Since 1999, the World Heart Federation has been organising World Heart Day (WHD) campaigns. This year WHD is being celebrated throughout September.

The WHD's theme is "How young is your heart?" with the slogan "A heart for life". Atherosclerotic heart disease and strokes are the world's greatest killers of 17.5 million lives annually. Bulgaria is traditionally a leading country in the mortality rate with about 70 000 deaths annually from strokes and myocardial infarction - the fatal sequelae of cardiometabolic diseases including obesity, atherosclerosis, hypertension, diabetes, and metabolic syndrome. The WHD's aim is to encourage people to adopt a heart-healthy lifestyle to maintain a well-performing heart for life. The major WHD message is that the lifestyle choices people make today can slow the heart's aging and improve their heart functions tomorrow. While the heart's affections are not topic of the WHD, their impact, both positive and negative, may also target our heart health. In a following letter, the reader will be informed about the neurobiology of romantic love and its impact on human health. This letter deals with feeding behaviour as related to overweight and obesity and associated cardiometabolic diseases.

To be ready to cope  with the next shortage of food, our progenitors, in relaxing periods of their life, ate a lot of food, not only hedonistic behaviour but also as an adaptation reaction:  to accumulate calories to be used during the next famine. To become fatter meant to better be able to cope with such an aggressive environment. However, the genes that governed  such "thrifty" feeding behaviour during the famine-feast cycle,  in the past 50-60 years, when food availabilty has flourished, lead to being overweight, followed by obesity. Briefly, these same thrifty genes became obesigenic in the years of McDonalisation of our food culture. Todays's man takes in a surplus amount of food, believing in his evolutonary lessons that "the fatter, the better". Since  the anticipated  famine does not occur and because of less physical activity, the stored calories are not expended. Metaphorologically, we deal with genes' archaic memory of famine and feast, a fear of being hungry, which was scientifically coined "thrifty gene hypothesis"of obesity. In other words, while the pattern of "the fatter, the better" was biologically meaningful during the ancient time of our evolution, it became obesigenic in the present time. This is a brief scenario of how Homo Obesus has emerged on our small planet.

Indeed, today's man is surrounding by a huge amount of food that he eats hedonistically. Specifically, there is an increasing consumption of high-fat, high-sugar food that is very unhealthy. For instance, it was five kg sugar/yr per capita at the beginning of the 20th century, while recent sugar consumption is increased to about 50 kg/yr per capita. Dolce vita, that brings us diseases! Recent experimental and epidemiological studies indicate that calorie restriction may promote healthy longevity, the major target of both medicine and society. 

     In effect, the incidence and mortality of the so-called lifestyle, also dubbed quality of life (QOL)-related diseases (as indicated above), has been progressively increasing in the past five to six decades. With some exceptions, Japanese experience in stroke is a role model for preventive medicine, including longevity. It is known that Japanese enjoy an average life span of 85 years (for women) and 78 years (for men), the highest worldwide. Significantly, Japanese people who migrated to Brazil, where they modernised their food culture, live about 10 years less than Japanese who stayed in their home country.

In contrast, Bulgaria is a very negative example in respect to QOL-related diseases. Nationwide, there are no preventive strategies. Sadly, about 70 000 Bulgarians die every year because of myocardial infarctions or strokes. A combination of a high mortality rate and low birth rate has put Bulgaria in a severe demographic crisis. We have to face our health problems: today, most Bulgarians should be considered patients: the number of healthy Bulgarian is declining progressively. At all levels - family, society, economics and demography -  the loss of a life is the most tragic event.  Then, why at political level are health problems traditionally ignored in Bulgaria? 

Indeed, obesity is a pandemic event, and Homo Obesus is not a Bulgarian patent. According to the World Health Organisation, globally, a billion people are overweight, at least 300 million of whom are Homo Obesus.  In Europe (population of about 700 million) there are 130 million obese and 400 million overweight people, that is, a total of 530 million fat people are living in the obese European Union! The US is even worse: 35 per cent of adults are overweight and an additional 30 per cent are obese, that is, 180-190 million fat Americans, a source of more than 50 per cent of deaths in that country.    Our Government must support the development of an anti-obesity, heart-healthy programme.

The reader may be interested to know at least two biological criteria to diagnose if one is overweight or obese. These are body mass index (BMI) and waist measurement. If your weight is, for example, 70kg and your height is 1.75 m, divide weight in kg to height in square metres, and you have a BMI of 22.9kg/sq m, which is within the recommended values (20 - 24.9kg/sq m); having BMI of 25 - 29.9kg/sq m reveals overweight, whereas 30 - 39.9 kg/sq m is obesity, and a BMI over 40, very morbid obesity. Regarding waist measurement, risk increases substantially if a woman's is more than 88 cm (36 inches) or as a man, more than 102 cm (40 inches). At the time when the European Union proclaims that we have to build a knowledge-based society, it will be a sin if we do not improve our health culture, to escape being Homo obesus. And, at long last, to be Homo Sanus (the healthy man).

George N. Chaldakov, MD, PhD
Visiting Professor at Medical Faculties of Kanazawa, Japan and Nis, Serbia, Head of Division of Cell Biology, Medical University, Varna, Bulgaria, and chairman of the Bulgarian Society for Cell Biology.