José Mª Ordovás es director del laboratorio de Nutrición y Genómica del USDA-Human Nutrition Research Center on Aging de la Universidad de Tufts (EEUU), profesor de Nutrición y Genética, director científico del Instituto Madrileño de Estudios Avanzados en Alimentación (IMDEA) e investigador colaborador senior en el Centro Nacional de Investigaciones Cardiovasculares (Madrid).
Vuelve a colaborar con EFEsalud a través del siguiente artículo.
Las doce caras de la obesidad
por José María Ordovás
La obesidad ha venido capturando de una manera continua y creciente la atención de los investigadores y profesionales de la salud, de los medios de comunicación, del mundo empresarial, de la gente de la calle, e incluso de los gobernantes.
Las noticias actuales exhiben un estado de alerta roja, y las previsiones mas influyentes son apocalípticas. Uno pensaría que con ese derroche informativo, ya deberíamos tener un conocimiento detallado del problema, de sus orígenes, de sus efectos y de su trayectoria y además tendríamos a la obesidad en huida.
Pero nada mas lejos de ello. La obesidad tiene su cara oculta que hemos ignorado en favor de las imágenes mas familiares, de los conceptos mas confortables intelectualmente, que hemos dogmatizado a la hora de definir el problema y derivar la solución.
Billones de euros se invierten o se gastan en la lucha contra la obesidad desde instituciones publicas y por parte de quienes, individualmente, buscan remedio a su problema; pero hasta la fecha no ha habido aparentemente manera de frenar su avance: ni desde el punto de vista de la salud pública, ni desde el mas clínico y farmacológico.
De hecho, la mayor parte de las practicas preventivas y terapéuticas en uso no se han renovado con el tiempo ni han adoptado muchos de los nuevos conocimientos y tecnologías.
Al igual que la línea Maginot, diseñada al final de la Primera Guerra Mundial, para defender a Francia de futuros ataques de Alemania no sirvió para frenar una estrategia militar totalmente diferente durante la Segunda Guerra Mundial, las tácticas envolventes de la obesidad no pueden ser contrarrestadas desde las trincheras clásicas en las que nos hemos refugiado. De ahí la necesidad de aceptar un cambio de estrategia de defensa y pasar al contraataque.
No es que desconozcamos la existencia de los factores emergentes. Están en la literatura científica, pero en muchos casos relegados a un segundo plano en comparación con los factores clásicos que todos conocemos.
Es necesario someter a estos nuevos factores de riesgo de obesidad al mas alto nivel de escrutinio sin sesgos ni ideas preconcebidas e incorporar en nuestro armamento aquellos que demuestran su relación causal con la obesidad y que además sean modificables a nivel individual o social.
La lista es larga, pero a continuación presento una serie de conceptos y factores emergentes cuya elucidación y aplicación podría finalmente poner freno al avance imparable de la obesidad.
Clase dentro de un programa contra la obesidad infantil/EFE/Holger Hollemann
1. Todas las calorías no son iguales: aunque sigue vigente el dicho de Francisco Grande Covián de que “la única caloría que no engorda es la que se queda en el plato”. Es cierto que aquellas que consumimos pueden tener diferentes efectos dependiendo del contexto del alimento en el que las consumimos y las rutas metabólicas involucradas.
2. No toda la obesidad es patogénica: aunque la obesidad se ha asociado con un mayor riesgo de enfermedades comunes, es evidente que el mismo nivel de obesidad aparente, es decir definida mediante el tradicional índice de masa corporal, es precursor de enfermedad en unos individuos, pero no en otros.
3. La obesidad es contagiosa: esto tiene una doble vertiente. Por un lado seria la clásica definición de contagio en la que patógenos están involucrados, y por otra la observación de que el circulo de amistades también contribuye al riesgo de obesidad.
4. La predisposición a la obesidad comienza antes de la concepción y se va forjando durante el embarazo, mediada en gran parte por mecanismos epigenéticos.
5. La “química nuestra de cada día” puede ser un factor que ha contribuido al aumento de las tasas de obesidad en las ultimas décadas. Parafraseando al refranero, sabemos que “lo que no mata engorda”. Es decir que mientras que las sustancias químicas de las que hacemos uso para todas las actividades de nuestra vida diaria han pasado el escrutinio de no ser letales, es posible que algunas de ellas produzcan desarreglos endocrinos conducentes a la obesidad. Quizá uno de las mas estudiados es el caso del bisfenol A, pero existen miríadas de ellos , incluyendo algunos metales.
6. La temperatura ambiental: hoy en día nos hemos liberado de muchas de las incomodidades de nuestros antepasados. En la sociedad actual ya nos podemos permitir mantener una temperatura confortable día y noche, invierno o verano. Esto ha hecho que las calorías utilizadas para mantener nuestro organismo en la zona de confort ya no sean gastadas. En relación a ello, recordemos como investigaciones recientes han demostrado que el frío es capaz de generar tejido adiposo marrón que en lugar de almacenar grasa hace consumo de energía.
7. La disrupción de las pautas tradicionales de luz y oscuridad: nuestro ritmo circadiano mantiene nuestra biología ajustada a los ciclos de luz y oscuridad. El desajuste provocado por la presencia continua de luz tiene como resultado la falta de balance hormonal y bioquímico y un mayor riesgo de obesidad.
8. Relacionado con ello están las cifras que demuestran que cada vez dormimos menos horas y que la obesidad esta asociada con esta carencia de descanso nocturno apropiado.
9. También relacionado con el ritmo circadiano y con la hipótesis de que no todas las calorías son iguales, existe hoy en día la creciente evidencia de que no solo importa lo que comemos y cuanto comemos, sino que también es importante cuando lo hacemos.
10. El estado socioeconómico y la educación: mientras que hubo un tiempo en que la obesidad parecía estar relegada a los que “podían”, hoy en día los factores se han invertido y obesidad hace presa principalmente entre los niveles socioeconómicos y culturales mas bajos.
EFE/Ballesteros
11. La flora bacteriana: la composición de nuestra flora intestinal es una de las áreas mas activas de investigación relacionada con la obesidad. La diversidad y composición de la flora bacteriana parece ser uno de los factores emergentes mas importantes con el atractivo adicional de que hay posibilidades de modificación mediante la dieta.
12. Predisposición Genética: por últimos, además de que no todas calorías son iguales, esta la evidencia de que no todos los individuos reaccionan de la misma manera al mismo numero de calorías. La identificación de la predisposición individual a la obesidad y de las alternativas de prevención y terapia mas apropiadas constituyen una de las áreas mas prometedoras de la medicina personalizada.
Por supuesto esta lista es parcial, incompleta. Es mas, a pesar de la evidencia actual que sustenta la relevancia de algunos de estos factores y conceptos relacionados con la obesidad, es muy posible que algunos de ellos desaparezcan para ser sustituido por otros.
La investigación, la ciencia, ha sido y es siempre así. Empecinarse en la defensa a ultranza de nuestras creencias a pesar de las nuevas evidencias, es decir, que seguir defendiendo que la tierra es plana y que el sol gira alrededor de la tierra, y que la culpa de la obesidad esta exclusivamente en el acto individual de comer mas y moverse menos; solo ha hecho, a lo largo de la historia, que frenar el progreso científico y retrasar la aplicación de nuevos conocimientos a la educación y salud de la población.
Fuente: efesalud.com
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