Obese yet malnourished…?

How this hidden hunger is affecting women and children

Photo by Thought Catalog on Unsplash

If you’d like to reach out you can find my contact details here. I work with a number of companies as a product and medical advisor.

We live in an increasingly polarised world, across politics, social issues, and media. A uniquely interesting example of this polarisation is the paradoxical truth that we are becoming more obese while simultaneously being grossly undernourished. How can this be true, and how does it impact women and children? Let’s discuss.

51% of the global population will be overweight or obese by 2035 based on current trends.

Hidden Hunger

The World Obesity Atlas report from the World Obesity Federation, predicts that 51% of the global population will be overweight or obese by 2035 based on current trends. The economic impact is set to reach $4.32 trillion annually if prevention and treatment measures do not improve. At almost 3% of global GDP, this is comparable with the impact of COVID-19 in 2020.

Similarly, childhood obesity could more than double by 2035 (from 2020 levels). Rates are predicted to double among boys to 208 million (100% increase) and more than double among girls to 175 million (125% increase) and are rising more rapidly among children than adults. (1) Childhood obesity has significant impacts on both the immediate and long-term health and well-being of children.

Obesity also has a significant impact on women’s health potentially predisposing women to an increased risk of ovarian, breast and endometrial cancer, increasing the likelihood and impact of polycystic ovary syndrome (PCOS) and impacting fertility. For example, one study found for each unit increase in BMI there was a 3% increase in the risk of infertility. (2)

A large study that followed individuals over 25 years found childhood obesity before 12 years of age appears to increase the risk of female infertility in later life. (3)

At the same time, women and children are malnourished, not from a caloric but a micronutrient perspective. Half the world’s children suffer from micronutrient deficiency, which can impede brain development. This is equally true in the UK where the National Diet and Nutrition Survey in the UK says nearly half of children in the UK are deficient in at least one key micronutrient. (4)

Women are also lacking key micronutrients and the consequences can be severe. In the UK the National Diet and Nutrition Survey found eighty-nine per cent of women of childbearing age had a folate concentration below the threshold indicating an elevated risk of neural tube defects (NTD), a congenital disorder. A further 76% of women had low iron intakes and 21% were significantly below the recommended level for iodine. The list could go on.

Impact on the World

The dual burden of obesity and micronutrient deficiency strains healthcare systems and economies worldwide. The rising rates of obesity lead to increased healthcare costs due to the treatment of obesity-related conditions, while micronutrient deficiencies can result in long-term cognitive and physical impairments, affecting workforce productivity and overall quality of life.

Wonder Drugs

Unless you’ve been hiding under a rock the last year you will have heard of the GLP-1 therapies Ozempic, Wegovy and Semaglutide. The market cap of Novo Nordisk, the manufacturer, now significantly exceeds the GDP of its home country Denmark! (5)

These medications can play a powerful role in the obesity epidemic and have proven to reduce the risk of medical conditions such as type 2 diabetes and cardiovascular disease. Their potential benefits are huge. However, it must be noted that they only address the symptom and do not address the underlying cause. The second-order effects of the widespread uptake of these medications are unknown.

Opportunities for Change

As a technophile, I believe technology can save us from most if not all of the world’s problems (including those created by tech, hello threats from AI). So how do we create solutions focusing on addressing the underlying causes of the fat/famish paradox and encourage people to eat less but consume more nutrients? Given the scale of the problem, there are a multitude of possible solutions and governments and public health bodies have an important role to play. Here are a few ways I believe private companies could address this global issue:

Addressing Trauma and Toxic Stress

An emerging body of research suggests that addressing trauma and toxic stress could be important in tackling obesity, particularly when it originates from childhood experiences. Both childhood trauma and toxic stress have profound impacts on physical and mental health, which can contribute to obesity.

• Childhood Trauma: Childhood trauma, such as abuse, neglect, or severe family disruption, can set the stage for lifelong health issues. The Adverse Childhood Experiences (ACEs) studies have shown a strong correlation between negative childhood experiences and the risk of obesity in adulthood. Traumatic experiences can lead to unhealthy coping mechanisms, such as emotional eating, which may contribute to weight gain. Effective treatment of childhood trauma often involves trauma-focused therapies, such as Cognitive Behavioural Therapy (CBT) and trauma-informed care, which help individuals process and manage their experiences.
• Adult Trauma and PTSD: Adults who have experienced trauma, including those with Post-Traumatic Stress Disorder (PTSD), may also struggle with obesity. PTSD can disrupt emotional regulation, leading to maladaptive coping strategies, such as overeating or using food for comfort. Treating adult trauma often includes a combination of therapeutic approaches such as Exposure Therapy or EMDR (Eye Movement Desensitisation and Reprocessing).
• Toxic Stress: Toxic stress refers to the prolonged and intense activation of the body’s stress response system. Unlike acute stress, which involves the return to a normal physiological state and can be manageable and even beneficial, toxic stress is detrimental. It can disrupt brain development, impair metabolic processes, and lead to chronic health conditions, including obesity.

Startups could look at integrating trauma-informed care into weight management programmes, creating a supportive environment that combines therapeutic interventions with nutritional and fitness guidance. This could help individuals confront the root causes of their weight issues through a more holistic approach.

Promoting Healthy Eating for Children

A potential area of interest could be startups focusing on healthy eating for children. Building for a young audience is inherently difficult because of the complex sales cycle for kids (via parents) and the additional complexity of addressing a vulnerable audience. However, technology could be used responsibly to link healthy eating to positive reinforcement and encourage children to develop and maintain nutritious eating habits.

• Gamification of Healthy Eating: An option could be to create interactive and engaging tools that use gamification to make healthy eating fun. For example, apps or online platforms could reward children with points, badges, or virtual items for making healthy food choices.
• Interactive Learning Experiences: Develop educational apps or games that integrate healthy eating principles into their design. For instance, children could embark on virtual adventures where they earn rewards for completing challenges related to nutrition.
• Reward Systems and Incentives: Implement reward systems in real-life settings, such as schools or home environments. Create incentive programmes where children receive small rewards for consistently making healthy food choices.

By tying healthy eating to dopamine-driven rewards and positive reinforcement, it could be possible to create a more engaging and motivating environment for children. This must be balanced with appropriate screen time usage.

Focusing on Preconception Health and Fertility

Supporting healthy weight management with a specific focus on women’s health is an interesting cross-section. Companies could look to offer specific plans and programmes designed to optimise preconception health and fertility.

• Personalised Programmes: Startups could provide programmes focusing on achieving optimal weight with a specific focus on preconception health, improving fertility and achieving optimal health to support a pregnancy.
• Optimal Nutrition: Nutritional requirements during pregnancy and preconception are different. Personalised advice on the attainment of key nutrients especially if on a calorie-restricted programme could be valuable.

Looking to the Future

The paradox of rising obesity alongside widespread undernourishment poses significant health and economic challenges. While medications like GLP-1 therapies show promise in addressing obesity-related risks, they primarily treat symptoms rather than root causes. The long-term impacts of widespread medication use remain uncertain.

Companies can create transformative change by finding ways to address the root causes of these issues. By leveraging technology, and prioritising holistic approaches, we can create a future where health equity and well-being are accessible to all, mitigating the dual burden of obesity and malnutrition on global health.

If you’d like to reach out you can find my contact details here. I work with a number of companies as a product and medical advisor.

References

1. https://www.worldobesity.org/news/economic-impact-of-overweight-and-obesity-to-surpass-4-trillion-by-2035
2. Zhu L, Zhou B, Zhu X, Cheng F, Pan Y, Zhou Y, Wu Y, Xu Q. Association Between Body Mass Index and Female Infertility in the United States: Data from National Health and Nutrition Examination Survey 2013–2018. Int J Gen Med. 2022 Feb 19;15:1821–1831. Link
3. He Y, Tian J, Oddy WH, Dwyer T, Venn AJ. Association of childhood obesity with female infertility in adulthood: a 25-year follow-up study. Fertil Steril. 2018; 110: 596–604.e1. Link
4. https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019/ndns-results-from-years-9-to-11-combined-statistical-summary
5. https://seekingalpha.com/news/4070894-glp-1-outpacing-gdp-novo-nordisk-meteoric-rise-with-ozempic-and-wegovy