Obesity, The Oldest Metabolic Disorder
Obesity has reached epidemic proportions worldwide. Recent estimates, by the World Health Organization and by the Center for Disease Control in Atlanta, indicate that the incidence of obesity is doubling every five years. Current statistics show 71% (compared to 56% in 1984) of adults are overweight and in excess of 30% are obese. Dr. CL Birmingham of UBC wrote in the Canadian Medical Association Journal in Oct. of 1999 that the estimated cost of obesity in Canada is in excess of $1.8 billion or 2.4% of the total government health care expenditures.
It is doubtful that any other metabolic disorder has received more published attention in the scientific and popular literature. More people talk about this disorder than any other health problem. Those offering quick and easy solutions have made fortunes. It has been call the "World's Oldest Metabolic Disorder" with recorded concerns unearthed from the Stone Age, Egyptian mummies and Greek Sculptures.
The risk of premature death and the morbidity statistics can be or are very depressing. Dr. Everett Koop, former Surgeon General of the United States, has said "... Obesity is the second leading cause of preventable pre-mature death in America". Although there are metabolic reasons for obesity, it is essentially a 'lifestyle' disease. Sustained caloric imbalance (too many calories consumed and not enough spent) with the consequent obesity is becoming a behavioral norm of the North American population.
One very sad footnote to the depressing statistics is that the trend has filtered down to children. The November 27 / 2000 issue of the Canadian Medical Association Journal shows the rate of obesity among Canadian boys aged 7 to 13 tripled between 1981 and 1996. Girls of the same age group have twice the prevalence of obesity over the same time period. Current estimates show 25 - 30% of Canadian children overweight and 12 - 14% are obese.
Another disturbing statistic from the Oct. 2001 issue of the American Journal of Obstetrics and Gynecology is that the average weight of pregnant women at their first pre-natal visit has increased from 144 to 172 pounds during the 1980 to 1999 time frame. The obesity figures (defined as those in excess of 200 pounds) for this group have risen from 7% to 24%. Obese women were at significantly increased risk for cesarean deliveries, gestational diabetes and large birth weight babies.
A second related epidemic appears in conjunction with obesity and that is Type 2 Diabetes, The Journal of the American Medical Association reported in Sept of 2001, that the 'twin epidemics' continue to threaten the health of Americans. With a 61% increase in the incidence of obesity and a 44% increase in the incidence of Type 2 Diabetes (another preventable lifestyle disease) between 1991 and 2000, there is just cause for concern and incentive for individuals to take action.
Risk of increased incidence of hypertension, coronary heart disease, stroke, cancer, gall bladder disease, pulmonary abnormalities, arthritis, other inflammatory diseases and Type 2 Diabetes among the obese are well documented. The prevalence of these major health risks and the likelihood of premature death increase disproportionately with increasing weight. Although the prevalence of these ailments shows strong correlations they cannot necessarily imply causation. (Obesity does not necessarily cause hypertension nor type 2 diabetes - they just occur together and another factor like chronically elevated insulin may well be the cause of all three ailments.) Chronically elevated insulin is due to excess consumption of easy to digest (high glycemic index) carbohydrates and the under-consumption of good protein and fat in conjunction with carbohydrates (further explanation of this is another column).
Enough gloom and doom, it has been said that 'knowledge is power' and you now have some of that knowledge. One has to wonder when the power of our collective knowledge is going to take effect. It is my position that with our current knowledge of nutrition, the solutions for the prevention and rehabilitation of obesity are relatively simple for the vast majority of the population. Knowledge, experience and published research have clearly demonstrated that wise nutrient rich food selection including adequate protein, good fats, low glycemic carbohydrates and responsible supplementation combined with some responsible exercise creates an anti-obesity 'lifestyle' solution.
The food selection issue seems to be the most controversial in spite of the overwhelming evidence that chronically elevated insulin seems to be one of the most significant causes a long list of metabolic upsets leading to most of the risk factors associated with obesity. When insulin is elevated, we store fat and cannot metabolize fat for energy. To metabolize fat, blood insulin levels must be reduced in favor of higher levels of the fat mobilizing hormone glucagon.
Simple rules to control insulin that work for the majority are
- Protein and fat control appetite and the rate of rise in blood sugar which helps to control insulin. Therefore eat protein in every meal and every snack and eat some of the protein food first - before any carbohydrates including alcohol.
- The nutrient density of colourful vegetables and fruits is higher than that of most grain products so get most of your carbohydrates from those colourful sources.
- Most grain products made from flour of any kind tend to be high glycemic index foods and raise blood sugar quickly unless you carefully follow rule #1
- Essential fatty acids are 'essential'. Add nuts, seeds and high quality oils to the food selection.
- Never miss meals, eat something approximately every 3 hours during the day. The two most common ways to slow metabolism are a) don't eat and b) don't exercise.
- Exercise at least 4 hours per week using target heart rates of 180 minus your age as the criteria (some call it 'conversational intensity'). The 4 hours should not all occur on the same day.
- Don't expect to lose more than 2 pounds of fat per week. Actually one pound per week would be ideal and reflect true fat loss.
Dr. L. Lee Coyne, the Healthy Professor, is a nutritional consultant, lecturer and author of Fat Won't Make You Fat and the Previous in Conditions: Lead Poisoning
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