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Obesity: Lifestyle Choice or Lifestyle Chance?



Readers of these pages should by now recognize that obesity is an extraordinarily heterogeneous and complex condition.

While energy balance is simply a matter of energy in and energy out, the determinants of energy in and energy out are anything but simple.

Indeed, the sociopsychobiology of ingestive behaviour is perhaps the most complex of all human behaviours (not surprising given its importance for survival of the species) and the physiological, neuroendocrine and biochemical pathways that determine energy metabolism and activity thermogenesis are clearly no simpler.

It is perhaps, therefore, not all that unexpected when study after study (let alone your own experience) shows that the simplistic formula: “eat less – move more” is so disappointingly ineffective in either preventing or treating excess weight.

Yet, health professionals, decision makers and the general public continue to believe that obesity is simply a matter of “choice”, or in other words, people struggling with excess weight are simply making the wrong choices. Were they only to smarten up and chose differently, their fat would simply melt away – hopefully forever.

The fact that this “simple” formula for maintaining a healthy weight is about as realistic and effective as the “simple” formula for getting rich on the stock market by simply buying low and selling high, apparently does not deter the “healthy living missionaries” from preaching to the uninitiated, who are simply too stupid to understand that weight management is really just a matter of choosing to do the right thing!

Let us for a minute assume that “lifestyle” truly is a major determinant of weight gain (and let us simply ignore the vast body of research on genetics, imprinting, fetal programming, environmental toxins, gut bugs, adipogenic adenoviruses, activated hypothalamic-pituitary adrenal axes, mood and anxiety disorders, addictions, attention deficit, abuse, emotional neglect, poor body image, obesogenic medications and the many other well-documented causes of obesity), then the question remains how much of lifestyle is truly simply a matter of “choice”.

How many of us simply chose sedentary jobs that keep us in front of a computer all day, simply chose to live in neighbourhoods with no sidewalks, simply chose to work in jobs where we earn so little that the only food we can afford to feed our family is crap, simply chose to live so far from work that we face daily hour-long commutes that leave little time for recreational activity (let alone enough sleep), chose to work rather than stay home so we can be around to fix a healthy meal from scratch in time for when the kids come home from school, simply chose to drive a car rather than spend our money on the 5-9 daily servings of fruits and vegetables for everyone in our family, simply chose to have a TV in the house that streams endless hours of advertising to our children, simply chose to drive our kids to school rather than let them cross those five busy intersections, simply chose to live in a country where the government subsidizes corn and meat producers rather than fruit and vegetables growers, etc, etc, etc? Are all of these “lifestyle” factors simply a matter of choice? If yes, then, I am sure we can all simply chose differently and obesity will simply vanish!

But what if obesity is not simply the result of lifestyle “choice” but rather the result of lifestyle “chance”. Do we all truly have a chance to always feed our families healthy foods, have the chance to live in neighbourhoods where it is safe for our kids to walk to school and play outside, have the chance to enroll them in daily sport programs, have the chance to prevent them from ever seeing ads for unhealthy foods, have the chance to ensure that they (and we) get 8 to 9 hours of sound sleep every night, have a chance to convince our politicians to make the right food and environmental policies?

If we don’t, but rather chose to continue living in this obesogenic environment, then do we truly have a chance of not gaining weight? Remember also, that the same environment does not treat everyone fairly – some people (the mutants?) can eat all the junk food they want and stay as thin as a rake, others, despite eating as healthy as possible and despite regular exercise, just keep packing on the pounds.

When it comes to lifestyle’s impact on obesity – is it not far more often a question of CHANCE than of CHOICE?

Let us do our best to first give everyone a fair lifestyle chance and then see if we can perhaps beat the obesity epidemic after all.

AMS
Edmonton, Alberta

12 Comments

  1. Truly Inpsiring!

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  2. Yes, inspiring Dr. Sharma.
    After talking with hundreds of clients in our clinic and getting a sense of the ‘choices’ that have lead them to us, I know I still regularly have to check a default reaction that wants to simply categorize the cause under the “they should have made better choices” heading. Fortunately, with more experience and with the opportunity to be exposed to the well-researched material such as yours it becomes easier to be more empathetic.

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  3. Dr. Sharma, I’m always impressed by your daily comments, but I really had to compliment you on this outstanding essay of today. Hope you don’t mind, but I’ve posted it to the Innovation Anthology website so others can read it.

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  4. Thanks you Doctor Sharma.
    All your work and understanding is greatly appreciated by those who are struggling with their weight (and environment).
    Please keep writing your blog. More than once it has helped me get over a rough patch.

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  5. Yes, let’s identify all the influencing factors. The more we know about what we’re up against, the better we can cope.

    In the meantime, before all these problems are solved, we still have to make choices in the things we can control, and those choices do have an effect.

    I know you say bariatric surgery is the best way to deal with morbid obesity, but except for a very small minority of people, that’s only a dream.

    The rest of us, who don’t have surgeons and a team of medical professionals at our service, have to live with the only possible alternative, that is, trying to do what we can with the flawed “eat less, move more” model.

    There needs to be a “middle way” in the medical profession between bariatric surgery (which simply selects a lucky few to receive top notch care AFTER their condition has reached life threatening extremes) and the inadequate advice to “follow the Canada Food Guide and take a walk every day.

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  6. I completely agree. But how do we create change? Unfortunately, information such as the things addressed in this blog are often reaching only those who seek it. In essence, I find we’re often preaching to the choir.

    At the same time thousands of physicians and the general public remain truly uninformed. And the weight loss industry that propogates these myths won’t go down without a fight.

    Identifying the problem is obviously the first step, but getting beyond that to find the solution is the most difficult one.

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  7. Outstanding note!! Very well said…I think we need more people like you to advocate for patients and ensure these messages get across all health professionals/educators and particularly decision makers.

    Keep up the good work….

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  8. “The mutants…” That is great! When you think of it, that makes sense. After all, a body type that didn’t store energy for times of famine over the human evolution certainly isn’t likely to be a winner for long-term survival of the species.

    Thanks for the wonderful image there! And the thoughtful other comments.

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  9. Check out “national weight control registry” Studies of people who loose weight and keep it off

    Some of those people take years to loose the weight. Don’t give up.
    they have lessons we can learn

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  10. Thank you Dr. Sharma. Your comments are right on as usual.

    It reminds me of Malcolm Gladwell’s newest book, Outliers, which challenges our beliefs about success and what makes people successful. He basically gives numerous examples of chance events that determine why people are successful but we, the public, continue to believe success is about personal choice.

    We have the illusion of choice when we go into a typical grocery store which show-cases ~48,000 items. When we realize that the majority of those products are made from a dozen or so base ingredients, corn, wheat, soya primarily, we realize it is just an illusion of choice. True choice would be reflected in affordable fruits, vegetables and staples versus more iterations of cornstarch, soya oil and sugar +/- flavours.

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  11. Dear Dr Sharma,
    Thanks for this illuminating commentary. It is amazing what power the discourses of ‘choice’ and ‘eat less, move more’ have. We need more columns like you from a greater range of people challenging these simplistic ideas about the causes and solutions to obesity.
    Thank you.
    Catriona

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  12. Dear Dr Sharma,
    This is a great article. I am not obese, I am not even overweight, but I have been studying the obesity field over the past few years as a forecasting analyst and believe that obesity is definitely not a lifestyle choice, but one that many people just cannnot avoid due to the situations they are put in and experiences they go through.
    I myself have an 18 month old daughter who does not sleep well at all, and therefore find it difficult to fix a healthy meal for my husband and I and sometimes my daughter too, although I try to focus on her meals before ours. This is simply because I am exhuasted. I even find it difficult even woriking the small number of hours that I do each week. So of course, I have put on weight as a result and feel more tired being unable to exerise as I would like to, and am therefore now breaching being overweight. No amount of education or knowledge can help you in some of the situations you are placed in throughout your life.
    I think with so many things, and especially obesity, factors in your life determine the path you go down, and with your health that is especially so. Clearly there are many factors that influence one becoming obese, and hopefully the shift towards obesity being viewed as a disease rather then a lifestyle choice will stop the stigma associated with obesity and help more obese people seek treatment for their condition before associated diseses present themselves. Lets hope insurance payers see it this way too!

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