Obesity is now the most common disease on earth; it is estimated that more than 600 million people are now obese and approximately another 1.5 billion are overweight. There are many more people in the world who are over-nourished compared to the number who are under-nourished.
Obesity and Weight Loss
Why are so many obese?
We now live in an obesogenic environment. Our hunter/gatherer forefathers had to chase and fight and forage for food. At times there was very little available and much of it likely to be contaminated and it was hard to get. As we have become more civilized, our eating pattern has slowly improved. Since the latter part of the 20th century, for the first time in the history of man, in the developed world, we now have too much food. It is of the highest quality, hygienic, colourful, tasty, cheap and available 24 hours in the day. And we don’t need to be active to get it. We are surrounded by labour-saving devices, in the home, in the community and at work.
The net result – we all tend to eat more than we need and do less than we should.
Why am I obese when others are not?
There are now more than 7 billion people on this earth. I hear you ask: Why am I one of the 600 million who are obese? Why am I not among the 6.4 billion who are not obese?
- It is not because you eat more than everyone else. You probably don’t.
- It is not because you lack self-control. There is just no evidence that your self-control is any different from anyone else.
- It is not because you have a problem with your hormones. This is almost never the cause.
- It is not because you are lazy. You are carrying maybe 40 kg of extra weight all day every day. There is no way those skinny people could do that.
It is really because you were born too late! If you had lived in the times of the hunter/gatherer you would have been the envy of all.
Let me explain. Almost everybody in Australia eats too much. Whether we become obese or not depends on how effectively we buffer that excess. We all vary. Some will burn off the excess with increased internal or external activity. Internal activity is an increase in our metabolic rate. The furnace has been turned up and more heat is generated. Increased external activity may be productive, such as working harder, doing exercise or it may be non-productive, such as fidgeting. Some, like you, don’t burn off so much of the excess – you will store it for later when you might need it.
Our bodies behave the way our genetic code tells us to behave. That code was written, in part, millions of years before man had existed and, in part, during the last 300,000 years during which man has been taking over the planet. Those have been tough times. Food was not always available and so the evolutionary process selected the genes that protect us from famine. When food was available in excess of need, it was best to store some as fat. Those who were best able to do that survived the next famine. Those who burned it off and remained skinny were at risk. If you were born 100,000 years ago you would have been a great success, storing food for those lean times. Those skinny people around you, who you may well envy, would be more likely to have struggled to survive.
We learned how to create a stable food supply with the agricultural revolution which started around 10,000 years ago but we have only just arrived at a general excess of food in the last 50 years. The genes do not change in that time. We have a modern food supply but we are stuck with our ‘Stone Age’ genes.
How harmful is obesity?
Obesity is our worst pathogen. A pathogen is something that causes disease. For example, bacteria and cancer cells are pathogens. Obesity is our worst pathogen because it either causes or makes worse numerous diseases including diabetes and a number of related metabolic diseases, heart disease, high blood pressure, various common cancers, degenerative disease of the lower back, hips and knees, infertility and depression among many others. And there are 600 million people around the world who are at risk of getting these diseases. But health is not the only aspect of life to suffer. Obesity also severely reduces the quality of life. Many find they are limited physically. They cannot do the things they should be able to do. For some, even the simple things in life like walking somewhere, going up stairs, attending to personal hygiene, crossing the legs when sitting, cutting toenails and buying clothes are a struggle. They may suffer socially and psychologically. They may be embarrassed by their appearance, avoiding social activities, having low self-esteem and may prefer to stay hidden away at home with their family rather than getting out and meeting new people.
Obesity also reduces the length of life. Most want to live a long life. They may be hoping to see their life plans realised or to see their children well into their adulthood or to see their grandchildren arrive and thrive. Obesity, through all the diseases it promotes, will limit life expectancy.
Does weight loss make you healthier?
Almost all the health problems that your obesity has caused or made worse will be improved and, in many cases, will go away completely if you can lose a substantial amount of weight. Think of the health problems you may now have. Are these likely to be related to your weight? Would you wish to have them resolved? Wouldn’t your life be better without them? And think about the weight-related diseases that you worry might occur in the future if your weight doesn’t change. People are afraid they will develop diabetes or have a heart attack or a stroke or develop cancer.
Does weight loss really enable you to live longer?
We and others have shown clearly that those who have weight loss surgery will, as a group, live longer than an equivalent group of obese people who do not have surgery. So many of our patients will say the most powerful drive to get their weight down was the fear of dying prematurely. They want to be there to see the kids grow up or the grandchildren appear and grow or just to be there. The evidence is now very clear – lose weight and you are much more likely to live longer.