We Have the 'Cure' for Obesity, But Is the Pill Too Difficult to Swallow?

When you read aboutᅡᅠone in 10 kidsᅡᅠfacing the possibility of a liver transplant due solely to the unhealthful American diet, you really do have to wonder: Where on earth is the tipping point?
06/18/2014 06:30 pm ET Updated Dec 06, 2017

Many years ago, I mentioned to a doctor friendᅡᅠthat a woman I knew --ᅡᅠa Seventh Day Adventist who never drinks alcohol -- had been toldᅡᅠshe was at risk forᅡᅠcirrhosis of the liver due toᅡᅠher poor diet and excess weight. ᅡᅠMy doctor friend looked at me skeptically and said I must have misunderstood the diagnosisᅡᅠ-- one could not develop cirrhosisᅡᅠthat way, she said --ᅡᅠand since I'm no medical expert, I assumed I'd been misinformed.

But while "nonalcoholic fatty liver" was so rare 30 years ago there was no medical name for it, theᅡᅠNew York Timesᅡᅠreportsᅡᅠit now affects one in 10 American children, with the rate among children and teens more than doublingᅡᅠin the last two decades. ᅡᅠOf those afflicted, 10 to 20 percent will eventually develop the liver scarring that can lead to cirrhosis, liver cancer and liver failure, requiring a transplant for survival. ᅡᅠThe condition is also aᅡᅠrisk factor for developing heart disease and Type 2 diabetes.

The cure for nonalcoholic fatty liver is quite straightforward: improving one'sᅡᅠdiet by cutting out fast and processed foods and sugary beverages. ᅡᅠBut despite incredibly powerful motivators ᅡᅠ-- ᅡᅠ"crippling" abdominal pain (one patient referred to it as "being stabbed in your stomach with a knife")ᅡᅠand theᅡᅠpossibility of needing a liverᅡᅠtransplant (or, far worse, needing a transplant and andᅡᅠbeing unable obtain one, as demand outstrips the number of organs available)ᅡᅠ-- many patients still find this "treatment" just too difficult:

Yubelkis Matias, 19 ...ᅡᅠwas told she has NASH several years ago. She is reminded of the trouble brewing in her liver by the sharp abdominal pains that come and go ... [S]he has been told by her doctors that diet and exercise may be her only shot at reversing the disease. But at 5-foot-5 and 200 pounds, she finds every day a struggle

"I'm on a roller coaster," she said. "I eat healthy, then not healthy -- pizza, McDonalds, the usual. My doctor told me I have to quit all of that. But it's cheap, and it's always there."

[...] "A lot of times when I see a patient with fatty liver," [Dr. Shahid M. Malik of the Center for Liver Diseases at the University of Pittsburgh Medical Center] said, "the first thing out of their mouth is, 'Well, is there a pill for this?' And there's not. There just isn't. You have to make lifestyle changes, and that's a much more difficult pill for people to swallow."

One could attributeᅡᅠthese patients' inability to improve their diets to aᅡᅠlackᅡᅠof individual willpower, but this conclusionᅡᅠignores a whole host of societal factors that make eating healthfullyᅡᅠon a regular basis extremely difficult for many people. ᅡᅠAs Dr. Thomas Friedan, director of the Centers for Disease Control andᅡᅠPrevention, once memorablyᅡᅠsaid:

... if you go with the flow in America today, you will end up overweight or obese.ᅡᅠ That is not a reflection of individual personal failing.ᅡᅠ It's a reflection of the structure of our society ... [T]he popularity of weight loss programs is a reflection of both the intense desire of many people to lose weight as well as the great difficulty of doing so. ᅡᅠ[Emphasis mine]

Meanwhile, when you have a condition like fatty liver disease that's growing ever more prevalent, and patients clamoring for "a pill" instead of weaning themselves off their unhealthful diets, it's predictable that drug companies would see the potential forᅡᅠhuge profits. ᅡᅠThe Times reports that at least two companies are now scrambling to develop drugs which will help treat the disease, and one of those companies saw its stock price "soar" when its first clinical trial showed promise.

There's nothing new about any of this, of course. ᅡᅠFood companiesᅡᅠprofit from our dependence on their productsᅡᅠwhile drug companies reap the profits on the other sideᅡᅠof the equation. ᅡᅠBut somehow the prospect of kids doubled over with liver pain and facing potential liver failure, entirely due to Big Food's grip on our palates and our lifestyles, got to me on a visceral level.

I'm reminded of this quote in the film Fed Up fromᅡᅠDr. David Ludwig, a professor at the Harvard Medical school and a pediatric obesity expert:

What does it say about our society if we wouldᅡᅠrather send children to such mutilating procedures but yet lack the political willᅡᅠto properly fund school nutrition and ban junk foodᅡᅠadvertising to children? It reflects a systematicᅡᅠpolitical failure. We're the richest society in theᅡᅠworld. We've failed because we've placed privateᅡᅠprofit and special interests ahead of public health.

Dr. Ludwig was referring to a morbidly-obese teen undergoingᅡᅠgastric bypass surgery, but he could just as well have been referring to an overweight child needing a liver transplant. ᅡᅠAnd, indeed, we are clearly in the midst of a "systematic political failure," because just as we already knowᅡᅠthe "cure" for fatty liver disease, we also alreadyᅡᅠknowᅡᅠthe the "societal cures" for all obesity-related illnesses:

  • Restructuring the agricultural subsidies thatᅡᅠmakeᅡᅠfast food and processed food unnaturallyᅡᅠcheap, while inadequately supportingᅡᅠfarmers growing fruits and vegetables;
  • Banning the advertising of junk food to children;
  • Taxing and/or placing healthᅡᅠwarning labels on non-nutritive, sugar-sweetened beverages;
  • Investing more money in federal school meal reimbursement, so schools can afford to buy healthier food and pay for the increased labor needed to prepare it;
  • Investing in school infrastructure, both to build school kitchens in whichᅡᅠscratch-cooked meals can be prepared, as well as home economics classrooms where children can acquire basic cookingᅡᅠliteracy and skills; and
  • Requiring and funding meaningful nutrition education curricula, including home economics, throughout the K-12 school years.

And yet, like a fatty liver patient addicted to fast food, our elected leaders are currently too addicted toᅡᅠBig Food's and Big Soda's lobbying dollars, and/or too afraid of "nanny state" rhetoric from the right, to muster the political courage to fulfill thatᅡᅠRx.

For four years now, I've been saying on my blog that some day the costs of obesity, both financial and personal, will be just too high for our legislators to continue to ignore. ᅡᅠBut when you read aboutᅡᅠone in 10 kidsᅡᅠfacing the possibility of a liver transplant due solely to the unhealthful American diet, you really do have to wonder: Where on earth is the tipping point?