The fat we see when we look in the mirror is the only fat we need to concern ourselves with. Wrong. As British film producer and director, Jacques Peretti, learned while he investigated the cause of the world-wide obesity epidemic for the BBC documentary, “The Men Who Made Us Fat.” Peretti submitted himself to a new kind of MRI – the kind of MRI that scans a body for fat distribution. Fat cells will appear a bright white in the rendered scans, and Peretti had an unusually high amount of visceral fat for a man of his seemingly good health level. Visceral fat is found mostly in the abdominal region, and it is literally what surrounds our organs. Subcutaneous fat, or the fat we all focus on when we look in the mirror, was at the proper level for Peretti’s age and height. So what was causing the high level of fat in his body?
Peretti takes it easy on us as a society. He speculates that it is not entirely our fault that we are unable to adjust to the overly accessible variety of food. Ten thousand years ago, while we were still hunters and gatherers, our bodies began to crave high-caloric sustenance to balance out the times of extreme starvation. Our genetics have not changed, but our environment is drastically different.
Peretti examines the factors that set the stage for such an enormous shift in our eating habits, and consequential collective weight gain. With more than one-third of US citizens obese, a dramatic factor had to be introduced into our food culture. According to Peretti, we are no greedier than we were before – so what was it? In the 1970s, high-fructose corn syrup was introduced into the American diet as a way to make use of the surplus corn being produced by America’s farmers. The food industry has put this sweetener to good use. It is in almost all processed food and has been linked to not only obesity, but to other chronic illness. It is also speculated to be addictive. The neuron-science is explained in the documentary.
High-fructose corn syrup has provided a cheap and endlessly supplied alternative to cane sugar. The food industry saw an opportunity to fill a literal gap in our food habits: the time between meals. Snacking was introduced, and people fell in love. Ruining your appetite was no longer a concern, as most snack foods being marketed were void of nutrition and did not satiate hunger; they were simply “just enough.”
“The Men Who Made Us Fat” provides wonderful insight into one of the most serious and deadly diseases we face. Perhaps knowing how we got here is the first and most crucial step in sparing future generations the physical, financial and fatal consequences of the obesity epidemic.
The late comedian Patrice O’Neal is now famous for saying, “My doctor has told me that if I don’t lose weight, it will kill me. That’s not motivation enough for me.” O’Neal had severe diabetes, which led to a stroke that killed him in November 2011 at the young age of 41.
Obesity can affect every system in the human body. In physical therapy we most commonly see obese patients who have complications associated with diabetes, arthritis and heart disease. There is a genetic component to each of these diseases, but for the most part, they are preventable. Diabetes, arthritis, and heart disease are non-communicable diseases. You don’t catch them from being in a room with someone who has them. You don’t get them from kissing or getting sneezed on.
The human condition is such that the possibility of being sick or dying is not enough to persuade most people to change the way they live. Most of us need to get a diagnosis from a professional or see someone close to us get sick or die to make significant changes in the way we manage our health. Diabetes, arthritis and heart disease are acquired subtly; you don’t just wake up with arthritis in all your joints one day. They take time to make their way into your life, usually without you even knowing. This can be a double-edged sword. If you choose to make a change, this can be a positive. Small tweaks in your diet and increases in your exercise volume can decrease your weight and improve your overall health. On the other hand, the slow creep of these obesity-related diseases allow people to rationalize doing nothing, with the excuse that they have plenty of time before it gets serious.
Obese patients usually see a Physical Therapist because the arthritis in their knee is so bad they can’t climb steps or the diabetic neuropathy in their feet is so painful that they barely walk any more. By this stage, these symptoms are very challenging for the PT to treat. Multiple medical issues coupled with a lack of mobility creates a complicated scenario. This patient has to get moving despite the pain.
Arthritis is caused by a constant wear and tear on a joint to the point of irritation and chronic inflammation. The inflammation leads to breakdown of cartilage and bone, causing pain and dysfunction. Obesity makes it nearly impossible to allow that joint to rest and heal. The patient’s de-conditioned state also makes it very challenging for them to get active enough to lose weight.
The complications associated with diabetes and heart disease are similar. A major element of healing is blood flow. Blood supplies oxygen to the body and oxygen fuels chemical interactions, including cell reproduction and growth. Healing is essentially growth of new, healthy cells and it can’t happen without ample blood supply. Heart disease prevents sufficient amounts of blood to be pumped throughout the body while diabetes affects the quality of that blood supply. Both diseases make it extremely challenging for the body to heal itself.
Movement and exercise are the key components of helping obese patients improve. A Physical Therapist is extremely aware of the risks and complications associated with obesity, arthritis, diabetes and heart disease. The major obstacle that most of these patients face is a fear that they are too overweight to exercise. This couldn’t be further from the truth. In fact, it’s necessary that they exercise. They just need to be guided by a professional.
Every patient is different and a PT will always do a thorough evaluation before designing a custom plan of care for each patient, but here is a typical program for someone who is experiencing complications related to obesity:
1. Pain control modalities if necessary
2. Cardiovascular exercise
3. Strengthening exercise
4. Balance training
5. Gait training
6. Aquatic exercise
7. Functional activity (ADL) training
8. General nutrition education and consult to nutritionist/dietician if necessary
Ask the Physical Therapists at WSPT how PT can help you manage Obesity and Obesity related conditions.