Obesity epidemics: simple or simplicistic answers?

Among the strategies suggested to face obesity epidemics there is also a mere reduction of only 100-200 kcal day, i.e. less mouthfuls of food and a little more walking every day. Are these proposals « simple and feasible » or, vice versa, « simplicistic and unrealistic » solutions? A possible source of such confusion comes firstly from dietary guidelines: the « food pyramid » may easily lead to misinterpretation as low-fat foods enriched in simple sugars produce similar metabolic abnormalities as saturated fat rich foods. Replacement of fruit derived fructose with other fructose-enriched beverages is not adequately considered. In total, 45-60 min of moderately intense physical activity, instead of « few steps », daily appears a more realistic evaluation of the role of physical activity in energy balance but is still an unrealistic intervention strategy in many obese individuals requiring a long preliminary rehabilitation period. Another complaint is the current poor distinction between « preventive, population oriented » and « therapeutic, clinical » intervention strategies possibly due to the long duration of the latent « preclinical » phase of the disease and the scarcity of safe and effective drugs. Obesity may be considered a « culture-bound » disease and as such it requires a proper cultural, political and educational strategies. The number of obesity clinics worldwide is too limited; educational interventions in the crucial period of the developmental age are lacky. The social science content of medical school curricula, and teaching healthy behaviours, needs to be improved. In conclusion, a deeper reflection from Medical Societies on the relationship between the negative aspects of the « transition diet » and « globalization process » may help to produce really « simple » and more successful strategies against obesity epidemics and its complications.