Guest Essay by Kip Hansen
Prologue: This is the fourth in a series of essays that will discuss ongoing scientific controversies, a specific type of which are often referred to in the science press and elsewhere as “Wars” – for instance, The Salt Wars. This essay covers the Obesity Epidemic, aka The Obesity Wars. The purpose of the series is to illuminate the similarities and differences involved in each of these wars. Warning: This is not a short essay. Dig in when you have time to read a longer piece.
Trigger Warning: This essay is about obesity – the condition of being fat or overweight. It is about being overweight, body size, fatness; it is about all the problems that accompany that condition. If reading about these topics will cause you any emotional distress or make you feel unsafe or threatened in any way – stop reading here.
Stephen Hawking is a very smart guy, a very very smart guy. But like some smart guys in other fields, he can make very foolish statements based on ideas that are commonly believed but almost entirely inaccurate.
In a video produced by Gen-Pep, a Swedish non-profit organization “that works to spread knowledge and get people involved in promoting the health of children and young people”, Hawking made the following statements:
[Important Note: Stephen Hawking, as you probably know, is and has been severely physically handicapped, suffering from ALS, and has been wheelchair bound since the late 1960s. His experiences with diet and exercise are not, by necessity, the same as for you and me. Neither human physiology nor human medicine are his fields of study. I do not know why he was called upon to make this promotional video for Gen-Pep.]
Hawking starts off by saying: “At the moment, humanity faces a major challenge and millions of lives are in danger…”
“As a cosmologist I see the world as a whole and I’m here to address one of the most serious public health problems of the 21st century.”
“Today, too many people die from complications related to overweight and obesity.”
“We eat too much and move too little.”
“Fortunately, the solution is simple.”
“More physical activity and change in diet.”
When Hawking says these things he is simply repeating the official opinions of almost every major medical and health organization in the world:
The US Surgeon General:
“… the fundamental reason that our children are overweight is this: Too many children are eating too much and moving too little.
In some cases, solving the problem is as easy as turning off the television and keeping the lid on the cookie jar.”
The UK’s National Health Service:
“Obesity is generally caused by eating too much and moving too little.”
The UN’s World Health Organization:
“The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:
an increased intake of energy-dense foods that are high in fat;
and
an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.”
The National Institutes of Health tell us:
“What Causes Overweight and Obesity?
Lack of Energy Balance
Overweight and obesity happen over time when you take in more calories than you use.
An Inactive Lifestyle
People who are inactive are more likely to gain weight because they don’t burn the calories that they take in from food and drinks.”
Of course, the NIH goes on to list the following as “other causes…”:
“Environment, Genes and Family History, Health Conditions, Medicines, Emotional Factors, Smoking, Age, Pregnancy and Lack of Sleep”
Everyone knows that the causes of obesity are eating too much and not exercising enough. All the major federal agencies, the United Nations, and the learned societies agree.
So how is this a Modern Scientific Controversy?
Simple: They are all wrong. Just how wrong are they on this issue? Just how wrong is Stephen Hawking on this issue?
Almost entirely wrong.
Bruce Y. Lee, associated with the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health, was so concerned by Hawking’s message that he was prompted to write an article for Forbes magazine titled “Stephen Hawking Is Right But Also Wrong About Obesity”.
Let me be perfectly clear: The obesity epidemic is a major challenge for medical science and public health because, quite simply, we have almost no idea whatever as to the true cause(s) of the phenomena, or, in another sense, we have too many ideas about the cause(s) of obesity.
In fact, Gina Kolata, in the Health section of the NY Times, says that Dr. Frank Sacks, a professor of nutrition at Harvard,
“…likes to challenge his audience when he gives lectures on obesity.
“If you want to make a great discovery,” he tells them, figure out this: Why do some people lose 50 pounds on a diet while others on the same diet gain a few pounds?
Then he shows them data from a study he did that found exactly that effect.
Dr. Sacks’s challenge is a question at the center of obesity research today. Two people can have the same amount of excess weight, they can be the same age, the same socioeconomic class, the same race, the same gender. And yet a treatment that works for one will do nothing for the other.”
Dr. Lee Kaplan, director of the obesity, metabolism and nutrition institute at Massachusetts General Hospital, is quoted by Kolata as saying:
“It makes as much sense to insist there is one way to prevent all types of obesity — get rid of sugary sodas, clear the stores of junk foods, shun carbohydrates, eat breakfast, get more sleep — as it does to say you can avoid lung cancer by staying out of the sun, a strategy specific to skin cancer.”
But wait, what about our beloved Stephen Hawking’s “Fortunately, the solution is simple. More physical activity and change in diet.”? Well, frankly, that is not just wrong, that’s utter nonsense.
Dr. Kaplan and his associates have identified, so far, fifty-nine (59) different types of obesity.
Dr. Stephen O’Rahilly, head of the department of clinical biochemistry and medicine at Cambridge University, and his group, have identified 25 genes “with such powerful effects that if one is mutated, a person is pretty much guaranteed to become obese.”
Many of these genetic disorders are on the rare side, but Ruth Loos and her team at the Icahn School of Medicine at Mount Sinai, have other evidence – that any one of 300 different genes may be involved in the tendency to overweight, and that each gene can add to the effect of the others—add to the genetic propensity for overweight and obesity. “It is more likely that people inherit a collection of genes, each of which predispose them to a small weight gain in the right environment….each may contribute just a few pounds but the effects add up in those who inherit a collection of them.”
There are more than three dozen available therapies (Dr. Kaplan claims to have 40 at his disposal) for overweight and obesity, and 15 different drugs. Using them is guided by experience and plain old-fashioned trial-and-error.
Bariatric surgery, in which the size of the stomach is physically altered by various means, is a drastic last resort for the profoundly obese.
Only the last mentioned treatment, bariatric surgery, is universally successful at bringing about a major and permanent reduction in the body weight of the obese.
In June of 2013, the American Medical Association announced that it had classified obesity as a disease. This event was covered by the NY Times – in the business–not science—section:
“The American Medical Association has officially recognized obesity as a disease, a move that could induce physicians to pay more attention to the condition and spur more insurers to pay for treatments.
In making the decision, delegates at the association’s annual meeting in Chicago overrode a recommendation against doing so by a committee that had studied the matter.
“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement. She suggested the new definition would help in the fight against Type 2 diabetes and heart disease, which are linked to obesity.”
“The vote of the A.M.A. House of Delegates went against the conclusions of the association’s Council on Science and Public Health, which had studied the issue over the last year. The council said that obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index, is simplistic and flawed.”
The move by the AMA was hugely controversial within the medical community. In fact, it prompted an editorial from the editors of the journal of the Australian Medical Association, Lee Stoner and Jon Cornwall, titled “Did the American Medical Association make the correct decision classifying obesity as a disease?”
“The American Medical Association (AMA) recently classified obesity a disease, defining obesity as having a Body Mass Index (BMI) measure above 30. This decision went against the advice of its own Public Health and Science Committee, and has sparked widespread discontent and discussion amongst medical and healthcare communities. The fact that this classification has been made has potential ramifications for health care around the world, and many factors need to be considered in deciding whether the decision to make obesity a disease is in fact appropriate.”
“Are we classifying obesity correctly?
“Before considering whether obesity should be considered a disease, we must question the suitability of BMI as a rubric. The assumption is that the ratio between height and weight provides an index of body fatness. However, there is an imperfect association between BMI and body fatness, and BMI does not and cannot distinguish adipose type and distribution. While total body fat is important, studies have shown that central adiposity (e.g., visceral fat) poses a higher risk for developing disorders associated with obesity than overall body fatness. There are superior anthropometric indices of central adiposity, including waist-to-hip ratio, yet BMI continues to be the criterion owing to previous widespread and historical use despite its obvious shortcomings. Using the BMI tool, incorrect clinical categorisation of “overweight” or “obese” is common. Therefore, this editorial accepts that the AMA has selected an imperfect tool for classifying obesity, and will hereafter focus on the theoretical notion of obesity.”
“Undeniably, obesity is a risk factor associated with a clustering of complications, including hypertension, hypercholesterolemia, and type 2 diabetes, each of which independently and additively increase cardiovascular disease risk. However, obesity is exactly that—a risk factor. Being obese does not necessarily equate to poor health, despite the hormonal alterations that are associated with high body fat. Strong evidence has emerged suggesting that an adult may be “fat but fit”, and that being fat and fit is actually better than being lean and unfit.”
The Australian Medical Association’s editorial wraps up with this:
“Conclusion
Obesity has reached pandemic proportions, is strongly associated with myriad co-morbid complications, and is leading to a progressive economic and social burden. However, being obese does not necessarily equate to poor health, and evidence suggests individuals may be fat but fit. Perhaps most importantly, labelling obesity a disease may absolve personal responsibility and encourage a hands-off approach to health behaviour. This knowledge raises the question of morality, as individuals must now choose whether they will invest effort into maintaining a healthy lifestyle in order to free society of the healthcare burden associated with obesity. Given the myriad issues surrounding the decision to classify obesity in this way, perhaps a new question should be posed in order for society to continue this discussion: who benefits most from labelling obesity a disease?”
And what about a cure? Is it possible, short of radical invasive surgery, to help an obese person permanently lose enough weight to become a normal weighted person?
If the learned societies, and Stephen Hawking, are correct in stating that obesity is as simple as eating too much and exercising too little, then the obvious cure is to take obese people, feed them less and exercise them more.
Let’s go back and look at the results from Dr. Frank Sacks, professor of nutrition at Harvard, and his study “Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates”.
Results
At 6 months, participants assigned to each diet had lost an average of 6 kg [13 lbs], which represented 7% of their initial weight; they began to regain weight after 12 months. By 2 years, weight loss remained similar in those who were assigned to …[the four diets, ranging from 6 to 9 lbs]…Among the 80% of participants who completed the trial, the average weight loss was 4 kg [ 9 lbs]; 14 to 15% of the participants had a reduction of at least 10% of their initial body weight. Satiety, hunger, satisfaction with the diet, and attendance at group sessions were similar for all diets; attendance was strongly associated with weight loss (0.2 kg per session attended). The diets improved lipid-related risk factors and fasting insulin levels.
Digging in a little more, we find that:
“At 2 years, 31 to 37% of the participants had lost at least 5% of their initial body weight, 14 to 15% of the participants in each diet group had lost at least 10% of their initial weight, and 2 to 4% had lost 20 kg [45 lbs] or more (P>0.20 for the comparisons between diets).”
These are serious weight loss diets, closely supervised, with group and individual reinforcement sessions, for 2 years. Only 2 to 4% of the participants lost truly substantial amounts of weight that would reclassify them as normal weight persons. The rest of the participants lost those easy first 10-15 pounds in the first six months, but after a year, they began to regain their lost weight, despite staying on the diet and receiving group counseling, to end up with average loss, for 80% of the participants, of 9 pounds [4 kg], after two years of supervised dieting.
Let’s see what these results mean for those suffering from obesity:
I’ve added three colored dumbbells, showing just what a permanent 10% reduction in body weight means for three sample obese patients. Two have managed to move from Morbidly Obese to Obese, and one is still Obese. We have not considered the more extreme cases, which are not rare – persons weighing > 286 lbs. You can picture for yourself what the loss of 9 lbs would represent for you or someone you know who is far too heavy.
The real finding is that under a strict diet, most people can generally (but not always) lose 10-15 pounds if they are supported by counseling (professional or family). With care, these people can keep most of those extra pounds off. This benefits those whom who (h/t jsuther2013) are classified Overweight, but not generally those that are truly Obese, who remain obese after this weight loss. Nonetheless, medical bio-markers do improve even with these fairly small weight loses. Whether this improvement in bio-markers adds up to improved health and longevity is not known.
It is important to note that the above chart is based on the metric BMI which is under serious doubt within the obesity research community.
25 genes guaranteed to make you obese; 300 genes that add to each other to pack on pounds; 56 different types of obesity; 15 drugs; 40 therapies; three or four surgical approaches…definitely not simple, Mr. Hawking.
But that’s not all.
Erin Fothergill’s “Biggest Loser” study found:
“In conclusion, we found that “The Biggest Loser” participants regained a substantial amount of their lost weight in the 6 years since the competition but overall were quite successful at long-term weight loss compared with other lifestyle interventions. Despite substantial weight regain, a large persistent metabolic adaptation was detected. Contrary to expectations, the degree of metabolic adaptation at the end of the competition was not associated with weight regain, but those with greater long-term weight loss also had greater ongoing metabolic slowing. Therefore, long-term weight loss requires vigilant combat against persistent metabolic adaptation that acts to proportionally counter ongoing efforts to reduce body weight.”
What this means is that a person’s body fights back against weight loss and adapts its base metabolic rate to burn fewer calories while resting in an apparent attempt to regain weight lost by dieting and thus maintain a set weight point under conditions of lower caloric intake. This study was such big news that it is featured in the New York Times’ “Medical and Health News That Stuck With Us in 2016”.
Eleonora Ponterio and Lucio Gnessi, in their study “Adenovirus 36 and Obesity: An Overview” report that:
“…the data indicating a possible link between viral infection and obesity with a particular emphasis to the Adv36 will be reviewed.”
Thus, the Obesity Epidemic might be just that, an infectious epidemic.
In a study titled “Trim28 Haploinsufficiency Triggers Bi-stable Epigenetic Obesity”, Andrew Pospisilik and team found that there are titillating hints that epigentics may play a role in determining who is fat and who is lean, even when they generally share the same genes (closely related individuals) , or in the case of identical twins, exactly the same genes.
No, the obesity epidemic is far from Hawking’s, “Fortunately, the solution is simple.” And the solution to obesity is orders of magnitude more complicated than “More physical activity and change in diet.” In fact, universally reliable solutions to the problem of obesity do not yet exist.
There is nothing clearer from obesity research than that the simplistic policies of the federal health agencies and the learned societies – all of which were summarized by Stephen Hawking — “Eat Less & Exercise More” are totally inadequate to address the problem and are not based on scientific evidence. The “Eat Less & Exercise More” policies include the war on sugar and the war on soda – they cannot and will not make a clinically important difference in public health.
Summary:
- The kernel of truth in obesity studies is that consuming more calories (food energy) than one expends can lead to weight gain–energy stored as fat.
- Reversing this does not lead to a remedy for obesity – eating less and exercising more is not a cure for obesity.
- The reality of the problem of obesity is vastly more complex and only vaguely understood at this time.
- Current public policy on obesity is almost universally based on #1 above, ignoring #2 and #3. Thus, this public policy – no matter how strenuously enforced through education, indoctrination, regulation of the food industry, punitive taxation, etc will not resolve the Obesity Epidemic.
- On a positive note, the recommendation that people “eat less and exercise more” will not hurt anyone [with the rare exception of the profoundly underweight, the anorexic, etc] but, in general, will actually improve most people’s health even though it may have no effect whatever on their weight status.
- The Obesity Wars share the common feature seen in other modern scientific controversies — public government agencies and scientific [and medical] associations forming a consensus behind a single solution, one known to be ineffective, to a complex problem – uniting in a broad effort to enforce the ineffective solution on the general public through regulations, laws, and mis-education.
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Author’s Comment Policy:
I have utilized only a tiny fraction of the information I have collected on this topic in the writing of this essay. Readers familiar with the literature on the topic will notice this immediately. This is not due to ignorance or laziness on my part – I have been constrained by the necessity of keeping the essay to a readable length, without unduly stretching the patience of you, my readers.
I realize that many readers here will want to move on immediately to discuss the Climate Wars – one of the distinctive science wars of our day. I ask that you please try to restrain yourselves
The last essay in the series will be an attempt to lay out a coherent pattern of modern science wars and maybe suggest ways that the different science fields themselves can break these patterns and return their specific area of science back to the standards and practices that should exist in all scientific endeavors.
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Kip, I agree that there is a lot of variability in individual body responses to diets, but you make one observation that supports the simpler arithmetic version: the fact that surgically reducing the stomach size has a universal effect of dropping a person’s weight significantly. I think we cunning folk have a variety of tricks that allow us to cheat on diets and this has to be a significant factor. I saw similar behavior in an alcoholic in-law. They somehow managed to get their booze when their cash and credit cards were controlled!
Gary Pearse ==> True but irrelevant…very carefully controlled diet studies all produce the same general results and do not support the “lazy, cheating fat people” hypothesis,
First, Kip, thank you for doing these articles. By looking at parallel universes we can better understand the climate universe. Great reporting.
One thing I don’t see here is any discussion of the role of the gut microbiome (bacteria) in modulating health, including obesity. Studies have shown that thin mice with “fat mice” gut bacteria transplanted into them (don’t ask how), become fat. This is only one example of the hundreds, maybe thousands of interactions that we have with the guys who process every ounce of food we swallow. We know, for example, that gut bacteria talk to our brains directly through the vagus nerve. All part of the complexity – and lack of knowledge – that you so eloquently point out.
However, before the (about) 2011-12 NIH study to sequence a group of complete gut microbiomes, there was essentially zero knowledge about what bacteria were present, in what quantities and even today, we are just getting a clue about what they do. It is equivalent to our knowledge of weather, Arctic ice and such before and after the advent of satellites. A company in San Francisco will sequence your gut bacteria for less than $100 and tell you “who you are.”
It is my strong feeling all.of the commentary in your article and the comments that follow are looking for answers in the wrong places. 90% of the cells in our body are bacteria and the gut microbiome is one of the most complex ecosystems on earth. They digest everything we ingest, and tell us what they want. Maybe we should ask them how to control weight?
markopanama ==> Gut microbiome research is very very young and does not yet produce consistent useful results. There are a lot of tantalizing hints of this or that….but nothing that leads to a solution for the obesity problem, yet at least.
Kip, Thanks for putting this post together. I have an interest in the gut microbiome. It is a piece of the puzzle that hasn’t received as much attention as it should. People who are obese have a very different microbial profile in the gut. They seem to get more calories out of the non-digestible fiber in food than the average person. Normally we get 7-10% of our calories from the small-chain fatty acid production of our gut bacteria. So it isn’t as simple as calculating calories that we can absorb on our own. Frequent antibiotic exposure and some medications can cause shifts in microbe populations that have been associated with weight gain. The same is true of circadian rhythm disruptions. It isn’t as simple as eating less and moving more.
Research in this area is just beginning.
Here are a few links that illustrate this line of thinking:
http://www.the-scientist.com/?articles.view/articleNo/44358/title/A-Complex-Disorder/
http://www.microbiomeinstitute.org/blog/2015/8/9/gastric-bypass-surgery-alters-microbiome-which-possible-contributes-to-weight-loss
http://www.microbiomeinstitute.org/blog/2015/10/29/the-microbiome-plays-a-role-in-antipsychotic-mediated-weight-gain
http://www.the-scientist.com/?articles.view/articleNo/44615/title/Gut-Bugs-to-Brain–You-re-Stuffed/
http://www.microbiomeinstitute.org/blog/2014/12/7/obesity-and-the-daily-cycle-of-the-microbiome
From May ’15 to May ’16, I went from 262 down to 202. I got a dog (two long walks a day), got a FitBit (averaged 19,000 steps a day for a year), quit ice cream for the first 6 months, and ate baby carrots all the time. Prior to that, I’d never tried a diet. Subsequently, I’ve added ice cream back, am not taking quite as many steps, and 15 pounds have returned. I’m 6’6″, so I still feel pretty good. At least my experience would suggest that the simple equation calories out > calories in = weight loss.
jefe ==> You have proven what the studies about obesity have found — one can force the body to give up extra weight by managed diet and exercise, but the body will fight back and attempt to regain the weight to some set-point that it “prefers”.
Well done on dropping 25 lbs — that’s abit better than most accomplish (averaging 10-15).
I would not be true to style without a parody, so , speaking of finding a simple explanation to a “complex” problem, here ya go:
Not necessarily permanent. A relative who is a nurse said that some people who’ve had bariatric surgery do gain weight after a while. That might be another example of the body’s adaptation to lower caloric inputs.
“Not necessarily permanent. A relative who is a nurse said that some people who’ve had bariatric surgery do gain weight after a while. That might be another example of the body’s adaptation to lower caloric inputs.”
Or they may just be putting more food in their smaller stomach more often.
Hi Kip, – I know you read all so will give some input regarding our intestinal micro-organisms’ role in the subject. What is relevant is the different short chain fatty acids they produce, the relative concentrations of short chain fatty acids to one another & where along the different sectors of our intestinal tract there is output of specific short chain fatty acids.
(2015) “Dietary Gut Microbial Metabolites, Short-chain Fatty Acids, and Host Metabolic Regulation” reveals that these (Quote): “… act as signal transduction molecules via G-protein coupled receptors (FFAR2, FFAR3, OLFR78, GPR109A) and as epigenetic regulators of gene expression by the inhibition of histone deacetylase (HDAC) … (&) … can be used for de novo synthesis of lipids and glucose … energy sources ….”
The short chain fatty acid appears to create better sensitivity to insulin, while acetate creates better glucose tolerance. Propionate instigates colon cells to put out postprandial plasma peptide YY & glucagon-like peptide-1.
Butyrate up-regulates production of peroxisome proliferator-activated receptor-gamma coactivator-1α; in muscle & liver cell leads to phosphorylation of adenosine-monophosphate-activated kinase. (Quote) ” …Acetate reduces the appetite by changing the expression profiles of appetite regulatory neuropeptides in the hypothalamus through activation of TCA cycle ….”. For free full text link = http://www.mdpi.com/2072-6643/7/4/2839/htm
(2016) “The Influence of the Gut Microbiota on Host Physiology: In Pursuit of Mechanisms” reveals how short chain fatty acids are absorbed via either (Quote) ” … hydrogen-coupled monocarboxylate transporter 1 (MCT 1), MCT 2 and MCT 4 [73] … (or) by dynamic exchange with bicarbonate … (or) … by non-ionic diffusion of protonated SCFAs (short chain fatty acids) at the apical tips of colonocytes ….” Those ” … absorbed into colon are transported into the hepatic portal vein and liver where they may be further metabolized before entering circulation. By contrast … (those) … absorbed in the rectum can bypass the liver and directly enter systemic circulation … “; apparently fewer than 10% of short chain fatty acids are excreted in the feces.
Acetate “… reduce serum free fatty acids … a major influence on host metabolism … GPR43 was necessary to mediate a reduction in host lipolytic activity …” in response to acetate & propionate. Short chain fatty acids influence synthesis of a fat metabolism regulator called “… fasting-induced adipose factor … (&) … activate peroxisome proliferator-activated receptor γ ….”
Liver tissue cells response seems to be that acetate instigates ” … a reduction in fatty acid synthase activity….” Short chain fatty acids influence energy balance of liver cells via activation of signaling by ” … the enzyme 5′ AMP-activated protein kinase … (to) … stimulate an increase in lipid oxidation ….” For free full text link = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045138/
(2016) “Nutritional Signaling via Free Fatty Acid Receptors” details the priority of reception by GPR43 for “acetate = propionate > butyrate” . Among other features this receptor elicits response by colon PYY-expressing L cells. ((Quote) “…PYY is an anorectic peptide that inhibits upper gastrointestinal tract motility … (&) … GPR43 activation … promotes GLP-1 secretion ….” Authors go on to explain (Quote) ” … GPR43 regulates adipose-insulin signaling …(it) … is also expressed in pancreatic β cells and regulates insulin secretion … (it) … inhibits fat accumulation in adipose tissue ….” For free full text link = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848906/
For more free full research see (2013) “The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism”; link =
http://www.jlr.org/content/54/9/2325.long
Some insight may be gleaned from (2015) “Propionic acid and butyric acid inhibit lipolysis and de novo lipogenesis and increase insulin-stimulated glucose uptake in primary rat adipocytes”; free full text link = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496978/
Of course there are non-linear influences to consider & some of this is gone into by the authors of (2016) “Regulation of immune cell function by short-chain fatty acids”; free full text link =
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855267/
gringojay ==> Still very early days for all that….what they have not yet shown is how this makes a difference in the health and lives of people. They might yet, someday…but not yet.
closer to the truth
http://www.yourenotfatyouretoxic.com/wp/
http://www.wheatbelly.com/articles/whatis
Just to add to the confusion…a specific adenovirus seems to be a major contributing factor.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517116/
CHARLES KALUZA ==> Yes, that study is mentioned and linked in the essay. An interesting possibility.
Sometimes weight gain does not play fair.
Hypothalamic obesity: causes, consequences, treatment.
Lustig RH1.
Author information
Abstract
Hypothalamic obesity, or intractable weight gain after hypothalamic damage, is one of the most pernicious and agonizing late effects of CNS insult. Such patients gain weight even in response to caloric restriction, and attempts at lifestyle modification are useless to prevent or treat the obesity. The pathogenesis of this condition involves the inability to transduce afferent hormonal signals of adiposity, in effect mimicing a state of CNS starvation. Efferent sympathetic activity drops, resulting in malaise and reduced energy expenditure, and vagal activity increases, resulting in increased insulin secretion and adipogenesis. Pharmacologic treatment is difficult, consisting of adrenergics to mimick sympathetic activity, or suppression of insulin secretion with octreotide, or both. Recently, bariatric surgery (Roux-en-Y gastric bypass, laparoscopic gastric banding, vagotomy) have also been attempted with variable results. Early and intensive management is required to stave off the obesity and its consequences.
And the chemical insults to the hypothalamus are…?
Speaking of chemical insults to the brain. The main point of the Kip Hansen article for me is that the AMA has classified obesity as a disease.
In fact, “overeating” is found as a treatable disease in the DSM.
Well, go on with all the conjecturing about what has gone wrong in America since the eighties. Good luck. Hope you trip over the truth sometime, and it flips up and hits you on the head like a rake, so you don’t miss it.
Plural “you” — not directed to any one person!
5′ 11″ 240lbs for me…morbidly obese? I don’t think so…
Forget BMI. Those are not good numbers. Please get a full metabolism workup ( blood chemistries plus an EKG stress test). You are at risk for several really bad chronic medical problems.
I am 6’0 and have weighted 180-190 since was a 21 yo college double athlete. Only issue is age related muscle atrophy despite exercise at my age of ~0.5%/yr without testosterone supplements. Male menopause is not hot flashes, it is less firewood chopped per day and more pain in the evening. So anerobic weights get ‘heavier’ and aerobic runs get ‘longer’ and weight can decline with muscle mass. And, metabolism slows so food intake has to go down. Ten years ago, my significant other (she is a divorced devout Catholic) and I would eat a chicken in two meals, now it is four, so we rarely buy a whole chicken any more. Life’s a bitch, and then you die anyway.
To look at me most would say I do not “look” 240lbs, and I don’t. Maybe it is because I have so much iron in my blood? Chronic medical issues are incurable, that’s what chronic means. I have a chronic blood disorder, you could say “cancer”, but it’s not cancer, but it is chronic.
OK so there isn’t just one or a few general “cures” for obesity. You have to find what works for you, that is if you feel the need to lose weight. And when you find something that works for you, guess what? You have to stick with it. Eventually you will hit a plateau but you have to stick with it in order to maintain what you have lost. And if you need/ want to lose more just tweak what you were doing. Trial and error- perspiration and inspiration.
I’m by nature a skeptic and contrarian but on this scientific debate, I side with the conventional wisdom. True, there are other causes of obesity but I think the majority of cases is just overeating and under exercise. Why? Because obesity in the US has more than doubled since 1960. I don’t think this is due to genetic mutations of the whole US population. The more plausible explanation is changing diet (high-calorie fast foods)
The research of Dr. Sacks monitored the diets of people but not their physical activities, how much calories they burned each day. This is just as important as diet. I believe in the conventional wisdom because that’s how I lost over 25% of my body mass. I was overweight. I reduced my calorie intake and did 10-km running and weightlifting. I regained my teenage body mass and muscle tone (you wouldn’t believe my age) But this is not possible for obesity caused by genetics.
reply to Dr. Strangelove comment on December 17, 2016 at 7:54 pm
I agree 100% with your comment.
Here’s a relevant book, maybe: Vitamin K2 and the Calcium Paradox: How a Little Known Vitamin Could Save Your Life, at https://www.amazon.com/Vitamin-K2-Calcium-Paradox-Little-Known-ebook/dp/B00D5TSMAS/ref=sr_1_1?s=books&ie=UTF8&qid=1482036111&sr=1-1&keywords=vitamin+k2+and+the+calcium+paradox+by+kate+rheaume-bleue
Before the obesity epidemic, people were heavy smokers and were engaged in what would now be considered manual labor employment. We could go back to that era as a solution, but it would take 10 to 20 years off our lives.
The fact is there is no simple measure of calories actually extractable from food and in practice it varies enormously between individuals. Biochemistry knowledge makes it incredibly complicated instead nutritionist (if they are even involved) do arbitrary maths protein times 4.5 to put a label on food.
It can’t be more simple. If you are putting on weight, you are indeed eating more calories than you are using. If your metabolism slows down, then you need to use more energy in other ways, or increase the amount of exercise you do.
Failure to loose weight, for whatever reason, does nothing to disprove the laws of thermodynamics.
Any argument that goes along the lines of “well, I’m expending more calories than I ingest, and I’m not loosing weight” is either underestimating your calorie intake, or overestimating the amount of energy you are using.
One of my favorite Aussie TV shows:
Dr Rudi:
“Eat less. It worked in Changi, it worked for Gandhi, no love handles on that man”
[youtube https://www.youtube.com/watch?v=h-jy3OtZAss&w=640&h=480%5D
I believe that Weight Watchers is the most effective program for people to lose weight and keep it off. They promote portion control and eating more fruits and vegetables while exercising more. I lost over 40 pounds and have kept it off for almost three years now. I ride an exercise bike an hour a day and do some weight lifting two or three times a week. (I am almost 70.) I eat almost the same foods every day, with minor variations. I was an athlete in my youth (football, wrestling, track – sprints, and competitive Olympic-style weightlifting.) Never had a weight problem until I got older and stopped exercising.
I eat any old rubbish, far too much for my energy needs. My job is mostly sedentary.
My weight never changes, I’m still tall and slim at age 66.
My body “dumps” what it doesn’t need, maintaining a set point.
If I ate too little, my energy level would drop. (If far too little, I guess my weight would drop.)
I usually eat more than I need. No problem. I’m fit and healthy.
I think that most people have an optimal genetic set point. It can’t change in a few generations.
Something in the environment has changed, either chemical or viral, to adjust many people’s set point.
Science could find the cause, but it’s too busy blaming people for being lazy and greedy.
Zaphod ==> The most likely explanation is that you won the “thin genes” lottery.
People ordinarily say now that exercise doesn’t do much, because the calories consumed are so low. However, on a Concept machine its not all that demanding to do 700 calories per hour. Has anyone done a study in which dietary intake is, say, 500 calories below maintenance and in addition 700 calories are consumed in exercise? One would have to do some resistance as well, which probably does not add much to calorie consumption.
So one might have someone with base rate of 2,000 calories, eating only 1500, and in addition burning 700 on a rowing machine or similar, for a deficit of over 1,000 calories.
Would not that lead to the loss of around a pound every three days? Or if not, surely it would be a directly falsifying experiment.
Intense exercise, or what I feel is intense for me, can burn 1200 calories in an hour. That’s the thing about “more exercise” argument, what some people consider exercise looks like standing around to me. Just like people have different tolerance to the discomfort of being hungry, people have different tolerance to the discomfort of exercise. I wouldn’t be surprised if those who don’t like strenuous exercise also don’t like being hungry. It’s a double whammy.
As far as I know, 77% of your weight is genetically determined. So if that weight is not the weight you like , you have to fight alive long against your body’s demand. But there are some simple rules: Eat only, if you are really hungry and eat only as much until you are full. And very important, eat what you like. Your body knows better, what you need than every expert in the world
I tried the high fat Atkin’s diet along with increasing my energy output by cycling everywhere for two years and 12,000Km. I was met with limited success and a return to my starting weight when I stopped the diet. After thinking about it for a while I figured that I have an endomorph body type (long in the abdomen and short in the legs) and as such seem to have a more efficient digestive system and don’t require as much food. So one year ago I started what I call the “high fat/eat less” diet with the emphasis on the eat less section.
So far in a year I have dropped 120lbs going from 440lbs to 320lbs and I only have an additional 80lbs to go for my ultimate goal. I set this goal because while seeing a specialist for my knees he stated that “There is nothing wrong with your knees that losing 200lbs won’t cure” so I’m going to see if he was right.
I have come to grips with the fact that I don’t need to eat as much as most people because my system is more efficient. I am now used to the reduced food intake and I no longer crave the large meals I always wanted before and I have no doubt that I will make my goal. By the way losing 120lbs feels fantastic. I can’t wait till next spring to see how climbing hills feels like on my bike when I am 200lbs lighter. 🙂
Matt Bergin ==> Great success story — glad to see you are doing so well with it. You are apparently one of the lucky 2-4% for whom this really works! (Not to detract from your dedication and effort, without which you’d still be 440 lbs).
Kip, a thought for your summary and conclusions.
It seems what has happened in the US and to some extent in England is that religious feeling and attitudes have moved from religious doctrine to what are nominally and vaguely scientific policy issues.
You notice in a couple of cases of the science wars that sometimes we have a public which simply refuses to accept the implications of the scientific and policy consensus. In other cases we have a split among scientists, with public followings for each party.
However, there is something in common in all the science war cases, and that is a sort of apocalyptic or millenialist view of the situation Doom in one form or another is forecast in language very reminiscent of fundamentalist Baptist preachers in turn drawing on the rhetoric of Revelation. We are in the end times, there will be mass death and destruction, there will be very few to be saved, the names of the wicked (the deniers) will be noted and they will reap their rewards.
Not only is doom forecast, but also dissenters are denounced in terms which are similar to those in which heretics or unbelievers are denounced. So we find the view that the dissenters, (the deniers) are going to be responsible for the disaster which will overtake the world. They are in some way responsible for it by uttering their views. Again, this goes back to the view that belief is what saves and unbelief damns. So in the world of fundamentalist religion, it is very wicked and very damaging to proclaim one’s unbelief. It is putting at risk the immortal souls of the credulous, who may waver in the belief needed for salvation.
The result is that argument in policy on social media ceases to be about the nominal subject. It turns into a forum in which the object is for the believers to identify the heretics or unbelievers. The important thing is to know whether one is talking to a denier. So to this end we scrutinize what is said, and when we find some doubts being expressed about any element of the canon, we know that we are dealing with a denier, and neither can nor should take anything he says seriously, for fear of contamination.
If you point out that this is basically a religious approach to a scientific controversy, the result will be even greater indignation. The whole style of the debate means that you cannot question, just as you could not in the religious world question the basis for the chain of reasoning that banned, for instance, theatrical productions. Meta argument is one of the things that has to be avoided.
What we are really dealing with in the science wars is, in the phrase, thunder without God. We have lost religion but are using the forms and attitudes of religious controversy in other fields, where it makes arriving at rational and evidence based public policy all but impossible. And involves extraorinary contradictions, which as soon as you start looking at it like this crop up all over the place. Here is one.
its said, in climate, that we are at a tipping point, that reduction of emissions is absolutely vital. Then when you point out that Paris committed the West to cut back and allows China to increase dramatically, along with the developing world generally, you get a moral argument. The argument from catastrophe due to tons emitted vanishes, and we now get the argument that its only fair, given they have just started to industrialise, given that they are installing wind, given that their per capita emissions are lower (not that they are). But of course, if the argument is from physics, none of this has any bearing. It has only a bearing if we are dealing with some moral assessment of righteousness.
But this is how we get to the proposition which the faithful seem seriously to be asserting, that continued emissions at current levels will lead to catastrophe, that every little helps and so we have to reduce even if our emissions are low, and also that the developing world can indulge in emissions increases which will more than cancel out our reductions. And this is because it is ‘fair’. Somehow its being fair will mean that 5 billion extra tons from China will have no negative effect, whereas a 2 billion reduction from us will save the planet.
Its religious approaches to what is nominally a scientific matter. It reminds one of Chesterton, who remarked the problem with disbelief what not that one no longer believed in religion, but that people after losing their faith felt free to believe anything at all.
michel ==. an interesting analysis.
https://www.theguardian.com/environment/climate-consensus-97-per-cent/2016/dec/12/on-climate-change-angels-and-demons-are-battling-over-trumps-soul
‘Angels and demons battling for his soul’?
Firstly, Kip Hansen, let me say thanks for this post. I like non-climate stuff. However;
This statement is NOT utter nonsense.
Perhaps it is too general or too broad a statement but it is true.
I’ve recently lost weight through simply reducing my calories and increasing my physical activity.
(My obesity must be the 60th type)
I KNOW this statement not nonsense.
Six Months, 25 lbs and I feel great
( I’m no apologist for Hawking. I think he’s an Elitist, Progressive tool.)
RobRoy ==> Thank you, glad you like my work. The original motto of WattsUpWithThat.com was “Commentary on puzzling things in life, nature, science, weather, climate change, technology, and recent news by Anthony Watts”. A lot of my essays fall into one or more of those categories. Quite truthfully, Climate Science and the Climate Wars are, to me, boring in their predictable tribal warfare kind of way.
The context for the Hawking statement is the Obesity Epidemic. In that context, what he says is truly utter nonsense The obesity epidemic not simple at all — it is complicated, complex, and a wicked problem that remains yet to be solved. His statement “Fortunately, the solution is simple. More physical activity and change in diet.”– in that context — is foolish — almost the entirety of the actual science on obesity shows that Eat Less Exercise More is NOT a solution to the obesity epidemic and not a cure at all for the vast majority of the obese.
The fact that you, and nearly everyone who is a little overweight, can drop 10-15 lbs (in your case, a commendable 25) by eating less and exercising more has almost no bearing on the obesity problem. I myself have had periods in my life where I have gained those 15 lbs and periods where I have lost them, so I know what you are saying.
But it just isn’t the same problem.
My wife and I live most the the year on our sailboat — and when we live “on the hook” (at long-term anchorages) we get our electrical power from solar & wind, with a backup diesel generator. This works for us in our context but is not a solution that should attempt to be applied to every suburban home in Los Angeles — wrong context — it won’t really work for them with their all-electric kitchens, air conditioners, chest freezers, etc etc. It just isn’t the same problem.
Food has never been cheaper in all of history. We learned reliance on a sole carbohydrate staple was an invitation to blight and certain famine. All by the age of enlightenment or reason. But now we also have worldwide logistics so famine is always political.
Back to obesity..at mininum wage, one need only work for less than a half hour to buy the recommended daily allowance of carbohydrates, fatty acids, amino acids, fiber, minerals and vitamins. Of course this is based on staples and not premium selections..and certainly not fast food. For example, a fresh, whole chicken is about $5 in my ville. The store also has the same carcass cooked for double the price.
History is why we are fat. No one remembers. No one cares. History is bunk. Those ignoring the failures of history are doomed to repeat…
Very few people in the western world need to be reminded to eat.
We could discourage food adverts, they are not helpful.