Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the world of health. Whether it’s research that makes the news, another miracle diet, or a new food fad, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
Let's begin with this. As a country we’re fatter than we’ve ever been. In 2021, 19 states exceeded 35% obesity among the residents; in 2022, it jumped up to 22 states. Three states exceeded 40% of residents were considered obese: Louisiana, Oklahoma, and West Virginia. If you want to find out where your state stands, simply go to www.cdc.gov and search for the word obesity. You'll find a link to the maps that graphically depict where we stand as a country as well as individual states. My home state of Michigan falls in the more than 30% but less than 35% obese category.
If you drill down into other maps and data that the CDC provides, you can get more specific as to age, ethnic group, and race. Here are a couple of examples. Which age group is the fattest? Those between 45–54 years with 39.9% obese. The leanest? Young adults at 20.5%. Looking at those maps, believe me, it’s not a pretty picture.
As I was reading through the press release announcing the annual study, something put me off a little bit. This is a statement by Karen Hacker, the head of the CDC’s Center for Chronic Disease Prevention and Health Promotion: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics, and certain medications.” I can’t get past the word “disease.” Let me explain.
While I agree that there are many factors that are ultimately involved in becoming obese, are they really causes or are they the result of being obese? I think that genes do play a role in developing obesity but perhaps not for the same reason as most people would think. We are alive because our ancestors survived periods of famine that have always occurred. Some call it the thrifty gene. But for the most part we are all genetically inclined to store excess food as fat.
Medications can wreak havoc on metabolism. Certainly, medications can dramatically impact fluid retention if you're on blood pressure medication. But do they put in more calories into the food that you eat? No.
Medications, especially treatment for chronic diseases like cancer or nervous system disorders, can change the use of calories by the body. But is it severe enough to cause the degree of obesity that we see in the United States today? Understand the numbers of obesity. Not everyone is massively oversized. It's easy to remember someone who is massively obese; it’s not as rare as it used to be. The average height for a man in the US is 5’9” and weighing over 202 pounds is considered obese while, for women the average height is 5’4” and over 173 pounds is considered obese. There are many people who can hide that weight well. My point is that it’s not the largest individuals who are tipping the scales in the increase in obesity; it’s everyone.
Some people want to argue the BMI is archaic and isn’t precise enough. All you're looking at is the relationship between height and surface area. The units are kilograms per meters squared. Excess muscle mass and maybe even large bones may impact it slightly. For obesity, BMI is as precise as we need.
There is only one real cause of obesity for most people. I'll get to that in a moment.
Let's start with a definition. The definition of disease is a disorder of structure or function in a human, animal, or plant, especially one that has a known cause and a distinctive group of symptoms, signs, or anatomical change. There is no question that obesity has anatomical changes that result in symptoms.
The disorder part of the obesity definition is one that is clear: the cause of obesity. The cause of obesity is the systematic overconsumption of calories, usually taking years, if not decades, to manifest itself. We can consider other factors from the availability of foods, the types of those foods, the development of suburbs, and on and on. Forgetaboutit! We’re fat because we eat too much.
Let me repeat the definition with the focus on the individual words
“The cause of obesity” - what causes obesity? Eating more calories than your body needs to maintain body weight.
“is the systematic” – I chose that word because every other one is overused. Consistent. Persistent. Systematic means that it’s on a schedule, and while the foods and amounts vary day to day, it’s systematic.
“overconsumption of calories,” Eat too much is an oversimplification because then arguments occur about carbs, sugars, fats, etc. A calorie is a calorie no matter where it comes from.
“usually taking years, if not decades, to manifest itself.” Some people seem to believe that yesterday they weighed 150 pounds and the next day they woke up at 200 pounds. Unless you have massive fluid retention due to congestive heart or kidney failure, that isn’t the way it works. It is one calorie at a time over a long period of time.
So what’s the evidence for my position?
There are two examples I’ll cite, both related to World War II. The first was the Minnesota Starvation Study. Male conscientious objectors had to lose 25% of their body weight in 6 months. They were normal weight when the study began. Their caloric intake was adjusted weekly to maintain the required weight loss per week. The result was a linear loss of 25% of their weight in 6 months.
This one is extreme but applies nevertheless. No one walked out of concentration camps after being liberated overweight. They were systematically starved until they no longer had the energy to work.
There was not a change in structure or function; the people were simply starved. The result was weight loss. There is no change in structure or function when we systematically overeat. However, once we are overweight and obese, there are changes in the structure and function of our bodies which have to be dealt with. But it still comes down to a calorie is a calorie.
You might say “that really isn't about weight gain” and you would be correct. If you look at the change in BMI over the years, the only explanation for the increase in body weight would be the over consumption of calories. Height certainly didn't change very much once a person is an adult. We've been a sedentary society for the past 25 to 30 years so that hasn't changed very much. Maybe ultra-processed foods contributes to those calories but The only explanation is the increase in consumption of calories.
We are obese because we consistently eat too many calories. We can reduce our weight if we systematically eat less. Yes, there are challenges to overcome because of those structure and function changes caused by chronically overeating. You just have to find the way to reduce your caloric input that works for you. Eat less. Eat better. Move more. Thanks for listening but we’re out of time. This is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
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