When an article starts like this, I instantly close it and wait for proper sources. Anyway, the phrase "metabolic syndrome" has been gaining currency for the last few years. For those who don't want to read journal papers and meta-analyses, there are plenty of doctors and fitness coaches (on YouTube) who have made videos on how to get metabolic syndrome under control or even reverse it. And many of the doctors do a good job of filtering and summarizing the research.
Why? You don't believe in car crashes or what?
This seems needlessly cynical. Someone can have multiple objectives in writing, to tell you facts and also to capture your attention or to convey an emotion and motivate you to action. Very little writing is done with a single purpose in mind. We don’t expect academics drafting research papers to eschew concerns about the impact the writing will have on their career for example.
Starting a story with an anecdote that humanizes the information is simply acknowledging the reality that people want more than just facts. If the latter was all they wanted, most of us would only read encyclopedias and textbooks.
Seems absolutely unnecessary, forced, immeasurably trite, off-puttingly boring, overused, so brazenly cliché that there has to be some kind of counter-intuitive selection going on, like with the email scammers that target those who are not immediately noticing the fraudulent intent.
... or simply our arrogance is showing, after all average minds discuss people, right?
https://www.ahajournals.org/doi/10.1161/01.atv.0000111245.75...
The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week. This will drastically improve the health 1000x more than say the insane stuff that Brian Johnson is touting.
I hate modern fitness influencers and health wellness people in general. My head near about exploded when I saw a Tiktok from Jeff Nippard claiming that eggs increase your testosterone on a study with a sample size of FIVE PEOPLE.
Don't be depressed is also excellent advice for people with depression: if they can manage that, it improves their mood tremendously. Not catching colds also greatly reduces your chances of cold-like symptoms.
By which I mean, what you're saying is a truism, not medical advice. Keeping your BMI under control is a natural no-effort thing for some people, and a grueling lifelong struggle for others. Telling fat people to stop being fat is not "advice", it is exactly as helpful as telling sick people to stop being sick.
That doesn't detach from the reality of the objectives, getting there is difficult for people and there is more research to be done.
FYI: None of my posts are medical advice and I am not a doctor
This logic error is easy to make, and the headlines all too often imply it, but it isn't always true (sometimes it is).
Though, to be play devil's advocate for a second, it does seem that diabetes is typically where the symptoms start, and we do understand that diabetes is fundamentally metabolic and/or functional dysfunction in 1 or more of 7-ish different areas.
I think it's the level of perspective zoom + timing we take that makes the article's assertion either useful or not.
If we zoom out, while catching disease early on, and we address the metabolic conditions via lifestyle and/or certain drugs like GLP1, then we prevent the need to intervene on the kidney and cardiac front.
But if we zoom in to a specific issue, after disease has progressed a profound amount, a GLP1 intervention may be too little, too late.
Hopefully though, this may help the messaging to folks that if they are contending with metabolic disease that presents as diabetes, introducing lifestyle and pharma interventions early may be helpful on the larger epidemiological front.
The main marker of kidney function, eGFR, was added with the AHA/ACC's PREVENT equations in 2023.
I wrote a bit about the science behind heart risk calculators, and their various inputs like cholesterol, blood pressure, A1c, eGFR, and so on here: https://www.empirical.health/blog/heart-attack-risk-calculat...
The article is trying so hard not to say that obesity is the cause. I call it the obesity pipeline: You start off young and obese and you don't have diabetes and it's all fine. Stay obese long enough and you get diabetes -> metformin. Stay in a diabetic state long enough and you get heart disease -> statins. These are obesity comorbidities.
Unfortunately, since Ozempic treats diabetes with or without obesity, and it also treats obesity without diabetes, it won't help us figure out if obseisty is a cause or a side effect of diabetes. But there really is little reason to pretend it's clear either way.
I find it exceptionally hard to believe populations at scale went from relatively “normal” weights to obese as the majority due to an emerging novel metabolic disorder. All within 1 to 2 generations.
Much simpler explanation is that diets and lifestyles changed leading towards obesity. Whether or not a metabolic disorder happened somewhere in the middle there seems irrelevant to me. It’s very clear to me that obesity causes the issues and not the other way around.
I’m open to thinking differently about it, I just find the evidence uncompelling as someone who was obese the majority of my adult life. Given the unique circumstances of how I grew up and then later experienced life, I’m quite confident obesity is primarily caused by lifestyle. Put simply - put yourself in a situation where obesity becomes easy to achieve and the majority of people will become obese.
Humans being what they are will of course have myriad of outliers to refute the point, but outliers are uninteresting to discuss in this context.
Even within these places, there are often huge disparities in obesity rate. For example, Colorado has half the rate of obesity as the USA: are people in Colorado leading such hugely different lives from the rest of the nation? And are people in Colorado leading lifestyles more similar to those in California than those in Kentucky?
To me, the much more plausible explanation is that there is some aspect of modern life (most likely some element in our food, but very possibly in our enviroment as well) that is causing metabolic issues that lead to this huge increase in appetite that in turn leads almost inexorably to obesity.
Yes, absolutely. I've spent time in very obese locations in the midwest, and spent time living in Colorado and have relatives there.
The lifestyle differences are exceedingly stark. Drastic even. It's clowned on for the hippie/health conspiracy nutjobs meme for a reason. You immediately realize why people look different.
> And are people in Colorado leading lifestyles more similar to those in California than those in Kentucky?
Yup. Again, this is obvious simply from spending time in both locations. You will find places in CA that are nearly as obese as many places in KY, and find that the lifestyles look quite similar between the two. Louisville lifestyle is quite similar to Bakersfield for example and the obesity rate just so happens to coincide with that observation.
I don't know enough about Tonga vs. France to comment, but I imagine if you spent a few months living within the populations of both and living a typical lifestyle/eating a typical diet you'd likely find immediately obvious differences. In this case, genetics is also a very plausible front-line explanation - where in western countries it simply is not due to similar demographics changing so drastically over a generation or two while removing the immigration confounder.
> To me, the much more plausible explanation is that there is some aspect of modern life
Yeah, it's the diet combined with a relatively fast switch to sedentary lifestyles. Mostly the diet and food environment. Participation in adult casual sporting leagues and other outdoor activities is right behind it. Changes in the average activity levels while at work. Just 12,000 steps a day makes a drastic difference in weight for many people.
Technology plays a major role - screen time went from minutes a day to double-digit hours for the majority of the population. Hard to be active while staring at a screen of any sort.
Like I said - I'm also open to some environmental variable not explained by much simpler facts like the food environment, but I think that's exceedingly less likely than what is smack dab obviously right in front of our faces that for some reason we ignore in pursuit of near-conspiracy level stuff. The obvious thing usually ends up being true, and I see no reason in this case to believe otherwise.
Again though - exceptions abound. Humans are complex creatures. They average out quite well though at population scale.
There is no doubt that hyper processed foods make this condition more likely, but its not just "you have weak willpower and got fat and sick" - I know a ton of fat people who do not have and will likely will never develop T2D.
This is just my unqualified opinion to be clear
Sometimes is just a bad roll on the genes.
Try losing more fat, to the 12% level, then check your biomarkers again.
If they find the drug of immortality, I am sure they will name every disease "partial death".
SilverElfin•1mo ago
Seems like this is mostly an extension of the previously existing label of metabolic syndrome, now including kidney. Ozempic is mentioned and I take that to mean obesity is the cause. But are some of these ailments like diabetes reversible?
liveoneggs•1mo ago
SilverElfin•1mo ago
liveoneggs•1mo ago
tl;dr it's everything you expect - home-cooked healthy meals, avoid sugary stuff, moderate exercise five days per week, etc
cestith•1mo ago
Also, remember not everyone with T2 is obese, not everyone obese has T2D, and obesity doesn’t mean a little overweight. These are people with a BMI of 30 or higher. Other, lesser-used definitions from the past included a certain percentage of body weight consisting of fat. There are many people with Type 2 who are normal weight or overweight.
liveoneggs•1mo ago
> T2D remission is defined as glycated hemoglobin (HbA1c) < 6.5% after discontinuation of hypoglycemic drugs for at least 3 months
> In the intensive treatment group, 78.57% patients in the prediabetes subgroup returned to normoglycemia and the diabetes remission rate was 75% in the diabetes subgroup at 12 months
75% of T2D people in this study were able to get cured and stop medications. It's a good outcome.
cestith•1mo ago
liveoneggs•1mo ago
cestith•1mo ago
The mean BMI in the study is around 24, which is overweight rather than obese. Their blood pressure was close to normal. Their A1C was in the diabetic range before intervention, but well below 8 so it was somewhat controlled.
After 12 months, 44% of people in the intervention group were off all their blood glucose meds. That’s far, far better than the control group for sure. It’s still not everyone in the intervention group.
This is also a pretty specific method of intermittent fasting, not just self control on a traditional meal schedule. So no, I don’t think this 72-person study shows that just having some self control solves T2D for everyone either. It looks like enough self control to stick to a specific, predesigned eating schedule works for almost half of people, though. That’s really good, but let’s not oversell it as a 100% cure.
liveoneggs•4w ago