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The Cause of Obesity - Part 3

January 29 2012

This is the last post on this topic (Part 1 & Part 2). Lot of people made comments and there were a lot of discussions on a few different blogs and forums. I had a posted in a couple of other forums too. I knew very well that I will get a lot of criticisms, but I am sure these articles will will make a lot of people think twice before they make comments about obesity and obese people.

This a very important topic and I admire all those passionate commenters who took the time to express their concerns and opinions.  In this article, I will be replying to some of the commonly asked questions about the articles

1. This is just a matter of how you view it. Environment is required for obesity. Look at the concentration camps and tell me how many people are obese, Anoop?

This is one question that was raised lot. This is almost a knee-jerk response from people. It is true that environment is required. I don't think anyone will argue against it. The concentration camp is just an example of the “absence” of environment or the “lack” of environment. If we don't give food, nobody will be obese, or for that matter, nobody will be even healthy or normal weight!

What we are concerned is when everyone is given free access to food (or the same environment) why only a few people become obese?  Here is an example I gave to one of the posters. I usually don't try to make analogies because they are often wrong, but I feel this gets the point across.

Obesity

Imagine you plant Sequoia tree (one of the tallest trees) and other trees in a plot which has the same type of soil (same environment). After a few years, you see the sequoia tree taller than others. Are you going to say the difference in tallness of the trees is because of the soil (environment) or simply because it is the sequoia tree (genetics)? Almost 99% percent of people would simply say it is the sequoia tree. We are not going to sit and argue if it weren't for the soil the tree wouldn't be this tall.  But when it comes to obesity, we just can't see the obvious. 


2. Just like other genetics disorders, obesity will not manifest if there is no environment.

“Every genetic disorder is 100% genes and 100% environment”, by Ken Rothman (one of the epidemiological greats). A classic example quoted is the phenylketonuria (PKU), a genetic disorder which characterized by a mutation in the gene for enzyme rendering it nonfunctional; this is about as 100% genetic as a disease can get!  If it goes untreated, the kids develop mental retardation and brain damage.  Nevertheless if there was no phenylalanine given - a phenylalanine free-diet, there would be no PKU, so one could argue it is 100% environmentally determined.

The huge mistake in comparing PKU (or other genetics diseases) and obesity is that in PhenylKetone Urea (PKU) kids are not “hungry” for phenylalanine.

In obesity, hunger is THE fundamental problem. We used to believe that people became fat because they had a slow metabolism or they spent less energy (Non-exercise activity thermogenisis). Now we clearly know that Leptin, Ghrelin and all other staggering complex of hormones are working at the hypothalamus by increasing or decreasing appetite. When leptin deficient kids who have a voracious appetite are treated with leptin, the first thing to drop is their hunger. Kids with Prader-willi syndrome eat from garbage cans because they feel they will die if they don't eat. Bariatric surgery works so well because it is bunting their appetite for some weird reason. People who lose a lot of weight gain weight back because they are primarily hungry. 

So obesity is not a “passive” genetic problem where the genes are just sitting there in the background silently until they see food. People eat because they are hungry.


3. Obesity is all about people eating more. If obese people eat less and move more, they will not be obese.

Obese people are fat because they eat too much. Everyone knows that. The question is why are these people doing it in the first place? Or why are 70% of the non-obese not doing the same? Is it lack of will power or laziness when both have access to the SAME toxic environment?

If it is not biology then it should be lack of will power or laziness. If that's the case, we have a bigger issue here. Obese people are lazy and are incapable of changing habits and behaviors. This is so earth shattering discovery that is worth the Nobel Prize in the field of psychology.

4.  Ok. Obesity is largely genetics. But there are a lot of people who lose weight and keep it off, right

And this is the problem with anecdotal evidence: looking at a few positives and casually extrapolating to everyone. Nobody wants to write about their tales of weight loss failure or struggles. People only hear (or want to hear) the grandiose tales of weight loss success in magaziines and on TV. And this is just a minority.

The negative hits never get counted or talked about.  In medicine they say, “dead men never tell any tales”. In research, they count the negative hits too. There are people who are struggling very hard, but still cannot lose weight and keep it off. 

Here is one commenter: How interesting! I have struggled with weight all my life. I have gone from a size 16/18 to a size 10/12 without ever going below 65kilos. It is as if my body simply will not release any more weight. Also, I recently lost 5kilos over 4 months or so, without losing any fat percentage whatsoever! Again, it just will not go! At size 10/12 I am still 35% fat, and have only ever been 40% fat at my heaviest at 85 kilos. It feels mad!

Her story will never come on a magazine or a blog. She might very well have a biology which makes it hard to lose weight and keep it off. But they are all lumped into the same category and just crucified for not working hard enough or making bad choices.  This is an example of how research or science helping morality. We are the very same people who back in the days labeled schizophrenics as possessed by demons and people with complex regional pain syndrome as mad! And what helped them? Science or understanding the biology - not more or better anecdotes.

5. Twin studies show heritability of obesity to be around 60-80% (very high). So 60% of your weight is explained by genes and the rest is environment.

No. Heritability can only explain the variation between individuals within an environment. So when they say heritability of height is 90%, it means 90% of the difference between average height and extremes of height can be explained by genes. We cannot say that this percentage of the weight is due to genes or environment.

6. Everyone can get obese if they eat enough food or have access to enough calories. Look around, people now are fatter than they were in the 70's. How do you explain that?

And this is the number one reason why people instinctively question these articles.

And this is another problem with anecdotal evidence. When people say people are getting fat, they have no accurate way of quantifying the gain in weight. They are just eyeballing and making conclusions. Did they gain 10, 20, 50, and 150? Most people are talking about their 5 to 15 lbs weight they gained or saw their friend gain and extrapolating it to the effect of environment on obesity.

There is no question that people gain 10-15 lbs due to environment. You won't call that fat do you? To go from overweight category to Obese (25 BMI to 30 BMI),you have to gain around 35-40lbs. To go from normal weight to obese (20 -30 BMI), you have to gain around 75-80lbs. To go from normal weight to extremely obese (20-35), you have to gain 125lbs. But if you are right below 30, you can gain just 2-3 lbs and be clinically obese!

Do you seriously think people gain this 50-100lbs weight by “accident” if they have food around?

And it is extremely hard for people to get obese. If you think it is easy, check this documentary of people trying hard to get obese

7. What about people who gain a lot of weight as shown in NHANES study in US?

This is a good point. For people who are already heavy (around obese), the toxic environment is making them worse. And Karky had commented on this. They are gaining 3-4 times the weight than the normal or underweight people. These are the same people who make the average weight gain on US go up and make the rest of us look fat too.  This is a classic example of gene-envronment interaction.  

8. This kind of gives people a cop out in that it justifies the genetic component, but it’s a bit like saying “Cancer runs in my family, all of the smokers died from it.

There are number of people on Facebook and other blogs that have made similar comments. When did we get so concerned about their health and welfare I ask?  Give them a break for heaven sake.

Obesity

Most obese people are often depressed, lack self esteem and live a life in an endless cycle of self-blaming. There is no other population that has been discriminated for so long, even in the 21st century. These people have been discriminated and judged everywhere, in schools, workplaces, and even by health care professionals. It is clear in research that even health professionals (also people who treat obesity) associate obese people with being “bad” and “lazy” and “worthless”. This is largely because we still think obesity is all about a personal choices and we are too cuddled up in our cognitive biases to question our assumptions.

And for all the normal people who are crying out loud, why can’t you all get a six pack? After all just like losing weight, getting a six pack is as simple eating less and working more. 

9.  So you are saying just lose 10-15 lbs or 5-7% of the weight?

Losing weight is extremely simple in principle, but extremely hard for the majority and maybe almost impossible for some. And this is what the research says too.  IOM (Institute of Medicine) and the NHLBI (National Heart, Lung, Blood Institute) recommends this too. In fact “success” in weight loss treatments is a weight loss of >=5% of bodyweight maintained for 1 or more years.

This amount of weight loss will not bring many people even close to normal BMI. Then why it is set so conservatively? Because we know that majority of people regain almost all the weight back within 3-5 years. The  IOM summarized the long term findings by saying” those who complete weight loss programs lose approximately 10% of the body weight, only to regain two thirds back within a year and almost all of it back within 5 years”. And this hasn't changed a bit even now.

We have number of studies to show that even moderate looses have significant health benefits. In fact, two of the the large multicenter trials - the DPP and the LOOK AHEAD study- has shown this.

So lose 10-15 and maintain it for 6 months. If it can be maintained without extreme difficulty, try to lose more. I am not going to sit and argue with people who want to lose more. But they should understand what they are dealing with and be better prepared.

9. People could become fatalistic in their approach to weight loss upon reading the article.
 
Does anyone here have a better option? 

What are you goona to tell them when they fail?  And most will. That since it not genetics, it is probably you; so try again. And you thoroughly deserve all the mental agony and suffering you go through and also the stigma associated with obesity?

10. Ok agreed it is largely genetics.  It will not change the treatment of obesity since we cannot change genes.

Finally, everything comes down what we can do about it. I wouldn't have written this series if there were no practical applications. Just understanding the biological basis of obesity, changes everything: It changes the way we treat obesity and treat obese people.

  • Obese people will set realistic goals (5-7%). Most people set weight loss goals looking at magazines or they think they have to come down to normal BMI to be called 'healthy'. If it can be maintained without extreme difficulty, try to lose more.
  • People will immediately focus more on weight maintenance than weight loss. I always tell my clients that “weight loss is easy, weight maintenance is the hardest part”. People just don’t get this idea because they have no clue about the biological basis of obesity whatsoever. People will think long term, and will think more about how to maintain their weight loss than how fast they can lose the most amount of weight. The typical Before-After picture is an example of weight loss - not weight maintanance. 
  • People will finally stop looking for the perfect diet or bothering incessantly about whether it is fructose, crabs, fat and so forth.  They will finally stop blaming their diet for failing them. There will be less tress wasted on diet books. 
  • Normal weight and lean people would look at obese from a different perspective - one filled with compassion and empathy. 
  • And for the most important part: Obese people will finally understand that it was never their fault. They will finally be free of their endless self-blaming, depression, and lack of self-esteem that they had to endure their ther whole life.
  • And this world would be a much better place to live in.

Note: If you want to learn more about this topic, start with this recent presentation about Friedman about the biological basis of obesty. He discovered Leptin. The book Rethinking Thin: The New Science of Weight Loss—and the Myths and Realities of Dieting by Gina Kolata talks about the same too.

 

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Anthony | Sun January 29, 2012  

It is interesting to also look at those people who win weight loss competitions.  I saw what was an advertisement at one cafe, where a woman lost something like 27 kilos in 20 something weeks.

Why doesn’t everyone lose the same amount of weight?  I know people will say compliance but there must be some studies where people were monitored.

Andrew | Sun January 29, 2012  

Anoop,

Really great article - you really stirred up the hornet’s nest with these series though, lol.

You really changed my view on this - I was skeptical at first but the physiology is sound.

As someone who used to be obese but has kept it off for 2 and a half years, I have a question:

Because we are biologically driven to be hungry and be obese, does that mean former obese persons who have successfully lost and maintained the weight have an atypical amount of willpower?
Ie, enough of a psychological drive to overcome their biological one?

I’m not at all calling obese people weak-willed at all, just commenting that it takes an abnormal amount of motivation to push them forward - perhaps that is something fitness should be more involved in? God knows the personal trainers I’ve met have been unsupportive. I’m starting to talk out of my ass at this point, but I suppose what i’m suggesting is more of an emphasis on the psychology of dieting in the industry? 

I know personally (from my own n=1 experiment) that I would not have been able to lose or keep off the weight as long as I have if I had not committed myself to counting cals and macros and keeping track of my training, every day of the week. Alot of people would call this unsustainable behavior, but it comes pretty natural to me.

Denis | Mon January 30, 2012  

I really have to say this series of articles have been enlightening. Keep up the great work.

Karky | Mon January 30, 2012  

what if all the trees suddenly started growing again, both the short and tall ones, with the tall one growing more than the short ones. What changed, genes, or environment?

Anoop | Tue January 31, 2012  

Hi Anthony,

Thanks for the comment.

Some do find it easy to lose a lot of weight. While some find it hard. And hard to say looking at one or two cases. Most before-after pictures, people intentionally put a lot of weight, and then lose it. So it looks like a lot of weight in a short time.

Hi Andrew,

Thanks! It is great to hear that I changed the way a few people think about obesity. I hope you watched the Friedman presentation.

Finally it comes down to a battle of conscious motivation versus the unconscious biological drive to eat and gain the weight back. Some people might have high leptin sensitivity or lower leptin resistance and some just have higher motivation levels and some may have both or some other unknown factors. This is the same way how leptin could help some lose weight, while it doesn’t work for the majority. This could also be why weight loss drugs are ineffective in some. So there are clearly biological changes that help some lose weight and maintain without any fuss. And it also depend on how much weight you lose too. 10-20lbs weight loss is maintainable. But the further you move away from this range, the harder it becomes.

And it is a good point. We might be focusing too much on the carbs, fructose, and minor details while we should be focusing on the psychological aspects . And recent studies are showing that it doesn’t matter what diet you are on and we should focus more on the behavioral aspects.  Keep in mind, cognitive-behavioral approaches play a big role in weight management. So it is not that we haven’t focused on those for the past 40 years.

Thanks Denis for the comment.

H Karky,

Sure it is environment if they grow taller. It is just like the 10-15 lbs gain due to the environment.  When people are 150-400lbs, the 10-15 gain doesn’t really add up to much. The relative differences are still huge. The lean will stay lean and the heavy will stay heavy. The same could be said about height. We have increased by an inch in the last couple of decades. That wouldn’t make us say height is largely environmental right.

Patrick | Sat February 04, 2012  

Anoop,

Just wanted to drop a line and say how much I appreciate your thoughtful, patient, science-driven approach in all of your articles.

Anoop | Sun February 05, 2012  

Hi Patrick,

That was really kind of you to take the time to say a good word.

Thanks again.

GChussir | Mon February 06, 2012  

I totally agree that we should emphasize more on the psychological aspect of dieting than discussing details like eating carbs at night or doing cardio fasted.

Harry | Mon February 06, 2012  

Hi Anoop,

It is incorrect to say that an extreme hypo-caloric environment (e.g. concentration camps) constitutes “no” environment.  By that logic, an equally extreme hyper-caloric environment where hyper-palatable food is abundant and free (e.g. someone who owns a candy store) is also “no” environment.

Clearly, food environments exist on a gradient; they are not a bifurcated between “no” environment and “some” environment.

Of course, the concentration camp example is extreme; it is not designed to illuminate free living conditions.  It is merely designed to show that the genetic influence on fat gain is limited, and in fact regulated, by the food environment. In a hypo-caloric environment (e.g. camps) everyone is lean; in a moderate food environment (e.g. agrarian pre-Industrial) most people are lean, but a few are fat; in a hyper-caloric food environment (e.g. Kings and Queens of England in the middle ages, the North American diet etc.) some people are lean, many people are overweight, and a minority of people are obese.

The change in the food environment is concomitant with the change in population fatness; that’s what we mean when we say that the obesogenic environent has ‘caused’ the obesity epidemic.  We don’t mean that every contributing factor is environmental, nor do we deny the necessary permissive role of genetics; we simple mean that the change in environment explains the concurrent change in population fatness.

Now, it seems we all agree on the substance of the issue (i.e. that people have gotten fatter and that it is the change in the food environment that explains this change).  The only disagreements are on the semantics (i.e. what constitutes a ‘cause’) and on the magnitude of the change in population fatness.

Personally, I’m happy to agree to disagree on those two issues. I think causative factors are better understood as regulating, rather than permissive factors.  And I think that the population’s mean body fat percentage has dramatically worsened over the last 30 years….even if that doesn’t show up as a huge increase in mean BMI change.

Cheers
Harry

P.S. The ‘obesogenic environment’ hypothesis(which subsumes the food reward hypothesis) does not blame obese people for getting fat.  Nor does it deny the importance of weight loss maintenance. Nor is it incompatible with empathy and compassion…etc.  It is not a case of “either we accept that genetics controls body fatness or we treat obese people like moral failures”...; it is possible to realise that environmental forces cause population fatness, and that both personal and social changes need to happen to combat this problem effectively.

P.S.S The tree analogy is a disanalogy, due to the use of different species (i.e. you’re introducing a confounding variable). In human, people with the SAME genetic heritage are either lean or fat, depending on food environment (e.g. native Okinawans versus those that emigrated to the US mainland). To make your analogy sound, you would have to plant the SAME trees in different nutrient environments and observe the differences in growth.

Anoop | Tue February 07, 2012  

Hi Ghussir,

It could be true. We probably are focusing on the wrong side of the coin. And research is showing the same too.

Hi Harry,

I think you are missing the point. We all agree on the change in environement is making people fatter. What I am saying is that 5-20 lbs increase in fat is not what making people obese . Unless you say people are gaining 40-100lbs due to environment, it is just not really adding much to argue about. The same people who are obese now will be just less obese in a pre-agrarian society. This is the same reason why there were obese people 2000 years back too. The environment is just pushing people who are right below the 30 BMI category to over 30 and classifying them to be obese. .

I don’t understand your comments about the tree analogy. The analogy was just to show that that anyone could easily go round and round to say that if it weren’t for the rich soil the Sequia wouldn’t have grown this tall. And they would be technically right. But most people simply don’t.

Dale | Sun February 26, 2012  

Anoop -

As a trainer, given that the substantial majority of my trainees are weight-loss aspirants, I appreciate the circumspect tenor of your article. It ain’t easy. And I readily confess that I can’t help everyone who comes to me.

That said, I’m slightly more optimistic perhaps than you are. Foolishly so ? Time will tell.

Part of my optimism stems from the fact that weight-loss aspirants are almost always people who lost weight previously, often gobs of it ... and gained it back. And when I ask them why they think they gained the weight back, without hesitation they *always* say something like “Because I went back to eating the way I did that made me fat it the first place.”

Given that that is always the case, as a trainer, I ascribe importance to the environmental/genetic factors you underscore only insofar as I am inclined to be more sympathetic towards some than towards others. In other words, I realize full well that it may be more difficult for some than others to cultivate the enjoyment of smaller amounts of food, it’s obviously something that can be done.

Also, I do speak to people, on a fairly regular basis, who attest that, having taken the weight off, they no longer suffer the sort of malignant attraction to food as they did while obese. Whether this is psychological or an actual hormonal change, I wonder if it really makes any difference.

Oh, and a special shout-out to your observation about dramatic health improvements with marginal weight loss. I do see that time and again with my trainees. And betcha by golly we celebrate that, as an important milestone, on the way to greater weight loss.

Currently, I’m working with a diabetic who aims to lose 100 pounds. But after losing the first 20 her A1C has dropped from 13 to 9 (nearing normal) and her average blood sugar levels, just weeks ago alarmingly high, are normal. This phenomenon is BY FAR one of the most rewarding aspects of my job and it sometimes perceived as an unexpected bonus by people I work with who want to lose large amounts of weight.

Viktor | Wed February 29, 2012  

Well, there are a lot of tree-species that develop very differently due to their environment so I don’t see the need to use different species, in regard to your response to Harry.

However, with regard to our rather heated exchange earlier, I do see your point now and I think you have provided a bascially sound argument for it.

Also, I do wholeheartedly agree with your conclusion that we need to stop stigmatizing fat people.

TheDane | Tue March 13, 2012  

Hello Anoop,
Haven’t been here in some time, which I feel I must apologize for, since supporting your extremely professional approach to health and fitness must be done at all costs.

I just watched this today about obesity, and immediately afterwards thought of your site.
Low and behold, you just did an article on obesity.

Here is the video:
http://www.youtube.com/watch?v=VgnbRK8pij8&list=UUZYTClx2T1of7BRZ86-8fow&index=9&feature=plcp

Anoop | Sat March 17, 2012  

Hi Dale,

It is not being optimistic and such. We have to go by what the numbers say. We have lot of cognitive biases which leads us to wrong conclusions.

Hi Viktor,

The hallmark of science is skeptical thinking. So I always welcome counter points. Sometimes I get caught up in a cognitive bias too. Thanks for the discussions.

Hi The Dane,

Thanks for the kind words, Dane.

Nice video.

Dale | Sat March 17, 2012  

Anoop -

I’m not sure what “cognitive biases which leads us to wrong conclusions” means. Do I wrongly conclude that people become obese due in large part to overeating, lose weight through calorie deficit, and then regain weight by returning to old eating habits a wrong conclusion ?

I don’t think so.

Anoop | Sun March 18, 2012  

Hi Dale,

I am just saying why you and everyone just cannot agree that weight loss and maintenance is extremely hard for many, though the research clearly shows it.

Basically because your conclusions are based on a few anecdotes you see and hence those incidents leave a lasting impression on you. Yours is just like everyone who see people lose a lot of weight which makes a dramatic impression. And every time you talk about weight loss, you immediately think of these instances and form a quick conclusion ( since they are readily available).

Hence the reason we should look what the research says about weight loss success, which is pretty pathetic. Here personal experiences are influencing more than statistical information.

This is called the availability bias or heuristic. One of the many cognitive biases which lead us in the wrong direction.

Dale Dykes | Sun March 18, 2012  

Anoop -

Alright, you can spare us the Latin and Greek.  Yes, the studies are in ... and they show that: (1) some are more apt to be obese than others (2) it is more difficult for some than others to lose weight and (3) some are more apt to regain lost weight than others.

Seriously, who knew ?

Tell you what, I’ll be sure and let you know the first time an obese, prospective client offers to pay me to take 5-7% off their bodyweight so they can normalize their health markers.

5-7% is the zone they typically rocket past on their way to more significant weight loss. Are you seriously going to suggest that the world would be a better place if I told my clients to cool their jets ?

BTW, this is not an heuristic. This is sarcasm. 😉

Anoop | Sun March 18, 2012  

Hi Dale,

Read the conclusion again. If you can maintain it for 6 months, lose more. That’s not me. Those are the guidelines and there is a good reason they are set.

And if you lose 1-2 lbs per week, they wouldn’t “rocket past”. If they are, they are losing muscle too.

That’s one reason they “rocket back” to their previous weight.

Dale | Sun March 18, 2012  

Anoop -

Whose guidelines are we talking about ? Are these some of the same people who told us that eating fat was making us fat ?

Quite typically obese people will lose 10-15 pounds the first week! Telling obese people to lose a comparative handful of pounds and then having them hold is, in my view, akin to watching a baby take his first few steps and then confining to the stroller.

When obese people begin to cultivate a healthier relationship with food ... good luck trying to keep the weight on them!

I do not grant this necessary correlation between rapid weight loss and rapid rebound. Indeed, one new study showed that people who lost 10% of their bodyweight rapidly were more successful maintaining than those who lost weight gradually.

I also suspect that fear of muscle loss is overstated so long as one is strength training.

Anoop | Wed March 21, 2012  

Hi Dale,

These are the federal guidelines from NHLBI proposed in 1998. They will be updating these in 2012,  but I don’t see any major changes.

All that talk about cultivate a “healthier relationship” just sounds great in theory.There are lot of obese people who eat healthy and exercise, but are still struggling.

And that’s a good point. VLCD is an effective diet. But now studies have shown taking a slower route maybe better.Large part of the reason is it is easier to make lifestyle changes and stick to it if done gradually.But either way we are not really getting there.

The whole keep muscle mass when dieting is just a sound theory.I don’t think we have any study to show that people who weight trained kept off the weight longer. We trainers like to talk about it because that is what we mainly do with our clients! But it is still an upcoming area in obesity field and not studied well.

MetroEast Beast | Fri March 23, 2012  

Great Series Anoop!  I had a long wait at the supermarket checkout last night and couldn’t help but notice what people had in their grocery carts.  The two that stood out were older women of different nationalities that were in good shape for their age.  The were probably older than they appeared.  Both had their carts filled with fresh vegetables, fruits, and the chicken breast that was the feature special ($0.89/lb) this week. 
I then noticed some other people in line with over-weight appearances with their cards full of convenience foods, chips, desserts, and pre-fried oven bake foods (also on special this week). 
These comments are strictly on the peoples appearance.  It would be interesting to see a study of random grocery shoppers to see how they would do in a fit test and maybe see some simple blood work results then compare it to their diet based on their grocery purchases.

Anoop | Sun March 25, 2012  

Hi Rob,

Thanks Rob!!

And that might be the problem. They just cannot control their food behaviors which maybe driven by their genetics.

The same reasoning applies for obese people eating more. But what is making them eat more than us is the million dollar question.

And people eating chicken breasts are just the minority like us. It is not a normal way to eat for the most.

Dale | Thu January 17, 2013  

Anoop -

Hope it’s not to late to pose another question. We know that the US has the highest obesity rate of the high-income nations, much higher than most. Accordingly, wouldn’t cultural attitudes towards eating be part-and-parcel of environment ?

America: give 315-million people ready access to food and apparently 30% will manifest obesity.

France: give the French free access to food ... and only about a third of the French will manifest obesity, presumably because it is deeply ingrained in culture to savor smaller amounts of food. What else could explain the disparity ?

Larger question: If there are fewer strictures in America against gorging, how do we know the so-called setpoint, that 10-15 pound range you talk about ? I know a gentleman who ballooned to 525 lbs. Now, I don’t expect him to become a svelte, 185-pounder, but surely he’s not consigned to bouncing around between 510 and 525 interminably, is he ?

Appreciate your thoughts ...

Anoop | Sat January 26, 2013  

Hi DAle,

Never too late for any questions in Exercise Biology!

I don’t disagree. The weight gained due to environment could be due to cultural factors and such. But that is regulated by your set-point. If you think about it, most people look the same throughout their life (skinny 1s always skinny, chubby is always chubby,..). Also, even in the obesegenic environment there are people who are lean with no exercise or diet and whatsoever. If you have to go from overweight to obese, you have to gain around 40-50 lbs. People don’t accidentally put that much weight you know.

People who do balloon like that (520lb) are exceptions and do have some genetic problems.

Dale | Sat January 26, 2013  

Thanks, Anoop -

Yes, I grant that the 500-pounder is an outlier. But I do see people, from time to time who, perhaps due to some sort of traumatic event, begin to overfeed, and appear to gain weight in linear fashion for some time.

I’m talking about adults, like my thirty-year old neighbor, who tells me he gained 55 pounds over the last year after he stopped smoking.

Then there’s a friend of the family who says she gained 100 pounds, over the course of three years, after a troubling marriage.

I suppose my question is, how can such people even begin to estimate their ‘setpoint’ ? In other words, seems that gross overfeeding might have them tens of pounds over their optimal (for them) weight.

For these people, would it perhaps be prudent to steer them away from weight-loss goals and invite them to eat more intuitively (and add movement) in the anticipation that they may eventually ‘settle in’ at a somewhat lower weight ?

Libby | Sun March 16, 2014  

Hi Anoop,

Great website! I have just stumbled across it and have been absorbed for hours!

So my thinking is this…

Imagine that an additional tap was installed at every kitchen sink, which dispensed free beer. Now, some people would never drink from the tap, some would drink moderately, and (presumably) a rising percentage would drink excessively, resulting in officials announcing in alarm that we have a rising alcoholic epidemic. On the one hand, we could note that certain people are not alcoholics, and that others drink in moderation…and could thus we could state that genetics are likely to be a significant factor (and that compassion and sympathy are thus necessary). On the other hand, when it comes to helping these people, encouragement to focus only on drinking 5-7% less or on keeping their intake constant seems to me to be a lot less useful than, for example, shutting off the tap. It might be helpful, for example, to alert ourselves to the fact that we have an addictive toxin pouring into every kitchen, and that, as a species, 30% struggling to control their intake is something we need to address?

I wonder:

-  Most human traits have variances…but why is there such a difference in the range of set points? Does it make sense that some people have a genetic makeup that causes them to eat and eat and eat? Were there truly few occasions historically when humans were required to exercise dietary restraint? (Maybe this is truly the case – I’m not sure).

-  When I read studies about leptin – and how some fat people seem unresponsive to leptin signals…and the suggestion is that these people are thus faulty in some way…I suddenly thought: we should know better. The human body has evolved over millions and millions of years. Why on earth would so many of us be faulty in something as essential as appetite regulation. What if leptin signals are ignored by our bodies for a very good reason: because, despite the overconsumption of calories, we still haven’t got what we need; a diet of manufactured, nutrient-empty food has left us starving.

By the way, great discussion Harry – do you have your own website / blog, Harry? Would love to hear more from you!

Sorry Anoop – I know this post is years old…but it is so refreshing reading discussion from clever, bright individuals who are approaching the issue from different angles…

Thank you!

Anoop | Mon March 17, 2014  

Hi Libby,

Thanks for the comment.

Very good point. What you just wrote is how obesity treatment is leaning towards. Putting the blame the individual is clearly not working. Now the community has to come together. In fact, a lot of significant public health outcomes were achieved by changing the environment than waiting for the individual to change. For example, chloirantion of drinking water, iodine is common salt, vit B in flour, fine for not wearing your seat belt and such.

With better technology, we will have more and more studies looking at the genetic makeup and how the genes interact.We clearly didn’t know much about the genes before 2000. Now we clearly know there is lot more happening than just people sitting and eating more food. And such a large variance may not be too large for the human body and was an evolutionary advantage. And we don’t see people gaining 100 lbs or more you know. From the article, “To go from overweight category to Obese (25 BMI to 30 BMI),you have to gain around 35-40lbs. To go from normal weight to obese (20 -30 BMI), you have to gain around 75-80lbs. To go from normal weight to extremely obese (20-35), you have to gain 125lbs.” Are people gaining so much weight? Nope

Why faulty? Maybe they are the lucky ones! they will survive the famine since they have a lot more fat to bite into.We won’t.

Thank you. Hope you liked on facebook or subscribed to the feeds.  I don’t think many people have wrote about this side nor even bothered to look at the genetic side of obesity. And it is sad.

john smith | Thu October 20, 2016  

Hi Anoop
You rightly highlight John Terry as a representation of a particularly unpleasant kind of “masculinity” but I think it’s over-simplistic and not a little patronising (though I’m sure unintentionally so) to assume that because he gets a lot of attention, this equates to people “looking up to him”.

What do you think?

Smileys

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