Teens Aren't Eating Veggies!

As a follow up to the obesity post, this was a curious piece of news published late last year.  In November, a CDC report stated that US teens are eating less than the recommended amount of fruits and vegetables.  On the surface, one could have a gut reaction, "Well duh- teenagers are teenagers.  French fries and Big Macs are the norm!" 

But lets keep in mind that these teens will go on to become unwell.  You can't run a car without the right fuel.  Our sophisticated bodies have a demand for the right fuel as well.  Because our bodies are so resilient, it can go a long time with lesser quality fuel.  But only at a cost.  There is always a cost.  

These teenagers may not know it, but they are slowly incurring a physiological debt that they may never be able to repay.  Systems decline, blood sugar is dysregulated, the bacteria in the gut are destroyed, hormones shift the wrong way and eventually, a state of sickness emerges. 

Unhealthy teenagers usually grow up to be unhealthy adults.  A reminder;  36% of American adults are now obese and at least 34% of us are overweight (not obese).  All these adults were teenagers at some point.  Will the current generation of teenagers  push these figures up?  Remember that experts anticipate 42% obesity rates by 2030.  They are counting on teenagers who currently don't eat fruits and vegetables (and presumably fill up on other nutrient poor, calorie rich foods) to either stay fat or get fat. 

Uh oh- Obesity!

In the news today:  Within the next 18 years, obesity rates will continue to rise steadily.  Currently, 36% of Americans are obese.  That alone is a staggering number.   But the numbers will continue to rise and experts predict that by 2030, 42% of Americans will be obese.  

It is universally understood that obesity is a disease where multiple systems in the body degrade and function declines.   In other words, there's no positive "spin" to obesity.  The science has clearly shown that obesity is incompatible with good health.  We're not talking about someone who carries an extra 15 pounds but can still crank out a 10K run.  This is obesity with all its debilitating consequences.  

I've written in the past about the crushing health care costs of obesity and its accompanying disorders.  Obesity related disorders burden the health care system and threaten to destroy it.  As we all know from the lively debates surrounding Obamacare, if health care melts down, the entire economy melts down.  The "new" cases of obesity are projected to cost an additional $550 billion over the next 20 years.

The good news is that obesity is entirely a preventable disease.  Some diseases happen and we don't know why.  There is no cure, only management (and even that is sometimes poor).  But in the case of obesity, we know the cause and we know the cure.  I don't mean to oversimplify it.  Once obesity happens, the physiology changes entirely and the "rules" of weight loss/gain change.  Appetite regulation is altered, sense of satiety is compromised, overall metabolic rate changes, hormones are disrupted, inflammation confuses the whole issue.  There is no doubt that fixing obesity is not an easy task.  But still, we know how to do it.  It may be incredibly difficult, but it can be done.  

Have you seen the movie Wall-E? It is an animated film where all humans are obese and out of shape.  There is humor to it.  It offended some.  But it was a typical Pixar movie; entertaining and brilliant.  It looks like we are moving closer and closer to that reality.  Remember that 42% are obesity rates.  At least another 35% of Americans are not obese; just overweight.  

Bad News About School Lunches

Is our overweight problem a threat to national security?  A group of retired military officers state that school lunches are so unhealthy, they are making future soldiers "too fat to fight."  Currently, 27 million young adults are deemed too fat to serve in the military. 

Let's remember that these fat kids become fat adults.  Our current health crisis starts with overweight and sick kids.  We are setting ourselves up for a dangerous future.

Vitamin D & Obesity

Summer is over. Fall is winding down and we're staring into winter. If you've not already done so, please go out and buy a vitamin D supplement. It's usually not appropriate to make blanket statements regarding supplement use. After all, supplement programs should be tailored to an individual's unique needs. However, vitamin D is one exception. Everyone who lives in Washington D.C., San Francisco or anywhere north of these cities absolutely must supplement with vitamin D between October and March.

Among the many diseases associated with vitamin D deficiency, a novel idea is popping up on the radar exploring its influence on obesity. This paper suggests that low levels of vitamin D promote an aberrant "winter response" that allows the accumulation of fat. The authors write, "It may be possible to reverse the increasing prevalence of obesity by improving vitamin D status."

$147 billion per year

$147 billion per year. That's how much we spend on obesity each year. A new report released today found that nearly 10% of our health care dollars go toward direct care of obesity related diseases. Obese people spend $600 more per year on prescription medications compared to normal weight individuals. Medicare expenditures are $1700 for obese individuals compared to normal weight individuals. Drug costs alone are $1400 higher for obese Medicare patients. Keep in mind that this does not include overweight... just obesity.

We're currently in a political climate where health care is a primary issue. I know we want drug companies to lower costs... insurance companies to care less about money and more about their clients. We talk about greed, bureaucracies, regulating insurers etc. But let's change the conversation from how we've been hurt to how we can help. Let's take ownership over our own health. There are costs that our lifestyle decisions collectively put on the health care system.

Let's put a new spin on 'political activism' and get physically active to do our part at chipping away at this health care crisis.

Weight Loss Strategies- Eliminate Food Allergies

Most of us are familiar with the scary types of IgE mediated food allergies like you may have read about in articles like this one in a February 2009 edition of Time Magazine.

But scientists are starting to identify different types of immune reactions involving IgG antibodies. (Your body makes 5 classes of antibodies, IgG, IgM, IgA, IgD, IgE).

People with IgG food allergies don't break out into hives or go into shock when they ingest inappropriate foods. The symptoms can be quite varied. Headaches, irritable bowel syndrome, rheumatoid arthritis and other conditions may result. Alternately, you may actually feel fine while chaos ensues internally.

In a 2008 study, researchers stated
"We show here, that obese children have significantly higher IgG antibody values directed against food antigens than normal weight children. Anti- food IgG antibodies are tightly associated with low grade systemic inflammation.... These findings raise the possibility, that anti-food IgG is pathogenetically involved in the development of obesity and atherosclerosis."

The jury is still out on IgG food allergies. Some clinicians dismiss them as irrelevant because we don't know enough about them. But the research is trending toward the recommendation that doctors identify and manage IgG food allergies.

This may be a key component in your chronic low grade inflammation and obesity.

Weight Loss Strategies- Probiotics

Gut microbiota (aka the normal bacteria that live inside your gut) also play a role in weight regulation. This article in Interdisciplinary Perspectives on Infectious Disease (Dec 2008) describes how important these bacteria are.

"... imbalances in the composition of gut microbiota have been associated with susceptibility to infections, immune-based disorders, and recently also with insulin resistance and body weight gain"

Does an imbalance in gut flora promote obesity or do obese people have imbalances? It becomes a bit of a 'chicken and egg' scenario. More than likely, it's a bit of both.

Without a doubt, steady diets of junk food promote obesity as well as gut flora imbalances. On the other hand, when gut flora balance is disturbed, energy regulation, nutrient absorption, immune function and hormone activity are all dysregulated.

From the same article above,
"The metabolic role of the gut microbiota is essential to the biochemical activity of the human body, resulting in salvage of energy, generation of absorbable compounds, and production of vitamins and other essential nutrients... "

Bottom line:
Probiotics may play a role in your overall strategy toward weight loss. It is not a weight loss method alone. But it plays a significant role in shifting your overall physiology to health and metabolic balance.

Obesity- Inflammation

You've probably all heard of inflammation. If you've ever sprained an ankle, you've seen and felt inflammation. But inflammation also happens internally and can be chronic with obesity. There's been a huge amount of research into this area and the consensus is that fat tissue releases signals that cause inflammation.

Inflammation is a product of your immune system and is characterized by immune cell infiltration into tissue. The immune system is actually a 'fighting' or 'defense' system. Inherently, it is good. But realize that whenever there is a battle, there are casualties and damages to the surroundings. For example, if you've every watched a superhero movie (Spiderman, Batman, Superman etc. ), you know that as they fight the bad guys, cars are overturned, buildings are destroyed and there may be millions of dollars in damages to the city! The immune system is a great thing to have but when its always on, there is potential for massive physiological distress.

In obesity, there is chronic low grade inflammation. This alone is problematic, but it may also lead to insulin resistance. To refresh your memory about how nasty insulin resistance is, go back to this blog entry.

So this is how the vicious cycle goes:
You are obese. Your fat tissue generates chronic inflammation. This promotes insulin resistance. Insulin resistance makes it harder to lose weight.

We'll talk about ways to break this cycle in other entries.

The Overweight Brain- Part 2:: Leptin Resistance

Leptin is a hormone produced by body fat that tells your brain (hypothalamus) that you are full. Here's how it works. You eat, leptin is released by your fat tissue, leptin tells the hypothalmus you are full, you lose your urge to eat and then you stop eating. It works well in most of us but scientists have revealed a phenomenon known as leptin resistance. This means that even though the hormone is released by your fat, your brain does not respond to it. The result is that you never really know that you are full so you keep eating. Here are a few things that can cause leptin resistance.

1. Inflammation: Poor diet, lack of sleep, food allergies, obesity itself and a host of other variables can promote inflammation. This can shut down the ability of the hypothalamus to respond to leptin. In other words, if you have inflammation going on, then you may not have adequate appetite regulation.

Neuroimmunomodulation 2008;15(3):189-93. Epub 2008 Sep 9.

2. Insulin resistance: There is a strong relationship between leptin resistance and insulin resistance. These 2 seem to go together like peas & carrot, peanut butter & jelly etc. Insulin resistance in and of itself is incredibly nasty. But some experts think that leptin levels even set you up for type 2 diabetes. Incredibly, some people who aren't even overweight have leptin resistance!
Journal of American College Health 2006 Nov-Dec;55(3):175-80.

3. Stress: It appears that hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA axis) can lead to obesity. And it appears that the HPA axis is regulated by leptin. While the links are still being drawn, it seems likely that poor leptin regulation may interfere with the HPA axis... subsequently leading to weight gain.
Obesity 2009 Mar 19.
International Review of Cytology 2007;263: 63-102

4. High Triglycerides: When your triglycerides are elevated, leptin has a difficult time reaching the brain because it can't cross something known as the blood brain barrier. Often, triglycerides are elevated in overweight folks. Unfortunately, this means that these same folks are not going to receive the "stop eating" signal. It doesn't seem fair, does it?
Current Pharmaceutical Design 2008; 14 (16): 1606-14.

5. Homocysteine: This is a marker that has been used to predict cardiovascular risk as well as cognitive decline. When you get your routine blood tests, ask your doctor to check your homocysteine levels. Elevations in homocysteine cause leptin resistance.
Molecular Pharmacology 2008; Dec 74(6): 1610-9.

6. MSG: Monosodium glutamate, a common flavoring in processed foods can actually promote leptin resistance. Now I know that some of you are thinking. "In what dose? Is a little bit ok? Just because it happens to rats doesn't mean it happens to humans right?" Let's not make excuses. Even if we can't say with 100% confidence that this happens, the science tells us nothing is good about MSG. At best, it's neutral. At worst, it alters the activity of your brain so that you don't know when you're hungry or full.
Obesity 2008 Aug; 16(8): 1875-80

Obesity- Kids

A new study in the April 2009 edition of Archives of Pediatrics & Adolescent Medicine reports that over 18% of 4 year old children in the United States are obese. The rate differed among children of different racial/ethnic backgrounds. It broke down like this:

Native Alaskan/American Indian: 31%
Hispanic: 22%
Non-Hispanic black: 21%
Non-Hispanic white: 16%
Asian: 13%

This kind of data reflects why pediatricians are becoming increasingly concerned with 'adult' conditions like nonalcoholic fatty liver disease in kids. Liver disease in kids! Due to largely preventable causes!

I know we think birthday cake is a standard rite of passage. A small cupcake after church on Sunday is no big deal... and it's so cute to see to see frosting on the noses of little ones! One cookie as an afternoon snack is alright. A family ice cream night after a long week is a time to bond. Everything in moderation, right?

Folks- when you add up an attitude of "moderation" over a typical week, the results can be staggering. We used to see this poor attitude manifest in adults who got sick as they entered their 40's following a lifetime of "moderation." Then we started seeing 20 year olds with health problems. Then, the teenagers started showing up with diabetes. After that, the kids started getting sicker. Now, we're seeing bad habits, poor health and a bleak outlook in our 4 year olds.

Overweight Kids and Fish

Tying together the last few articles I wrote in this blog, this study links prenatal exposure to toxins in our fish with obesity.

“What we have found for the first time is exposure to certain toxins by eating fish from polluted waters may contribute to the obesity epidemic in women,” Janet Osuch, MD, MS, professor of surgery and epidemiology at Michigan State University in East Lansing, said in a press release.

This particular study looked at 2 environmental contaminant; DDE (a breakdown product of Dichloro-diphenyl-trichloroethane aka DDT, a pesticide that was banned in the 1970's) as well as PCBs (another chemical no longer produced in the United States). Only DDE was found to have a relationship with obesity.

Folks, these chemicals aren't even produced in the United States any more. So are they coming from 'less civilized' places of the world? No! They are still lingering as a result of our past negligence and lack of foresight. They are still in the environment and are creating health consequences for us and our children today.

What are we doing today that will harm the next generation's health? It is clear that we are probably the sickest generation the United States has ever seen (consider that chronic disease so prevalent in the U.S. as well as obesity and overweight rates). So if we are this sick now, and we continue to demand-consume-throw away and pollute as much as we do now, then what will the next generation see?

The Overweight Brain- Part 1: Damages

The overweight brain undergoes a few hazardous changes. Here are the problems you'll have with your brain if you are overweight.

1. Your brain will operate slowly...: Cognitive decline normally accompanies obesity. The good news is that it is reversible!
Endocrinology. 2008 May;149(5):2628-36. Epub 2008 Feb 14

2. ... but age more quickly:
Researchers think that obesity can speed up age-related changes to the brain. It also makes your brain more vulnerable to injury.
Biochimica et Biophysica Acta 2008: Oct 17.

3. You'll probably get Alzheimers...: Obesity is a risk factor for the development of Alzheimers disease. Experts say that regulating body weight is a major preventative step in avoiding Alzheimers as you age.
Current Opinion in Clinical Nutrition and Metabolic Care 2009; Jan;12(1): 15-21

4. ... or have a stroke: Obesity is a major risk factor for stroke! No surprise here.
Neurologic Clinics 2008; 26(4): 1007-45

5. Your memory will suffer: While not clearly established, there is evidence that learning and memory decline in obese individuals. We need to keep in mind that obesity is usually accompanied by hormone irregularities, widespread inflammation and immune dysregulation. Any of these may actually be the cause of brain based changes in learning and memory. Nonetheless, obesity is unhealthy and it stands to reason that normal brain function will decline.
Physiology and Behavior 2009 Jan 8;96(1):1-5. Epub 2008 Jul 29.

This is just your brain! Being overweight causes many other issues with your heart, lungs, endocrine system, immune system and more.

Obesity Pill

Arena Pharmaceutical's experimental obesity drug, Lorcaserin, cleared another hurdle en route to FDA approval but the results were less than hoped for. With the relatively disappointing results, share prices fell this week.

It's no secret that Americans are fat. Two thirds of us are overweight and about 100 million Americans are obese. In a nation of fast food, caloric excess, massive sugar consumption, weird breakfast cereals, soda machines in schools, 600 empty calorie 'afternoon snacks', and a general culture that promotes excess (as we're seeing with the economy these days, it hasn't just been caloric excess we've been guilty of the past few decades), it's no wonder that we're looking for a quick fix and hang our hopes on Arena Pharmaceutical Inc.

Let me tell you something we already know- there is no quick fix. I admit that obesity and overweight is a complicated issue. In the old days, we would simply say, "eat less and exercise more." But most clinicians understand that we've let the obesity beast get out of control and for many people, that simple mantra (still repeated in many health clubs across the U.S.) just doesn't hold true any more. Don't get me wrong- you absolutely must exercise. But we understand that there is much more to the picture of weight loss.

In April, we'll spend time taking a different look at weight loss. I'll explain some of the vicious cycles that can promote further weight gain and what you can do about them.