Obesity: five facts

[Aractus]

Okay, some of you know I'm passionate about this issue. Recently for uni I had to do a public health interventions essay, which I chose to do on obesity. Now that I've been graded on the essay I have uploaded it to my website and I can finally start talking about it! I refrained from doing so before because I did not want there to be any possibility that I would be done for plagiarising myself. I got a high distinction (92%) for the essay. This is what the unit convener said: "It was really impressive – one of the few that took a critical perspective on policymaking. It was very well written, clear, well referenced and persuasive." I have 27 references in the essay, and most are peer-review - so if you want more information I suggest you look to the references I provide there, I'm only going to mention a handful in this post. Also, the essay focused on policy (because that's what I had to do) and less on science, so I ended up leaving out a lot of science which I would have liked to have included if I was to do a 2500 word essay on the science behind obesity. I must have deleted 3 or 4 entire paragraphs that would have been science-focused.

What irks me is the blatant disregard of facts and science when it comes to this important issue.

1. Obesity as a disease: Yes and no. First proposed in the 1940's by the WHO as a disease in its own right, it is recognised by WHO and by the American Medical Association as a disease, but it is not recognised by such in Australia or for that matter most of the world.

2. 1lb of fat equals 3500 kcal. NO, No, no no no! It's true that if fat cells are roughly 87% lipid that in total they would yield 3555 kcal (approx) when catabolized. But the devil is in the detail. Adipose tissue is essentially a permanent structure that is not easily catabolized; thus if you loose weight you're only burning the lipids you are not burning the fat cells themselves at all.

3. Hunger is controlled by a homoeostatic process. As difficult as it might be to believe, the two hormones that control hunger - ghrelin and leptin - are responsible for biochemically controlling how much energy a person consumes from food. It is not possible to consciously choose to consume more or less than what is determined biochemically. If you don't believe me, then you have to explain to me the 20-year study done in the USA (Mozaffarian et al. 2011) that showed that long-term weight gain in 120,000 non-obese patients averaged to 0.38 kg per year . Per day that is 7 kcal or one single McDonald's French Fry. No one has that level of conscious precision over what they eat.

Now I want to put this in a way that perhaps is very easy to understand. Endurance athletes like marathon runners and cyclists sometimes drop dead, just like Bruce Lee. Right, a normal resting heart-rate for humans is between 60 to 100 beats per minute, and typically it's 80 or very close to 80 beats per minute. Endurance athletes actually change their physiology, in that they build up their RBC (red blood cell) count and consequently their resting heat rate can go all the way down to just 40 beats per minute. This is not what the body is designed to do, it is not healthy, and at 40 beats per minute your heart may "skip a beat" or simply stop beating and then you literally drop dead. So your food intake, just like your red blood cell count, you cannot consciously choose to increase or decrease, but you can choose to engage in activities that will influence it significantly. How many kcal you consume is well beyond your conscious control.

4. Diets and the diet industry cannot reverse obesity long-term. There is plenty of peer review literature on this, this is well known, and I will will quote one expert, Joe Proietto: "we now know body weight is very vigorously defended by the brain. In that following weight loss the hormones that control hunger (that circulate in our blood) change in a direction to make people more hungry. And hence making it very difficult to maintain weight loss." (see ). Non-medical intervention does not work to reverse obesity long-term, end of story. The diet industry sells a product that doesn't work, and consumers of the product typically blame themselves instead of the product!

5. Policy has not worked. I guess I may as well mention this now since I had to research this! In Australia the various governments (state, territory and federal) have focused their efforts on mass-marketing campaigns costing tens of millions of dollars, starting with "Measure Up" in 2008 and continuing through to today. These campaigns have raised awareness of risk factors, but so far have not had any effect on changing behaviour. I was pretty scathing in my essay regarding them because they a. ignore the more detailed science and b. ignore the non-individual (environment and social) risk factors. So in short: the campaigns have had no benefit whatsoever beyond being an effective means of communicating the risk factors.

I hope that this discussion can help move us beyond seeing obesity as an individual problem or caused by gluttony or other such nonsense. Obesity is not caused by "overeating", it is caused by hormone imbalance and the two hormones most directly responsible are leptin and insulin.

[LostLocke]

Just to make sure, when you say obese here you mean 'obese', not just some one who is a little over weight, or wants to shed a few cosmetic pounds right?
In the later two, you definitely can lose that weight just by changing what/how much you eat.

[Aractus]

Yes, by obese I mean (generally speaking) BMI higher than 30. A BMI between 25-29.9 is pre-obese (and I much prefer the term pre-obese to overweight).

[professor]

Interesting write up.
I have been with very overweight people when they ate.
2 of them, ate like shoveling it in and eating far more than myself or others nearby.
Another (my wife's good buddy) can't help herself from eating constantly.
Wife says (kiddingly) that they are like rats- if food is around -they eat.

So do you think there is more than intrinsic body design involved, because of the above?

[Manowar]

The fat people are killing us

http://www.forbes.com/sites/rickungar/20...n-smoking/

Aractus< i did not read your post, it is way too long. If fat people would just eat a bit less then their daily maintenance they would lose some weight, feel and look better and not cost us so much. Stay away from sugars, they are low in nutrients, high in calories and stimulate your appetite.
http://www.forbes.com/sites/rickungar/20...n-smoking/

Start doing some push ups fro cryin' out loud

[KUSA]

I am curious as to what you would call her body type.

[Aractus]

If fat people would just eat a bit less then their daily maintenance they would lose some weight, feel and look better and not cost us so much.

Incorrect. If they do that they will feel worse. I know it's counter-intuitive and the opposite of the lies you're told by the ineffective diet industry, but it's the God's honest truth.

Interesting write up.
I have been with very overweight people when they ate.
2 of them, ate like shoveling it in and eating far more than myself or others nearby.
Another (my wife's good buddy) can't help herself from eating constantly.
Wife says (kiddingly) that they are like rats- if food is around -they eat.

So do you think there is more than intrinsic body design involved, because of the above?

The quantity of energy you need, as a man, is 2500 kcal on average. If you put on weight you increase your BMR and consequently increase your weight maintenance level, perhaps to 3,000 kcal or more if you're obese. Your body uses the ghrelin hormone to make you feel hungry, and when you've eaten enough your fat cells release leptin which works on exactly the same receptors in the brain as ghrelin, but to reduce hunger and stop you from eating. Obese people have a decreased effectiveness of their leptin hormone. The easiest way to explain this is to think of type 2 diabetes - in type 2 diabetes your pancreas still produce the correct amount of the insulin hormone, however it has become less effective because the cells they work on have begun to shut down their insulin receptors. We now know that pre-diabetes (the medical condition that leads to type 2 diabetes) is in fact reversible, but once a person has diabetes it is no longer reversible. This is much the same with leptin, hunger and obesity. Once a person becomes obese their body no longer responds correctly to the leptin hormone.

Furthermore, adipose tissue as I mentioned is essentially a permanent structure in the body and if more of it is built it never goes away. Generally speaking pre-obese people have not increased their adipose tissue, they've only increased the amount of lipid stored in the adipose tissue. But once people become obese a good quantity of them have increased their adipose tissue, that is now a permanent fat structure in the body, and when they lose weight the body tries to put it back on. As Joe Proietto says, "we now know body weight is very vigorously defended by the brain. In that following weight loss the hormones that control hunger (that circulate in our blood) change in a direction to make people more hungry. And hence making it very difficult to maintain weight loss." (See the fact-check video in the links I provided in the op).

If you want a much simpler version of this concept that's easy to get your head around hop onto youtube and watch "the skinny on obesity". Robert Lustig is an expert in this area and does a very good job of explaining why the cause of obesity is biochemical and not lifestyle options. It's important to remember though that his hypothesis is that increased sugars are the culprit, whereas there are others who think it is in fact cereal grains and not refined sugars that are most to blame. I don't know who's right, and in fact no one knows for certain. It may not be that simple either, it may be more complicated.

To address the issues you raised: it doesn't matter if a person is a complete pig. Their hunger hormones should stop them from over-consuming, for the vast majority of people.

[Drich]

You guys kill me. Seriously. Most of you will be the first to say Homosexuality is a genetically controlled (even though the gay gene remains ellusive) but will over look the fact that there are 7 documented genes that directly effect weight and one's predisposition for caloric intake and storage of fat.

While being obese may not be in vogue as being gay is, but it does indeed hold the genetic pedagree gay people are trying to use to justify their life styles.

If you can make allowances for homosexuals in soceity sighting a genetic predisposition, then you should make allowances for the fatties as well. Because if one (unknown/unknowable) mystry gene can make one deny the sum total of trillions of years of evolutionary mandates, then one who has 7 genes telling them the NEED the second piece of pie, can't possibly stand a chance.

[Aractus]

Also I forgot to mention this. I have only found one confirm-able negative health consequence of pre-obesity. If a woman is pre-obese (BMI between 25-29.9) then she is significantly more likely to require a cesarean than a woman who's weight is below 25 BMI. Besides that one issue there seems to be no real negative health effects, generally speaking, for people who are pre-obese.

[Manowar]

If fat people would just eat a bit less then their daily maintenance they would lose some weight, feel and look better and not cost us so much.

Incorrect. If they do that they will feel worse. I know it's counter-intuitive and the opposite of the lies you're told by the ineffective diet industry, but it's the God's honest truth.

Maybe you did not understand what I meant. I am a bodybuilder
my world is all about dieting, not a day goes by that I don't count my cals or my macros. Simply put, when calories in (what you eat) are greater than calories out (what you burn/exercise off), you gain scale weight. The same is true for scale weight loss: Calories in are less than calories out. Maintenance occurs when the two are equivalent.
I got down to 6.2 % Body fat then I did a bulk, now I am cutting again.
It's not hard to do, people just need to do it.

When you lose weight you will feel better about yourself and you once you are used to that lifestyle you will feel better in every other way.
That's the truth.!!!!!

manowar