Category Archives: Overweight & Obesity

Obesity Rate In U.S. Women Now Up to 40%; Men Hold the Line at 35%

That excess weight can shorten your life

That excess weight can shorten your life

Yahoo has a brief article with a few more details. For $30 you can read the original scientific report from Journal of the American Medical Association.

Obesity in this context is defined as a body mass index of 30 or higher. Calculate your BMI here.

Is it your fault if you’re obese?

Steve Parker, M.D.

PS: If you want to buck the overweight/obesity trend, check out my books.

Ludwig Versus Guyenet: Why Are We Fat?

Neither Ludwig nor Guyenet

Neither Ludwig nor Guyenet

Dr. David Ludwig and Dr. Stephan Guyenet recently debated why we get fat. Ludwig favors the Carbohydrate-Insulin-Obesity Theory. Guyenet thinks leptin plays a central role although it’s by no means the only piece of the puzzle. It’s a gross oversimplification, but let’s just call it the Leptin Theory.

Guyenet published a critique of Ludwig’s proposition, then Ludwig released a response. This would be a good time to click and read the Ludwig response link unless you’re already bored.

Guyenet’s explanation of overweight and obesity “acknowledges the fact that body weight is regulated, but the regulation happens in the brain, in response to signals from the body that indicate its energy status. Chief among these signals is the hormone leptin, but many others play a role (insulin, ghrelin, glucagon, CCK, GLP-1, glucose, amino acids, etc.).”

Rather than paraphrase Guyenet’s response to Ludwig’s response, I’m just going to quote the most pertinent parts:

Here is a simplified schematic overview of how the system works, from a 2012 review paper I wrote with my scientific mentor Mike Schwartz, titled “Regulation of food intake, energy balance, and body fat mass” (1). This figure summarizes more than a century of research in our field:

https://advancedmediterranean.files.wordpress.com/2016/03/93210-fig2b2.jpg

(graphic from Dr. Guyenet’s blog)

Here’s the gist of it: there are negative feedback loops between the brain and fat tissue, and between the brain and the gut. These are what regulate body fatness and appetite. The primary known feedback signal that regulates body fatness is leptin– a fact that has remained scientifically unchallenged since shortly after its identification in 1994. Insulin plays a role as well, acting directly on the brain in a manner similar to leptin, although much less powerfully. As you can see, this model doesn’t resemble the CICO model– or the insulin model.

Regulation happens principally as a result of the brain changing the number of calories entering and leaving the body (in humans, mostly entering)– so the much-maligned calorie maintains a central role in the process. Even though calories aren’t the first link in the causal chain, they are nevertheless a critical link.

Most people in my field also believe that calorie intake is determined both by hunger (homeostatic eating), and factors other than hunger (non-homeostatic eating). I agree with them.

Why does it matter which of the theories, or some other hypothesis, is correct? Well, if we want to cure or reverse the overweight and obesity epidemic, it might be helpful if we know the cause. Then we address the cause directly. For example, if I have a patient with fever, my treatment plan depends on whether the fever is caused by cancer, an overactive thyroid, adverse drug effect, environmental heat exposure, a broken thermometer, or infection.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Dr. Eades: Why We Got Fat

Dr. Michael Eades of Protein Power fame thinks he knows why we’ve gotten fat starting 35 years ago (at least in the U.S.:

Along with carbohydrates, vegetable oils have increased dramatically in the typical American diet. Over the same time period, we’ve all started eating away from home more and more, so that we’ve lost control of exactly what kinds of fats we’ve been eating.

Click the link for the details of his hypothesis, which involves the effects of various dietary fats and carbohydrates on intracellular energy metabolism and insulin resistance.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Is Insulin the Reason You’re Always Hungry?

So easy to over-eat!

So easy to over-eat! Is it the insulin release?

No, insulin probably isn’t the cause of constant hunger, according to Dr. Stephan Guyenet. Dr. G gives 11 points of evidence in support of his conclusion. Read them for yourself. Here are a few:

  • multiple brain-based mechanisms (including non-insulin hormones and neurotransmitters) probably have more influence on hunger than do the pure effect of insulin
  • weight loss reduces insulin levels, yet it gets harder to lose excess weight the more you lose
  • at least one clinical study (in 1996) in young healthy people found that foods with higher insulin responses were linked to greater satiety, not greater hunger
  • billions of people around the world eat high-carb diets yet remain thin

An oft-cited explanation for the success of low-carbohydrate diets involves insulin, specifically the lower insulin levels and reduced insulin resistance seen in low-carb dieters. They often report less trouble with hunger than other dieters.

Here’s the theory. When we eat carbohydrates, the pancreas releases insulin into the bloodstream to keep blood sugar levels from rising too high as we digest the carbohydrates. Insulin drives the bloodstream sugar (glucose) into cells to be used as energy or stored as fat or glycogen. High doses of refined sugars and starches over-stimulate the production of insulin, so blood sugar falls too much, over-shootinging the mark, leading to hypoglycemia, an undeniably strong appetite stimulant. So you go back for more carbohydrate to relieve the hunger induced by low blood sugar. That leads to overeating and weight gain.

Read Dr. Guyenet’s post for reasons why he thinks this explanation of constant or recurring bothersome hunger is wrong or too simplistic. I tend to agree with him on this.

The insulin-hypoglycemia-hunger theory may indeed be at play in a few folks. Twenty ears ago, it was popular to call this “reactive hypoglycemia.” For unclear reasons, I don’t see it that often now. It was always hard to document that hypoglycemia unless it appeared on a glucose tolerance test.

Regardless of the underlying explanation, low-carb diets undoubtedly are very effective in many folks. That’s why I offer one as an option in my Advanced Mediterranean Diet. And low-carbing is what I always recommend to my patients with carbohydrate intolerance: diabetics and prediabetics.

Steve Parker, M.D.

front cover

front cover

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

front cover

front cover

60% of American Adults Are Taking Prescription Drugs

"These are flying off the shelves!"

“But selling drugs is good for the economy!”

The 60% drug use figure is up significantly over the last decade, from 50%. UPI has the pertinent details. A snippet:

Many of the most used drugs reflect the effects of metabolic syndrome, a group of conditions tied to obesity and diet.

“Eight of the 10 most commonly used drugs in 2011-2012 are used to treat components of the cardiometabolic syndrome, including hypertension, diabetes, and dyslipidemia,” researchers wrote in the study, published in the Journal of the American Medical Association. “Another is a proton-pump inhibitor used for gastroesophageal reflux, a condition more prevalent among individuals who are overweight or obese. Thus, the increase in use of some agents may reflect the growing need for treatment of complications associated with the increase in overweight and obesity.”

I’m not anti-drug, generally. Lord knows I prescribe my fair share. But in addition to the cost of drugs, we have side effects and drug interactions to worry about. If we in the U.S. would effectively attack overweight and obesity, we’d be much better off.

It’s a lot easier to just pop a pill, isn’t it? Especially if someone else is paying for the pill.

Steve Parker, M.D.

Obesity May Soon Affect Overall Longevity in U.S.

That excess weight can shorten your life

That excess weight can shorten your life

“The medical community seems to be under a fog that we can constantly and forever reduce death rates, and that’s simply not true,” said Professor Olshansky, who published a study in 2012 showing that life spans for white women without a high school diploma had declined, a rare event in developed countries.

“You need to look at the health status of the living,” not the mortality statistics of the dead, he said, adding that obesity is afflicting younger generations in a way that will eventually make the numbers worse.

RTWT at The New York Times. 

Do something about your obesity before it’s too late.

Steve Parker, M.D.

 

For Seniors on a Weight-Loss Diet, Resistance Training Beats Aerobics for Bone Preservation

according to an article at MedPageToday.

"One more rep then I'm outa here!"

“One more rep then I’m outa here!”

The two experimental groups had about 60 participants each, so it was a relatively small study. (In general, the larger the study, the more reliable the findings.) Most participants were white women; mean age was 69. The experimental intervention ran for five months. An excerpt:

In one trial, the participants were randomized to a structured resistance training program in which three sets of 10 repetitions of eight upper and lower body exercises were done 3 days each week at 70% of one repetition maximum for 5 weeks, with or without calorie restriction of 600 calories per day.
In the second study, participants were randomized to an aerobic program which was conducted for 30 minutes at 65% to 70% heart rate reserve 4 days per week, with or without calorie restriction of 600 calories per day.

The beneficial bone effect was seen at the hip but not the lumbar spine.

Thin old bones—i.e., osteoporotic ones—are prone to fractures. Maintaining or improving bone mineral density probably prevents age-related fractures. In a five-month small study like this, I wouldn’t expect the researchers to find any fracture rate reduction; that takes years. 

Most elders starting a weight-training program should work with a personal trainer.

Steve Parker, M.D.