This shows you as heavy as I was. It's called acanthosis. 18 plus percent of our children right now are obese.
How old are you? I'm about 280. If you go with the flow in America today, you will end up overweight or obese, as two-thirds of Americans do. I don't want to be fat for the rest of my life.
I've got diabetes. Sleep apnea. High blood pressure.
I get dizzy when I get up. Everything's hurting though. You don't crave broccoli.
And our generation has grown up craving a Big Mac. We have built a cheap food model. And that's the one we're dealing with right now. It's so hard to combat against what the TV's telling you to buy your kids. The kind of food that we eat is the kind that's most profitable.
Local and regional foods taste better. The weight of the nation is out of control, but we can fix that. How do you like the market?
The market means everything for this neighborhood. We have got to come together as a country and really make this a priority. So once we stick together, that's what it's about.
It's not only health. It's about survival and well-being of the United States as a nation. The reason we have government in the first place is to solve problems collectively that we can't solve individually. If we don't now take this as a really serious, urgent national priority, we are all of us individually and as a nation going to pay a really serious price.
Then you start having a family and after my second child it was like poof and it was my grandmother, my mother, my sister and myself we've got it's been the same story. It's not easy to take weight off and that's liposuction, patches, pills, fad diets, counting carbs, counting calories, I've tried it all. I've tried it all.
And I've asked my husband, let's be honest here, am I that big? And when he doesn't answer me, I think, oh my God, what has happened to me? You know, or if he says, no way, then I feel better about myself, you know.
But the ones that he don't answer, I know I'm that big. And it's like a slap in the face, wake up, you know, do something. You try and it doesn't.
And you lose hope then. Boca Lucia is just like any town. Throughout the southeastern United States, and there's some variations you get rural in northern Mississippi, there's really a lot of poverty and so forth and it partly relates to the industry and agriculture. But we're just like any old country town.
It's strawberries and cheese and-No, it's not strawberry. It's strawberry jello. And it's got bananas and pineapple and you would not believe how good it is.
Get your plates, start eating. This is Louisiana cooking, this is Louisiana at its best. Where's the shrimp pasta? You get tired of the diet that's not gonna work. And then you fall off the wagon, so to speak.
And then you really pig out on something you're not supposed to have. You get tired of that feeling of failure. If you don't fry it, you grill it.
If you don't grill it, you boil it. That's the way we eat down here. Good morning. Hello. Hi, what's the name?
Cindy and Gary Roach. Cindy, you're going to be first. Gary's going to be second.
OK. Just have a seat. When did you start coming to the hard study? We were in grammar school.
Grammar school. Both of us were. I want to say about the third, fourth, fifth grade.
Third, fourth grade. Kathy Pike. Kathy, when did you start coming through screening? I started heart study, my first year was in 1973. I was in kindergarten. The Bogalusa Heart Study is a landmark investigation of the...
genesis of cardiovascular disease from childhood right through adulthood and many of us as we came up through our biomedical sciences in undergraduate university we learned about the Bogalusa heart study the main focus is on cardiovascular disease pathogenesis of disease over time, really starting in childhood. In the Bogalusa Heart Study, we're looking at risk factors in children. Since we want to look at the early natural history, it's obvious that we ought to look at the early onset of these diseases.
When I'm in Bogalusa, I'll be home to stay. The major effect of the Bogalusa Heart Study is the biannual general examination of all school children in Bogalusa. I can remember being very excited when they used to come to the school.
They used to come, it was a big white trailer, and that's where they did all of your work. And back then I was just happy because we were getting out of class. When I got the heart study, the intention was to look at risk factors, just like Framingham, but to do it in children. What I need is a list of the people that you don't have any kind of record on.
Some of them we have because we knew the cause, we just didn't have the death certificate. So you've exhausted all the data from the coroner's office. After we had been in the study five or six years, we clearly established that heart disease began in childhood.
What clinched our information was doing an autopsy study. 560 deaths since 1972. When we began to see lesions in kids, it really gelled the fact that looking at risk factors clinically in life and here looking at the actual vascular disease and death and having a strong correlation, highly significant relationships. Stand straight. All right, take a breath.
Our children are now 50 years old. And we have a 30-35 year history on them. It's the only study like that in the world.
It has long-term black-white population. The obesity that we're seeing is very damaging to the cardiovascular system. I just found out that I have high blood pressure.
And they said that I was on the borderline with maybe diabetes. So my doctor told me to go brown, so no more white rice or potatoes or white bread. So we've gone to like wheat pasta, wheat bread, that type of thing.
Okay. All right, what did you get for the subscapular? 132.9. And 133. Obesity is not just fat cells sitting there, but particularly the central fat, the abdominal fat, the android deposition, the male deposition of fat.
the waist measurement. This is to measure the abdomen. But it's the obesity which is the major driving force for insulin resistance.
Insulin resistance and obesity are the driving force for hypertension, diabetes. Okay, thank you. The blood pressure was... 140 over there is high. If you lost 20 pounds, it might go to...
Well, I am working on that. You ought to be on some medicine. I don't care. You ought to be on some medicine.
I'll go back and see a doctor. That's good. Hey, Sandy. How are you?
I'm fine. You doing OK, Miss Rita? I'm doing fine.
I found a picture of you this morning. I found out through heart study I had high blood pressure. And I can take that to the doctor. OK. Thank you, ma'am.
That's all we need. My grandmother had a heart attack. Both my grandmothers.
I'm sorry. But I know going through heart study that if something is wrong, it's going to be caught early on, and maybe I'll be here to see my grandkids grow up. I've got to learn to eat the right things at the right times.
And I'm gonna try it. I'm gonna give it a shot. And come back and y'all see maybe a new me. Thank y'all.
Life is really hard for people who are obese. And by hard, I mean both the social consequences of that and the health consequences of that, right down to the fact that those who are very obese are not going to live as long as others. What makes me frustrated, ordering on angry, is that this is preventable. This is not one of those unfortunate acts of nature that we just have to accept as reality. This is not the product of a tsunami.
The weight of the nation is not healthy. And to get it healthy, we're all going to have to do our part. All of us have to be part of the solution to reduce obesity in this country. Otherwise, we're going to be faced with steadily increasing healthcare costs and the lives that are lost from cancer, heart disease, diabetes, and other problems.
How many people in this society are able to maintain a healthy weight? A third or less? Something's wrong with this picture. Levels of obesity in the United States have increased in alarming ways.
In the 1980s, the Centers for Disease Control began putting together maps showing levels of obesity state by state, and then they went through the years. And every time a state changes colors, it suggests increasing levels of obesity. When you look at the rates of adult obesity from 1960 until 2008, you can see that the rates were moderate and relatively consistent over time, but then start... Starting in the 1980s, we saw a rapid increase resulting in the current level, which is fully over a third of adult men and women in the United States are obese. But it's the morbid obesity where we've seen the most striking increase from 1988 until 2008. We have childhood obesity at levels where people aren't denying it anymore.
So it is a teachable moment. When it was only adults or only people in less valued groups, you could put it aside it's those people but when it's children you can get a conversation going People who are poorer tend to have higher rates of obesity. So if you look back in the late 1980s and early 1990s, there's a linear relationship between poverty and obesity.
But if you look more recently, from 2005 to 2008, everybody's rates have gone up. And being wealthier is not nearly as protective against obesity as it used to be. There is some regional variation, but it's all different degrees of terrible. The levels are so high everywhere that every state has to pay attention to this issue. The health care costs, not to mention the human burden, are very high in every corner of this country and increasingly.
every corner of the world. Obesity is an enormously complex problem with inputs from several places. Genetics is one.
We know that about 60 to 70% of the risks of obesity are heritable ones. When it comes to obesity, for the vast majority of people, there's no one gene that makes a difference. There's many, many genes, dozens, perhaps hundreds, each of which has a small effect on the obesity in the population, but which add up to a susceptibility when exposed to this environment we live in for getting more overweight or not. There are a large number of genes that have been identified in humans that do play a role in the control of body weight and very interestingly the majority of these genes are genes that influence food intake.
Obesity is a classic example of what we call a gene by environment interaction. Any individual's body weight, in most instances, is a result of the interaction of their genetic makeup with the environment that they happen to be living in. There's no doubt that genetics, the DNA that we inherit from our parents, affects how much we weigh.
There's also no doubt that the environment we live in affects how much we weigh. There's no nature versus nurture. There's nature and nurture. Both nature, by that we mean genes, and nurture, we mean experience, affect each other.
And they're inextricably intertwined. Is there a genetic predisposition to obesity? Absolutely. Is obesity caused by environment and behavior?
Absolutely. I've been interested in obesity for a long time, but now I'm responsible for a city of 8.3 million people. Every one of those people I consider to be my patient as a doctor.
And of all the health problems I deal with, this is the one problem that's getting worse, obesity and diabetes. This shows the diabetes and the obesity in the South Bronx here. The lowest income county in New York State, very high prevalence of obesity, very high rates of diabetes.
Just a short distance away here in Manhattan, the Upper East Side where it's the highest... In the neighborhood of the city, we have very low prevalence of obesity, very low prevalence of diabetes. Obesity is driving the epidemic of diabetes. In the darkest areas on this map, close to 90% of adults are overweight or obese.
You do have to literally start connecting some of these dots. You know, 57% of the kids in Philadelphia are overweight or obese. You want to play around?
Okay. Serious diabetes problems, obesity, especially with our children, and they just need more options right here in the community, right on the avenue. We already know, based on the information from the Center for Disease Control and many others, that for kids living in these neighborhoods, many of them will die before their parents. A child born in 2000 has a one in three lifetime chance of having diabetes.
If that child is African-American or Latino, it's one in two. The red spots are where the highest rates of poverty are. In this area, almost one out of every three children is considered to be overweight or obese.
And this is an area, as you were saying, with poverty, the average household income is less than $25,000 for a family of four. If you look at the state of Tennessee and Nashville, it is a crisis level here. I mean, we rank at the bottom.
If we don't take on strategies that affect how the low-income community is dealing with the obesity epidemic, we're going to see this phenomenon across our society in a relatively short period of time. I'm going back to Boca Rosa, people where I can have my fun. We're pretty much in downtown Bogalusa right now, which I'm sure was really nice back in the 60s or 70s. And up here on the left is the lumber mill. The smell of the lumber mill kind of permeates this whole place.
That's one of the lingering memories. When I first left Louisiana, people begged me not to go. Going back down in Boca Lucia, I ain't gonna need no more. Boca Lucia Middle School is our next stop. Y'all have a good day.
I think a really important question is when we look at the levels of overweight and obesity that we're seeing in Bogalusa, you know, 50% of kids being overweight or obese, is Bogalusa unusual? Or if we looked at other places like this around the country, would we be seeing similar levels of overweight and obesity? You know, is Bogalusa special or do we just happen to to have through 35 years of data on it. In the 1970s, 5% of children were overweight and obese. Today, that's over 30%.
So we've seen just dramatic increases in a very short period of time. So our biology has changed quite rapidly within a very short timeframe. on the evolutionary time scale.
And the Centers for Disease Control and Prevention have produced these maps. And this area around the lower Mississippi Delta, encompassing Arkansas, Mississippi, Louisiana, historically has the highest prevalence of obesity and is kind of at the forefront of the obesity epidemic in the United States. Pull this pink one for me.
Actually, brand. Come on in here. Let's get your height and weight.
You ready, Dean? So you're 12? Yes, ma'am. I've been here 10 years, and I have seen a drastic change in the obesity. And I've seen a change in the blood pressures.
It's definitely going up. Their blood pressure should not be that high. Actually, it should never be over 120, over 80. So this is a kid that we'll watch. We'll monitor his pressure. We will probably do lab work on him, get an EKG, make sure everything with his heart's okay, send him to cardiology.
If that comes back clean, we may send him to see a kidney specialist to make sure there's nothing going on with the kidneys because that sometimes can cause blood pressures to go up. So this will be a kid that we watch and we follow. Can you use that for me? Here, let's see.
OK. Step up on the scale. We have to address it now. These are going to be our patients that have are on dialysis in their 30s if we don't do something now. They're our future.
They need us. They need us to care and we do. We as pediatricians never had to worry about learning a lot about hypertension.
That was a specialist disease. We sent the occasional one to the cardiologist. But now there will be many, many times that I'll be facing children with...
blood pressure. I think the results that we're showing in Bogalusa may be reflective as to where the country is going. The blue line is the national data and the red line shows the Bogalusa.
By the mid-1980s, Bogalusa really began outstripping the pace of the rest of the country. We don't really see ethnic disparities. We see that both African American and white children have comparable levels of overweight and obesity.
This is it. This is what the kids have. The swings are broken down. There's no basketball court for them to play on. And, I mean, what does a parent do?
You know, what voice do they have in... demanding safer play spaces for their kids. And this is actually, we're in a part of town with higher poverty rates, and the density of kids is actually one of the higher areas in Bogalusa.
I guess, you know, we as communities need to realize that these features of our environment have health consequences and have consequences for the obesity epidemic. It has to be a complete community, entire society approach to reducing this complex problem. Not only is the prevalence of overweight and obesity going up, in other words, more and more children are classified as overweight or obese, but within that category, those children are becoming heavier and heavier.
Around the world, obesity rates continue to climb, so I don't think we've reached the maximum yet. One of the most important ways we've learned about cardiovascular health and what a normal heart and vessel system looks like, as well as how disease process develops across the lifespan in the cardiovascular system, is by studying tissue from autopsy specimens in people who have died. for completely different reasons, but also in people who have died related to cardiovascular causes.
Weight that's present in young adulthood and weight that is gained from young adulthood to middle age has tremendous consequences. So we really think of this as a perfect storm, a hurricane of consequences that drive cardiovascular risk. And what we have in this case, this is the heart from a 26-year-old woman of normal size, height, and weight, who died of a non-cardiac cause.
Her cardiovascular system is entirely normal. Now, in contrast, we have a heart from another individual, in this case, a male. He was in his 50s. He weighed 500 pounds.
He was 5'9 in height. His BMI was calculated to be 70. Over 30 is obese. It's really dramatically different from the normal heart.
You can see here there's a lot of fat. The cavity is a little bit small. and the wall thickness is extreme. It's more than a centimeter and a half.
So this heart had to do a lot more vigorous pumping to push around a larger amount of blood volume, and also was pumping into a thicker, stiffer arterial bed, so it had to beef up the muscle in order to compensate. for that. So this is hypertrophy.
Pretty quickly that heart muscle that thickens so dramatically can actually start to weaken so the cells go through changes they pass a sort of tipping point where they then become weaker and the heart overall starts to dilate or enlarge and that ultimately can lead to heart failure. So here we see the thickened wall in a very small cavity but this individual died of a heart attack. The contrast here is a woman who has thickened walls as well.
but she didn't have a heart attack and over time those thickened walls got weaker and weaker and the heart got bigger and bigger and dilated to the point where she had this big baggy ineffective pump. Now the heart's a muscle like any other muscle in your body with one important difference it never gets to rest so the heart is particularly dependent on its continuous blood supply and if that blood supply gets interrupted such as in a heart attack there's damage to the heart muscle that starts to occur within seconds to minutes. And so in the end, with the patient's death, the pathologist sees. This is a 71-year-old woman.
who weighed about 260 pounds. You can see here that it's enlarged. It also has a fair amount of fat on the epicardial surface of the heart. This patient has had a bypass operation. We can see the bypass grafts laying on the surface of the heart.
So this woman, as a result of her obesity, developed atherosclerosis and required coronary artery bypass, and that's the graft that you see here that was done sometime before her death. You can imagine as a plaque forms in an artery, it will affect the dynamics of that artery, Normally an artery is composed of smooth muscle cells that actually expand to accept blood when the heart is pumping, and then contract to push it forward to the rest of the tissue that's downstream. Over time, when plaques start to build up, there's more ingrowth of tissue and severe limitation to blood flow.
And that may cause symptoms like angina or chest pain when someone is exerting themselves. So when a plaque forms, that plaque may gradually enlarge over time. And if too much blood clot forms, it can completely blocks the artery. Once that happens, almost instantaneously, the heart muscle cells downstream will start to die.
Now, the blue vessels that you see are actually veins, which are bringing blood back to the heart, and the red vessels coming out are arteries. This is the aorta, which carries oxygenated fresh blood to the rest of the body tissues. This is our aorta from our 26-year-old.
She has a normal heart and a relatively normal aorta. But if we look very closely, you see a little bit of yellow rays. lesion here here here fatty streaks are among the earliest lesions and they occur in children between the ages of five and ten we think this process begins those early life experiences the development of obesity and overweight at a very young age we know has major consequences much earlier than than we should see for the arteries in particular this is an aorta from our 71 year old woman and you can see that this is a lot more more complicated. The surface is very rough and in fact this aorta is crunchy, it's calcified, it's hard, it's stiff and some of these lesions, these plaques have ruptured exposing the lipid to the bloodstream and when you see this kind of disease in the aorta you know it's present in other vessels as well.
So ideal cardiovascular health is really defined by seven factors in health behaviors and they include having optimal levels of total cholesterol, a normal blood blood pressure, not having diabetes, having a lean body mass index, meaning you're not obese or overweight, not being a smoker, and participating in recommended levels of physical activity as well as pursuing a healthy diet. Unfortunately at present in the United States, less than 1% of individuals actually meet the definition for all seven of these criteria for ideal cardiovascular health. Last February I was training for the Country Music Half Marathon. I had reached 10 miles and I was going to do 12 that day. And I started to feel really nauseous and lightheaded and my legs started to fail.
And it was a heart attack. This is me on my wedding day. I'm at my heaviest.
You can see by the look in my eye how I feel. I remember feeling ashamed. I weighed 400 pounds.
I've lost 100 plus pounds since this day. I play a very wind-driven instrument. It's a very physical instrument. And I noticed changes in my playing.
My weight affected my musicianship. You know how people say they look at a photograph of the way they were and they say I never want to go back to being that guy. I don't believe that.
I think I am that guy, but I'm taking care of that guy now. I'm the only one. I'm the only one. I'm the only one. Nobody's my body.
It's my body. It's my body. It's my body. It's my body. You can change even if you weigh 400 pounds.
You can change. It boils down to a decision and saying this is what will happen. It's not a matter of saying I want to or I would like. to it is what will be.
And that kind of decision and that kind of fortitude changes things. The individual with the abdominally preponderant fat, if you will, is at higher risk for the complications of obesity, meaning diabetes, high blood pressure, heart attack, than an individual who has fat stored elsewhere. There are health consequences associated with fat deposition, specifically within the belly. We now know that there are hormones that are released from these fat cells that then could interact, for example, with your heart or with your pancreas, and they may become detrimental. This person, as you can see, where white is body fat, has a thick rim of fat underneath their skin called subcutaneous fat.
This person also has a lot of fat inside of their abdomen. You can see all of these white blotches here inside the belly. Almost every organ system in the body is adversely affected by having excess body fat.
And this is excess body fat underneath your skin, excess body fat inside your abdomen, and excess fat inside of other organs like liver tissue and muscle tissue and heart tissue affects the function of those organs. All of us have fat inside our tummy. We have to have a little bit because we actually mobilise that fat every night when we're fasting while we're asleep. That's the fat that is metabolised and turned into the fuel supply to keep our brain happy while we're asleep until we have our breakfast.
Evolutionarily, men and women have been programmed to deposit fat into two different fat depots. We have the visceral depot, which is this depot of fat that's located inside the abdominal wall. It's the first fat depot that is readily mobilizable. It's burned up very, very quickly. And so men who needed to go out and actually find the game or the bear or the food for the family, they needed to be able to have a calorie substrate that was able to burn up really, really quickly to provide them some energy.
Women, on the other hand, we fight against losing weight in our hips and thighs. And the reason we're programmed that way is that we rely on the calories in our hips and thighs evolutionarily to provide us with calories for breastfeeding or to help sustain a potential famine while we're pregnant. Now that's all in evolutionary terms. In the modern world, of course, we're all living with excess energy supplies. And therefore both males and females store that fat inside their abdomen.
Inside their muscle, inside their liver, and under the skin. And all of a sudden the system which was elegantly designed now no longer is necessarily advantageous for the species. I work in a department of surgery where we do liver transplants and we're finding this very scary finding over the last decade that the reasons we do liver transplant are changing. It used to be hepatitis was the reason we did liver transplants. but increasingly a form of cirrhosis, where the liver gets really stiff, stiff called cryptogenic cirrhosis, has been the reason we're doing more and more liver transplants.
This is a lot of fat to get past. It looks like you've done a good job. of it, sweeping it over.
It's not what a normal liver looks like. See how pale and pink it is? It looks like injected with fat.
It's normally much redder if it doesn't have all these fat globules in it. This is called fatty liver. And it's also very thick and hard to move around.
So what's cryptogenic cirrhosis? Turns out that's a bad term that defines people who have stiff, diseased livers for reasons that we don't fully understand. Except it turns out that almost all of those people have a very severe form of obesity and they have a form of liver change related to obesity where fat literally gets stuck between the cells of the liver, causes inflammation, causes stiffness, liver disease, and it may be the leading reason why in America in the next decades we're doing liver transplants. Thirteen percent of all children who die in autopsy studies have non-alcoholic fatty liver disease.
and 38% of obese children. This is a disease we never saw before. It didn't exist before in adults or in children.
And now 38% of obese kids have it. The liver is a critical organ in our body because of the important functions that it serves. And now we're realizing that the liver is very important in the metabolic problems that are associated with obesity. This has been a particular interest for us because we really are recognizing more and more the liver's central role in causing, or being involved at least, in the metabolic complications of obesity, which lead to serious long-term outcomes like diabetes, high blood fats and blood lipids, and eventually heart disease and death. I've battled my weight my entire life.
I've never been a person that had an easy time with weight from when I was about 18 years old on up. About a year ago, I was a little over 200 pounds. Following the weight gain portion of the study, all of my vital statistics changed.
My cholesterol went up from somewhere in the normal range to like 250 or 260. My triglycerides went up. My fat, when they measured my fat, it went up about 10%, I think. Being a person that basically yo-yoed, I really wanted to have some answers as to what it really means and is it okay to stay obese? As I found out from the study, it isn't okay.
It didn't work out well for me, my body, or my mind. Okay. We're gonna do a whole body scan on you, measure for body fat.
Takes about 10 minutes. I just need you to hold real still. This liver, as you can see here, a brown organ in the center of our body is a metabolic workhorse.
It's a four pound organ that has extraordinary metabolic functions. It makes a large number of proteins that are secreted throughout the body. It also makes fats that are secreted throughout the body and also make sugar to keep our blood sugars at a normal level and prevent hypoglycemia and fainting when we don't have food and if you take two obese people who are the same body size same amount of body fat and one of them has a lot of fat in their liver and the other has normal amount of fat in the liver the one with the high liver fat will have all the metabolic abnormalities that are associated with cardio ...vascular disease risk, whereas the person with the normal liver fat will be relatively healthy and metabolically normal.
So what we will be doing today is that we will be infusing some molecules. We will use these molecules in order for us to understand how well your body metabolizes fats. We want to understand and see, try to understand what is the mechanisms that causes this increase in fat in your bloodstream. They've asked us to use five, one of five fast food restaurants, McDonald's, Burger King, Kentucky Fried Chicken, Taco Bell, or Pizza Hut. So, and the idea is to add a thousand calories.
calories a day to my daily normal diet so that I gain weight over a course of about six to eight weeks. Many studies that have looked at obesity have really evaluated the effect of weight loss on obese people because that's what we're trying to get. get obese people to do and we know a lot about the metabolic effects of losing weight. Much fewer studies have actually looked at what's the effect of weight gain in obese people and that actually occurs much more frequently in our population than is weight loss. So we decided to do a study that would really evaluate in a rigorous way, well-defined way, well-controlled way, what is the effect of gaining 5% body weight in people who are already obese on their metabolic function.
I just need a cheeseburger and a small order of fries and that's it. It's a hand-tossed pepperoni pizza. Those of us that have on occasion eaten an entire pizza.
Each piece has 340 calories and 14 grams of fat. Bean burrito for 550 calories is a lot. of calories for a small amount of food.
I'm a volume eater so I could probably polish this off for lunch and still be hungry. I don't know. I keep these diaries and shows everything we eat. I did the diary for about a month before we started the overfeeding so that they would know about how many calories I took in on a normal basis every day and then they added a thousand calories to that. I'm going to pick up I guess maybe...
Hi, can I have an eight piece meal? A chicken, extra crispy chicken breast has 500 calories and 33 grams of fat. It's a great piece of chicken, I'll admit that. I'm going to take the eggs, serve it with the little biscuits, one biscuit and one... 180 calories and 8 grams of fat.
Now that I'm aware of the fact that it's 33 grams of fat, I don't think I would be as eager to grab the chicken. You increased your LDL cholesterol, the bad cholesterol, by 14% and you increased your triglycerides by 33% after gaining this 5% of body weight over such a short period of time. Your liver fat went from 3.9% up to 10.2%.
and you can see this peak much higher. That's 160% increase in liver fat content. This is 5 pounds of fat, and you literally gained 10 pounds of fat.
So you actually gained 2 of those fat mobs. models by that small 5% weight gain, which you did over really a period of a couple of months. Pretty disgusting.
Body fat is not an inert dead tissue. It's a live acting tissue. It's not just a volume, but this tissue has metabolic function that can cause harm. Now the good news is that the smallest amount of weight loss is needed to improve your health.
A 5% or 10% weight loss can have significant benefits on your metabolic health. These are microscopic pictures of a liver from a lean lean man and extremely obese man before and after massive weight loss. You can see in this lean person that the liver cells are pink and very tightly packed. Whereas in this very obese person, there's a lot of white open circles which consists of fat inside of those liver cells.
Almost half of this person's liver is comprised of fat. But once this obese person loses weight, their liver has returned to its normal state. turn completely to a normal architecture.
About 30% of adults in the United States have fatty liver disease. So this is not a simple issue. This is a very complicated problem that involves a large number of people in the United States.
We know that when we begin the weight loss process, you'll very, very rapidly reduce the fat content of your liver. In fact, we found that 48 hours of calorie restriction causes a 25% reduction in liver fat content. Following the study, when you start the weight loss program, Dr. Klein's office worked with me, and we charted everything I ate, and we talked about it, and we got into a plan of eating mostly lean meats, fruits and vegetables, and whole grains.
As soon as I started doing that, the weight started coming off, and... All of my statistics went back to where they were when I started. Thank you. I didn't want another hamburger. I didn't want another piece of fried chicken.
I didn't want another cookie. I didn't want any of it. Hi.
How are you? Good. I found out that with only a 5% weight gain, a person who has a genetically healthy disposition...... is at risk also. So even though I've considered myself always to be a normal person and never that much overweight and never that unhealthy, going through all this taught me that it's it's almost like you're just at the line waiting to go over the edge.
This is a serious medical problem that we need to address because this excess fat in the liver is driving a lot of these abnormalities that are associated with obesity. not just in adults but also in our children. What obesity has done as it's moved in this wave through the population is to create right behind it a wave of chronic disease. Obesity causes An enormous number of health problems. There's hardly any part of your body that it doesn't harm.
It increases your risk of cancer, increases your risk of joint problems. Our bodies were not designed to carry two times our body size. So there's consequences. Arthropathy, that's a fancy way of saying joints that hurt.
And joints that hurt, hurt more when you carry too much weight around. Obesity negatively affects the function of the human brain. The higher the problem with obesity, the less the activity of areas of the brain that are extremely important for cognitive operations.
The list goes on and on and on. Gallbladder disease, liver disease. People individually with obesity are much more likely to have diabetes. If they have diabetes, they may have foot infections that fester and don't heal, and so it requires amputations.
They may develop blindness. They may develop kidney failure, which leaves them tethered to a dialysis machine for the rest of their lives. What is this doing to ourselves as a nation?
This is really having enormous implications. Diabetes follows obesity as night follows day. I always thought when they talked about someone being overweight and that caused this and then it caused that, I thought they meant being huge. Well, we weren't huge, but we were overweight. It just takes a little bit of overweight to hurt the heart, to start the diabetes, to lose a toe, then to have to have bypasses in the leg and trying to save it and then losing a foot.
He's found out just how much he can do and what he can't do. Oh, yes, yes. There you go.
Diabetes just means high blood sugar. Type 1 diabetes means you don't have enough insulin to run your body's functions. Type 2 diabetes says I have plenty of insulin but it's not working well at the level of the cell.
So the level of insulin is high but the ability to clear sugar into say fat is lost. Therefore the blood sugar rises makes you sick. We understand much better than we have in the past what are the risk factors for developing type 2 diabetes.
The one that everyone is most acquainted with, of course, is obesity, increasing weight. And it doesn't have to be that you become obese. It can be even at lower levels of weight when you go from being you know, 2% overweight to 5%.
That increases your risk substantially. You were in football. Yeah. And then you went to Boston College.
This is my Boston College graduation picture. and I've put a little bit of weight on there. This was 30 years ago.
So you were just about 42, 43 in that picture. Yeah. This probably shows you as heavy as I was.
You can see it in my face. And it seems like, I mean, as we get older and we gain three pounds, well that's not very much and it's, we don't have to, we think we don't have to worry about it, but at the end of 10 years... Three pounds a year is 30 pounds, and that's huge. Somehow, obesity, especially in the abdominal area, makes you resistant to your own insulin. So what happens?
Your pancreas is... now really trying to keep up, trying to make more in order to keep your blood glucose from rising too high, ultimately it gets exhausted and the cells that are making the insulin are now themselves sick because of being overstimulated and then diabetes ensues. If you look at a study called the Nurses'Health Study in which they took nurses back more than 20 years ago, asked them how much they weighed and if they didn't have diabetes at that point, they then followed that study. followed them over something like 15 years.
And for those nurses who had a high BMI, body mass index, which was in the obese category, they had a risk that was between 50 and 100 times higher than women who were thinner at that time. We could have probably eaten better, and we could have done a lot of things better if we knew it was leading to diabetes. You don't have to have steak and rice.
roast beef and all those things that we used to like we don't have anymore fish is wonderful chicken is wonderful and that's pretty much where where we stand today when you're in your path it's the fourth door on the left absolutely So you've got some early cataracts that make it a little bit difficult for me to see absolutely clearly in there. Diabetes affects the vessels, and it affects the vessels supplying the eye, the vessels supplying the kidney, maybe the vessels supplying the nervous system. Those are the small vessels and then it also affects those medium-sized vessels that if that supply Circulation to the heart to the brain and to the legs the periphery now Let's get to where the action has been I'm gonna take a look at the foot And this is where the problem has been on the bottom of the foot here, right? This foot.
Okay. Actually on the side of the foot. The peripheral nervous system is what gives you sensation.
So people with diabetes who suffer from peripheral neuropathy means that they don't feel their toes as well. They don't have the same sensation to light touch or to temperature. And their feet, therefore, are very vulnerable to various kinds of trauma.
You don't realize all that can go wrong when you are a diabetic. And 2010, January, actually it was New Year's weekend and he woke up about three in the morning and his foot had mushroomed to twice its size. We called his primary care doctor and he said, get in immediately. I'll have the vascular team set up, which he did in the emergency room. They took a look at his foot and said, if it's between your life and your foot, your foot goes.
Now I want to take a look at the stump, okay? Can you get that off okay? Nice, that slips right out.
And that's one of the problems with the diabetic foot, because the circulation is reduced, the bacteria kind of get their way in, it looks like an innocent little infection. Not unlike sometimes what this looks like. But this one's... Absolutely.
Absolutely. There's this risk that we know of that... About 50% of people with an amputation on one side will get an amputation on the other side within about five years or so. Got it?
Okay. In the U.S., at this point in time, there are approximately 24 million people with type 2 diabetes. Of that group, there are about 5 million or 6 million who haven't been diagnosed.
And we know that from having done screening programs where we pick up cases of diabetes where the people didn't know it. So, something on the order of 19 million or so with diagnosed type 2 diabetes and another 5 million or so with undiagnosed diabetes. This has slowed us down but it's not going to keep us slowed down.
I think we have to work at it every day or else I think you have a tendency just to die. And I mean I've got grandchildren, we both have grandchildren we want to see and things like that. There's too much in life that's important to us.
Just to give up. Oh, you forgot our wedding picture. Wedding picture? This was...
The world, this could be the number one issue, both in terms of human misery, the severity of the disorders that are consequent to it, and that the cost of this enormous problem, which is only going to get bigger. We're living in somewhat of a damage control mode, where we're waiting for people to get sick, hospitalized, diabetes, stroke. Cardiovascular disease, cancer, and then we're investing an enormous amount of money in trying to mitigate the chronic disease state. That's a huge drag on our Someone who's obese costs on average more than $1,400 to care for more per year than someone who's not obese.
Someone with diabetes costs on average $6,600 more to care for. Per year than someone without diabetes. Collectively, obesity costs about $150 billion a year.
Out of that almost $150 billion a year, about half those costs are paid for by public funds, Medicaid and Medicare. If you look at the skyrocketing healthcare costs in the United States, which we don't have solutions for, whatever competitive position that we have in the world today will even be weakened. by this overweight problem that we have.
We're going to have a productivity crisis. We're going to have an employer-employee crisis. We're going to have people say, I'm not sure that I'm going to be able to manage my bottom-line business system if I don't have fit employees. One of the things businesses are doing is increasing the premiums for obese individuals. North Carolina state employees, if they're obese now, pay higher rates.
Alabama employees pay higher rates if they're obese. Private sector firms are doing similar things. But in fact, some are saying, you know what, it's just too expensive, and they're moving their sites to India or China for cheaper labor and basically offloading the costs entirely. What type of nation can live without a workforce that is healthy? So what diabetes and obesity is doing to this nation is...
Crippling the workforce, but beyond that, crippling the families and the individuals and the communities. 27% of young people trying to get into the military cannot get in because they wait too long. That affects the productivity not just the military but think about that effect for police forces and fire departments and workplaces around the rest of the country. What is this doing to ourselves as a nation? This is really having enormous implications.
I gained about 150 pounds. I don't want to live like this anymore. Please rise. If I set my mind to it, I can do almost anything. Why can't I solve this problem?
What can I do about it? I need to find something that works for me. When it comes to fighting obesity, what is the best thing that I can do for me and my family?
Soda and... other sugary drinks are the number one source of calories in our diet. It's really not just about what we're eating, but it's about what is eating you. We can separate out environmental factors from genetic factors.
You gotta get this weight off. People who are overweight or obese and people who already have diabetes doesn't mean that the game is up. You gotta start somewhere. Physical activity really is the wonder driver. It's a lot of hard work.
But it's worth it. But it's all worth it. The payoff is huge. I'm just an ordinary person who does a whole bunch of very, very tiny ordinary things that together are extraordinary.