Is Obesity a Disease?

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In a podcast about GLP-1 receptor agonists and several new medications that are under development, the expert was a researcher on the cutting edge of what these peptides can do for weight loss. A couple of things she said didn’t sit right.

One was that obesity is a disease of genetic tendencies to store fat more effectively and create a body-fat setpoint. The implication is that in a land of food abundance, specifically ultra-processed food, the setpoint could be raised but never lowered without medical intervention. The second was that these medications are the best solution for obesity, and thus people will have to take the medications for life or they’ll gain back weight.

According to the World Health Organization and just about every other medical society in the world, overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. But is it as simple as that? Based on a recent paper, the risk of getting type 2 diabetes is 7% to 12% in men and women at a BMI of 30; as BMI increases to over 40, the risk goes up to 74% for both men and women. It’s not an excuse to stay obese, but does it mean someone who is obese will get the diseases associated with obesity?  I have more questions, and I’ll cover them on Saturday.

Insider Conference Call is tomorrow night. The topics of the evening are reviewing the top five foods that prevent cancer as well as answering Insider questions. Interested? Become an Insider by 8 p.m. Wednesday and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. Int. J. Environ. Res. Public Health 2024, 21, 73.
2. Stat Pearls. 2025. Obesity and Type 2 Diabetes

Absolutely Monumentous!

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Happy Mother’s Day to all the mothers who perform monumentous tasks every day. For those of you who still have your mom in your life, make it a habit to treat your mom like every day is Mother’s Day. It’s similar to working on your health. It’s not what you do once in a while that matters; it’s what you do every day.

London Marathon

Back to the monumentous marathon. The world record and two-hour mark was broken five years ago in an unofficial marathon run on a track under ideal conditions. But running under track conditions, much like breaking the four-minute mile, is different while being paced by other elite runners compared to running a race on the road.

While reading about the prep for the race, much was made of the weight and construction of the Adidas running shoe and justifiably so. The Adidas Adizero Adios Pro Evo 3 weighed in at 97 grams—similar to a pack of cards or 20 sheets of paper—with a variety of other features to make the shoe strong and durable.

I checked the weight of my new running shoes. They are a dream to walk in, and I can’t wait to finally start running again. My running shoes weigh in at a whopping 339 grams—almost 3.5 times more! That works out to about four ounces per shoe lighter, every step, for 26.2 miles. If I were still running marathons, I’d probably not buy a $500 pair of shoes, but I’d be tempted.

The Training

While the shoe is important, and I won’t diminish the impact in any way, it is the training that makes the runners elite. While I have no knowledge of his specific training programs, I would wager it consisted of three specific factors:

  • Long, slow distance, mostly at altitude
    The purpose is to get used to running long distances. Running at altitude adapts the body to less oxygen in the blood so when he comes back to sea level where there’s more oxygen in the air, he can gain an advantage. Just realize that for him and other elite runners, that pace might be 5:15 to 5:30 per mile and 6 miles per hour for her.
  • Interval training to raise the lactate threshold
    Running intervals just to the point where lactic acid starts to build up allows the body to increase stamina. Short version: effort over time increases.
  • Exact nutrition
    I would imagine every calorie is accounted for as to composition, time in relation to training, and specific tapering so he and she were both primed to run fast.

One thing to realize is that runners at this level eat, train, and sleep—that’s it. But that’s also what they get paid to do. There are some estimates that Sawe earned over $350,000 for his victory.

The Bottom Line

I bet neither you nor I are going to become elite marathon runners any time soon, but the consistency of their efforts is what we need in our lives. We need to make the time to do the things we can do day in, day out, to increase our healthspan. Maybe getting better walking/running shoes instead of the $20 tennies we’ve had for five years might be a good investment. A lifetime of abuse adds up and can make walking difficult as we reach old age. Respect your feet, starting when you’re young, and you’ll be able to keep going for longer.

What are you prepared to do today?

        Dr. Chet

Reference: Photos courtesy of Adidas Media

Monumentous Marathon

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Once in a while, something happens that you need a made-up word to describe. More than momentous, more than monumental, the new world record for the marathon was more than that. It was monumentous: four athletes broke the world record for the men’s and women’s marathon.

At the London Marathon in late April, the official world record for the marathon (that’s 26.2 miles) was broken for both the male and female marathons. More than that, it was shattered by three male runners and one female runner. Kenyan Sabastian Kimaru Sawe’s winning time was 1:59:30, more than a minute faster than the previous record. Two more men crossed the finish line under the prior world record time. Tigist Assefa broke the women’s world record with a time of 2:15:41 and broke her own world record by nine seconds.

Without question, this was a monumentous event. Was it inevitable? I’ll give you my thoughts on that and more on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Photos courtesy of Adidas Media

I Can See Clearly Now

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I left you with some questions I had to ponder and have gotten a couple more. Then I’ll leave you with the answer I posed to my ocular surgeon.

Glaucoma

Glaucoma is not just a single ocular disease; there are several types. Some are related to how well the eyes drain fluid; some drain slowly while others seem to get plugged. The key to limiting damage is to get the pressure down by draining excess fluid. While there are still more types, the most important thing is to know your family history. There’s genetic testing available, but it’s not always predictive of what will happen to an individual, because some forms of glaucoma are caused by a combination of genetic factors.

Regular ocular pressure tests are the best way to find out whether the pressure in the eye is normal or not. If I had not gone in to get new glasses, I would not have gotten a diagnosis until later and may have lost even more vision.

Cataracts

There’s really nothing you can do to prevent cataracts because it’s partially a function of aging. However, you can protect your eyes by wearing UV protection sunglasses to reduce the impact of sunlight; it’s always better the earlier you start, so keep that in mind with the kids and grandkids. Other steps we can take are to quit smoking and keep blood sugar under control.

Two questions I’ve gotten are about the types of lenses and the cost. I got the simplest mono-focal intraocular lenses because my distant vision was my primary concern. The glaucoma created the need for reading glasses to balance both eyes.

If you’ve always worn corrective lenses, those issues can be addressed depending on the type of lenses. The person who knows that best would be your ophthalmologist. The cost will vary depending on what you want the lens to do. It also depends on the type of health insurance coverage you have. The American Academy of Ophthalmology has a Q&A on lenses at the link below. It’s obvious to me that eyecare is a good investment because it affects your quality of life and productivity.

The Bottom Line

I asked my surgeon the question about how to prevent cataracts and glaucoma. He thought about it and said prevention can be tenuous, so the best thing to do to keep your vision as long as you can is to get regular eye exams every year; that will protect your vision as well as keeping your glasses up to date to reduce eye strain. That seems like sound advice to me. Just another step to improve our healthspan.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.aao.org/eye-health/tips-prevention/best-artificial-lens-implant-iol-cataract-surgery

My Eyes!

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No, it’s not like when Phoebe saw Monica and Chandler kissing on Friends—but it is rather dramatic.

Let me recap my vision story. My dad died at 41, so I have no info from him or his family. My grandmother had cataracts removed when she was about 70. It led to a decline in her health; she never could get used to the glasses with thick lenses that looked like the bottom of Coke bottles. Remember, lens replacement as we have today didn’t become common until the mid-1980s. My mother had glaucoma, which was the genetic factor in my development of glaucoma.

I still remember the exact moment I discovered I needed reading glasses. I had been given a badge to enter campus during an international sport competition, and I couldn’t read the fine print on the badge. My real journey began when I finally had an eye exam about 10 years ago. The ophthalmologist tested me for glaucoma and the numbers were high—over 30 in each eye, and it should be below 8. Prescription eye drops lowered the pressure, but they can’t repair the damage I have in my right eye. Neither the cataract surgery nor the drains can repair it. I consider myself lucky it wasn’t more severe.

As for my vision about a month after the first replacement? I would say it’s excellent—over 18 inches away. I typed this without glasses at all in a 12-point font. I still need glasses for reading to help the eye with the lost vision, but that seems relatively easy.

The questions I have are: what could I have done to prevent either condition? And what should you and I do in the future? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Again with the BMI?

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I got an email from a long-time reader about a recently published study comparing BMI calculated from height and weight with percent body fat calculated via Dual Energy X-Ray Absorptiometry commonly called DEXA. The objective of the study was to see if BMI was accurate in predicting the differences between underweight, normal weight, and several degrees of overweight and obesity with measure of body fatness.

Their subject pool was 1,351 Caucasian men and women 18–98 years old. This was a cross-sectional study (and more than likely a retrospective study) of patients in Italy who had their body fat assessed via DEXA between 2013 and 2024. While this paper contained hundreds of numbers, the essence of what they found was that for those with normal-weight BMI, body fatness was accurate, but for underweight and overweight and obese subjects, BMI under or overestimated their actual body fat; in the chart above, a red dot indicates someone whose BMI was misclassified. The authors felt that the World Health Organization should consider more research because the misclassification may impact diagnostic capability and thus lead to unnecessary treatment protocols.

Why BMI Should Still Be Used

I think the researchers are wrong in their conclusion for the following reasons:

  • While there were definite points where people were misclassified based on the graphic presentation of all data points, it was mostly on the margins. Is there a difference between a BMI of 24.5 versus 25.5? Is there a real difference in a person who has a BMI of 33.0 versus 36.0? Because of the way the data were analyzed by weight classification, the measure loses the nuance.
  • Regardless of the numbers, a physical examination by the healthcare professional should confirm whether a person is normal weight or overweight based on the fluffiness factor. People of the same height and weight may look muscular or like the doughboy of commercials.

The Bottom Line

The question of using BMI as a measure of body fatness in large groups will probably never be over. But when assessing large groups of people, it’s still the best measure for an overview of whether a population is underweight, normal weight, or overweight. If people really need to know more, they can always pay to have a DEXA scan done.

On a personal level, will it really give you any more information than when you stand naked in front of a mirror? When you know, you know. The important question is what are you going to do about it?

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients. 2025. https://doi.org/10.3390/ nu17132162

When in Doubt…

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When I was doing a post-doc in the late 1980s, I was part of a team of researchers who tested a group of swimmers. This was one of four parts of an overall documentary on an innovative look at health by the PBS’s Nova. I had about a half-second of screen time in this PBS film and that was it; no YouTube or Instagram videos to show. But the segment that had the most impact on me was a section on what to do when you think you’re having a heart attack.

The film crew happened on a case where a man didn’t feel right and thought he was having a heart attack, so he went to see his cardiologist. The nurse said he should go to the emergency room. He drove there by himself. There were many factors pointed out by an ER doc, but here are the two most important lessons:

  • Heart attack pain can vary but most often presents itself as an elephant sitting on your chest and you can’t breathe.
  • Call 911 or if you are close to an ER, have someone drive you but don’t drive yourself. Ambulance personnel know what to do to prevent further damage to your heart if it’s a heart attack, not to mention that they’re less likely to pass out.

Since watching that documentary, my mantra is when in doubt, check it out. Now.

During tomorrow night’s Insider Conference Call, I’m going to talk about two primary topics: the potential use of vaccines to prepare for future infections and the timing of intermittent fasting. If you become an Insider by 8 p.m. ET Wednesday evening, you can participate in the call and get your questions answered.

What are you prepared to do today?

        Dr. Chet

Does Your Weight Affect Disease?

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Researchers from Finland investigated the relationship between being overweight/obese and infectious diseases. Not any one specific disease—all 925 of the known microbes that cause infectious diseases. They used data from two Finnish studies and the UK Biobank Study. They obtained the height and weight to calculate BMI and examined hospital and death records from the electronic medical records of both countries.

They used data from 2018 through 2020, deemed before COVID, 2021 during COVID, and 2023 after COVID; they looked for hospitalizations and death due to infections. There were about 47,700 Finnish subjects and 479,500 UK subjects. The researchers used the standard definitions of normal, overweight, and the four classes of obesity: normal BMI less than 24.9 kg/m2, overweight as 25.0 – 29.9, grade I obesity as 30.0 – 34.9, grade II obesity as 35.0 – 39.9, and greater than 40.0 as grade III obesity.

Comparing grade III obesity with normal-weight subjects, they found the risk of infections and deaths was three times greater in the obese subjects. Combining all the data, the risk of infectious diseases contributing to hospitalizations and death increased in a stepwise manner. Simply put, as the level of obesity rose, so did the risk of infectious diseases. One more thing? The hazard ratio increased dramatically during the COVID epidemic and returned close to baseline after the pandemic ended.

The Bottom Line

This is just one study and because it’s an observational study, no cause and effect can be determined. But my feeling is that this should give pause to everyone who carries extra body fat. The very nature of being overweight or obese compromises the immune system; that means the person is at risk for an infectious disease from any one of 925 potential microbes and maybe more by now. This is the time to work toward getting to a normal weight for your height. Increase your healthspan: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

Reference: Lancet 2026; 407:951–62

A Longer Healthspan

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I’m back! The cataract surgery on the second eye was successful; there’s one more exam to make sure everything is healing properly. Then it’s a matter of the full recovery to get my reading vision back to normal. But for everything besides that, it’s a whole new world. The colors are more vivid and I can see distance, say two feet and greater, just fine. Getting used to the sunlight and possible new prescription for up-close work, I’m back.

While reading for long periods will take some time as my eyes heal, I’ve been listening to several podcasts. I heard an expression I hadn’t heard before: healthspan. In the current longevity movement, the focus should be on how many healthy years you live, not how many years you’re alive. No matter your age today, especially if you’re younger, the lifestyle you lead today directly impacts your healthspan. Thinking about it, that’s what I’ve always tried to do: teach you how to do the things today that will help you live a healthy life as long as you can. It’s better to prevent a disease than treat one.

Of course, accidents happen and you can’t control every virus or bacteria that comes your way. But preparing your body now can help in dealing with what comes your way in the future. That all begins with what I said before spring break: Eat better. Eat less. Move more.

What are you prepared to do today?

        Dr. Chet

Spring Means Renewal

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It’s no secret I’ve had one cataract removed, and the other eye is next week. When I was having the surgeon check the eye this week, he asked me a question. The conversation went something like this.

“Do you have a son?”

“No,” said I.

“I was wondering because there’s this guy on the radio, usually during lunchtime, who I think is a physician. Because your name is similar, I thought he might be related. He always talks about health and how to be healthier.”

“Is he called Dr. Chet?” I asked.

“That’s right!” he said.

Then I said, “That’s me. I’m Dr. Chet.”

His reaction was terrific. He thought that was the coolest thing. I thanked him for asking me if I had a son because that meant my voice didn’t sound like an old man. It’s nice to have your ego boosted like that once in a while. We’ll see each other again on the surgery table this coming week so he can replace my other lens. I certainly appreciate his expertise.

I’m going to take next week off and enjoy Riley’s Spring Break while I recover from the surgery. For sure I’ll be writing about it at some point, and the surgeon said if I had any questions about procedures, just ask. I certainly will take him up on that.

Because spring is a time for nature to renew the earth from the winter, take some time to practice some new habits to enhance your body’s renewal. A couple of hints? Eat better. Eat Less. Move more.

What are you prepared to do today?

        Dr. Chet