Billions of dollars are spent in America in caring for illness and disease. Many tears have been shed from the lives lost to our biggest killers, the chronic diseases of lifestyle. Modern medicine has struggled to combat the rising tide of these conditions, like heart disease, stroke, and diabetes. And the link to the epidemic of obesity over the last half century is hard to ignore.

Obesity is a global epidemic; every analysis is showing increasing numbers around the globe. In general, this rise appears to be linked to the spread of the fast-food, ultra-processed dietary regimen. These are foods capable of sitting on a shelf for years. Or frozen meals engineered to be physiologically addictive.

Globally, there are over a billion people considered obese. Since obesity is classified as one of the top 5 risk factors for death, it results in about 5 million deaths per year. The association of obesity, especially carried around the middle, termed central adiposity, is well-established.

The links to numerous potentially deadly medical conditions is irrefutable. Certainly, the association of central adiposity to heart disease is well-established, the evidence accumulating over many years. But new information arrives almost daily connecting obesity to many disease states, from Alzheimer’s to cancer, gout to diabetes, arthritis to emphysema.

Generally, obesity has been gauged with body mass index, shortened to the well-known BMI. It’s a deeply flawed method, and overly simplistic, using only height and weight. It does not differentiate between a stocky, muscular individual and someone who has obesity, between a large-boned body type and someone with extra belly fat. A body builder will often be rated as obese according to the BMI.

BMI has been used for many years. Huge numbers of Americans are obese according to their calculated BMI. It’s been the predominant screening tool, used by the military and in many studies. Yet, it has been recognized for decades as being deeply flawed. But that was what we had, the easiest and most accessible technique.

The ability to accurately measure and quantify something allows us to create more accurate predictions. Thus, the margin of error associated with BMI has led to the search for other means of studying this ubiquitous condition. A new term is BRI, Body Roundness Index, which looks at the human body shape, defining in a number the degree of body roundness. Body Roundness Index has been noticeably more accurate, incorporating as it does weight and height but also waist circumference.

In essence, BRI reflects visceral fat distribution. BRI’s has been found superior over all other measures for predicting all-cause mortality, especially due to cardiovascular disease, metabolic diseases (diabetes), and also kidney. The reason has become clear.

Body roundness reflects the accumulation of visceral fat, which is contained amongst the internal organs. Healthy individuals store the great majority of their body fat in the subcutaneous tissue layer. The general consensus, backed by many studies, states visceral fat is much more dangerous to health than subcutaneous fat.

A global commission recently determined that by 2035 more than $4 trillion will be spent annually, as a result of the health conditions associated with obesity. This works out to approximately 3% of the global Gross Domestic Product (aka GDP, a measure of total goods and services produced). To better understand this growing threat to global health, BRI shows great promise as a more accurate measurement of obesity and its association with all-cause mortality.

Historically, the approach in the US has been to treat disease, although many say this is not the healthiest nor most economical approach. Perhaps a more effective one would be one aimed at prevention. This would certainly be a less expensive path and ultimately more efficient means to wellness. This is obviously a complex question, with a multitude of the societal, environmental and biological factors involved in this discussion.

The philosophical differences, treating disease versus maintaining wellness, are profound. But there is much we have to learn on the topic of health maintenance through the years, with its often debilitating consequences. Obesity is a man-made condition and was a rare finding up until the 70’s. The evidence is clear; we have done this to ourselves, consuming a diet saturated with sugar and chemicals. The data is out there (and it’s not the reduction in exercise): our diet is killing us.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.