Obesity is an imposing problem in health care. A mere third of Americans have a body mass index of 25% or less. Nearly 10% of Americans exceed a BMI of 40%, an astounding doubling in the last decade.
Obesity adversely affects body image perception and, in the susceptible, leads to dysmorphic interpretations with a spectrum of psychosocial issues. Obesity can breed guilt, depression and stress. Stress generates hunger, looking for “comfort” food, putting in motion an amplifying cascade of guilt, food and worsening obesity.
A dysmorphic interpretation of obesity is not a mere vanity-driven issue, as obesity spawns a plethora of modern chronic health problems that include heartburn, hypertension, enraged inflammation, arthritis, atherosclerosis, cancer, obstructive sleep apnea, metabolic derangement, diabetes, bronchial asthma, heart attacks, diabesity, blindness, amputations and stroke that come together in a toxic dance of reduced health span and premature death.
The Bogalusa study, a longitudinal study to assess the effects of obesity and elevated LDL, was the first to demonstrate that obesity-related cardiovascular risks begin in childhood and continue into adulthood.
Cheap food has a cost burden of $175 billion and counting in health care expenses.
The beginning
Obesity, you see, is a problem that a solution to hunger stumbled upon.
As the USA entered World War II, many potential recruits, numbering hundreds of thousands, failed to qualify for their dream of serving the motherland. Numerous patriots flunked physical eligibility, held back by malnutrition.
Hunger needed a solution.
Concurrently, the technology that lent to giant bombs helped create better fertilizers. The company that produced Agent Orange made better pesticides. The agricultural output didn’t increase in percentages; it increased by a factor of magnitudes. Big oil intersected at every level of expanding agrarian possibilities.
Coca-Cola was taken across the world by our military and became a sought-after American symbol of prosperity.
In 1972, the Nixon administration was concerned about the political fallout of food costs, and the president decided to get the food out of the kitchen conversation. Secretary of Agriculture Ed Rusty Butz was entrusted with the task. Farming in the U.S. was industrialized, and small farmers in rural communities were sacrificed in the pursuit of a loftier goal of satisfying hunger at a cheap price. To this day, corn and soya industrial farms sow more than half of the nation’s cultivated land and avail the majority of the subsidies. Ethanol and fructose are byproducts of that pursuit.
The world’s food giants buy subsidized grains to process corn, soy, etc., for edible conveniences.
The prevailing science in the 1970s and ’80s misinterpreted the data and blamed rising heart attacks on a high-fat diet, giving sugar a pass.
A perfect storm was born: Post-World War II technological advances, fertilizers, industrialized farming, an abundance of corn syrup, convenient foods with extended shelf-life, political complicity, erroneous medical advice and corporate profits coalesced into a solution to address chronic hunger. As the women were pulled to work, the household could use the convenience of packaged food, deceptively promoted as healthy.
We have grocery stores overstuffed with processed foods that crowd out healthy choices.
The undernourished recruits who failed to qualify for service in World War II now have great-great-grandkids who fail to qualify for reasons of obesity. Police, fire departments and security services are at risk.
Targeted and predatory advertising using childhood heroes, animals, celebrities and elite athletes prey upon the highly impressionable minds of the children, offering them addictions that would travel faithfully from the cradle to the grave.
The well-honed marketing skills, an undercurrent of misinformation, a lack of regulatory standards, and a failure of implementation have allowed Big Food a comfortable hiatus to thrive in the credulous populations of developing countries. The adoption of ultra-processed edibles has leapfrogged the timeline of the Western world. The recently prosperous are sleepwalking from undernourishment to toxic overdoses designed to kill.
Unfortunately, socioeconomic factors figure prominently in the obesity epidemic. The plentiful engineered and packaged edibles sold deceptively as nutritious food have convenience, accessibility, affordability, shelf-life, portability, palatability, and, yes, addiction built into the packages.
Fructose in the omnipresent corn syrup contributes to insulin resistance, high blood sugar levels, and increased fat storage in the liver, with an increased risk of developing type 2 diabetes, obesity, liver disease, cirrhosis, cancer and cardiovascular disease.
Body positivity movement
In recent years, there has been a movement to accept a more generous body size as an acceptable reality. It seems to be a countercultural effort to negate the social media-based emphasis on unrealistic body image. Internal peace is imperative as long as we don’t overdo an effort to normalize obesity.
Weight loss industry
A plethora of diets and gazillions of promoters have enriched themselves as the perpetually suffering bounce from one plan to another.
Even a slight weight reduction can materially alter the trajectory of health.
It’s time to aim for both satiety and health.
We must emphasize food and nutrition to school kids as a part of the health syllabus. Education and redirected economic incentives for a healthier diet can help build a healthier nation.
Exercise
Exercise is foundational to physical health, chronic disease prevention, mental health, immunity augmentation, musculoskeletal health, cognitive function, healthy sleep and an overall sense of well-being. Brisk walking for 30 minutes a day (or jogging for 15 to 20 minutes daily) five days a week can cut the overall risk of death by half. In other words, exercise is the most modifiable factor for disease prevention and death reduction.
Weight loss and Pharma
Beyond food fads that fail more than succeed, the pharmaceutical industry has had a similarly unenviable record until recently.
Only bariatric surgery has had a consistent and demonstrably successful track record.
Let us waltz into a new world where you can have your cake and eat it, too, if nausea won’t hold you back.
Semaglutide (Ozempic and Wegovy) is a class of medicine that mimics the GLP-1 agonist (glucagon-like peptide) and helps release insulin and suppress glucagon release. It helps suppress appetite and delays gastric emptying. It’s an effective medicine in treating diabetes and can help lower weight by almost 15%. Its side effects vary from a queasy stomach to pancreatitis and rarely cancer. Its most significant handicap is the $1,000 price tag a month that’s necessary in perpetuity to sustain the weight loss.
Then, there is an even more effective class of drugs (Mounjaro, Zepbound) that mimics the dual effect of GLP-1 agonists and GIP (glucose-dependent insulinotropic polypeptide) agonists.
Like any other new class of medicine, these drugs will have to stand the test of time in sustained efficacy and safety. Many medications lose effectiveness over time, and severe side effects can surface. Continued compliance is a perennial challenge for patient care. The notion of committing adolescents and young adults to a lifetime of treatment of newly approved medications seems excessive and should stir a healthy debate.
Weight loss, no matter how attained, is invariably associated with some muscle loss. Muscle loss in the geriatric creates a unique problem and is likely to enhance the risk of falls.
Ozempic face
Ozempic face is a term that appears to be a disparaging commentary on the facial transformation in some due to quick weight loss. Losing facial face and loose skin can impart the impression of accelerated aging.
Knock-off drugs
The high prices of these new weight loss drugs have given an impetus to some compounding pharmacies to sell the generic version of the active ingredient. This improvisation lacks the rigors of precise dosing and is fraught with contamination hazards and, at times, outright scams.
Weight loss and Big Food
There is an exciting dynamic emerging on the Big Food side, as Eli Lilly’s stock has rocketed some 60% in the last year, and Pepsi and Coke are down by 8% to 10%, highlighting the concern for decreasing product demand as the obese eat less and demand healthier options.
A shrinking waist with a shrinking demand for ultra-processed food is just the recipe your doctor may rejoice in.
– brij