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The Obesity Apologists

Doctors have been telling fat people to eat less and exercise more for at least 2,500 years.

Here’s Hippocrates, father of Western medicine: “It is very injurious to health to take in more food than the constitution will bear, when, at the same time one uses no exercise to carry off this excess.”

And here’s the blunt advice of Polybus, student (and son-in-law) of Hippocrates: “Persons of a gross relaxed habit of body, the flabby, and red-haired, ought always to use a drying diet . . . Such as are fat, and desire to be lean, should use exercise fasting; should drink small liquors a little warm; should eat only once a day, and no more than will just satisfy their hunger.”

Public health experts no longer disparage red-haired folks, and as far as I know, they don’t recommend drinking warmed-up liquors. But they’re still spreading the message of the harms of obesity, via television, magazines, school curricula, and even First-Lady policy agendas. These efforts have some merit. People who are obese (defined as having a BMI of 30 or higher) have an increased risk of developing heart disease, diabetes and some cancers compared with people who are not obese. And people who are severely obese have a higher death rate than thin people.

The message that thinner = better just seems intuitive, doesn’t it? I’ve certainly heard it all my life (or at least since 3rd grade, when I was mortified to be one of the chubby kids in gym class to not get the President’s Physical Fitness Award badge) and have never questioned it. But over the past few months, while researching a story published in today’s Nature, I’ve started to wonder whether we’ve gone too far in our cultural war against fat.

Weight is just one factor of many — sleep, diet, fitness, psychological health, socioeconomic status — that influence whether we are healthy or sick. But politicians don’t talk about a sleep deprivation epidemic; there is no Biggest Loser of Poverty reality TV show.

What’s more, the health risks of being “overweight” (defined as a BMI between 25 and 30) are not at all clear. As I describe in depth in the new story, mortality rates of people in the overweight category are actually 6 percent lower than those in the “normal” category, and some people who are overweight (and even mildly obese) show no signs of illness. Conversely, lots of thin people out there have heart disease and diabetes.

Yes, being obese usually takes a toll on health, no question. But guess how many obesity drugs or diet-and-exercise regimes have been proven to last more than a year or two?

Oh, right, zero.

And yet, the battle cry remains: if you’re obese, just crank up that willpower! Eat less, move more!

“I would like to believe that modern medicine and modern science can be better than just repeating a 2,000-year-old recommendation,” says Jeffrey Friedman, a molecular biologist and trained medical doctor at The Rockefeller University in New York. Friedman has many strong opinions about the so-called obesity “epidemic,” which we talked about at length over coffee recently.

Friedman has been studying the genetic roots of obesity for more than 30 years. In 1994 he made headlines for the discovery of leptin, a hormone that circulates in blood and turns off hunger signals in the brain. Subsequent studies have found genetic mutations in the leptin gene that cause rare cases of obesity. Twin studies have also shown that obesity has strong genetic roots (it’s about as heritable as height, in fact, and yet we don’t think of being too short or too tall as some kind of moral failing).

Despite these unquestionable genetic contributions, most of us think of weight as environmentally driven: a direct consequence of a person’s personal eating habits. It’s this emphasis on behavior that “gives the public a license to stigmatize the obese,” Friedman says.

“A lot of people try to couch it in ways that don’t as directly lead to stigmatization, but they end up always getting there,” Friedman says. “Because you end up saying, at some level, that the obese have made a series of poor choices that have led them to this.”

Friedman sees things quite differently, as he eloquently explained in a 2003 commentary in Science. Each of us, he argues, has a different genetic predisposition to obesity, shaped over thousands of years of evolution by a changing and unpredictable food supply. In modern times, most people don’t have to deal with that nutritional uncertainty; we have access to as much food as we want and we take advantage of it. In this context, some individuals’ genetic make-up causes them to put on weight — perhaps because of a leptin insensitivity, say, or some other biological mechanism.

In other words, morbidly obese people lost the genetic lottery. “The irony is, it’s the people who are the most obese who are stigmatized the most, and in fact, they’re the people who can do the least about it,” Friedman says.

Environment is important, of course: No one, no matter what their genome looks like, can become obese without food. But scientists don’t know most of the details of how the environment interacts with genes to control our eating habits. They don’t know why this system has such extreme variability in the human population. They don’t know why a (very select) few obese people can lose 50 percent of their weight and maintain that loss for decades. And, as I found in my story, researchers definitely don’t know why extra weight leads to sickness in some people but not in others. (It’s not even clear that fat tissue itself is harmful; it could just be an innocuous byproduct of a harmful diet, say, or of not exercising enough.)

This whole subject is steeped in political controversy and a wide array of financial interests, which has made it difficult for me to write about and to think about. But I’ve tried to be provocative in this post. Considering the economic and cultural investment we’ve put into the war on obesity, doesn’t the public deserve more transparent and rigorous discussions about it?

Is this a public health emergency that warrants the $1+ billion a year the U.S. is spending on it? Or are we fighting a war that’s unjustified, unjust, and impossible to win?


Quotes from Hippocrates and Polybus cited in this 2007 commentary by D. Haslam (.pdf here)

42 thoughts on “The Obesity Apologists

  1. This debate also has legal ramifications. If being fat is partly genetic and thus not fully a lifestyle choice, why is it legal to discriminate against fat people in the workplace (which happens all the time)? How is that any different from discriminating on the basis of race, gender, sexual orientation, etc? I wrote about this in 2007 (http://www.boston.com/news/globe/magazine/articles/2007/08/05/do_we_really_need_a_law_to_protect_fat_workers/?page=full), which was coincidentally the year the first FTO GWAS came out. It should have been a banner year for making it clear that weight is not entirely in people’s control. But I don’t think the policy debate has changed one bit in the last six years. Which is sad.

  2. “We don’t think of being too short or too tall as some kind of moral failing…” But we do! We can’t help it. We involuntarily pile shame onto victims (and sometimes even onto malefactors) of every kind.

    Full disclosure: I am fat. But I may have found a way out. A certain calorie and exercise-monitoring internet service is currently working very well for me. The key is that the software in effect watches me all day and informs me, with each ingestion, how much eating I have left for that day. Sometimes, as even a lifelong nonconformist like me has to admit, we need to be told what to do, just can’t manage without.

    As of now, this service-which-must-not-be-named requires my full cooperation to enter what I eat throughout the day. But it knows the full specs on practically every kind of food there is in my life, most of it measured in precisely the portions one encounters in stores and restaurants. This level of automatonic omniscience is apparently enough to convince some part of my brain that the software behind the site really is my stern friend, leading me on the path to become ever less, less, less.

  3. Curious. I’ve begun to wonder if our standards of “health” and “attractiveness” with regard to fat aren’t as misguided as our obsession a couple of decades ago with the “healthy tan”.

    It seems like just a survival mechanism that hasn’t adapted to a culture of plenty. Fat insulates; that area that’s hardest to lose is around the vulnerable core. It protects against temperature extremes, provides a buffer against starvation (as seen every fall and winter in nature), and may even provide padding against trauma, according to a recent analysis of pedestrians and bicyclists hit by cars in NYC. I swear I saw that in the NY Times, although I can’t find it now.

  4. Well, it seems to me there are more and more overweight/obese people now than ever. The War on Fat has certainly NOT gone too far. If people are still gambling with their health, let them. We’ve given them all of the tools, and if they fail to utilize them, they’ll pay the price later. But for those who do heed the message, they can more than likely enjoy a satisfying healthy life.

  5. Sometimes people leave comments that make me wonder if they even read the story. Ben’s is one of those.

  6. OK Mary like most things in life it is a combination of nurture and nature. You can say there is a genetic component to obesity, but you can also make a conscious decision to address the problem (and yes being obese is a problem. Obesity leads to shorter lives and higher medical expenses, my health insurance does not charge extra for clients with higher weight so I am subsidizing the health insurance costs of obese individuals.) Or you can just choose to ignore the problem and let the weight accumulate and have your options in life lessen. I will make the point of my little sister who is very disorganized and her excuse is,”I am the adult child of an alcoholic.” And she never will get make any attempt to improve her condition. I have my troubles too, but I work to overcome them. Same parents, different outcomes.
    As far as obesity, some of the blame falls to President Nixon by wanting both cheap foods and rich farmers. His policies increased the amounts of grains grown in the US which lead to all the cheap processed foods and the abundance of corn syrup and the high cost of sugar.
    You can blame any number of sources for obesity, but the solution for any one individual lies with the person themselves to be responsible for their own actions.

  7. Right, Todd. Like I said, “partly genetic.” So, also partly environmental. But remember, environmental factors work in part by acting *on your genes*. So if you have genetic variants that predispose you to obesity (like this: http://www.sciencemag.org/content/316/5826/889.abstract), the “environmental approaches” to losing weight (e.g. diet and exercise) probably won’t work as well for you as they might for someone who has more favorable genes and just wants to lose a few pounds or look better in a bathing suit. Of course people should be responsible for their actions. Of course they can make conscious decisions to try and address their problems. But if their outcomes are poorer because of something over which they have no control (their DNA), they shouldn’t be blamed for that.

    (Also, “same parents, different outcomes” doesn’t quite work as an explanation. You and your sister only share about 50 percent of your DNA. She may carry different relevant genes than you do. And she’s certainly had a different environment growing up — “same parents” is but one factor.)

  8. “I would like to believe that modern medicine and modern science can be better than just repeating a 2,000-year-old recommendation,” This is not a reccommendation this is a normal life, moving and eating when you are hungry. The war with obesity can be won, but people can’t be in regime for two years and then get back to devouring hamburgers. If genes had so strong influence on obesity then people would be obese 100 years ago, and they weren’t.

  9. Excellent article but like Ben, so many people don’t get it nor do they take the time to read the research of a molecular biologist/scientist such as Jeffrey Friedman. I know “thin” people who drink alcohol for most of their calories and think they’re healthy because of their weight. I know people who ride motorcycles w/o helmets and they think they should have the right to do so at the expense of those of us who are safety/health conscious. There are so many self-righteous hypocrites out there that truly believe that they are superior human beings because they are thin. Btw, I do NOT have a weight problem. My late husband was slightly overweight we got married. He later discovered the joy of running and he ran a marathon, a few half marathons and many, many road races. He was in the best shape of his life when he was diagnosed with a rare heart condition (his coronary arteries were completely clear/open) at age 35. He didn’t smoke or drink, he was passionate and positive about life. Despite the best treatment available, he died suddenly and unexpectedly at age 46. He did everything right but that cardiomyopathy killed him. Yet his father who smoked 3 packs of cigarettes/day lived to be age 78 and his 83 yr old Mom, who has diabetes, high blood pressure and is morbidly obese is still alive today. To be thin—and tan!—-is the beauty standard of today but it does not equate with good health. As my late husband used to tell his students, “life isn’t fair, it isn’t even partly cloudy.” We somehow think that we have control over many factors in our life but it is an illusion. Of course, if you care about your health and longevity, it makes sense to practice moderation and to exercise. But it’s not that simple and I think genetics play a huge role in much of this. Thanks for an important and insightful article.

  10. When did BMI become an acceptable metric for measuring an individual? The statistic was originally created to measure the weight of a large populace. Applying it to an individual is a bad practice, and should be stopped.

  11. The problem with every pro-fat movement is that it is quickly shot down by facts. For every study that shows fat MAY not be linked to health, there are 30 that show the exact counter point.

    If genetics were the primary factor in weight (just like height) then our weights would not fluctuate as much. Clearly, our habits influence our body size a great deal.

    Fat apologists like to paint a picture of anorexics throwing rotten fruit at the girl who is 25lbs overweight. No one has ever said that being skinny is synonymous with being healthy. On the flip side of that coin, being obese is not being healthy either. The “war of obesity” is a made up thing that apologists tout to gain sympathy. The “health movement” is very real however. Being healthy benefits you and everyone around you. If you are healthy and obese at the same time, good for you, you are a genetic lottery winner. The fact remains that most individuals who are obese also have health problems, and being obese at a young age will greatly increase your chances of having health problems as an adult.

  12. in response to ‘Thegoodman” & the “pro-fat movement”/”obesity apologists”—-I don’t think that anyone truly wants to be overweight or obese . But this is probably a backlash movement because “fat people” are subjected to such judgement, ridicule and shame. The true measure of a man/woman is NOT their BMI nor their weight nor their cholesterol reading. The culture of Abercrombie and Fitch where anything over a size 10 is considered a “plus” size encourages an unrealistic,unhealthy and very elitist approach to appearance. It is particularly toxic for young pre-teens and teens who in their quest to be a size 0 often times end up with eating disorders, depression, alcohol and substance abuse. I work in a high school and it’s a very cruel world, esp with the anonymity of social media. We need to foster good health in a more positive way instead of vilifying and demeaning those who struggle with being overweight. Again, the self-righteous comments and remarks that are evident everywhere about “fat people” do nothing to promote life long health. And when I die, I hope that I’m remembered for my compassion, genuine concern for others and my actions/words, not the number on the scale.

  13. It would be nice if the people who inevitably show up in these comment threads to let us all know that obesity is really just a straight forward problem that can be tamed simply with a little vigor and discipline would actually acquaint themselves with what the obese are actually up against.

    It’s not a problem that scales up. Losing 100 pounds isn’t a matter of losing 20 pounds and then doing that 4 more times. If your hormones that regulate appetite aren’t working properly, it feels like you are starving. It’s like expecting someone to use discipline to hold their breath for half an hour.

    Our understanding of the role of endocrinology in weight regulation has undergone a sea change over the last decade. I’ve gathered a lot of the reporting and some lectures here http://themarcusreader.wordpress.com/2013/03/20/special-edition-understanding-weight-regulation-endocrinology-over-arthimetic/ for anyone who’d like to have a sense of why we are beginning to understand that lectures about ‘calories in / calories out’ are beside the point.

    PS Before you start, you are engaging in a fallacy of logic. Yes, calories in / calories out DESCRIBES what is happening. That irrefutable and why it leads to so much smug commenting. The problem is that it doesn’t EXPLAIN what is happening.

  14. As a recovering fat person, I agree with both arguments in this thread.

    I understand that there are genetic and environmental effects to weight gain and loss. My sister and I grew up obese. Not just obese, but poor, suffering from mental health issues, and even issues insulin resistance. On top of that, my sister suffers from hormonal issues that affect weigh gain.

    As adults, my sister has lost 70 lbs and I’ve lost 91. Clearly we had to overcome our mental health issues, and understand what drove us to overeat, but also to understand how nutrition works; how much we should be eating and what our bodies required.

    I have to be honest… it was a combination of a lack of self-awareness, laziness, and the need for instant gratification that fueled our obesity.

    It’s a steep, uphill battle and requires a ton of vigilance, but that makes it no different to any other challenge that life throws our way. As a result, I’ve become prejudice against fat people. Much like my prejudice against any person who wakes up every day and makes the choice to be the exact same person they were yesterday. Good, bad, rich, poor, too skinny, or too fat.

    We can see here and talk genetics and why we shouldn’t be prejudice. I understand why I shouldn’t be; certain things we just can’t help. One of those things is our desire to create hierarchies. It can’t be avoided.

    Unlike being short, being obese is something you can change. When people see you live the same problem – and yes, being obese is a major healthy issue – day in and day out, without making strides to fix it, they determine you do not have the willpower, personal strength, or courage to do something about it. And in a ton of cases, that’s true. Much like the smoker who says they can’t quit – everybody can quit. It’s just hard to do.

  15. “And people who are severely obese have a higher death rate than thin people.” I have a problem with this statement, obese people statisticly may die younger than thin people but they don’t die anymore often. We only get one kick at the cat o to speak.

  16. how many of us “overwieght” ppl have been told growing up that we couldnt go out and play till we cleaned our plates?

  17. This is not an all or nothing issue. Sure there are countless thin people who smoke, drink excessively, under-eat and as a result have health complications. Certainly (from the perspective of someone who works in health care with mostly obese patient’s) there are also many overweight people who are healthy. This doesn’t change the fact however that serious health conditions such as Type II diabetes and HTN are exacerbated and accelerated by obesity. Does this mean that obese people are lazy, less than, or ugly? Of course not. Does it mean that people would choose to be obese, not likely. This goes beyond appearance. Do I wish that being thin (or for that matter young, wrinkle free, tall, busty etc) wasn’t the standard for beauty in our society? Yes. Cigarette smoking kills a multitude of people each year. So do obesity-related illnesses. So does alcoholism. It is just easier for people to pick on those who are obese because it is more obvious.

  18. Doesn’t anyone notice the inherent contradictions in this article? You say that obesity is genetic and therefore people with a genetic predisposition to gain weight are more likely to be obese. Yet, you also admit that these predispositions are only becoming reality in modern times due to our constant access to food. But then you claim it’s not an obese person’s fault that they are obese because it’s genetic! A genetic predisposition just means a person who consumes a certain amount of calories is more likely to gain weight than someone else. But they still have to eat those calories to gain weight! Our constant access to food gives those with a predisposition to obesity the ability to become obese. The food is there, so they eat it and they gain weight. It still comes down to a matter of will-power. The food is there, but if you don’t eat it then your genetic predisposition isn’t going to cause you to gain weight in the absence of calories. Matter doesn’t come out of thin air and attach to our thighs – calories must be consumed in order for fat accumulation to occur. Therefore, it IS a matter of will-power. And for all those complaining that it is so hard to lose weight: just as it’s easier to not start smoking in the first place, it’s easier to not overeat and gain weight in the first place. I do not think that people should be ridiculed or discriminated against because of their weight, but I also don’t think you should mollycoddle people and say “it’s not your fault you’re obese; it’s in your genes.” That’s incredibly disempowering and that message does more harm than good. Thin, fat, young, old – we all have the ability to improve our health and should be encouraged and empowered to do so.

    1. You’re kind of missing the point, Kara. I’ve heard some researchers explain it in terms of thirst, which is often easier for people to understand. Imagine if you had been in a desert for a week without water, and then you’re offered a plentiful supply of water. If you don’t drink it, yes, you’re exhibiting will power. But after a certain amount of time you’re going to either drink or die. That’s the situation of some obese people whose genetics tune down their metabolism in a way that doesn’t happen in non-obese people. Or that’s the argument, anyway. I think prevention is a good goal, but again, it hasn’t really worked…

  19. I never went beyond 105lbs until pregnancy and then lost it rapidly. Then I hit 30, changed from a physical job to a sedentary one, and the weight started creeping up on me. I’m now late 40’s and struggling with keeping it at 170. it isn’t just will power, it’s also age and really, who wants to be tied to an exercise machine or spend hours exercsing for the sake of it? WXXI had a provocative episode where the argument was made for brief intensity of exercise was more benefical than hours of it. I really like that concept and have adopted. so far I’m maintaining within 4-5 lbs rather than losing. which is fine with me.

  20. Marta, that’s not actually true. 100 years ago, people were a lot shorter, too. 100 years ago, it was extremely rare for a person to reach 6′. Today, it’s common. That doesn’t mean that height isn’t genetic. Changes in the environment and food supply allow genes to be more fully expressed. Today, people who have the genes to be tall are able to be taller because of environmental factors, just like people with the genes to be fat can get fatter. It’s still genetic.

  21. One of my cousins had weight issues when she was younger. Her mother controlled her diet completely. Whenever she came to visit, she was only allowed to eat a third of what the rest of us kids were allowed to eat. She wasn’t allowed to eat sweets. I remember she used to cry a lot because she was so hungry. If she had been any other person, I would have accused her family of deliberately starving her to death.

    And yet, she weighed more than I did.

    Not all obese individuals face genetic circumstances this extreme. However, some do. Assuming the solution to obesity is as easy as “just develop more willpower” is overly-simplistic and ignorant.

  22. I have been obese for most of my youth, 130kg at 1,60m at my peak.

    I think the social disgust has a strong part in continuing obesitas. It’s this social factor that -for a long time- kept me from going outside very often, while also exaggerating my eating habits (dopaminergic compensation for a lack of social stimulation and reward?).

    I’ve been at (the higher regions of) a healthy weight for about fifteen years now. The thing that changed this around for me was to say: to hell with them all, I don’t care what people think of me.

    So it’s a vicious circle, and to my opinion the interpersonal environment does play a major role through stigmatization.

  23. One aspect of exercise, which is absolutely vital in this age of high fructose corn syrup in everything.. is often overlooked.

    Growing up, I wasn’t fat. But I was rather clumsy and my lazy left eye meant that I lacked the depth perception to reliably catch a football or hit a baseball or dunk a basketball.. so I was the “last one” a lot, and this left a lot of shame around athleticism for me. And God knows I’m not the first, last or only ungainly kid who didn’t get real coordination until almost age 30!

    The point of this is that exercise-the simple joy of moving your body and feeling its response and letting yourself just feel more alive because of it-it sorely lacking in our ultra-competitive PE and athletic schemes these days.

    If you can’t run fast, hit a baseball, catch a football or etc. then you aren’t what I’d call “traditionally athletic” in the sense of you’re gonna get a letter jacket for physical prowess-and you get left behind.

    Thanks to my father who imbued a lifelong love of cycling in me, I discovered later in life that I am, in fact, kinda athletic 🙂 And I don’t need to end up pushing 260 lbs like every single one of my uncles on both sides. I kinda freak out if I hit 185, at 6’1″; and I know that’s vanity.

    But still, Physical Education in this country needs to be shifted-away from the hero worship of the jocks and more towards encouraging more and different types of athleticism-track and field is a good start although hyper-competitive; but what about swimming, walking, cycling, different types of workouts as with kettleballs, medicine balls etc.. the point not to be shamed because you can’t bench press 240 but to feel good and exalted because you did the whole routine and it felt good and that’s all that matters.

    Society overlooks it-you don’t have to be Lance on the bike or Jack LaLane in the pool or Micheal Jordan.. you just have to spend a couple hours a week movin’ your body. That’s what is undersold, and it’s too bad.

  24. Virginia I appreciate your nuanced, thoughful approach to an incredibly complicated issue. If you’d like to learn more from medical doctors, researchers, psychologists, social workers, public policy folks, nutritionists and sociologists who are thinking outside the box I suggest you check out the Health At Every Size approach. Linda Bacon’s site is a good place to start. lindabacon.org

  25. Something for the willpower crowd to ponder, is the difference in daily exercise between US cities and other cities. Compare Groningen in the Netherlands, to Boston-Cambridge-Somerville. Similar population, similar density, somewhat similar climate and topography (there are some annoying hills in Somerville). Yet in Groningen, over 50% of the trips are by bicycle, and most of the rest are walking and transit. Here, we’re proud if it’s 5%. Do they get all that exercise because they have more willpower, or did they arrange their society in a way that people were encouraged to get that exercise?

    Much the same is true of food and eating — look at how we are all carefully nudged in the direction of eat-eat-eat, and attempts to blunt that nudge (e.g., Bloomberg’s soda ban) are shouted down in the name of “Freedom!” “Free” to be constantly nudged in direction of unhealthy, sedentary, product-consuming lives, that’s what it is.

  26. The new generation are pretty much conscious about their physique yet if they are fat it’s not a fully lifestyle choice, I think. “Eat, drink and be merry” phrase is there in the lives of many people yet it’s not the ultimate factor involved in all the cases. Every obese has a different story to explain why he is like this. On average bases it is concluded by medical research that genetic factors are involved but obesity can be controlled by a proper diet and exercise plan.

    Samreen M

  27. At the end of the day, you are simply an apologist making an excuse that is an umbrella for ALL fat people, when in reality these “genetic dispositions” while real, don’t apply to nearly as many people as you’re suggesting. Lets talk about macronutrient breakdowns shall we? We know that a diet high in lipids and simple carbohydrates generally leads to excessive weight gain, while diets high in protein, low in lipids, and high in complex carbohydrates (fibrous carbohydrates) generally leads to healthier, and in most cases, a thinner body. The point is that we have it all wrong in the way we are sending the message. Fat people don’t need to be told “eat less” they need to be told to “eat better” and become at least mildly active. True, they don’t need to be made fun of, we don’t need size 0 models used as the prime example of health. But we also don’t need to apologize and use new science as an excuse to let people off the hook for their weight. Higher healthcare costs, food costs etc is massively effected by the fact that there ARE so many people that overeat and make poor dietary choices, who then gain weight, who then are far more likely to develop health problems that can become burdensome on everyone around them. Sure it isn’t as simple as magically finding willpower, but that doesn’t mean that we should just apologize and turn a blind eye to an extremely serious issue.

    At the end of the day whether you are someone who ridicules fat people, or someone who apologizes and makes excuses for them, we cannot deny the fact that it has become a problem and is taking a toll on society. Sure, we shouldn’t be mean about it, and we should change the message in more than one way, but that doesn’t mean we should turn a blind eye and say “let them be.” There may be some who will gain weight at the sight of food due to genetic predispositions, and there may be some who are overweight and somehow remain healthy. We need to remember, they are the exception, not the rule. No matter your stance, you have to see the effect that having a population of people that are mostly overweight is effecting everyone and that something must be done.

    1. “The point is that we have it all wrong in the way we are sending the message. Fat people don’t need to be told “eat less” they need to be told to “eat better” and become at least mildly active.”
      You completely ignore the most basic of science in regards to nutrition – calories. The average person consuming more calories than the body requires will gain weight, no matter whether the calories come in the form of healthy or junk food. You’re tangling up weight with nutrition, which are related but not the same.
      “we cannot deny the fact that it has become a problem and is taking a toll on society.”
      Another person who, perhaps didn’t read… or missed the point? The point is that what’s currently considered “overweight” may actually be the most healthy weight, which means we need to adjust our conceptions of what’s “healthy”.

  28. You’re telling a personal trainer that being “overweight” is what we should consider the new norm when we have established science that gives us a general scale of what healthy weight looks like. If you’re insinuating being thin is more unhealthy then being overweight, then you Solitha are the problem. You can’t argue with hard scientific evidence that shows people who are overweight have a higher risk of heart disease, diabetes, etc. That doesn’t mean someone is healthy because they’re thin or unhealthy because they are fat, but again the exceptions are not the rule. Imperial evidence has shown us that the majority of fat people are far less healthy than the majority of “thin” people. To suggest otherwise and basically say that we need to throw out science and “change” what science has proven is a healthy weight is completely absurd and laughable. When you can show me a study that delineates that the MAJORITY of fat people are healthier than thin people, I’ll agree with your argument.

  29. Lifestyles that involve overreating fatty processed food and lack of exercise lead to weight gain which take a toll on the body. The majority of fat people are fat due to poor lifestyle choices that cause poor health. That is science.

    Also you’re telling a trainer who has helped dozens of people lose weight (and who feel so much better about themselves and are generally much healthier now, but that’s just coincidence that their weight loss helped them become healthier right? I mean that is so odd considering the fact that you think these people who are now ‘thin’ are potentially less healthy than they were before?) about “calories-in, calories-out” and trying to tell me that anyone who overeats whether it be healthy food or junk is prone to weight gain? Wrong. I have had clients, and I myself, consume a diet of food that is healthy in “excess” of what we burn off through lifestyle and exercise, and somehow I am thin, muscular, and in excellent health… Oh could it be because I exercise regularly and most of my excess calories come from protein, vegetables and other whole natural non processed food sources. Sure, those exceptions to the rule who have genetic dispositions toward weight gain would likely become overweight even if they followed a clean diet such as this while overeating. But the evidence is pretty clear, even if you “overeat” you can be healthy assuming you exercise regularly and are selective in what you consume. I have been in a caloric surplus almost every day for years, but because I exercise and eat carefully, most of any weight i may gain is from skeletal muscle, not fat. Interesting how that works. Leave the science to those who understand stand it Solitha, because you clearly have so little idea of what you’re talking about that its laughable.

  30. “People who are severely obese have a higher death rate than thin people.” Picky point: we all have the same death rate, eventually. It’s more accurate to say that people with certain risk factors die younger than the average.

    I was disappointed to see no discussion here of what health researchers call an “obesogenic environment.” Basically, this is the idea that we are surrounded by vast quantities of unhealthy foods, many poor people live in “food deserts” where fresh food is not available in the neighbourhood, and we are probably on the second or third generation of people who think “cooking” means heating up a frozen entree. Not to mention the fact that we’ve engineered the activity out of daily life; many neighbourhoods don’t even have sidewalks any more, and even if they do, there’s nowhere to walk to. Fewer children walk to school than ever before. Yes, there’s a genetic component, but the U.S. is not so genetically different from other countries where cities are designed differently, and cultural views of eating are different. I’m Canadian, and though we’re on a similar trajectory to the U.S., it’s not as extreme. When I visit the U.S., I’m astounded at the ridiculous portion sizes, and the vast number of garbage chain restaurants like Chili’s, Denny’s, Applebee’s (we have them here too, but as someone who grew up eating real food, I think they’re awful). I like my junk food fix just like anyone, but I find in North America, junk food has ceased to be a separate category, and “junk” has pervaded all the food we eat, including meals.

    1. On the subject of an obesogenic environment, I was once told how to fatten cattle by a man who had once worked at such an operation. He told me the method of fattening cattle was simple. You just have to leave them inside, with the light on at all times, feed available 24 hours / day, and sweeten the feed with molasses. That was all you had to do! The cattle would then automatically eat until they became quite fat.

      We are now in a situation much like the plight of those cattle. Their instincts tell them to eat, so they eat. So do we.

  31. I’m among the “fit-fat” – obese by BMI and any visual standard, but with all numbers in normal levels. Blood pressure today was 124/80 when I gave blood. Cholesterol and blood sugar counts were normal in January. I don’t smoke, I limit my alcohol consumption to 1-2 drinks a week, and I eat plenty of vegetables. (Dinner tonight is a squash casserole with a mixed green salad. Yum.)

    Am I trying to lose weight? Of course! No one wants to be fat. But even a careful diet and exercise isn’t working.

    I’m hoping for more progress in the realm of microbiota. I don’t expect a magic bullet, but I’ve been on antibiotics very frequently since I was a young child, and antibiotics are well known to cause cattle to fatten up. Quite reasonable to accept that it happens the same with people, too.

  32. I currently work for a company that says “If you want to carry health insurance from us, you will have to pay more if you choose to have an unhealthy lifestyle.” They take our blood, vitals, and measure our waists. Lets not forget the questionnaire. While some of it makes sense, like if your a smoker, I can appreciate that. Or tracking your “inner workings” year after year as a preventative measure. But I see people struggle with their health and at some point it definitely feels like if you weren’t born with the perfect genes, you’re literally going to pay for it. It’s feels like the new natural selection, in a sense. It’s hard enough just to make it through a day. If this is supposed to give people a better quality of life why isn’t it? If this is a 2000 year old practice, I’ve got to tell you I’m a little bit tired of beating a dead horse. I, for one, am ready for science to transcend this issue. People deserve their peace. All these pills and diets seem to cause more harm than good. GO SCIENCE!

  33. Seems obesity is not the only American epidemic, but folie-a-deux or perhaps folie-a-everybody posting comments also. The inference throughout all of these comments is this: our genes, not our lifestyle, is responsible for our unhealthy, perhaps even morbid obesity. You have exported your obesity epidemic to us in the UK. Please don’t export your mental illness to us as well. Calories in vs. calories out is the only argument for 99% of obese people. Do you really think that millions of Americans SUDDENLY in the late 20th century had a problem with their leptin or other made-up chemical that is responsible? Incidentally, I just thrashed myself around a 30-mile cycle ride this afternoon in the blazing English sunshine. THAT is why I have a normal Homo Sapiens morphology!!!!!!!!!

  34. This is a fantastic article and it gives Jeffrey Friedman his due. This is a sorely misunderstood subject and the more light we can shed on the underlying causes, the less power the stigma will have.

    Thank you for a great article, Virginia.


  35. > If being fat is partly genetic and thus not fully a lifestyle choice,
    Genetics plays a part in what your TDEE is; that doesn’t mean being fat is genetic.

    The biggest determinant to good health and resiliency is having significant muscle mass. Trauma and disease devour protein, and additional muscle built by regular exercise increases survivability.

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