Stanley Feld M.D.,FACP, MACE
The public’s perception is that obesity cannot be cured. In my opinion this is wrong.
I received two comments from readers after publishing War on Obesity: Part 15
Don’t you know that Obesity is a genetic disease? No matter what you do people cannot lose weight. If they lose the weight they will gain it back. A genetic disease cannot be cured.
Type 2 Diabetes Mellitus is also a genetic disease.
All obesity is not genetic. There are many diseases, situations that can lead to overeating. The majority of the obesity is due to environment factors.
Type 2 Diabetes Mellitus is genetic. At least 25% of Hispanic and Black people have a genetic abnormality making them less sensitive to insulin. (Insulin resistance). Insulin resistance increases as weight increases.
As the insulin resistance increases the person cannot metabolize glucose. Insulin is needed at the cellular level to permit the glucose to pass into the cell. The insulin resistance decreases the effect of insulin to permit this passage.
The person’s cells are starved of energy producing glucose. This causes the person to release stored glucose from the liver in order to overcome the insulin resistance. The very high glucose causes increased urination and increased thirst. The lack of glucose metabolism causes weakness.
Type 2 Diabetes Mellitus, the result of obesity causing increasing insulin resistance, can be asymptomatic for an average of 8 years.
The resulting high circulating blood sugar denatures proteins in the body. It causes blood vessels to decrease in diameter. Many people present with Type 2 Diabetes Mellitus at the time of a heart attack. Over the eight years of asymptomatic Diabetes Mellitus the blood vessels have been slowly constricting. This can result is a heart attack or stroke.
The hemoglobin molecule is a protein within red blood cells (RBC). RBC’s carries oxygen to the tissues. Hemoglobin molecule with the RBC also gets deformed. It is converted to HbA1c. The measurement of the percentage of HbA1c in the circulation is an estimate of the average blood sugar over a three month period of time.
Each red blood cell lives for 3 months. New RBC’s are born every second. If they are born and live in a high blood sugar they become deformed. The higher the blood sugar the higher the percentage of HbA1c.
Normal Hba1c is up to 6%. The lower the level the less the chance there is for blood vessel narrowing and the lower the risk of complications such as heart attacks and strokes.
The cost of Diabetes Mellitus to the healthcare system is $217 billion dollars a year. The challenge is to decrease the incidence of Obesity. Decreasing obesity will decrease the incidence of insulin resistance. In turn the incidence of Type 2 Diabetes Mellitus and its complications will decrease.
The only way to decrease obesity is through public education program and advertisement, changes in the fast food industry’s economic incentives, and providing economic incentives to consumers to lose weight.
Consumers must be made to be responsible for themselves.
Decreasing obesity will decrease healthcare costs dramatically.
President Obama should be spending taxpayers’ dollars on this goal and not on pilot studies and bureaucracies destined to fail.
The second comment received illustrates that weight loss can be accomplished. A long time reader responded with the following note to my last blog.
I previously sensed he doubted consumers’ ability to control their own health and healthcare dollars.
Dear Dr. Feld
There is hope. Yesterday I was at a client’s office when I met an old friend who serves as a security officer for the company.
I said, “John you look great” and he told me he had lost 85 lbs. I said “wow that’s awesome”. When we were away from other folks there I quietly asked him if something had precipitated the change and he said “yes, I was diagnosed as a type II diabetic and when I was diagnosed I had an A1c of 11.0%”.
He said “the Dr. wanted to start me on Meds immediately but I said no meds, I want to try diet and exercise first”. The Dr. was skeptical but let him have 3 months to try diet and exercise. In the 3 months, John lost 70 lbs and his A1c was 5.5% when he next saw the Dr. He has since lost 15 more lbs and he is now accountable for his health.
With no accountability, people will not modify their behavior. Death is inevitable, the questions that we must answer are:
1. How much money am I willing to spend on delaying the inevitable?
2. Whose money is it going to be, mine or someone else’s?
3. Depending on the answer to question number 2, what’s the effect on the answer to question number 1?
It can be done with proper motivation. It is difficult to lose weight. Obesity does not cause symptoms. Type 2 Diabetes Mellitus can be asymptomatic for a long time. This patient did lose weight for his own health. Many people can be helped to lose weight.
Consumers are bombarded with the stress of daily life. Americans are constantly exposed to anxiety by the popular media. Local murders, national oil spills, two wars, auto accidents, other disasters, the threat of unemployment and increased taxes all heighten our anxiety.
Salty and fatty foods taste good and are cheap. These fast foods help relieve stress. Fast food temporarily ameliorates the epinephrine surge caused by stress.
He is giving this essential initiative lip service and little expenditure of money.
He should empower consumers to reverse this impending disaster.