The Pol-e-Pill Finally Arrives

Date: 
07-01-2008

he global obesity epidemic affects billions of
people (1), and, in its wake, a worldwide epidemic
of type 2 diabetes has followed (2,3).
Obesity is not only associated with diabetes, of
course, but also with the other partners in the X-gang:
hypertension, hyperlipidemia, and cardiovascular disease
(4). As exemplified in an original article in this issue of
Diabetes (5), the link between diabetes and obesity continues
to be scrutinized in detail. In the wake of this
metabolic catastrophe, the ill effects of joint pain, degenerative
arthritis, and sleep apnea ensue (6). A ripple of
despair similarly washes over the oncology community,
who now realize that the global tragedy of obesity claims
cancer lives too (7–10). “But how about us?” the immunologists
(11) and vascular (4) specialists cry; obesity dulls
the body’s response to infection, impairs wound healing,
and, consequently, diminishes reproductive capacity (12).
All of this is important, but none of it matters to Keith
Mitchell, who expresses his frustration to his impotent
physician, “Doc, I’ve tried every diet on earth. Why can’t
you help me?” (13). Keith returns home bereft of hope to
later apologize to his children, with whom he is too tired to
play (14), and to his wife, whom he feels ill adept to love.
Obesity touches every aspect of society, from the economic
viability of nations (15) to the look of defeat
reflected in the eyes of Keith’s daughter as she gazes upon
her broken father (16). The obesity epidemic accounted
for 27% of the increase in health care spending in the U.S.
between 1987 and 2001 (17). Is it any surprise that we in
the medical community feel despair at our incapacity to
provide scalable real-world solutions to the 300 trillion
excess calories stored in the human fuel reserve and its
associated torrent of disease? (An average person with a
BMI of 22 kg/m2 has 13 kg of fat mass, and an average
person with a BMI of 33 kg/m2 has 36 kg of fat mass. The
difference is 20,000 g or 180,000 kcal. With 1.5 billion
[1,500,000,000] people in the world with obesity, the
excess stored calories approximate 270,000,000,000,000
kcal.)

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Authors: 
James A. Levine, and Ronald M. Davis