Obesity: Why Are Men Getting Pregnant?

By Alexander G. Schauss

In this groundbreaking book, Dr. Alexander G. Schauss explains the relationship between stress, insulin resistance and glucose intolerance to disordered eating, compulsive eating, and the resultant overweight or obesity - including the 'apple-shaped' paunch, called 'intra-abdominal fat', that can be a direct result of life's stresses leading to excess levels of the hormone cortisol.

• Language: English
• Publisher: Turner Publishing Company
• Release date: Dec 1, 2006
• ISBN: 9781591206293

Alexander G. Schauss

Director of natural and medicinal products research at the American Institute for Biosocial and Medical Research, Inc., and Adjunct Research Professor of Botanical Medicine at the National College of Naturopathic Medicine.

Book preview

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Introduction

Many will view middle age, when the six-pack stomach more closely

resembles a keg, and the hourglass figure, a mailbox, as inevitable. . . .

   —A. STEWART, FAT PATTERNING: INDICATIONS AND IMPLICATIONS. NUTRITION, 2003

Y

ou’ve seen the unmistakable scene of a man walking by you who is so obese in his midsection that he looks strangely like he’s pregnant: his belly sticking out way beyond his chest, his back straining, and a disagreeable amount of extra fat being carried smack in the middle of his body. Why would any man allow his body to become so distorted as to take on the visual appearance of a woman at the end stages of pregnancy? A lot of people wonder. I wondered. But why I cared enough to give it much thought is another question.

Back in my late teens, while attending the University of New Mexico as an undergraduate in 1966, I was driving east across the country with my roommate to visit our parents for the holidays. Soon after getting some much-needed gasoline and finding our way back to the freeway, our car was pulled over by a local Tennessee deputy sheriff who wondered what a car with New Mexico license plates was doing in his jurisdiction. We were just buying gas, back at the last exit, on our way to the East Coast, sir, I explained while searching for my driver’s license and automobile registration. Finally, I found both documents and handed them to him. While waiting for the officer to check my license and registration, my roommate, who was on the university’s track and field team, wondered how anyone in law enforcement could have such a large belly and work as a police officer. Before I could tell him to be quiet, he said, That’s quite a belly you’ve got there, to the officer.

At that moment my heart rate doubled and I had images of us getting out of the car, placed in handcuffs, taken to the local jail, and forgotten through the holidays. This all occurred in the days when officers didn’t read you your rights, especially in the southern states. And we had long hair and were driving a Volkswagon bug, which meant he probably thought we were hippies carrying drugs across the country. We wondered if we had made a mistake by not calling our parents from the service station to let them know where we were. Between the two of us we might have had forty dollars, probably not enough to pay a fine or bail us out of jail.

But instead of asking us to get out of the car, he handed back my license and registration and, to our surprise, held his belly with both hands and said, Yep, I’ve got to do something about this someday. You boys take it easy and watch your speed limit. As he was handing me back my license and looking around the inside of our car, probably noticing that we were wearing jogging suits, he added: You boys keep working out. You just don’t want to get diabetes; it’s a pain in the butt. And then he walked back to his car.

As you can imagine, we caught our breath and looked at each other, realizing that instead of spending the holidays in jail for nothing more than being in the wrong place at the wrong time caught by someone who just didn’t like northerners or hippies, we were back on our way heading east. At the time, we didn’t really appreciate the insight this big-bellied officer from Tennessee had just shared with us.

Now, let’s fast-forward a few decades to tie this story to the reason I wrote this book. Years later, my seven-year-old son, ten-year-old daughter, and I attended a local stamp show. I used to collect stamps when I was a young boy, and I wondered if my kids would be interested. I always felt that you could learn a lot about other cultures by collecting stamps from around the world. We came up to one dealer’s table and met the nicest stamp dealer you could imagine. He urged my kids to sit in front of his table and look through boxes of stamps from all over the world. A penny a piece, he told them. My kids’ eyes lit up, because with the dollar I gave to each of them, they were able to select a hundred stamps. Well, needless to say, they couldn’t wait to get home and show their mom what they had acquired.

Soon we watched for future stamp shows for no other reason than to meet this very friendly stamp dealer who always treated my kids so well. Eventually, my wife and I got to be good friends with him and even visited his home on a number of occasions, where he treated us to some of the finest French and Italian cooking imaginable. He was a master chef who could turn a meal into an epicurean experience.

There was just one thing that bothered me. By that time, I had been studying nutrition and behavior for more than twenty-five years. I was the research director at an institute that organized toxicology studies and clinical trials, and I reviewed scientific literature related to nutritional products sold to consumers. I was also a professor affiliated with an academic institution. What bothered me was that this great cook, who went out of his way to befriend kids and get them interested in a hobby he clearly loved, also had a belly so large that he could have read a book on it without holding it with his hands.

Over the course of several dinners, he started to learn what I did for a living. Thinking back on my experience in Tennessee those many years ago, I began to wonder if I should ask him about his belly and see if I could make some suggestions. After offering to do the dishes, which he kept insisting was unnecessary, I told him I’d dry the dishes while he was washing them, so we could get the table cleaned off quickly and look at some of his prized, personal stamp collections. He agreed. So, while drying one dish after another, I finally asked, Aren’t you worried about that gut of yours?

He confided to me that indeed he was. His weight gain had started some years earlier when, due to a recession, he got laid off from a company where he had worked for many years. That’s when he decided to pursue his lifelong hobby and become a full-time, professional stamp dealer. When he first began his new career he was in excellent health. He took long walks and even worked out on a regular basis. However, the loss of his job affected his self-esteem and eventually his relationship with his family. Finally, he divorced and lived alone without his wife and children.

Living alone proved difficult, and slowly he discovered that food could console his emotions. Organizing his stamp collection and preparing for each weekend’s stamp show meant long hours working late into the evening, during which time he found himself eating large meals late at night. His health started to give way to various aches and pains, including a condition that affected his ability to breathe, making it difficult for him to exercise aerobically. Finally, he just accepted his growing belly and put on the face of what seemed like a content, but divorced, single man doing what he enjoyed.

But there was far more to this man’s life than anyone knew. He also had a secret, a secret he had never shared with anyone—not even his family. Making me promise never to reveal it, he told me the whole story one day over dinner. He ended his revelation by asking if I had some words of wisdom for him. I only had one piece of advice: Tell your family all about what you just told me—I have a feeling they will be relieved to finally have you share it with them. It was my belief that they would still love him. More important, it would help them understand the many strange events and odd behaviors they had observed through the years. This insight would bring all the pieces together for them and help them realize what he felt compelled to hide, even from his family.

One day he brought his family together and told them the whole story. As they listened, tears flowed down their cheeks and they realized how much they loved him and how much his secret had contributed to the division that led to their separation.

This should have ended as a happy story, but it didn’t. He started having severe pains somewhere near his stomach that no over-the-counter medication would relieve. He arranged to visit his family doctor who immediately sent him to a local hospital. In a matter of days, he discovered that he had advanced stage IV pancreatic cancer. Whereas stage I means that there is a treatable tumor in the pancreas that is 2 centimeters or less in any direction, stage IV meant that the cancer had grown further into the stomach, spleen, large bowel, or nearby blood vessels. My friend’s oncologist, a specialist in pancreatic cancer who also worked at a nearby, well-known cancer-research center, told him that his cancer was stage IVb, meaning that it had spread to a major organ—in this case, his liver. He was immediately scheduled for chemotherapy, despite a very poor prognosis of success, and told to put his personal effects in order.

It was very difficult for his family to learn of his pending death—especially at a time when so much was being resolved. News of his condition led his wife to move back into his home and his children to visit him daily. This story would have ended within a month or two, based on the oncologist’s prediction of how long he would survive. However, he didn’t die in a month or two; instead he lived for another twenty-one months, a length of time almost unheard of for such a lethal late-stage form of cancer.

What allowed him to live so long was the wisdom to incorporate complementary and alternative medical (CAM) modalities with conventional cancer therapies and to let go of his stressors. Even the most conservative oncologist had begun to believe in the value of combining conventional therapies with CAM modalities and to recognize the role that stress management can play in cancer therapy.

Eighteen months after his diagnosis, with the joint support of licensed naturopathic and allopathic doctors and his family around him, his stress levels were at an all-time low. He called me that month to ask if I would come to a local stamp show the following weekend. I told him that of course I would. As I entered the large hall filled with dealers, I could hear his voice in the distance. First, I just couldn’t believe my eyes; his belly was gone! Second, he shared the news with me and others that his oncologists had concluded not only that his cancer was in remission, but that tests had shown his cancer was gone! Whatever the reason was, I couldn’t care less. What mattered was that he was alive, well, and on the road to a full recovery.

Unfortunately, just two months later, his pancreatic cancer came back with a vengeance. This happened about six weeks after an oncologist placed him on an experimental drug that he believed would keep the cancer in remission. It didn’t. It brought the cancer back so fast that before his doctors could take him off the medication, he went into a coma and died. From the day he was diagnosed to the day he died, he had lived twenty-one months, a remarkable achievement.

I still miss my friend. Everyone who knew him missed him. But his death motivated me to write this book and find out whether his intra-abdominal adiposity had anything to do with his premature death. Before he died, I was able to put together a chronology of his physical changes and life events. This provided me with considerable insight as to how his secret became a chronic source of stress, stress so severe that it left him in a permanent state of fight or flight. If I hadn’t made this connection, there really wouldn’t have been any motivation to write this book. But because of it, I not only found one of the primary reasons for why these potbellies develop in men, but more important, what to do about it.

Men, and the people who love them, need to know the risks associated with these protruding bellies—bellies that make men look pregnant. It’s abnormal, unhealthy, and can take years away from your life. Men, take a moment to realize that when you die prematurely, you leave your loved ones to live without you. Retirement dreams are shattered; grandchildren whom you will never see are born; and historical events unfold, but not in front of you. Worse, you leave loved ones behind who will wonder why they waited so long to speak up and urge you to do something about that potbelly so you could live out your life with them in health and wellness, instead of becoming nothing more than a memory.

WHY WE ARE SO FAT

There is little doubt that overeating in America is associated with making poor food choices and the increased availability of fast-food restaurants. A study looking into this possibility found that consuming restaurant food was directly correlated with an increase in body fat in adults.¹ The image of a typical dinner has changed dramatically from sitting down to a well-prepared meal made from scratch to today’s quick-fix meal. Studies have shown that only 25 percent of Americans plan their dinner meals in advance: 37 percent decide that day and another 37 percent decide at the last minute. This approach opens the door for fast-food outlets to take care of our meals by providing an abundance of calories, including many unhealthy ingredients. In addition, people skip breakfast and eat away from home more often, both of which have also been linked to an increased prevalence of obesity.²

Economic differences between those at higher income levels and those living in poverty also influence obesity rates. The highest rates of obesity occur among population groups with the highest poverty rates and the least education. There is also an inverse relationship between the amount of calories consumed and the cost of food. Those foods composed of added sugars, fats, or refined grains represent the lowest-cost options to many consumers. Basically, Americans are consuming more added sugars, refined carbohydrates, and fats, and spending a lower percentage of disposable income on food than they have at any other time in history.³

Some research, including studies conducted at Tufts University in Boston, have found that waist circumference is associated with the amount of white refined grains you consume. This was discovered when researchers tracked the eating habits of a group of healthy, largely middle-class residents of Baltimore, Maryland. The belt size of the group eating refined grain-rich foods (such as white bread, doughnuts, pastries, croissants, pizza dough, pasta, refined breakfast cereals, and so on) expanded about one-half inch a year, adding one and a half inches to their waist circumference within a three-year period. The group from Baltimore who ate a diet of unrefined foods, rich in fibrous bran, showed very little gain in waist size in the same time period.⁴

HEALTH PROBLEMS ASSOCIATED WITH OBESITY

To determine the overall health burden of obesity on older adults, the Vitamins and Lifestyle Cohort Study of western Washington state recruited 73,003 adults aged fifty to seventy-six. These people completed a self-administered questionnaire on current height and weight, medical history, and risk factors. The study focused on disease prevalence (or history), the health burden of being overweight or obese, and how that condition’s health ramifications correlate with the participant’s body mass index (BMI). Forty-nine percent of the participants were men (35,998), of which 72.7 percent were overweight or obese, which is somewhat above the estimated national average of 66 percent (in 2005). Health conditions reported by the participants were divided by gender. To determine if the health condition was linked to obesity, the data was adjusted for age, race/ethnicity, education, and smoking status. Out of the forty-one health conditions studied, thirty out of forty-one were associated with being overweight or obese.⁵ A listing of all the health conditions reported by all the men in the study—those with a normal weight (a BMI of 24.9 or less), those who were overweight (a BMI of 25.0 to 29.9), and those who were obese (over 30.0)—is shown in Table A.1. Keep in mind that nearly 73 percent of the male participants were overweight or obese.

The twelve most common health conditions that overweight and obese men (those with a BMI of at least 25.0 or more) reported are shown in Table A.2 in descending order. Note the high incidence of hypertension, allergies, impotence, osteoarthritis, hypercholesterolemia, and neck, back, and joint pain.

Coronary artery disease, reported by 13.4 percent of men in this study, was defined as any of the following: heart attack, coronary bypass surgery, angioplasty, or physician-diagnosed angina. Stress was classified as reporting high levels of stress in life combined with a poor ability to handle stress.

As a health condition, diabetes was reported as only 8 percent of all men participating in the study, whether in the normal, overweight, or obese range. But when comparing the reported incidence of diabetes in men who are obese (those with a BMI equal to or greater than 30), diabetes was by far the most common health condition reported—not just self-reported, but based on a physician-diagnosed medical condition. This finding is in agreement with numerous other studies.

For all the men studied, of the forty-one health conditions examined, thirty were associated with increasing levels of obesity, with the strongest associations being diabetes, knee replacement, hypertension (high blood pressure), congestive heart failure, fatigue/lack of energy, pulmonary embolism, and insomnia. The strongest associations between obesity (BMI greater than 30) and health conditions reported by overweight and obese men—when compared to the same associate in normal weight men—were (in order):

1. Diabetes                                                                  5. Gallbladder removal

2. Knee replacement                                                 6. Pulmonary embolism

3. History of congestive heart failure                     7. Chronic fatigue/lack of energy

4. Hypertension                                                          8. Insomnia

This study provides the largest database on the association of obesity (based on BMI) and related health problems ever reported. Based on the findings of this study, obesity is associated with numerous serious diseases that are life threatening, an increased risk of serious diseases, and a reduction in the quality of life. As such, this study supports the concerns of most public-health workers that obesity has the potential to become the most serious health problem facing the United States and other countries around the world.

In summary, this Washington state study agrees with previous findings on the growing incidence of obesity and obesity-associated diabetes and other serious life-threatening health conditions.⁶ However, the list of diseases and health problems associated with being overweight or obese could be much longer. For example, obstructive sleep apnea, in which a collapsed airway causes breathing to stop or become irregular, is not only associated with obesity, but also with diabetes, heart disease, and high blood pressure. Individuals with sleep apnea are nine times more likely to have diabetes than those without it.⁷

What does intra-abdominal adiposity look like? The drawing below provides a visual image.

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Intra-Abdominal Obesity.

The figure on the top has a BMI in the normal range with no evidence of central adiposity or accumulated intra-abdominal visceral fat. The figure on the right, however, clearly has a potbelly.

To see just how much of a problem obesity is in the United States, three maps of the country comparing the incidence of BMIs above 30 in 1995, 2000, and 2005 are shown on the following page. Not until 2001 did any of these annual maps from the U.S. Centers for Disease Control and Prevention (CDC) include a BMI category of 30 and above for the average BMI of any state’s adult population. But it became necessary to add a BMI of 30 or greater as an additional BMI group in 2001 when Mississippi became the first state in the United States to require the category.

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Growing incidence of weight gain. Maps of U.S. states comparing the dramatic increase in the percentage of overweight and obesity between 1995, 2000, and 2005.

Metabolic Syndrome

Another basic concept to understand is metabolic syndrome, or Syndrome X, as it is also called. Metabolic syndrome is very common in men with potbellies. Having metabolic syndrome significantly raises your risk of having a stroke; heart attack; and type 2 diabetes, with all its complications from medication and daily blood-glucose monitoring to amputations and even blindness. In addition, diabetes also has numerous cardiovascular-disease risks.

Several routine tests can be performed to tell you if you have metabolic syndrome. Here are the key items to look for:

1. Waist greater than 40 inches (101 centimeters)

2. Triglyceride (TG) level above 150

3. High-density lipoprotein (HDL) cholesterol (the good cholesterol) level that is less than 40

4. Blood-pressure reading that is greater than 130/85

5. Fasting blood sugar that is greater than 100.

If you have any three of these factors, you are at high risk of having metabolic syndrome and you should read every chapter in this book. Afterward, take that knowledge and act upon it immediately to lower the many risks to your health. Your yardstick for success is your waist measurement.

BE SAFE, NOT SORRY

If and when you see your health practitioner, ask him or her to do an assessment of your body-fat distribution, particularly visceral-adipose tissue (another way of saying intra-abdominal fat). This will give your health practitioner and you a fairly accurate risk evaluation for the various cardiovascular diseases associated with a potbelly. You should also get tested for the above five items associated with metabolic syndrome at the same time your visceral-fat tissue is measured. The older you are, the more important measures of fat distribution become as an independent indication of your risk for coronary heart disease in particular.⁸ In 2004, more than 1.5 million Americans died of heart disease; let’s not include you or your loved ones in these statistics.

If dying prematurely doesn’t worry you, then consider the impact that excessive weight can have on your pocketbook. In a study of adults in the United States from 1985 to 2000, the net worth of an obese person was roughly half that of a person with a normal body mass.⁹ Adults with a BMI of 22 held the most net worth. From 1985 to 2000, for every one-point BMI increase, net worth fell an average of $1,000. Part of the reason for this remarkable finding is that individuals with normal BMIs live longer and receive more inheritances than heavier individuals, who did not live long enough to inherent additional wealth.

Americans are also complaining about the rising cost of health insurance. A study of medical costs has revealed that among the more seriously obese, known as morbidly obese (BMI greater than 40), medical expenditures rose 81 percent between 1990 and 2000 and cost more than $11 billion. For those overweight, this cost rose by 65 percent. The increase in medical costs was due to how much money was spent on doctor visits, prescription drugs, outpatient care, and inpatient treatment. The medical conditions that had to be treated most often included cardiovascular diseases, cancer, hypertension, and diabetes.

Although the adverse associations of abdominal obesity have been known for some time, recent studies (discussed in Chapter 2) clarify the pathophysiological mechanisms at work. For example, abdominal fat contributes different magnitudes of risk depending on ethnicity. One study reported that 24 percent, 39.9 percent, and 15.7 percent of type 2 diabetes in white, black, and Hispanic women, respectively, could have been avoided if abdominal obesity were absent in the United States.¹⁰ The same may hold true for men.

STRESS IS YOUR ENEMY

Considerable attention in this book is also given to the role of stress, particularly chronic stress, in promoting the accumulation of fat in intra-abdominal visceral tissue. African Americans are exposed to a variety of psychosocial stressors, such as age, race discrimination, and economic hardship, and studies place them at risk of metabolic syndrome (Syndrome X) and cardiovascular and coronary heart disease. These stressors are believed to promote the central deposition of fat by means of stress-related neuroendocrine responses, which are discussed in detail in chapter 11. The evidence is also strong that intra-abdominal adiposity is associated with mental stress, and that the end result of layering large amounts of fat in the midsection of the body is an increased risk of serious complications and life-threatening conditions and diseases that can have a devastating effect on your quality of life and longevity.¹¹

This book is long overdue. If the title of the book alone encourages someone to pick it up and consider purchasing it to learn more about this phenomenon, then thinking of men walking around looking pregnant is well worth the attention it attracts.

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Obesity and Its Causes

Patients with an abdominal predominance of fat tissue have

more complications than those with a predominance

of fat tissue in the buttock and thigh region.

—W. MAYO-SMITH, ET AL. RADIOLOGY, 1989

The causes of obesity are complicated. It is not as simple as reducing energy (caloric) intake and increasing energy expenditure (exercise). Age, gender, height, weight, waist circumference, metabolism, diet, genetics, fat cells, fat distribution, physical activity, stress, and possibly many chemicals in the environment are all related to some degree to whether a person struggles with a weight problem or not—particularly a potbelly.

This chapter begins a journey of discovery as to why a man gets a potbelly and what can be done to eliminate it, with the hope that by getting rid of the potbelly the health consequences related to it will be dramatically reduced.

HOW THE BODY PROCESSES FOOD

Energy intake within the body is synonymous with the term caloric intake. Just as the energy from electricity is measured in watts, the energy from food is measured in calories, also known as chemical energy. A calorie is a measure of heat, specifically the amount of heat needed to raise the temperature of 1 gram (g) of water 1°C. The term kilocalories is also used when talking about caloric intake. Thus, 1 kilocalorie is the amount of heat