I’ve been embarking on a personal research project, looking at the expert panels recommendations as well as primary literature regarding subjects such as diabetes, heart disease, metabolic syndrome, obesity, plant-based diets, etc.
There is indeed one underlying theme tying many of these issues together. Insulin resistance. It appears that insulin resistance is the mechanism driving the metabolic syndrome, which is a condition where a patient has 3 or more of the following: abdominal obesity, high blood pressure, low HDL, high triglycerides, and/or elevated blood sugars. Yes salt does play a role in high blood pressure. But it also appears to be associated with insulin resistance as well. And the metabolic syndrome substantially increases risk of heart disease and all-cause mortality by around 40%.
Treating metabolic syndrome has traditionally been about treating each individual aspect (BP, triglyderides, glucose, etc). But experts are encouraging a more root-cause treatment, focused on reversing insulin resistance. The weight, BP, triglycerides, HDL, glucose, etc. will then begin to normalize once the root cause (insulin resistance) is treated.
The literature is clear: diet is one of the most important factors influencing insulin resistance and obesity. It might be the single most important. In essence, insulin resistance is a dietary problem that needs a dietary solution. Medications (and even exercise) should only play a secondary role. Exercise is good, but should be considered an add-on to the main treatment of better diet.
I just wanted to kind of expand the discussion beyond “losing weight”. There may be too much focus on losing excess body fat for aesthetic appearance. But, if we see excess body fat as more of a “canary in the coal mine”, it makes more sense. Excess adiposity is usually the first recognizable sign of insulin resistance. And chances are, by this point we have already begun having mildly elevated blood sugars and triglycerides. We may have already started the early stages of atherosclerosis and the microvascular damage seen in diabetes.
The good news is that it can be reversed and we can improve our health. But, it must start first with the things we put in our mouth. This has far more influence than how much time we spend exercising.