by SAS and the existence of effective treatments make it essential to diagnose the disease.

The diagnosis is based on a recording of sleep and cardiorespiratory parameters: the poly-somnographie.

It is necessary to decide the treatment to suit each individual case and monitor its effectiveness.

If in doubt, please talk to your doctor. Some clinics or specialized centers allow you to quickly obtain an appointment for an assessment or screening:

Pickwickian syndrome

It affects four times more men than women. The patient falls asleep at any time of day but rather during periods of inactivity or after meals. The name of Pickwick was given in memory of Charles Dickens valet massively obese and cyanotic who fell asleep as soon as his attention was no longer kept awake.

Problems of Obesity

The risk of developing complications is increased by the onset of diseases related to obesity such as:

The non-insulin dependent diabetes mellitus (NIDDM):

60-90% of patients with NIDDM are obese;

Dyslipidemia:

20-30% of obese patients with dyslipidemia cons about 4% in the general population;

The hyperuricemia:

Three times more frequent than in non-obese person, it may in some cases accompanied by manifestations of gout or kidney stones;
Hypertension:

More common in obese young adults (under 40 years), the prevalence of hypertension in obese decreases with age but continues. Blood pressure measures the pressure exerted by the flow of blood in the arteries.
We measure two figures:

* A high value: it corresponds to the systole (rest of the heart muscle),
* A low value: it corresponds to the diastole (contraction of the heart muscle),

It varies, when you are healthy, between 90 and 140 cm of mercury, or as you communicate more frequently: 14 / 9.
When one of these values is greater than these figures, it is called hypertension.
Cardiovascular disorders

* The risk of heart attack: it is multiplied by 1.5 in case of overweight between 10 and 30% and by 2 if overweight is more than 30%;
* Congestive heart failure: it affects primarily the massive obesity;
* Sudden death: Hippocrates once said that "sudden death is more common among those who are naturally fat than in lean";
* The paper clip-embolic accidents: deposition of fatty plaques along the arteries (atherosclerosis) increases the risk of angina pectoris or myocardial infarction. It also leads to phenomena of ischemia (reduced blood flow), which can lead to necrosis of rainfed areas;
* The strokes are also more common in obese patients;
* The venous disorders.

A higher concentration of fat in the blood leads to deposits, which slows blood flow. This can cause pain or problems, the most frequent varicose veins, phlebitis, edema and heavy legs.