Obesity is the leading cause of death in America. When will we talk about it?

Bill Maher called for fat shaming last week. His argument makes sense.

Photo by Francis Dean/Corbis via Getty Images
  • As the NY Times reports, obesity is the leading cause of death in America, costing the health care system $1.72 trillion.
  • Bill Maher called for fat shaming as a means of transforming the lethargic mindset about obesity.
  • When implemented properly, shame can be an important and powerful tool, writes NYU professor Jennifer Jacquet.

There are many eye-opening moments in the Netflix documentary, "American Factory." The film details the culture clash that occurred when a Chinese billionaire opened a factory in an abandoned General Motors plant in Ohio. The workforce, consisting of Chinese and American employees, at times feels like two alien races trying to figure one another out.

To Americans, the required obedience and seven-day workweek demanded by Chinese managers (of Chinese workers) is startling. The level of enthusiasm for Fuyao at the employee party in China disturbs on an Orwellian level. But there's an unspoken difference that proves equally shocking: the two ethnicities look like different species. Nearly every American worker is overweight.

As the NY Times recently reported, obesity is the leading cause of mortality in the United States. Obesity costs the nation $1.72 trillion every year. As Bill Maher pointed out last week, 53 people were killed in mass shootings in August. By comparison, in the same month 40,000 Americans died because of diseases associated with obesity, causing him to call liberals "the NRA of mayonnaise" for their unwillingness to openly discuss this mass killer.

I grew up overweight and was bullied for it (a topic I discuss in more detail in this article about male body dysmorphia.) Add to the fact that I have large ears and there's a recipe for a lonely childhood. I spent many of my formative years being taunted as Dumbo. There's nothing fun about it. Those experiences destroyed my confidence and created plenty of self-doubt later in life. Still, I was able to use that shaming as motivation to transform.

I would never advocate bullying as the proper course of action, yet bullying is not shaming. This is where the PC crowd gets tripped up. As Jennifer Jacquet writes in her book, Is Shame Necessary?, frivolous shaming distracts our attention from what matters, and right now healthcare in America really matters.

New Rule: The Fudge Report | Real Time with Bill Maher (HBO)

Jacquet writes that, according to anthropological studies, two-thirds of human conversation is gossip about other people—a stunning number, but given our fascination with selfies and social media, one easy to comprehend. We are influenced and inspired by others. We might obsess over what we don't have too often, but when it matters, we can also change our habits. Shame is one means for accomplishing this.

This is how many documented tribal cultures work. Their justice system is a circle, the accused in the center. Shame is an evolutionary tool that helps create better behavior when performed with the intention of transformation. It can establish and enforce new norms.

Of course, we don't live in tribal cultures befitting of Dunbar's number. Though we mostly remain close to a limited number of people (also per Dunbar), our "tribe" is global. Circles are too wide to implement. We need better recourse for shame. For better or worse, that relies on governmental intervention (as we'll discuss below).

There are seven habits of effective shaming according to Jacquet.

"The transgression should (1) concern the audience, (2) deviate widely from desired behavior, and (3) not be expected to be formally punished. The transgressor should (4) be part of the group doing the shaming. And the shaming should (5) come from a respected source, (6) be directed where possible benefits are highest, and (7) be implemented conscientiously."

Obesity fits the bill of transgression. Every American is implicated in skyrocketing healthcare costs, regardless of how healthy or unhealthy; the premiums of the fit increase due to costs of avoidable treatments for obesity. Obesity deviates wildly from natural biological behavior; the photo from fifties Maher points to is evidence of how quickly Americans have grown. Of course, there should be no formal punishment, yet that doesn't imply that we remain silent.

As for respected sources, the Times article notes that the simple act of implementing medically tailored meals for the sickest Americans could save each patient $9,000 a year. There are other actions, many of which require the government: taxing sugary beverages; subsidizing healthy food over the added income that corn, soybean, and beef manufacturers receive; lowering sugar and trans fat standards on foods; improving school meals and better educating children on nutrition; and expanding school garden programs. I would also add reducing the amount of processed foods being sold as that is the biggest source of our malnutrition.

Large oversized women competitors in action at the wall climb obstacle during the Reebok Spartan Race. Mohegan Sun, Uncasville, Connecticut, USA. 28th June 2014. Shaming might help inspire people to lose weight through better diet and exercise—such a mindset should be supported.

Photo by Tim Clayton/Corbis via Getty Images

Reality is far from idealism, however. Michelle Obama was derided by conservatives for planting a garden at the White House, while one of the first actions taken by the Trump administration was destroying it. The very agricultural feat that allowed the proliferation of our species is now seen as an "agenda." We're killing ourselves by what goes in and what comes out of our mouths.

Americans, as the Times states, are sick; more adults are obese than not. Over 100 million American adults are pre-diabetic or diabetic, nearly half of the nation's adult population. Add to that the 122 million people suffering from cardiovascular disease.

We're simply unwilling to discuss this public health crisis in any serious manner. We'll ogle at statistics yet never point to the responsibility citizens need to take in reversing those numbers. Even more tragically, we're unlikely to hear any Democratic hopeful frame the healthcare crisis in this context even as the data stare us straight in the face.

Obesity is affecting the bodies and minds of younger generations as well. In 2016, the largest increase in any cosmetic surgery was teenage male breast reduction. I remember the stigmatization I felt at that age—it sucks. But every cosmetic surgery is a response to a neurosis we maintain about ourselves, one that is often the result of a society setting unrealistic beauty standards.

As Maher stated, though, this is not about beauty. It's about health, and we're failing by that measure. As mentioned, bullying is not the right response, but I did feel shame about my weight as well. That sensation led me to invest in my health. I've taught group fitness for 15 years and maintain an optimal weight. At 44, I'm stronger, more mobile, and more flexible than I've ever been. That shame was fuel for focusing on good health, energy that keeps me in the gym five to six days a week.

It must also be pointed out that not everyone is in the same position. Food deserts are real. Processed foods infiltrate neighborhoods as plentifully as opioids, yet not nearly as discussed. And some people are physically incapable of regular exercise, though at times this is due to injuries or other health problems—some caused by being overweight, pointing to the vicious circle that obesity creates.

Sometimes, though, we simply make excuses because we languish in our bad habits. We focus more on what we don't think we can do than what we actually can accomplish. This is where shame can be utilized most powerfully as a tool for change.

Is shame necessary? Sometimes it is. The data are evident yet we seem incapable of having a mature conversation about them. Until we do, the problem is only getting to get worse, and we simply can't afford to let that happen.


Stay in touch with Derek on Twitter and Facebook.

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Reactive oxygen species (ROS) accumulate in the gut of sleep-deprived fruit flies, one (left), seven (center) and ten (right) days without sleep.

Image source: Vaccaro et al, 2020/Harvard Medical School
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  • Surprisingly, the direct cause seems to be a buildup of Reactive Oxygen Species in the gut produced by sleeplessness.
  • When the buildup is neutralized, a normal lifespan is restored.

We don't have to tell you what it feels like when you don't get enough sleep. A night or two of that can be miserable; long-term sleeplessness is out-and-out debilitating. Though we know from personal experience that we need sleep — our cognitive, metabolic, cardiovascular, and immune functioning depend on it — a lack of it does more than just make you feel like you want to die. It can actually kill you, according to study of rats published in 1989. But why?

A new study answers that question, and in an unexpected way. It appears that the sleeplessness/death connection has nothing to do with the brain or nervous system as many have assumed — it happens in your gut. Equally amazing, the study's authors were able to reverse the ill effects with antioxidants.

The study, from researchers at Harvard Medical School (HMS), is published in the journal Cell.

An unexpected culprit

The new research examines the mechanisms at play in sleep-deprived fruit flies and in mice — long-term sleep-deprivation experiments with humans are considered ethically iffy.

What the scientists found is that death from sleep deprivation is always preceded by a buildup of Reactive Oxygen Species (ROS) in the gut. These are not, as their name implies, living organisms. ROS are reactive molecules that are part of the immune system's response to invading microbes, and recent research suggests they're paradoxically key players in normal cell signal transduction and cell cycling as well. However, having an excess of ROS leads to oxidative stress, which is linked to "macromolecular damage and is implicated in various disease states such as atherosclerosis, diabetes, cancer, neurodegeneration, and aging." To prevent this, cellular defenses typically maintain a balance between ROS production and removal.

"We took an unbiased approach and searched throughout the body for indicators of damage from sleep deprivation," says senior study author Dragana Rogulja, admitting, "We were surprised to find it was the gut that plays a key role in causing death." The accumulation occurred in both sleep-deprived fruit flies and mice.

"Even more surprising," Rogulja recalls, "we found that premature death could be prevented. Each morning, we would all gather around to look at the flies, with disbelief to be honest. What we saw is that every time we could neutralize ROS in the gut, we could rescue the flies." Fruit flies given any of 11 antioxidant compounds — including melatonin, lipoic acid and NAD — that neutralize ROS buildups remained active and lived a normal length of time in spite of sleep deprivation. (The researchers note that these antioxidants did not extend the lifespans of non-sleep deprived control subjects.)

fly with thought bubble that says "What? I'm awake!"

Image source: Tomasz Klejdysz/Shutterstock/Big Think

The experiments

The study's tests were managed by co-first authors Alexandra Vaccaro and Yosef Kaplan Dor, both research fellows at HMS.

You may wonder how you compel a fruit fly to sleep, or for that matter, how you keep one awake. The researchers ascertained that fruit flies doze off in response to being shaken, and thus were the control subjects induced to snooze in their individual, warmed tubes. Each subject occupied its own 29 °C (84F) tube.

For their sleepless cohort, fruit flies were genetically manipulated to express a heat-sensitive protein in specific neurons. These neurons are known to suppress sleep, and did so — the fruit flies' activity levels, or lack thereof, were tracked using infrared beams.

Starting at Day 10 of sleep deprivation, fruit flies began dying, with all of them dead by Day 20. Control flies lived up to 40 days.

The scientists sought out markers that would indicate cell damage in their sleepless subjects. They saw no difference in brain tissue and elsewhere between the well-rested and sleep-deprived fruit flies, with the exception of one fruit fly.

However, in the guts of sleep-deprived fruit flies was a massive accumulation of ROS, which peaked around Day 10. Says Vaccaro, "We found that sleep-deprived flies were dying at the same pace, every time, and when we looked at markers of cell damage and death, the one tissue that really stood out was the gut." She adds, "I remember when we did the first experiment, you could immediately tell under the microscope that there was a striking difference. That almost never happens in lab research."

The experiments were repeated with mice who were gently kept awake for five days. Again, ROS built up over time in their small and large intestines but nowhere else.

As noted above, the administering of antioxidants alleviated the effect of the ROS buildup. In addition, flies that were modified to overproduce gut antioxidant enzymes were found to be immune to the damaging effects of sleep deprivation.

The research leaves some important questions unanswered. Says Kaplan Dor, "We still don't know why sleep loss causes ROS accumulation in the gut, and why this is lethal." He hypothesizes, "Sleep deprivation could directly affect the gut, but the trigger may also originate in the brain. Similarly, death could be due to damage in the gut or because high levels of ROS have systemic effects, or some combination of these."

The HMS researchers are now investigating the chemical pathways by which sleep-deprivation triggers the ROS buildup, and the means by which the ROS wreak cell havoc.

"We need to understand the biology of how sleep deprivation damages the body so that we can find ways to prevent this harm," says Rogulja.

Referring to the value of this study to humans, she notes,"So many of us are chronically sleep deprived. Even if we know staying up late every night is bad, we still do it. We believe we've identified a central issue that, when eliminated, allows for survival without sleep, at least in fruit flies."

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