Are We Powerless in the Fight Against Obesity?
I read an opinion piece in the New York Times, Scientists Don’t Agree on What Causes Obesity, but They Know What Doesn’t, a few times before I could figure out what bothered me about it.
First a bit of background, much or which was laid out very well in the article. Presently about 40% of Americans are obese, defined as a body mass index > 30.[i] This percentage has grown enormously over the 40 years. Here is a representative graph from the NIH:
The CDC maps of the US that follow the increasing rates of obesity in each state over the last decade are terrifying. Obesity is closely linked to many of the diseases that we struggle with in medicine. The increased risk of death from COVID in people with obesity was unexpected and striking.
The NYT article made, or alluded to, excellent points about some things that are and are not related to the rising rates of obesity. The rates are certainly related to the changes in how live and eat. We are more sedentary. This is partially due to how our anthropocene world is designed. Although much of the physiology is not understood, it seems clear that the synthesized and heavily processed food that fill our stores, often priced below fresh and unprocessed options, make it easier to gain and harder to lose weight.
Then there are the things we know are not responsible for our weight gain. We know humans have not changed. We are not metabolizing food differently and we have not lost will power. Based on the popular media I see and the catalogues that burden my mail carrier, I do not think we have gotten a whole lot more comfortable with a diversity of body types. Movie stars remain impossibly slim.
What did I struggle with about this article? It was that a political bent, one that is currently the most acceptable, completely drove the focus. We were portrayed as victims of the food industry, powerless to resist. We are forced to use UberEATS without standing from our computers, We are paralyzed by a lack of sidewalks and easy access to ride share.
Physicians, researchers, parents, and humans should be able to hold two contradictory thoughts. It has become much easier to gain weight. There are many forces, some downright pernicious, working to addict us to brilliantly engineered “edibles” that our grandparents would not recognize. Yet, we can recognize that we are not helpless. As the Times articles stated:
“No presenter argued that humans collectively lost willpower around the 1980s, when obesity rates took off, first in high-income countries, then in much of the rest of the world. Not a single scientist said our genes changed in that short time.”
We can simultaneously work against the forces and designs that have led us to gain weight while also working towards presently achievable healthier lifestyles. We can develop better medical and surgical treatments for obesity while not shaming people who need them. We can avoid looking at problems through a social lens that only allows us to interpret facts in one way.
[i] In metric units: BMI = weight (kg) ÷ height2 (meters). In US units: BMI = weight (lb) ÷ height2 (inches) * 703.
“No presenter argued that humans collectively lost willpower around the 1980s, when obesity rates took off, first in high-income countries, then in much of the rest of the world. Not a single scientist said our genes changed in that short time.”
Funnily enough, the first official US government recommendations that the entire population eat a diet low in saturated fat (which means, by default, increasing carbohydrate consumption) were published in 1980. You’re correct in that nothing has changed with respect to our physiology or psychology (willpower) but we have been subjected to a population wide dietary intervention with little to no thought to long term effects. Wonder where we’ve heard that in the last couple of years......
Well I'm down 100+ lbs. Still a ways to go. And as much as I like the doctors I visit, they had terrible protocols and advice when I tested off the charts for Type II diabetes. It wasn't completely from a lack of trying. Honestly I had nearly given up having gotten onto that roller coaster of lose-gain, lose-gain that I'd seen my mother struggle with throughout her life. Keto, OMAD, down with omega 6 oils, upped the saturated fats, you probably know the story. My HbA1c is now in the completely normal range, having been at 13.8 in August, 2020. Blood pressure low normal. No drugs. And I look forward to hiking mountains. But here's the rub. The doctors just said good job. Not one asked me what I had done. There was zero curiosity. They've probably had patients previously who were successful and they could have passed that information on to me. And certainly now that they've seen me, they could have had information they could pass along to the next poor slob whose diet is killing them.