By Dr. Larry Chiaramonte
In the South Bronx where I work, the rates of asthma are sky high, in large measure because of a high volume of diesel fumes from commercial traffic and cockroaches in homes. Properly treated and advised by doctors, patients do what they can to take their medicines and clean up their homes; these are things they can help. They tend to ignore the things they can’t help, like traffic, which is economically crucial to the neighborhood.
But asthma is not the only epidemic. The South Bronx also leads in obesity. And as with asthma, the rest of the country is following its lead. Why are we becoming too fat? I did a quick survey of a rehabilitated stretch of row houses nearby on afternoon. There were no children. No one riding bikes, jumping rope, playing stick ball. No one skating or using a skateboard. The playgrounds were empty. When I asked about this I received, “Doctor it is not safe for the kids, we rather have them play video games, or watch TV.” Mothers work and do not cook. Fast food has become the regular diet.
“Mechanical” factors associated with obesity, such as airway blockage, increase the frequency and severity of asthma. Obstructive sleep apnea—basically severe snoring as the airways are blocked and the body must jolt itself into breathing again–is in part due to obesity, and in turn aggravates the tendency to gain weight. Obstructive sleep apnea also increases the frequency and severity of asthma. These factors alone support the case for obesity being a causal agent for asthma.
But the association also extends to body chemistry itself. Researchers have compared the controls on the production of IgG [protective] and IgE [allergic] antibodies in normal and obese patients. They have found that fat cells promote IgE production disproportionately, making obese patients more “allergic” than is healthy. There is evidence that proinflammatory cytokines in fat tissue to contribute to both heart disease and asthma.
I know that Americans are weary of being told that they, and particularly their children, should get more exercise, eat less, and eat healthier foods. The consequences of this range of behavioral are thrown at us—hypertension, heart disease, diabetes. Now, you have to add asthma to this death spiral. It’s enough to make you drown your sorrows in a Big Mac and 32 ounces of soda. Don’t.