metabolic syndrome

208 Million Americans are Obese or Overweight

Robert Cucin MD JD MBA metabolic syndrome, obesity

In a study published in Lancet on November 14, 2024, conducted by the GBD 2021 Forecasting Collaborators using 132 data sources, nearly half of adolescents and three-quarters of adults in the U.S. were classified as being clinically overweight or obese.

The authors forecast that by 2050, 1 in 4 children and 1 in 3 adolescents will be obese.

While clinical research has brought us new pharmacologic agents such as the GLP-1 receptor and GIP dual agonists with both central and peripheral sites of action, none of these drugs are either universally effective or without significant side effects. Further most need to be injected.

The U.S. already has one of the highest rates of obesity and the trend seems to be accelerating. The economic impact on the economy and its exacerbation of racial inequalities is burdensome and unacceptable. We can only hope that as research continues oral medications and solutions that we anticipate will be permanent such as Endoscopic Visceral Lipectomy will brighten the horizon.

We welcome the new Administration’s move to Make America Healthy again. Let’s take a step backwards into less processed foods, more exercise, and un-supersized portions. The most effective drug or operation will fail without suitable patient motivation and participation. And the failure of one generation has a cascading effect on the next with the offspring of obese mothers and fathers being born with more visceral fat and destined to earlier obesity and type 2 diabetes.

CDC Reports the U.S. is Supersized

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity, technology , , ,

The CDC reports that 7 out of 10 Americans are overweight or obese and almost 4 out of 10 Americans are obese.

There is an underlying pattern of racial and ethnic disparity.  Almost half of Hispanics and blacks are obese with obesity rates for 2015-2016 of 47% and 46.8% for adult Latinos and non-Hispanic blacks respectively.

Obesity is most readily defined by Body Mass Index (“BMI”) which takes a person’s weight in kilograms and divides it by their height in meters squared.  For adults, those with a BMI between 18.5 and 24.9 are considered to have a normal weight.  A BMI between 25 and 29.9 is considered overweight and anything above 30 is deemed obese.  The NIH provides a calculator for you to determine your own BMI.

It is apparent to anyone following these statistics or even just walking down the street that current efforts to control the obesity problem have failed to reduce obesity rates.

We have learned that visceral fat or “belly” fat within the abdomen hijacks the metabolism by secreting the cytokine resistin.  This cellular hormone antagonizes insulin, blocking sugar from entering cells or reaching the brain.  It saps energy, shuts down the metabolism, causes brain fog, and hunger.    Cellular hormones are secreted directly into the portal circulation and the body’s protein factory, the liver, is commandeered to produce bad lipids which cause strokes and heart attacks.  Mesenteric fat thickness is closely correlated with carotid intimal narrowing.  Belly fat doesn’t just shorten your life, it reduces its quality with sleep apnea, gastric reflux, type 2 Diabetes mellitus, heart attacks, strokes, autoimmune diseases, and cancers.

New technology facilitates a new approach to the problem.  Rather than just starving this belly fat and letting it remain in place as do current bariatric surgical alternatives, removing it this visceral fat in a minimally invasive procedure may prove to be a simpler, more direct and permanent, safer and highly effective alternative.  Endoscopic visceral lipectomy could be just be what the doctor ordered.   It is clearly time to seek new approaches and fresh solutions as obesity rates continue to rise.

 

The Mesentery Gets Recognition

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity , ,

The mesentery, that humble peritoneal fold suspending the bowel and providing its blood supply, has finally been recognized as an organ.  Prof J Calvin Coffey and D Peter O’Leary , PhD in a recent article appearing in the Lancet    propose that the mesentery be recognized as an organ in its own right.   We applaud the elevation of the mesentery’s status to the 79th recognized organ in the body.  Recognizing the mesentery as an organ, is important as it allows us to study its effect on maintaining healthy or contributing to diseased states.

We have maintained that the noxious cellular hormones secreted by the mesenteric fat constitute a deadly cytokine factory responsible for Type II Diabetes (resistin), hypertension (angiotensinogen), autoimmune diseases and cancers, blood vessel inflammation (TNF, interleukin 6, PAL-1), and hunger (neuropeptide Y).  And mesenteric fat causes sleep apnea and gastric reflux simply as a result of its bulk.

For decades, surgeons have intervened to remove tumors of the mesentery or to untwist it in cases of volvulus to save compromised bowel.  However, Endcopic Visceral Lipectomy may well be the first intervention explicitly directed at the mesentery’s function as an organ to crease a diseased state, namely metabolic syndrome and Type II Diabetes.  Bravo.