2020 Sidney Licht Lecture

Abstract

There are important connections between metabolic abnormalities and poor function. This is relevant because the World Health Organization and the Centers for Disease Control and Prevention indicate that we are facing an epidemic of obesity and pre-diabetes/diabetes, which present substantial and challenging health-care concerns. Most of these people have metabolic syndrome (MS), including hypertension, hyperglycemia, obesity, hyperlipidemia, and hypertriglyceridemia. The relationships among function and MS seem intuitive and reasonable. One link could include abnormal energy production and mitochondrial efficiency in the generation of adenosine triphosphate(ATP). Another link might result from insulin resistance and its impact on interfering with glucose uptake. Sedentary behavior with increased waist circumference is associated with obesity and fatigue. In addition, there has been a reported association between sarcopenia and obesity, both associated with reduced function. The health implications include increased all-cause mortality and is thought to be mediated through processes that include inflammation of muscle and MS. Human function is likely to be influenced by physiological and anatomical as well as environmental and personal factors. These factors will be discussed in an effort to integrate them and explain why people with MS have significant functional problems. The premise is that fatigue is frequently reported, negatively impacts activity and exercise tolerance, and may explain why this group of people is so sedentary. We have effective treatments for fatigue that is associated with MS and obesity. Unfortunately, at this time in the history of medicine, the best treatments are behavioral and require patience and commitment. Risks are very low, rewards are high but not instantaneous.