Rapid Response for MONDAY and TUESDAY, August 6 and 7, 2018

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Offerings by George A. Sprecace M.D., J.D.:

OBESITY: THE LATEST AND MOST LETHAL “COMMUNICABLE DISEASE” 

Listen up. Folks: The life you save will be your own.

• This country is now in the grip of four epidemics: Obesity; Diabetes Mellitus; Obstructive Sleep Apnea; and Alzheimer’s Disease.  And these four conditions may well be connected by a common cause: chronic suffocation of our body’s tissues, including the brain. 
• At a recent meeting of the American Academy of Neurology, David Wilson, PhD reported that beta-amyloid, one of the hallmarks of Alzheimer’s Disease in the brain is markedly increased by acute –and quite possibly chronic – low oxygen levels.  Obesity, by means of its promotion of the other epidemics listed above, is very likely operating through this mechanism to promote even this deadly neurologic disease. 
• Obesity is defined by the Body Mass Index, relating height and weight as it impacts health and disease.  A BMI of under 25 is normal.  A BMI up to 30 is Overweight.  A BMI of 40 or over is Morbid Obesity. 
• Other factors in the increased morbidity and mortality associated with Obesity include: EXCESS ABDOMINAL GIRTH; WEIGHT GAIN DURING ADULTHOOD; AEROBIC CONDITIONING; AND ETHNICITY / GENETICS. 
• The Pathophysiology of Obesity is complex…nothing like the earlier idea that fat cells (adiposities) were merely storage bags for fat cells.  It involves Central Nervous System connections and also the fact that fatty tissue turns out to be an endocrine organ (like the pancreas or the thyroid) that secretes hormones.  One of these hormones is Leptin, which controls satiety – the sense of fullness that pushes us back from the table.  Problems with Leptin can be either those of quantity / secretion or of sensitivity to its effects. 
• There are at least 30 genetic determinants related to obesity.
• The prevalence has increased by 75% in the U.S. since 1980: 65% with BMI over 25 and 33% with BMI over 30.  17% of children are now obese.  Worldwide, obesity exceeds chronic malnutrition. And it is clearly associated with urbanization. 
• Obesity is a causal factor for many diseases, besides those mentioned above, and a cause of pre-mature death.  It has become the #1 cause of Cirrhosis of the Liver, as Fatty Liver, exceeding Alcoholism as a cause.  In fact, the losses from Obesity may soon outpace the gains in longevity from smoking cessation, leading to the first reduction in life expectancy in our history.  As one example, the life expectancy of a NFL player is currently 50 years!
• OBESITY TREATMENT is multi-pronged, but always based on reducing caloric intake and substantially increasing energy expenditure (exercise).  One of the proven best approaches to diet and life-style modification is the Mediterranean Diet and Life-Style, as highlighted on this web-site (www.asthma-drsprecace.com)  There is a small role for medications, although the recent report of an experimental drink containing alginate could be helpful.  By contrast, several anti-psychotic medications promote weight gain.  Increasing restful sleep can definitely promote weight loss, just as inadequate sleep promotes weight gain.  Here, diagnosing Obstructive Sleep Apnea, one of the epidemics noted above, is vital…and easily treated.  The probably central role of refined sugars is addressed in a recent article in the NYTimes Magazine (April 17, 2011) entitled: “Sweet and Vicious: The Case Against Sugar”, by Gary Taubes.  And Bariatric Surgery has now become Standard of Care for many obese and especially morbid obese persons.  This includes the Roux-en-Y procedure, which can now sometimes be performed by laparoscopy.
• Some psychologic support is always necessary, and can be as simple as regular visits to one’s physician or even regular telephone consultations with trained medical personnel.  In some cases, psychologic or psychiatric follow-up – in the form of “talk therapy”…much more important than medications…is necessary and very useful. 

SO, THERE YOU HAVE IT, FOLKS.  IT’S DECISION TIME.  WHAT WILL IT BE: DIABETES MELLITIS, HYPERTENSION – HEART ATTACKS – STROKES, OTHER CHRONIC NEUROLOGIC DEFICITS, CIRRHOSIS OF THE LIVER, MULTIPLE JOINT REPLACEMENTS DURING MANY YEARS OF PAIN, CHRONIC SUFFOCATION, OR ALL OF THE ABOVE AS YOU PROCEED TOWARD ALZHEIMER’S DISEASE? 

IT’S ALL RELATED TO OBESITY, A VERY TREATABLE DISEASE.   YOUR CHOICE.

GS

This major medical problem has been under study for decades.  But the resulting knowledge and insights continue to be limited, as witnessed by the many dietary and other approaches to it.  My extended family and I have decided to make our contribution, by simplifying and popularizing the only diet and life-style that has been successful since before Roman times: the Mediterranean Diet and Life-Style.  Please visit our new web-site devoted to this effort:

www.medidietresources.com

ABOUT FAT KIDS

Sorry, but there is no other way to express it.  It's even more appropriate in view of the fact that many parents of fat kids don't perceive them as such.  "Love is blind".

This is important.  The incidence of fat children, beginning at pre-school ages, and defined conservatively as being beyond the 95th percentile, has more than tripled in the last 25 years.  So has the occurrence of diabetes mellitis in children, sometimes causing serious illness and even death at the time of first diagnosis.

What is unfortunate is that more than 2/3 of kids who become fat in childhood will have that problem throughout their lives.  And all children who develop diabetes in childhood will have it throughout life, with the onset of serious complications (heart attacks, kidney disease and failure, vision loss) within twenty years.  See what I mean?

Why has this happened?  Heredity and expansion of the obesity, metabolic syndrome and diabetic gene pool.  Junk foods.  Massive portions.  Drowning in soft drinks.  No exercise, not even in school.  Hours and hours in front of the TV and computer and game screens - all the while snacking on fatty and high-glycemic-index foods.  No parental guidance, or poor guidance.  Massive advertising targeted to all those harmful habits.  And even schools plastering the halls and cafeterias with dispensers for this junk...in return for pay-offs from the junk food and soft drink industries.  The demise of the home-cooked meal, replaced by fast foods and by unhealthy breakfasts and lunches offered...fast...for poor and at-risk children.  In addition, there may be a connection between the early use of oral contraceptives in young girls - during puberty - and marked obesity.

What to do?  1) Get all the junk food dispensers and McDonald-type outlets out of the schools.  2) No sodas for kids.  Drink water!  3) Fruit and vegetable snacks, or well-prepared left-overs from previous meals.  4) Restore at least one hour of gym three times per school week.  5) Maximum combined TV, computer and game-screen time to two hours per day on weekends, and less on school days.  6) The "Rule of Half" for all portions, whenever eating out...and possibly also at home.   7) Seriously consider the ramifications of early use of oral contraceptives and of early pregnancies.

Obesity in this country was declared an epidemic by Federal health agencies three years ago...and it is rampant, with very serious consequences for the fat kids and their parents...and for society, which will ultimately have to pick up the tab for their health care and life-long complications.  Not a pretty picture.  Nothing "pleasingly plump" about it.