“And put a knife to thy throat, if thou be a man given to appetite.” Proverbs 23:2
“The benefit derived from food does not depend so much on the quantity eaten as on its thorough digestion.” –Counsels on Diet and Foods, p. 107
“The Lord has instructed me that as a general rule, we place too much food in the stomach. Many make themselves uncomfortable by overeating, and sickness is often the result. The Lord did not bring this punishment on them. They brought it on themselves; and God desires them to realize that pain is the result of transgression.” –Counsels on Diet and Foods, p. 136
Last month we learned that almost 2 billion people, or 38% of the population of the world is overweight, and of those, 650 million, or 32% of overweight people are obese. Overall, this amounts to 12% of the world’s population. The range of obese individuals in specific countries varies, but the numbers in every country is on the rise. The percentages of overweight and obese people are growing year by year, and the impact that obesity has on the health of the world’s population is also increasing.
Evidence clearly shows that people who are obese have more health problems than normal weight people. Therefore, it would be logical to assume that prevention of obesity can reduce the risk of health problems, and that if a person is obese, if weight can be reduced, this will have a positive impact on the health of the individual. This month, we will explore the effects of obesity on one’s health, and how significant this impact is. Not only is there an impact on one’s physical health, but obesity also has consequences related to a person’s social, economic, and psychological wellbeing. As more children are being diagnosed as being obese, the health effects of obesity are starting at a much younger age, and disability and sickness, as well as other aspects of obesity become a lifelong problem.
Because of the health impacts of obesity, prevention of overweight and obesity is as important as treatment. Prevention includes primary prevention of overweight or obesity itself. Secondary prevention includes the avoidance of regaining weight following weight loss, and the avoidance of further weight increases in obese individuals unable to lose weight. Both environmental and lifestyle factors contribute to individuals being obese in childhood or to gaining weight progressively during adulthood. These factors are further influenced by the genetic makeup of individuals, which are unavoidable. There has been little research done on how governments and health systems can influence these factors to prevent obesity; however, with the increase in numbers of obese children and adults, efforts to understand the genetic, behavioural and environmental factors that contribute to obesity and strategies to prevent obesity is being recognized as critical.
OVERALL MORTALITY RATES
Last month, we learned that BMI numbers are an effective guide in determining if an individual falls within the range of underweight, normal weight, overweight, or obese. In the majority of studies looking at the health effects of weight, the mortality (death) rates begin to increase with BMIs over 25 (considered overweight). This increase is modest until a BMI of 30 is reached (considered obese), and then mortality rates from all causes increase 50-100% above those with BMIs in the normal range (21–25). These numbers reflect the severe consequences of obesity on one’s overall risk of death from any illness.
Besides the general increase in death from all causes, certain health conditions are more significantly prevalent with increases in weight. Many of these health conditions are also contributing factors for other health conditions, and the interplay between them compound the severity of the effects on health. For example, if someone has diabetes, they are at a higher risk of heart disease. If someone has heart disease, they are at a higher risk of strokes, and if someone has high blood pressure, they are at a higher risk of both heart disease and strokes. However, all these health conditions also have their own complications and effects on one’s health. Let us look at the main health conditions that are caused by or worsened by obesity and the challenges they present.
“The quantity of food eaten does not determine the benefit received. Many, even among Seventh-day Adventists, eat too freely. Their health would be much better if they ate less. When too much food is eaten, the stomach is overburdened, and is unable to perform its proper functions. The result is that the digestive organs are disordered. If those who have brought themselves to this condition would eat proper food, and only about half as much as they have been in the habit of eating, their digestive organs would recover.” –Manuscript Releases, vol. 3, p. 326
HIGH BLOOD PRESSURE
Blood pressure measurements are calculated as the pressure in the heart when it is pumping blood to the body (systolic blood pressure), and the pressure in the heart when it is at rest in between pumps or beats (diastolic blood pressure). Therefore, blood pressure values have two numbers, separated by a forward slash, e.g. 120/80. The pressure in the heart when it is pumping is higher than when it is at rest, and is the higher number of the two. High blood pressure is defined as having systolic blood pressure ≥ 140 mm Hg, or diastolic blood pressure ≥ 90.
Prevalence of high blood pressure increases progressively with higher BMI levels in both men and women. In individuals with a BMI greater than 30, 38% of men and 32% of women have high blood pressure. This is an increase from 18% of men and 16% of women who have high blood pressure with a normal BMI. The rates of having high blood pressure double once someone is obese. Individuals who are obese tend to retain sodium (salt) and this puts increased pressure on the blood vessels in every part of the body. When high blood pressure weakens the blood vessels of the heart and brain, it increases the risk of heart attacks and strokes; the risk increases by approximately 13% with increased blood pressure. Dementia risk also increases because the damaged blood vessels cannot carry proper nutrients to brain cells. High blood pressure also can damage the blood vessels in the kidneys, and is the leading cause of kidney failure.
Tiny, delicate blood vessels supply blood to your eyes. Like other vessels, they, too, can be damaged by high blood pressure. Damage to the eye blood vessels is called retinopathy. This condition can lead to bleeding in the eye, blurred vision, and eventually, complete loss of vision. The optic nerve can be damaged, which leads to vision loss. If you have diabetes, the risk is even higher.
Not only are the blood vessels of the heart affected, but the function of the heart muscle is also affected. High blood pressure forces your heart to work harder than necessary in order to pump blood to the rest of your body. This causes the left ventricle of the heart to enlarge and become stiff. These changes limit the ventricle’s ability to pump blood to your body. Over time, the strain on your heart caused by high blood pressure can cause your heart muscle to weaken and work less efficiently. Eventually, your heart becomes overwhelmed and begins to wear out and fail.
TYPE 2 DIABETES
According to the Canadian Journal of Diabetes, “it is now widely accepted that the obesity epidemic continues to be the principal driver for the rising global prevalence of type 2 diabetes.” Diabetes is one disease that even normal weight individuals have a higher risk of contracting, starting when BMIs rise within the normal range between 22–25. With every point above 22, the risk of diabetes increases by 25%. Obesity is believed to account for 80-85% of the risk of developing type 2 diabetes, while recent research suggests that obese people are up to 80 times more likely to develop type 2 diabetes than those with a BMI of less than 22.
In high risk populations, Type 2 diabetes has been found in individuals as young as 18 years old with weight increases, even if within the normal range. A recent study from the United States indicates that 27% of new cases of diabetes were attributed to a weight gain of 5 kg (11 pounds) or more during adulthood. At least a third of people in the U.S. will develop Type 2 diabetes in their lifetime. Type 2 diabetes differs from Type 1 in several important ways. Type 1 diabetes is often hereditary and unpreventable. It is a disease that is caused by the immune system attacking and destroying the cells in the pancreas that produce insulin. The body then does not produce insulin, so the person needs supplemental insulin from the time they are diagnosed with the disease.
Type 2 diabetes is much more common than Type 1. For every person with type 1 diabetes, 20 people will have Type 2 diabetes. Type 2 can be hereditary, but excess
weight, a lack of exercise and an unhealthy diet increase the risk. Abdominal obesity, or a waist size of over 40 for men, and over 35 for women, is a major risk factor for Type 2 diabetes. Studies suggest that abdominal fat causes fat cells to release “pro-inflammatory” chemicals, which can make the body less sensitive to the insulin it produces. Cells become resistant to the effects of insulin. This is called insulin resistance. If blood glucose (sugar) is always high, the cells will be overexposed to insulin. They become less responsive or unresponsive to insulin. In time, the body stops producing enough insulin, and the body can no longer use glucose effectively. This means the cells cannot absorb glucose, and glucose builds up in the blood. The high sugar levels in the blood vessels causes a majority of the damage from diabetes. Damage from diabetes can be extensive and affect many body systems.
One-third of people who have diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, sometimes skin problems are the first sign that a person has diabetes. Some of these problems are skin conditions anyone can have, but people with diabetes get more easily. These include bacterial infections, fungal infections and itching.
Because the small blood vessels are impacted significantly by high blood sugar, any area with small blood vessels are at risk for damage. These include the small blood vessels of the kidneys, eyes, and nerves, affecting the blood supply to these areas. In the eyes, this damage can lead to cataracts and retinopathy; both can cause loss of vision. Kidneys are vital in cleaning the blood. Kidney disease can result from damaged blood vessels, leading to impaired kidney function or complete failure, necessitating dialysis or a kidney transplant. Damage to the nerve cells from diabetes is called diabetic neuropathy. It mostly affects the nerves going to the hands and feet. People may lose sensation in their extremities; they can also experience pain, weakness, or tingling. One serious complication of diabetic neuropathy in the feet is that people may not realize when they have a wound on their foot. The wound can become infected, the infection can spread, and left untreated, the foot may need to be amputated to keep the infection from spreading further. Hearing loss and imbalance can also occur of the small blood vessels of the ear are affected.
People with diabetes are more susceptible to developing infections, as high blood sugar levels can weaken an individual’s immune system. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the risk of infections. Yeast infections especially are more prevalent in diabetes.
High blood sugar can also affect the large blood vessels of the body, causing plaque to build up in the arteries, potentially leading to a heart attack, stroke, blockage in the legs, and erectile dysfunction. Another complication of diabetes is the development of dementia and Alzheimer’s, due to reduced blood flow to the brain. In regards to cholesterol levels, diabetes tends to lower “good” cholesterol levels and raise triglyceride and “bad” cholesterol levels, which increases the risk for heart disease and stroke.
Complications from diabetes are compounded if someone also has high blood pressure, as they both affect the health of the blood vessels. These complications can be avoided if good blood sugar control is maintained. According to studies, a 5% reduction in body weight followed up by regular moderate intensity exercise could reduce Type 2 diabetes risk by more than 50%.
Find more resources on type 2 diabetes at www.jenreviews.com/diabetes/
CORONARY HEART DISEASE
Coronary heart disease is when the waxy substance known as plaque builds up in the arteries of the heart, which supply blood to the heart muscle. Until recently, the relationship between obesity and heart disease was considered indirect, in that the risk of heart disease associated with obesity was usually caused by another condition such as high blood pressure, high cholesterol, or diabetes. Studies now prove that obesity is an independent predictor of plaque buildup in the arteries of the heart, and especially fat in the abdominal area. Abnormalities in the function of the left ventricular of the heart also occur in obesity, in the absence of high blood pressure. Changes in the right side of the heart also occur in obesity, related to sleep apnea and the pressure this puts on the pulmonary (lung) artery, subsequently enlarging the right ventricle. Sudden death from heart attacks is thought to be related to these abnormalities. Even though plaque buildup in arteries of the heart can occur with normal cholesterol levels, obesity can also raise total cholesterol levels, LDL (bad) cholesterol, and triglycerides which, in turn, increases the risk of plaque buildup.
STROKES
Strokes are ranked as the fifth leading cause of death in the United States, with nearly 800,000 people dying every year. Similar to diabetes, obesity increases the risk of stroke due to inflammatory chemicals released by excess fatty tissue. This can lead to reductions in blood flow to the brain and an increased risk of blockage of blood vessels by clots, both of which can cause strokes. Risk levels rose with increases in the BMI value, waist circumference, or waist-to-hip ratio. The risk factor was greater for ischemic stroke (stroke due to lack of blood flow, rather than due to clotting).
Stroke risk increases also if an individual has other health conditions. High blood pressure is the leading cause of strokes. Diabetes, heart disease, and sleep breathing disorders also increase the risk of strokes.
GALLBLADDER DISEASE
Findings show that for every point increase in BMI, the risk of gallbladder disease increases by seven percent, therefore obese individuals are more likely to develop gallstones. For women, obesity is an even stronger risk factor for developing gallstones. Studies show that if you are obese, your body produces higher levels of cholesterol. Bile, which is stored in the gallbladder then contains more cholesterol than your body can dissolve. When this happens, gallstones can form from the undissolved cholesterol. Also, gallbladders of obese individuals may not empty normally or completely, increasing the chance of developing gallstones. Especially if you have excess fat around your stomach you may be at greater risk for developing gallstones than people who carry excess fat mainly around their hip and thigh areas. Recent studies show that obese children also have gallstones, which is a surprise finding, as gallstone disease is typically regarded as an adult disorder. However, the epidemic of obese children is recent. Doctors need to be aware to be alert for gallstone symptoms in their pediatric patients.
CONCLUSION
As this article has shown, there are many health conditions that obese people are at a higher risk of contracting, and the impact on one’s overall health is severe, with many of these conditions affecting multiple body systems. Most of the aforementioned health conditions also increase an individual’s risk of dying at a younger age than a normal weight person, with quality of life also being affected. Obesity is a leading risk factor for the increase in an individual’s “years of sickness” during one’s lifetime. Unfortunately this is not the end of the list of the health conditions that individuals with obesity are at a higher risk of developing. We will continue to explore and discuss other health risks next month. With the increases in death and sickness caused by obesity, preventing people from becoming overweight and obese is of critical importance, if we are to improve the overall health of the world’s population.
Gluttony is sin
“It is sin to be intemperate in the quantity of food eaten, even if the quality is unobjectionable. Many feel that if they do not eat meat and the grosser articles of food, they may eat of simple food until they cannot well eat more. This is a mistake. Many professed health reformers are nothing less than gluttons. They lay upon the digestive organs so great a burden that the vitality of the system is exhausted in the effort to dispose of it. It also has a depressing influence upon the intellect, for the brain nerve power is called upon to assist the stomach in its work. Overeating, even of the simplest food, benumbs the sensitive nerves of the brain and weakens its vitality. Overeating has a worse effect upon the system than overworking; the energies of the soul are more effectually prostrated by intemperate eating than by intemperate working.
“The digestive organs should never be burdened with a quantity or quality of food which it will tax the system to appropriate. All that is taken into the stomach, above what the system can use to convert into good blood, clogs the machinery, for it cannot be made into either flesh or blood, and its presence burdens the liver and produces a morbid condition of the system. The stomach is overworked in its efforts to dispose of it, and then there is a sense of languor which is interpreted to mean hunger, and without allowing the digestive organs time to rest from their severe labor, to recruit their energies, another immoderate amount is taken into the stomach, to set the weary machinery again in motion. The system receives less nourishment from too great a quantity of food, even of the right quality, than from a moderate quantity taken at regular periods. . . .
“It is impossible to have clear conceptions of eternal things unless the mind is trained to dwell upon elevated themes. All the passions must be brought under perfect subjection to the moral powers. When men and women profess strong faith and earnest spirituality, I know that their profession is false if they have not brought all their passions under control. God requires this. The reason why such spiritual darkness prevails is that the mind is content to take a low level and is not directed upward in a pure, holy, and heavenly channel.” –Counsels on Health, p. 160–161
NEXT MONTH: HEALTH EFFECTS OF OBESITY, PART 2