Arizona Advanced Medicine Clinic

The Effect of Obesity on Health

I just attended a seminar – the 6th Annual Southwest Diabetes Symposium” sponsored by a large number of pharmaceutical companies including Eli Lilly and Boehringer-Ingelheim – on the treatment of diabetes. It was recognized that diabetes is an almost invariable accompaniment of obesity, and that “diet and lifestyle” are the primary modalities of treatment.

Diet and Lifestyle were the top banner of every treatment recommendation slide. Lifestyle was defined as exercise for at least 150 minutes per week – cardio (getting the heart rate up) and resistance (increasing muscle bulk). But not once was “diet” defined – except by the absence of sugary drinks and junk food. This is the same thinking which affirms the notion that health is the absence of disease. Included in the “healthy food choices” regimen are items like “low fat macaroni and cheese”. The exercise advice was reasonable – taking the stairs instead of the elevator – but the dietary advice was inconsistent with recent published literature that a high carbohydrate diet is more associated with cardiovascular disease. One metaanalysis reports “These findings suggest that low-carbohydrate diets are at least as effective as low-fat diets at reducing weight and improving metabolic risk factors. Low-carbohydrate diets could be recommended to obese persons with abnormal metabolic risk factors for the purpose of weight loss.”[1]

If those who teach physicians are so entrenched in the pharmaceutical model that they spend no time teaching the metabolic effects of food, the improvement in metabolism caused by exercise, how are new physicians going to learn anything but pharmaceutical models?

If we, as physicians, put so little practical emphasis on the food that we eat, and so much practical emphasis on the drugs that we take to prevent the natural consequences of eating the food we eat, how can we possibly expect our patients to change their behaviors?

And if we, the teachers, are unable to teach food and nutrition because we have no real idea as to their value, how are we going to persuade our patients to think anything different?

Anthony Winson, who studies the political economics of nutrition at the University of Guelph in Ontario, states in a New York Times article: “The prevailing story [from the medical establishment and government] is that this is the best of all possible worlds — cheap food, widely available… [but] To put it in stark terms: The diet is killing us.”

Worldwide, the study found that 5% or children and 12% of adults qualify for the diagnosis of obesity (BMI greater than 30). Convincing evidence was found for the association of obesity with specific health outcomes.[2]

Diabetes and cardiovascular disease (heart attacks, strokes, arteriosclerosis) accounted for 40% of the deaths of obese people, and resulting disability for 30% of the obese population.

Chronic kidney disease and cancer were the second and third highest cause of obesity-related deaths.

Adam Drewnowsk, director of the Center for Public Health Nutrition at the University of Washington, states: “It is all very nice to talk about the need to eat less unhealthy foods and more healthy foods,” he said. But “unhealthy foods cost less; healthier foods often cost more. People eat what they can afford.”

Do we really want to live in a world where our health maintenance depends on the use of drugs to treat the high blood pressure, diabetes, heart disease and kidney disease caused by the food we eat?

Who benefits from the world-wide epidemic of obesity? Processed food manufacturers and pharmaceutical companies come to mind.

In the early days, it is reported that there was cocaine in CocaCola. Cocaine and sugar affect the same areas of the brain as those affected by addiction – the pleasure dopamine-producing areas. In 1866, Coca Cola was marketed as "Coca-Cola: The temperance drink." – no alcohol, just cocaine in the formula.[3]

In 2017, Coca Cola remains one of the most popular and most consumed soft drinks in the world, despite having removed cocaine from the formulation. The Coca Cola company spends money on research which, according to Marion Nestle, mostly shows that consumption of soft drinks I not unhealthy.

An article published in the Mayo Clinics Proceedings, and sponsored by Coca Cola, maintains that most data collected for purposes of determining the effect of diet on health is flawed, being based on people’s self-reported diet histories – or what the article calls “memory based recall”. Because of this data collection method, the article asserts: “we present evidence that M-BMs are fundamentally and fatally flawed owing to well-established scientific facts and analytic truths. First, the assumption that human memory can provide accurate or precise reproductions of past ingestive behavior is indisputably false. Second, M-BMs require participants to submit to protocols that mimic procedures known to induce false recall. Third, the subjective (ie, not publicly accessible) mental phenomena (ie, memories) from which M-BM data are derived cannot be independently observed, quantified, or falsified; as such, these data are pseudoscientific and inadmissible in scientific research.”[4]

If you can’t disprove their theories, call their integrity into question. Disparage their conclusions. Re-define “science”.

Fortunately, not all scientists are subject to the pressures of research funding. One study examined genetic predisposition to obesity and dietary intake of sugar-laden beverages, concluding that those who are predisposed to obesity genetically and more affected by their intake of the beverages.[5]

Marion Nestle’s 2002 book Food Politics: How the Food Industry Influences Nutrition and Health, is a look at the politics of the food industry, written by a professor of nutrition (no relation to the Nestle corporation). The book was reviewed in the New England Journal of Medicine.[6] And is available on Amazon.[7]

There is an easy solution, if we are willing to change our habits. Eat food that looks like what it is – vegetables, fruits, whole grains, grass fed and free-range meats and poultry. Eat organic as much as possible (at least the Dirty Dozen, if there are budget constraints). Eat non genetically modified (GMO) foods (especially grains) to avoid the large dose of glyphosate (RoundUp®) that comes with every bite of GMO grains. Cook it yourself. Avoid fast food restaurants like the plague.

I am the first to admit that obesity has a genetic component. I do not ever remember being truly thin (except when I simply stopped eating due to a personal catastrophe). But I am still healthy in my 70s, and take no pharmaceutical medications for anything. My blood pressure is good, my blood sugar is a little high, I still work long hours and require remarkably little sleep. I do not eat GMO foods, I seldom eat fast foods, and take my lunch to the office with me every day. I choose where I shop, I do not buy processed foods. I never drink sodas,[1] and I drink my coffee black.

Changing our diet habits not a perfect solution – but it’s a start. And it’s something we can do. We may not have much (or any) control over government policies. But we do have control over our own habits. And as long as we avoid sugar and sugar substitutes, we may even have some control over our own weight and state of health.

[1] I stopped drinking diet sodas the day that I ate an entire dozen donuts in one sitting, and realized that there was something seriously wrong. I connected it with the hunger associated with the diet sodas, and make the logical choice.


[2] Afshin, Ashkan, et al. "Health Effects of Overweight and Obesity in 195 Countries over 25 Years." The New England journal of medicine 377.1 (2017): 13-27.

[3] https://www.theatlantic.com/health/archive/2013/01/why-we-took-cocaine-out-of-soda/272694/

[4] Archer, Edward, Gregory Pavela, and Carl J. Lavie. "The inadmissibility of what we eat in America and NHANES dietary data in nutrition and obesity research and the scientific formulation of national dietary guidelines." Mayo Clinic Proceedings. Vol. 90. No. 7. Elsevier, 2015.

[5] Qi, Qibin, et al. "Sugar-sweetened beverages and genetic risk of obesity." New England Journal of Medicine 367.15 (2012): 1387-1396.

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