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Our genes: government endorsement of genetic predisposition use.

DNA Testing: Scientific Relevance
                 
The World Health Organization states that an escalating global epidemic of overweight (BMI between 25-30) and obesity (BMI=30) is taking over many parts of the world. The number of obese adults increased 67 percent between 1995 and 2000 worldwide. Up to 1.7 billion people worldwide are overweight or obese, making it the biggest health threats facing the world's population. In the seven major markets (United States, France, Germany, Italy, Spain, United Kingdom, and Japan) the number of obese adults was estimated at 95 million in 2000 .

Several statistics have been produced in many countries in order to evaluate the state of this epidemic. In Canada, 8% (or an estimated 500,000) children were obese in 2004. Among adults, the growth rate was dramatic: in 1978/79, the adult obesity rate was at 14% and reached 23% in 2004, or an estimated 5.5 million individuals. For the United States, the latest statistics depict astronomical number as well. More than 64% of the adult population is overweight or obese, with 60 millions obese and 120 millions overweight [Obesity statistics, NAASO, The Obesity Society, 2005.].

Childhood obesity is also a well known fact, with over 15% of boys and girls above the percentile corresponding to adult BMI>25 in countries such as Hungary, France, Italy, Germany, etc . Again, the USA counts over 15% of its children as overweight and 15% as obese.

The health consequences of obesity range from a number of non-fatal complaints that impact on the quality of life such as respiratory difficulties, musculo-skeletal problems, skin problems and infertility, to complaints that lead to an increase risk of premature death including non-insulin dependant diabetes, gallbladder disease, cardiovascular problems (hypertension, stroke and CHD ) and cancers.

Diabetes
In the United States alone, in 2003, 17 million people have been diagnosed with type II diabetes through blood tests which demonstrated a build up of sugar in the blood. An other 16 million people have their blood sugar level higher than normal and fall in the category "pre-diabetes".

Heart disease
Obesity also brings heart complications. According to the American Heart Association, cardiovascular diseases claim 1 life every 33 seconds in the United States. In 1996, among United States adults, $31 billion in treatment costs for CVD was related to overweight or obesity (AHA report: Heart disease and stroke statistics- 2003 update ).
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The medical community has identified physical activity and the availability of high fat, energy dense foods as the two principle modifiable environmental factors promoting the development of obesity. It has been proven that not everybody is equally susceptible to the adverse effects of the obesity-promoting environment in which we live. Over 60% of obese women and 40% of obese men actively try to lose weight every year: only 2% of them succeed in keeping the weight off for over a year.

Our genes
Genetic factors play an important role in this phenomenon. The genes underlying this genetic predisposition can be revealed and exploited to both create personalized weight management programs based on a patient’s genetic profile and to develop new obesity drugs. It has been demonstrated that 23% of obesity-related diabetes can be avoided with a weight management program tailored to the genetic make up of the individuals.		    
Some people have an increased risk of obesity when exposed to an unfavorable life style and our genetic make-up plays a crucial role in the development of the disease.
(Handbook of Obesity, Bray, G.A.)
     
The WHO describes obesity as "one of today’s most blatantly visible – yet most neglected – public health problems" [Controlling the global obesity epidemic, WHO, Sept. 3, 2003.]. Several companies have long been involved in weight management products in order to help fight this epidemic. Research associations, Universities, Industries, and Government resources are now joining efforts in order to bring order to the chaos brought onto the market by several of these companies with weight management ideas. Consumers have a very large selection of products which all have the same goal: weight management.

However, for years now weight loss techniques have always turned around the diet or the exercise programs. There are so many new one on the market. Which one will work? The tendency has been to look into the environment in order to make a change. In some efforts, biochemical tests will be ordered for some individuals. As stated by the Office of Genomics & Disease Prevention, Centers for Disease Control and Prevention (CDC) :

Obesity is a condition that results from an environment of caloric abundance and relative physical inactivity that is modulated by a susceptible genotype. Although rare obesity syndromes caused by mutations in single genes have been described, by far the greatest proportion of obesity in humans is not due to mutations in single genes. Genetic predisposition may not be health destiny, but studies indicate that inherited genetic variation is an important risk factor for obesity.

The Office of Genomics & Disease Prevention, CDC (Centers for Disease Control and Prevention) describe well the role of genetics in human in playing a role for the establishment of obesity. The Office writes about obesity as a major public health problem and describes it as a complex metabolic condition. We may find a group of people at a healthy weight which can accomplish moderate changes in diet and exercise as the proper interventions because they work. There is another group of individuals in the population being classified as overweight and who do not respond as well to these interventions. We all know someone in this category! The CDC mentions then

"… more than 80% of those who lose weight will gradually regain it unless a weight maintenance program is implemented over the long-term".

One difference between these two groups of individuals

"...may be genetic risk factors that affect energy metabolism and result in an inborn susceptibility to gain weight".

The CDC has been involved for a few years now at drawing attention to the obesity epidemic since it can not only lead to what the society perceives as an image problem, but most of all it can lead to high blood pressure, cardiovascular difficulties, diabetes, respiratory difficulties, infertility, cancer, back and knee problems, etc. The CDC writes that

"...for people who are already overweight, the public health interventions aimed at the general population are not a complete solution. Insights from genetics and molecular biology in controlling appetite and activity may provide more effective solutions. As we continue to emphasize the importance of diet and exercise as major factors that affect long-term health, public health needs to also seek new approaches—such as considering genetic factors in risk factor assessment and intervention design--to more thoroughly address this complex problem". (CDC, 2005. Note: The CDC is part of the Department of Health and Human Services in the USA.)		    
...public health needs to also seek new approaches—such as considering genetic factors in risk factor assessment and intervention design--to more thoroughly address this complex problem. (CDC, 2005)
 


DNA Testing: Scientific Relevance
It is important to verify how to compare all the DNA tests available on the market with Gene Ob's scientific work. Genetics of obesity is the core of GeneOb's work and foundation. An extensive scientific literature can be found in libraries as of 2005. What can we make of it. In the field of genetics, the best term to remember is: associations. When a particular genetic mutation is found associated with a disease, in several populations, this association must be statistically significant (p value often lower than 0.01) in order to be considered valid by the scientific and medical communities. We then interrogate the data regarding the use of such mutation in the context of patient use for testing. Such examples have been studied in breast cancer research. The genes BRCA1 and BRCA2 are moderately used as of 2005 in order to evaluate cancer risk in women. "A woman’s lifetime chance of developing breast and/or ovarian cancer is greatly increased if she inherits an altered version of the genes." As well, "Men with an altered BRCA1 or BRCA2 gene also have an increased risk of breast cancer (primarily if the alteration is in BRCA2), and possibly prostate cancer." [Genetic testing for BRCA1 and BRCA2: it’s your choice, NCI, National Cancer Institute, June 2002.] The likelihood of developing the disease cannot be estimated accurately since other genetic or environmental factors may play a role in the development of the disease.

It is also a well know fact that a positive result provides information only about a person’s risk of developing cancer. It cannot tell whether cancer will actually develop—or when. It is also impossible to predict the effectiveness of special screening or preventive medical procedures for people with alterations in BRCA1 or BRCA2. Not all women who inherit an altered gene will develop breast or ovarian cancer. As well limited data exist on the effectiveness of approaches for managing cancer risk in individuals with alterations in their BRCA1 or BRCA2 genes. A list of these approaches include surveillance, prophylactic surgery, risk avoidance (behavioural changes such as exercising regularly and limiting alcohol consumption), chemoprevention and gene therapy. As mentioned by the NCI, the benefit of genetic testing allows people to make informed decisions about taking steps to reduce cancer risk. The testing is a tool and the results are a guide for patients. As well, there is no preventive cure, and patients can only alleviate the disease, not eliminate it when found with the mutations.

The company Myriad Genetics holds the rights to sell DNA tests for the genes BRCA1 and BRCA2. As of 2005, DNA Direct, a home brew type of DNA testing company in the United States, partners with Myriad in order to sell the tests. The tests will be sold at roughly $300.00 for only very few of the mutations in the two genes. [DNA testing goes DIY, Associated Press, Mars 2005.]




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