O implement and sustain them. On theAuthor Manuscript Author Manuscript Author

April 3, 2018

O implement and sustain them. On theAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptAnn N Y Acad Sci. Author manuscript; available in PMC 2016 July 01.Wahlqvist et al.Pageother hand, if the people have access to credible information (Avermectin B1a web enabled in this age of communication) they might be able to adopt healthy habits aimed at reversing maladaptive behavior, regardless of their ability to hold their leaders accountable. These processes require effective, accessible public education with well-defined reformulated goals incorporating the neglected topic of human fitness. Predictors–There is ample evidence from epidemiologic studies to predict risk of offspring diabesity without the use of scarce resources. The majority of items in Table 2 only require physical presence and obtaining a competent history, which are, unfortunately, not universally possible in vulnerable populations susceptible to diabesity. Each item alone is robustly associated with diabesity and should trigger preventive measures, without a need for sophisticated technology. Prevention–Prevention and treatment are inseparable: healthy habits, when adopted, have palliative as well as curative potential and provide primary and secondary prevention. Correction of intrauterine energy balance can override genetic susceptibility to obesity and obesogenic lifestyle during childhood, leveling the trajectory of the dysmetabolic syndrome and pre-empting adult disease,105,106 providing pre-emptive or primordial prevention, which has been demonstrated using metabolic Vasoactive Intestinal Peptide (human, rat, mouse, rabbit, canine, porcine) side effects surgery. Regardless, since operations cannot realistically be offered to the increasing numbers of metabolically unfit fertile girls and women, large-scale accessible methods must be given priority. Health by a thousand cures–In the final analysis, changing maladaptive behavior has the capacity to mitigate effects of maladapted genes by “fighting fire with fire” through mechanisms of epigenetics, cellular plasticity, and pluripotency, some of which have contributed to the maladaptation in the first place. Contrary to “death by a thousand cuts,” the present paradigm suggests “health by a thousand cures.” Table 3 is an inventory ranging from small, simple, cheap “cures” (e.g., healthy habits) to ambitious policy-requiring initiatives, altogether resulting in creeping normalcy based on the premise that major positive change, which occurs slowly, in many unnoticed increments, is not perceived as burdensome or objectionable, thus more likely to succeed (possible policy). Summary Achieving energy balance for sustainable metabolic fitness requires cutting food intake: quantity, rate, and choices, as well as increasing exertion, sleep, and socializing, adapting both ingestion and exertion to human chronobiology. Changes must start before conception, extending beyond the years of reproductive capacity throughout the entire life cycle, keeping in mind “grandparent effects” benefiting the next generation but also the substantial costs of caring for unhealthy aging populations threatening gross national products worldwide. With an evolutionary developmental perspective, a plan of action would start by prioritizing the fitness of the founder generation. Maybe extension of the concept of fetal rights to include provision of an optimal intrauterine environment preventing known contributors to postnatal disease carried into adulthood could move politicians to support educational programs, including preconception coun.O implement and sustain them. On theAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptAnn N Y Acad Sci. Author manuscript; available in PMC 2016 July 01.Wahlqvist et al.Pageother hand, if the people have access to credible information (enabled in this age of communication) they might be able to adopt healthy habits aimed at reversing maladaptive behavior, regardless of their ability to hold their leaders accountable. These processes require effective, accessible public education with well-defined reformulated goals incorporating the neglected topic of human fitness. Predictors–There is ample evidence from epidemiologic studies to predict risk of offspring diabesity without the use of scarce resources. The majority of items in Table 2 only require physical presence and obtaining a competent history, which are, unfortunately, not universally possible in vulnerable populations susceptible to diabesity. Each item alone is robustly associated with diabesity and should trigger preventive measures, without a need for sophisticated technology. Prevention–Prevention and treatment are inseparable: healthy habits, when adopted, have palliative as well as curative potential and provide primary and secondary prevention. Correction of intrauterine energy balance can override genetic susceptibility to obesity and obesogenic lifestyle during childhood, leveling the trajectory of the dysmetabolic syndrome and pre-empting adult disease,105,106 providing pre-emptive or primordial prevention, which has been demonstrated using metabolic surgery. Regardless, since operations cannot realistically be offered to the increasing numbers of metabolically unfit fertile girls and women, large-scale accessible methods must be given priority. Health by a thousand cures–In the final analysis, changing maladaptive behavior has the capacity to mitigate effects of maladapted genes by “fighting fire with fire” through mechanisms of epigenetics, cellular plasticity, and pluripotency, some of which have contributed to the maladaptation in the first place. Contrary to “death by a thousand cuts,” the present paradigm suggests “health by a thousand cures.” Table 3 is an inventory ranging from small, simple, cheap “cures” (e.g., healthy habits) to ambitious policy-requiring initiatives, altogether resulting in creeping normalcy based on the premise that major positive change, which occurs slowly, in many unnoticed increments, is not perceived as burdensome or objectionable, thus more likely to succeed (possible policy). Summary Achieving energy balance for sustainable metabolic fitness requires cutting food intake: quantity, rate, and choices, as well as increasing exertion, sleep, and socializing, adapting both ingestion and exertion to human chronobiology. Changes must start before conception, extending beyond the years of reproductive capacity throughout the entire life cycle, keeping in mind “grandparent effects” benefiting the next generation but also the substantial costs of caring for unhealthy aging populations threatening gross national products worldwide. With an evolutionary developmental perspective, a plan of action would start by prioritizing the fitness of the founder generation. Maybe extension of the concept of fetal rights to include provision of an optimal intrauterine environment preventing known contributors to postnatal disease carried into adulthood could move politicians to support educational programs, including preconception coun.