Interview with Dr. Deborah Burks: “Obesity takes its toll in all environments.”

Entering the impressive Príncipe Felipe Research Center is an invitation to see the problems that concern us all through the eyes of science. Science is the future, and, for Dr. Deborah Burks, director of the Center and researcher at the Molecular Endocrinology Laboratory, “it is essential that it reaches citizens, who are ultimately the people who need it”. She is currently doing research on diabetes and obesity, with the aim of understanding the role of insulin and the failures of a complex process called signalling. We talked to her about the worrying figures of obesity and overweight and how food influences our health.

By 2025, according to UN estimates, some 167 million people will be in poorer health due to obesity or being overweight. “Long before the global pandemic of COVID-19 we had seen evidence of overweight and obesity figures of great concern. At that time, there was already talk of considering them a pandemic. Ultimately, the frequency was already so high that we can apply the word pandemic appropriately”, says Dr. Burks.

Finding ways to combat these scourges is essential. In the first instance, to improve the quality of life of those who suffer from it, since their daily life is marked by joint pain and other complications. These people are more prone to other diseases, such as visual disturbances, fertility problems, diabetes, cancer and heart disease. In addition to the personal cost, obese or overweight people are more likely to have psychological problems and are often victims of bullying. Even in adulthood, they tend to have problems entering the labour market and coping with the demands of their work.

We need customised plans

On the other hand, it entails a very high economic cost for the public health system. Because if a person suffers from obesity from an early age, the problem is likely to extend throughout his or her life. “Obesity takes its toll in all environments and has very important personal, social and economic consequences. We have to solve it through customised plans, through a plan of attack tailored to the characteristics of each individual”, adds Burks.

And inequality is to blame for everything. It has been proven that there is a close relationship between poverty and the groups most affected by obesity, overweight and diabetes, one of its associated diseases. “In general, they are people of a low socioeconomic level, with few resources and who have a low level of education. Another group affected are those who live in rural areas, because they have greater difficulty in accessing supermarkets with an offer of healthy products”, adds the doctor.

This occurs mainly in countries whose rural areas are far from the city and do not have large retail stores. In the U.S. and Spain, for example, rural areas are the most prone to obesity. “Imagine a grandparent who, in order to buy healthy food, has to rely on someone to drive him to a larger town or city. In the U.S., in these cases, the only alternative is often to buy food at a gas station, where they can buy some things like cheese and nuts, but never fresh food. It’s just another example of the inequality we see in these areas”, he explains.

Prevention, starting from the kitchen

It is evident that access to a healthy diet is fundamental to prevent diseases. Dr. Burks explains that during the months of pregnancy the mother’s diet is important to maintain her body weight and adequately nourish the foetus. “The weight of the foetus will determine health for the rest of its life and, for example, if it is born to a mother with gestational diabetes, it will have a higher risk of metabolic diseases in its adult life. It is important to note that there is a close relationship between metabolism and fat, and insulin and proper brain development. That is why the concept of maternal health and the intervention of the health system to provide sufficient care and information about the mother’s diet at this stage is key”, says Burks.

Now, what are we doing wrong to keep the numbers rising? First of all, we must improve the quality of the supply of food products. “We need to examine how and what we do with food. Buying vegetables and spending half an hour cutting and preparing the food is a way of conditioning the body biologically to receive and process the food. That is a completely different experience to opening a package of crisps and eating it in five minutes”, Burks points out. And it throws out an alarming statistic: by consuming just 100 more calories a day for a year, you would gain 10 kilos. This means that, if you continue like this, in two years, you could be overweight.

It is necessary to follow a healthy diet, yes. Another thing is to be able to pay for it. Dr. Burks stresses that subsidies for healthy foods would be helpful in preventing metabolic diseases and obesity, as they are related to the ability of families to purchase quality products. In fact, for most people with diabetes, 90% can correct insulin resistance through a healthy diet and physical exercise, but that takes two things: time and money.

To solve the economic constraint, the consumption of fresh and seasonal fruits and vegetables can be part of the strategy. “They are cheaper and healthier because the nutrients in these foods are much more available to the human body. In addition, we connect in a different way with food, promote the local economy and support small producers.

On the other hand, strategies to address obesity and overweight by medical personnel should be personalised and take into account that it is a multifactorial disease. And communication must also be effective, empowering people to take responsibility for what they eat and providing positive information on healthy eating, both in the doctor-patient relationship and through awareness campaigns or food labelling.

From family to public policy

Families also have to do their bit. Parents have a responsibility to ensure that their children adopt a healthy diet and to prevent screens from affecting their lifestyle and cognitive development. Involving them in the kitchen is a way to increase self-esteem, gives them a role in the family structure and they learn to discern between healthy and unhealthy foods. “Cooking is a way of doing science. Every meal we prepare is an experiment, the kitchen is a laboratory and at the end of the process, it gives us joy to discover new flavours”, Burks explains with a smile.

It cannot be repeated too often that public policies are essential to alleviate the situation. Until a few months ago, Spain did not have a strategy to tackle obesity and has just launched the National Strategic Plan for the Reduction of Childhood Obesity. “It’s about time. We had had very high figures for years and the scientific community no longer knew how to warn that urgent action was needed to prevent this public health problem”, she explains. The expert maintains that in addition to a children’s plan, it would be good to address a more generalised strategy to attack the problem in adults. “In the best case scenario, if you take obesity as a general problem and manage to reverse the habits in the parents, you have already freed the family from this problem”, the doctor points out.

In addition to the line of research led by Dr. Deborah Burks, the Príncipe Felipe Research Center carries out other studies, such as the one led by Alfonso Benítez-Páez on the microbiota and how the food we eat is directly related to our intestinal flora. “Eating five fruits and vegetables a day and having a diet rich in fibre generates a very different microbiota colony than eating meat and processed products. Science is already getting to the perspective my mother had when I was little: you are what you eat. A basic philosophy that we should all follow”, says Dr. Burks.