Obesity and Diabetes in Vulnerable Populations: Reflection on Proximal and Distal Causes

Abstract

Around the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting factors include events occurring during fetal life, maternal physiology and life context, the thrifty genotype, the nutritional transition, health impact of urbanization and immigration, social attributions and cultural perceptions of increased weight, and changes in food costs and availability resulting from globalization. Better appreciation of the complexity of causation underlying the worldwide epidemic of obesity and diabetes can refocus the work of clinicians and researchers to work at multiple levels to address prevention and treatment for these conditions among vulnerable populations.

Challenges to addressing obesity for Māori in Aotearoa/New Zealand

“…The Māori experience, which has been mirrored by many other indigenous groups, has resulted in: wide-scale migration into urban centres; increased consumption of cheap processed foods high in fat and sugar; reduced physical activity levels; and rising rates of obesity and cardiovascular diseases. 19 In addition, historically, Māori were deliberately excluded from higher-level education. Until the 1960s and 1970s, national policies largely ensured that Māori students were taught a non-academic, technical curriculum that severely restricted access to higher education, limiting life chances and resulting in a Māori working class.…”

“…While some consider the association between poverty and obesity as paradoxical, it is not the extremely poor populations who suffer from obesity, but those with access to the cheapest foods -which are usually high in fat, salt and sugar and lower in beneficial vitamins and minerals. 19 Personal choice in the types of food one can consume and the ability to participate in physical activity is often greatest for those who are socially advantaged. 28 Focusing on the historically driven social determinants of Māori obesity moves the focus away from blaming Māori for their own ill health and enables identification of appropriate interventions to address obesity.…”

Weight status, fatness and body image perception of North African immigrant women in Italy

“…Obesity has increased steadily over the past two decades, mainly affecting low-income communities and ethnic minorities (1,2) . Immigrants are at particular risk of weight gain and acculturation in the host country seems to be responsible for it (3) .…”

Organic consequences of ileal transposition in rats with diet-induced obesity

“…However, these conditions do not only affect the obese population, because there is an increasing incidence of type 2 diabetes among individuals with a body mass index (BMI) that is in the eutrophic and overweight ranges. 35,36 Insulin resistance is known to be the primary cause of cardiovascular disease in these individuals. 37 The etiology of insulin resistance in obesity may be due to genetic factors.…”