By Dr. Harry Preuss M.D.

A question arose at a national level not too long ago, whether overweight/obesity is truly a disease.  The question was certainly important to governments that were looking for another health issue to regulate. To put it bluntly, if obesity is truly a disease, the world is rapidly becoming more illness prone.  Many years ago — well over 20 — I remember on a visit to Japan asking one of the sponsors of the trip whether obesity was becoming a problem in Japan, because it was surfacing as an epidemic in the U.S. She said, “Walk out on the street and observe.  In general, you will notice that the adults are still relatively lean, an observation that will not hold up among the younger generation.” Obviously, the forewarning was out there. It was then I remembered my experiences coaching in little league baseball in the Washington, D.C, area – proportionately, there were as many, if not more, overweight Asiatic boys than American ones.  Obesity was everywhere.

In any case, we’re getting used to the obesity epidemic in this country.  It is much more acceptable to carry around an exaggerated BMI than ever before.  Today, the majority of individuals can walk down the street, pass a number of strangers who are over-sized, and simply think nothing about it.  If by magic, we could return to the past, see a similar sight 20 or 30 years ago, it would no doubt immediately hit home that there are an awfully lot of fat individuals – age, genetic background, and gender would make little difference in the arrived conclusion.  

It is not that people wish to become overweight/obese.  The fact is that over time most individuals have tried to change their status and failed.  Obviously to do so is not easy, especially as one gets older – blame the addition of unfavorably changing hormones in this case.  Whether too much fat accumulation is a disease or not, the undertaking to lose weight usually occurs because of a desire to create a better appearance.  However, health problems should be more important in one’s reasoning. Of utmost importance, the real problem is that fat accumulation leads to insulin resistance which, in turn, causes a multitude of health disorders such as life-threatening cardiovascular disorders, diabetes, and even certain cancers.

The importance of the location for the fat accumulation should be noted.  When it comes to location as emphasized in the title of the article, it is better to be a”pear” than an “apple.” That saying has been common for years.  In other words, fat around the buttocks is preferred to fat around the belly. With continuing human existence, this concept has been gradually refined – even the language has been refined.  Nutritionists are now aware that the problem is “central fat” – that around our middle, the fat most associated with insulin resistance and its accompanying manifestations – obesity, diabetes, high blood pressure, abnormal circulating lipids and inflammation.  The importance of central fat has been narrowed down even further to the more important accumulation in the liver. This so-called “non-alcoholic fatty liver” problem affects as many as 30-40% of Americans and creates more problems with insulin resistance. If you see the collection of letters spelling out NAFLD, you know the reference is to the most common liver disturbance prevalent among Americans – non-alcoholic fatty liver. More on this unwanted dilemma will be described in the next report.

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