Chapter 58
Obesity and Diabetes — 17
There has also been the question raised about the category of “metabolically healthy, obese.” That is quite unfortunate, since there is no evidence that the condition of obesity can be viewed as being healthy, even without metabolic syndrome. Debunking that notion, many studies have demonstrated that people in this category should not be considered safe.
Figure 4.4. Mortality risk associated with Metabolic Syndrome (MetS) and weight status. Adapted from Ting Huai Shi et al., “The influence of metabolic syndrome in predicting mortality risk among US adults: Importance of metabolic syndrome even in adults with normal weight,” Preventing Chronic Disease 17 (May 2020): E36, https://doi.org/10.5888/pcd17.200020.
Similar confusion surrounds prediabetes. In the journal Science, the investigative reporter Charles Piller wrote about a frontal assault on the classification of prediabetes, claiming it was scaremongering, invented by a public relations officer for the American Diabetes Association. Piller went on to highlight the financial conflicts of this organization and the outspoken researchers who have advocated diagnosing prediabetes as well as the potential gain of pharmaceutical companies to offer drugs for this diagnosis. While many of these points were valid, prediabetes is real and has since been shown to be linked to heightened risk of heart attacks, strokes, and death.
What’s more, improvements in lifestyle, and to a lesser extent taking metformin, have been shown to mitigate this risk. Like suggesting that obesity can be healthy if in some narrow sense your metabolism is, questioning whether prediabetes is worthy of diagnosing was a bad public health message.
Instead of trying to assuage concern for people with metabolic syndrome or prediabetes, we should be sounding alarms. These are red-flag warnings that a person carries a high risk for progressing to chronic disease that has serious secondary consequences. And we’re better positioned now to intervene without relying solely on hard-to-adopt lifestyle changes. A big step in achieving maximal health span is maintaining metabolic health. Keep in mind that only 7 percent of Americans fulfill the definition of being metabolically healthy.
Let’s circle back to the GLP-1 drug breakthrough. Since these drugs have anti-inflammatory effects and improve metabolic biomarkers, including better glucose control, promoting sensitivity to insulin, achieving a more favorable lipid profile, and modifying behavior, their potential applicability for metabolic syndrome and prediabetes is clear, yet not adequately tested.
THE WAY OF MEDICAL TECHNOLOGY
Just being highly effective drugs for obesity and diabetes, and preventing their complications, GLP-1s would have been considered a major medical triumph. But now it seems possible, especially with increasingly potent triple-receptor agonists, available in pill form, that the GLP-1 family of drugs will offer far more. It is conceivable that most people will be taking one of the GLP-1 drugs in the future.