Peter Gluckman - Fat, Fate, and Disease: Why exercise and diet are not enough

FAT, FATE, AND DISEASE

Why exercise and diet are not enough

PETER GLUCKMAN & MARK HANSON

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Peter Gluckman and Mark Hanson 2012

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First published 2012

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Our professional lives have been occupied with the study of development in early life, both before and after birth, and of how different patterns of development affect our health in both the short and the long term. Our research has focused not just on the mechanisms underlying these relationships, but also on the larger question of why our early development is so plastic. The implications of this research for understanding the human condition are substantial. As our research progressed, we thought increasingly about the mismatch between the way evolution has moulded our biology and the world we have created. Our fundamental biology appears to be at odds with our contemporary world. Although both are parts of our normal lives, they have consequences which are reflected in the growing burden of the so-called non-communicable diseasesespecially diabetes, cardiovascular disease, and the associated condition of obesity.

As we talked these ideas over, we realized that they were not widely appreciated, and were not incorporated into current strategies to reduce the burden of non-communicable diseases. In fact the reverse seemed to be truethe relevance of early developmental life to the risk of later disease seemed to be side-lined, just as developmental biology had been in biological and medical science for much of the 20th century. In addition, despite the fact that current strategies to reduce non-communicable disease met with limited success in many situations, there appeared to be a stubborn adherence to an inappropriate medical model of these diseases, as if we were viewing them in the same way as infectious diseases. The strategy seemed to be directed at treating those adults who already have the diseaseat least in societies where such treatment can be affordedand trying to isolate individuals from the causative agents, namely smoking, dietary sugar, salt and fat, and sedentary behaviour.

For despite all the efforts of public health and of medical science to promote healthy lifestyles, the problems of diabetes, heart disease, and obesity continue to grow. Similar trends exist for some allergic and immune disorders and lung disease. The Western world gets fatter and the diet industry richer. And now the problem is exploding in the developing world toothere are hundreds of millions of people who now have diabetes or heart disease, even though many of them are not obese by Western standards. Many of them are young adults, although traditionally these are diseases of middle age. But it is also apparent, as we look at developing countries, that the solution requires attention from not just a medical perspective but a much broader developmental agenda. The more we thought about this, the more we realized that clearly something is missing from our strategy, because we are not winning the war against these diseases.

We started to communicate our concerns about this omission in lectures at conferences and in academic articles. Some of our scientific colleagues welcomed the intercession, others seemed uninterested or even resistant. The more we pursued the implications of the ideas, the more we felt the presence of vested interests in various forms, which operated to limit their inclusion in current strategy formation. What seemed increasingly obvious to us was sometimes met with denial as well as incomprehension. We began to feel like the little boy who cried The emperor has no clothes! His statement of what everyone knew but did not want to admit produced a social change, although not so much through a direct effect on the emperors deceitful courtiers as from the public reaction which followed his outburst. This book is our cry.

Given the many years and the multiple dimensions of our research, there are many people who have wittingly or unwittingly influenced our thinking. Many of them encouraged us in pursuing what was clearly an unpopular set of ideas. First we must acknowledge the colleagues, research fellows, and students with whom we have worked most recently, including Alan Beedle, Tatjana Buklijas, Felicia Low, Mark Vickers, Deb Sloboda, Tony Pleasants, Wayne Cutfield, Allan Sheppard (Auckland); Chong Yap Seng, Michael Meaney, Ravi Khambadur, Melvin Leow, Lee Yung Seng, Emilia Tng, Tai E. Shyong (Singapore); Keith Godfrey, Cyrus Cooper, Karen Lillycrop, Graham Burdge, Philip Calder, Christopher Byrne, Lucy Green, Kirsten Poore, Felino Cagampang, Rohan Lewis, Christopher Torrens, Geraldine Clough, Hazel Inskip, Caroline Fall, Nick Harvey, Aven Ahie-Sayer, Richard Oreffo, Kim Bruce, Jane Cleal, San Robinson, Elaine Dennison (Southampton). Felicia and Tatjana also helped with some research for the manuscript.

We are very grateful to Terrence Forrester in Jamaica, Ronald Ma in Hong Kong, Alex Ferraro in Sao Paolo, Huixia Yang in Beijing, Tony Duan in Shanghai, Torvid Kiserud in Bergen and Ethiopia, Guttorm Haugen in Oslo, John Newnham in Perth, Australia, Anibal Llanos in Santiago de Chile, and Carlos Blanco in Dublin for their collegiality and scientific insights and for giving us important perspectives into problems in parts of the world they know well.

We have had informal discussions with many colleagues including Steve Simpson (Sydney), David Raubenheimer (Auckland), Paul Zimmet (Melbourne), John Funder (Melbourne), Pat Bateson (Cambridge), Randy Nesse (Ann Arbor), Carl Bergstrom (Seattle), Craig Rubens (Seattle), Hamish Spencer and Peter Dearden (Otago), James Heckman and Chris Kuzawa (Chicago), Tessa Roseboom (Amsterdam), and several scientists active in the nutrition and pharmaceutical industries.