Are we running out of colors? And a little more in support of D and aspirin

In 2004, when talking about our new book, YOU: On A Diet, the Owner’s Manual to Waist Management, (a NYT #1 Bestseller that displaced Harry Potter as #1 on Amazon for 177 days I am proud to say) I would start by showing the CDC maps of obesity and worry we would just see all red—1 color. The US through its Center for Disease Control and Prevention has long tracked the rising prevalence of obesity by state using color-coded maps of the U.S. But the last two administrations added colors, so we wouldn’t be all red.

The latest update is now hot off the presses ( In 1994, no state had obesity rates more than 20%. Now no state has an obesity rate less than 20%, and 7 states with obesity rates above 35% (in red on the new map).




But obesity is not a joking matter, or just a matter for jokes about running out of colors. People suffer with the diseases it causes, and the country is much disadvantaged by it. It costs the USA more than 700 billion a year (5 % of all of our GDP) in medical costs (direct, due to type2 diabetes, cancer, dementia, heart disease, arthritis it causes, to name just a few diseases triggered by obesity) and lost productivity due to medical issues.

Our politicians need do something about this epidemic and not just Bloomberg. Obesity is much worse than opioids in the number of people affected and in the long-term disability it causes. Yet we see no national issue or bill to fight it. It is a cultural change that occurred in 1983 when personal responsibility went away apparently, and it became okay to eat anytime, anywhere, and anything from the then new fastfood and convenience stores on every corner and at every gas station (33 percent of Americans eat the type of fast food every day that contributes to hooking you to it). And now more than 50% of Americans do less than 10 minutes of any physical activity, including walking, any one day of the week.

These changes force increased medical costs (more than 50% of the increase since 1994 can be traced to obesity and its consequences) and increased income inequality (more than 100% since 1994 can be traced to increased medical costs) , and will cause much social disruption due to the rationing of health care services that will result if we don’t stop gaining weight.

Our genes haven’t changed since 1994, but the food we eat turns on the genes that make us addicted to some of those foods that foster weight gain. But our culture has changed since 1983, and that change needs to be reversed. Worksites need to take action too—by changing the culture and incentivizing proper weight, the Cleveland Clinic’s 101,000 employees and dependents have lost (on average) more than ½ pound a piece per year for 8 years while the typical American has been gaining 1.5 pounds per year. Doesn’t sound bad till you realize that’s a 30 pound per person difference after 20 years, and much more arthritis, cancer, and dementia. The USA can change the culture—we did it during World War II, and we need to do it again before obesity eats our society alive.

Okay, enough theory [actually it is put in practice as the culture change and incentives plus a whole mess of other things is what is helping Cleveland Clinic avoid over $1000 in health care cost per employee who has joined the health choice program (and well over 60% have), and allowing employees to pay less in premiums and payors to save too]. Recently the New York Times questioned the need for and wisdom of extra vitamin D testing and supplement use. So let me summarize the data in short form, and promise to write more about it next month (by the way another two articles came out revealing how those two baby aspirin’s a day (with a half glass of water before and after each) we discussed last month decrease ovarian cancer risk by over 20% and liver cancer risk by over 50%. We stand by those recommendations for the reasons we enumerated (do check with your doc first).

As to vitamin D2/3, I think the data are much stronger than in the article, which indicated the doc who had done most work to encourage you to get tested had a conflict of interest. Never mind that conflict, he was right as I think much benefit is likely by measuring your vitamin D level and getting it to where it should be. No doubt the level of vitamin D2/3 to shoot for is controversial (we do not even know which to measure, D2 or D3) but in intervention studies in women and men we know that levels above 35 are associated with substantially less breast cancer than below 35 (mg/dL).

Over 67% of those living in Pittsburgh have levels less than 23; the controversy is: is vitamin D the active substance promoting health or is a low vitamin D level a marker of a gene or genes that promote cancer and dementia risk. To summarize studies of over 95,000 people with 10,000 deaths, the genes associated with lifelong low Vitamin D levels increase cancer mortality by 40%. The side effect of vitamin D supplementation does not seem to occur (it is kidney stones) till levels exceed 100 mg/ dL, and you malabsorb it’s active conversion from sun and from your GI tract as you get older. So I recommend measuring it at least once every two years after age 50, and once a year after age 60 and seeking supplements that get your level to between 35 and 80.

So to summarize, since vitamin D2/3 has minimal to no risk as levels under 100, and in intervention trials decreases all cause mortality by 7 to 23%, and is associated with (and in intervention trials does) reduced dementia and cancer risk, I recommend testing and getting (thru salmon or supplements) your D level over 35 and preferably between 50 and 80. But do check with your doc, and we’ll write more when we have more space.

Dr Mike Roizen

Thanks for reading. Feel free to send questions—to [email protected]

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Michael F. Roizen, M.D., is chief wellness officer at the Cleveland Clinic.