THE ENEMY WITHIN: THE GLOBAL OBESITY EPIDEMIC

Medicine Globally by Dr. Rene Menguy

By Dr. René Menguy

During the past decades, an insidious disease has permeated the world and our country in particular. When I went to Medical School, obesity was not considered a disease but a curiosity afflicting people who “ate too much”. Only now, do we understand that a drastic change in our life style is to blame. We do eat too much; especially processed foods. These are “bad” because their high fat and carbohydrate content render them calorie-dense, i.e., a small amount contains a lot of calories. After a meal one may feel only moderately sated and yet, have ingested more Calories than needed. One’s perception of satiety depends more on the size of a meal than its caloric content. Theoretically, we control our lives, but few aspects of living are harder to manage than eating. We have two innate drives, both pleasurable: the sex drive preserving the species and one to eat that preserves the individual. For some, one or the other, or both, are irresistible.

We use our muscles less; compounding the problem. Mechanization of blue collar work, from the assembly line to home construction, has increased a worker’s hourly output, and his productivity. Good for the economy, but bad for the worker who burns fewer calories with his pneumatic nail driver than his predecessor did with a hammer and gains weight earlier than his father did, working at the same job,. The trend suggests that by 2025, half our population will be obese, probably an underestimate since 30-40% of our population is already there.

.Diet books urge us to avoid sugar. However, the way our bodies function, we can and should eat all the common food stuffs, including those sweet ones that primitive man learned to recognize as a source of energy. It is no accident that one of the four receptors on our tongues is for sweets. In 2004, an article implicated "high-fructose corn syrup" in the recent surge of obesity. This so-called "goo", a mixture of 55% fructose and 42% glucose, used by the food industry to process soft drinks and cookies, has also been called "crud". You might as well call the sugar you put in your coffee, “crud”, since it’s made up of 50% glucose and 50% fructose, two sugars differing only in that fructose is sweeter and our body must convert to glucose before using it for energy. For example, a diabetic, with a low blood sugar from too much insulin, takes glucose tablets. The only connection between high fructose corn syrup and the "epidemic of obesity" is our addiction to “soda pop”. Sugar is “bad” only to the extent that its consumption exceeds our caloric needs. Moderation is the operative word.

Although modern medicine has accustomed us to expect quick fixes for our ailments, there is no quick and easy solution. For obesity, except for people best treated surgically, self-help is the basis of programs consisting of diet, exercise and behavior modification. Because “behavior mod” is so hard, these people often succumb to” clinically proven” nostrums.

Medicine has gradually recognized that obesity, once considered purely cosmetic, is a disease with deadly complications such as high blood pressure, cardiac enlargement, diabetes, breast and prostate cancer, all major causes of death in our country. We’re not talking cosmesis any more. Obesity-related diabetes has been called “one of the biggest health catastrophes the world has ever seen”. According to the International Diabetes Federation, the world-wide incidence of Diabetes went from 30 million to 230 million, during the past twenty years.

Because “obesity” is not in the Medical School curriculum, doctors have difficulty coping with it. A recent study showed that most pediatricians feel incapable of treating overweight children, especially if overweight themselves. It also revealed that many of those surveyed hadn’t realized they were overweight and some didn’t know what to call overweight or obese children. If their doctor can’t find a name for those unfortunate kids, their classmates will.

Estimating the prevalence of obesity-related deaths is difficult. For example, a 5' woman weighing 200# is 80# overweight, something an E.R. physician, diagnosing her stroke caused by obesity-related high blood pressure, might not appreciate. Her death certificate would read: "cerebrovascular accident”, with a secondary cause of “high blood pressure" and the root cause of her death would be overlooked. In 2000, there were 435,000 obesity-related US deaths; probably an underestimate.

One of the jewels in the crown of the administration’s health care plan is: PREVENTION, an idea that I would qualify, charitably that is, as naïve. History tells us we’ve had little success in curbing substance abuse. During our infamous prohibition, people drank more than ever. Ah yes; I can see it coming: a food czar with food police fanning out into our homes. They’ll get the same reception one gets when telling an alcoholic:

“You’ve gotta quit. Alcohol kills slowly.”

“So what, man. I’m in no hurry.”

To be continued

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[1] Excerpted from the author’s book on obesity.

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