Addressing the Obesity Epidemic One Patient at a Time
Today the CDC released the latest statistics on obesity and weight in the US. “Nearly 40% of adults and 19% of youth are obese, the highest rate the country has ever seen in all adults, according to research released Friday by the National Center for Health Statistics.” More than 93 million Americans and over 600 million people worldwide currently have obesity. The numbers keep growing, and the impact is astounding. This global public health issue is not just about weight but also about the chronic diseases that are a result of our expanding waistlines such as heart disease, diabetes, dementia and some cancers. In fact, this generation of children may be the first to have shorter lifespans than their parents.
It is simple to place blame for weight gain, but, in reality, there are many contributors to why people gain weight; some of which are in our control and some aren’t. This is because obesity is a very complex disease that is not completely understood. Obesity was formally recognized as a disease by the American Medical Association in 2012, and we need to treat it as such. Just like other chronic conditions such as diabetes, cancer and heart disease, there is no place for weight stigma or judgment. Let’s not place blame but look closer at how we can address this epidemic one patient at a time.
Managing weight is not as simple as "calories in and calories out". Having said that, calories do matter, and maintaining a negative energy balance (restricting calories) during weight loss is important, but what else matters? Our energy storage and metabolism are complex systems influenced by many other factors some of which are highlighted below.
To date over one hundred genetic markers associated with excess weight have been identified. Some of these are inherited from our parents, and others are “turned on" as a result of our environment, particularly during pregnancy, infancy, and early childhood. This change in DNA places people at risk for developing obesity during adulthood. What does this mean? We are evolving on a genetic level to be a society of excess weight and can pass these genetic traits on to our children.
Our environment has become “obesogenic”. This means we have created a culture that promotes weight gain. This includes our tendency to drive more and walk less, an increase in sedentary jobs, and an increase in screen time. A recent study noted that teenagers today, on average, have the activity level of the elderly! We need to move more and find ways to change our environment so the healthy choice is the easy choice.
Food Addiction and the Food Industry
Most of us know to avoid refined sugars, high sodium, and saturated fat. However, we are not aware of these hidden ingredients in processed food or the addictive nature of these ingredients. The food industry has done a great job of creating unnatural, processed foods that stimulate the reward center in our brain to drive our strongest cravings. We can break this cycle and take the power away from the food industry by choosing whole, unprocessed foods. A diet rich in natural foods such as vegetables, fruit, whole grains, and lean protein is the healthy choice!
It’s true…we need healthy poop! Or at least healthy bacteria that live in our gut. It ends up these bacteria, known as the “microbiome”, plays a big role in weight and energy metabolism. Unhealthy, processed foods promote the overgrowth of “bad bacteria”, but a diet rich in fruits, vegetables, and whole grains promotes the growth of a diverse population of “good bacteria” which is exactly what we want in our gut to help promote healthy weights!
This is where weight management gets tricky (and probably is a topic just by itself). In the last 20 years, we have learned so much information about fat cells. We now know that collectively, they are the largest endocrine organ in our body. These cells produce hundreds of different substances, many of them hormones, that help regulate a variety of bodily systems, especially weight and metabolism. When there is excess weight, these cells become dysregulated resulting in a hormonal imbalance that promotes more weight gain. Therefore, a weight loss of even 5% can improve this imbalance and promote more weight loss.
Sleep and Stress
Who has time to get a good night’s sleep these days, and, when you can get to bed at a decent hour, do you ever actually feel relaxed? We are a stressed-out, sleep deprived nation, and this is bad for weight! Both stress and sleep deprivation promote weight gain through the release of cortisol, the “stress” hormone, and dysregulation of the circadian rhythm, our internal clock that regulates all of the hormones associated with weight. Learning to better manage stress and improve sleep routines can help reduce the risk of weight gain.
Again, obesity is a complex disease, and there is no cure. However, there are treatments to improve obesity, prevent weight gain, and optimize health such as intensive lifestyle intervention, medications, and even more invasive strategies such as gastric bypass. Now is the time to take action and address the contributors to weight gain that you can control. The good news is that you do not have to attain a “normal” weight to improve your health. A weight loss of 5-10% is effective at improving many of the health conditions associated with excess weight, and this can be done with a focus on achieving and maintaining a healthy lifestyle.