Obesity is not the primary driver of poor health
I was putting together a lecture this weekend and started organizing my slides about metabolic disease and how it’s the biggest problem we are fighting and I realized that although that concept is common knowledge to me, that many people haven’t heard it. Although I tell all of my patients that when we are fighting excess weight, we are fighting biochemistry (not calories), the rest of the world may not know this stuff. So I figured I would throw a small portion of the lecture out here for all of you – to help you understand why we are losing the battle with weight. Why it’s time to start working on science – not assumption.
Most people think the biggest health problem we have today is excess weight – that the epidemic of obesity is the cause of most people’s poor health.
Most doctors are taught this in med school. It’s not a bad concept. As of 2018, over 42% of American adults are struggling with obesity. Another one-third have overweight – meaning over two-thirds of the adult population is currently struggling with excess weight. And this number keeps rising every year.
But let’s look at something very interesting: The US population currently contains 331 million adults. 42% of them have obesity – so 139 million.
About 80% of adults with obesity also have one or more chronic lifestyle diseases like type 2 diabetes, high blood pressure, high cholesterol, fatty liver, etc. We focus a lot on these people. We tell them that the most important thing they need to do – to get healthier and improve their diseases – is to lose weight. We have other tools to help treat their diseases – like medications – but the real solution is for them to jump from the red circle to the blue circle. And for the 20% of people with obesity who don’t have a chronic lifestyle disease – we tell them to lose weight too – so that they don’t get disease – and because it will help their joints and so forth.
But ponder this:
40% of the population without obesity also have one or more chronic lifestyle diseases. What about these 76 million people?
How are these people supposed to cure their lifestyle diseases? If cutting calories and losing weight is the key to curing the diseases for the people in the red, how do we cure the people in the blue? In fact, how do we explain them in the first place? If you can get these chronic diseases unrelated to weight – how can it just be about weight?
Maybe because it’s about something else. Maybe it’s time to acknowledge that something else besides excess weight and excess calories is driving this epidemic of chronic lifestyle diseases. If that were true, it would explain why eating less is not a cure-all for all chronic lifestyle diseases. More often than not, obesity is a consequence of metabolic disease. Instead of this:
we should be thinking about this:
So what is metabolic disease? Metabolic disease – or metabolic syndrome is a cluster of risk factors that dramatically increase a person’s risk for developing heart disease, stroke, and type 2 diabetes. There are multiple definitions of this syndrome but they all involve insulin resistance. And the data is absolutely clear that metabolic disease is related to diet. The standard American diet leads to the standard American diseases -> most notably, metabolic syndrome.
Metabolic Syndrome (NIH criteria) – includes 3 or more:
- Waist circumference ≥35” (women) or ≥40” (men)
- Triglycerides ≥150 mg/dl
- Low HDL cholesterol: <50mg/dl (women) or <40mg/dl (men)
- Elevated blood pressure: ≥130/85
- Elevated fasting glucose: ≥100mg/dl
As you process this, take a minute to stop & think why this isn’t the lead story when it comes to health. Why do we keep hearing about calorie counting instead of science?
Big food & beverage companies spend billions of dollars every year in marketing – making sure you hear that calorie balance formula – over and over again. Why? Well, if you are the ones profiting off of the foods that are causing the problem, it is in your best interest to deflect the blame on to something else. Repeating the calorie balance hypothesis puts the blame on the consumer – not the products. Think about it. Most of us blame our excess weight and chronic lifestyle diseases on our own inability to balance our calories – or our lack of self-control. On our lack of willpower. Sound familiar?
It’s time to stop and start talking about science.
If you need more help or have questions, you know where to find me!
Have a wonderful mid-November and stay safe. Wear your masks, wash your hands and if you have it, start treating your metabolic disease. It only takes a few weeks of health to start turning this process around. Doing it – reducing the inflammation associated w/ metabolic disease – can be the difference between life and death if you are infected with COVID-19.
Courtney Younglove, M.D.