Back when I was much younger it seemed the reason behind obesity was quite obvious – people ate too much. Now days, it seems with the ever growing epidemic of obesity, many people either do not understand how it is caused, or have just accepted it as a normal part of life and do not even consider doing anything about it. As a result, our cost for health care and the burden placed on the system is growing daily too. By one estimate, the U.S. spent $190 billion on obesity-related health care expenses in 2005-double previous estimates. Just think, that was fifteen years ago. Obesity greatly increases our risk of developing conditions such as diabetes, heart disease, osteoarthritis, and some cancers, to name just a few. Yet few understand or do not care that their obesity can and will reduce their life span. Treating obesity and obesity-related conditions costs billions of dollars a year, yet far too many do not care to do anything about it. Sadly, obesity has reached epidemic proportions in the United States. Over two-thirds of adults are overweight or obese, and one in three Americans is obese. The prevalence of obesity in children has increased markedly as well. Can we continue to kick this can down the road?

What is obesity?

Depending on what you read, you might find a variety of definitions. In general, overweight and obesity indicate a weight greater than what is healthy. Obesity is a chronic condition defined by an excess amount of body fat. Of course we all need a certain amount of body fat for storing energy, heat insulation, shock absorption, and other functions. But, this is not a license to believe there is anything healthy about being a body fat hoarder.

Forget all the vanity reasons why obesity is not desirable. The concern for obesity needs to go far beyond the cosmetic considerations, it is harmful to one’s health as it is a risk factor for many conditions. In the United States, roughly 112,000 deaths per year are directly related to obesity, and most of these deaths are in patients with a BMI over 30. Patients with a BMI over 40 have a reduced life expectancy. Just think, we have had the entire nation in a panic over the Covid-19 Corona virus because it may kill an equal number of people as obesity actually does each year. Yet no one blinks an eye when it comes to the many problem associated with being fat.It is perfectly acceptable for me to load a grocery cart with sugary sweet treats and unhealthy foods, so long as I am wearing a face mask while doing so…

Obesity increases the risk of developing a number of chronic diseases, including the following:

• Insulin resistance. The hormone Insulin is required for the transport of blood glucose (sugar) into the cells of muscle and fat (which your body uses for energy). By transporting glucose into cells, insulin keeps the blood glucose levels in the normal range. But, you cannot keep hammering the pancreas for more by eating large carbohydrate meals and snacks before you develop Insulin resistance (IR) which is the condition where your body now has a diminished effectiveness of your insulin transporting glucose into your cells. Fat cells are more insulin resistant than muscle cells; therefore, one important cause of insulin resistance is obesity. The pancreas initially responds to insulin resistance by producing more insulin. As long as the pancreas can produce enough insulin to overcome this resistance, blood glucose levels remain normal. This insulin resistance state (characterized by normal blood glucose levels and high insulin levels) can last for years. Once the pancreas can no longer keep up with producing high levels of insulin, blood glucose levels begin to rise, resulting in type 2 diabetes, thus insulin resistance is a pre-diabetes condition. A couple good analogies for how too many carbohydrates affect your pancreas is to think about how many cigarettes can one smoke before they have developed COPD and can no longer breath. How much alcohol can one consume before they have trashed their liver with cirrhosis? Just the same, the damage to your pancreas is most often also self inflicted!
• Type 2 diabetes. The risk of type 2 diabetes increases with the degree and duration of obesity. Type 2 diabetes is associated with central obesity; a person with central obesity has excess fat around their waist. Type 2 diabetes is a serious medical condition that often requires the use of anti-diabetic medication, or insulin to keep blood sugar levels under control. However, the development of type 2 diabetes and its complications can be prevented if detected and treated at an early stage. In recent years, it has been discovered that many people with type 2 diabetes are actually able to reverse their diabetes through methods including low-carb diets, medically supervised very-low-calorie diets and exercise. Yet, you will find a great many who will go on about their nutritional habits as they always have, the habits that lead them to having type 2 diabetes in the first place. Seriously, I find this to be utterly stupid when one does not even attempt to manage their disease through a change of lifestyle. It is pure selfishness when one with type 2 diabetes does nothing about making a positive change for the better – these types will eventually become a burden for their loved ones when they have to become caretakers or to plan a funeral and disposition of an estate.
• High blood pressure (hypertension). Hypertension is common among obese adults. Ladies, you need to know that weight gain also tends to increase blood pressure in women more significantly than in men.
• High Cholesterol.
• Stroke risk rises with obesity.
• Heart attack. A prospective study found that the risk of developing coronary artery disease increased three to four times in women who had a BMI greater than 29. A Finnish study showed that for every 1 kilogram (2.2 pounds) increase in body weight, the risk of death from coronary artery disease increased by 1%.  In patients who have already had a heart attack, obesity is associated with an increased likelihood of a second heart attack. Think about the implications for one who is 50 to 100 plus pounds over weight.
• Congestive heart failure
• Cancer. Obesity is a risk factor for cancer of the colon in men and women, cancer of the rectum and prostate in men, and cancer of the gallbladder and uterus in women. Obesity may also be associated with breast cancer, particularly in postmenopausal women. Fat tissue is important in the production of estrogen, and prolonged exposure to high levels of estrogen increases the risk of breast cancer.
• Gallstones
• Gout and gouty arthritis
• Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back
• Sleep apnea

The balance between calorie intake and energy expenditure determines a person’s weight. If a person eats more calories than he or she burns (metabolizes), the person gains weight (the body will store the excess energy as fat). If a person eats fewer calories than he or she metabolizes, he or she will lose weight. Therefore, the most common causes of obesity are overeating and physical inactivity. However, we do recognize that body weight can also be a result of genetics, metabolism, environment, and culture.

• Physical inactivity. It is not rocket science that lazy, sedentary people burn fewer calories than people who are physically active. This is a truth for both men and women.
• Overeating. Overeating leads to weight gain, especially if the diet is high in simple carbs and bad fats. Foods high in sugar and  bad fats such as fast foods, fried food, and sweets) have high energy density (foods that have a lot of calories in a small amount of food). With these poor food choices you can easily consume your daily needs of calories in just one sitting.
• Genetics. A person is more likely to develop obesity if one or both parents are obese. Genetics also affect hormones involved in fat regulation. For example, one genetic cause of obesity is leptin deficiency. Leptin is a hormone produced in fat cells and in the placenta. Leptin controls weight by signaling the brain to eat less when body fat stores are too high. If, for some reason, the body cannot produce enough leptin or leptin cannot signal the brain to eat less, this control is lost, and obesity occurs. The role of leptin replacement as a treatment for obesity is under exploration. However, you cannot just assume you are leptin deficient when you are quite possibly just carb addicted. Your parents and everyone in your family might actually be carb addicted instead of being leptin deficient.
•  A diet high in simple carbohydrates. The role of simple carbohydrates in weight gain is quite clear. Carbohydrates increase blood glucose levels, which in turn stimulate insulin release by the pancreas, and insulin promotes the growth of fat tissue and can cause weight gain. Simple carbohydrates (sugars, fructose, desserts, soft drinks, beer, wine, etc.) contribute to weight gain because they are more rapidly absorbed into the bloodstream than complex carbohydrates (pasta, brown rice, grains, vegetables, raw fruits, etc.) and thus cause a more pronounced insulin release after meals than complex carbohydrates. This higher insulin release contributes to weight gain. Weight loss programs such as Weight Watchers who tell their carb addicted patrons they can continue to eat simple carbs know this, these people are an easy source for a perpetual income stream. By telling their carb addicted patrons they can still eat sugary foods as long as they track it is no different than if Alcoholics Anonymous told their members they could still have the occasional drink.
• Frequency of eating. The relationship between frequency of eating (how often you eat) and weight is somewhat controversial. There are many reports of overweight people eating less often than people with normal weight. Scientists have observed that people who eat small meals four or five times daily, have lower cholesterol levels and lower and/or more stable blood sugar levels than people who eat less frequently (two or three large meals daily). One possible explanation is that small frequent meals produce stable insulin levels, whereas large meals cause large spikes of insulin after meals. One huge problem that cannot be ignored is those who eat less frequently are also more prone to eat excessively when they do. Binge eating is a common issue with the obese.
• Medications. Medications associated with weight gain include certain antidepressants, anticonvulsants used in controlling seizures such as Tegretol, Tegretol XR , Equetro, Carbatrol, Depacon, and Depakene. Other medications such as for  diabetes used for lowering blood sugar such as insulin, sulfonylureas, and thiazolidinediones along with certain hormones such as oral contraceptives, and most corticosteroids such as prednisone can cause weight gain. Weight gain can also come from some high blood pressure medications and antihistamines. The cause of weight gain from medications are multiple and differ for each medication. If this is a concern for you, you should discuss your medications with your physician rather than discontinuing the medication, as this could have serious effects. You may have little control over the effect of medicines on your body, but you do have control over what you put in your mouth. If you are on medicines that might cause weight gain, it is paramount that you remain disciplined with your dietary habits.
• Psychological factors. For some people, emotions influence eating habits. Many people eat excessively in response to emotions such as boredom, sadness, stress, or anger. While most overweight people have no more psychological disturbances than normal weight people, about 30% of the people who seek treatment for serious weight problems have difficulties with binge eating.
• Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome, and Cushing’s syndrome are also contributors to obesity. Some diseases, such as Prader-Willi syndrome, can lead to obesity.
• Social issues: There is a link between social issues and obesity. Lack of money to purchase healthy foods or lack of safe places to walk or exercise can increase the risk of obesity.

Childhood obesity.

A person’s weight during childhood, the teenage years, and early adulthood can and will influence the development of adult obesity. With each passing year we see more and more children with weight issues and the ailments associated with them. Therefore, decreasing the prevalence of childhood obesity is one of the areas Brenda Sue and I try to focus on in the fight against obesity. For example,

• being mildly overweight in the early 20’s was linked to a substantial incidence of obesity by age 35.
• being overweight during older childhood is highly predictive of adult obesity, especially if a parent is also obese.
• being overweight during the teenage years is even a greater predictor of adult obesity.

While we obviously want to give our children and grandchildren the best lives we can, pampering them with poor nutritional choices and not encouraging them to be physically active only serves to hurt them in the long term while we make them only feel a little better in the very short term.

As a society and a culture, we must do better by our children.

Their future health depends on us to do them right, not what is comfortable in the moment..