To curb the lasting plague of overweight, the professor of Biochemistry and Molecular Biology at the University of Granada Ángel Gil (Granada, 70 years old) urges a national strategy that begins at school and accompanies families. Because 70% of obese children will also be obese in their adulthood and the cost to the health system is high, but fixable. With an overwhelming career —701 publications, 28 books, 17 patents and 40 national and international awards—, the president of the Ibero-American Nutrition Foundation has just received the Sir David Cuthberson Award, awarded by the European Society for Clinical Nutrition and Metabolism. Gil is the author of Nutrition Treaty, manual used in all Spanish schools to train doctors.
Question. In 2019, half of adults and 40% of children aged six to nine were overweight, according to the Aladino study. How is the problem today?
Answer. Same as two years ago: the current EsNuPi study [Estudio Nutricional en Población Infantil Española, con 1.514 niños] shows that the situation of overweight and obesity continues in the population, with children who do not meet international recommendations on the intake of certain nutrients such as vitamin D or folates [vitamina B que aportan las verduras]. Children consume an excessive amount of protein; There is a group that is close to the Mediterranean diet, but another consumes a large amount of fat and sugary products, and many children have a significant sedentary pattern. A high percentage of the population has unhealthy consumption patterns and it is clear that a significant educational effort must be made throughout the State.
P. How has the pandemic affected our diet?
R. Luckily there has been a consumption of local products and food should not only be safe and healthy, but also socially responsible. However, it does seem that a sedentary lifestyle has produced overweight problems in adults because the intake exceeds the expenditure. Many families struggle to obtain resources, including the purchase of food.
P. Does the quality of the shopping cart always deteriorate with crises?
R. Sometimes not. Some families, in times of crisis, buy less meat. But, in the end, the purchasing power suffers, due to family income, of products such as fish, which is essential to cover micronutrients and polyunsaturated fatty acids. It is very important, especially for developing children. The effects of crises are always negative as a whole.
Food is part of education
P. Do Spanish families have enough support from the educational or health system to develop a healthy diet and attack the root of the problem when shopping?
R. I do not think so. In Spain, Dr. María Neira developed the Naos Strategy against obesity [Agencia Española de Seguridad Alimentaria y Nutrición], but very little has been implemented. There has been no global political will from the parties. Politicians are short-term and Spain has a need for global education in the field of healthy living. Food is part of education and this is achieved with a strategy that affects several ministries. In schools, teachers must be taught to teach children. The autonomous communities must also ensure that families receive instructions on how to do that, because children, from the first year of life, take what their parents take. In 1984, Professor Manuel Bueno published the first data on the prevalence of childhood obesity and gave 4.8%. We have increased the figure by 400% in a short period. We will probably need another 20 years to go down, and a global strategy must be implemented.
70% of obese children continue to be obese in adolescence and later as adults. The problem is that this conditions cardiovascular disease, with a very important cost in our health system
P. The moment seems propitious, with public health at the center of the debate.
R. Indeed, especially to attract the political sphere, because they are budget issues with Health, Consumption and Finance, among others involved. Obesity in childhood conditions obesity in adulthood: 70% of obese children continue to be obese in adolescence and later as adults. The problem is that this conditions cardiovascular disease, with a very important cost to our health system. The World Health Organization tells us that 45 million people die from chronic non-communicable diseases each year. In the current pandemic there are many [2,6 millones], but compare. If we applied the knowledge we have about healthy lifestyle habits, we would cut these chronic diseases in half. What are we waiting for? We need to implement that Naos strategy. Of obese prepubertal children, a quarter already have biomarkers of cardiovascular damage. This is unacceptable and scientists have to make efforts to remedy this with early education. We know that, if we reduce obesity in childhood, we reduce the risks of cardiovascular diseases in adulthood and, therefore, health costs. Prevention is always cheaper than cure. We lack a global vision, as in research, which then happens to us now and everyone remembers Don Santiago Ramón y Cajal. The recommendations for the general population are simple: a varied, moderate diet, with not very large portions, try to use nearby products due to their lower environmental impact, cook at home and not eat many processed products.
The recommendations for the general population are simple: a varied, moderate diet, with not very large portions, try to use nearby products due to their lower environmental impact, cook at home and not eat many processed products
P. Is it worrying that citizens receive a lot of nutrition information motivated by economic interests and not by public health interests?
R. There is a serious global problem with many vectors. Scientists do studies that other scientists read. It is important to build science, but there must be a translational effect. For the normal citizen it is difficult to discern what is based on science and not, a hoax from what is not. Nutrition societies themselves have to make a significant effort to transmit our knowledge to inform citizens. There are unions with particular interests, but we need important public elements, with established scientific committees, and medical societies also need to provide reliable and affordable information.
P. What do you think about the controversy over the Nutri-Score (labeling system intended for food) that gives the same note to olive oil and rapeseed oil? The scientific community seems divided on this.
R. Nutri-Score has important buts, as it is based on limiting salt, sugar and saturated fats and does not take into account other very important aspects, such as bioactive components, the density of vitamins and minerals, if they are ultra-processed products … It values products, but not diets, and there are enormous paradoxes such as qualifying virgin olive oil with a C and also qualifying rapeseed or sunflower oil, which are ultra-processed. The emergencies are bad and the logical thing is to make a much more valued decision, because the most important thing is that the population understands it. Nutri-Score has positive aspects, but the algorithm can be improved. It is preferable to launch a new car on the market and not with major defects.
P. Do you allow yourself any quirks in your diet?
R. Well yes, sometimes, the diet has to be healthy but also pleasant. When we eat we respond to a hedonic aspect, we have neural relationships that tell us when to eat, but there are also limbic reward systems. Food can be enjoyed by eating healthy, it is not a matter of being with the numbers, the issue is to have a healthy and sustainable life pattern, and also satisfactory.
Eddie is an Australian news reporter with over 9 years in the industry and has published on Forbes and tech crunch.