Last week I heard a piece on National Public Radio (NPR) that was way off the mark. The speakers attacked the fact that excess fat causes chronic disease. They called it a myth. Here is the core of the argument—and it is wrong!
GORDON: “Yeah, there's a very clear correlation between weight and bad health outcomes, but weight is not the only thing that's correlated with health. We know that poverty has a devastating effect on people's health. The life expectancy in various counties in America can be up to 20 years of difference. The poorest, most marginalized counties in America, people live to about 65. And, like, I think it's, like, Boulder, Colo., or something, they live until they're 85. There's all these other health disparities that sort of we accept as correlations.
And yet, weirdly, when it comes to obesity, it's like, oh, no, no, we know that the obesity is causing this, right? Like, people have kind of jumped to this causal explanation. And there is a very strong association, but there's very strong associations of all kinds of things with health outcomes”
The speaker claims there is correlation—increased weight and chronic disease occur in the same people—but she denies causation. She claims increased weight does not cause chronic disease. This piece is a disservice. There is so much public confusion about weight, weight control, diet, chronic disease and how we can live longer, healthier lives. There are many people from all kinds of backgrounds making recommendations on diet, exercise, weight, and health. These recommendations are highly variable. There is a 17-year gap between new medical knowledge and its broad application. Opinion is worthless. Optimal medical treatment and the lifestyle management that goes with it has been proven to prolong healthy life and delay chronic disease. There is proof that excess abdominal fat causes chronic disease directly. We know how fat causes disease and we know how to precisely interfere with that mechanism. You want to use proven solutions.
The root causes of dramatically increased weight and associated metabolic diseases began decades ago and coincides with the increased availability of fast food, processed food, and the idea that fat causes heart disease and carbohydrates are OK. The combination of fat, salt, sugar, and processed carbs in these foods is irresistible for many of us. These foods are addictive. These foods are the norm in food deserts where disadvantaged people live. They lead to increased abdominal fat.
Excess abdominal fat causes chronic disease. New science defines the ways that increased abdominal fat causes chronic diseases. Increased abdominal fat increases angiotensin II and aldosterone (see the top of the diagram) activity which causes high blood pressure, diabetes, and the complications of those diseases. Abdominal fat increases the inflammation in the body. In obesity and with a poor diet, mTOR is chronically switched on and AMPK is switched off. These are many academic papers on this topic. All the green box medical interventions in the diagram precisely block the effects of excess abdominal fat and result in much better outcomes. The optimal medical treatment in the diagram prolongs life and delays heart attacks and strokes by eight years. Obese patients on optimal medical treatment have one fourth as many heart attacks and one fifth as many strokes as patients in usual care—the care that most people receive. Losing weight does help, but the genes that are switched on by excess abdominal fat never do switch off entirely. That is why medication should not be stopped when the risk factor normalizes.
Extra weight is not merely correlated with chronic disease—it causes it. There are now proven ways to lose weight and reduce the illnesses that result very precisely. Please let me know if you have any questions.
Well written!