Obesity Isn’t Going Away

Obesity rates continue to rise, continuing a process that began in ernest more than 20 years ago. A survey this year by the Centers from Disease Control (CDC)1 identified over 32 states with more than 25% of its adult population in the obese category. Six states (Alabama. Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia) had obesity rates of over 30%.

These numbers have an effect on health care costs. The cost of treating an obese person in 2001 was $3450.00, and by 2006 it was $5150.00. Comparable figures for the overweight were $2800.00 and $3315.00.

To many who study the causes of this overweight and obesity epidemic2, one of the main dietary culprits is the increasing consumption of high fructose corn syrup (HFCS). Very little (20%) of the fructose consumed by Americans is in its natural form in fruits and vegetables. In its whole food form, fructose is accompanied by fiber which slows absorption, has low calories, satisfies hunger, and controls weight.

High fructose corn syrup, found in many soft drinks and processed foods, lacks fiber and other nutrients, and not only fails to satisfy hunger, but stimulates it. Fruit juice has similar effects when separated from the whole fruit.

Dr. Miriam B. Vos and colleagues of Emory University reports3 that in adolescents aged 12-18, over 12% of daily energy comes from HFCS, and a quarter of them get over 15% of daily energy from it. The main source is sweetened soft drinks.

What are the effects of this choice of beverage? High fructose intake is associated with increased fat production by the liver, and increased blood fats, insulin resistance, and obesity. Total fructose intake also predicts formation of small low-density LDL, which is strongly linked to heart disease.

In addition to the weight gain and disease risk effects, soft drinks are taking the place of milk which provides calcium and vitamin D, both of which are essential for bone formation during adolescence, particularly for girls.

So how much greater is your risk of disease or death when you are overweight or obese? By looking at the results of 57 different studies together4, involving almost 900,000 people in Europe and the U.S., researchers found that death rates were lowest in those with a BMI of 22.5 – 25, i.e., in the healthy range.

For every 5 points the BMI increased:

• Overall death risk went up by about 30%
• Heart disease death risk rose by 40%
• Risk of death from diabetes and its associated diseases of the kidney and liver rose by 120%
• Cancer death risk rose by 10%
• Death from lung disease and all other causes each rose by 20%

The authors of this study also comment that it is probably easier to avoid excessive weight gain in the first place, rather than trying to lose it later in life.

A direct outcome of a diet which contains too much refined carbohydrate such as HFCS, white bread, potatoes, rice cakes, processed breakfast cereals, and pretzels is not only weight gain but also high blood sugar. New research shows that high blood sugar is now one of America’s most common killers.

According to Harvard researchers5, there were between 163,000 and 217,000 deaths caused by high blood sugar that could have been avoided. High blood sugar levels are associated with overweight/obesity and diabetes risk, but also other metabolic diseases which may be untreated for a long while.

This point is made in a presentation6 by Dr. Adam Tabak of University College London describing how insulin resistance due to high blood sugar levels begins up to 13 years before type 2 diabetes is diagnosed.

This means that if you are overweight/obese with high blood sugar levels, you are probably insulin resistant. Your pancreas is working hard producing insulin in an attempt to get your blood sugar lower, but insulin resistance won’t allow blood sugar to fall. This is an inflammatory state, and damage is being done to blood vessels and organs like heart and kidneys.

According to Dr. Tabak, this situation can continue for up to 13 years before your pancreas becomes exhausted and no longer produces enough insulin. At this point you receive a diagnosis of type 2 diabetes. Already, a great deal of irreversible has been done which increases risk of heart disease, kidney disease, and nerve damage leading to amputation.

This makes obvious why the overweight and obese incur higher medical costs. The kinds of diseases mentioned are expensive to treat, not to mention devastating to quality of life.

So yes, it does matter whether or not you are carrying a few extra pounds. Even at quite low levels of overweight, risks increase significantly. The overweight and obesity in both adults and even more worryingly, children are a ticking time bomb, the costs of which we all will contribute to in one way or another.  Tragically, the great majority of this accelerating disaster is avoidable if the right lifestyle choices are made.

kai kapai,

adiposer

References

1. Centers for Disease Control. News Release, 08 July, 2009.
2. Medscape J Med. Published online 09 July, 2009.
3. M.B. Vos et al. Medscape J Med. Published online 09 July, 2009.
4. G. Whitlock et al. Lancet. Published online 18 March, 2009
5. G. Danaei, E.L. Ding, D. Mozaffarian, et al. Public Library of Science Medical Journal. 2009; Vol 6.
6. A.G. Tabak. American Diabetes Association 69th Scientific Sessions: Abstract 1050-P. Presented June 8, 2009.

Fitness is a Lifelong Process

If your ambition is to succeed in controlling your weight and avoiding the metabolic diseases of overweight and inactivity, then the lifestyle you adopt to achieve this must be lifelong.

Three recent studies all point to the same conclusion; fitness needs to begin in childhood and maintained throughout life, maintaining muscle mass is one of the keys to avoiding type 2 diabetes, and it is probable that more than the recommended amount of exercise is needed to prevent weight regain after weight has been lost.

In the first case, an Australian study (1) shows that children with low levels of cardiorespiratory fitness often have even lower fitness levels as adults. If this is the case, they also have increased risk of obesity and insulin resistance.

Conversely, if high activity levels and fitness can be established in childhood, there is a greater chance of being more active in adulthood. This higher activity level maintains adequate cardiorespiratory fitness, and lowers the risk of becoming obese and suffering from type 2 diabetes.

Implicit in maintaining your fitness level is that it will in turn help conserve your muscle mass. In fact the only way to conserve muscle is to exercise the muscle, preferably in a way that stresses the muscle beyond what it is used to. In this way, muscle mass will actually increase which helps burn more calories even at rest and improves insulin sensitivity which assists blood sugar control and lowers diabetes risk.

A group of Japanese researchers (2) has recently found that a low level of a substance found in muscle called creatine, and which shows up in your blood as creatinine, is a predictor of increased diabetes risk. People with low muscle mass have low levels of muscle creatine, and low levels of blood creatinine.

The study suggests that exercise, and in particular resistance exercise (weights, exercise bands, etc), which increases muscle mass will increase creatinine and reduce diabetes risk.

Finally, yet again, it has been found (3) that the commonly recommended 30 minutes of moderate exercise on 5 days a week, or 150 minutes a week, might not be enough. This was shown to be the case among women who had lost 10% of their body weight and were trying to keep the weight off.

Women who had succeeded in losing 10% of their weight were assessed 2 years later, and those who did 55 minutes a day, 5 days a week, or 275 minutes a week, kept off all the lost weight. This amount of exercise burned about 2000 calories a week.

Those exercising less regained some of the lost weight. For women who had only lost 5% of their weight, 2 years later, the 30 minutes a day, 150 minutes a week program kept their lost weight from returning. Note that as well as exercising, both groups of women were consuming 1200 to 1500 calories a day.

So if keeping off a 5% weight loss is your goal, the 30 minutes a day/150 minutes a week should do it. But keeping off a 10% loss takes 55 minutes a day/275 minutes a week, which will burn about 2000 calories per week. In either instance, eating 1200 to 1500 calories a day is the limit.

Avoidance of chronic metabolic disease, type 2 diabetes in particular, is a lifelong process, beginning in childhood and lasting well into maturity. The choices you make as to diet and exercise are the key.

Kai kapai

adiposer

References
T. Dwyer, C.G. Magnusson, M.D Schmidt, et al. Decline in physical fitness from childhood to adulthood associated with increased obesity and insulin resistance in adults. Diab Care 2009;32:683-687.
N. Harita, T. Hayashi, K. Kogawa Sato, et al. Lower serum creatinine is a new risk factor of type 2 diabetes. The Kansai Healthcare Study. Diab Care 2009;32:424-426.
J.M. Jakicic, B.H. Marcus, W. Lang, C. Janney. Arch Intern Med. 20080;168:1550-1559-1559-1560.2

A common refrain from those burdened by overweight or obesity is, “Oh, it’s genetic. My parents and other relatives struggled with being heavy, and I’m the same.” Those not persuaded by these justifications, might make a reply reflecting some other point of view, such as :

• Genes are not destiny

• While you can’t control your genes, you can control your environment

• Hog wash; you eat too much and exercise too little

For all three replies, there is some recent validation. Some people do indeed have a quite common genetic mutation which favors weight gain. But they can reduce their risk of obesity via physical activity. A recent study (1) says that those who had the mutation, but were also physically active, tended not to gain weight.

Physical activity not only burns calories, reduces weight gain, improves insulin sensitivity, and allows blood sugar to be more easily burned by muscles. It can also blunt the effect of the genetic abnormality that predisposes towards weight gain.

Although it takes a significant amount of exercise to burn enough calories to lose significant weight, besides reducing a predisposition for weight gain, it also improves insulin sensitivity which is key to keeping type 2 diabetes at bay.

One of the favorite excuses for those resigned to a lifetime of overweight or obesity is now in serious question. A common genetic propensity for weight gain can be offset by physical activity. And even if your overweight/obesity is not caused by a genetic anomaly, you should be exercising anyway, if only to maintain your insulin sensitivity. That alone will significantly reduce diabetes and other metabolic disease risk.

Kai kapai,

Adiposer

References

1. Arch Intern Med, 2008;168:1791-1797

Introduction

Prologue
The ambition for this initial positing is to set the stage for what will follow by giving a brief background of the underpinnings (etiology) of the cluster of diseases known as the metabolic syndrome. Later entries will be less formal in tone and merely comment on the recent research findings which have a bearing on lifestyle-related causes and cures for these diseases.

The most-recognized metabolic abnormality is type 2 diabetes, but before a diagnosis of diabetes is made, the average sufferer has had the disease for 9-10 years. And prior to that, there is a lengthy period of being insulin resistant with impaired glucose metabolism. During this time, a great deal of unnoticed damage is done to arteries, veins and major organs by persistent:
• high blood sugar levels (hyperglycemia/glucotoxicity)
• high blood fat levels (hyperlipidemia/hypertriglyceridemia/lipotoxicity)
• proinflammatory state, evidenced by high c-reactive protein(CRP), and other inflammatory markers

Early intervention in these abnormalities is essential to reduce the damage. Both prevention and control of diabetes by lifestyle change has been found to be more effective than by reliance on drug therapy (pharmacotherapy). Not to mention a whole lot less expensive. This lifestyle change intervention is referred to in the literature as theraputic lifestyle change (TLC) or medical nutrition therapy (MNT). This approach to prevention of metabolic disease is endorsed by such organizations as the American Diabetes Association (ADA) and the American Heart Association (AHA).

Upcoming postings will comment on what the peer reviewed research is saying about the causes and cures, as dictated by lifestyle choices.

Kai kapae to you,

Nick