The Obesity Burden?

The Burden of Obesity Is Not Carried Equally

— Misconceptions are hurting the fight for health equity in communities of color

by David Satcher, MD, PhD August 26, 2022

UNHEALTHY PROCESSED FOOD AND SNACKS CAN LEAD TO OBESITY

“Since leaving my post in 2002 as the U.S. Surgeon General, the nation’s leading public health role, America has made great strides in battling public health crises. From reducing tobacco use and improving maternal and child health, to most recently advancing vaccine technology to fight the COVID-19 pandemic. Yet, another epidemic has gained strength, debilitating and killing millions of people on its deadly upward trajectory. The chronic disease of obesity is a misunderstood condition impacting millions of Americans from every demographic group living in every corner of the country. Unfortunately, obesity and comorbid diseases disproportionately impact communities of color in nearly incalculable ways.

In the early 2000s, the national adult obesity rate was 30.5% and we had made progress on achieving many health goals related to heart disease, type 2 diabetes, cancer, and multiple other chronic health challenges. Back then, my office released “The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,” which underscored the increasing severity of obesity’s impact on our collective health and outlined a vision for the future. Today, the adult obesity rate has climbed to 42.4% and is projected to reach nearly 50% by 2030.

Disparities in obesity rates between racial and ethnic groups are stark. The latest data show that non-Hispanic Black adults have the highest age-adjusted prevalence of obesity in the country at 49.6%, followed by Hispanic adults at 44.8%, and non-Hispanic white adults at 42.2%. Obesity is also a significant health challenge among American Indians and Alaskan Natives, with adults in those communities 50% more likely to have obesity than white adults. Furthermore, a projection of obesity rates found that “severe obesity” will become the most common BMI category among non-Hispanic Black adults (31.7%) — as well as among women (27.6%) and low-income adults (31.7%) — by 2030.

Despite researchers making significant advances in the last 2 decades, obesity is too often myopically viewed as the result of an individual’s lifestyle choices around diet and exercise. Viewing the disease through this lens omits that body weight is determined by a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic factors. In fact, we know that a significant proportion of obesity can be influenced by genetics.

While recent scientific discoveries have greatly improved obesity care options, our collective effort to stem the tide of the disease has fallen short. Obesity is a public health crisis deserving maximum effort from policymakers, healthcare providers, insurers, and community partners working in concert to dramatically reduce the burden of this disease.

Our politicians and policymakers must focus on the core causes and dire consequences of unchecked increases in obesity rates among the people they serve. It is imperative that updated federal, state, and local policies grant equitable access to the full continuum of obesity care. Healthcare providers must seek continuing education on advances in metabolic science and the availability of pharmacotherapies that are proven to safely reduce disease prevalence and the impact of comorbid diseases. Insurers must take a long view of obesity care, taking immediate action to close coverage gaps that block access to obesity trained physicians, consultation with nutritionists, physical therapists, and prescriptions for FDA-approved metabolic therapies. Our community leaders must advocate for healthcare equality and equitable access to obesity care to lift the physical, mental, and financial burden of the disease on all Americans, especially Black and brown people.

I believe generating coordinated, sustained solutions for a positive impact on obesity in America will come from the hard work of public health stewards, policymakers, healthcare providers, and community leaders at the intersection of health equity and policy. I am making a renewed call to action for the challenging situation we find ourselves in. Every one of us deserves the opportunity to live our healthiest life. It is time we remove the impediments to health equity through access, and promote a path that eliminates the obesity epidemic persisting in communities of color across our nation.”

David Satcher, MD, PhD, is the 16th U.S. Surgeon General and the founder of the Satcher Health Leadership Institute.

Those interested should also read the book by Sandra Aamodt, Ph.D., Why Diets Make Us Fat: The Unintended Consequences of Our Obsession with Weight Loss. More emphasis should be placed on the development of how to control or manage damaging weight regain after endless weight loss attempts. Sally Feltner, M.S, Ph.D.

One in two US adults have diabetes or prediabetes

In the latest edition of Nutrition Action from Center for Science in the Public Interest, December 2022, there is a very comprehensive article on Diabetes type 2. Here are the important takeaways. The article was written by Bonnie Liebman.

“Fifteen percent of U.S. adults have diabetes. Another 38% have prediabetes (and 8 out of 10 of them don’t know it). The good news: Many cases can be prevented and, in some people, even reversed.”

        Prevention is the key with the practice of lifestyle changes in diet and exercise.

The Bottom Line:


“The best way to dodge prediabetes is to lose (or not gain) extra pounds.

Cutting carbs –  especially white flour, potatoes, juice and sugary drinks- may help lower blood sugar even if you don’t lose weight.

Replace unhealthy carbs with unsaturated fats like olive oil or canola oil, nuts, avocado, and fatty fish.

Fill half of your plate with nonstarchy vegetables.

Aim for at last 30 minutes of brisk walking or other aerobic exercise daily.

If you have type 2 diabetes, don’t try a very-low-calorie or a low-carb diet without a doctor’s or dietitian’s help. They may cause dangerously low blood sugar, and your doctor may need to adjust your medications.

If you have prediabetes, find a CDC-recognized-in-person or online Diabetes Prevention Program. (Go to cdc.gov/diabetes/prevention.)”

Source: Nutrition Action\ December 2022.

Weight Gain? The Brain and Gut Disconnect?

“A good predictor of who will gain weight is who says they plan to lose some. Last year, 108 million Americans went on diets. Long-term studies of dieters find that they’re more likely to end up gaining weight in the next two to fifteen years than people who don’t diet.” Sandra Aamodt, Ph.D. Why Diets Make Us Fat. 2016.

Rebound’ Weight Gain: A Disconnect Between Brain and Gut May Be a Factor

Healthline. By Christopher Curley, September 15, 2022

Fact Checked: Jennifer Chesak

“Experts say weight gain after weight loss is common among adults and children.

  • Researchers say a new study indicates that a disconnect between the brain and the gut may be a reason that people tend to gain weight after initially losing weight.
  • They say in many people who have lost weight their gut will tell them they’re full after eating a meal, but their brain will try to tell them they’re still hungry.
  • Experts say the disconnect may be due to the body’s attempt to store fat during weight loss.

Nearly halfTrusted Source of adults in the United States try to lose weight each year, but many will not keep that weight off long-term.

In fact, only about one in five people who are overweight can maintain weight loss for a year or longer, research showsTrusted Source.

While there are many competing theories about why that is, ranging from psychological to biological, a new study of children with obesity suggests the answer might lie in a disconnect between gut hormones and brain signals.

Researchers at Seattle Children’s Hospital in Washington put children with obesity on a 24-week weight loss program, monitoring their brain activity and gut hormone responses before and after the trial.

At the end of the weight loss program, the researchers reported that after eating a meal the children’s gut showed normal levels of regulatory hormones indicating that they were full and satisfied.

Their brains, however, showed levels of activity signaling that they were still hungry.

The researchers also found that the more weight a child lost, the more likely they were to react to food cues after completing a meal —their brain essentially telling them they were still hungry while their gut was telling them the reverse.

“Our results imply that during weight loss intervention, your body acts to conserve fat through maintaining hunger responses in the brain and that this needs to be addressed,” Dr. Christian Roth, a lead study author and professor at Seattle Children’s Hospital, said in a press release.

Roth said larger, more extensive studies would be required to confirm these findings.

“It would also be useful to investigate how long the disconnect between central and local appetite regulation persists after maintained weight loss, to guide intervention plans,” he added.

“This is a very interesting study and I think that a lot of these findings are applicable to adults as well,” said Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California.

“I see in my patients that they feel the need to eat, even if their stomach feels full,” Ali told Healthline. “There is certainly a strong psychological component to eating behavior that surgery and medications cannot always address completely.”

“I feel this research is on the right track and we need to find a way to satisfy the brain as well as the gut,” he added. “This will require extensive research in both children and adults to find the right solution.”

Beyond hormones

One of the more notable aspects of the study is how it complicates our understanding of how hormones affect appetite and rebound weight gain.

Previous studies have shown that an increase in appetite hormones after weight loss might be a key driver of these rebound gains.

The results of this study paint a more nuanced picture where even if gut hormones are normal, the brain is out of sync.

“The study underscores our understanding of obesity and weight homeostasis as a chronic disease of the brain,” said Dr. Mert Erogul, an attending physician at Maimonides Medical Center in New York.

“The regulation of appetite is enormously complex and layered,” he told Healthline. “From the digestive tract, there are hormones that signal fullness, such as leptin, CCK, and peptide YY. There are also hormones that signal hunger, such as ghrelin. These are in constant interplay with seemingly subjective feelings that come from the brain such as food preference and liking as well as motivation to eat.”

Ultimately, experts say this may require a holistic approach to weight loss and maintaining a healthy weight.

“Rebound weight gain is very common and happens for many physiological, behavioral, and psychological reasons,” said Dr, Steve Patching, a medical director of bariatric surgery at Sutter Hospital in Sacramento, California.

“Believe it or not, weight loss actually sets up your body for weight gain,” he told Healthline. “This is because the body always strives for symbiosis. This is why we often still feel hungry or even starving after we eat a ‘normally satiating’ meal. It is also why correct weight loss should be done slower than we often want.”

Weight loss needs to occur in the context of a durable commitment to changes in diet and lifestyle,” he said. “Even then, obesity medicine specialists recognize that people who are overweight often need lifelong therapy with medications to maintain weight loss.”

Immunity and Metabolic Syndrome

The Metabolic Syndrome and the Immune System

The metabolic syndrome is not a disease alone but is a cluster of related disorders that include:

  • Excess fat around the waist (>40 inches or more (men)and >35 inches or more for women).
  • Blood pressure of 130 /85 mmHg or higher, or being on blood pressure medication
  • Triglycerides above 150 mg/dl
  • Fasting blood glucose greater than 100 mg/dl, or being on glucose-lowering medications
  • High density lipoprotein (HDL) less than 40 mg/dl for men or less than 50 mg/dl for women.

A person can be considered to have metabolic syndrome if they have at least three of these conditions.

An important function of the immune system is to provide healthy, short-term (acute) inflammation that is normal in most situations. This is necessary for the immune function to battle injuries made from disease-causing bacteria, and viruses (antigens). What results is redness, swelling, heat, sometimes fever, and pain.

However, one of the unhealthiest conditions is paradoxically chronic inflammation that ultimately can result in complications, and even a greater risk of death. The greater overreaction of immune system components is often referred to a “cytokine storm”. Cytokines are small proteins that are used to convey information. I call them “messengers”. They play a crucial role in the development of diseases and how your cells are able to respond. In a sense, cytokines are the language of your immune system.

Chronic inflammation can come from the accumulation of belly fat as well as low levels of HDL cholesterol, which normally can have anti-inflammatory properties. (Scott Butsch, MD, Director of Obesity Medicine at the Bariatric and Metabolic Institute at Cleveland Clinic.)

“Those with metabolic syndrome typically have low levels of HDL and thus, have less of its beneficial properties to fight infection”, says Dr. Butsch. This can also occur with aging, poor diet, and other unhealthy practices.

How Does Obesity affect the Immune System?

“One of the many reasons obesity is such an unhealthy thing is that fat tissue produces loads of inflammatory cytokines. So even on a good day, an obese person has a lot of inflammatory biomarkers (signals) in their system. When infected by the coronavirus, for example, their starting point is already worse, they are already more inflamed than they should be. In any case, the coronavirus pandemic was a stark reminder of why your immune system is so incredibly important and why we should all benefit from understanding it better.” (Immune: A Journey into the Mysterious System that Keeps you Alive. Philipp Dettner. 2021).

According to Dr. Butsch, “obesity impairs the response of immune cells that “remember past viruses so you can attack that virus effectively the second time you may encounter it. This is why obesity is linked to an increased failure of vaccines”

How Can You Improve Immunity with Metabolic Syndrome?

“Losing weight is the key to improve your metabolic syndrome biomarkers as well as your immune system responses. When you lose some extra weight, your fat cells shrink and cause an improvement in systemic chronic inflammation,” Dr. Butsch says. Increasing your physical activity may also help. In this case, this is one time that eating less and moving more is primary to decreased inflammation, metabolic syndrome biomarkers and its complications from infectious diseases.

Weight Loss: The Good News

CLICK HERE.

The Metabolic syndrome may not be a household phrase, but it should be. It’s been estimated that more than 30% of the U.S. population may have this disorder. It is defined as a cluster of symptoms that include excess fat around the waist, high blood sugar, high blood pressure, low levels of HDL and high triglyceride (blood fat levels). Diagnosis involves having at least three of these conditions.

The good news is that even a small weight loss (at least 10% of your current weight) may have a positive effect on your health.

Going Vegan?

Lose weight and live longer on a vegetarian diet.? From the Harvard Medical School Health Guides

There is a lot of attention being paid to switching to a plant-based diet. There are many published articles and recipes on plant-based diets to achieve a lower body index, lower blood pressure, and reduced risks for heart disease, diabetes, type 2, cancer, and longevity. Plenty of attention is being paid to the health benefits of those centenarians living in the Blue Zones, particularly ones that live in a plant-based environment as well as those with a more modified vegetarian approach. I suggest you search for more posts on these excellent topics on the “Blue Zones” on this blog or check at your local library.

If you’re thinking of going vegetarian but worried about making such a big change, there are several ways to try to see if you can manage a diet with less animal protein.

Here are some options:

  • A flexitarian diet – meat is limited as a condiment and not considered the main attraction. Use vegetables, appetizers instead.
  • Semi vegetarian diet (no red meat)
  • Pescatarian – avoid meat and poultry but eat fish and seafood.
  • Lacto -ovo -vegetarian – skip all meat, fish, and poultry but include dairy and eggs in your diet.

If you’re trying to lose weight -go heavy on fruits, vegetables, and whole grains but limit foods high in saturated fats (ice cream, whole milk, and cheese.) An important aspect of losing weight is often not what you eat – but how much you eat to keep daily calories in check. After all, vegan foods have calories, too. And some are not as healthy as they could be.

In the U.S. Standard diet (SAD) our meals and snacks are taking on gargantuan proportions. “The food industry decided they had to make portions larger to stay competitive and people got used to larger sizes very quickly. Today, normal sizes seem skimpy,” says Marion Nestle, PhD, MPH, Professor of Nutrition and Food Studies at New York University.

When eating out, the transition to a plant-based diet is easier than than you might think. Fill your plate with vegetables – cooked, raw, or in a salad. Check out the sides that are offered. Then gradually introduce all vegetarian meals once or twice a week and if you like, increase it until you are as “vegan” as you want to be. Try a few meals from a local vegan restaurant, then try a few on your own. You may be surprised. Bon Appetit!!


INTERMITTENT FASTING?

“The weight-loss idea is quite appealing: Limit your eating to a period of six to eight hours each day, during which you can have whatever you want.” However, is it effective for weight loss?

“Almost every type of diet out there works for some people,” he said. “But the take-home supported by this new research is that when subjected to a properly designed and conducted study — scientific investigation — it is not any more helpful than simply reducing daily calorie intake for weight loss and health factors.”

Nevertheless, intermittent fasting may act as a positive tool for some people to practice the act of mindful eating. (SJF).

CLICK HERE.

CHOOSING A PLANT-BASED DIET?

Michael Pollan started it – “Eat food, not too much, mostly plants”. In Defense of Food: An Eater’s Manifesto and The Omnivore’s Dilemma.

Many people are taking more of an interest in plant-based diets. People are switching for various reasons – weight control, sustainability, the environment in general, health reasons, media hype. Food companies load their products fortified with grams and grams of protein in order to “make up” for an alleged protein deficit – however, there are plenty of non-meat sources of protein found in plant foods. Most Americans get enough protein. “Protein is not the key for weight loss and animal protein is not the healthiest food we can eat. Carbs are not the enemy – they are a source of energy, and are staples in the diets of the longest-living people in the world.” Garth Davis, M.D. Proteinaholic: How Our Obsession with Meat is Killing Us and What We Can Do About It. 2015


High amounts of protein are not needed by most consumers unless there is a medical reason. The adult RDA or Daily Value is about 50 grams for most adults. That amount can be found in only 3-4 ounces of most meats – or a portion about the size of a deck of cards.

People have tried a number of diets – Paleo and Keto are of the low carb genre resulting in high protein and high fat diets. Since then, weight gain has taken over with an obesity rate higher than ever along with its companion- diabetes type 2.

Michael Pollan refers to the American diet as ‘the “American paradox” – the more we worry about nutrition, the less healthy we seem to become”.

CLICK HERE.

Is Your Liver Fat?

Most people have never heard of NAFLD, a.k.a. non-alcoholic fatty liver disease, HOWEVER, nearly one in four adults in the U.S. has NAFLD. NAFLD is more common in obesity and diabetes type 2.

In the long term, NAFLD can cause fibrosis (scarring) of the liver that eventually can cause impairment of normal liver function. Advanced scarring can lead to cirrhosis, an irreversible condition that can lead to liver failure. The only long-term treatment is a liver transplant. No drugs are currently approved to treat it.

The emphasis should then be on prevention with the usual recommendations: Eat less processed foods, lose a little weight if necessary, and more exercise comes to mind – healthier lifestyles in general, e.g. less alcohol.

Normally most of the blood draining from the GI tract (gut) travels directly to the liver before entering general circulation. This exposes the liver to toxins that may cause oxidative stress and chronic inflammation.

There are new clinical trials on subjects diagnosed with NAFLD to investigate the influence of probiotics on the microbiome residing in the GI tract. These findings suggest that the probiotic – prebiotic blends can stop the progression of liver disease, liver damage and liver inflammation when compared to a placebo. Interesting???

Richard Moore. Life Extension: The Science of a Healthier Life, May, 2022.

CLICK HERE.

The Gut Microbiome

Body Image Acceptance: Health at Every Size

The obesity epidemic rages on with no end in sight. Unfortunately, as we focus more on weight control and body size, more people are affected by being the victims of fat shaming. Even health professionals are often guilty by not addressing the weight problem with their patients – patients become ashamed due to the lack of help they experience from their physicians or the professionals themselves may be victims of the epidemic. They may be crying out for help for weight loss advice and interpret the silence as a shameful topic. This can result in more cases of body dissatisfaction, more dieting attempts like yo-yo dieting and/or avoidance of reporting eating disorder symptoms such as bulimia and anorexia.

There is an alternative approach – Health at Every Size (HAES). This concept focuses more on healthy weights rather than how much a person weighs. A study in 2011 called the Succeed Foundation conducted a Body Image Survey that aimed to improve body image and prevent eating disorders. The survey revealed the following:

  • “30 percent of women say would trade at least one year of their life to achieve their ideal weight and shape.
  • 46% of the women say have been ridiculed or bullied because of their appearance.”

“ HAES approach briefly states: 

  • Accepting and respecting the natural diversity of body sizes and shapes.
  • Eating in a flexible manner that values pleasure and honors internal cues of hunger and satiety.
  • Finding the joy in moving one’s body and becoming more physically active.
  • Reference: https://haescommunity.com/pledge/

Citation

Evelyn Tribole, M.S.,R.D, Elyse Resch, M.S., F.A.D.A., C.E.D.R.D.

Intuitive Eating: A Revolutionary Program That Works.