Jeroen Lackerfeld started his work as a physiotherapist in a hospital in Utrecht. He ended up in the vascular department. “Almost all of these people had type 2 diabetes and all of these people were smokers. When I picked them up from the smokehouse I thought: ‘It’s too late!'” Then he started doing doctoral research into lifestyle interventions. The frustrating thing is that what worked in controlled conditions It didn’t work in real life. “I saw no effect at all, and the health risks didn’t go down. “You can try to change someone’s behavior, but it won’t work if the environment doesn’t change.”
Now, Lakerfeld has been focusing on that environment for thirteen years. In November, the Medical University of Amsterdam received €10.5 million to work with other European researchers to collect and analyze data for five years and better determine the causes of obesity. The project is called OBCT: Obesity: Biological, Social, Cultural and Environmental Risk Pathways. Simply put, researchers look at groups of people with different backgrounds in different places. Why is one person overweight and the other not?
Isn’t this an open investigation?
“At first glance, it’s simple, yes. It’s all about lifestyle, exercise and nutrition, where more energy goes in than out. But there are reasons behind this behavior and there are different risk factors. In this project we are identifying a genetic predisposition to being overweight. We are also looking at Social and cultural environment: What is the norm for the people you interact with? Is it normal to eat on the sofa in front of the TV? We analyze the physical environment. For example, what is the density of fast food in the neighborhood, or what about Ease of driving?
Driving ability?
“In some areas, including the Netherlands, you are practically pushed into the car. In Groningen East more than in Amsterdam, because the supermarket is far away, the shops in the area are closed, everything is too far away to cycle, and because you can park your car easily.” Anywhere. In neighborhoods with high altitude Ease of driving Diabetes is more common.
“Sometimes you find counter-intuitive results or unhealthy factors that go hand in hand with healthy results. Take Utrecht Central Station. There is a huge variety of unhealthy foods, but it also has the largest bike warehouse in the world.
What can you do with this data?
“It is important to show that this is really the case, so policymakers can intervene. Differences between neighborhoods are relevant because everyone has been exposed to these factors and these factors are part of a system that contributes to health problems and inequality. For example, you can create a map using dipstick and know which areas light up so you know where you need to intervene.At the same time, you also have to look for good comparison materials and see over time whether the modification in the environment actually leads to different behavior, or whether obesity decreases later and in Ultimately there is a reduction in diabetes and cardiovascular disease.
Are you also looking at “blue zones”, where people age healthily, such as in parts of Italy?
“We mainly focus on obesity and health risks and inequality. At the same time, you find out a lot about areas where things are going well. By the way, there’s something interesting going on in those blue areas. Those things that make people live very long lives, often It was not born out of necessity. These healthy elderly people had to start a vegetable garden out of poverty. Now, it is cheaper to go to the supermarket and eat ultra-processed foods.
How do you draw a map of 28 countries?
“This is a huge challenge. The Netherlands is a kind of living laboratory. There is a lot of data available on a small surface. Not only geographically, but also from cohort studies, for example from the Central Bureau of Statistics. With the help of our geographers, we can enrich this with environmental data to make Epidemiological research. In the Netherlands there are also many differences: city and countryside, social and cultural… and you also need these differences to explain the distribution in data sets.
“If you want to compare across countries, high-resolution local data is not of much use, you have to look for data that measures in the same way. It is very difficult to get standardized data sets for something like neighborhood socioeconomic status or exposure to fast food.”
What do you do with genetic data?
“You not only want to know to what extent there is a genetic predisposition to obesity, but also how the interaction between genes and environment works. We translate this data into a screening tool: one version for health care providers and another for lay people. Suppose we have your zip code, then we can To see how strong exposure to unhealthy factors is in your area. It’s also helpful to know the places you go often, like where you work. We’ll take some cheek swab to see your genetic makeup. This gives you a comprehensive view of your risks and what you can do to reduce them.
How far can you zoom in on the map?
“Up to about one hundred by one hundred metres. This scale provides sufficient opportunities to study relevant exposure zones around residential addresses. It is difficult to determine a good size. Some people stay close to their homes, others have a long distance. Another point is: people do not live “Where they live is a coincidence. Anyone who has a dog and enjoys running will choose the neighborhood that suits them. So, if you link the friendliness of physical activity in a neighborhood to the behavior of residents, you may encounter reverse causality. These are all challenges for my field.”
You call yourself the source. What is this?
“A story. Three men are sitting by the river when they hear a child screaming in the water. They jump into the river and save the child. Then another person comes, and soon they are in the water saving all these children. One of them makes a raft, saving a few at a time, and the other throws a rope For the children out of his reach. The third one walks away. Upriver he sees children falling into the water near a broken bridge. He repairs the bridge so that no more children will fall into the water.
“That translated to today’s chronic conditions. We take people out of the water with chronic diseases due to high blood pressure and cholesterol caused by unhealthy lifestyles. This is due to a lack of knowledge, perseverance and skills. This in turn is affected by the environment. You can give an asthmatic child a puffer, but you also need to know if there is dampness in the house, what the housing association does and whether the house is next to a motorway. You have to address the causes of the causes.”
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