Tag Archive for: overweight

Obesity: A Man-Made Disease

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In order to determine whether obesity is an untreatable disease without pharmaceuticals, I took a look at BMI data since 1960. In comparing the BMI of people in the lowest income brackets with the highest income from 1960 through 2024, the lowest income group is always about one BMI unit above the highest income group. The adjusted mean is roughly a BMI of 27 for the poor people versus 26 for the richest people. That continues until the mid-1980s. After that point, the mean BMI continues to rise for the next 40 years—a mirror image with the same one BMI-unit difference.

Mid-1980s

What happened in the mid 1980s that caused the surge in obesity? After checking various sources, there appear to be three factors, not ranked in any particular order.

  • The mid-1980s saw increases in two-income families. There are plenty of economic reasons for that, but the net effect was less time spent preparing food in the home and a reliance on convenience food purchases.
  • There was an increase in fast-food drive-thrus and take-out foods. Since COVID, there is more reliance on food delivery.
  • The mid-1980s saw an increase in ultra-processed foods. Using inexpensive ingredients, particularly carbohydrates and fats, and filled with flavor enhancers that accented the salty and umami, the amount of ultra-processed food has risen to over 50% of the typical American’s diet.

She was asked, “If people stop using GLP-1, will they gain back the weight?” She said yes because there’s no other way to maintain weight loss because of the fat setpoint. I just can’t accept that premise.

The Bottom Line

Overweight and obesity appear to be man-made diseases because of the environment we live in today with so much easily available food. However, I cannot accept that the fat setpoint is permanent. Yes, there are many factors in the brain, the pancreas, and the digestive system that control the feelings of hunger and the anticipation of food, but that doesn’t mean you really need nutrition. You and I just have to learn to ignore those signals that say, “what will my snack be?” when we’re still stuffed from dinner. We must take command. I’m not suggesting it will be easy, but it’s not impossible. In my mind, it’s a lot easier than taking a medication every day for the rest of my life.

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

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

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

By Any Means Necessary

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The second discussion was between a tech expert and a finance expert—neither one in the healthcare field. The tech expert shared a story of how a nurse who weighed over 300 pounds was using a GLP-1 agonist to get to a more reasonable weight so she could participate in more activities with her family. That really touched the tech expert.

But that story lit up the finance expert. The GLP-1 agonists are offered at a fraction of the price around the world compared to the U.S. price; Americans pay $936 to $1,396 per month compared to the next highest price of $169 to $319 per month in Japan.  He went on to say that if we were really serious about addressing obesity and health, the price of the GLP-1 agonists should drop to an affordable level of about $50 per month. The pharmaceutical companies would end up increasing sales overall and reduce the number of overweight and obese citizens from 70% by half or more.

That would have an effect of saving about half a trillion dollars in healthcare costs or more per year. That would help around 100 million people and probably save even more than his estimate. More than that, the population would be healthier as long as they were also trained on how to make better food choices, cook better, and exercise on a regular basis to maintain the weight loss.

Why This Approach?

Would I prefer to not even mention a medication when the solution is really simple at its core? Of course. But in the 35 years I’ve been doing what I do, I can’t say that anything else has really worked to help people eat less, eat better, and move more for life. I’ve had challenges myself; I’m still not at my ideal weight for height. That shouldn’t prevent me from giving you every approach to help yourself get there. If you have insurance that can cover the cost of the GLP-1 agonist, have a discussion with your physician about whether it’s right for you.

The Bottom Line

“By any means necessary!” I don’t usually quote Malcolm X but in this case, it fits. Getting to and maintaining a normal weight for height is important to live better and maybe live longer. Using the medications available, together with planning what to do when you stop the medication to maintain the weight loss, may be the solution for you as long as you can tolerate any side effects. For me, I’m modifying the Optimal Performance program slightly to achieve my goals including eating more protein, a challenge that seems to burden everyone over the age of 50. Whatever you decide to do, I’ll finish with a phrase that everyone seems to scream all the time: Let’s go!

What are you prepared to do today?

        Dr. Chet

Same Problem, Different Solution

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Close to 70% of all adult Americans, as well as an increasing number of children, are overweight or obese. The solution for society has been as elusive as it is simple: eat less. Eat better. Move more. But there’s one more part that’s the problem: for life. We could review the reasons why, but let’s look at alternative solutions.

I recently listened to a couple of podcasts that were completely unrelated but talked about the same subject: GLP-1 agonists. To review, GLP-1 receptor agonists are medications that allow the manufacture of the hormone GLP-1. Without getting technical, GLP-1 helps the body release insulin which can lower hemoglobin A1c (HbA1c) levels in diabetics. It also functions to increase satiety so users don’t eat as much and thus lose weight. GLP-1 agonists aren’t a panacea. The come with side effects, but most are manageable. With that in mind, here is a recap of the conversations.

In the first discussion, a physician stated that he puts his overweight patients on a low dose of a GLP-1 agonist to help get their appetite under control. The objective is to help the individual reduce hunger while transitioning to a higher protein diet. It’s using the pharmaceutical the way it was designed. The result helps the patient lose weight with an exit strategy of adopting a new lifestyle of eating less and moving more. Of course, that depends on whether they can afford the medication.

I’ll talk about the second podcast on Saturday. It’s all about the money.

What are you prepared to do today?

        Dr. Chet

BRI: It Just Doesn’t Matter

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Continuing our look at the BRI, the mathematician demonstrated that BRI is associated with body fat distribution. It makes sense; the waist measurement would provide an indication of fat around the waist. The next question is: would the BRI be a better predictor for cardiometabolic disorders than BMI?

BRI and Mortality

A group of researchers decided to use open-source data from the National Health and Nutrition Examination Survey database to examine the relationship between BRI and all-cause mortality. They coincided with the years that physical assessments were done including height and waist circumference; body weight was collected but not used in this instance. The time period began in 1999 and continued every two years through 2018.

There were two observations that were significant. First, in every demographic group, regardless of age, gender, or race/ethnicity, the BRI has increased during every examination period. As a country, the U.S. has gotten fatter. That matches every other measure such as body weight or BMI as well.

The second observation was that the hazard ratio (HR) increased as the BRI dropped below normal, then normalized when the normal BRI was reached, and the HR rose again as the BRI increased. Simply stated, there was an increased risk of mortality when people were too lean or too fat.

You may be wondering why I don’t give you a formula to do calculations for yourself. It’s very complicated and there are BRI calculators available on the website below. The main reason is that it just doesn’t matter—the BRI is no better at predicting mortality than the BMI. The researchers had the body weight data they needed to compare the BRI with the BMI directly. They just didn’t do it. However, looking at the mathematicians’ validation study, the categories of adiposity associated with BMI matches up quite well with the BRI and thus with body fatness. There’s no need for any more precision than is achieved with BMI.

The Bottom Line

It’s really the clinical use that seems to bother everyone, but with rare exceptions, the BMI gives an indication of body fatness. If physicians or other health care professionals cannot see the patient before them and realize they are too lean or too muscular to fit the typical interpretation of BMI, the fault lies with them, not the tool they are using.   

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2024; 332(16):1317-1318. 10.1001/jama.2024.20115
2. JAMA Netw Open. 2024; 7(6):e2415051. 10.1001/jamanetworkopen.2024.15051.
3. https://doi.org/10.1002/oby.20408
4. https://bri-calculator.com/#calculator

Body Roundness Index

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The Body Mass Index (BMI) has been used to provide an indication of whether someone is under weight, normal weight, overweight, or obese and the degree to which they are obese. There’s no measure of percentage of body fatness implied, but physicians and other medical professionals have used it for that purpose for a couple of decades. Why? It can be used to assess the potential risk of developing cardiovascular disease, pre-diabetes, and other metabolic conditions.

I happened upon a commentary in JAMA on the Body Roundness Index or BRI for short. It was published in response to a recent study published in a JAMA Network Open by researchers who examined the relationship between BRI and mortality.

Let’s start with this: what is the BRI? The BRI was developed by a mathematician. The reason was interesting; the developer told the commentator that the BMI is based on a “cylindrical” model but when she looked in the mirror, she felt she was more egg shaped. What she did, as a mathematician, was develop a model based on an “ellipse.” Why? She gave a couple of reasons.

The first reason is that BMI can misclassify individuals because it fails to distinguish between individual amounts of fat-free mass (FFM) and fat mass (FM). BMI also does not provide information about the distribution of body fat—specifically, visceral fat versus subcutaneous fat. She developed a mathematical model, to assess body fatness which would indicate where the fat is distributed. With some very complicated math, she developed the BRI. It uses only two measurements: height and waist circumference. The benefit of using the BRI is that it may be a better predictor of body fat than the BMI. Is it? We’ll check out the research study that began this examination of BRI on Saturday, because as Shaq famously said about getting in shape, “Round is a shape.”

The Insider Conference Call is tomorrow night. If you become an Insider by 8 p.m., you can participate in the call to get your questions answered.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2024; 332(16):1317-1318. 10.1001/jama.2024.20115
2. JAMA Netw Open. 2024; 7(6):e2415051. 10.1001/jamanetworkopen.2024.15051.
3. https://doi.org/10.1002/oby.20408

Today!

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I’ve said before that in my opinion, the single most important thing you can do to limit the problems of aging is to get to a normal body weight and maintain it. If you’ve been overweight most of your life, as I have been, that can be a real challenge. While the research on what’s called Blue Zones is somewhat controversial, all we have are the observations of different researchers over the years. What seemed obvious to me, as a professional observer, is that people who lived longer seemed to be a normal weight for their height. And to me, that is the absolute goal to work towards.

It’s not easy, and it’s not going to happen overnight. But whether you’re 20, 50, even 70, if it takes you five years to get there, you’re still relatively young. That means that when you do get to be 80, you’ll actually be 80 instead of having died when you were 77. When do you begin to eat less, eat better, and move more to get to that normal weight for height?

Today. No matter how long it’s going to take, you begin today.

Insider Conference Call

I’ve been asked about cyanocobalamin, a synthetic form of vitamin B12. That’s the topic of the evening along with answering personal and product questions. If you’re not an Insider, become an Insider by 8 p.m. Wednesday evening and you can join in the conversation.

What are you prepared to do today?

        Dr. Chet

Obesity and Prenatal Omega-3s: Premature Conclusions

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Women frequently ask about prenatal supplementation, and omega-3 fatty acids are always part of prenatal recommendations; that’s why this study attracted my attention. Did they come to the right conclusions? I think the best place to begin is by reading the conclusion statement of the abstract, and then examine the data from the paper to see if it supports those conclusions.

Here we go:

“In this randomized clinical trial, children of mothers receiving omega-3 fatty acid supplementation had increased BMI at age 10 years, increased risk of being overweight, and a tendency of increased fat percentage and higher metabolic syndrome score. These findings suggest potential adverse health effects from n-3 long-chain polyunsaturated fatty acid supplementation during pregnancy and need to be replicated in future independent studies.”

Problems with the Conclusions

The difference in body weight was two pounds, with the fish oil group weighing more than the placebo group; neither group was classified as being overweight by international standards. With height being equal, that automatically meant that the BMI would be higher in the fish oil group. However, both groups would be classified as underweight based on standards for children five to ten years old. The implication was the omega-3 group might be overweight. They were not; in fact they were closer to normal weight than the lighter kids. The increased risk of being overweight isn’t supported by the data presented.

Related to the higher metabolic syndrome score, the researchers calculated the score using an algorithm that considered waist circumference, systolic BP, negative HDL cholesterol, the log of triglycerides, and the Homeostatic Model Assessment for Insulin Resistance or HOMA-IR for short. There was a difference of 3/10 of an inch in waist circumference, with the omega-3 group being slightly larger. There was no difference in triglyceride levels, and the omega-3 group had a higher HDL cholesterol level than the control group. There was no difference in systolic blood pressure between the groups. That leaves us with the HOMA-IR calculation.

Typically, serum insulin would be used in the calculation to determine the HOMA-IR number. They didn’t collect insulin data, so they used another indicator of insulin levels in calculating the HOMA-IR. The problem is that that algorithm was based on 21 adult subjects; it was never validated with a larger group or for use in children. I question its use, but for argument’s sake, let’s say it doesn’t matter.

The Real Problem

The real problem that I have is with the remark about a tendency towards increased percent body fat. When they assessed body composition at 10 years of age, they used bioelectrical impedance analysis (BIA). I worked on comparing methods of body composition analysis when I was a graduate student, so I can tell you from experience that underwater weighing is the gold standard for any group (and, yes, I’ve underwater weighed 10-year-olds). Specifically, there are two factors that are always concerning with BIA:

  • The algorithm is 95% dependent on height and weight. A two-pound difference in body weight in children could impact the calculation, even if the actual body composition was the same.
  • BIA is sensitive to fluid levels of the body. It assesses total body water and calculates fat mass by making an assumption about the water content of the remaining tissues. It’s not the best way to assess body fat in a major study such as this.

The Bottom Line

How?!!!

We hear that a lot when our grandson plays a videogame. When something happens that he doesn’t anticipate or understand, he yells “How?!!!” and that’s what I’m thinking right now. The most frustrating part of this research paper is their conclusion that omega-3 supplementation in the last trimester of pregnancy may result in adverse effects to the children.

How? How would supplementing with omega-3 fatty acids cause the offspring to have an increased risk of being overweight or obese? They did not provide any comment on how that could occur.

As it stands now, we really don’t know much more about omega-3 supplementation in the third trimester of pregnancy other than the kids whose mothers took omega-3 fatty acid had fewer serious asthma and allergy symptoms; because the incidence of asthma and allergies are rising steadily, that may be the most important observation from this study so far.

As for body composition? Not so much. This study will continue until the subjects are adults, so maybe further testing will yield more conclusive results.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

Obesity and Prenatal Omega-3s

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Scientists continue to research the causes of obesity. For many, as we’ll see, it’s not as simple as eating less and moving more; in the study I’m going to review this week, the researchers are going prenatal.

The Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC) is an ongoing longitudinal study to examine the effects of omega-3 supplementation in the third trimester of pregnancy on a number of factors. The primary objective was to see if allergies and asthma were reduced in the offspring of women who took the omega-3s versus those who took a placebo. Asthma or persistent wheeze showed a 31% reduction in risk in the group receiving fish oil compared to 23% the placebo group.

The researchers also collected a variety of anthropometric data, plus blood samples for metabolic and blood lipid analysis, and assessed body composition. In a prior paper when the children were age six, the omega group were about one pound heavier but with a proportional increase in lean and fat mass.

In the current analysis at age ten, the omega group were determined to have an increased BMI, increased risk of being overweight, a tendency for increased fat percentage, and higher metabolic syndrome score when compared to the placebo group. That doesn’t sound good. Does this mean women should avoid omega-3 fish oil during pregnancy, especially the third trimester? I’ll let you know on Saturday.

Tomorrow is the monthly Insider Conference Call. I’m going to cover starvation but not the Minnesota Starvation Study—you’ll come away stunned. I’ll also answer your questions. If you’re not an Insider, become one by 8 p.m. tomorrow and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. BMJ 2018. doi: https://doi.org/10.1136/bmj.k3312
2. AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015