The Weight of the Nation: Part 1 - Consequences (HBO Docs)

This joa is as heavy as me, it's called acanthosis. More than 18% of our children right now are obese. How loud are you around 280? If you go with the flow in America today you will end up over

weight

or obese, as 2-thirds of Americans do. I don't want to be fat for the rest of my life. I have diabetes. Sleep apnea. High blood pressure. I get dizzy when I get up. Everything hurts. Although you don't crave broccoli and our generation has grown up longing for the great man we have built. a model of cheap food and that is what we are facing right now it is so difficult to fight against what television tells you to buy your children the type of food we eat is the most profitable local and regional foods taste better

weight

of the

nation

is out of control, but we can fix that, however you want, the market means everything to this neighborhood, we have to come together as a country and really make this a priority, as long as we stick together, that's what it's all about.

It's not just about health, it's about the survival and well-being of the United States as a

nation

. The reason we have government in the first place is to solve problems collectively that we cannot solve individually if we don't take this as a truly serious urgent national priority, we are all individually and as a nation we are going to pay a really serious price. I weigh 99 pounds when my husband and I got married 30 years ago, then you start having a family and after my second child it was like poof. It was my my grandmother my mother my sister and I had it has been the same story it is not easy to lose weight and that is life suction patches pills fad diets counting carbs counting calories I have tried everything and I asked my husband let's be honest Here I am this big and when he doesn't answer me I think oh my God what happened to me you know or if he says no way then I feel better about myself you know but those who don't answer that, I know I'm that big and it's like a slap in the face in the face, wake up, you know, do something, you try and it doesn't do it and you lose hope, so B Lu said it's like any city everywhere. in the southeastern United States and there are some variations: in northern Mississippi there is a lot of poverty and that is

part

ly related to industry and agriculture, but we are like any Old Country Town: strawberries, cheese, strawberry jelly and it has bananas and pineapple and you wouldn't believe how good your dishes start to taste this is Louisiana cuisine this is the best of Louisiana where is the pasta with shrimp you get tired of the diet that's not going to work and then you fall off the wagon, so to speak, and you know it, then you really get rid of something you're not supposed to have or you know you get tired of that feeling of failure, if you don't fry it, you grill it if you don't. t Grill it, ball, this is how we eat here good morning hello, hello, what are your names Cindy and Gary roach Cindy, are you going to be the first, Gary will be the second?

Okay, just have a seat, when did you start coming to the hard? study we were in elementary school elementary school we both want to talk about third grade third fourth fifth grade Kathy P Kathy when did you start taking the test? I started studying the heart, um, my first year was in 1973, I was in kindergarten, the baloa. The study of the heart is a historical investigation of the genesis of cardiovascular diseases from childhood to adulthood and many of us, as we advanced in our biomedical sciences in undergraduate University, learned about the study of the baloa heart, the main focus is on cardiovascular diseases and the pathogenesis of the disease over time really begins in childhood I'm going home to home toala I'm going home to home toala in the baloa heart study we are looking at risk factors and children, since we want to observe early natural history.

It is obvious that we must consider the early onset of these diseases. The main effect of the Baloa heart study is the semi-annual general examination of all children in Baloa schools. I remember being very excited when they used to come to the school they used to come to. It was a big white trailer and that's where they did all the work and back then I was happy because we were leaving class when they did the heart study on me. The intention was to observe risk factors like in Framingham. but to do it in children what I need is a list of people for whom you do not have any type of record, some of them we have because we knew the cause, we simply did not have the death certificate, so you are already exhausted. all the data from the caregiver's office yes sir after having been in the study for five or six years we clearly established that heart diseases began in childhood what we needed our information was to do an autopsy study 560 deaths since 1972 when we started to see injuries in children It really cemented the fact that by looking at the risk factors clinically in life and here, by looking at actual vascular disease and death, and having a strong correlation, the highly significant relationships are right, okay, breathe , our children are now 50 years old and we have a 30 35 year history on them, did you give us your email address?

It is the only such study in the world that has a long-term black and white population. The obesity that we are seeing is very harmful to the cardiovascular system. I just found out I have high blood pressure and was told I was borderline with maybe diabetes so my doctor told me to go brown so no more white rice, potatoes or white bread so we have been into pasta wheat, wheat bread of that type. Okay, okay, what did you get for the subscapula? 1329 other and 133 obesity are not just fat cells there, but

part

icularly central fat, abdominal fat, android deposition, male fat deposition, waste measure, this is to measure. the abdomen, but obesity is the main driving force of insulin resistance.

Insulin resistance and obesity are the driving force of hypertension. diabetes. That's fine thanks. Blood pressure over 140 is high. If you lost 20 pounds, it might gain. I'm not working. In that, I have lost, you should take some medicine. I don't care, you should take some medicine. I'll go back and see a doctor. God, well, hey Sandy, how are you? I'm fine, okay, Miss Rita? I'm fine, I found a photo this morning. I found out through a heart study that she had high blood pressure and I can take her to the doctor. Okay thanks. All we need. My grandmother had a heart attack.

My grandmothers. I'm sorry. But I. By having a heart study, I know that if something is wrong it will be caught early and maybe I will be here to see my grandchildren grow up. I have to learn to eat the right things at the right times and I'm going to do it. To prove it I'm going to try it and I'll come back and everyone will see maybe a new me. Thank you, life is very difficult for obese people and by difficult I mean both the social

consequences

of that and the health

consequences

. From that, I write the fact that those who are very obese are not going to live as long as others.

What makes me feel frustrated and almost angry is that this is preventable. It's not one of those unfortunate acts of nature. that we just have to accept as reality this is not the product of a tsunami the nation's weight is unhealthy and for it to be healthy we are all going to have to do our part we all have to be part of the solution to reduce obesity in This country, otherwise we will face ever-rising health care costs and lives lost to cancer, heart disease, diabetes and other problems. How many people in this society are capable of maintaining a healthy weight?

By a third or less, something is wrong with this picture: the level of obesity in the United States has increased alarmingly. In the 1980s, the Centers for Disease Control began putting together a map showing obesity levels state by state and then looked back over the years and each time. a state changes color, suggests increasing levels of obesity when looking at adult obesity rates from 1960 to 2008, you can see that the rates were moderate and relatively consistent over time, but then, starting in the decade The current level, which is more than a third of adult men and women in the United States, are obese, but it is in morbid obesity where we have seen the most striking increase since 1988. until 2008.

We have childhood obesity at levels where people do not deny it. So it's a teaching moment when it's only adults or only people from less valued groups. You could put it aside, it's those people, but when it comes to kids, you can start a conversation. People who are poorer tend to have higher rates of obesity, so if we look back to the late 80s and early 90s, there is a linear relationship between poverty and obesity, but if we look more recently Between 2005 and 2008, rates around the world have increased and being richer is not as protective against obesity as it used to be.

Some regional variation, but they are all different degrees of terrible, the levels are so high everywhere that every state has to pay attention to this problem, health care costs, not to mention the human burden, are very high in every corner of this country and increasingly in every corner of Global obesity is an enormously complex problem with contributions from various places, genetics is one, we know that around 60 to 70% of obesity risks are hereditary. When it comes to obesity, for the vast majority of people there is no one gene that makes a difference. There are many many genes, dozens, perhaps hundreds.

Each of which has a small effect on obesity and the population but which adds up to a susceptibility. When exposed to this environment that we live in to be more overweight or not, there are a large number of genes that have been identified in humans that play a role in controlling body weight and interestingly, most of these genes are genes that influence food intake. Obesity is a classic example of what we call a gene by interaction with the environment and the body weight of any individual. In most cases it is the result of the interaction of their genetic makeup with the environment in which they live.

There is no doubt that genetics, the DNA we inherit from our parents, affects our weight. There is also no doubt that the environment in which we live. in affects how much we weigh there is no nature versus nurture there is nature and nurture both Nature by that we mean genes and nurture we mean experience they affect each other and are inextricably intertwined is there a genetic predisposition to obesity absolutely is obesity caused by environment and behavior absolutely I have been interested in obesity for a long time, but now I am responsible for a city of 8.3 million people, each of those people I consider my patients as a doctor and for all the health problems I treat . with this is the only problem that is getting worse, obesity and diabetes, this shows diabetes and obesity in the South Bronx here, the lowest income county in New York State, very high prevalence of obesity, very high rates. high diabetes rates within walking distance. here in Manhattan, the upper e, where it is the highest income neighborhood in the city, we have a very low prevalence of obesity, a very low prevalence of diabetes, obesity is driving the diabetes epidemic in the darkest areas of this map, about 90% of adults are overweight or obese, you literally have to start connecting some of these dots, you know, 57% of kids in Philadelphia are overweight or obese, you go to the playground, okay, problems severe cases of diabetes, obesity, especially with our children, they just need more options. right here in the community right on the Avenue we already know, based on information from the Center for Disease Control and many others, that for children who live in these neighborhoods many of them will die before their parents.

A child born in 2000 has a one in three chance in life of having diabetes if that child is African American or Latino, it is one in two. The red dots are where the highest poverty rates are in this area. Nearly one in three children is considered overweight or obese. it's an area like you were saying with poverty the median family income is less than $25,000 for a family of four if you look at the state of Tennessee in Nashville it's a crisis level here I mean we're in last place if not Adopt strategies that affect the way in which the low-income community is dealing with the obesity epidemic.

We are going to see this phenomenon throughout our society in a relatively short period of time. I will return to the people of Bal, where I can have fun. We're pretty much in the center of B Lua right now, which I'm sure was very nice back in the 60s OR7 and up here on the left is the sawmill, the smell of the sawmill permeates this whole place, which is one of the lingering memories people begging me not to go I'm not going back to any school it's our next school everyone have a good day I think areally important question is when we look at the levels of overweight and obesity that we have.

We're looking at Bogaloo so you know 50% of kids being overweight or obese is very unusual or if we look at other places like this around the country we would see similar levels of overweight and obesity you know it's very special or Do we by any chance have 35 years of data on this from the 1970s? 5% of children were overweight and obese today, that's more than 30%, so we've seen dramatic increases in a very short period of time, so our biology has changed quite a bit. rapidly in a very short period of time in The evolutionary time scale and the Centers for Disease Control and Prevention have produced these maps and this area around the world.The lower Mississippi Delta, which encompasses Arkansas, Mississippi, Louisiana, historically has the highest prevalence of obesity and is at the forefront of the obesity epidemic in the United States.

All this pink to me, actually, Bri, come here and let's check your height and weight. You're ready, Danel, so you're 12 years old. Yes ma'am it's not that bad as I've been here for 10 years and I've seen a drastic change in obesity and I've seen a change in blood pressure it's definitely going up. The blood pressure shouldn't be that high, it should never really be above 120 or above 80, so this is a child that we will monitor, monitor his blood pressure, probably do lab work, do an EKG and make sure that everything is fine. heart, okay, send him to Cardiology, if it comes out clean we can send him to see a kidney specialist to make sure there's nothing wrong with the kidneys because that can sometimes cause the blood pressure to go up, so this will be a boy to the one who looks and we follow the shoes for me, okay, go up the scale, we have to address it now, these will be our patients who are on dialysis in their 30s, if we don't do something now emergency, they are our future.

They need us, they need us to take care of them and we as pediatricians never had to worry about learning much about hypertension, which was a specialized disease, we occasionally sent one to the cardiologist, but now there will be many, many times where I will be. facing children with high blood pressure Stacey gives her a note to go back to class, okay ma'am, I think the results we are showing in baloa may reflect where the country is going. The blue line is the national data in the The red line shows Baloa in the mid-1980s, Baloa really began to outpace the rest of the country.

We don't really see ethnic disparities. We see that both African American and white children have comparable levels of overweight and obesity. This is all. It's what the kids have, the swings are broken, there's no basketball court for them to play on and I mean, what voice do parents have to demand safer play spaces for their kids and this is where we are? a part of the city with higher poverty rates and density of children is actually one of the highest areas in Bogalusa. I assume you know that we, as communities, need to realize that these features of our environment have consequences for health and for the obesity epidemic.

There has to be a comprehensive Community and Society-wide approach to reducing this complex problem, not only is the prevalence of overweight and obesity increasing; In other words, more and more children are classified as overweight or obese, but within that category those children weigh more and more. Global obesity rates continue to rise, so I don't think we've reached the peak yet. I want another one on one of the most important ways we've learned about cardiovascular health and what a normal heart and vascular system looks like, as well as how the disease process develops throughout life in the system. cardiovascular is by studying tissue from autopsy samples in people who have died for completely different reasons, but also in people who have died related to cardiovascular causes, the weight that is present in young adulthood and the weight that is gained through From a young adult to middle age has tremendous consequences, so we really think of this as a perfect storm, a hurricane of consequences that drive cardiovascular risk and what we have in this case is the heart of a 26-year-old woman. of normal size and weight who died from a non-cardiac cause his cardiovascular system is completely normal now in contrast we have the heart of another individual in this case a man was about 50 years old weighed 500 lbs and was 5'9 his BMI was calculated to be 70 out of 30 is obese it is really dramatically different from the normal heart as you can see here there is a lot of fat the cavity is a little small and the wall thickness is extreme it is more than a centimeter and a half so this heart had to pump a lot more vigorously to push a greater amount of blood volume and it was also pumping into a thicker, stiffer arterial bed, so it had to strengthen the muscle to compensate for that, so this is pretty rapid hypertrophy.

Muscle that thickens so dramatically can actually begin to weaken, so the cells go through changes. They pass a sort of tipping point where they then weaken and the heart generally starts to dilate or enlarge and that can ultimately lead to heart failure, so here we see. the thickened wall and a very small cavity but this individual died of a heart attack the contrast here is a woman who also has thickened walls but she did not have a heart attack and over time those thickened walls became weaker and weaker and the The heart got bigger and bigger and dilated to the point where it has this big, ineffective pump.

Now the heart is a muscle like any other muscle in the body, with one important difference: it never rests, so the heart is particularly dependent on its continuous blood supply. and if that blood supply is interrupted, as in a heart attack, there is damage to the heart muscle that begins to occur within seconds or minutes, so in the end, with the death of the patient, the pathologist sees that it is a 71 year old woman who weighed approximately 260 pounds, you can see here that it is enlarged and also has a good amount of fat on the epicardial surface of the heart.

This patient has had a bypass operation. We can see the bypass graphs on the surface of the heart, so this woman as a result, Al due to obesity developed atherosclerosis and required coronary artery bypass and that is the graph that you see here that was made some time before death her. You can imagine that as plaque forms in an artery, it will affect the dynamics of that artery. Normally it is composed of an artery. of smooth muscle cells that actually expand to accept blood when the heart is pumping and then contract to push it toward the rest of the tissue downstream;

Over time, when plaque starts to build up, there is more tissue ingrowth and severe limitation of blood flow and that can cause symptoms like angina or chest pain when someone strains, so when plaque forms, That plaque can gradually enlarge over time and, if too much of a blood clot forms, it completely blocks the artery. Once that happens almost instantly, the heart muscle cells will begin to flow downward. to die now the blue vessels you see are actually veins that carry blood back to the heart and the red vessels coming out are arteries this is the aorta that carries fresh oxygenated blood to the rest of the body's tissues this is our Iota from Our girl 26 year old has a normal heart and a relatively normal aorta, but if we look very closely we see a small raised yellow lesion here here here fatty streaks are among the earliest lesions and occur in children between the ages of 1 and 2 years. 5 and 10 we believe that this process begins those early life experiences, the development of obesity and overweight at a very young age, we know that it has important consequences much earlier than we should see, for the arteries in particular, this is an aota of our 71 years. -old and you can see that this is much more complicated the surface is very rough and in fact this aota is crunchy it is calcified it is hard it is rigid and some of these lesions these plates have ruptured exposing the lipid to the bloodstream and when you see this type of disease in the aorta and you know it's also present in other vessels, so ideal cardiovascular health is actually defined by seven health factors and behaviors and includes having optimal total cholesterol levels, normal blood pressure, not having diabetes , have a lean body mass index, which means you are not obese or overweight, are not a smoker, and participate in recommended levels of physical activity, in addition to following a healthy diet;

Unfortunately, in the United States today, less than 1% of people actually meet the definition of all seven of these criteria for ideal cardiovascular health last February I was training for the country music half marathon. I had hit 10 miles and was going to do 12 that day and I started to feel very nauseous and lightheaded and my legs started to give out. and it was a heart attack this is me on my wedding day I'm at my heaviest you can see by the look in my eyes how I feel I remember feeling embarrassed I weighed 400 lbs I've lost 100 plus PBS since this day I play a very driven instrument because of the wind, it's a very physical instrument and I noticed changes in my plane, my weight affected my musical ability, you know how people say they look at a photograph of what they were like and say I never want to be that again. boy I don't think so, I think I'm that boy, but I'm taking care of that boy now, you can change even if you're 400 pounds, you can change, it all comes down to a decision and saying this is what will happen, it's not. a matter of saying I want or I would like is what will be and that kind of decision and that kind of strength changes things.

The individual with predominant abdominal fat, so to speak, is at greater risk of suffering from the complications of obesity, that is, diabetes. high blood pressure heart attack than an individual who has fat stored elsewhere Sam, do you have any questions? It will be around 5 to 10 minutes. There are health consequences associated with fat deposition specifically within the abdomen. Now we know that there are hormones that are released from these fat cells that could then interact with, for example, your heart or your pancreas and can become harmful to this person, as you can see, where the white is, the body fat has a border thick fat under the skin called subcutaneous fat, this person also has a lot of fat inside the abdomen, you can see all these white spots here inside the abdomen, almost every organ system in the body is negatively affected by having excess body fat and this is excess body fat under the skin, excess body fat inside the abdomen. and excess fat within other organs such as liver tissue, muscle tissue, and heart tissue affects the function of those organs.

We all have fat inside our belly, we have to have some because we actually mobilize that fat every night when we are. fasting while we sleep, that is the fat that is metabolized and converted into the fuel supply to keep our brain happy while we sleep until we eat breakfast. Evolutionarily, men and women have been programmed to deposit fat in two different fat stores that we have. Visceral deposit, which is this fat deposit that is located inside the abdominal wall, is the first fat deposit that is easily mobilized and burns very, very quickly, so men who needed to go out and find the game or the bear or the food for the family that they needed to be able to have a caloric substrate that could burn very very quickly to give them some energy women on the other hand struggle with weight loss in our hips and thighs and the reason why we are programmed That's how we are evolutionarily dependent on the calories in our hips and thighs to provide us with calories to breastfeed or to help sustain a possible famine while we are pregnant, that's all in evolutionary terms in the modern world, of course we are. everyone lives with an excess supply of energy and therefore both men and women store that fat inside the abdomen inside their muscles inside the liver and under the skin and suddenly the system that was elegantly designed now it is no longer necessarily advantageous to lower species.

I want this PE to be a little bit higher than this rib. I work in a surgery department where we do liver transplants and in the last decade we are finding a very scary finding that the reasons we do liver transplants are changing, before it was hepatitis. The reason we did liver transplants, but increasingly a form of therosis in which the liver becomes very stiff, called therosiscryptogenic, has been the reason we are doing more and more liver transplants. This is a lot of fat to overcome, uh, it looks like you. you've done a good job sweeping it away it's not what a normal liver looks like look how pale and pink it is it looks like it's been injected with fat normally it's much redder uh if it doesn't have all these fat globules inside it this is called fatty liver and also It is very thick and difficult to move, so it turns out that cryptogenic curosis is a bad term that defines people who have stiff, diseased livers for reasons we don't fully understand, except that it turns out that almost all of those people have a form very severe obesity and have a form of obesity-related liver change where fat literally gets trapped between liver cells causes inflammation causes stiffness liver disease and may be the main reason why in the United States in the next decades We are doing liver transplants 133% of all children who die at autopsy Studies have non-alcoholic fatty liver disease and 38% of children are obese this is a disease that we have never seen before it did not exist before in adults or children and Now 38% of obese children have it.

The liver is a critical organ in our body due to the important functions it performs and we are now realizing that the liver is very important in the metabolic problems associated with obesity. It is of particular interest to us because we are really increasingly recognizing the central role of the liver in causing or being involved at least in the metabolic complications of obesity that lead to serious long-term outcomes such as diabetes, high levels of fats and lipids in blood and eventually heart disease and death Like I have struggled with my weight my entire life. I have never been a person who found it easy to lose weight since I was 18 and up and about a year ago I weighed a little over 200 pounds after the weight.

I won part of the study, all my vital statistics changed, my cholesterol went up from somewhere in the normal range to 250 or 260 my triglycerides went up my fat when they measured my fat went up about 10%. I think being a person who basically yo-yos I really wanted to have some answers about what it really means and is it okay to still be obese, as I found out in the study, it's not okay, it didn't work well for me, my body or my mind. , you're okay, very good, let's do a full body scan on your body measurement. the fat takes about 10 minutes.

I just need you to hold this liver very still, as you can see here. A brown organ in the center of our body is a metabolic workhorse. It is a 4B organ that has extraordinary metabolic functions. It produces a large amount of proteins that are secreted throughout the body, it also produces fats that are secreted throughout the body and also produces sugar to keep blood sugar level at a normal level and prevent hypoglycemia and fainting when not we have food and if we take two obese people who are the same body size, the same amount of body fat and one of them has a lot of fat in the liver and the other has a normal amount of fat in the liver; the one with a high level of liver fat will have all the metabolic abnormalities associated with cardiovascular disease risk, while the person with normal liver fat will be relatively healthy and metabolically normal OB, that's right palate palmitate, so what We will do today is infuse some molecules, we will use this molecule so that we can understand. how well your body metabolizes fats we want to understand and see try to understand what are the mechanisms that cause this increase in fat in your bloodstream start to press we have been asked to use five one of five fast food restaurants McDonald's Burger King Kentucky Fried Chicken Taco Bell or Pizza Hut, then, and the idea is to add 1,000 calories a day to my normal daily diet to gain weight over the course of about 6 to 8 weeks.

Many studies that have looked at obesity have actually looked at the effect of weight loss on obese people because that's what we're trying to get obese people to do and we know a lot about the metabolic effects of losing weight, let alone. Studies have looked at what the effect of weight gain is on obese people and it really does happen. much more frequent in our population than weight loss, so we decided to do a study that would really evaluate in a rigorous, well-defined and well-controlled way, what is the effect of gaining 5% of body weight in people who are already obese in your metabolic function thanks to CH McDonald I just need a cheeseburger and a small portion of fries and that's it, thank you, it's a hand-made pepperoni pizza, those of us who have ever eaten a whole pizza.

Each piece has 340 calories and 14 G of fatty bean burrito for 550 calories is a lot of calories for a small amount of food. I'm a big eater, so I could probably eat this for lunch and still be hungry. You know, I don't know. I keep these diaries and programs. Every time we eat, I kept a diary for about a month before I started the overfeeding so they knew how many calories I normally ate every day and then they added 1,000 calories to what I'm going to consume. um, I guess maybe hello, um, could I have an eight-piece meal? and 8 grams of fat now that I'm aware of the fact that it's 33 grams of fat.

I don't think I would be that eager to eat chicken. You increase your LDL cholesterol and bad cholesterol by 14%. And you increase your triglycerides. by 33% after gaining this 5% of body weight in such a short period of time, liver fat went from 3.9% to 10.2% and you can see this peak much higher, which represents an increase of 160% in the fat content of the liver, that is 5 pounds. of fat and you literally gained 10 pounds of fat, so you actually gain two of those models of fat with that little 5% weight gain that you made over a period of a couple of months.

Pretty nasty body fat isn't inert dead tissue, it's alive. The tissue that acts is not only the volume, but this tissue has a metabolic function that can cause damage. Now the good news is that it takes the least amount of weight loss to improve your health. A 5% or 10% weight loss can have significant benefits on your metabolism. Health These are microscopic images of the liver of a thin man and an extremely obese man before and after massive weight loss. In this thin person you can see that the liver cells are pink and very tight, while in this very obese person there is a lot of white.

Open Circles, which consists of fat within the liver cells, almost half of this person's liver is composed of fat, but once this obese person loses weight, his liver has completely returned to its normal architecture. Approximately 30% of adults in the United States have fatty liver disease, so this is not a simple issue, this is a very complicated problem that involves a large number of people in the United States. We know that when we start the weight loss process, you will very, very quickly reduce the fat content of your liver. In fact, we found that 48 hours of calorie restriction causes a 25% reduction in liver fat content after the study when starting the weight loss program.

Dr. Client's office worked with me and we recorded everything I ate, talked about it and made a meal plan. um mostly lean meats fruits vegetables and whole grains as soon as I started doing that the weight started coming off and all my stats went back to where they were when I started thank you enjoy I didn't want another burger I didn't want to. I want another piece of fried chicken I didn't want another cookie I didn't want anything Hello, how are you? I found that with just a 5% weight gain a person who has a genetically healthy disposition is also at risk.

So while I've always considered myself a normal person, never that overweight and never that unhealthy, going through all of this taught me that it's almost like you're standing in line waiting to go over the edge, this is a serious medical issue that we need to address. because this excess fat in the liver is causing many of these abnormalities associated with obesity, not only in adults but also in our children, which obesity has done as it moves in this wave through the population. is creating right behind this a wave of chronic diseases obesity causes an enormous amount of health problems there is almost no part of the body that does not damage increases the risk of cancer increases the risk of joint problems our bodies were not designed to carrying twice the size of our body, so there are consequences for our health, that's a fancy way of saying, joints that hurt and joints that hurt hurt more when you carry too much weight.

Obesity negatively affects human brain function the greater the problem. with obesity, the lower the activity of areas of the brain that are extremely important for cognitive operations, the list goes on and on and on, gallbladder disease, liver disease, individually obese people are much more likely to have diabetes, they have diabetes, they can get foot infections that rot and don't heal, requiring amputations, they can develop blindness, they can develop kidney failure, which leaves them tied to a dialysis machine for the rest of their lives, what is this doing to ourselves as a nation? This is really having huge implications for diabetes. follows obesity like night follows day I always thought that when they talked about someone being overweight and that caused this and then I thought they meant being huge, well, we weren't huge, but we were overweight and it just takes a little bit of getting overweight, hurting my heart, starting diabetes, losing a toe, then having to have a bypass on my leg and trying to save it and then losing a foot, okay, oh, maybe I can make it through, okay, I'll just take it out.

I find out how much it can do and what it can't do. I'm coming home yeah, yeah, there you go. Diabetes just means high blood sugar levels Type 1 diabetes means you don't have enough insulin to run your body's functions Type 2 diabetes says I have a lot of insulin but it doesn't work well at the cell level, so the insulin level is high, but the ability to eliminate sugar into fat is lost, therefore, blood sugar increases makes you sick. We understand it much better than in the past. What are the risk factors for developing type 2 diabetes? The one that everyone knows best, of course, is obesity.

Increase weight and it does not have to be that you become obese. It can even be at lower weight levels when you stop being obese. You know, between 2% and 5% overweight, that substantially increases your risk. You were in football and then you went to Boston College. This is my graduation photo from Boston College and I put a little weight on it. This was 30 years ago, so you were. about 42 43 in that picture, yeah, this probably shows how heavy I was, you can see it on my face and it looks like I mean, as we get older and we gain three pounds, well, that's not a lot and it's not.

We don't need to think that we don't have to worry about it, but at the end of 10 years, 3 pounds a year is 30 pounds and that's huge. In some ways, obesity, especially in the abdominal area, makes you resistant to your own insulin, so what happens to your pancreas? Now you're really trying to keep trying to make more to keep your blood glucose from getting too high. Eventually it runs out and the cells that produce the insulin are now sick because of the overstimulation and then diabetes sets in if you look at a study called the nurses' health study where they took nurses over 20 years ago and asked them how much weighed and whether they did not have diabetes at that time.

Then they followed them for about 15 years and for those nurses who had a high body mass index (BMI), which was in the obese category, they had a risk between 50 and 100 times higher than women who were thinner at the time, probably We could have eaten better and we could have done many things. things would be better if we knew that this is leading to diabetes, we don't need to eat steak and roast beef and all those things that we used to like, we don't have fish anymore, it's wonderful, chicken is wonderful, and that's pretty much where We are on its path today, it is the fourth door on the left, so it has some early falls that make it a little difficult for me to see with absolute clarity.

Diabetes affects the vessels and it affects the vessels that supply the eye the vessels that supply the kidney maybe the vessels that supply the nervous system uh those are the small vessels and then it also affects the medium-sized vessels uh that that It supplies circulation to the heart to the brain and the legs then through the periphery now let's go to where the action has been. I'm going to take a look at the foot and this is where the problem has been on the bottom of the foot.here, well, actually on the good side, the peripheral.

The nervous system is what gives you sensations, so people with diabetes who suffer from peripheral neuropathy means they don't feel their toes either, they don't have the same sensation to light touch or temperature and therefore, Your feet are very vulnerable to various types of trauma You don't realize how much can go wrong when you're diabetic In January 2010 it was actually New Year's weekend and you woke up around 3:00 in the morning and his foot was twice the size we called his primary care doctor and he said come in right away. I will have the vascular team set up, which he did in the ER.

They examined his foot and said, "If it's between your life and your foot, your foot is going now. I want to take it." one look at the stump, okay, you can remove it, okay, it comes out fine, and that's one of the problems is that with the diabetic foot, because the circulation is reduced, the bacteria get their way, it looks like a little innocent infection. Sometimes I don't like how this looks, but this one had me absolutely dreading it. There is a risk, which we know, that about 50% of people with an amputation on one side will receive an amputation on the other side within about 5 years.

In the US right now there are about 24 million people with type 2 diabetes in that group, there about 5 or six million are undiagnosed and we know that from having screening programs. where we detected cases of diabetes that people did not know about, something on the order of approximately 19 million with diagnosed Ty 2 diabetes and another approximately 5 million with undiagnosed diabetes, this has slowed us down, but it is not going to keep us slower. I think we have to work in it every day or I think you have a tendency to die and I mean, I have grandchildren, we both have grandchildren that we want to see and things like that, there are too many things in life it's important for us to just give up and, oh, you forgot our picture of wedding, wedding photo, this was in 1968, 68, yes, I give you a kiss, happy anniversary in June, among the health problems facing this country and now increasingly the world, this could be the number. a problem both in terms of human misery, the severity of the disorders that result and the cost of this enormous problem that is only going to get worse: we are living in a kind of damage control mode in which we are waiting for people to get sick hospitalized diabetes stroke cardiovascular disease cancer and then we are investing an enormous amount of money to try to mitigate chronic disease State that is a big drag on our economy someone who is obese costs on average more than $1,400 to care for more per year than someone who is is not obesewith diabetes costs on average $6,600 more to care for per year than someone without diabetes, together obesity costs around $150 billion a year, of those almost $150 billion a year, approximately half of those costs are paid with funds public Medicaid and Medicare if you look at the Health costs are skyrocketing in the United States and we have no solutions for whatever competitive position we have in the world today.

They will even be weakened by this overweight problem that we have. We are going to have a productivity crisis. If we have an employer-employee crisis, people will say: I'm not sure I can manage my business system if I don't have FIT employees. One of the things that companies are doing is increasing premiums for obese people, even North Carolina state employees, if they are obese, now pay higher rates. Alabama employees pay higher rates if they are obese. Private sector companies are doing similar things, but in fact, some say you know what it is too. expensive and are moving their sites to India or China for cheaper labor and basically offloading the cost entirely.

What kind of nation can live without a healthy workforce? So what diabetes and obesity are doing to this nation is crippling the workforce, but beyond that, it cripples families, individuals and communities, 27% of young people trying to enter the military They can't do it because they weigh too much, which affects the productivity of not only the military, but think about that effect for police forces and fire departments. workplaces in the rest of the country, what is this doing to ourselves as a nation? This is really having huge implications. I gained about 150 pounds. I don't want to live like this anymore, please get up or do it again if I want to.

I can do almost anything. Why can't I solve this problem? What can I do about it? I need to find something that works for me when it comes to combating obesity. What is the best thing I can do for myself and my family? Soft drinks and other sugary drinks are the number one source of calories in our diet. In reality, it's not just about what we eat, but what eats you. We can separate environmental factors from genetic factors. To lose weight for overweight people. or obese and people who already have diabetes doesn't mean the game is over, yes you have to start somewhere, physical activity really is the Wonder Dragon, it's a lot of hard work, it's all worth it, the reward is huge, just I am an ordinary person.

A person who does a lot of very small and ordinary things that together are extraordinary.