The Nutrition Debate #165: Obesity is Not the Problem

Robert Lustig’s UCTV YouTube video sensation, “Sugar, the Bitter Truth,” has been seen almost 4 million times. Recently, the UCSF pediatric endocrinologist made a sequel, “Fat Chance: Fructose 2.0,” that will also go viral. It’s 86 minutes long, so you’ll need to set aside a block of time to watch it, but it’s worth it. Here’s a 45 second excerpt I transcribed (starting at +/-12:00) that fits in with a theme I’ve been beating the drum about since The Nutrition Debate #9, “The Metabolic Syndrome,” published almost 3 years ago.

Lustig: “Obesity is not the problem. It never was. They want you to think it’s the problem, but it ain’t the problem. What is the problem? Metabolic Syndrome is the problem. The cluster of diseases that I’ve described to you. That’s where all the money goes. Obesity costs almost nothing. Metabolic Syndrome is 75% of all health care costs today. And there’s the list right there. [Slide lists: DIABETES, HYPERTENSION, LIPID ABNORMALITIES, CARDIOVASCULAR DISEASE, NON-ALCOHOLIC FATTY LIVER DISEASE, POLYCYSTIC OVARIAN DISEASE, CANCER, DEMENTIA] Everybody with me now? Do I have your attention?”

A brief recap – What is Metabolic Syndrome”? And how is it diagnosed? Definitions vary but most have five “risk factors” in common, with the first always being obesity. It is variously defined as “central obesity,” or what I have coined “omental adiposity”, or a Body Mass Index (BMI) ≥30, or elevated waist circumference (men ≥40 inches, women ≥35 inches). The other four “risk factors” are elevated triglycerides (≥150mg/dl), reduced HDL, the “good” cholesterol (men ≤40mg/dl, women ≤50mg/dl), elevated blood pressure (≥130/85mm Hg, or use of medications for hypertension) and elevated fasting glucose (≥100 mg/dl, or use of medications for hyperglycemia). If you “present” with 4 out of 5, you have Metabolic Syndrome. Do I have your attention?

The corollary to “obesity is not the problem” is equally riveting: “everyone’s at risk,” as Lustig explains: “Everyone’s at risk, because everyone is exposed.” That, of course, begs the question: exposed to what?

Dr. Lustig precedes his “obesity is not the problem” mantra with a nice explanation of the implications of the difference between subcutaneous fat (fat near the surface of the skin) and visceral fat (fat around the abdominal organs).The latter is the “bad” type of obesity. He starts with a diagram showing 30% obese and 70% “normal” weight, “and everybody assumes that the problem is this group over here [the 30% obese] because 80% of the obese population is sick in some fashion: type 2 diabetes problems, lipid problems, hypertension, cardiovascular disease, cancer, dementia, non-alcoholic fatty liver disease, polycystic ovarian disease, etc.”

“But,” he continues, “you do the math on this, 80% of 30% [of the 240 million adult population] is 57 million, and it is those 57 million that are bankrupting the country, so it’s the obese person’s fault only, and that’s the way everyone views this. This is wrong. This is a mistake. This is a disaster, actually, ‘cause it’s not correct. Here’s the real story. In fact, 20% of the obese population is completely metabolically normal. They have normal insulin dynamics. They don’t get sick. They live a completely normal life, die at a completely normal age, cost the taxpayer nothing. They’re just fat.”

“Conversely, up to 40% of the “normal” weight population has the exact same metabolic dysfunction that the obese do. They’re just normal weight, and so they don’t even know they’re sick until it’s too late; because normal weight people get type 2 diabetes, they get hypertension, they get dyslipidemia, they get cardiovascular disease, they get cancer, they get dementia, etc. etc. And so, when you do the math on that, that’s another 67 million, and so that’s actually outclassing the 57 million obese, and so the total is 124 million; that’s more than half [the adult population] of America.”

So, that’s why Dr. Lustig says, “Everyone’s at risk, because everyone is exposed.” Exposed to what, you ask? Metabolic Syndrome! And how do you treat Metabolic Syndrome? Answer: you “treat” the risk factors: 1) central obesity, 2) elevated triglycerides, 3) reduced HDL, 4) elevated blood pressure, and 5) elevated fasting glucose. And what treatment, pray tell, addresses all five risk factors for Metabolic Syndrome? In case you haven’t figured it out yet, the answer is a Low Carbohydrate Way of Eating. No pills, no injections, no surgery. Just a different way of eating.

Okay, you say, I can see how a low-carb Way of Eating can help me lose weight and control my blood glucose. And I can see that as I lose weight (as almost everyone wants to do anyway), how my blood pressure will go down. (Mine did, from 130/90 to 110/70 on the same meds.) And maybe I can believe that by eating low-carb, I can lose weight without hunger and without snacks, and even keep the weight off, so long as I continue to eat low-carb. But how can I expect that eating low-carb will cause my elevated triglycerides to go down and my HDL to go up? Well, mine did, dramatically: My HDL doubled from 39 to 81, and my triglycerides dropped by about two-thirds, from 137 to 49, just by eating very low carb. Scientifically, an n = 1 means nothing, unless that n = 1 is you!

PS: Here’s another interesting n = 1 on Low Carb Lowers Triglycerides from Dr. Art Ayers’s blog.