Obesity in America


A rather startling report by the Centers for Disease Control and Prevention was published in the Journal of the American Medical Association last week warning that overweight or obesity was becoming an epidemic that threatens to surpass tobacco use as the leading cause of preventable illness in America.   The National Institutes of Health issued their report last year, and the Food and Drug Administration has issued its report.   All of these reports are in agreement with the CDC's conclusions.


Here in Southern California where what you appear to be is as important as what you really are, avoiding excess poundage is almost a religious effort to many.   Yet as a physician in practice here for over twenty-five years, I can say that obesity is rampant and is related directly to the cause or exacerbation of many conditions that occupy my clinical practice.


If you move about our country, especially to the Mid-West and Southeast, it becomes literally abundantly clear that America has become “supersized”.   The “shifting” demographics have even prompted our airlines to alter their considerations for seat sizes and weight limitations when designing future aircraft.


The CDC report suggested that dietary indiscretion (quality and quantity) combined with physical inactivity (biblically known as gluttony and sloth), contributed to 400,000 deaths in the year 2000, a third more than 10 years previously.   Tobacco-related deaths increased by less than 9 percent in that same interval, attributable in my estimation to aggressive public health and restrictive advertising policies.


The problem is this.   The metabolic changes that occur with obesity are far more than just physical appearance, the improvement of which motivates many individuals to action.   The things you cannot see are the real culprits here.   Blood pressure elevation may increase the risk for stroke, heart failure, coronary artery disease, aortic aneurysms and kidney failure.   Blood fat profiles may deteriorate to potentially lethal levels by often profoundly lowering the good cholesterol, HDL-cholesterol and raising the level of bad atherogenic lipoproteins.   Larger fat cells that accompany obesity make the body more resistant to insulin, often unmasking a tendency for diabetes.   In cardiovascular disease, diabetes is another epidemic in which three-quarters will die a premature cardiovascular death.   The fat cells inside the body cavities may trigger chemicals known as chemokines that may trigger inflammatory changes in blood vessels that may precipitate an acute cardiac event like a heart attack.


Once disease becomes manifest, medications may be prescribed.   Medications involve cost and potential adverse effects that may compound being sick with additionally being poor and miserable to boot.   Multiple medical conditions arising from the fundamental problem of obesity may only add additional cost and potential for drug interactions.


Seems like a rather bleak scenario for an avoidable problem.   Weight loss, especially when combined with even a modest exercise program can reverse many of the pathological physiologic conditions I outlined earlier.   Hey, I'll even give you a twenty-minute head start like in the LA Marathon.   If the goal is at least 30 minutes of modest exercise three times a week, starting off with a 10 minute walk and adding 5 minutes every week or two until you get to the 30 minute goal is what I suggest to patients almost every day.   Any weight loss is better than weight gain, and the benefits in blood pressure, blood fats, insulin sensitivity and less wear and tear on weight-bearing joints and spine are clearly worth it.   And you'll need doctors less, and perhaps even avoid taking the medications that you didn't want in the first place.


And one other button I push a lot with my patients.   It's human nature to rationalize one's own behavior, and thus avoid doing things even if you know you should.   But obesity has become an epidemic in children as well, with long term epidemiologic studies documenting the subsequent health and social hazards befalling overweight children compared to their lean counterparts.   Go to any shopping mall.   Fat parents have fat children.   It's not always genetics.   Learned lifestyles need to be unlearned.   Lose weight so you can be around for them, and so they don't learn habits that will haunt them for life.


And, yes, I know all the stories of people with bad habits, who ate what they wanted, drank what they wanted, and never exercised and yet lived to be 100.   Good genes are wonderful if you picked your parents carefully.   Just don't bet your life on it.