Did HBO get it Backwards? Is Obesity a Cause of Metabolic Mischief or an Effect? Or Both?

HBO’s “The Weight of the Nation” docuseries airing last night and tonight pushes the message that obesity, excess body fat, causes a host of metabolic diseases (diabetes, stroke, CVD, cancer, Alzheimer’s, sleep apnea, etc.).   And that if we can just lose b/w 5-10% of our body weight, this will fix the dislipidemia (low HDL, high triglycerides, high sd-LDL), hypertension, hyperinsulemia, etc. and put us back on the pathway to health.

But what if they got it backwards?  What if, for many obese people with these metabolic diseases (most falling starting with a precursor condition called “the metabolic syndrome”), the obesity itself is simply an effect of the metabolic disorder (insulin resistance) that causes all of these related metabolic diseases?  And, the subsequent 5-10% of body fat lost is an indicator of improving metabolic health, not a cause of it?

Is obesity a symptom of metabolic derangement or a cause of it?  Is it both an effect and a cause (like sleep apnea)?  Does the insulin resistance condition drive metabolic syndrome (central obesity, hyperglycemia, hyperinsulemia, hypertension, high trigly., etc.) and then the condition of central obesity release harmful hormones that cause the insulin resistance to be exacerbated, as HBO implies?

I’m not sure.  It’s an important topic though because, if obesity is largely an effect, than focusing on obesity only may distract from the important fact that many lean people suffer from insulin resistance (and therefore, are at high risk for diabetes, stroke, and CVD) as well.

Fat seems to be a strong symptom of metabolic derangement, but it’s not the only symptom.  Maybe the entire population should be screened by being given a HA1C test to gauge average insulin levels (over a 3 month period) to check for insulin resistance?

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