Arnaud Basdevant, a leading nutritionist who launched France's first national obesity plan, describes obesity as a disease of society and economic transition. Without losing sight of people’s individual susceptibility to weight gain, this means that radical lifestyle changes are partly to blame for the rise in obesity. These changes are themselves related to a shift in human activity prompted by industrialisation. We have been able to introduce preventive measures for urban planning in the past and their effectiveness has been demonstrated. One example is cycle paths: cycling is very popular in society as long as an appropriate infrastructure of safe and protected cycle paths is put in place.
Architecture plays a key role in obesity. It is well known, for example, that room temperatures can affect metabolism. Using specific data, engineers have developed algorithms that enable residential heating systems to be controlled in order to constantly adjust temperatures. These algorithms aim to vary the room temperature: it is gradually lowered to levels that stimulate the body’s metabolism, over periods of time that are short enough to not be uncomfortable. As a result, it intermittently stimulates the metabolism of people exposed to these temperature changes, which leads to an increase in basal energy expenditure. This is an effective technique to help prevent weight gain.
Buildings should also be redesigned to encourage daily physical activity. Stairwells should become pleasant and airy communal spaces, ideally with windows, to encourage residents to use them as often as possible. We also need to question the practice of automatically installing escalators in public spaces and shopping centres. In a society concerned about promoting the health of the population, new regulations should be introduced for safe and comfortable staircases to be built next to lifts, which are reserved for people with reduced mobility.
These few examples illustrate the complexity of obesity and demonstrate that controlling this epidemic, which has still not been eradicated, cannot be limited to priority nutritional measures that are broadly targeted. Instead, an in-depth review of the determining factors of our lifestyle, involving all key members of society, is needed.
Prof. François Pralong, Consultant, Endocrinology & Diabetes and Obesity Centre at Hôpital de La Tour.