Dovid has been searching for a job for 20 months. With four years of experience in the tech industry, he once felt secure in his career but something has changed. Is it the rise of artificial intelligence?
He has sent out numerous résumés and applied to endless job postings, but responses are rare. Weren’t employers just saying recently that they couldn’t find enough workers?
Meanwhile, the bills keep piling up. How will he feed his family and keep up with the mortgage?
Do you consider obesity a disease, or is it something that causes other diseases?
For people whose weight is really high, I consider it at its core to be a disease of body-weight regulation, just like hypertension is a disease of blood-pressure regulation and diabetes is a disease of glucose regulation. For many people, high glucose alone doesn’t cause a lot of problems, although over time it can lead to blindness and kidney failure. Likewise, some people with a high weight do fine throughout their lives, while others develop other weight-related problems like arthritis in their knees and back, type 2 diabetes or high-pressure coronary disease.
Is it true that this generation is suffering from obesity more than in the past?
Definitely. In the 1990s, there was an NIH consensus panel that gave a definition of obesity based on a body mass index (BMI) over 30. Before that, we used Metropolitan Life Insurance tables, but there wasn’t any real clarity. Because BMI is easily measured by height and weight, the CDC had data from people all over the country, so they were able to go back and look at their data over the preceding ten or 15 years and draw obesity maps. This showed that there had been a dramatic rise in the number of people with a BMI over 30. Since then, they have followed this every year, and you can see the prevalence rates on a state-by-state basis. So yes, the rates of obesity have increased a lot since the 1970s and ’80s.
What do you see as the cause of that increase?
I think that some people have a genetic predisposition to high weight; it tends to run in families. In fact, some 40% to 60% of a person’s weight is determined genetically. But it takes the environment to make that manifest. Our bodies used to live in a world where food was scarce, and it took a lot of physical activity to obtain it. If you look at cultures that are less developed, weight isn’t such a big problem. But once we have labor-saving devices and access to tasty food, those who are genetically predisposed to it tend to have a higher weight. There are many other causes, such as not getting enough sleep, high levels of stress and taking certain medications. There may also be environmental toxins involved. But primarily, I think it’s the decrease in physical activity both at work and at home and the kinds of food we eat compared to 100 years ago.
Let’s discuss some of the challenges faced by our generation. So many different types of diets have been touted, and it has become a massive industry. Are most of them more hype than medically proven substance?
In 2001, there was a really important classic study published by the Diabetes Prevention Program. It showed that a prudent diet was helpful to people. It took people with pre-diabetes and women with gestational diabetes and had them go on a diet. That particular diet was a lower-calorie one that restricted fat and encouraged higher levels of physical activity. There was a control group, and almost 40% of those people developed diabetes over the four years of the study. The group that was on the diet only lost about 5% of their body weight, but it cut the progression to diabetes by more than 50%. A lot of those people eventually regained the weight they had lost, but even years later they still had health benefits from that period of a prudent diet. That study really established that modest weight loss through a healthy diet has health benefits.
Since then there have been lots of different diets, some of which have been studied very well while others haven’t. There are a lot of popular books that have not been studied. Of the diets that have been studied very well, one of them is the Mediterranean-style diet. There are epidemiological studies showing that people who are Mediterranean eat a diet that is higher in fat, but they don’t get a lot of heart disease or have a lot of diabetes. That style of eating has been studied both for the prevention of heart disease and diabetes as well as for weight control, and it is one of the evidence-based healthy diets.
Are diabetes and cardiac issues the two main problems that are caused by obesity?
There are more than 200 diseases that are associated with obesity, and they involve every organ in the body. These include sleep apnea, infertility in women, polycystic ovary disease, fatty liver, degenerative arthritis and cancer, as many cancers have a predisposition based on weight. The reason why heart disease and diabetes have been the most studied is that they’re very common, and also because diabetes in particular responds really well to weight reduction. The best treatment we’ve had in the past for weight loss is surgery, and for many of those who undergo it their diabetes goes into remission so they don’t need any medication and their blood sugars are normal.
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