Doctors spoke about the tragic future of fat men

As the academician of the Russian Academy of Sciences, professor, head of the department of urology and andrology of the FFM of Moscow State University named after M.V. Lomonosov Armais Kamalov, some 150 years ago, medicine could not provide a long life expectancy for men: in the time of Chekhov, they died on average up to 50 years, mainly from heart and infectious diseases.

But with the beginning of the 20th century, the natural sciences began to actively develop: the laws of heredity were discovered, antiseptics, ether anesthesia were invented, and in 1929 Ian Fleming discovered penicillin. As a result, life expectancy began to increase. “And yet, despite the high possibilities of medicine, men in Russia live an average of 10 years less than women. According to large studies, the life expectancy of a man in Russia is 64 years, and women – 74.8 years,” says the academician Kamalov.

According to Rosstat, the main medical causes of death today are CVD (cardiovascular diseases), cancer, respiratory and digestive diseases. And in each of these categories, the mortality rate for men is higher than for women.

“A separate problem is obesity, which is associated with many CVDs (heart attacks, strokes, coronary heart disease, etc.), and type 2 diabetes, and oncological diseases, and diseases of the respiratory system, and digestion,” the expert continues. – In 2016 The Lancet published a major meta-analysis with data on more than 10 million people that established the relationship between obesity and mortality from various causes.

It has been reliably proven that with an increase in BMI (body mass index), the risk of mortality in men increases. So, with a BMI of 30-35, the risk of death in men exceeds the risk of death in women with a similar body weight by 1.7 times; and with a BMI of up to 40, it is already 2.7 times higher. And for each of the listed diseases, it is also higher.

Of course, the whole world has already realized the horror of the situation – and in different countries at the state level, strategies and national programs have been adopted to combat obesity, which WHO has recognized as one of the most serious problems of the 21st century. Policies include increasing the availability of healthy foods and conditions for physical activity, but so far the trends are disappointing: in half a century, the number of obese people has tripled – and continues to grow at an alarming rate.

As Armais Kamalov explains, obesity triggers a whole cascade of pathological processes in the body, which leads to the early onset of chronic diseases and a reduction in life expectancy: “Obesity leads to the same mechanisms for acquiring diseases as natural aging processes – but it accelerates them. Obesity and aging – two sides of the same coin, the mechanisms of their influence on the body are the same. For example, one recent study showed that obese adolescents experience shortening of telomeres (sections of DNA associated with lifespan), which until now was known to be also caused by inflammation and oxidative stress.

A large study published in January 2023 of more than 400,000 men found that obese men doubled their risk of colon and prostate cancer. For prostate cancer, every 5 units increase in BMI increases the risk of advanced cancer by 8%. “Adipose tissue is associated with oncogenesis,” the expert says.

It is also known that the Japanese living in their homeland are much less likely to get prostate cancer than the Japanese living in the United States. “Perhaps this is due to the peculiarities of nutrition, but also with a higher incidence of obesity in the United States,” says Academician Kamalov.

And finally, there is something that scares men the most. “As Tolstoy said, a man can survive any tragedy and catastrophe, everything except the tragedy of the bedroom. And obesity reliably leads to a decrease in erectile function, libido and fertility. A man should really think about this seriously.

According to one large meta-analysis conducted among more than 40 thousand men, the prevalence of erectile dysfunction (ED) increases with increasing BMI. ED is 1.6 times more common among obese men; obesity is an independent predictor of ED. Only a quarter of obese men are satisfied with the quality of their sexual life, and 80% show sexual interest. In addition, ED is a barometer of men’s health. Atherosclerotic lesions of the cavernous arteries (in the penis) appear 2-3 years before the onset of symptoms of heart and vascular diseases,” Armais Kamalov continues.

As a researcher at the Faculty of Fundamental Medicine of Moscow State University, endocrinologist Zukhra Pavlova, against the background of subclinical inflammation of adipose tissue, a man has an increased risk of developing CVD, carbohydrate metabolism disorders, androgen deficiency, arthritis, thrombosis, sleep apnea, ED.

“We did a study on a male sample of people with a high BMI to understand the prevalence of testosterone deficiency. It showed that its prevalence is 57.5% – this is higher than the world average. But the most interesting thing is that we proved that with increasing BMI, the number of men with testosterone deficiency increases dramatically – it increases from 35% to 89% with the third degree of obesity,” says Zukhra Pavlova.

According to the deputy director for scientific work of the Medical Research and Education Center of Moscow State University named after M.V. Lomonosov, cardiologist, corresponding member of the Russian Academy of Sciences, Professor Simon Matskeplishvili, the relationship between diseases of the circulatory system and obesity has long been known. And if after 2014 in our country it was possible to achieve a decrease in mortality from CVD, then the pandemic again threw us back a decade.

“The body weight of people around the world is changing, which is associated with changes in diet and with a sharp decrease in physical activity. The number of people with a high BMI is constantly increasing; today, about half of the people are overweight, and about 20% of the people are obese.

We, cardiologists, consider obesity as a metabolic disease, manifested in the excessive development of adipose tissue, which progresses over time, has a range of complications and is likely to relapse after a course of treatment. With diabetes, CVD, non-alcoholic fatty liver disease, kidney failure, respiratory diseases in people with obesity, mortality is much higher, and the higher the BMI, the higher the likelihood of dying,” says Dr. Matskeplishvili.

Not so long ago, scientists found that with obesity, a huge amount of pro-inflammatory agents accumulate in the heart muscle. However, they may not be visible in the tests, but their presence leads to type 2 diabetes and kidney disease.

“In addition, this causes hypoxia of cardiomyocyte cells and their death, disruption of the processes of contraction and relaxation of the heart, changes in the geometry of the heart, which ultimately results in heart failure, leading to the death of the patient. And he seems to have metabolically healthy obesity, all tests normal – but there is such a serious complication.

As a doctor, I often hear from patients: all my tests are normal, the cardiogram is normal. And what? A recent study of 3.5 million obese people without CVD or diabetes found that these people had a 60% higher risk of CVD. And they also have a two-fold increase in the risk of developing heart failure – and this is a disease with a much worse prognosis than most cancers! ”says Simon Matskeplishvili.

At the same time, if earlier it was not possible to detect the early stages of myocardial dysfunction, now diagnostics have appeared, and practice shows that in obese people, even with good blood test results, a serious violation of the longitudinal deformation of the heart muscle is often detected. “The Russian Federation is a region of increased cardiac risk, and in men it is much higher than in women. And obesity in men is a very serious factor in adverse cardiovascular risk,” says Professor Matskeplishvili.

And the good news is that obese and overweight men who exercise regularly have a much better prognosis for CVD than men who are not overweight but do not exercise regularly.

Armais Kamalov recalls that problems can be solved by modifying one’s risk factors: a simple change in diet (including not eating after 6 p.m.) leads to a decrease in BMI and all risks of diseases.