Physicians’ Perspective: Obesity, Lifespan and Diet
by Dr. Rick Bayer
In the January 8, 2003 Journal of the American Medical Association, researchers from the University of Alabama–Birmingham reported Years of Life Lost Due to Obesity. Being obese at age 20 can take 20 years off life if you are an African-American male, 13 years if you are a white male, 8 years if you are white female and 5 years if you are an African-American female.
In the January 7, 2003 Annals of Internal Medicine, researchers in the Netherlands reported Obesity in Adulthood and Its Consequences for Life Expectancy: A Life-Table Analysis. In non-smokers, being overweight at age 40 decreases life expectancy by 3 years and being obese decreases life expectancy by 7 years. The conclusion? Being overweight presents a decreased life span that is similar to the decreased life span caused by smoking cigarettes.
To define overweight and obese, the researchers used body-mass index (BMI), which is a weight-to-height ratio. BMI is calculated as body weight in pounds multiplied by 703, then divided by height in inches squared. An ideal BMI is 18 to 25 while 25 to 30 is overweight and above 30 is considered obese.
Obesity increases risks for common killers, especially heart disease, high blood pressure, & diabetes. Until these data were published, information that quantified effects of obesity on life span (mortality) was scarce. Obesity is more than a socio/cosmetic problem—it ranks with smoking as a major risk factor for premature death. More than 22% of Oregonians are obese, which is higher than other western states.
The primary reasons: decreased physical activity and increased calories. The balance between these two is important even in young children because the number of obese children has tripled in the last 30 years. Children are now developing diseases like Adult Onset Type II Diabetes, which used to be rare in kids. Since I grew up in the pre-Nintendo days when we were always outside playing, the physical activity part seems pretty easy to understand. On the other hand, what happened to the American diet?
In medical school, registered dieticians taught us the latest science. In residency, I learned about the “Alternative American Diet”, which was primarily a very low fat, high complex carbohydrate diet designed to prevent heart disease. Cardiologist Dean Ornish proved that using a low fat diet could actually reverse coronary artery disease. I adopted a low fat “don’t eat anything with a face” vegetarian diet and advocated the same for my patients who wished to improve cardiovascular health. Then came the high-fat diets to help people lose weight and what seemed like an amazing heresy spread.
Oregon Health Science University (OHSU) Lipid Clinic News recently published an article titled Which is the Bad Guy—the Fats or the Carbs? They point out that, when medical science suggested cutting down fats, the food industry took fat out of packaged foods but replaced it with huge quantities of sugar. Result? No net calorie loss. Get real! Cutting down on fat is good if we replace the fat with whole grains, legumes, fruits, and vegetables, but cutting down on fat to replace it with an equal calorie amount of refined sugar is not the answer to a healthy diet.
All fats are equal in calories but saturated fats, hydrogenated fats, and cholesterol have a negative impact on blood cholesterols. Poly unsaturated (like corn oil) and mono unsaturated fats (like olive oil) have no direct negative impact on blood cholesterols. Lately, I have changed the fat in my diet by eating more nuts and olive oil. I have learned that a baked potato or bread with extra virgin olive oil tastes better than margarine, which contains partially hydrogenated fats that raise the bad cholesterol levels.
Overeating is often related to eating habits. Engaging in activities such as reading or watching TV while eating often contributes to overeating. So be smart. Bring only proper amounts of food to the table or you may eat it all. Many people do not drink water with meals. Has fast food propaganda made it seem normal to consume a huge sugar-laden drink on top of the bacon double cheeseburger?
Finally, to answer that question: the “Bad Guy” in the diet is neither the fats nor the carbohydrates. Getting the right kinds of fats and carbohydrates is important if you are concerned about obesity or cardiovascular health. Getting the right quantity is important too, and balancing that with regular exercise is a key to freedom from obesity and subsequent risks. Modifying habits as part of your life-long commitment to good health works best.
Rick Bayer, MD is board-certified in internal medicine, a fellow in the American College of Physicians – American Society of Internal Medicine, and practiced in Lake Oswego for many years. Co-author of Is Marijuana the Right Medicine For You? A Factual Guide to Medical Uses of Marijuana, he was a chief petitioner for the Oregon Medical Marijuana Act in 1998.