by Dan Munro
First posted on Forbes 6/29/2013
Last week the AMA officially weighed in on obesity as a disease. An editorial in the Boston Globe (here) captured the essence of the decision with these two (and separate) sentences:
“Despite reaching epidemic proportions, obesity has been wandering in the wilderness of medical lexicon.”
“The AMA wants to end the common perception — even among many doctors — that the condition is merely a consequence of a chosen lifestyle.”
Whether you support or oppose the AMA decision, the battle lines will logically shift from being purely social and lifestyle to ones that are more scientific and clinical. From here in the bleachers, that alone seems long overdue.
Of course some have suggested that the AMA move was entirely economic as it paves the way for a clinical diagnosis and subsequent treatment — all of which is designed to simply generate more revenue for providers and pharmaceutical companies. Not long ago, I would have agreed with that cynicism, but a TEDMED talk I saw earlier this year (via livestream) challenges that cynicism very directly.
The TEDMED talk is the one that Dr. Peter Attia gave this last April at TEDMED2013. Of the sessions I saw, this was the one that I found to be the most provocative and compelling — especially in light of our current war on obesity.
We’ll get to the compelling in a minute, but the provocative aspect was a flurry of questions around a topic that has strong opinions (globally) but surprisingly scant scientific evidence.
Since obesity is often the on-ramp to cancer, heart disease and even Alzheimer’s, and given the lack of scientific data, the questions Dr. Attia asked during his talk most definitely need scientific answers.
What if obesity is the lesser of two metabolic evils?
What if we have the cause and effect backward?
What if insulin resistance is the cause of obesity?
If obesity is nothing more than a proxy for metabolic illness — what good does it do us to punish those with the proxy?
As with all TEDMED talks, they ultimately become available online and Peter’s 16 minute session is now viewable here (free — no registration required). Some of the statistics Peter used to support this line of questioning — and his new thinking — are definitely insightful.
“About 30 million obese people don’t have insulin resistance and about 6 million lean people are insulin resistant.”
Those numbers are really hard to rationalize — especially as a clinician or scientist — and they defy the notion that obesity is simply the result of lazy lifestyle choices or overeating. All of which is the basis for Peter’s non-profit organization — the Nutrition Science Initiative — or NuSI.org.
The compelling part to the story is that Peter actually lived this debate in both a professional and then deeply personal way.
As a general surgery resident at John Hopkins he recounted the case of an obese women who presents in the ER with a foot ulcer that will need amputation. His first judgment — all too common as we encounter obesity in our own lives — is why didn’t this person do something about such an obvious problem that was clearly within their control? Why wouldn’t someone simply put down the fork before needing life-changing surgery? As he readily admits now — his quick judgment was the hubris of youth and a quick acceptance of conventional wisdom. That wisdom, Peter thought, was a well known pathological sequence of events that was simply settled science. Case closed.
His own personal experience is what changed his view.
“Despite exercising 3 or 4 hours every single day and following the food pyramid to the letter I gained a lot of weight and developed something called metabolic syndrome. I had become insulin resistant.” Dr. Peter Attia — TEDMED13
It was these experiences (spanning several years) that forever changed Peter’s way of thinking about the relationship of insulin resistance and obesity — and culminated in the co-founding of the nonprofit organization NuSI with Gary Taubes. The mission is simply this:
“… to create an organization that would finally provide full resources — regardless of cost or technical risk — necessary for the independent researchers to do the hard science that indeed answer these controversial but critical questions, once and for all.”
In our global war on obesity, we need a lot more scientific evidence. We need to challenge conventional wisdom that isn’t based squarely on scientific or clinical fact. We may chose not to believe it, of course, but as the famous astrophysicist Neil deGrasse Tyson recently tweeted: