Obesity : "Awareness Creates Concern."

From New York University's Medical School, Bhama Ramkhelawon responded to DiscovHER's questions on obesity. This young promising scientist from Mauritius points out the lack of public awareness of health issues linked to obesity.

A major risk factor for both cardiovascular disease and diabetes, which cause at least 2.8 million deaths annually, obesity was once a problem only in high income countries but is now dramatically on the rise in medium- and low-income countries around the world. Bhama Ramkhelawon’s research aims to solve the mystery of precisely how dysfunctional immune reactions in obese patients trigger these widespread and often fatal illnesses.

DiscovHER : You work on the malfunctions of immune response in obese patients. What are the factors at the origin of this pathology? Genetics, malnutrition?

Bhama Ramkhelawon: A lack of "energy balance" most often causes overweight and obesity. Energy balance means that your energy intake obtained from calories from food consumption equals the energy output your body uses to maintain vital functions as well as to perform physical activities. Obesity develops over time when this energy equilibrium tends either towards an excess of “in” and/or a lack of “out”. An inactive lifestyle and poor eating habits such as oversized food portions, lack of healthy natural products, excessive food advertising can also increase the propensity to develop obesity. People suffering from a medical condition such as lack of thyroid hormone production can slow down metabolism and promote weight gain. Moreover, old age, which is associated with muscular mass loss, pregnancy, lack of sleep and quitting smoking are amongst other factors that can influence weight gain. Obesity also tends to run in families and, as such, some genes responsible for excessive body fat accumulation have been identified.

D/H: Do treatments exist today for obese people? Do methods exist for anticipating and preventing this disease in children?

BR : Lifestyle changes focused on eating habits and physical activity are the keys to combattng obesity. Measures should be adopted in order to maintain the balance between the energy intake and energy expenditure by cutting back on calorie-rich food at the expense of healthy fat-free, protein-rich fruits and vegetables in your diet. Performing routine physical activity will supplement the energy expenditure and re-establish the balance. Obese people who have successfully reduced their weight find it a challenge to maintain their weight loss over time. The strategy is to adopt the new lifestyle changes as a new way of life and to lose weight slowly.

In extreme cases of obesity, when other behavioral attempts have failed, people can undergo either a gastroplasty or a gastric bypass, which limits food intake and calorie absorption by the body.

Obese or overweight children tend to have overweight parents and are more likely to become obese as adults. Nutrition classes explaining better eating habits and promoting physical activities should be included the school programs. Parents should be made aware of the deleterious consequences of obesity in children and address them appropriately.

D/H: What are the dangers of obesity for health?

BR: Many health problems are associated with obesity. Overweight people have a higher risk of coronary heart diseases such as heart attacks, strokes and heart failure. They are predisposed to develop type 2 diabetes and hypertension. In some cases, colon cancers, knee and hip joint problems, gallstones as well as reproductive problems are observed more frequently in obese people.

D/H : To what extent could your research project on netrin-1 develop new innovative and effective treatments?

BR: Emerging studies on obesity and on its associated complications tend to show that there is a better correlation between the level of inflammation in the adipose tissue and insulin tolerance rather than the BMI (body mass index, indicative of metabolic status) itself. Although we now better understand and have identified putative factors that are implicated in the homing of these immune cells in the adipose tissue, why they persist within the highly lipidic environment is still a mystery. We have identified that the protein Netrin-1 is responsible for the defective resolution of inflammation in obesity. This novel finding will allow better drug design to combat inflammation in obesity. Our discovery will allow optimized drug strategies targeting a new angle of the disease characterized by the defective resolution of inflammation in the setting of obesity.

D/H: Obesity is becoming a public health problem around the world. What are your recommendations to defuse this trend?

BR: I believe that media should participate more in disseminating the detrimental effects on health such as coronary heart disease/stroke, hypertension, type 2 diabetes, colon cancer, gallstones, reproductive problems amongst others associated with obesity. Nutrition and physical activity classes should be a must in school curriculums.

D/H: The pursuit of your research has led you to work in several countries: Mauritius, France, and now in the United States at the New York University. What is your outlook on the diversity of this disease from one country to another?

BR: I observed a common detrimental impact of obesity in these countries primarily due to lifestyle and lack of physical exercise. In the industrialized societies, there are many “hidden” sugars and harmful modified types of fat in the food we consume. Our body was not used to digest these modified substances. Mauritius, although considered an island paradise rich in seafood resources and benefiting from a optimal climate for vegetables and fruits, has unfortunately one of the most important incidences of diabetes in the world mostly due to sedentary lifestyle and consumption of calorie-rich foods. In France and the USA, there is a real discrepancy in the propensity of obesity depending on the location. In the modernized cities, obesity is scarce probably due to the importance of maintaining a good physical presence as opposed to rural/underdeveloped areas where obesity is more visible.

As a general observation, I would say awareness creates concern.

D/H: Are women more affected than men by obesity?

BR: Both women and men of are susceptible to developing obesity. However, women tend to be protected due to their hormones before menopause. Weight differences between genders vary between age groups and often among racial or ethnic groups and differ in different regions of the world. Different strategies should be adopted at different ages and stages of obesity to limit its complications.

Bhama Ramkhelawon is a postdoctoral researcher at the New York University School of Medicine (USA). She received a research fellowship from L'Oréal-UNESCO For Women in Science program. 

For Women in Science

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