Obesity and chronic disease in younger people: an unfolding crisis.

radical alterations in the factors determining energy intake and expenditure that we have witnessed over recent times have fundamentally changed the way we view the interplay between the environment and our physical selves. It was only at the advent of the 20th century that technological advancement finally began to squeeze out the manual labour associated with the production and transport of goods. Later in the century, this trend started to infiltrate the home where new technologies, such as electric and gas cookers, central heating, washing machines, vacuum cleaners, and dish washers all made significant inroads into the amount of physical labour associated with everyday life. Our modern environments are now completely divorced from those in which we evolved; indeed, all the necessities of modern life, such as shopping, banking, working, socialisation, and entertainment can be fulfilled while sitting in front of a screen. As a result, we are surrounded by a landscape of energy dense foods designed to appeal to our innate desire to maximise energy intake and storage, while the need for vigorous activity has evaporated. The trade-off has been an epidemic of obesity and metabolic dysfunction. THE DEMOGRAPHIC SHIFT Within the UK, over 50% of the population now falls outside healthy levels of body fat, and rates of chronic disease, such as type 2 diabetes, affect an ever increasing proportion of the population. 1 This has already placed a substantial strain on the NHS that is projected to increase in the future; one estimate recently projected that rising obesity rates would add an additional £2 billion to current levels of annual healthcare spending by 2030. 2 In a period of economic austerity, we will be ill prepared to meet this additional healthcare burden. Unsurprisingly, the trend of rising obesity rates has also been observed across younger populations where rates of overweight and obesity have risen sharply over the last 20 years and now affect one in three children; 1 however, less well known is that this trend has started to produce devastating consequences. This is highlighted clearly by the shifting demographic of type 2 diabetes. Type 2 diabetes was traditionally associated with older age, with type 1 diabetes being the dominant form in younger populations. However, prevalence rates of type 2 diabetes in younger people has increased by up to 10-fold in recent decades, and now commonly represents 20% of all registered diabetes cases in this group. The …