Arab Food Pyramid

When we think of the global obesity epidemic, we tend to conjour up images of of US-Americans, literally hefting along excess pounds as they go about their lives across America. We may also recall that Canada and most other Western countries have a problem.

But, interestingly, nowhere is the obesity problem as big as in the countries of the Gulf Region and the Middle East (exceeded perhaps only by populations on remote Oceanic islands).

According to the United Arab Emirates global school-based student health survey (GSHS) 2005 fact sheet, over 30% of 13-15 year olds exceed the 85th percentile for body weights. The adult population (though it is hard to find accurate statistics) apparently does not fare much better.

Why, you may wonder, am I interested in this?

Because tonight I am heading out from Munich to speak on Saturday at the 1st International Abu Dhabi Diabetes Conference, in the United Arab Emirates.

Although the conference focusses on diabetes, it is obvious that the prime driver of the diabetes epidemic in that region of the world (as elsewhere) is the obesity crisis.

It is therefore not surprising that the organisers have opted to include sessions on obesity assessment and management (although most of the conference of course focusses on diabetes management, which I have often described as “palliative care”).

As should be obvious to anyone who has recently visited the UAE, population-based prevention measures in a society that spends most of its time indoors (I would too when it’s 40-50 degrees C outside) and enjoys food as one of the only officially endorsed “vices” (there are tough restrictions on alcohol, gambling and other worldly “pleasures”), is lilkely to be challenging if not simply impossible.

Given that the Arab susceptibility to obesity appears similar to other Asians in that they appear more prone to abdominal obesity with all its dire metabolic consequences, diabetes may in fact be the least of their worries.

I look forward to attending the meeting and learning more about the Arab “diabesity” epidemic from my friends and colleagues in the Emirates.

AMS
Munich, Germany

Today, I am attending the 8th World Congress on Trauma, Shock, Inflammation and Sepsis in Munich, Germany.

Interestingly, this conference features a whole series of seminars on the interdisciplinary management of obesity (under the rather unfortunate title ‘Fat Man – We Will Help You’ [sic]).

I have been invited to chair and speak at the session on medical therapy, but there are also sessions on adipose tissue biology, perioperative management, bariatric surgical procedures, and the emergency management of bariatric patients.

As I often say in my presentations to colleagues: it does not matter what discipline in medicine you practice – you will be seeing an increasing number of heavier patients with their own issues and complications.

The fact that a world conference on trauma should devote this much time to sessions on obesity assessment and management is clearly to be commended in the light of the global obesity epidemic.

The more all health professionals learn and understand the complexities and problems posed by heavier patients, the better we can serve this particularly vulnerable patient population.

AMS
Munich, Germany

Richard Lehner

New findings published by University of Alberta researchers in a recent issue of Cell Metabolism may point to a new pharmacological target for reducing fat and blood sugar levels in blood while also positively affecting energy expenditure (at least in mice).

The research team, led by Richard Lehner (picture), showed that genetically knocking out an enzyme called TGH (triacylglycerol hydrolase), which is normally involved in helping the liver (and other tissues) process fat, not only reduces blood fat levels but also improves insulin sensitivity and glucose tolerance.

Interestingly, the animals were also better able to utilize glucose and, despite consuming significantly more energy, they displayed increased locomotor activity and consequently did not gain weight.

As always, such studies in mice must be taken with a grain of salt in that there is usually a long way to go before (if at all) these findings pan out in new treatments for humans.

On the other hand, these studies do demonstrate the potential of TGH as a therapeutic target for lowering blood lipid levels and possibly body weight through a novel pathway.

AMS
Munich, Germany

In medical school I learnt that we have four senses of taste: sweet, sour, salty, and bitter.

Several years ago a fifth sense, umami, was officially added to this list. Umami is stimulated by glutamate (as in MSG) and apparently allows us to taste protein (as in meat, sea food, or cheese).

Now, Jessica Stewart and colleagues from Deakin University in Australia show that a sixth sense, i.e. the ability to orally “sense” the fat content of foods may explain differences in fat preferences (British Journal of Nutrition).

Indeed, previous studies in animals have suggested that oral hypersensitivity to fatty acids (the building blocks of fat) are associated with decreased fat intake and body weight.

In the current study, the investigators first examined the taste thresholds for different types of fatty acids (olate, linolate, and laurate) in 31 normal weight subjects and classified them as hypo- or hypersensitive. Subjects also completed a fat ranking task using custard containing varying amounts (0, 2, 6 and 10 %) of fat.

Hypersensitive subjects reported lower energy and fat intakes, had an increased ability to rank the custards based on fat content and also had a lower BMI levels.

These data suggest that the increased ability to detect nutritional fat may result in lower energy and fat intake, which in turn may result in lower body weights.

Obviously, the idea here is that people who are less sensitive to fat are likely to need more fat in their foods to get that same level of enjoyment as people with more sensitive fat receptors. Because of fat’s high caloric content, this means that they may in the end also end up with more calories, and thus, weight gain.

I can think of a number of interesting questions that these findings may prompt:

1) Is the increased ability to taste fat genetic or are changes in fat-sensitivity determined by habitual fat intake (gustatory plasticity)?

2) Does weight loss affect people’s ability to taste fat (resulting in them searching out fattier foods when on a diet)?

3) Does going on a low fat-diet increase fat sensitivity thereby allowing people to get the same pleasure out of low-fat foods?

4) Can we develop artificial compounds that can stimulate the fat receptors thereby mimicking a higher fat content of foods (like we do with artificial sweeteners)?

Lots of interesting questions, which may not only explain why some people derive more pleasure from fatty foods than others but also open new possibilities for the food industry to manipulate the taste of foods (hopefully to our benefit).

I’d love to hear from my readers regarding their thoughts on “tasting” fat.

AMS
Edmonton, Alberta