“Fat”: What the Experts Know (Part 1)

The film opens with a fetching red-head puffing away on a treadmill. She’s perspiring, but she’s smiling gamely into the camera. “It’s not an average work-out, but I wasn’t an average weight,” she explains. “I have to do above and beyond what any of you guys would have to do. I have to try twice as hard, sometimes three times as hard—just to maintain this level of…chubbiness.”

And she is right. She is chubby. By 21st century mainstream (and magazine) standards of beauty this young woman is probably 30 pounds overweight. The dimples, the pony-tail, the strawberries and cream complexion, and the undeniable on-camera charisma make her very appealing. But there is no doubt that most physicians would urge her to lose weight. 

Later in the film, we learn that she exercises three hours a day.  And when her mother was dying of cancer, this thirty-something nursed her and learned a great deal about nutrition. Dedicated and determined, she eats healthy meals and sticks to a strict exercise regime.  Why, then, is she “chubby?”

Doctors don’t know.  That is one of the first things you learn in “Fat: What No One is Telling You,” a 2007 documentary that is, by turns, entertaining, moving, and eye- opening. (The PBS home video, directed by Andrew Fredericks, can be rented on www.netflix.com or purchased on www.amazon.com).

The questions are endless, a narrator tells the audience. “Is it her genes, her childhood, a flaw in her character, stress, sadness, a lost love, processed food, television, seductive advertising, lack of sleep, a government that subsidizes corn, sugar and beef?”

All of the above may well contribute. But taken together, they still don’t constitute an answer. Doctors cannot help the vast majority of obese people lose weight–and keep it off—because doctors don’t know what causes obesity.

“If It Were That Simple…”      

Although many physicians still “believe that obesity is caused by
eating too much and not exercising enough, such thinking is too
simplistic,” says Dr Robert Lustig, of the Division of Pediatric
Endocrinology at the University of California, San Francisco. An expert
in the field, he knows that obesity is “a chronic condition.” And we
don’t have a cure.

This is why, even when patients enter medically supervised weight-loss
programs, and stick with the rules, Lustig explains, “95 percent”
regain whatever pounds they lose. 

“This is not simply ‘energy in and energy out.’  If it were we would
have solved it a long time ago,” says Harvard’s Dr. Lee Kaplan, who
heads the Weight Reduction Program at Mass General Hospital and has
established a new, comprehensive basic and clinical research program.

Obesity doesn’t seem like a subtle disease,” adds Kaplan, who appears in the documentary. “But it is. If
something is off kilter by just 1 percent in your system that can lead
to a 100 pound weight gain. More than 400 genes are involved in weight
regulation.
And that doesn’t include the environmental factors.”

“Fat” goes on to introduce us to a very bright, 300-pound 18-year-old
who has sought medical help, researched obesity and, with the support
of his doctor, is now planning on bariatric surgery (a.k.a.
“stomach-stapling”). “They just haven’t figured out this obesity
thing,” he says. “There is something haywire in your body.

“You become depressed when you realize that…you’re going to die
earlier. And when they bury you, they’ll need twenty people to carry
you rather than four.”  (I found hearing an 18-year-old worrying about
how many people would be needed to carry his coffin to his grave
incredibly sad.)

Obesity is “indescribably complex,” he adds. In his own family, it is a
mystery “My twin sister is skinny. I’m not. When we were born, we were
the same weight and length.  But many people in the family are
overweight, which suggests a genetic component.”

Another character in the film was not heavy as a child. “A tomboy, I
was always very athletic,” this young woman confides. And the pictures
of her as an adolescent confirm that she was an extremely attractive
female athlete. No fat—just great muscle tone. But then “I moved into
the corporate world,” she explains.  “And since I’ve been at Microsoft,
I’ve gained 125 pounds.”

As an executive she travels frequently, and “If I’m traveling coach,
it’s really tight,” she confides. “Last time, I was in a center seat,
and kept apologizing to the people next to me. They were squished, but
very nice about it,” she says, still obviously terribly embarrassed by
the memory.

Many young athletes move into the corporate world, and don’t gain 125
pounds. Why would a young woman who loved sports suddenly find herself
too heavy to play? This is the conundrum that medicine hasn’t cracked.
Meanwhile, this Microsoft executive would do anything to lose weight. 

“I hate this,” she says. “I can no longer do the things I love to do.”
She and her husband (who is also a very big man) haven’t been able to
get pregnant.  To try to solve their problem, they have signed up for a
comprehensive (and no doubt expensive) program that includes doctors,
nutritionists, and trainers.

They have purchased health cook books, and admit that they really don’t
know how to cook. “I have no idea how to cook chicken,” she
acknowledges.

“What is chicken?” he asks, only half joking.

But, she tells her husband, “We’ll just have to try these recipes. Some
of them we’ll hate—so we won’t cook them again.” She is hopeful that
they will find others that they like.

In part 2 of this post, I’ll disclose what happened to this couple, the
boy who is hoping for bariatric surgery, and the young woman on the
treadmill. I’ll also expand on what doctors do know, at this point,
about obesity and weight gain, cultural and ethnic differences, and why
physicians say that people who come in larger shapes—and exercise—are
healthier than very thin couch potatoes.

I’ll also discuss why we have reason to hope that we are beginning to
understand the neurological causes of unwanted weight  as researchers
investigate how the “lower brain” (in the gut) communicates with the
“upper brain” (in the head).

Finally, I’ll explore the role that society plays in obesity. On that
score, I found the following Amazon review of the documentary telling:

“I happened upon this movie on PBS when I was on a business trip, and
it essentially helped to kick-start my journey into a healthier
lifestyle, where I have lost 40 lbs already in a 150lb long term goal,”
the reviewer wrote.

“I remember being deeply and personally moved by the stories, but it was also a game-changing flood of information about the latest biological research that did the trick for me.
It allowed me to see the issue not in terms of will power and laziness
(as is all too common in popular culture as well as years of medical
haranguing), but in terms of physical compulsion akin to and even
surpassing opiate addiction.

“Why was this new information so critical in my current success, where
previously I had tried and failed? It is definitely that it shatters the myth that weight loss is as simple as consuming less than you expend—a
glib and harmful misstatement of the problem as profound as saying that
beating heroin addiction is as simple as going cold turkey. You’d think
that learning exactly how hard it is, really, to lose weight would be
discouraging, but it was exactly the opposite. After years of people,
including my doctor and nutritionist, breezily tossing off advice and
plans of action, I finally learned what I was up against.
Then I declared war on it.”

I would add this: Knowledge is power. Conventional wisdom is not. Right
now, only 5 percent of those who fight the war win—and keep the weight
off. Sadly, the way that both society and our healthcare system treat
those struggling with this chronic disease can make their battle harder.

21 thoughts on ““Fat”: What the Experts Know (Part 1)

  1. I don’t want to sound insensitive, but there are no fat people in Darfur.
    The truth is that if one eats a restricted calorie diet one weighs less. That’s simple conservation of energy. So that’s not the issue.
    The issue is why can’t people eat a limited calorie diet. I think you listed many of the reasons.
    It would seem that in the US many of the reasons boil down to cultural factors. This includes the types of food being offered, the large preponderance of packaged and pre-made foods as compared to elsewhere and the fact that it is more expensive to eat a low fat, low calorie, filling diet.
    Aside from a few people who specialize in criticizing the junk food industry we don’t hear much about this issue as a political problem. If the government could ban McDonald’s and its competitors what would people eat?
    The entire system is geared up to corn-based subsidized foods like beef and fried potatoes. We don’t have the capacity to replace these industries on a large scale and there are no efforts to do so.

  2. I spent two weeks in Cuba about 7 years ago. The flight back stopped in Miami then Minneapolis. And to echo the words of Dr. Feinman, the prevalence of obesity in Cuba vs. the US was astounding. And I did NOT see anybody starving or even significantly underweight on the island. They had ENOUGH.
    So abundance, excess is, I believe a big part of it.
    But I agree it’s not THAT simple. I sit next to a colleague, Adventist, who eats for lunch a 1 1/2 quart container full of broccoli, cashews, cheese, sunflower seeds, carrots, probably 2+ pounds of food, maybe 1500+ calories just for lunch. And he’s skinny.
    And then there’s the emotional issues.Depression and over weight…Chicken and egg.
    Are you going to look into the Obesity Hypoventilation Syndrome? I had two patients on chronic O2, pulmonary hypertension one with an implanted defibrillator, both over 350#. And seeing the cardiologists treat these folks and never mention the underlying cause, OBESITY, makes me a bit embarassed of my profession.
    It’s a fascinating condition with the MEDICALIZATION of this CONDITION now “curable” with surgery…Another symptom of our poor ability to study, understand and answer a question.

  3. I don’t know whether the TV show “Biggest Loser” is good for the obese or bad for them. What I do know is that it seems everybody on that show is able to lose significant amounts of weight once they put their mind to it. Maybe some of them will always be chubby, but there is a difference between being chubby and wondering how many people will have to carry your casket. When you see 425-pound contestants losing well over a hundred pounds, it starts to seem that the natural range of weight is much smaller than an article like this might lead us to believe.
    Like Dr. Feinman said, the societal push to corn-based foods is a huge factor, as is our society’s twisted message of “having it all” meaning that you should eat whatever you want but should also look like a model, etc. There are metabolism issues, but I don’t think 25% of the people in Texas have a rare genital defect leading them to be obese.
    Here’s another vote for ending the corn subsidy.

  4. One other thing I wanted to add. My dad struggled with obesity for 15 years after a hugely stressful period of his life led him to gain about 50 pounds.
    He joined a 12-step program geared towards helping people deal with food addiction and has lost about 60 pounds. There probably is an addiction component to this and help in that regard might be extremely helpful.
    But increasing activity and reducing food intake is going to cause you to lose weight. I don’t think that’s a mystery.

  5. While there are certainly lifestyle issues out there, the “war on obesity” is, IMO, approaching witch-hunt proportions.
    Certainly the time-tested combination of dietary changes and physical activity (aka “diet and exercise”) make a difference. But it’s not always that simple, and it’s not always the case that given two people, the “fatter” one will be less healthy even with almost all else being equal.
    I guess the thing I take issue with is that it seems like 90% of the emphasis is placed on what you eat (with particular vilification of so-called “junk foods” and fast food and the like). I grew up in the 1970s, and we never had to be told to go outside to play. We played baseball all summer — 5-6 days a week, 8-10 hours a day — and football and basketball at other times of the year. We’d be riding our bicycles and our skateboards. And this even *after* we got our Atari VCS (aka 2600) at home.
    We had a lot of “homestyle” country-type foods — many that would make “fat warriors” cringe. And we had large portions and even seconds. None of us became overweight!
    We don’t to face the reality that physical activity plays as much a role (if not more) than what/how much you eat.
    I’d also add that the emphasis in height/weight tables and “BMI” might be a bit misleading and in some cases, just plain wrong. Listed at 5’10” and 221 pounds, the BMI chart would list San Diego Chargers running back LaDainian Tomlinson as “obese,” which is simply ridiculous.

  6. The entire tone of this war against fat people is founded on the belief that it is a disease. Humans throughout history have come in a diversity of sizes. Just because it is currently socially desirable to be thin, does not make naturally fat people diseased freaks of nature. If fat was so deadly, the fat people would have long ago died off; instead, on average they live longer than the skinny people. Being fat is the only physical characteristic that appears to be free reign for discrimination — round them up and force them into fat camps is next, it would appear. It wasn’t that long ago in human history when blacks and jews were similarly demonized with all sorts of scientists and doctors with popular theories (all seemingly scientific, of course) of their inferior and diseased bodies, minds and behaviors. This is nothing but discrmination.

  7. On the genetic issue. Good evidence. Twin studies, separated at birth. 99% concordance of body type of child with biologic parents vs. adoptive parents.
    Stunkard, AJ; Harris, JR; Pedersen, NL; McClearn, GE. The body mass index of twins who have been reared apart. N Engl J Med. 1990;322:1483–1487.
    So we inherit our body type. But obesity is more than body type. Usually 30-100 lbs more.
    I treat weight like blood pressure, a vital sign. I was taught in Medical school that 90+% of hypertension is “essential”… Meaning “no identifiable” cause…Then I read Benson
    http://search.barnesandnoble.com/The-Relaxation-Response/Herbert-Benson/e/9780380815951
    I appreciate that you (Maggie) are taking the Medical Industrial complex to task on this issue. How’s it feel to be a fly buzzing around an elephant?

  8. While I have no doubt that some people gain weight much more easily than others, the incidence of obesity in the U.S. is higher than in the past which is hard to attribute to genetics. Moreover, international comparison data that I’ve seen show that the U.S. obesity rate (BMI >30) for the 15 and older population is 31%, the highest in the world. The next two highest are Mexico at 24% and the UK at 23%. Most of the rest of Western Europe plus Canada range between 9% and 14%, while Japan and Korea are at a mere 3%. This data suggests that factors such as diet, exercise and culture play a much greater role in obesity than genetics.
    If one could design a tax on unhealthy food that could be fairly applied and efficiently administered, I think we should implement it. Resource allocation is most efficient when the price of goods and services reflect the full cost, including the external social costs, of producing them. That said, others have argued on this blog that people who smoke and/or are significantly overweight tend to die sooner than average thereby costing society less over their lifetime than healthy people who are often ultimately afflicted by Alzheimer’s, dementia, Parkinson’s or renal failure which can persist for a long time and result in very high healthcare costs including long term care costs.

  9. It is a tough leap to go from “personal responsibility” to the medicalization of obesity. There are times I am cynical, but I do believe in a thrifty gene theory and the concept of a “defended weight setpoint.” Put this genetic hardware in a default environment of caloric bounty though, and yes, folks will gain weight.
    I wish dieting was the answer, but often it is not. Marion Nestle, Kelly Brownell, and Michael Pollan, etc., wax more eloquently on the subject than I, but diets frequently fail (duh). Even in the most supervised, experimental of conditions, weight loss after 1-2 years of 5% is considered satisfactory. Then, with the passage of time, after the nutritionists and health coaches are gone, a majority put the pounds back on. If that effect came from a pill, it would be taken off the market.
    Those on the right are critical (twinkie tax, etc), and I do agree that soda withdrawal from school and the like is a band aid, but this really is a public health issue on a grand scale. Our food policy, culture, and norms of eating are major culprits. However, like alcoholics who have a disease but are always responsible and accountable for that first drink, obese individuals also must acknowledge some responsibility. Nonetheless, harsh critics of those afflicated with this problem also must look deeper and realize severe obesity is a lot more that Big Macs and lack of will power. It is a multifactorial melange of genetics and a woefully corrupt culture of plenty.

  10. Banning McDonald’s and taxing junk food is one idea; however this seems like a television show that parent’s don’t want their kids watching…if you don’t like what’s on don’t watch it. If your eating McDonald’s everyday and you are obese, try to stop eating McDonald’s every day and see what happens.
    I also absolutely agree that part of the stigma that goes with obesity is purely cultural. I was told that as a 5’4 woman 130lbs is obese…When we start making unrealistic guidelines for what is “normal” we create diseases like obesity and are left with nothing but crash diets and blame..

  11. This is thoughtful, Maggie.
    I subscribe to the feeds of PhysOrg and Science Daily, and so I’ve been reading about leptin, ghrelin, the strange metabolism and propensity of high fructose corn syrup to beget metabolic syndrome.
    I think that when we understand the complexity and relationships of all of the components of metabolism, hunger, appetite, energy production, storage and use, we will have a very different view of what obesity is and how to address it medically, socially, culturally and nutritionally.
    Like many other diseases, we have placed a cultural stimga on it, and societally, we treat people who are overweight – or at least conform to our notions of a less than ideal body shape, as inferior and undesirable.
    This, like any other form of bigotry and prejudice, is unfounded, wrong and harmful.
    We can do better, and we must.

  12. I’ve been traveling, and haven’t had a chance to respond, but this is a great thread.
    Robert–
    No doubt there are no fat people in Darfur–in famines, as in concentration camps, everyone is thin.
    But in the U.S. today, a great many children still don’t have enough to eat, at least part of the time. (I read a statistic about a study in USA Today this morning, I don’t have the number in front of me,
    One of the many reasons that poor childrenn are more likely to be obese is that, when food is available (usually at the beginning of the month), they fill up–not being sure when plenty of food will be available again.
    But I have to disagree when you write: “The truth is that if one eats a restricted calorie diet one weighs less. That’s simple conservation of energy.”
    That’s actually not true for the obese. Most people will lost weight if they restrict calories. But most will lose weight only for a while–and then they stop losing.
    Their body begins to fight the loss of weight. Metabolism slows down, etc. It’s a very complicated survival mechanism.
    .
    The experts explain that the “brain in the gut” begins sending signals to the “brain upstairs”–so that the dieter cannot continue to lose weight.
    Bariatric surgery has taught us about this “brain in the gut.” (Originally we thought bariatric surgery worked because it made the stomach so small that it was impossible to eat a lot. Now we know that bariatric surgery works becuause it cuts into that coversation between the two brains. I’ll explain in part 2.)
    Cultural factors also are important, but they are not the whole answer.
    What makes obesity so complex is that it’s a combination of culture, genes, and metabolic factors that we are just beginning to understand.
    But I agree, for the sake of kids–and the general health of the nation– it would be great if we could view McDonald’s and corn-based subsidies as a public health problem.
    ddx:dx– Let me respond to both of your comments.
    First, as you say: “we inherit our body type. But obesity is more than body type.”
    And yes, it seems that stress plays a large role in obesity. It also plays a huge role in overall health–which is why socio-eocnomic status is so important. Being poor is stressful–and even if employed, poor people are more likely to have boring jobs that they hate.
    (There is now quite a bit of reaserach on how socio-economic status and how you feel about your work is key to how long you will live.)
    It is true that the medical industrial complex has quite a bit invested in the myths about obesity. But so does society as a whole.
    Obesity is one of those diseaess –like mental illness–that we view with such horror and fear (that it will happen to us) that we blame the ill person for a lack of character. It’s a way of telling ourselves “This won’t happen to me; I’m better than that.”
    The whole “individiual responsibility” theme is tied up with our fear of death–and the fact that so many Americans resist the idea of taking care of each other. Instead, we’re each responsible for ourselves. (It was interesting that in his victory speech, Obama specifically spoke about taking care of each other.)
    Re: obesity in Cuba: It’s important to recognize that white American culture tends to view anyone who is not skinny as “overweight.”
    In many other cultures– include Latin and Caribbean cultures– people who we would call fat are considered extremely attractive. And, if the person gets plenty of exercise, he or she might also be healthy– healthier than white American women
    who constantly diet and don’t get the right kind of exercise.
    Mike C. Only 5 percent of obese people who attempt to lose weight under a medically supervised program keep it off.
    The doctors who specialize in obesity say that this is NOT due to a lack of will power or compliance.
    It is a matter of biology.
    They don’t necessarily put the weight back on the next month. It may be 1 1/2 years later.
    When it comes to obesity 12-step programs are no more successful than oher programs.
    Scientists are quite clear: Oesity is Not an addiction to food. If it were, doctors would have figured out how to help obese patients long ago. (They can help the vast majority of smokers because smoking is basically simply an addiction to nicotine.)
    Obiviously you don’t know what happens to the people on this TV show later. But in general, television shows are a not a good source of medical knowledge.
    Tim–
    Virtually everything you say is true.
    When it comes to children the fact that most don’t just “go out in play” is a major problem.
    Part of this has to do with the fact that today’s parents are so fearful–that their child will be hurt, kidnapped, etc. So they drive them to school, don’t let them play on the front sidewalk, bike in their neighborhood, hike in the woods, etc. etc. You can walk through a suburban town on a beautfiul week-end day, and see virtually no children on the street.
    Of course Video games and computers also keep kids indoors.
    Finally you’re absolutely right, the running back you are describing is probably in perfectly good health. (This doesn’t mean all athletes are in good health; but his BMI does not tell us he has a disease.)
    The whole BMI thing is a pretty simplistic meaasurement that ignores different body types and shapes. It assumes that the Caucasian body is the model for perfection — a very parochial (essentially racist) assumption.
    Rene–
    I agree that we persecutive people who are obese the way we so often persecute people who are in any way “different.”
    Whether obesity is a disease depends on how it affects your health.
    For most people, carrying say 250 o4 300pounds of weight, much of it fat, is not going to be good for their health.
    Unfortuantely, only a very few will be lucky enough to be able to take weight off and keep it off through diet and exercise. (Genetics, metabolism and the body’s survival instincts will make it impossible for most.
    Given the fact that obese people struggle so hard with the physical problems of trying to lose weight,and putting it back on, it is extraordinarily cruel that society persecutes and stigmatizes them, adding to their stress.
    Barry–
    Yes, on average, obese people do die sooner, and cost society less in medical bills.
    It’s also correct that obesity is on the rise–but, as Dr. Nortin Hadler points out, we also are living longer. He points out that when you put these two facts side by side, you should eperience a certain amount of congitive dissonance. . . I’ll write more about what Hadler says about obesity in Part 2.
    Brad F–
    Yes the “thrifty gene theory” (which says that some people are hardwired to eat fat and carbs when food is available as a way to survive cycles of feast and famine) does seem to explain part of obesity.
    But I don’t quite understand where “personal responsibility” comes into play. You write:
    “However, like alcoholics who have a disease but are always responsible and accountable for that first drink, obese individuals also must acknowledge some responsibility.”
    You
    can blame he alcoholic who fails to struggle with the disease, but I’m not sure that you can blame the alcohollic who repeatedly goes on the wagon and falls off, for “taking that first drink.”
    According to Dr. Steve Schroeder (who for many years ran the smoking cessation program at UCSF) that medicine still hasn’t found a way to help many alcoholics.
    . AA works for some people, not for others. We’re better at helping alcoholics than we are at helping the obsese, but not as good as we are at helping smokers.
    And with alcoholism, we know that so often the underlying disease is mental illness–depression, anxiety . . . A combination of talk therap and medication will help some people, but often only for a period of time.
    I think of William Styron’s “Darkness Visible,” a slim memoir that describes his struggle with depression, how he used alcohol to self-medicate, and what happened when his body revolted, and he could no longer drink. It’s by far the best description of depression that I’ve ever read.
    Going back to your comment, I’m struck by the phrase “a woefully corrupty culture of plenty.”
    Sixty years ago, people in this country starved to death for lack of food.
    In “Fat,” the author of “Fast Food Nation” points out how much food you can buy today for $4.
    It’s may not be nutritious but it provides enough energy to keep a person going.
    If you could buy that much food for that amount of money in the 1930s (in 1930s dollars) so many people–including children–would not have starved to death. (See Grapes of Wrath)
    So was that a better culture?
    If you have the bad luck to be born into a very poor family, there is something to be said for the “abundance” of inexpensive food available today.
    That said, ideally we would ban advertising of hi-fat, high-carb foods on television, do away with the corn subisidies, etc.
    We need subsidies that encourage farmers to grow fruit and vegetables.
    More importantly, as you say, this is “a public health problem on a grand scale.”
    Ideally, we as a society would be willing to pay the taxes to provide nutritious school lunches (and school breakfasts in poor neighborhoods–something we did in the 1960s and it helped); build safe playgrounds in poor neighborhoods; pay for gymns and gymn teachers in all public schools; subsidize green-makets in poor neighborhoods . . .
    But most people are not willing to pay higher taxes to wage a war on poverty. (Though when we did fight poverty from the 1960s to the early 1970s, we were very successful.)
    One reason we “blame the victim” for being obese is that we do not want to take responsibilty for tolerating a degree of poverty that no other developed nation tolerates. Taxes are much higher in these countries, but in return, they have safety nets.
    So we blame the obese for being obese just the way we blame the poor for being poor, (And obesity is highly correlated with poverty.)
    Alexis–
    Yes, a society that
    tells a woman that she is obsee if she weights 130 and is 5’4″ is an unhealthy (not to mention misogynistic) society.
    It does strike me that societies that “like women” (where men love their mothers, older women are respected, younger women are adored) more voluptuous women are admired. (Latin, Caribbean, African/American cultures.)
    In the U.S. we want young woman to look like young boys—why is that?
    Annie ==
    You write: “I think that when we understand the complexity and relationships of all of the components of metabolism, hunger, appetite, energy production, storage and use, we will have a very different view of what obesity is and how to address it medically, socially, culturally and nutritionally”
    Yes.
    And yes, our view of obesity is a form of prejudice that we must outgrow.

  13. Maggie
    To clarify:
    Culture of plenty = abundant, cheap, calorically dense, nutritionally empty food. We dont disagree, just semantics.
    As far as ETOH, yes, alcoholics are always responsible for that first drink. Do they have a disease. Of course. However, drive while intoxicated and kill someone and you go to jail, etc., etc. I have worked fairly extensively around substance abuse professionals, and this is pretty standard. Part of lifelong recovery is taking responsibility for your actions.

  14. Brad–
    Okay– what you say makes sense. any disagreement is semantic.
    And I completely agree about people drinking and driving. This is criminal irresponsibility.
    On the other hand, to me, taking that first drink and falling off the wagon
    is suicidal behavior.
    And I don’t blame people who are in such great pain that they commit suicide.
    I do think that if you kill yourself when you have young children, you are doing them great harm.
    This seems, to me, selfish.
    On the other hand, to have young children and be able to decide to leave them forever, must mean, in most cases, that you are in extraordinary pain. So I don’t presume to judge.

  15. From the NY Times:
    TV Ads Contribute to Childhood Obesity, Economists Say
    “Banning fast food advertisements from children’s television programs would reduce the number of overweight children in the U.S. by 18 percent and decrease the number of overweight teens by 14 percent, economists have estimated in a new study.”
    I still say obesity is a cultural issue in the US more than anything else.
    By this I mean how society regards eating and the types of foods that are acceptable.
    My trips to the supermarket keep getting shorter as all I do is skim the periphery (where the fresh vegetables, milk and meat and located) and skip the rows of processed, packaged stuff.
    Stores like Target, which now has a grocery section, don’t even carry fresh vegetables or meat – everything is packaged. I assume that shoppers there prepare more TV dinners and similar items since going to a second store would seem to defeat the purpose of getting your groceries in a general merchandise store in the first place.
    Walmart carries “fresh” food, but its meat is frozen and then thawed and much of it is injected with salt water.
    Avoiding these types of products is difficult or impossible for those pressed for time or money.

  16. Maggie, I’m having a difficult time understanding your point here. It sounds like you’re saying that compliance has nothing to do with the weight coming back. I’m not trying to be insensitive to the overweight, but it strains credulity that people who are going through a sensible program that leads to weight loss and learning new healthier habits, maintain those healthy habits and still wind up gaining all the weight back.
    Maybe there are certain things in their brains that make it very difficult for them not to over-eat or make it extra difficult to exercise, but it’s a pretty safe bet that the reason the weight came back is because they stopped eating as healthy and stopped exercising as much. Which to me is a compliance thing.
    Granted, I’m not an expert on obesity science. But while you’re saying it’s a mystery why this is happening, you also seem to have a long list of policy proposals, so you probably understand at least some of the reason why people are obese, right?

  17. Robert & Mike C
    I suspect that part 2 may provide answers to your questions.
    (It shoudl be posted in about an hour.)
    The science is complicated–too complicated for most articles in the mainstream press, including the NYT.
    (Though the Times has reporters who could tackle it, if their editors gave them the space. But editors may well assume that most readers would find the science too complex or boring.)
    And unless you’ve dug into medical reserach, you wouldn’t know about thrifty genes, or the fact
    (shown over and over again) that 95 percent of people who REMAIN IN medically superivsed weight loss programs put the weight back on.
    This is a number that the mainstream press is not likely to print–it’s just too discouraging.
    (See, by contrast, Brad F.’s comment on the “thrifty gene” this thread. He’s an M.D. and knows the medical research.
    When you think of how society punishes the obese, you can imagine how much they want to keep the weight off.
    The fact that only 5% do it confirms the science: we’re not talking about will power.
    And while environment (the abundance of food available) is a factor the fact is that many people eat huge amounts of food, and never gain weight.
    Both my first husband and my seond husband belong in that lucky category. So I’ve spent many, many years witnessing the phenomena –both in a young man and in an older man.
    Today, my husband’s idea of a good dinner is a first course (say, prosciutto and pear) followed by a light pasta course, followed by a meat course, (Italian bread or a baguette served with this course) followed by dessert (preferably chocolate).
    My husband has a 94-year-old great-uncle who looks a lot like him, and is still extremely fit . No stomach. And enjoying his pasta con sarde with bread on the side, a glass or two of wine and dessert. . .
    Genes really do matter.

  18. Robert & Mike C
    I suspect that part 2 may provide answers to your questions.
    (It shoudl be posted in about an hour.)
    The science is complicated–too complicated for most articles in the mainstream press, including the NYT.
    (Though the Times has reporters who could tackle it, if their editors gave them the space. But editors may well assume that most readers would find the science too complex or boring.)
    And unless you’ve dug into medical reserach, you wouldn’t know about thrifty genes, or the fact
    (shown over and over again) that 95 percent of people who REMAIN IN medically superivsed weight loss programs put the weight back on.
    This is a number that the mainstream press is not likely to print–it’s just too discouraging.
    (See, by contrast, Brad F.’s comment on the “thrifty gene” this thread. He’s an M.D. and knows the medical research.
    When you think of how society punishes the obese, you can imagine how much they want to keep the weight off.
    The fact that only 5% do it confirms the science: we’re not talking about will power.
    And while environment (the abundance of food available) is a factor the fact is that many people eat huge amounts of food, and never gain weight.
    Both my first husband and my seond husband belong in that lucky category. So I’ve spent many, many years witnessing the phenomena –both in a young man and in an older man.
    Today, my husband’s idea of a good dinner is a first course (say, prosciutto and pear) followed by a light pasta course, followed by a meat course, (Italian bread or a baguette served with this course) followed by dessert (preferably chocolate).
    My husband has a 94-year-old great-uncle who looks a lot like him, and is still extremely fit . No stomach. And enjoying his pasta con sarde with bread on the side, a glass or two of wine and dessert. . .
    Genes really do matter.

  19. Robert & Mike C
    I suspect that part 2 may provide answers to your questions.
    (It shoudl be posted in about an hour.)
    The science is complicated–too complicated for most articles in the mainstream press, including the NYT.
    (Though the Times has reporters who could tackle it, if their editors gave them the space. But editors may well assume that most readers would find the science too complex or boring.)
    And unless you’ve dug into medical reserach, you wouldn’t know about thrifty genes, or the fact
    (shown over and over again) that 95 percent of people who REMAIN IN medically superivsed weight loss programs put the weight back on.
    This is a number that the mainstream press is not likely to print–it’s just too discouraging.
    (See, by contrast, Brad F.’s comment on the “thrifty gene” this thread. He’s an M.D. and knows the medical research.
    When you think of how society punishes the obese, you can imagine how much they want to keep the weight off.
    The fact that only 5% do it confirms the science: we’re not talking about will power.
    And while environment (the abundance of food available) is a factor the fact is that many people eat huge amounts of food, and never gain weight.
    Both my first husband and my seond husband belong in that lucky category. So I’ve spent many, many years witnessing the phenomena –both in a young man and in an older man.
    Today, my husband’s idea of a good dinner is a first course (say, prosciutto and pear) followed by a light pasta course, followed by a meat course, (Italian bread or a baguette served with this course) followed by dessert (preferably chocolate).
    My husband has a 94-year-old great-uncle who looks a lot like him, and is still extremely fit . No stomach. And enjoying his pasta con sarde with bread on the side, a glass or two of wine and dessert. . .
    Genes really do matter.