Addressing the Diseases of Excess Weight Much More Effectively: Another Form of Precision Medicine
Better Health at Lower Cost
.This topic is deeply personal to me. I am an internal medicine physician who practiced preventive cardiology the last half of my career and weighed 307 pounds. My waist size was almost 50 and I had been too heavy all my life. I hated being fat. It interfered with my effectiveness as a doctor. I wanted to lose weight, but the advice of that time was wrong. I tried all the diets and I nearly died with diffuse large cell lymphoma in 1990. That illness was probably related to my weight. Many cancers are.
Now we understand the disease of obesity and the other illnesses related to that disorder. If you have too much abdominal fat, there are perfectly predictable consequences that treatment should address. Obesity related diseases are not a place for individualized treatment. They are a place for standardized treatments delivered by teams using protocols. That treatment can easily be scaled. We understand obesity so well now that this is another form of precision medicine.
When you gain a little abdominal fat, it becomes the largest gland in the body, and it starts putting out hormones like angiotensin II and aldosterone. It also increases the enzymes that make cholesterol and fats in the blood. The more abdominal fat you have, the more resistant you become to the hormone that tells you that you have had enough to eat. You are hungry all the time and it becomes a vicious cycle. You gain still more abdominal fat. Switching on those hormones and enzymes increases oxidant production and inflammation to cause heart disease, hypertension, diabetes, and cancer. ADMA levels are increased in all cardiovascular and related diseases. It is increased in obese patients. Abdominal fat dramatically increases inflammation even in patients with type II diabetes and a normal blood sugar. As you can see, the metabolic consequences of too much abdominal fat are completely predictable and they lead to more rapid aging and chronic disease development.
Fortunately, we can address these changes with tremendous precision now. When we do that in patients with advanced diabetes, there are one fourth as many strokes and one fifth as many heart attacks compared with the care that most people receive. Patients receiving this care live 8 years longer. Their heart attacks and strokes were also delayed by eight years. Now we have replicated that work in community practice in the United States. Vestra Health provides care in a worksite clinic owned by the Coushatta Casino Resort. About half of the members are seen in the community and half in the worksite clinic. The members seen in the clinic cost half as much as those seen in the community. ER visits were reduced by 64%. Hospitalizations were reduced by 80%. That is because the members seen in the clinic were healthier. The best care is the least expensive care. Best practice medical care or optimal medical therapy (OMT) is an important part of the Vestra Solution.
The treatments to produce these results are precise. Lisinopril, losartan, spironolactone, and eplerenone for high blood pressure block the effects of angiotensin II and aldosterone to reduce the oxidant production and inflammation that make us age and develop chronic diseases faster. Statins for cholesterol do the same thing. Metformin for diabetes has the same effect. Eating real food like lean meat, eggs, seafood, fruits, vegetables, beans, peas, and nuts is the most effective way to avoid putting on abdominal fat and to get it off once you have it. Exercise also reduces oxidant production and inflammation. These medicines are all generic and are proven to be safe and effective. They have benefits beyond simply lowering the target risk factor. It matters as much how you lower blood pressure as how far you lower it. If your sugar is not low enough with carb restriction and metformin, adding Jardiance is expensive, but it has these same effects. That’s all there is to it! We can all have better health at lower cost now! Let’s get started!
Since nearly 80% of people who are either overweight or obese have metabolic dysfunction stemming from hyper Insulinemia, prediabetes and will develop preventable chronic diseases, such as coronary artery disease, hypertension, and cancer, the best and ONLY way to stop the development of these chronic diseases is to early detect the metabolic dysfunctions and reverse them to provide much better care at much lower costs. People can live longer and healthier due to our work on developing Multifunction Cardiography Technology to deliver the much-needed early detection and monitoring to enable lifestyle optimization and chronic disease prevention/reversal.
I did not noticed, if you mentioned it, what happened to your own weight. Where is it now? When did it drop? What was done?