The visible consequences in a situation where the invisible consequences are much, much worse/America’s Obesity Epidemic

The ‘Soft American’ grows ever softer

With the unUnited States of America having become, collectively, the fattest, unfittest, unhealthiest and, in some ways, unfriendliest nations in the Western world thanks to the road-rage stresses of driving, it would be easy to blame the engines of ease: motor vehicles, television and computers.

But one cannot realistically ignore the human element that transformed a nation that only 80 years ago saved the world from the brutal, totalitarian warlords of Nazi Germany and Imperial Japan into a country now so unfit and unhealthy that it faces difficulties in fielding an army.

In all areas of health, America has done nothing but slide downhill in the post war years, and especially so since 1960 when the late President John F. Kennedy penned an essay for Sports Illustrated magazine titled “The Soft American.”

In it, he warned that “despite our unparalleled standard of living, despite our good food and our many playgrounds, despite our emphasis on school athletics, American youth (lag) far behind Europeans in physical fitness.”

JFK’s only error in that summation might have been in the use of the word “despite.” Some of what has become of American youth, and their elders, might well have come “because” of that “unparalleled standard of living.”

At the time Kennedy penned his essay, it was reported that when given six tests for muscular strength andflexibility, “57.9 percent of the American children failed one or more of these testswhile only 8.7 percent of the European youngsters failed.”

Since then, American children have done little but add fatness to their unfitness. Along with that old lack of fitness, the country now faces an epidemic of childhood obesity that has seen the percentage of obese children triple since the 1970s.

One in five kids are today not just overweight, according to the Centers for Disease Control; they are obese at a cost of more than $1.3 billion in medical costs per year. And those costs are only destined to grow in the future, given that at least a third of obese children are destined to remain obese forever, according to a peer-reviewed meta-analysis of obesity research conducted in 2016.

Blame politicians unwilling to confront this health crisis, urban planners designing communities more for motor vehicles than people, technocrats dedicated to making life ever easier, educators willing to ignore the importance of fitness, big pharma pushing drugs as the solution to anything and everything, and the nation’s medical establishment.

Today, according to the Kaiser Family Foundation (KFF)and other reputable sources, the U.S. spends twice as much on medical treatments for its citizens as the average in other Western nations and yet produces worse outcomes.

Health spending per capita topped $12,000 per person in the U.S. in 2021, according to KFF, besting the spending in Germany and Switzerland by $4,600 per year, doubling the spending in the other European nations and almost tripling the per capita expenditures in Japan.

Not working

All of this to produce a nation that is steadily falling behind all of those countries in terms of life expectancy, a general measure of good health. And all of this before the now emerging consequences of what has come to be called “Long Covid” emerged as a major, new, national disability.

Debilitating Long Covid is, for some, a consequence of having been infected with the Covid-19 causing SARS-CoV-2 virus, and here again the danger of America’s lack of fitness raises its head.

“Pre‐COVID fitness, on average, (was) lower among people who developed long COVID,” researchers reported in the peer-reviewed Journal of the American Heart Association just days ago.

“Our results regarding lower physical activity among those with Long Covid suggest that differences in physical activity post‐Covid reported in prior literature may be at least partially explained by lower physical activity pre‐Covid.”

Translation? A lot of people who came down with Covid-19, the disease caused by the SARS-CoV-2 virus, were fundamentally unhealthy to begin with and Covid-19 just made them more unhealthy.

This should come as no big surprise given what was already known about who died in what was a pandemic of the unfit and unhealthy no matter how Covid-czar Anthony Fauci and the political-medical community might have tried to spin the disease into a deadly threat to everyone.

The CDC summed this early in the pandemic when it reported that in only about 5 percent of deaths was Covid-19  “the only cause mentioned on the death certificate. For deaths with conditions or causes in addition to Covid-19, on average, there were 4.0 additional conditions or causes per death.”

Those conditions or causes are what were once commonly called “chronic diseases” but are now more often referred to as “comorbidities,” and most of the worst of these comorbidities are linked to a lack of physical activity.

“Physical inactivity puts adults at greater risk of cardiovascular diseases such as heart attacks and strokes, type 2 diabetes, dementia and cancers such as breast and colon,” according to the World Health Organization (WHO), which has underlined that this is not a uniquely American problem in the Western world.

Around the globe, WHO estimated “nearly 1.8 billion adults at risk of disease from not doing enough physical activity.”

America, unfortunately, happens to be the world leader in this pandemic of sloth.

Doctor – heal thyself!

And the role of the American medical community – with its focus on medications rather than health and its widespread refusal to recognize the physical-unfitness problem in this country – cannot be ignored.

The medical community would now like Americans to believe that the pharmaceutical industry created vaccines that saved us all from the first big pandemic of the new millennium, and it is true the vaccines might have saved hundreds of thousands or more.

But what is left unsaid is that fundamental physical fitness saved tens of millions and is likely to do the same when the next pandemic arrives and another scramble begins to find the drug to treat the new disease.

This is evolution at work as it has been at work since the first of our species came into being. Disease has for hundreds of thousands of years killed the the young, because their immune systems have yet to fully developed; the weak, because their immune systems are compromised; and the old suffering with immunosenescence, the natural decay of the human immune system over time.

This decay is beyond human control, but the rate of decay has been shown to be slowed by physical activity. It’s the old “use-it or lose-it” axiom.

“Numerous studies have demonstrated that regular exercise can positively affect immune function, attenuating the detrimental effects of immunosenescence,” researchers noted in the peer-reviewed International Journal of Biological Sciences earlier this year. “The mechanistic basis of this positive effect involves the modulation of inflammatory mediators, enhancement of immune cell activity, and formation of an immune environment conducive to effective antitumor responses.”

The majority of Americans, however, now ignore this reality, and American physicians have become their prime enablers in an effort to replace exercise with chemistry. Glucagon-like peptide agonists, a hormone commonly referred to as GLP-1, are the latest chemical concoction of the day.

First introduced to treat diabetes, GLP-1s such as Semaglutide and Tirzepatide, are now hailed as “highly effective treatment options for people with type 2 diabetes and obesity, enabling effective control of glucose and weight loss, while reducing cardiovascular and renal morbidity and mortality,” according to a paper published Nature Reviews Drug Disovery last month. “The success of these medicines has spurred development of next-generation GLP-1-based drugs, promising greater weight loss, improved tolerability and additional options for the route and frequency of dosing.

“Structurally unique GLP-1-based medicines that achieve substantially greater and rapid weight loss may impact musculoskeletal health, providing a rationale for therapeutics that more selectively target adipose tissue loss while preserving muscle mass and strength. Ongoing clinical trials in peripheral vascular disease, neuropsychiatric and substance use disorders, metabolic liver disease, arthritis, hypertension and neurodegenerative disorders may broaden indications for GLP-1-based therapeutics.”

The current GLP-1s, unfortunately, don’t improve “musculoskeletal health.” They do the opposite.

As reported in a November study in The Lancet, a highly respected medical research journal, the drugs “are effective for weight loss, but can cause substantial muscle loss. Studies suggest muscle loss with these medications ranges from 25 percent to 39 percent of the total weight lost over 36 to 72 weeks.

“By comparison, non-pharmacological caloric restriction studies with smaller magnitudes of weight loss result in 10 to 30 percent losses. In context, on an annual basis, the decline in muscle mass with GLP-1 receptor agonists is several times greater than what would be expected from age-related muscle loss, Dismissing the importance of muscle loss can create a disconnect between patients’ increased awareness of muscle and the role it plays in health, and clinicians who downplay these concerns, affecting adherence to and the development of optimised treatment plans.”

Those “optimized treatment plans” ironically dictate telling patients to engage in the physical activity most of them refused to do on their way to putting on all the extra weight that has made these drugs the hot ticket for rapid weight loss.

“When patients are taking these weight loss medications, they should also implement measures to reduce muscle loss. Muscle loss can lead to weakness and other problems,” Dr. Mir Ali last month told the website Medical News Today.

“The main things patients can do is ensure adequate protein intake and exercise. Resistance-type exercises are helpful in maintaining and possibly even building muscle.”

Exercise to build muscle while taking GLP-1s is the optimistic view based on the 25 to 39 percent muscle loss reported in The Lancet. A study published in the peer-reviewed journal Diabetes, Obesity & Metabolism last year reported that “in some studies, reductions in lean (muscle) mass range between 40 percent and 60 percent as a proportion of total weight loss.”

The authors involved in that study said they couldn’t determine why various studies reported widely different losses of muscle in people talking GLP-1s and warned that “factors such as older age and severity of disease may influence the selection of appropriate candidates for these therapies due to risk of sarcopenia,” the degenetative loss of skeletal muscle.

“To further improve muscle health during weight loss,” they added, “several pharmacological treatments to maintain or improve muscle mass designed in combination with GLP-1-based therapies are under development.”

Or as the rock-and-roll band Jefferson Airplane put it in 1967, “One pill makes you larger, and one pill makes you small….”

Exercise is Medicine

And much of this medicating is done to avoid the reality that “Exercise is Medicine” (EIM), as the poorly promoted  “global health initiative managed by the American College of Sports Medicine” puts it.

“EIM encourages physicians and other health care providers to include physical activity when designing treatment plans and to refer patients to evidence-based exercise programs and qualified exercise professionals,” according to its website.

The EIM blog pretty well summarizes the failures of the EIM, the organization promoting it and a medical community addicted to prescribing drugs.

“Recent results from a study analyzing 2022 U.S. National Health Interview Survey (NHIS) data found that only 22.9 percent of adult women and 17.8 percent of adult men had been advised to increase their physical activity level by a doctor or other healthcare professional,” EIM admitted on its blog in April of last year. 

“These low rates come despite many disheartening statistics: 1) only 24 percent of US adults (18 and older) meet recommended levels of aerobic and muscle strength training; 2) 40 percent of US adults are obese; and 3) between the first quarter of 2020 and the end of 2022, prescription volumes for GLP-1 medications (a new type of weight loss drug) increased 300 percent.”

Could anything else be expected in this country?

It’s a lot easier for a doctor to write a prescription for GLP-1s than to tell a patient they need to get up off their ass – whether it has been planted in front of the television, behind the computer or in a driver’s seat – and move. And it so easy for a physician to rationalize this with the view of “first I’ll help the patient get the weight under control and then we’ll worry about the lack of fitness….”

All of which amounts to putting the horse before the cart, as it has been said, but it is easy and everyone makes money: the doctors who can quickly process high volumes of patients by writing them prescriptions and sending them out the door, and especially the pharmaceutical companies which have found another drug it would appear patients are going to need to stay on forever to maintain their new, slimmer self.

The late President Dwight D. Eisenhower, in his 1961 farewell address, warned of a U.S. need to “guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.”

Today, the country has a parallel to the military-industrial complex – the medical-pharmaceutical complex. It has boosted U.S. spending on drugs and medical care to heights never imagined while producing worse outcomes than comparable wealthy nations.

When the Peter G. Peterson Foundation examined health care outcomes in nine European nations plus Canada, Australia and Japan, it found the U.S. last in life expectancy among these 12 countries, last in infant mortality, last in unmanaged diabetes, last in safety during childbirth, third to last in heart attack mortality, and fifth to last in unmanaged ashtma.

“A healthcare system with high costs and poor outcomes undermines our economy and threatens our long-term fiscal and economic well-being,” the think tank concluded. But there must be a drug to cure that, right?