don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

The previous essay reviewed the impact of dramatic increases in the obesity levels of the American population on medical system costs, especially hospitals. In response to the rhetorical questions, "What else can be done, other than to spend more money?" and "Can a way be found to halt the rise in obesity levels?", my response was, "Not much. It's hopeless."

It's time to revisit the notion, expressed here on many occasions that, with respect to sustaining successful, healthy lifestyles distinguished by reason, exuberance and liberty, the reality for most is "icandoit." An example can be seen in the case of those who struggle with weight issues. In this area as much as any other, preventing or dealing with obesity reveals many of the obstacles to achieving healthy lifestyles.

The number one factor that seems to make "icantdoit" a reality for so many obese people seems to be a genetic predisposition to becoming and remaining fat. Making things worse are lesser but still significant factors, including unfavorable environments and unhealthy cultures. Together, these factors reinforce poor choices while producing unhealthy outcomes.

A new book by Times reporter Gina Kolata describes many genetic obstacles faced by overweight dieters. (See Rethinking Thin: The New Science of Weight Loss - and the Myths and Realities of Dieting, Farrar, Straus & Giroux.) Research studies are cited to support the author's concern that while human genes change very slowly (thus the heritability of body weight should take many thousands of years), we are seeing striking changes from one generation to another. Something potent is going on.

One of the studies Kolata cites was conducted half a century ago by Jules Hirsch at Rockefeller University. Dr. Hirsch's work indicated that obesity is largely determined by genetics. His study revealed that obese people have huge fat cells, cells that constantly send a "feed Me" message, like the giant plant from outer space that bullied Seymour in the musical "Little Shop of Horrors." These cells are filled with yellow fat. When someone with prodigious quantities of fat cells goes on a diet and loses weight, the cells don't just go away. They demand to be fed, with strong messages sent to the dieter's brain.

In a study considered rigorous and demanding over a two-month period, Hirsch's obese subjects lost large amounts of weight on 600 calorie diets. However, soon after release from supervision, they all regained the lost weight. Why? Their metabolisms had adjusted to the restricted diet (burning a quarter less calories than normal weight people); once normal eating resumed, the shrunken cells, still there, filled up and obesity was reestablished. No wonder the obese can't stay trim -- the genetic deck is stacked against them. How many folks can live on 600 calories a day? Who would want to, at nearly any price? The Rockefeller study author concluded: "It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved non-obese individuals."

Obese folks, not surprising, have what researchers call a "semi-starvation neurosis," meaning they obsess about food, dream about it, fantasize about it and lust for it. What a burden to bear. I can relate to dreaming, fantasizing and lusting for something; but fortunately, nothing I felt that way about was fattening. More important, I grew out of it as I neared 70 years of age. Good thing, I suppose.

Does "icantdoit" mean you can NEVER do it, if the odds are rigged against you, as it seems to be for those with obesity issues? No, a few can manage despite the obstacles, but it is never easy. The task of battling against a fat fate is never won for those with embedded cells, cells waiting like homegrown terrorists for an opportunity to fill up and strike out (or "puff up," not a scientific term). A few of the Rockefeller study subjects decided to make staying thin their life's work, becoming professional weight management counselors. By counting calories, remaining vigilant in a state of semi-starvation, they overcome an otherwise certain "icantdoit" fate. How many in today's society are willing to be so steadfast and heroic?

A more recent study gives further support to the "icantdoit" reality of those whose fate it is to be obese. A Vermont researcher took a different approach from the classic Rockefeller study. Instead of gathering subjects with lifetime obesity problems, this innovative scientist recruited thin people who never had a weight problem -- and asked them to become fat! "Who in their right minds would volunteer for a study like that," you might be wondering?

Prisoners. No doubt given some potent incentives to volunteer, the normal to thin size incarcerated subjects increased their weight by as much as 25 percent. It was not easy and, in fact, required six months to do it, while munching out on as much as 10,000 calories daily. This study was also done with rigorous controls, including the presence of attendants at meals who recorded everything the prisoners consumed.

Two fascinating observations were noted: 1) once fat, metabolisms increased by 50 percent; and 2) when the study ended, the prisoners had no trouble losing weight, returning to normal and staying there with no special effort.

The lesson went right to genetics: the built-in body metabolism we have, for better or worse, "speeds up or slows down to keep weight within a narrow range." Body weight is largely inherited. Of course obesity trends are even more likely if food is readily available, cheap, abundant and tempting, particularly for young children. It only takes an extra 100 calories daily to add 10 pounds in a year. In five to ten years at this pace, you are going to be obese. Even on a more modest basis, gains will occur steadily over time. For example, an additional 20 calories per day will add about 2 pounds a year, or 30 pounds of added weight in just 15 years.

A follow-up study used a Danish registry of 540 children who had grown up to an average age of 40. Ninety percent of these children had been adopted in the first year of life. The follow-up revealed that the grown adoptees were as fat as their biological parents, or as thin, in such cases. It made no difference how fat or thin their adoptive parents were, nor were the environments and cultural conditions a factor. Genetics ruled. This study, published in The New England Journal of Medicine in 1986, strongly indicated that being fat is an inherited condition.

It is not an entirely hopeless situation for the obese, but it's a challenge to succeed over time at weight management and other aspects of a wellness lifestyle. Perhaps as much as 70 percent of variation in weight is due to inheritance. Not the best odds. In "Rethinking Thin..." Kolata shows fat is something over which the obese have little control. "Most people who are overweight struggle to change their shape throughout their lives, but remain stuck within a relatively narrow weight range set by their genes. For those determined to foil biology, strict dieting is a life sentence." (Emily Bazelon, "Fat Chance," NY Times, May 6, 2007.)

"Not hopeless" applies to other challenges related to overcoming an "icantdoit" reality. It means that the wellness challenge cannot be taken lightly if success is to be realized. Expect that, like other outcomes that are highly desirable, living well with high life quality is difficult for all and more so for some than others. But, you already knew that life is not fair, so deal with things as they are while doing your best to look on the bright side of life.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of nutrition. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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