{"id":1975,"date":"2013-07-25T21:56:52","date_gmt":"2013-07-25T21:56:52","guid":{"rendered":"http:\/\/skinnygeneproject.dreamhosters.com\/?p=1975"},"modified":"2013-07-25T21:56:52","modified_gmt":"2013-07-25T21:56:52","slug":"ted-is-obesity-problem","status":"publish","type":"post","link":"https:\/\/www.skinnygeneproject.org\/ted-is-obesity-problem\/","title":{"rendered":"Is the Obesity the Problem"},"content":{"rendered":"<p>We enjoy posting other people&#8217;s perspectives on obesity, prediabetes, and type 2 diabetes. We hope that by sharing these perspectives, \u00a0it will help all of us have a clearer picture of what we&#8217;re truly fighting.<\/p>\n<p>If you&#8217;ve watched any of the TED videos, you know that they are generally very thought provoking speeches that often challenge conventional thinking. Well, this video is no different. The question is simple&#8230;&#8221;<strong><em>Is obesity the problem&#8221;<\/em><\/strong>\u00a0; the answer is anything but.<\/p>\n<p>Simply put, this video is not just thought provoking, it&#8217;s a great story. What begins as a snap judgement ends as a tearful plea for forgiveness. And in-between the two are a series of statements that really question how we view obesity and diabetes, and treat those with this very complicated metabolic disease.<\/p>\n<p>Although we may not completely agree with all statements and conclusions made in this video, there are a few questions and points he raised that we absolutely stand behind. The 4 comments and statements below justify and reiterate why our work, as a\u00a0non-profit\u00a0diabetes prevention organization, in the community is still so desperately needed.<\/p>\n<ol>\n<li><span style=\"line-height: 13px;\">There isn&#8217;t a set dietary prescription for being insulin resistant and preventing diabetes.<br \/>\n<\/span><\/li>\n<li>Can people make the necessary changes in their diets\u00a0in a way that&#8217;s safe and practical to implement? How can we move their behavior in that direction\u00a0so that it becomes more the default\u00a0rather than the exception?<\/li>\n<li>Just because you know what to do doesn&#8217;t mean\u00a0you&#8217;re always going to do it.\u00a0Sometimes we have to put cues around people\u00a0to make it easier.<\/li>\n<li>We can&#8217;t keep blaming our overweight and diabetic patients.\u00a0Most of them actually want to do the right thing,\u00a0but they have to know what that is,\u00a0and it&#8217;s got to work.<\/li>\n<\/ol>\n<p><em>What points did he make that stood out the most to you?<\/em><\/p>\n<p><iframe loading=\"lazy\" src=\"http:\/\/embed.ted.com\/talks\/peter_attia_what_if_we_re_wrong_about_diabetes.html\" height=\"315\" width=\"560\" allowfullscreen=\"\" frameborder=\"0\" scrolling=\"no\"><\/iframe><\/p>\n<p>TRANSCRIPT<br \/>\nI&#8217;ll never forget that day\u00a0back in the spring of 2006.\u00a0I was a surgical resident\u00a0at The Johns Hopkins Hospital,\u00a0taking emergency call.\u00a0I got paged by the E.R. around 2 in the morning\u00a0to come and see a woman with a diabetic ulcer\u00a0on her foot.\u00a0I can still remember sort of that smell of rotting flesh\u00a0as I pulled the curtain back to see her.\u00a0And everybody there agreed this woman was very sick\u00a0and she needed to be in the hospital.\u00a0That wasn&#8217;t being asked.The question that was being asked of me was a different one,\u00a0which was, did she also need an amputation?<\/p>\n<p>Now, looking back on that night,\u00a0I&#8217;d love so desperately to believe that I treated that womanon that night with the same empathy and compassion\u00a0I&#8217;d shown the 27-year-old newlywedwho came to the E.R. three nights earlier\u00a0with lower back pain\u00a0that turned out to be advanced pancreatic cancer.\u00a0In her case, I knew there was nothing I could do\u00a0that was actually going to save her life.\u00a0The cancer was too advanced.\u00a0But I was committed to making sure that\u00a0I could do anything possible to make her stay\u00a0more comfortable. I brought her a warm blanket\u00a0and a cup of a coffee.\u00a0I brought some for her parents.\u00a0But more importantly, see, I passed no judgment on her,\u00a0because obviously she had done nothing\u00a0to bring this on herself.\u00a0So why was it that, just a few nights later,\u00a0as I stood in that same E.R. and determined\u00a0that my diabetic patient did indeed need an amputation,\u00a0why did I hold her in such bitter contempt?<\/p>\n<p>You see, unlike the woman the night before,\u00a0this woman had type 2 diabetes.\u00a0She was fat.And we all know that&#8217;s from eating too much\u00a0and not exercising enough, right?\u00a0I mean, how hard can it be?\u00a0As I looked down at her in the bed, I thought to myself,\u00a0if you just tried caring even a little bit,\u00a0you wouldn&#8217;t be in this situation at this moment\u00a0with some doctor you&#8217;ve never met\u00a0about to amputate your foot.<\/p>\n<p>Why did I feel justified in judging her?\u00a0I&#8217;d like to say I don&#8217;t know.\u00a0But I actually do.\u00a0You see, in the hubris of my youth,\u00a0I thought I had her all figured out.\u00a0She ate too much. She got unlucky.\u00a0She got diabetes. Case closed.<\/p>\n<p>Ironically, at that time in my life,\u00a0I was also doing cancer research,\u00a0immune-based therapies for melanoma, to be specific,\u00a0and in that world I was actually taught to question everything,to challenge all assumptions\u00a0and hold them to the highest possible scientific standards.\u00a0Yet when it came to a disease like diabetes\u00a0that kills Americans eight times more frequently than melanoma,\u00a0I never once questioned the conventional wisdom.\u00a0I actually just assmed the pathologic sequence of events\u00a0was settled science.<\/p>\n<p>Three years later, I found out how wrong I was.\u00a0But this time, I was the patient.\u00a0Despite exercising three or four hours every single day,\u00a0and following the food pyramid to the letter,I&#8217;d gained a lot of weight and developed something\u00a0called metabolic syndrome.\u00a0Some of you may have heard of this.\u00a0I had become insulin-resistant.<\/p>\n<p>You can think of insulin as this master hormone\u00a0that controls what our body does with the foods we eat,\u00a0whether we burn it or store it.\u00a0This is called fuel partitioning in the lingo.\u00a0Now failure to produce enough insulin is incompatible with life.\u00a0And insulin resistance, as its name suggests,\u00a0is when your cells get increasingly resistant\u00a0to the effect of insulin trying to do its job.\u00a0Once you&#8217;re insulin-resistant,\u00a0you&#8217;re on your way to getting diabetes,\u00a0which is what happens when your pancreas\u00a0can&#8217;t keep up with the resistance and make enough insulin.\u00a0Now your blood sugar levels start to rise,\u00a0and an entire cascade of pathologic eventssort of spirals out of control that can lead to heart disease,\u00a0cancer, even Alzheimer&#8217;s disease,\u00a0and amputations, just like that woman a few years earlier.<\/p>\n<p>With that scare, I got busy changing my diet radically,\u00a0adding and subtracting things most of you would find\u00a0almost assuredly shocking.\u00a0I did this and lost 40 pounds, weirdly while exercising less.\u00a0I, as you can see, I guess I&#8217;m not overweight anymore.\u00a0More importantly, I don&#8217;t have insulin resistance.<\/p>\n<p>But most important, I was left\u00a0with these three burning questions that wouldn&#8217;t go away:How did this happen to me if I was supposedly\u00a0doing everything right?\u00a0If the conventional wisdom about nutrition had failed me,\u00a0was it possible it was failing someone else?\u00a0And underlying these questions,\u00a0I became almost maniacally obsessed\u00a0in trying to understand the real relationship\u00a0between obesity and insulin resistance.<\/p>\n<p>Now, most researchers believe obesity\u00a0is the cause of insulin resistance.\u00a0Logically, then, if you want to treat insulin resistance,\u00a0you get people to lose weight, right?\u00a0You treat the obesity.\u00a0But what if we have it backwards?\u00a0What if obesity isn&#8217;t the cause of insulin resistance at all?\u00a0In fact, what if it&#8217;s a symptom of a much deeper problem,\u00a0the tip of a proverbial iceberg?\u00a0I know it sounds crazy because we&#8217;re obviously in the midst\u00a0of an obesity epidemic, but hear me out.\u00a0What if obesity is a coping mechanism\u00a0for a far more sinister problem going on\u00a0underneath the cell?\u00a0I&#8217;m not suggesting that obesity is benign,\u00a0but what I am suggesting is it may be the lesser\u00a0of two metabolic evils.<\/p>\n<p>You can think of insulin resistance as the reduced capacity\u00a0of ourselves to partition fuel,\u00a0as I alluded to a moment ago,\u00a0taking those calories that we take in\u00a0and burning some appropriately and storing some appropriately.\u00a0When we become insulin-resistant,\u00a0the homeostasis in that balance deviates from this state.\u00a0So now, when insulin says to a cell,\u00a0I want you to burn more energy\u00a0than the cell considers safe, the cell, in effect, says,\u00a0&#8220;No thanks, I&#8217;d actually rather store this energy.&#8221;\u00a0And because fat cells are actually missing most of\u00a0the complex cellular machinery found in other cells,\u00a0it&#8217;s probably the safest place to store it.\u00a0So for many of us, about 75 million Americans,\u00a0the appropriate response to insulin resistance\u00a0may actually be to store it as fat, not the reverse,\u00a0getting insulin resistance in response to getting fat.<\/p>\n<p>This is a really subtle distinction,\u00a0but the implication could be profound.\u00a0Consider the following analogy:\u00a0Think of the bruise you get on your shin\u00a0when you inadvertently bang your leg into the coffee table.\u00a0Sure, the bruise hurts like hell, and you almost certainly\u00a0don&#8217;t like the discolored look, but we all know\u00a0the bruise per se is not the problem.\u00a0In fact, it&#8217;s the opposite. It&#8217;s a healthy response to the trauma,\u00a0all of those immune cells rushing to the site of the injury\u00a0to salvage cellular debris and prevent the spread\u00a0of infection to elsewhere in the body.\u00a0Now, imagine we thought bruises were the problem,\u00a0and we evolved a giant medical establishment\u00a0and a culture around treating bruises:\u00a0masking creams, painkillers, you name it,\u00a0all the while ignoring the fact that people\u00a0are still banging their shins into coffee tables.How much better would we be if we treated the cause &#8212;\u00a0telling people to pay attention\u00a0when they walk through the living room &#8212;\u00a0rather than the effect?\u00a0Getting the cause and the effect right\u00a0makes all the difference in the world.\u00a0Getting it wrong, and the pharmaceutical industrycan still do very well for its shareholders\u00a0but nothing improves for the people with bruised shins.\u00a0Cause and effect.<\/p>\n<p>So what I&#8217;m suggesting is\u00a0maybe we have the cause and effect wrong\u00a0on obesity and insulin resistance.\u00a0Maybe we should be asking ourselves,\u00a0is it possible that insulin resistance causes weight gain\u00a0and the diseases associated with obesity,\u00a0at least in most people?What if being obese is just a metabolic response\u00a0to something much more threatening,\u00a0an underlying epidemic,\u00a0the one we ought to be worried about?<\/p>\n<p>Let&#8217;s look at some suggestive facts.\u00a0We know that 30 million obese Americans\u00a0in the United States don&#8217;t have insulin resistance.\u00a0And by the way, they don&#8217;t appear to be at anygreater risk of disease than lean people.\u00a0Conversely, we know that six million lean people\u00a0in the United States are insulin-resistant,\u00a0and by the way, they appear to be at even greater risk\u00a0for those metabolic disease I mentioned a moment ago\u00a0than their obese counterparts.Now I don&#8217;t know why, but it might be because,\u00a0in their case, their cells haven&#8217;t actually figured out\u00a0the right thing to do with that excess energy.\u00a0So if you can be obese and not have insulin resistance,\u00a0and you can be lean and have it,\u00a0this suggests that obesity may just be a proxy\u00a0for what&#8217;s going on.<\/p>\n<p>So what if we&#8217;re fighting the wrong war,\u00a0fighting obesity rather than insulin resistance?\u00a0Even worse, what if blaming the obese\u00a0means we&#8217;re blaming the victims?\u00a0What if some of our fundamental ideas about obesity\u00a0are just wrong?<\/p>\n<p>Personally, I can&#8217;t afford the luxury of arrogance anymore,\u00a0let alone the luxury of certainty.\u00a0I have my own ideas about what could be at the heart of this,\u00a0but I&#8217;m wide open to others.Now, my hypothesis, because everybody always asks me,\u00a0is this.\u00a0If you ask yourself, what&#8217;s a cell trying to protect itself from\u00a0when it becomes insulin resistant,\u00a0the answer probably isn&#8217;t too much food.\u00a0It&#8217;s more likely too much glucose: blood sugar.\u00a0Now, we know that refined grains and starches\u00a0elevate your blood sugar in the short run,\u00a0and there&#8217;s even reason to believe that sugar\u00a0may lead to insulin resistance directly.\u00a0So if you put these physiological processes to work,\u00a0I&#8217;d hypothesize that it might be our increased intake\u00a0of refined grains, sugars and starches that&#8217;s driving\u00a0this epidemic of obesity and diabetes,\u00a0but through insulin resistance,\u00a0you see, and not necessarily through just overeating and under-exercising.<\/p>\n<p>When I lost my 40 pounds a few years ago,\u00a0I did it simply by restricting those things,\u00a0which admittedly suggests I have a bias\u00a0based on my personal experience.\u00a0But that doesn&#8217;t mean my bias is wrong,\u00a0and most important, all of this can be tested scientifically.\u00a0But step one is accepting the possibility\u00a0that our current beliefs about obesity,\u00a0diabetes and insulin resistance could be wrong\u00a0and therefore must be tested.\u00a0I&#8217;m betting my career on this.Today, I devote all of my time to working on this problem,\u00a0and I&#8217;ll go wherever the science takes me.\u00a0I&#8217;ve decided that what I can&#8217;t and won&#8217;t do anymore\u00a0is pretend I have the answers when I don&#8217;t.\u00a0I&#8217;ve been humbled enough by all I don&#8217;t know.<\/p>\n<p>For the past year, I&#8217;ve been fortunate enough\u00a0to work on this problem with the most amazing team\u00a0of diabetes and obesity researchers in the country,\u00a0and the best part is,\u00a0just like Abraham Lincoln surrounded himself with a team of rivals,\u00a0we&#8217;ve done the same thing.\u00a0We&#8217;ve recruited a team of scientific rivals,\u00a0the best and brightest who all have different hypothesesfor what&#8217;s at the heart of this epidemic.\u00a0Some think it&#8217;s too many calories consumed.\u00a0Others think it&#8217;s too much dietary fat.\u00a0Others think it&#8217;s too many refined grains and starches.\u00a0But this team of multi-disciplinary,\u00a0highly skeptical and exceedingly talented researchers\u00a0do agree on two things.\u00a0First, this problem is just simply too important\u00a0to continue ignoring because we think we know the answer.\u00a0And two, if we&#8217;re willing to be wrong,\u00a0if we&#8217;re willing to challenge the conventional wisdom\u00a0with the best experiments science can offer,\u00a0we can solve this problem.<\/p>\n<p>I know it&#8217;s tempting to want an answer right now,\u00a0some form of action or policy, some dietary prescription &#8212;\u00a0eat this, not that \u2014\u00a0but if we want to get it right,\u00a0we&#8217;re going to have to do much more rigorous science\u00a0before we can write that prescription.<\/p>\n<p>Briefly, to address this, our research program\u00a0is focused around three meta-themes, or questions.\u00a0First, how do the various foods we consume\u00a0impact our metabolism, hormones and enzymes,\u00a0and through what nuanced molecular mechanisms?\u00a0Second, based on these insights,\u00a0can people make the necessary changes in their diets\u00a0in a way that&#8217;s safe and practical to implement?\u00a0And finally, once we identify what safe\u00a0and practical changes people can make to their diet,\u00a0how can we move their behavior in that direction\u00a0so that it becomes more the default\u00a0rather than the exception?\u00a0Just because you know what to do doesn&#8217;t mean\u00a0you&#8217;re always going to do it.\u00a0Sometimes we have to put cues around people\u00a0to make it easier, and believe it or not,\u00a0that can be studied scientifically.<\/p>\n<p>I don&#8217;t know how this journey is going to end,\u00a0but this much seems clear to me, at least.We can&#8217;t keep blaming our overweight and diabetic patients\u00a0like I did.\u00a0Most of them actually want to do the right thing,\u00a0but they have to know what that is,\u00a0and it&#8217;s got to work.\u00a0I dream of a day when our patients can\u00a0shed their excess pounds\u00a0and cure themselves of insulin resistance,\u00a0because as medical professionals,\u00a0we&#8217;ve shed our excess mental baggage\u00a0and cured ourselves of new idea resistance sufficiently\u00a0to go back to our original ideals:\u00a0open minds, the courage to throw out yesterday&#8217;s ideas\u00a0when they don&#8217;t appear to be working,and the understanding that scientific truth isn&#8217;t final,\u00a0but constantly evolving.\u00a0Staying true to that path will be better for our patients\u00a0and better for science.\u00a0If obesity is nothing more than a proxy\u00a0for metabolic illness,\u00a0what good does it do us to punish those with the proxy?<\/p>\n<p>Sometimes I think back to that night in the E.R.\u00a0seven years ago.\u00a0I wish I could speak with that woman again.\u00a0I&#8217;d like to tell her how sorry I am.\u00a0I&#8217;d say, as a doctor, I delivered\u00a0the best clinical care I could,\u00a0but as a human being,\u00a0I let you down.\u00a0You didn&#8217;t need my judgment and my contempt.\u00a0You needed my empathy and compassion,\u00a0and above all else, you needed a doctor\u00a0who was willing to consider\u00a0maybe you didn&#8217;t let the system down.\u00a0Maybe the system, of which I was a part,\u00a0was letting you down.\u00a0If you&#8217;re watching this now,\u00a0I hope you can forgive me.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>We enjoy posting other people&#8217;s perspectives on obesity, prediabetes, and type 2 diabetes. We hope that by sharing these perspectives, \u00a0it will help all of us have a clearer picture of what we&#8217;re truly fighting. If you&#8217;ve watched any of the TED videos, you know that they are generally very thought provoking speeches that often&#8230; <\/p>\n<div class=\"clear\"><\/div>\n<p><a href=\"https:\/\/www.skinnygeneproject.org\/ted-is-obesity-problem\/\" class=\"excerpt-read-more\">Read More<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[264,1],"tags":[471,1118,73,74,201,435,1337,313,1338,81,82,83,446],"jetpack_publicize_connections":[],"acf":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p90Iz0-vR","jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/posts\/1975"}],"collection":[{"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/comments?post=1975"}],"version-history":[{"count":0,"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/posts\/1975\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/media?parent=1975"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/categories?post=1975"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.skinnygeneproject.org\/wp-json\/wp\/v2\/tags?post=1975"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}