Genotype, obesity and cardiovascular disease – has technical and social advancement outstripped evolution?

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Abstract
Zimmet P, Thomas CR (International Diabetes Institute, Caulfield, Australia; and BioScience Communications, London). Genotype, obesity and cardiovascular disease – has technical and social advancement outstripped evolution? (Review). J Intern Med 2003; 254: 114–125. Teleologically, our ancestors were highly adapted hunter‐gatherers. In recent history, the environment in which Homo sapiens exists has altered drastically and humans are exposed to environments for which the hunter‐gatherer genotype is ill‐suited. The adoption of a sedentary Western lifestyle, and the case of obtaining food of a high calorific content imposed upon a thrifty genotype, have resulted in the current global epidemic of obesity, Type 2 diabetes and the Metabolic Syndrome. The ramification of this epidemic is that cardiovascular disease is becoming a global healthcare problem, which will have its greatest impact on the developing nations. A global strategy is required to reduce the impact of the Western lifestyle on the health of developing nations and prevent obesity and Type 2 diabetes. Such an approach needs to be culturally sensitive, integrated, and multidisciplinary and involve a range of interventions that work at the individual and community levels. If lifestyle measures fail, then pharmacological intervention may be necessary. For this, novel agents such as dual PPARα/γ agonists may be the therapy of the future.