Fighting for Muscle: The Failures of the Current Obesity Paradigm

The current obesity epidemic is one of the greatest health crises facing the modern world. Over 70% of American adults are overweight or obese. Despite decades of research and public health initiatives aimed at combatting obesity, rates continue to climb. We have failed in our approach.

I learned this firsthand during my nutritional sciences fellowship I saw thousands of overweight and obese patients in the later stages of their lives. Almost universally, these individuals struggled with chronic health problems – diabetes, hypertension, heart disease, dementia. Their quality of life was tremendously diminished.

In the process, of going low fat ageing people destroyed their metabolism, lost muscle mass, and damaged their brain. I was told this was simply the standard of care – but that was not good enough. There had to be a better way.

The Muscle Health Crisis

When I dove into the research, I realized the unifying factor among my sickest patients was poor muscle health. This opened my eyes to a new paradigm – we are facing not just an obesity crisis, but a muscle health crisis.

Muscle is the key organ for metabolism, movement, and overall health. It is our metabolic “sink” where carbohydrates and fats are burned for energy. It powers our immune system. It acts as our body armor, protecting our bones and organs. Muscle is the organ of longevity.

Decades of overeating and under-exercising have clogged up our metabolic sink. Our muscle is marbled with fat rather than strong and lean. As we age, we lose muscle mass and strength. This brings on all manner of chronic disease.

We have focused obsessively on body fat, when we should have been focused on building strong, healthy muscle. Obesity is not a disease of excess fat, but rather a disease of insufficient muscle. We do not have an obesity epidemic – we have a muscle and mobility crisis.

Why Muscle Matters

  • Metabolism – Muscle is the engine of our metabolism. Loss of muscle mass causes metabolic rate to plummet. More muscle means you can eat more calories without gaining fat.
  • Blood Sugar – Muscle helps stabilize blood sugar by taking up glucose from the bloodstream. More muscle means better blood glucose control.
  • Immunity – Muscle produces important immune regulatory proteins. Loss of muscle weakens the immune system.
  • Mobility – Muscle powers movement and balance. Loss of muscle leads to frailty, disability, and falls.
  • Brain Health – Signals from muscle maintain brain volume and connections. Loss of muscle is linked to dementia.
  • Quality of Life – Muscle allows greater independence, energy, and vitality as we age. It improves physical function and self-esteem.
  • Longevity – Higher muscle mass is one of the strongest predictors of longevity across the lifespan. More muscle means longer life.

Why Have We Were Wrong?

For 50 years we have waged a “War on Obesity” – demonizing fat, counting calories, promoting endless diets. And for 50 years the problem has only grown worse. Why? Because our approach is wrong.

Our health guidelines are skewed – 70% of our diet is processed carbs and sugar. We overlook the importance of exercise – only 23% of people meet physical activity recommendations. We under appreciate protein – 40% of elderly women do not get adequate protein.

Mainstream nutrition advises lowering protein. This will have devastating consequences. We need more high-quality protein from both plants and animals, not less.

We have failed to educate people properly about exercise and nutrition. We did not warn Betsy and others about the perils of muscle loss. This ignorance has bred an epidemic of preventable chronic disease.

The Path Forward: Fight for Muscle

We need a paradigm shift in medicine and public health – from an obesity model to a muscle-centric model. We must help people understand why muscle matters and how to build and maintain it across a lifespan. This is the key to combatting diabetes, dementia, frailty and more.

As a physician, this is my fight. It should be your fight too. Here is what we must do:

1. Resistance Exercise

  • Resistance training is the closest thing we have to an anti-aging elixir. It builds muscle, boosts metabolism, and improves health from head to toe.
  • All adults should perform resistance exercise at least 3 days per week. Use free weights, resistance bands, or bodyweight exercises. Work all major muscle groups.
  • Continue resistance training even after you want to quit. Consistency over time is key for building muscle.

2. Protein Intake

  • Protein provides the essential building blocks for muscle growth and repair. Make high-quality protein a priority at meals.
  • Good protein sources include lean meats, poultry, fish, eggs, dairy and plant proteins like beans, nuts and soy.
  • Women over 65 should aim for at least 40g of protein daily, while men should get over 50g. Spread protein intake throughout the day.

3. Meal Timing

  • Muscle growth is maximized by consuming protein around exercise and at breakfast and before bed.
  • Eat at least 20-40g of protein at these key times to stimulate muscle protein synthesis. Include protein in snacks too.
  • Carbohydrate intake also helps drive protein into muscle when eaten along with pre- or post- workout protein.

Muscle Equals Health

We must spread the message that muscle equals health. Staying strong and lean gives us the best chance to enjoy a long, vibrant, independent life.  Muscle is the most important organ for maintaining health, function and longevity. Here’s why:


  • Skeletal muscle is our main metabolic machinery. It accounts for ~40% of our total body weight and yet burns over 20% of resting calories.
  • When muscle is lost, resting metabolism plummets. This makes it much easier to gain fat.
  • More muscle mass equals a higher metabolic rate. Individuals with more lean muscle can eat more calories without weight gain.
  • Building muscle through resistance training can boost resting metabolism by 7% or more. This adds up to hundreds more calories burned per day.

Blood Sugar Control

  • Muscle helps maintain stable blood sugar by taking up glucose from the bloodstream. It stores glucose as glycogen and burns it for energy. Muscle helps circulate essential nutrients and growth factors that nourish the brain and nervous system. It protects brain health.
  • Loss of muscle mass is directly linked to insulin resistance and poor blood sugar control. More muscle means better insulin sensitivity.
  • Resistance exercise makes muscle more responsive to insulin and better able to handle large glucose loads. This effect lasts for up to 2 days after strength training.


  • Muscle produces cytokines and other peptides that regulate immune function. It helps control inflammation. Signals from muscle help maintain brain volume and keep neural connections sharp. Loss of muscle is linked to cognitive decline.
  • Sarcopenia (loss of muscle) weakens immunity. Muscle helps mobilize immune cells, proteins and antibodies. People with more lean muscle mass are less likely to develop dementia. Resistance exercise may improve memory and thinking skills.
  • People with more muscle have better vaccine responses and are less likely to get infections or cancer. Muscle keeps immunity strong.

Mobility and Function

  • Muscle powers all movement and physical function. Loss of leg strength leads to slower gait speed, difficulty with balance, and falls.
  • Weakening of grip and upper body muscles makes daily tasks like cooking, cleaning and dressing difficult. Muscle loss impairs independence.
  • Resistance exercise builds strength and coordination. This keeps us mobile and functioning at the highest level throughout life.

More muscle brings greater energy, vitality, self-confidence and enjoyment of life. Muscle means you can seize each day to the fullest. Staying strong allows us to keep up with kids and grandkids, pursue hobbies, travel and maintain independence into old age. Muscle gives us control over our lives. It is crucial for living life to the max throughout the lifespan.

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