Processed Food, Fast Food, and Obesity: The Cardiac Chickens Are Coming Home to Roost

Heart Disease Deaths in Obese People Have Tripled in the Last Twenty Years

While there was an overall decrease in the rate of age adjusted heart related deaths over the last two decades of 36%, that same rate tripled in patients with obesity. Addressing this problem effectively must be a national priority. This is just the beginning. Over the last decade in this country, obesity rates have risen another 10% to 42%. As you can see from the graph above, the obesity rate tripled over the 40 years between 1975 and 2015. Now those overweight adults have become old enough to have heart problems, and deaths due to heart disease have tripled.

That is bad, but this is worse. The impact is dramatically worse in poor people and disadvantaged minorities like blacks and Native Americans. Deaths due to heart disease in obese Native Americans have increased by over 400% in the last 20 years. Obesity and these heart related deaths are a food problem. Obesity rates started racing upwards when Americans changed what they eat. We have been eating more and more super-sized portions of fast and processed food accompanied by wall-to-wall promotional campaigns. Our food industry knows how to combine fat, salt, sugar, and carbs in ways that are irresistible—even addictive. When you are eating that kind of food many of us cannot stop. The answer could not be simpler. Our poor and minorities need access to real, whole food. I have seen very few people lose weight permanently who don’t change what they eat permanently. It astonishes me how this is all tied together. Rural populations have more deaths due to heart disease except for blacks. Among blacks, urban populations fare worse than their rural cousins probably because so many live in food deserts—all they can get is processed food. We would save money all day long by solving that problem.

This whole thing is entirely predictable. When we gain extra abdominal fat, a vicious cycle begins. The hormone that tells us we have had enough to eat no longer works. (Leptin) The more fat we gain, the more damaging hormones, enzymes, and inflammatory mediators the fat makes. These damaging factors in combination lead to resistance to the hormone insulin, high blood pressure, high cholesterol, high triglycerides, prediabetes, and finally diabetes. Most Americans today who have a heart attack or heart failure are somewhere along this path. We can identify them easily and interfere directly with their disease process. We can block the hormones directly by given losartan or lisinopril and spironolactone or eplerenone for high blood pressure, atorvastatin for cholesterol along with metformin for prediabetes and diabetes. That is precision medicine, but poor and disadvantaged people don’t have access to that either.

There are reasonable solutions to these problems. Optimal medical therapy delivered by advanced primary care teams can turn this tide. No other answer works. Poor and disadvantaged people should have access to these teams.The United States spends nearly $30 billion a year on farm subsidies.  Most direct subsidies go to large farms and wealthy people producing carbs– corn, soybeans, wheat, cotton, and rice—not for small farmers producing meat, fish, poultry, fruits, and vegetables. We would get a lot more bang for the buck by supporting poor and minority farmers in producing real, whole food, especially near large cities. We could support supplying that food to food deserts in the cities. Like it or not, we are facing some hard choices and the serious, calm heads among us need to start developing solutions that have a chance of working. It is much cheaper to provide fruits and vegetables than it is to pay for ER visits, hospitalizations, and dialysis. The evidence is clear. Fast and processed foods are as dangerous as cigarettes. Continuing on this path will break the bank.