Thursday, April 5, 2012

The three hidden barriers to chronic health, weight loss and weight maintenance.

Into The Age of Chronic Health
The most amazing thing about modern health care systems is that they let most of us die from chronic diseases which we know how to prevent. So why don't we?
As a public health scientist I have devoted the past 15 years of my life to answering this question. Many of my colleagues outdo each other with doom and gloom predictions of aging societies buckling under the economic burden of aging related diseases. I believe that the age of chronic health and longevity is about to begin. With you. And with a radically new approach to make the prevention of heart attacks, strokes diabetes and cancers finally work.     
Because, until now, it doesn't. But don't just take my word for it, let's look at some of the facts first:
You have probably heard that obesity is the new smoking. In fact for every American who stopped smoking in 2011 another one became obese.   
Today, for the first time in human history there are more overfed than malnourished people walking this planet. And their lifestyles of too much food and too little exercise have become the number one risk factor for the number one chronic disease and killer: cardiovascular disease with its most well-known end points - heart attack, stroke and heart failure. With nasty other diseases on the side: diabetes, kidney failure and certain cancers.
You probably also heard about major studies, like the U.S. government funded Diabetes Prevention Program, and the Look AHEAD trial, which proudly, and correctly, report weight loss and major reductions in cardiovascular risk factors among participants in the lifestyle arms of these trials. What you don't hear so often, is that within 3-4 years after enrollment, most participants will have regained not only most of their weight but also all their risk factors.
Ok then, lifestyle change prevents disease. But what prevents lifestyle change?
Why is it that over the last 30 years of public health efforts we have not seen a demonstration of any program that results in a clinically meaningful weight loss that can be maintained for more than 2-3 years in the majority of participants and at low cost?  That's the question which Dr. Richard Khan threw at an assembly of public health advocates, who had gathered earlier this year under the event's message "Prevention works!".  Dr. Khan, who teaches medicine at the University of North Carolina, was the chief scientific officer of the American Diabetes Association for 25 years. The man certainly knows what he is talking about. 
Now think about the implication. If you chose a lifestyle of which you know might increase risk of disease and premature death, then you make that choice either willingly or it is not your free will which makes that choice.
My money is on the latter. Because how else could we explain that an obese child maintains her fattening habits despite experiencing the same psychological agony as a child with cancer? How else could we explain that obese adults maintain their bulk when it significantly reduces their chances of getting an academic education, a job and a mate? How else could we explain that over the past 20 years the obesity rate in the US went up by 60% when, during the same period, Americans doubled their spending on weight loss products to US$ 60 billion annually? They WANT to lose weight, but they don't. The explanations are called addiction, hormones and hyperbole.  
Food addiction
The neurohormonal architecture which drives an addict to crave and consume his drug, despite knowing and hating the consequences, is exactly the same architecture that keeps us going for the sweet, fatty and salty stuff in restaurants, hawker centers and vending machines. Does that explain, why the food industry adds sugars to so many foods in which you least expect it? You bet. In fact we shouldn't be afraid of calling ourselves food addicts, because this is what Mother Nature intended us to be all along. With this addiction she drove our ancestors for millions of years to what is naturally sweet in the natural human habitat: fruits. They deliver not only the carbohydrates for which we have very little storage capacity in our bodies and without which our brain can't function. Fruits also pack a punch of essential micronutrients. Unlike the cokes and cakes and cookies which deliver more sugar than we need and no other nutrients with it.  
Hormones
Once you have changed your figure into the shape of a beached whale, you will also have changed the way the hormones of your gut and of your fat tissue work. It's a rather complicated picture unfolding in the labs of biomedicine, but one emerging theme is a colossal malfunction of the satiety and appetite signaling pathways. Instead of feeling full, you are now ready to add a tiramisu to a lunch that would have satiated a family of four in rural Bangladesh.
Hyperbole
Actually it's called hyperbolic discounting, and it's a simple mathematical formula, which behavioral scientists have found to neatly describe why we will still grab that tiramisu tomorrow even though we swear today that we won't. It has to do with how we more steeply discount the relatively larger but more distant reward of staying healthy against the relatively smaller but immediate reward of enjoying the tiramisu. It doesn't operate only in humans. The behaviors of rats, pigeons and apes, for example, follow the same formula. Which means, Mother Nature must have found out early during evolution that this principle is a recipe for survival in her species. We simply inherited this survival tool.   
With all these issues stacked in favor of an ever expanding population of chronically ill people, why do I believe that we might be close to the age of chronic health and longevity? For three reasons: Because Wall Street is getting into the act, because we can outfox our brain, and because biomedical science has got the tools ready.
How we will enter the age of chronic health is the subject of the next episode, so stay tuned!
In the meantime, visit my crowd funding campaign, watch the videos, recommend the campaign to your friends and, if you like what you see, participate in our chronic health project: www.indiegogo.com/adiphea

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4 comments:

  1. Very interesting article about weight lose, also, I found a very interesting guide about weight loss and never get fat......

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  2. I am closing in on 64 years of age. I have been 25 pounds lighter than my identical twin brother my entire adult life. So how can you account for this difference with your theories about physiology? The difference is that I had a reason to be athletically trim. I married two decades later than my twin did, and I noticed that there was a powerful incentive in the dating market to maintain a "normal" weight. I take as "normal", what a man of my (6-feet-tall) build would weigh if he were a 25-year-old male ballet dancer, which in my case means 176 pounds with so much muscle that everyone assumed I must be gay.

    I married 22 years ago now and so I am now 10 pounds heavier than "normal", but my twin has also put on 16 pounds. While I still fit in the same clothes I wore 20 years ago (barely), 10 pounds is more than enough to make my blood work make my M.D. want to put me on lipitor and to really limit my running distance. The notion that the human body was designed to carry even 10 extra pounds without grave health risks is risible.

    I have associates who have lost over 100 pounds and kept it off. They were always females who decided they wanted to have sex lives again which meant losing their 100 pounds plus about 200 pounds of husband. Anytime you see a long-married obese woman suddenly lose a tremendous amount of weight, assume there is a divorce filing in her future.

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  3. Hi JediWonk

    Let me start from the end of your comment. Occasionally I do come across the scenario you describe: a severely overweight woman whose (intentional) weight reduction seems to coincide with a marriage that teeters at the abyss. I must admit I never made the association you suggest, but you might be right here. Interesting observation!
    Now to your major stab at the content of my post: I'm glad I provoked some comment, which I'm always very happy to receive.
    My intention is NOT to say that these biological mechanisms are the only ones driving our behaviors. My intention is NOT to say that we are mere puppets of these mechanisms. It is however my intention to point out that these mechanisms do exist. In public health we tend to conveniently disregard them. But they do certainly not exculpate the obese. I have touched on that subject in my post on the question whether obese people are just lazy.
    Anyway, when looking at the problem of obesity we can take cues from other areas where addiction and biological mechanisms drive self-destructive behaviors. There are many people who have experimented with drugs, but never became addicts. There are reformed alcoholics and ex-smokers who successfully kicked the habit. So there are ways to change. I know from own experience. 23 years ago I stopped smoking the day when my non-smoking girlfriend moved in with me. Not because she asked me to, she never did, but because I knew that a smoker stinks. We are now married for 21 years. All the desires to smoke, especially after a meal, are long forgotten, and I'm so grateful that I kicked the habit. But it took some determination. My experience, though, is that most overweight people do not muster enough of the determination required to do what it takes to reduce fat. I love to work with those who have it. It is very rewarding for both sides when one brings the determination and willpower and the other the tools to make that effort a maximally effective and rewarding one. Which is why I do not even sign on any client who is giving me the excuse of not having enough time to exercise. We all have the same 24 hours in every day. You and your twin have had the same amount of time. It's what we make of it, that makes the difference.

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  4. Thanks for your useful information on weight loss. It is always necessary to know the cause for the obesity before undergoing a diet plan. It helps in making a right choice of diet plan.

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