March 29, 2005
Response To Obesity Epidemic Should Be Urgent Priority
Jane Brody of the New York Times asks an important question about the growing incidence of obesity.
I can't understand why we still don't have a national initiative to control what is fast emerging as the most serious and costly health problem in America: excess weight. Are our schools, our parents, our national leaders blind to what is happening - a health crisis that looms even larger than our former and current smoking habits?
Brody is right. Obesity is causing more damage than smoking does. Brody is reacting to a new book Diabesity : The Obesity-Diabetes Epidemic That Threatens America--And What We Must Do To Stop It by pediatric endocrinologist Francine R. Kaufman MD. Brody says type II diabetes is rapidly growing.
In just over a decade, she noted, the prevalence of diabetes nearly doubled in the American adult population: to 8.7 percent in 2002, from 4.9 percent in 1990. Furthermore, an estimated one-third of Americans with Type 2 diabetes don't even know they have it because the disease is hard to spot until it causes a medical crisis.
Type II diabetes is the type where the body becomes insensitive to insulin. It accelerates a variety of degenerative diseases (heart disease, kidney failure, stroke, peripheral vascular diseases that lead to amputations, blindness, and much more) just as type I diabetes does.
Obesity does a lot more harm beyond causing type II diabetes. Obesity causes neural cell loss in the temporal lobe and is a risk factor for dementia. Rudolph Liebel of Columbia University and other researchers have found that fat cells release over 2 dozen compounds that cause harmful changes the body. The more fatty tissue you have the more of those compounds are excreted into the bloodstream. Increased obesity may even lead to decreasing life expectancies.
Kaufman and Brody blame fast food for this state of affairs. But fast food is in large part the result of advances in agriculture that made the production of starches incredibly cheap. Measures to change grade school and high school cafeteria menus are certainly called for. Kids should be taught to avoid foods that increase obesity. Parents should be discouraged from keeping junk food around the house. Junk food vending machines should be removed from schools and places of employment. But while all these obvious measures will help my guess is they will make only a small dent on the problem.
One problem mentioned by Brody is that lots of kids can not safely bike to school or play outside afterward. Part of the danger here is the distance between schools and homes and the heavy road traffic that makes bicycling too risky. But neighborhoods made dangerous by criminals also contribute to obesity. However, part of the problem in many instances is irrational fear on the part of parents. Child kidnappings and other crimes against children more rare than news reports lead many to believe. Parents who imagine a larger threat than exists keep their kids indoors more than is necessary. Still, longer prison terms for pedophiles and child kidnappers and a generally harder line toward criminal activity would probably create conditions more conducive to good health of all children.
Our biggest problem is that we are not evolutionarily adapted to the environments we have created. We could build bike trails, lock up criminals for even longer periods of time, and make other changes to suburban and urban enviroments to make it easier safer to get exercise in our daily routines. But many of the changes would be expensive to implement and have little popular support. For most communities the needed zoning ordinance changes that would enable, for example, bike trails or pedestrian trails would had to have been implemented decades ago. The communities have already been built. There is no room for sidewalks and trails. Schools have already been built surrounded by very busy streets and highways.
A more basic problem is that today food is cheap but we evolved under conditions where calorie deficiency malnutriton was very common. So we are designed to eat too much. As biotechnology advances food prices will rise more slowly than inflation. So food will become cheaper still. Access to food will become even easier. Its preparation will become ever more automated. Blaming this on McDonalds and Carls Jr really misses the bigger technological picture.
Programs and proposals to encourage weight loss also ignore history: The long running torrent of diet books, talk show discussions, and commercial weight loss companies produce lots of yo yo dieters whose weight goes up and down many times. Sustained weight loss is the exception for dieters.
Brody mentions lots of ideas for her idea of a national initiative to control obesity. But she ignores the one obvious option that will eventually provide more benefit than everything else she mentions: the development pf appetite suppressing treatments. We need an increase in funding for research to develop therapies that suppress appetite and cause fat cells to burn off their stored fat. The appetite suppressants will be the best solution. Eventually we will even have gene therapies that permanently adjust metabolism so that appetite declines when a person begins to become overweight. A few billion dollars per year spent funding research into the mechanisms of appetite control would pay back orders of magnitude in avoided diseases, greater physical and mental vigor, and longer healthier lives.
Insert microcapsules filled with gene-engineered cells under the skin. The capsules would keep the GE cells in place, prevent uncontrolled growth, and prevent rejection by the immune system. The cells would be engineered to release high levels of leptin (and other hormones whose increase would increase health). If problems arise the capsules could easily be removed or replaced. If more fat loss is needed more capsules could be inserted.
Another approach that I believe has potential is to genetically modify gut bacteria to produce beneficial substances. This should be less dangerous than modifying our own cells.
Having been a yo-yo dieter for years, I've done a lot of personal research on the issue of fat loss. It is too much starch and trans fat. It is overeating. But it also that people don't eat often enough. Optimally, people should eat 6 or more times per day. If you don't eat for 3 or more hours, you put your body in starvation mode which lowers their metabolism and triggers the burning of muscle (which, since muscle uses up calories more than fat, is the smart thing for the body to do if there's not enough food around). It's called a 'catabolic state'. What we really need to do is reorganize society to allow for smaller, more frequent meals. Making sure kids have a healthy snack in the late morning, have breakfast if they missed it at home, and have a later snack in the afternoon before they go home will do wonders for our children's energy levels and overall health.
Basically, we should take books like 'Body for Life' and implement them nationwide.
Long time, no hear from. Hope you are well.
So then have you found a diet that allows you to keep yourself skinny for years at a time? If so, time to write a book!
My guess is that there is no single diet that will work for all people. My further guess is that diet alone will not handle the problem because the reduction in exercise is part of the problem.
Fasting and catabolic state: But if you do not eat every other day you will be healthier. I've begun going 14 hours daily not eating (including the time spent sleeping). I think it makes my mind sharper. I may even narrow the eating window further. I'll see what it does to my weight.
Lack of sleep also causes obesity. It causes decreased leptin and increased ghrelin production. Hence more appetite. So a decline in hours sleeped is another contributing factor to obesity.
"I can't understand why we still don't have a national initiative to control..."
Probably similar to tobacco - powerful lobbies from industry (food against, that is), the problem is not a now problem (people are notoriously uninsterested in problems that will occur later) and of course there is no political capital (who is going to get elected on an "end obesity" platform)
Here in the UK there has just been a TV series about the food served in schools by the TV chef Jamie Oliver.
The average amount spent on a child's meal is 37p (about 67 cents). Whereas about four times more is spent on prisoner's food. Judging by what I saw on the four part series many children never eat vegetables or fruit whether at home or at school. Many refused to eat them and spat them out during the experiment. In one telling scene children where unable to name a number of vegetables but went beserk when shown a McDonald's logo.
I'm experimenting with fasting on weekends when I can put up with the increased difficulty in concentrating. I've found fasting for around 20 hours pretty easy. I've also found it makes my mind sharper and it makes me feel more energetic.
I agree with Randall that diet is just part of the problem. Another part is evolutionary. We have simply not adapted in the developed world to an overabundance of food. This combined with a massive decrease in manual labour and increase in physically sedentary work has lead to where we find ourselves now.
I've belonged to a gym for years. Initially high on the buzz of the novelty of the experience and quick improvements I was motivated enough to go 5 times a week. Over the years this has decreased to 3 times a week and below. Now I'm focusing on combining activities (I've bought a small step machine which I use while watching TV).
Now if someone could come up with a nice ergonomic design which integrates a stationary bike with a PC workstation I could use at home and at work then I could really burn some calories!
For once this is a problem that, in terms of research, really is getting all the attention it deserves. Every pharmacuitical company in the world knows that a fat-buster pill is worth more than any AIDS cure, (if only because there is little likelihood of governments stepping in and confiscating a successful product)and they are investing likewise.
(A note to the morally outraged, obesity kills more people than AIDS, get over it.)
Hi Randall, yes, I am well. I just took a break from posting for a while.
Yes, different diets work for different people. As a matter of fact, the diet I'm on doesn't keep me skinny, it keeps my fat percentage down. Aside from pushing any particular diet, I think that we should all be careful (myself included) about defining as precisely as possible what we want. For example, almost nobody needs to "lose weight," they need to lose fat.
Fasting is an interesting idea and it certainly may work. I'd be very concerned about prescribing that for kids until lots more research is done. Until then, we can use a pretty simple model: What do the healthiest happiest highest-achieving kids do for food? Then let's get all the kids to do what they are doing.
Randall, there is an easy solution for this.
Simply: "A calorie tax".
The Europeans have for decades had high fuel consumption taxes. This drives their population to be relatively more conservative with their fuel use. Why should we not have taxes on the fuel we put into our bodies?
It would drive down human calorie consumption, drive up tax revenues, reduce the budget deficit, and push farmers more towards the production of
fuel for cars rather than food for human consumption.
It would also give those in politics something useful to do -- as such a proposal would have various lobbying groups running screaming to DC. (The race to define the minimal nutritional diet that should not be taxed would be huge.)
(This is in contrast to passing laws that attempt to save the life of a single woman who may or may not be brain dead. This by any reasonable read is a case of politics gone mad.)
Honestly, a $1.00 - to - $2.00 a gallon gas tax would probably do wonders in battling obesity, over time. It would make pedestrian-hostile suburbs unviable and push people into neighborhoods where they would walk to do errands. (I'm 39 and have never owned a car, having lived in Eugene, Ore., and New York City, and while I'm technically overweight, I'd probably be dead if I lived the Midwestern, drive-everywhere lifestyle.) People who are already obese would likely stay obese, but young people who adapted to a walking-oriented environment would likely never add the pounds to begin with.
Of course, my suggestion is a sociological fix, not a technological one. But the causes of obesity are sociological -- our society is at odds with our bodies -- so perhaps this is appropriate.
I wonder if there is not a way to tailor diets specifically to particular people based on their genetic make-up - similar to new/future drugs tailored to specific people's gene types. It seems that many people naturally enjoy different foods and react differently to different diets.
I have had wonderful results on a revolutionary, self-made diet I call my 'no coke, no fries' diet that, suprisingly, involves turning down sweetened soda and french fries/potato chips. I have a number of friends who have also had success on this diet. it seems its only downside is there is not enough to it to fill a whole book. feel free to apply it to your life, royalty-free.
Raise the Gas Tax
Traveling across the world, I notice that I lose more weight when I live in countries where I don't drive, but take public transport. With pulic transport, you walk more. Higher gas prices may mean less driving.
Also, global warming may warm up US winters and encourage more walking.
jlw and FredW,
The empirical evidence strongly suggests high gasoline taxes will not prevent obesity: Europe has very high gasoline taxes. Europe also now has several countries that have higher obesity rates than the United States. See my recent post "European Obesity Rates Surpassing American Levels".
Nutritional genomics is not yet feasible. Once DNA sequencing becomes much cheaper (say a 4 order of magnitude decline in costs) then it will be possible to tailor diets per individual genetic make-up. We might be able to get there sooner with SNP testing methods. Though if large copy variations play a role in obesity then simple SNP testing won't get us there. A recent study on MnSOD genotypes, cancer risks, and vitamin supplements (see the bottom half of that post) illustrates, however, that some major gains in health will be possible once we can tailor nutrient content of food to personal genotypes.
Certainly obesity is a huge target for pharmaceutical research. But the pharma cos are not going to fund much basic research into the mechanisms of appetite. They'll only try to develop drugs for receptors known to play a role in appetite regulation. But currentlly known receptors might turn out not to be appropriate drug targets (either because of side effects or because of mechanisms that the body will turn on to invoke appetite once those receptors are blocked). So more basic research funded by governments could certainly help.
First off, don't use carriage returns when typing a comment.
A calorie tax has no chance of passage. It would be seen as a severe hardship for poor people. Never mind that obesity is a big problem in American ghettoes. There are children whose parents are so irresponsible with money (e.g. mom needs her crack, meth, or heroin fix) that the kids do not have enough food. There are school lunch programs for poor kids. With all that as a backdrop a calorie tax does not stand a chance.
Because people, of their own volition, tend to overeat, we entertain the idea that the government should intrude into our lives to force us to eat right. This is not exactly a den of Libertarianism, is it? Folks who wish to be allowed to live forever should be the last to advocate allowing the government to dictate what we eat.
The problem, at least for people who are looking at the situation as it now stands, rather than an ideal libertarian world, is that other people's overeating leads to high medical/social service expenses, that OUR taxes pay for.
Ideally of course, your medical insurance (either private, or Government via taxes) would vary according to your smoking/body fat content/drug use/exercise/wearing seatbelts and other behavioural variables.
Of course now you are talking about an ideal world again. I have no idea how many of these aspects could be monitored without opressive surveilance.
Though a yearly medical exam (voluntary, for those who want lower rates) could cover obesity and probably test for drugs, tobacco and some others.
One reason I favor the development of appetite suppressant drugs is that most overweight people would gladly take such drugs voluntarily and would even willingly pay for such drugs out of their own pocket.
I want less government intervention in what choices people make. Therefore I look for technological solutions that reduce the demand for and extent of government interventions.
I have a similar attitude about energy research. I favor the development of technologies that are cleaner and also cheaper so that the market would take up those techonologies to replace more polluting technologies.
I expect that if anything is going to overcome the obesity epidemic, it would be something of the kind that you propose. My primary point is that I wonder about people who, when faced with a problem, can only conceive of one way to solve it--kick it up the chain of command so that more capable experts can solve it. After being around for a while, you begin to realize that often the higher ups are neither capable nor expert.
Yes, obesity is a problem but so is cancer, AIDS, hypertension, Parkinsons, the Flu, ... The list is endless. The issue is how to to prioritize all the illnesses that impact humanity, not talk about each in isolation. I will be more direct and assert that humanity at this moment is materially bound and thus one choice closes the door to another. That is, opportunity costs confront humanity and the medical community must accept this FACT.
Another issue that we must confront is in the free society in which we currently inhabit the government has no RIGHT to prescribe behaviors. Are we going to changes these norms to eradicate obesity?
Now obesity like several other diseases appears to have large behavioral components associated with it and thus suggests a different approach than say Parkinsons. We can educate people about the consequences of over eating and failing to exercise and call it a day.
At the end, I align with Randall's suggestion of drugs that suppress appetite (for those who choose to act accordingly and out of their own financial means).
OTOH, the most car oriented portion of America, Souther California, is also regarded as the most obsessively image conscious. I don't think raising fuel cost will get more people walking. That isn't an option here where everything is so spread out. At best they'll move to places where they can confine their movements to a small area, resulting either in little exercise and/or acceptable fuel costs.
I used to be obese. I know all the consequenses that obesity causes.
I made the decision to eat low fat food such as lots of fresh veggatables, fresh fruits of all the different fruits that are all available out there.
When I cook meat, I make sure it has low fat and let the fat drop into a pan below and after that cut off the remaing fat.
I have found many recipies that are low in calories that are delicious meals. Plus breads that have twelve grains in them as well.
We also eat lots of large fish from the northern areas by cooking the whole thing,(Head to tail) with a little stuffing. Fish is very important in our diets here at home.
It is a lot cheaper. I rather make soups, and other delicious meals myself so that I know what goes in it then eating anything that is highly full of highly process foods.
I am now 100lbs. I feel so much better.
My husband decided one day to get a Harvey's Hamburger and the grease was so bad, we only took one bite and felt so ill, we through it away.
You do feel so much better on these foods.
Never again would we eat at a fast food restaurant and we do not miss it at all. We enjoy our own barbecuing as well, we let the fat drain out. However, we cook delicious fish, chicken and some hamburgers that have very little fat.
It is amazing that the costs by eating this way is so much lower than most people believe.
Exercise is important. I have destroyed hips, knees and a severe damage to my spinal chord but that will not stop me.
People should check this out. I lost 130lbs.