“Bruno,” Dr. Livingston had said, “you should be dropping dead any second.”
Phil Bruno was super-sizing again. It was just past 5:30 on a spring evening in 2004, and he was driving home from work. He pulled into a White Castle, one of many fast-food outlets lining Route 100 in his hometown of Manchester, Missouri, a suburb of St. Louis. He was only a mile from his house, where his wife, Susan, was cooking the usual big Italian dinner for their family of five, but he was hungry now. The urge was automatic.
Ten minutes later, with a bag of burgers steaming on the seat beside him, he pulled into a McDonald’s and ordered a Double Quarter Pounder with Cheese, an apple pie, and a chocolate shake to wash it all down. “I did this because I would be embarrassed to order too much from one drive-through,” Phil explained to me. “I didn’t want the person at the window to look at me funny.”
Phil had always loved food, which was part of the fabric of his tight-knit Sicilian-American family: Grandma and her lasagna were right down the street. But he’d been athletic in his youth, playing high school football and carrying a robust but reasonable 215 pounds on a six-foot-three-inch frame. Then, in his mid-twenties, he’d stopped working out, as many of us do when life starts to chew up our time. Over the years, his regular meals and high-calorie bingeing had turned him into a physical and emotional wreck. His joints ached whenever he used the stairs, his heart hammered, and he was possessed by a strange, burning thirst that no amount of ice water could quench. “I was 47 years old,” he says, “but I felt like I was 80.”
Prodded by a friend, Bruno finally went to see his long-time family physician, Don Livingston, in early 2004. The results were harrowing: his blood pressure was at a firehose-like 230 over 150, his blood sugar was off the charts, and his A1C—an important blood marker for diabetes—was 16. (It should have been under six.) He weighed a scale-crushing 470 pounds.
Phil had developed Type 2 diabetes, but that was just one of his problems. He walked out of the doctor’s office with prescriptions for 12 different medications and supplements, from fish oil to blood-pressure medicine to Lipitor for his cholesterol to Glucophage for his diabetes. And he never forgot Dr. Livingston’s ominous words at the end of the visit. “Bruno,” he had said, “you should be dropping dead any second.”
Everyone knows that being fat is bad for you, but most people can’t explain exactly why. Some reasons are obvious. Fat tends to go hand in hand with diabetes, and more weight means increased stress on joints and the heart. More puzzling to researchers is that excess fat seems to be linked with cancer of the kidneys, colon, and liver, and even to cognitive decline.
Until fairly recently, fat was thought to be inert, evolution’s wobbly way of letting humans store energy for lean times. And we’ve long known that it’s better to be slightly overweight than underweight, as a recent study in the Journal of the American Medical Association reiterates.
Starting in the 1990s, though, scientists began to realize that fat is best understood as a single huge endocrine gland, one that wields powerful influence over the rest of the body. “For a typical North American, their fat tissue is their biggest organ,” says James Kirkland, M.D., director of the Robert and Arlene Kogod Center on Aging at the Mayo Clinic.
