The Susceptibility of South Asians to Cardiometabolic Disease as a Result of Starvation Adaptation Exacerbated During the Colonial Famines

Abstract

South Asians, representing one quarter of the world's population, have disproportionally high rates of obesity and cardiometabolic disease thus resulting an epidemic health crisis. This crisis could be the consequence of epigenetic effects exacerbated during the colonial-era famines resulting in a unique starvation-adapted physiology. Due to evolutionary mismatch in circumstances of abundance, this starvation-adapted physiology can become harmful. Evidence for this starvation adaptation in South Asians includes high body fat and unfavorable adipokines; low lean body mass; lower resting energy expenditure (compounded by lack of brown adipose tissue); greater insulin resistance and insulin response; exaggerated lipemic response to fat and sugar intake; less capacity to handle an overabundance of food; lower fat burning (oxidative capacity) and VO2max during aerobic exercise; and energyconserving response to resistance exercise, as well as increased lipoprotein (a) levels. The Roma people, also of South Asian ancestry, may represent an interesting pre-colonial historical control. Physician and patient knowledge of this unique physiology in South Asians will promote a stronger physicianpatient relationship and foster compliance with treatment.

Mitigating Weight Bias in the Clinical Setting: A New Approach to Care

“…67,68 Research findings also indicate that when an individual engages in restrictive eating patterns, the body cannot interpret the difference between intentional restriction (such as going on a diet) and unintentional restriction (such as famine), 56 which causes the metabolism to slow. 56,69 Human bodies are evolutionarily wired to react to this potential threat to survival by increasing the release of stress hormones, and thus hold onto weight as a form of protection from future starvation. 56,69 For the brain and body, food restriction (either intentional or unintentional) can lead to food obsession and higher rates of disordered eating.…”

“…56,69 Human bodies are evolutionarily wired to react to this potential threat to survival by increasing the release of stress hormones, and thus hold onto weight as a form of protection from future starvation. 56,69 For the brain and body, food restriction (either intentional or unintentional) can lead to food obsession and higher rates of disordered eating. Additionally, this can lead to intergenerational trauma and familial patterns of disordered eating.…”

“…55 Overall, the effects of chronic stress and embodied trauma cannot be understated, as evidenced by their association with generational epigenetic changes. 56…”

“…65,66 According to the National Center for Health Statistics, between 2013 and 2016, 49% of the US population from all BMI categories attempted to lose weight in the prior 12 months, yet there has been no reduction in rates of individuals with an elevated BMI. 67,68 Research findings also indicate that when an individual engages in restrictive eating patterns, the body cannot interpret the difference between intentional restriction (such as going on a diet) and unintentional restriction (such as famine), 56 which causes the metabolism to slow. 56,69 Human bodies are evolutionarily wired to react to this potential threat to survival by increasing the release of stress hormones, and thus hold onto weight as a form of protection from future starvation.…”