“Dr. Jones, don’t waste your time”, a 37 year old, moderately rotund female patient cautions me. “I don’t think you can help me. I know why I’m fat.” Does this perhaps sound like you? Worse, if you do not struggle with your weight, does this sound like what you secretly (or perhaps not so secretly) assume when you consider someone who does? So far at least 57 distinct causes of obesity have identified. Of course, some of these are far more common than others, but with this in mind doesn’t it stand to reason that perhaps we would be wise to step back for a moment and not assume we have this problem all figured out? Even if you happen to be one who has tackled your own weight problem successfully, is it not possible – or even likely – that the “causes” that you overcame may be totally different than your portly friend who has yet to overcome?
So, I simply asked my patient, “Ok, why? Why are you fat?” “Because I have a love affair with sweets”, she confidently answered, one eye-brow raised. “That’s not the problem”, I replied. Puzzled, she quickly, and somewhat scoffingly, retorted, “How is that not a problem?” “Notice, I did not say it is not A problem, I said it is not THE problem.” The fact is, what she has assumed is the nidus of her entire weight issue is not so much a cause as it is an effect (a symptom) which happens to cause other effects. So what IS the problem? Great question, I’m glad you asked. First, however, permit me to begin to answer this with another question. As with this patient, we generally are satisfied to find what appears to be an obvious culprit, assume it is the crux of the issue and allow curiosity to die, never asking the “why” question. “Why…why do you have a love affair with sweets?”
As I’ve intimated, obesity and energy balance in the human body is a VERY complex issue, but think about it, in this case is it really because the sweets taste good? Does it not also taste good to the thin person? Why does my heavy patient obsess over it and partake regularly and the thin person does not? Ok, so it must be a “slow metabolism”. Wrong again. As far back as 1982 in an article published in the New England Journal of Medicine (in adults) and a 1990 Pediatric Research article (in adolescents), among others, we have had good evidence that while a “slow metabolism” can occur, it is quite rare and is almost never the underlying cause of obesity. Think about it from simple Newtonian physics: A calorie is just a measurement of energy. Energy (Work) = Force x Distance. Who’s doing more work, the person carrying 250lbs or the person carrying 150lbs? One study showed that both obese and non-obese adults in the US consume on average approximately 1200 calories per day more than they burn. We have been told that 3500 calories of intake causes 1lb of weight gain. So, why are the thin folks not obese. More interesting, why are the obese people generally relatively stable in their obesity? We have measured that it takes about a 1 mile run to burn 100 calories. How many thin people do you know who run an average of 12 miles per day? Very few I’ll wager.
This is just two of the many misconceptions related to this issue. I hope to gradually unpack these more fully and address others as well. Stay tuned…