The number 1 visual of the poor health epidemic in the US and the world is the ever growing numbers of overweight and obese people. According to the CDC, it is estimated that over 1/3 of American adults are obese. That equals 34.9% of American adults. In actual numbers, that 34.9% equals 78.6 million adults. Add in those that are overweight and the percentage of those that are either overweight or obese increases to 69% or 154.7 million adults. That leaves a staggering 31% of Americans that are normal weight.
The distinction of the highest increasing prevalence of obesity is found in women over the age of 60. But that is in adults in the here and now. What of America’s future? Is the future bright or bleak? The younger generations hold the future of America and its Health in its hands. According to the CDC, the future looks bleek and very big:
- 12.1% of children age 2-5 are currently obese
- 18% of children age 6-11 are currently obese
- 21% of adolescents age 12-19 are currently obese
- > 1/3 of children and adolescents are either overweight or obese
It would be one thing if Obesity was confined to childhood. It is another matter all together if Obesity in childhood continued into adulthood. That is exactly what research has revealed. According to research, childhood Obesity correlates significantly with Obesity in adulthood.
So, women lead the way in the prevalence of Obesity > 60 and the future of America’s children appears ready to continue the Obesity trend. What are the specific statistics in men? After all, this post is primarily about the association between Testosterone and Obesity in men? According to the American Heart Association, 36.8 million American men currently are obese and according to the same statistics 79.9 million men are either currently overweight or obese.
What does the future hold for men? Unfortunately, the current trends and projections don’t point to leaner, healthier times ahead for men. According to the National Health and Nutrition Examination Surveys (NHANES), the estimates are that 83% of men will be either overweight or Obese by the year 2020. That is just 5 years away. By the year 2030, a Lancet study projects the Obesity rate in men alone will reach 50%. Maybe Pixar’s WALL-E was more prophetic than simple animation and entertainment.
Lets put these numbers into something everybody understands—$$. According to the same American Heart Association statistics above, the total estimated costs (direct and indirect) of obesity were estimated at $254 billion in 2010. This number is expected to increase to just under a $1 trillion by 2030 if trends don’t change. As I reviewed above, there is no reason to see a significant course correction in the near future. There is no pill or surgical procedure that is going to fix this disease tsunami. The disease model of Health care has lead to the coming disease tsunami. Only a paradigm shift to a Wellness lifestyle model can reverse the coming tide.
Back to the link between Testosterone and Obesity in men. Clearly, there is a bi-modal relationship between low Testosterone and Obesity in men. Low Testosterone in men is associated with increased Obesity rates in men. A 2014 Journal of Endocrinology publication highlights the mechanism(s) by which low Testosterone levels in men leads to an increase in adipose/fat tissue (figure 1). Low and declining Testosterone levels in men are associated with increased abdominal Obesity. Low Testosterone levels actually promotes insulin resistance, muscle loss, and an increase in abdominal subcutaneous fat in men. This metabolic dysfunction that results from low T, including an increase in abdominal subcutaneous fat, then leads to an increase in visceral fat (fat inside the abdomen around organs). Fat, whether visceral or subcutaneous, is biologically active. Adipose tissue produces inflammatory signals (TNF-alpha, CRP, and IL-2 to name a few) and disrupts Hormone balance (Estrogen, Leptin, Adiponectin, Gherlin…). It is this increase in visceral Obesity that has been found to be the culprit in the many adverse health effects (Type II Diabetes, Metabolic Syndrome, Cardiovascular disease…) associated with Obesity. Testosterone therapy has been found to reduce abdominal subcutaneous Obesity, improve lean body mass (muscle), and been found to reduce visceral Obesity in men with low Testosterone. Studies have not been 100% uniform that Testosterone will reduce both visceral and subcutaneous abdominal fat, but studies trend significantly to a reduction in subcutaneous fat and less significant in a reduction in visceral fat. However, 2 studies from 2008 and 2012 have actually shown a reduction in visceral Obesity and increase in muscle mass (2008 only) with Testosterone therapy for men with low-normal Testosterone levels.
In contrast to the association between low Testosterone and Obesity in men, Obesity in men is associated with declining Testosterone levels. The severity of Testosterone decline directly correlates with the severity of Obesity. Greater than 50% of Obese men have low Testosterone. In fact, the best means to increase Testosterone levels in men that are Obese with low Testosterone levels is to lose weight. Some additional studies that highlight this complex, bi-modal relationship include:
Wang C et al. Low Testosterone associated with Obesity and the Metabolic Syndrome contributes to Sexual Dysfunction and Cardiovascular disease risk in men with Type 2 Diabetes. Diabetes Care. July 2011;34(7):1669-1675.
Allan CA, McLachlan RI. Androgens and obesity. Curr Opin Endocrinol Diabetes Obes. 2010;17:224-232.
Faris JE, Smith MR. Metabolic sequelae associated with androgen deprivation therapy for prostate cancer. Curr Opin endocrine Diabetes Obes. 2010;17:240-246.
Hamilton EJ et al. Increase in visceral and subcutaneous abdominal fat in men with prostate cancer treated with androgen deprivation therapy. Clinical Endocrinology. March 2011;74(3):377-383.
Traish AM, Abdallah B, Yu G. Androgen deficiency and mitochondrial dysfunction: implications for fatigue, muscle dysfunction, insulin resistance, diabetes, and cardiovascular disease. Hormone Molecular Biology and Clinical Investigation. Oct 2011;8(1):431-444.
Dhindsa S et al. Testosteorne concentrations in diabetic and nondiabetic obese men. Diab Care. 2010;33:1186-1192.
Maddalena CD et al. Impact of testosterone on body fat composition. Journal of Cellular Physiology. Dec 2012;227(12):3744-3748.
For Testosterone and Obesity in men, which came first–the chicken or the egg? For some men, low T is the cause of metabolic dysfunction. For others, Obesity and resultant low T is the effect of metabolic dysfunction. For some men, the 2 occur together and the exact determination of the cause is impossible. The body is not linear. The body is physiologically dynamic and all these metabolic functions/dysfunctions in the adipose tissue, Testes, Hypothalamus, and Pituitary occur simultaneously (see figure 2).
The relationships between Testosterone and Obesity discussed in this blog applies only to men. The opposite relationship is found between endogenous Testosterone and women. The relationship between Testosterone and women will not be discussed in this blog. Listen to recent youtube posts on the data of Testosterone in women and the Quagmire of Testosterone in women.
To say that Testosterone will help all men lose weight is a grandiose statement devoid of science. But, there is strong, compelling evidence that low Testosterone leads to metabolic dysfunction in men and physiologic Testosterone replacement in these men will improve the metabolic dysfunction, aid in fat loss, and prevent progression to disease.
- Testosterone: the Tale of Two cities (seasonswellness.com)
- Blinded with Science reload (seasonswellness.com)
- Man Boob Nation highlighted on High Intensity Health podcast (seasonswellness.com)