Obesity article in Irish Times

MrCreosote

I was wondering what people though of the article in the Irish Times on Tuesday by Muiris Houston.

http://www.irishtimes.com/newspaper/health/2011/0524/1224297612388.html

I know it's an opinion piece but I found it bizarre that a medical professional could try to excuse the levels of obesity. The vast majority are overweight not because of endocrine disorders or medications, but just that calories in>out (not saying it's personal fault, a lot of it is due to societal changes in my opinion). And saying that being overweight usually represents a lifestyle that increases the risk of heart disease and diabetes is not "judgemental"- it's just a fact.

opinion guy

I think the most critical sentence in that article is:

Dr Houston wrote:

(Full disclosure: I am one of those who has failed to “stop the spread”, having struggled with my weight for about 10 years now.)

seamus

I think what worries me most is that a doctor seems incapable of understand the basic science behind weight loss/gain.

All of which would be bad enough if it could be scientifically proven that all cases of obesity were due to personal selfishness and laziness. But it is an undeniable fact that a substantial minority of overweight people can point to other factors that contribute to their extra weight.

Thousands of people in Ireland are prescribed beta blocker drugs to prevent them having a heart attack or stroke. But beta blockers are known to slow down the body’s metabolism and can make it difficult to lose weight. Thousands more take anti-depressants and other psychoactive drugs which as a side effect add to a person’s weight.

What about the many Irish people with either undiagnosed or poorly treated thyroid disease? An underactive thyroid indisputably causes weight gain as do other hormonal imbalances. Then there are genetic factors: a recent paper in Nature Genetics claims to have identified a gene that contains a “master switch” that causes weight gain.

The only thing which causes weight gain is eating more than your body requires. While slower metabolisms, thyroid problems, etc point to contributing factors, it still doesn't mitigate the fact that if you eat more than you burn, you will put on weight.
You don't spontaneously "add weight" from nowhere when you go on anti-depressants or have thyroid problem. The weight has to come from somewhere - food.

Wyldwood

seamus wrote: »

I think what worries me most is that a doctor seems incapable of understand the basic science behind weight loss/gain.
The only thing which causes weight gain is eating more than your body requires. While slower metabolisms, thyroid problems, etc point to contributing factors, it still doesn't mitigate the fact that if you eat more than you burn, you will put on weight.
You don't spontaneously "add weight" from nowhere when you go on anti-depressants or have thyroid problem. The weight has to come from somewhere - food.

I must take issue with this. I am a long term sufferer of an underactive thyroid & have recently had my thyroid go spontaneously overactive. I have not changed my eating habits & am exercising less due to feeling unwell but lost at least a half stone in a few weeks. Weight is definitely not only related to what you eat but to medical conditions also.

seamus

But you admit yourself that you haven't changed your eating habits. I'm not interested in starting a debate and I don't mean to offend you, but when you do have a medical condition which affects how your body processes nutrition, then the appropriate response (both from yourself and your doctor) is to adjust your food intake accordingly. In much the same way that diabetics must regulate their sugar intake, those with hypo- or hyper-thyroidism must equally regulate their diet.

Part of the message that's lost a lot is that everyone's required intake is different. While the rule of thumb of 2,000/2,400 kcal per day for women/men fits the average, there are multitudes of variables to consider. A 5 foot women will have a much lower requirement than a 6 foot woman. So too a man with hyperthyroidism will have different requirements to an ultra-fit marathon runner.

While a medical condition can explain why someone is gaining or losing weight in spite of their diet, the basic rule of "calories out == calories in" will always hold true. In fact, unintentional weight loss or weight gain should be considered a medical issue by everyone and a trigger to find a way to deal with it.

ferike1

My gran grew up during WW2 and then lived in communist Hungary. There was less food for everyone. Funny enough obesity was not a big problem. During school her P.E classes were graded properly and gymnastics was an integral part.

Eat less, exercise more. Simple as.

opinion guy

Sorry Seamus I actually have to disagree with you here.

We talk about these things in the simple terms of 'metabolism speeds up' or 'metabolism slows down' but in reality these things are highly complicated. In the normal healthy person all facets of nutrition should be balanced, but in illhealth you cannot assume that all facets of nutrition - i.e. carbohydrate metabolism, protein metabolism, cholesterol metabolism, essential fatty acid metabolism, micronutrients etc etc - are or are not equally affected.

It is possible, nay likely that these things become imbalanced.

Its not as simple to say to a sick person - eat less or eat more. If a hypothyoid person eats far less food to offset weight gain they may become malnourished, equally if a hyperthyorid person eats more to put on weight they may be increasing their risks of diabetes, heart disease etc. Furthermore these things can directly affect appetite. I can see why Wyldwood would be offended.


Strange for me to be arguing this point as I am normally on the side of the you are what you eat mentality, but I think you are going too far in including people with thyroid or other hormone disorders or people on steroids etc. By very definition of illhealth - things are not working as they should - the assumptions that apply in good health do not necessarily apply in illhealth. There is a difference between someone who sits on the couch shovelling in food who puts on weight, and the person who puts on weight due to a thyroid problem. The problem I have with the article is that he is saying we should ignore the first group because of the second group. The first group are by far the biggest issue.

seamus

opinion guy wrote: »

Its not as simple to say to a sick person - eat less or eat more.

No, it's not. And this is why I hope I avoided saying that and instead mentioned adjusting your intake rather than a simple "eat more" or "eat less".

My main issue really was that this doctor was claiming that in some cases weight gain was an unavoidable side-effect of some illnesses, as if the excess weight simply appeared out of thin air. Which is simply not the case. It's wholly avoidable once the sufferer's diet is managed properly. But on the whole, what he's actually done is display his own personal offence to the advertising campaign and used the small number of people suffering with illnesses to back up his opinion that the campaign is cruel and offensive.

I like the campaign, because it's simple. If your waist is over 37 inches, you're probably fat. That's what it says. And for 90% of men, it's right.

opinion guy

seamus wrote: »

No, it's not. And this is why I hope I avoided saying that and instead mentioned adjusting your intake rather than a simple "eat more" or "eat less".

My main issue really was that this doctor was claiming that in some cases weight gain was an unavoidable side-effect of some illnesses, as if the excess weight simply appeared out of thin air. Which is simply not the case. It's wholly avoidable once the sufferer's diet is managed properly.

And I'm telling you that's not true.
In particular I'm thinking of people on steroid medications.

seamus

opinion guy wrote: »

And I'm telling you that's not true.
In particular I'm thinking of people on steroid medications.

Look, I'll take it back to basics. You cannot create something out of nothing. Without food intake, the body will not put on weight. Even if someone's BMR was zero, unless they eat, they will not put on weight in the form of fat.

Therefore, if someone is putting on weight or losing it, there is an imbalance somewhere, which can be resolved.

ferike1

What proportion of overweight people are on these 'weight gaining medications'? Also many of these medications could be avoided in the first place with a healthy diet.

I am sorry but the majority of overweight people are looking for excuses or shields. The proportion of people who actually gain weight due to a medical condition far outweighs the average overweight person whos is simply lazy or doesnt care.

Tree

Im not sure a stigmatising bully campaign is the way to go about public health education. I think the original article didnt object to curbing obesity but more the shock tactic and guilt that is used to get the message across.

ferike1

Maybe because the other tactics haven't worked at curbing the rising obesity levels? Sometimes people need a reality check

MrCreosote

Tree wrote: »

Im not sure a stigmatising bully campaign is the way to go about public health education. I think the original article didnt object to curbing obesity but more the shock tactic and guilt that is used to get the message across.

This is where I have a problem- it's not 'stigmatising' and it's not bullying. Maybe a bit blunt, but just because the truth is unpalatable doesn't mean it shouldn't be aired. It's the same with those anti-smoking ads.

Now whether it works or not is a completely different question...

kipple

seamus wrote: »

the basic rule of "calories out == calories in" will always hold true.

Gary Taubes author of Good Calories, Bad Calories makes a convincing case that this is NOT the case.

His case is that metabolic problems cause weight problems, not the other way around. A lot of his research resolves around insulin and the fact that people with higher levels of insulin are typical overweight. His claim is that eating a low-glycemic diet will cause insulin levels to decrease on average which will result in weight loss without hunger.

The human body can regulate its weight regardless of how many calories we eat as long as the basic hormone system of the body is functioning. Sugar and high carb diets cause the bodies weight regulation system to break down.


I found both his books to be very interesting and both rely on clinical studies to back up his case.

HQvhs

I'm not a big fan of placing all the focus on individuals when it comes to obesity. So much of it comes down to environmental and societal factors that need to be addressed. Obesity levels haven't risen over the past 40 years simply because people decided - as individiduals - to eat more and to exercise less. They rose because the environment around them changed.

Similarly, I don't think obesity levels - at a population level, whatever about an individual level - will fall significantly if we expect people to decide as individuals to eat less and exercise more.

I don't deny the importance of personal responsibility, but I think we would be much better off to target the environmental factors rather than rely on people to make the right decision consciously day-in and day-out on what to eat.

My tuppence anyway.

eilo1

HQvhs wrote: »

but I think we would be much better off to target the environmental factors rather than rely on people to make the right decision consciously day-in and day-out on what to eat.

I agree with you to an extent that there are a lot of social factors in our society that need to be addressed and improved.
But I do think people need to stop being patients/victims and take responsibility for them selves.
There is plenty of education and support on healthy eating and the importance of excerise these days.
That is not to say there is no excuse for weight gain, I only meant that people need to admit that they are over weight and be pro active to loose weight.
It should not be socially acceptable to be over weight in the same way that smoking is no longer acceptable.

HQvhs

eilo1 wrote: »

I agree with you to an extent that there are a lot of social factors in our society that need to be addressed and improved.
But I do think people need to stop being patients/victims and take responsibility for them selves.

I agree, but we should not spend money vilifying them that I believe could be better spent on ensuring people don't become overweight in the first place - things like Dublin Bikes, funding sports clubs, PE in schools etc.

There is plenty of education and support on healthy eating and the importance of excerise these days.

There is plenty of information, but not a lot of implementation. Our environment is conducive to eating too much, and exercising too little. For example, Dublin is still relatively inhospitable to cyclists due to poor cycle lanes, not being able to bring bikes on public transport etc (admittedly, this is changing - but slowly). Another is advertising for fast-food and junk food which is widespread, and often specifically targeted at kids. At home, modern conveniences like dishwashers, dryers, TVs etc means we spend a lot less energy even on simple chores like cleaning, not to mention we now spend much of our leisure time sitting down in front of TVs or computers rather than outside.
Whilst I recognise personal responsibility to be an important factor, I think the environment is much more important. Also, it is very difficult to change people's behaviour and to get them to resist the temptations and conveniences that surround them and eat less and exercise more by scolding them and victimising them. We should be facilitating society to eat more healthily and be more active.

That is not to say there is no excuse for weight gain, I only meant that people need to admit that they are over weight and be pro active to loose weight.
It should not be socially acceptable to be over weight in the same way that smoking is no longer acceptable.

If you mean being overweight should be as socially unacceptable as smoking, I have to disagree entirely (I say this as someone who is nowhere near overweight). First of all, being overweight doesn't directly harm those around you in the same way smoking does. Second, the link between being moderately overweight and ill-health is not as strong as people believe. A more important determinant for high blood pressure (if I recall correctly) is physical fitness, not BMI. And third, if we start stigmatising being overweight, why not stigmatise being physically unfit, or eating too much salt, or engaging in dangerous activities like mountain-climbing or other adventure sports? Where do we draw the line?

opinion guy

Personally I'm all for a fat tax. That is a tax on unhealthy foods. Anything with transfat in it - lop a tax on it. Anything with excess salt in it - lop a tax on it. Anything with sugar injected into it - lop a tax on it. Anything overly processed - lop a tax on it. No taxes on healthy foods, fresh produce, etc.

People can still eat the crap foods, but the healthy stuff will be cheaper. Also the tax would be a nice source of income to offset against the health costs of the crap food. Actually I think the income should be ringfenced for health expenditure

SteelyDanJalapeno

As i've said in a recent thread on obesity in kids, it seems relevant here too

Horgan wrote: »

Processed food has only been around for the past 100 - 150 years ago, its no coincidence that heart diseaze, diabetes and other nutrional diseazes have dramatically increased in this period,

everyday you buy something from the supermarket we're voting as the item passes the till, if its cheap processed food, we're supporting usually massive food production companies over processing corn, yup most of the processed food you buy is a derivative of corn, which may aswel just be sugar, if its in a sealed wrapper its usually no good,

if we could just start buying some fresh veg and meat, demand will increase, prices will come down, your local farmer will stay in the job, processed food will become less popular, diseaze will decrease, people will become healthier!

YOU ARE WHAT YOU EAT!

gypsy_rose

Y'know, maybe this is a bit off topic, but I find it really weird that governments sponsor ads to discourage people smoking, stop eating so much etc., and yet still allow other advertising to push the exact opposite.

If they really wanted to stop people smoking or eating so much they'd ban cigarettes and vending machines, but they don't because Coke and Marlboro have too much power and are too financially important.

So what exactly do they want? If they really believed in what they were saying they'd tell those companies to shove their money up their hole, I think they just do it because they have to be seen to be doing something, "trying", but not really bothering.

kipple

Where is the scientific evidence that exercise leads to weight loss?

An extract from Taubes book:

Per Björntorp, a Swedish investigator, reported about his own clinical trials on obesity and exercise. After six months of a thrice-weekly exercise program, his seven obese subjects remained both as heavy and as fat as ever. Four years later, when the NIH again hosted a conference on obesity, the conference report concluded that “the importance of exercise in weight control is less than might be believed, because increases in energy expenditure due to exercise also tend to increase food consumption, and it is not possible to predict whether the increased caloric output wil be outweighed by the greater food intake.”


In 1989, when Xavier Pi-Sunyer, director of the Obesity Research Clinic at St. Luke’s Roosevelt Hospital Center in New York, reviewed the evidence that exercise “without caloric restriction” could lead to weight loss, he stil found little reason for optimism, despite what the press was now claiming as gospel. “Decreases, increases, and no changes in body weight and body composition have been observed,” Pi-Sunyer noted. That same year, Danish investigators reported that they had indeed trained previously sedentary individuals to run marathons (26.2 miles). At the end of this eighteen-month training period—a time of almost fanatic exercise—the eighteen men in the study had lost an average of five pounds of body fat. “No change in body composition was observed” among the nine female subjects.

SteelyDanJalapeno

kipple wrote: »

Where is the scientific evidence that exercise leads to weight loss?

An extract from Taubes book:

Per Björntorp, a Swedish investigator, reported about his own clinical trials on obesity and exercise. After six months of a thrice-weekly exercise program, his seven obese subjects remained both as heavy and as fat as ever. Four years later, when the NIH again hosted a conference on obesity, the conference report concluded that “the importance of exercise in weight control is less than might be believed, because increases in energy expenditure due to exercise also tend to increase food consumption, and it is not possible to predict whether the increased caloric output wil be outweighed by the greater food intake.”


In 1989, when Xavier Pi-Sunyer, director of the Obesity Research Clinic at St. Luke’s Roosevelt Hospital Center in New York, reviewed the evidence that exercise “without caloric restriction” could lead to weight loss, he stil found little reason for optimism, despite what the press was now claiming as gospel. “Decreases, increases, and no changes in body weight and body composition have been observed,” Pi-Sunyer noted. That same year, Danish investigators reported that they had indeed trained previously sedentary individuals to run marathons (26.2 miles). At the end of this eighteen-month training period—a time of almost fanatic exercise—the eighteen men in the study had lost an average of five pounds of body fat. “No change in body composition was observed” among the nine female subjects.

Its as simple as calories in vs calories out!

obviously if your gonna exercise your calories out are going to increase and thus lose weight if you remain at the same calorie intake, now if your gonna expend an extra 500 calories a day in exercise, and the go ahead and eat an extra 500 calories in food well thats obviously gonna negate that 500 calories burned. The part bolded from that study backs up this.

kipple

It is not as simple as calories in vs calories out. It is the type of calories that matter.

Put simply:
Eating sweets makes you fat.
Eating lard does not make you fat.

2Scoops

What is it about obesity that boils the blood of internet commentators? Where is the outrage for all the other, less visible, risk factors?

+1 to HQvhs for a well-thought out contribution.

opinion guy

2Scoops wrote: »

What is it about obesity that boils the blood of internet commentators? Where is the outrage for all the other, less visible, risk factors?

+1 to HQvhs for a well-thought out contribution.

???????

2Scoops

opinion guy wrote: »

???????

LOL, fat people are rubbish, innit? A stupid picture like this or a giant burger makes it into every 'professional' talk I've seen on this issue.

opinion guy

2Scoops wrote: »

LOL, fat people are rubbish, innit? A stupid picture like this or a giant burger makes it into every 'professional' talk I've seen on this issue.

Err well I was more making the point that people who spend all day arguing on the internet are more likely to be fat

nickcave

kipple wrote: »

Where is the scientific evidence that exercise leads to weight loss?

Everywhere, basically

You're quoting extensively from a single source to support your claims. And as has been pointed out, the argument from that source is a little thin. In that particular case, exercise failed to affect the obesity of seven people because they all increased their calorific intake as a result.

Although exercise “without caloric restriction” in the hands of the obese is probably doomed to failure, yeah.

El_Dangeroso

I'd like to see what the people who talk about calories in calories out would say to a middle-aged woman with a 33" waist but is so thin on top you can see the top of the ribs.

I know several women who fall into this category. Middle age spread is down to hormones largely, I'm not saying I know why exactly but there are populations where waist expansion is not an inevitable cause of ageing, for example the Japanese (even with a starchy diet). In populations where they still eat a traditional, unprocessed food diet, the trend in middle-age is to lose weight, not gain it.

In fact, I would say a large proportion of the adult obesity epidemic is attributable to a demographic shift as much as anything else. On average we're 10lb heavier and 10 years older. That's a pretty average weight gain for someone ageing a decade in the western world.

What is far more worrying is the childhood obesity trend. For two reasons:

1. The obesity epidemic in the US started in the 1970's almost exclusively in children, it took a decade to spread to adults.
2. You can create new fat cells up until adulthood, by which time you can only stretch the ones you have. If you become obese in childhood you have a snowball's chance in hell of ever achieving a normal weight without bariatric surgery, which is life-shortening.

Bottom line is we need to treat fast food like we treated cigarettes. Tax the hell out of it, make it less available and stop it being marketed to children.

MrCreosote

El_Dangeroso wrote: »

In fact, I would say a large proportion of the adult obesity epidemic is attributable to a demographic shift as much as anything else. On average we're 10lb heavier and 10 years older. That's a pretty average weight gain for someone ageing a decade in the western world.

This is a big problem- the idea that the common weight gain in middle age is somehow a normal part of growing older. Just because it is common does not mean it is somehow to be expected, and doesn't mean it is without consequences. Certainly it's harder to lose weight and easier to gain it as you get older, but that doesn't mean it should just be accepted.

One of the things the campaign is trying to do is to counter the "normalisation" of being overweight.

El_Dangeroso

MrCreosote wrote: »

This is a big problem- the idea that the common weight gain in middle age is somehow a normal part of growing older. Just because it is common does not mean it is somehow to be expected, and doesn't mean it is without consequences. Certainly it's harder to lose weight and easier to gain it as you get older, but that doesn't mean it should just be accepted.

One of the things the campaign is trying to do is to counter the "normalisation" of being overweight.

Oh I know it shouldn't be normal. But it has been common for for decades now, I'm just saying the issue seems more apparent now because of the demographic shift.

What would you do for my example of the 'weight around the middle' people who look positively skeletal in the face and neck when they lose weight while still carrying a bigger waist?

There are weight loss strategies that can target the visceral or 'dangerous' fat (when it comes to relative risk for diabetes, CHD and stroke) better than others. And that goes way beyond cutting calories and into the biochemistry of how different food is metabolised. Some strategies are surprising (such as getting enough sleep), but these are the things we need to be researching and focussing on. Conscious calorie restriction is has notoriously poor long term adherence rates.

maninasia

Anybody who has read into the subject will see it's a pretty complex area. If it was as simple a task to 'just eat what you need' and maintain that long-term you wouldn't have so many obese people as they could stick to their diet. Obviously diets don't work in general and that points to an addiction of sorts.
The type of food we eat has changed dramatically along with the amount of physical exercise required to get through the day. It's not so simple to say just eat less.

For instance, what if modern people actually need to injest the same amount, say volume/calorie wise, than their ancestors i.e. it is a genetic inherited need that can't be changed by willpower alone as much as somebody can control their sexual orientation!

You take away the physical exercise or you change the type of food we eat in the modern day and that genetic mechanism that we were born with doesn't work anymore...it keeps telling us eat more and eat the sugary/stachy stuff that is at hand, eat more was fine for our ancestors but not for us.


My point..yes people should try to control their urges but don't get sanctimonious about modern people and their obesity problem, much of it involves battling strong natural impulses and brain chemistry that don't suit the modern world. If willpower could do it alone it would have worked already, so time to roll out some new thinking.

maninasia

Let's get back to the biological reasons folks and get away from the moralising.

http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html?src=me&ref=general

Have a look at this image. Is there some reason that Samoans like to eat more and exercise less? No I don't believe there is.
http://farm4.static.flickr.com/3240/2698089170_25d7787187.jpg

maninasia

MrCreosote wrote: »

This is a big problem- the idea that the common weight gain in middle age is somehow a normal part of growing older. Just because it is common does not mean it is somehow to be expected, and doesn't mean it is without consequences. Certainly it's harder to lose weight and easier to gain it as you get older, but that doesn't mean it should just be accepted.

One of the things the campaign is trying to do is to counter the "normalisation" of being overweight.

This is a big problem- the idea that homosexuality is somehow a normal part of modern society. Just because it is common does not mean it is somehow to be expected, and doesn't mean being gay is without consequences such as high rates of venereal disease and perversion. Certainly it's harder to ignore the corruptions of the modern world and easier to be dragged down, but that doesn't mean it should just be accepted.

One of the things the campaign is trying to do is to counter the "normalisation" of being gay.


I picked sexuality at random but I think it gives good context to how society's views along with medical views change over time.

MrCreosote

maninasia wrote: »

Have a look at this image. Is there some reason that Samoans like to eat more and exercise less? No I don't believe there is.
http://farm4.static.flickr.com/3240/2698089170_25d7787187.jpg

Really? I can think of many reasons- most of them are cultural.

MrCreosote

maninasia wrote: »

This is a big problem- the idea that homosexuality is somehow a normal part of modern society. Just because it is common does not mean it is somehow to be expected, and doesn't mean being gay is without consequences such as high rates of venereal disease and perversion. Certainly it's harder to ignore the corruptions of the modern world and easier to be dragged down, but that doesn't mean it should just be accepted.

One of the things the campaign is trying to do is to counter the "normalisation" of being gay.


I picked sexuality at random but I think it gives good context to how society's views along with medical views change over time.

Not really sure what point you're trying to make here, but maybe you could show us some examples of how the medical views about the effects of obesity have changed over time.

maninasia

I think my point is very clear but I will spell it out for you anyway.

Society stigmatises many obese people in the same manner that it stigmatised homosexuals by indicating that it was an aberrant behaviour that should be reformed. Actually, as is well known now, homosexual orientation is something that people are often born with. The medical community is often slow to change it's viewpoint too. After many decades of fruitless efforts in combating obesity it is obviously time to take a new direction.

As for Samoans or other Polynesians here is the standard explanation for their levels of obesity.

http://www.maxwell.syr.edu/uploadedFiles/moynihan/dst/curtis5.pdf?n=3228

Some of the highest levels of obesity in the world are found in the island populations of Oceania. Rates of obesity as high as 75% have been reported
in Nauru, Samoa, American Samoa, the Cook Islands, Tonga and French Polynesia. The factors for this epidemic of obesity are a dramatic decrease in
physical activity and a dependence on a Western diet. The traditional foods of the islands such as fresh fish, meat and local fruits and vegetables have been

replaced by rice, sugar, flour, canned meats, canned fruits and vegetables, soft drinks and beer.


Notice anything? The writer is making a huge error here. He forgets to mention this same trend has happened ALL OVER THE WORLD over the last half century. It has not however resulted in large parts of the world having this severe level of obesity that Polynesians populations suffer from. In fact I think it's a fair bet that Polynesians walk and do more physical exercise than the average Irish person. Therefore, a genetic component is heavily implied ASWELL as the environmental component.

Here is some research to that end.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025936/

MrCreosote

maninasia wrote: »

As for Samoans or other Polynesians here is the standard explanation for their levels of obesity.

http://www.maxwell.syr.edu/uploadedFiles/moynihan/dst/curtis5.pdf?n=3228

Some of the highest levels of obesity in the world are found in the island populations of Oceania. Rates of obesity as high as 75% have been reported
in Nauru, Samoa, American Samoa, the Cook Islands, Tonga and French Polynesia. The factors for this epidemic of obesity are a dramatic decrease in
physical activity and a dependence on a Western diet. The traditional foods of the islands such as fresh fish, meat and local fruits and vegetables have been

replaced by rice, sugar, flour, canned meats, canned fruits and vegetables, soft drinks and beer.


Notice anything? The writer is making a huge error here. He forgets to mention this same trend has happened ALL OVER THE WORLD over the last half century. It has not however resulted in large parts of the world having this severe level of obesity that Polynesians populations suffer from. In fact I think it's a fair bet that Polynesians walk and do more physical exercise than the average Irish person. Therefore, a genetic component is heavily implied ASWELL as the environmental component.

Here is some research to that end.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025936/

I've had personal experience with the modern Polynesian diet, and it is in general atrocious. Now I'm not disagreeing that there isn't a genetic component, but here's the thing- at the moment there's sweet FA anyone can do about genes.

As for the "homosexuality" argument- it has nothing whatsoever to do with this. If you're implying that the medical community should change its message that obesity is unhealthy because it is somehow stigmatising....what a joke!

My point about normalising being overweight is that people feel their (too high) weight is healthier than it actually is when the population rates of obesity hit 20%+. Saying their weight is actually not healthy is not a statement about a person's self-control or in any way stigmatising- it's just laying it out as it is. Your argument is like saying that a BP of 200 is unhealthy stigmatises an individual, just because the average population BP is 200.

maninasia

I'm no medic but I imagine in large part that to treat a disease successfully you have to understand it's causes.

It's pretty obvious that genetics is a large part of the influence of obesity, whether heriditary or epigenetic in nature. If we understand the genetic or epigenetic component we can say, hold on a minute, no matter what we say or do with this section of the population it's not going to work, we'll have to try something else. Stop wasting time repeating the same old tired mantras.

There is some indication to say that obesity is not well understood, because current treatments are failing. Yes people need to get out there and consciously change their behaviours and yes Polynesians just like Irish and Americans need to get off their asses and do more exercise, but it's also obvious that just doesn't work for most of the population at present.

If the genetic part is actually the key component (when all else is taken into account such as modern lifestyles) you won't get real successful results until that is focused on and understood. In the case of Polynesians, it should be possible to do a controlled study on children who were adopted by families from other cultures and raised in Australia. That would be my way of ferreting out the genetic component.

You make a good point about society accepting norms that are actually unhealthy. There's definitely an element of acceptance in different societies i.e. bellies in Ireland might be more predominant than some other countries . I just think a balance should be made between promoting norms that are healthy and stigmatising people unfairly with a label that says 'it's because of your own poor behaviour and choices'. We need to break down the reasons for obesity for the individual and subsections of the population and work from there.

MrCreosote

maninasia wrote: »

I just think a balance should be made between promoting norms that are healthy and stigmatising people unfairly with a label that says 'it's because of your own poor behaviour and choices'. We need to break down the reasons for obesity for the individual and subsections of the population and work from there.

Good point. For what it's worth I reckon the solutions are only going to come from a public policy/nanny state type interventions. The lawmakers have to make it easier to lose weight than to put it on- tax unhealthy food, control advertising better but even more fundamentally look at the design of towns and cities and make it easier and safer to walk/cycle etc. Add in some safe pharmacological help to alter appetite which should hopefully be available in the next few years and some change for the better might be possible.

Trying to change a societal problem by getting individuals to alter behaviour is pissing in the wind really.

But that doesn't mean that people like Muiris Houston in the health section in the Times should fudge the fact that obesity is fundamentally unhealthy.

drumm23

maninasia wrote: »

This is a big problem- the idea that homosexuality is somehow a normal part of modern society. Just because it is common does not mean it is somehow to be expected, and doesn't mean being gay is without consequences such as high rates of venereal disease and perversion.

I've seen some horrendously bad analogies drawn on Boards - but you have just trumped all other efforts with possibly the most absurd and flawed argument I've ever witnessed; take a cookie.

maninasia

@Drumm - as is common on this forum in particular you lope in with a criticism without contributing whatsoever to the debate.


Reagarding your comment, I don't think so, I think there are many parallels in the way homosexuality was viewed as a disease of individual perversion or poor behaviour which can cured if only the individual would stop their aberrant and perverted behaviour.

Obese people are the last section of society (along with white males) who it is clearly acceptable to mock. Eating so much is not so much seen as an addiction, which it clearly is, but often seen as disgusting, greedy and perverted. In the case of having genetic or metabolic reasons to put on so much weight obese people are still criticised as lacking will power when in fact they could have more will power than the average person.

This is was why it was easy to switch the words. It's not an exact analogy but it shows how societal and medical views change over time.

drumm23

You're talking complete nonsense.

People didn't like gays because they didn't understand it and the powerful authorities of the time were vehemently against it. Undoubtedly being gay brings some heightened risks that you probably avoid if you're not gay. That's it. Being obese is not the same; critically it is -in the majority of cases, not all, but the majority- an avoidable condition (unlike being gay); while it also brings significant and numerous health risks to the obese person and, therefore, health costs to society.
There is, clearly, an upsurge in obesity that precludes it from being a genetic effect (unless obese-inclined people are more likely to produce dominant offspring - they are not, the opposite being more accurate). Ultimately, to imply, which you essentially are, that the proportion of people who are "by design" obese is closely equivalent to the proportion of people who are "by design" gay is preposterous and blind to the reality that western society is increasingly fat, increasingly lazy and increasingly eating increasingly large amounts of increasingly crap food.

nesf

drumm23 wrote: »

There is, clearly, an upsurge in obesity that precludes it from being a genetic effect

It's not as simple as that.

El_Dangeroso

Epigenetics is probably involved in the obesity epidemic. This would indicate a genetic component triggered by environmental change. We know that populations that experienced famine during WWI had an increased incidence of type 2 diabetes 2 generations later. We can demonstrate it in other mammals such as cats also.

We know that the obesity epidemic in most countries is first observed in children. Children are normally the most resilient when it comes to weight gain. I was a very skinny child who could eat a lot of junk and never gain weight. So when you become obese as a child we know from studies that your chances of ever becoming a normal weight drop to close to zero. That would indicate an epigenetic component in obesity.

JuliusCaesar

I haven't read the entire thread, but also take issue with seamus. I'm a psychologist, and studied psychophysiology in college, including the psychology of hunger.

Anyway, most of my life, I ate when I was hungry and stopped when I wasn't. I exercised by walking or cycling places (I didn't think of it as 'exercise', it was getting to somewhere I wanted to go), and I swam because I enjoyed it. I was slim and fit. I maintained a fairly steady weight with a fluctuation of about half a stone. I think I put on a stone and a half being pregnant and that vanished afterwards, although my body shape was permanently changed - and so my body image took a trouncing.

Anyway, after the age of 45, my weight started creeping upwards. I couldn't walk or cycle as much due to having children with me. Then I was exhausted and did very little, suspected of having heart problems, and was eventually diagnosed as hyperthyroid. (I couldn't believe this: surely you mean hypOthyroid, I said to the doctor) And here I am at 50, having to eat less than I feel like eating, and eat when I don't want to and don't eat when I do want to. I'm not always hungry at dinnertime. I'm having to retrain my appetite, while at the same time being an example of normal eating to teenagers. And I'm still at the same weight, about 2 stone above my previous longterm weight. Stuck!

And let me tell you, the hardest thing about trying to lose weight is feeling hungry all the time.

El_Dangeroso

JuliusCaesar wrote: »

And let me tell you, the hardest thing about trying to lose weight is feeling hungry all the time.

That is certainly the key and also a fact that people forget about when discussing the problem of reversing obesity.

The most cutting edge research is investigating the possibility of a body fat 'set-point' or 'adipostat'. A healthy body will tightly regulate blood pressure, blood glucose and body temperature, why would it also not regulate body fat levels unless something was physiologically wrong? In fact we have lots of research going back decades that shows that the body will 'defend' itself from weight loss or weight gain by modifying appetite accordingly. Most interesting of these studies was the Vermont prison study (which would never get past an ethics committee nowadays) that force-fed inmates in order to make them gain 25% of their body weight. Of all the inmates that achieved the feat, almost all rapidly returned to their pre-study weight, this showed the 'defense' of body fat levels works both ways.

What this tells us is that in order to invoke a long term reduction in body-fat mass (which is so rare that the US keeps a special register of people who manage to lose 20% of their body weight and keep it off for 5 years or more) you need to cause the body fat set-point to go down. Physiologically speaking this involves the hypothalamus sensing adequate leptin in order to send the correct satiety signals so that calorie restriction becomes effortless.

How this is done is the 1 billion dollar question (gastric bypass success gives us some clues but isn't as effective as you'd expect it to be) but the issue is so far from as simple as 'eat less move more', which does work, but not in the long term for 99% of people who are eventually overcome by hunger.

maninasia

http://www.newscientist.com/mobile/article/mg21428625.100

Microbe flora in the gut linked to obesity levels in animals.

El_Dangeroso

maninasia wrote: »

http://www.newscientist.com/mobile/article/mg21428625.100

Microbe flora in the gut linked to obesity levels in animals.

Yeah, it joins a lot of other research implicating gut dysbiosis in obesity

Pity we haven't found a way to change gut flora in any meaningful way for the better.

maninasia

The idea would be to do a faecal transplant, supposedly works wonders with some people who have certain disorders. In this case you could choose the faeces of a slim person who eats lots of junk and doesn't exercise, in the absence of any other way to select.

Here is another interesting article from the Indo about the effects of breasfeeding.
http://www.independent.ie/lifestyle/parenting/babies-breastfed-for-at-least-six-months-less-likely-to-be-fat-at-age-9-3096859.html

Researchers found the risk of a nine-year-old being obese was reduced by 51pc if breastfed for six months or more, compared with an exclusively formula fed child.

Infants breastfed for three to six months were 38pc less likely to be chronically overweight by nine, they added.


The findings are based on the Growing Up in Ireland report, which previously revealed a quarter of nine-year-olds are rated overweight or obese, at 19pc and 7pc respectively.


Professor Richard Layte said factors including parental weight, status, lifestyle, exercise and diet were also taken into account.


Hope people who think they know it all already are getting away from the 'it's the willpower dummy' simplistic arguments and looking a bit deeper.