The Obesity/Diabesity Pandemic

Obesity is a major risk factor for the development of  type 2 diabetes mellitus, so much so that the epidemic is often called diabesity. It has been described as one of the most important crises that has invaded our public health system.

Global Statistics,  Source: Lancet

• Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014.
• Diabetes is fast becoming a major problem in low and middle-income countries.
• From 1980 to 2014, the prevalence of diabetes more than doubles for men in India and China.
• Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.

So what are some solutions?  

The standard American diet is in much need of an overhaul and our national food systems need to change if we wish to reverse or at least slow down this trend. Many say that it would take the same determination as the campaigns to change behaviors that were utilized during the campaigns against smoking. .

Prevention awareness should be first on the front lines of treating the people with prediabetes that can often be reversible using lifestyle modifications. There are already some prevention models in the community; however, these should be expanded so that they become more easily accessible to more people. The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). When this program is followed, the number of people progressing to have diabetes comes down by more than half. In people over 60, the reduction was 70%.

Nutrition education should be incorporated into the school system in the early years to help young children understand the importance of knowing where our food comes from and why nutritious foods are the best choice. They can be taught about balanced eating, calories, reading labels and grocery shopping. Nutrition education can also be offered at the middle and high schools levels by returning to a revamped and modernized home economics course in the curriculum. 

A lingering problem has existed for many primary care physicians for many years in that they say they were never adequately prepared in nutrition principles in medical schools. In a survey of family physicians (2009), two thirds said that dealing with extremely obese patients is “frustrating “and one-half said treatments are often ineffective. This is reflected by a lack off obesity training.

Shockingly, another survey in 2010 of 140 doctors revealed that nearly one-third were not even familiar with the American Diabetes Association (ADA) prediabetes guidelines. Only 6 percent were able to identify all 11 risk factors and on average, the doctors could only identify just eight of the warning signs. Only 17 percent knew the correct laboratory values for blood glucose and only 11 percent said they would refer a patient to a behavioral weight loss program..

There should be an increased access to professional treatments. Medical professionals not trained in obesity management should refer their patients to outside providers such as dietitians, exercise trainers, behavior therapists, psychologists, or a new concept of health coaches. These providers should be trained, certified, and credentialed to protect the public from unscrupulous treatments and to provide quality care. Reimbursement of qualified health professionals needs to be enhanced to keep. Otherwise patient volume high and they lessen out-of-pocket expenses.

We have become a nation of non-cooks and prefer to have our meals prepared by someone else. Encourage home cooking and home kit meals to help to counter using fast foods and packaged highly processed meals loaded with calories, fat, sugar and salt.

Educate the public on food labeling including ingredient lists. Beware of food companies that promote products with a “health halo” meaning exaggerated claims are made that appear to make unhealthy foods seem healthy because of an added nutrient or ingredient. Corporations also mislead consumers with their labeling so they include four different types of sugar to keep sugar from being listed as the first ingredient. This is misleading to the consumer when attempting to make wise food choices.

Stop corporate-government partnerships and diminish lobbying.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by myriad food companies such as Coca-Cola, PepsiCo and Kellogg’s. The dairy industry has a long history of influencing the food pyramid and Dietary Guidelines. A good example is the placing of a glass of milk on the MyPlate Logo.

Another health organization guilty of taking in millions from food companies is the American Heart Association. They offer a “Heart – Check logo for a price: $5, 490 to $7,500 that is renewable for another fee annually. The product has to be low in fat, saturated fat and cholesterol to gain this “honor.” However, some products such as Boar’s Head processed meats have the logo and still may still contain high levels of sodium. If the AHA were sincere in their efforts to help consumers choose healthier foods to rein in obesity/diabetes, they would realize that research has shown that a 1.8 oz. daily serving of processed meat raised the risk of diabetes by 19 percent and heart disease by 42 percent. Most current dietary recommendations emphasize a reduction in processed meats (my emphasis).

There is bad news on rising obesity rates – read about them HERE.

It will take a concerted effort from government, politics, industry, communities, and consumers and the perpetrators of our obesigenic culture to begin to change this trend.

The authors of a study found that 70 percent of mouse genes respond to time-restricted eating.

Satchidananda Panda, PhD – Salk Institute for Biological Studies

“By changing the timing of food, we were able to change the gene expression not just in the gut or in the liver, but also in thousands of genes in the brain,” the authors say.

Nearly 40 percent of genes in the adrenal gland, hypothalamus, and pancreas were affected by time-restricted eating. These organs are important for hormonal regulation. Hormones coordinate functions in different parts of the body and brain, and hormonal imbalance is implicated in many diseases from diabetes to stress disorders. The results offer guidance to how time-restricted eating may help manage these diseases.

Interestingly, not all sections of the digestive tract were affected equally. While genes involved in the upper two portions of the small intestine — the duodenum and jejunum — were activated by time-restricted eating, the ileum, at the lower end of the small intestine, was not. This finding could open a new line of research to study how jobs with shiftwork, which disrupts our 24-hour biological clock (called the circadian rhythm) impact digestive diseases and cancers. Previous research by Panda’s team showed that time-restricted eating improved the health of firefighters, who are typically shift workers.

The researchers also found that time-restricted eating aligned the circadian rhythms of multiple organs of the body.

“Circadian rhythms are everywhere in every cell,” says Panda. “We found that time-restricted eating synchronized the circadian rhythms to have two major waves: one during fasting, and another just after eating. We suspect this allows the body to coordinate different processes.”

Next, Panda’s team will take a closer look at the effects of time-restricted eating on specific conditions or systems implicated in the study, such as atherosclerosis, which is a hardening of the arteries that is often a precursor to heart disease and stroke, as well as chronic kidney disease.

Other authors include Shaunak Deota, Terry Lin, April Williams, Hiep Le, Hugo Calligaro, Ramesh Ramasamy, and Ling Huang of Salk; and Amandine Chaix of the University of Utah.

The research was supported by the National Institutes of Health (grants CA258221, DK115214, CA014195, and AG065993) and the Wu-Tsai Human Performance Alliance.

Micronutrient Needs of Older Adults

Source: Smolin and Grosvenor. Nutrition: Science and Applications, Third Addition

Changes in digestion, absorption, and metabolism affect micronutrient status and may contribute to the development of some of the disorders that are common in older adults.    

This may be a concern especially for the B vitamins, and vitamin D, iron, and zinc.

B vitamins 

The only B vitamins for which recommendations differ between older adults and younger adults are vitamins B6 and B12. The  RDA for B6 is greater to maintain levels while the RDA for vitamin B12 is not increased, but is a nutrient of concern because of both reduced absorption and low dietary intakes among some groups like vegans. Also as we age, many people develop a condition called atrophic gastritis from a lack of acid in the stomach necessary for the absorption of vitamin B12. Eating fortified foods or taking a supplement under the guidance of a physician are the best way to counter this situation. 

Folate is another B vitamin of concern. Low folate along with inadequate levels of B6 and B12 may result in an elevated homocysteine level which increases the risks of cardiovascular disease. The fortification in grain products began in 1998 has increased the intake of this vitamin, however, when folate is consumed in excess, it can mask signs of a vitamin B12 deficiency and go untreated. Again, consuming any vitamin is unnecessary in excess and should be supervised by your primary care doctor or a trained dietitian.

 Vitamin D 

Vitamin D is necessary for adequate absorption of calcium which is also a concern in elderly people.  Intake is often low and synthesis  in the skin is reduced due to limited exposure of sunlight and because the capacity to synthesize vitamin D in the skin decreases with age. 

Iron 

The iron needs in women decline sharply at menopause when blood loss has ceased.The iron needs of men do not change., Nonetheless, iron-deficiency anemia is common in the elderly often due to chronic blood loss from disease and medications and poor absorption due to low stomach acid and antacid use. 

Zinc 

The RDA for zinc has not changed in older adults, but low energy intakes as well as absorption, stress,  trauma, muscle wasting  and OTC medications can all contribute  to poor zinc status. The consequences can  contribute to malnutrition by reducing food intake, Reduction in immune function and wound healing increases the risk of infection, which can also impair  nutritional status.

Food Guidelines: The Blue Zones Way

 Is Eating Fast Food a Dementia Risk? 

The health risks of eating ultraprocessed foods —including sausages and burgers as well as pizza and ice cream — are well documented. They have been shown to raise the risk of obesity, diabetes, and cancer among other chronic ailments. (CNN.com). 

In a new study, researchers followed more than 10,000 Brazilians with an average age of 51 for more than 10 years. They found that people who consumed more than 20% of their daily calories from ultra processed foods had a 28% faster cognitive decline compared with those whose intake was less than 20%.  Unfortunately, that 20% is not a high threshold: just 400 calories out of the 2000 calorie diet. And most Americans are well over that, getting on average a whopping 58% of their calories from ultraprocessed foods.

 “The sample size is substantial and the followup extensive,” says Dr. David Katz, a nutrition specialist who was not involved in the study. While short of proof, this is robust enough that we should conclude ultraprocessed foods are probably bad for our brains,” 

Source: The Week. December 23, 2022, Volume 22, Issue 110.