By Dr. Conway McLean, DABFAS, FAPWHc

The battle of the bulge is being waged on America’s streets and in the homes. Judging by the advertisements, the headlines, and the variety of weight loss products available, it is a titanic conflict. Billions of dollars and many lives have been lost in this struggle. Indeed, many Americans would state they are “struggling with their weight.” At the latest count, two-fifths of America is obese or overweight, a shocking increase over the last few decades. Worldwide, obesity rates have almost tripled over the last four.

Being obese means you are carrying excessive amounts of fat, what is medically termed adipose tissue. Maybe we are being too critical regarding this ubiquitous substance? It turns out adipose tissue has many functions and benefits. As you may be aware, fat cells are the body’s energy storage facility. Consequently, fat is important in maintaining our energy balance and is the most efficient source of energy in the body.

But fat also has important endocrine functions. Certain hormones apparently are produced by adipose tissue, a more recent discovery. It appears fat cells respond to signals produced by organs throughout the body. Functions of these hormones produced by adipose tissue include maintenance of glucose levels, cholesterol, and sex hormones. In addition, it is an effective insulator for heat retention and even produces heat on its own.

Another new finding, a nerve connection has been found to exist between fat tissue and the brain that was heretofore unknown. This network seems to be carrying information from fat tissue to the brain and back. The studies indicate an active relationship between the two, maybe more than simply monitoring what is happening. Control is exerted by the brain on these tissues, helping to maintain blood sugar levels.

As you might expect, fat is carried in different regions of the body, with sex differences accounting for variations in distribution. Visceral fat is carried amongst our organs in contrast to that found under the skin, the latter important in body temperature regulation. Carrying too much visceral fat is associated with significant health risks. Increased amounts have been clearly linked with a heightened risk of many debilitating conditions. We cannot yet say the exact mechanism for these dramatic consequences, but we know they exist.

Carrying too much adipose tissue, especially around the middle, increases greatly the likelihood of developing diabetes, heart disease, or a stroke. Another consequence less often mentioned is that of osteoarthritis. The increased burden of extra pounds on the weight bearing joints, the knee especially, results in excess stress to cartilage tissue and its degradation over time. How many knee replacements could have been prevented had a few pounds been lost?

Advances in medical research in these decades have revealed some exciting developments in healing, and how the body performs this vital function. The actions and abilities of stem cells have garnered tremendous attention. This special cell type has the potential to turn into any kind of tissue and is essential for the process of cell and tissue production. They have the capacity for self-renewal, meaning they can make new ones of themselves.

The creation of blood cells is an on-going process and stem cells are required for it. It turns out, adipose tissue has stem cells, quite a few apparently, and is obviously readily available. And easy to access, as any plastic surgeon will tell you. A new field of research has sprung up revolving around these adipose-derived stem cells. These plentiful cells are being used routinely in tissue engineering medicine, as well as various surgical procedures, and have been proven effective.

Treating diseases with stem cells is another direction of research. Clinical trials are in progress evaluating these unique cells in the treatment of liver disease, diabetes, and many skin problems. Stem cell preparations derived from a type of blood cell have been used for many orthopedic problems. Stem cells obtained from placental tissue (from a planned C-section) are also becoming a routine technique to resolve some commonplace musculoskeletal issues.

Functioning joints are critical to health and well-being. When they become painful, too often a loss of cartilage is the problem. The “holy grail” of orthopedic medicine is a replacement for cartilage, some material that we can control and produce. Although results are not definitive, there are indications that stem cell therapy may aid in cartilage production, an exciting direction of study.

An under-appreciated part of the human body, the bottom of the foot receives tremendous stress over the course of our lives. When the specialized padding in this area thins, weight bearing becomes painful. Fat tissue has been transplanted from another area into the ball of the foot trying to reconstruct the fat pad. Two small studies were promising, and research is on-going.The evidence is clear: fat tissue is important in our general health, but (as is often the case in nature) too much of anything is a bad thing. When we carry more weight than we should, excessive stress is placed on our musculoskeletal system….and many others. Fat has some vital functions, and we need some in our body, but it would appear our Western diet stimulates the development of an unhealthy excess. Our nutrition is important to health.

EDITORS NOTE Dr. Conway McLean is :a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.