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There is No Universal Causal Theory of Obesity…



…except perhaps that there is no universal causal theory of obesity.

In a world where everyone is looking for quick-fixes and approaches to dealing with almost any societal problem, quickly degenerate into opinionated activism, I often find it important to remind myself that obesity is not a simple problem where identifying (and eliminating) one cause will “solve” the issue.

I was reminded of this by some of the comments to yesterday’s post on emotional eating, which pointed out that too much emphasis on the emotional aspects of overeating simply adds another narrative to “pathologizing” people with excess weight.

In other words, not only are obese people gluttonous sloths without will power, they are now also emotionally-wounded wrecks (you can chose, which of these is worse).

The fact, however, is that the vast majority of people with excess weight are none of these.

There are countless people with excess weight, who eat as much or as little as skinny folks; the problem of inactivity and sedentariness in Canada affects 95% of the population (and not just the 60% who are overweight or obese); throughout history, overweight and obese individuals have expressed incredible feats of determination and will power; and psychiatric wards are full of skinny people with mental illness.

Thus, as I have often discussed in previous posts, the ‘root causes’ of obesity are as diverse as not having enough money or time to eat to taking medications for your allergies. Throw in an ounce of genetics (any of the the 1000s of genes involved in appetite, hunger, metabolism), and you have the perfect scenario for continuous and fruitless debates on what is really driving the obesity epidemic.

For those of us, who embrace activism, we can chose the target we happen to feel most strongly about and go for it with all our energy and passion.

The list of seemingly worthwhile and deserving targets is long: junk food, caloric beverages, TVs, computer screens, lost cooking skills, built environments, cars, automation, over-scheduled kids, poor parenting, sleep deprivation, environmental toxins, allergies, gut bugs, viruses, stress, dieting, fashion ideals, bullies, and probably a few more.

Which of these factors individually or in combination are most responsible for making us fat is anyone’s guess – what may have some evidence or support at a population level is often irrelevant when it comes to individuals (your reasons for being overweight are different from mine).

So, yes, my readers are right – most of the obesity epidemic is simply the natural response to living in an unnatural environment – or perhaps even just living.

For most people with excess weight, there is probably no real underlying “pathological” driver apart from being human.

This does not mean that obesity, once established, cannot become a pathological state in that it can adversely affect all dimensions of physical, emotional and functional health (or not).

After all, what do most thin people do to stay thin? The correct answer is probably, “not much”.

AMS
Edmonton, AB

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5 Comments

  1. Good analysis. If I might add my 2 cents worth, I’d say alterations in the quality of the food supply are the dominant factor driving the global obesity/noncommunicable disease epidemic. And two major components in the food supply seem to be doing most of the damage; added sugars and omega-6 industrial seed oils.

    At present, added sugars are finally being scrutinized thanks, in large part, to Robert Lustig, Peter Havel, Gary Taubes, Peter Attia, and a few other outspoken writers, researchers, and activists. Sad to say, the omega-6 controversy is still just so much background noise(1). Yet, arguably, omega-6 is at least as harmful as added sugars if not more so(2). And the spread of obesity corresponds to the global proliferation of omega-6 cooking oils and manufactured foods laced with omega-6s(3). Meanwhile, the United States government and the Harvard School of Public Health continue to recommend that consumers replace saturated fats(4) with polyunsaturated oils(5).

    References
    1. http://www.asbmb.org/asbmbtoday/asbmbtoday_article.aspx?id=18365
    2. http://evilcyber.com/nutrition/disrobing-dogma-polyunsaturated-fat-and-health/
    3. http://articles.orlandosentinel.com/2003-09-28/news/0309270148_1_overweight-or-obese-women-were-overweight-south-africa?pagewanted=all
    4. http://www.docsopinion.com/2012/06/04/the-case-against-saturated-fat/
    5. http://www.hsph.harvard.edu/nutritionsource/fats-full-story/

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  2. As a thin person, I take objection to the last sentence that thin people likely do “not much” to stay thin. I vigorously exercise 3-4 times per week (for over 45 mins each time), I walk to/from work each day (1 hr total), I cook my families meals almost without fault each night, we rarely as a family go to a fastfood – we do eat out once a week, and I buy nutritious food to have a good stock always on hand (ie. I don’t fill my cupboards wth junk food). If that is NOT MUCH, then I don’t know what to say.

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  3. Well, Thin Person, those are exactly the same things I was doing for many years. It may be a healthy lifestyle, but for those of us who are predisposed to be fat, it isn’t a way to become thin.

    Doing exactly what you’re doing – right down to the walks to work and back – did keep me on the lower end of my normal weight range for ten years. However, my normal weight range starts at a BMI of 30 and goes up to around 37. So, I had the same lifestyle that you think is keeping you thin, and all it did was keep me slightly less fat than I would have been if I’d been a bit less active and a bit less puritanical with my eating habits.

    Oh, yeah. It also kept me very healthy, strong and capable. So, cheers to both of us, but no need to gloat about your size. Eating a balanced diet and staying active is its own reward.

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  4. By completely missing Dr. Sharma’s final point, “Thin Person” proves it. We are all what it’s natural for us to be. In our food-obsessed, obesogenic culture, that gives some people an advantage while making life difficult for others. So good for you, Thin Person. You want to be congratulated for demonstrating the behaviors our culture associates with thinness? You certainly seem insulted. Do you have a need to “prove” you possess none of the negative traits associated with being overweight?

    This was a tough week. Daniel Callahan’s thoroughly offensive proposal to treat obesity with stigmatization seemed like Juvenalian satire. He based his proposal on an assumption that fat people are clueless, mindless idiots who don’t even know they’re fat and have to be “awakened to the reality of their condition.”

    We need more voices like Dr. Sharma’s post today to start entering the collective mindset. I believe strongly that a big part of the reason we have this obesity problem is because we’ve thrown so much futile pointless effort at “causes” that were not going to fix or change anything and in fact, only perpetuated the problem. We need to stop looking for blame or “cause” and simply begin working with the situation as it is, right now.

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  5. For every thin person who works at it, there are ten who do not.

    Let’s start with my boyfriend. 55yrs old. Sits at a desk all day. Drives everywhere. Never seen the inside of a gym. Has never run or jogged since at school. Never lifted a weight. Eats whatever he likes, takes 2 sugars in his tea ten times a day, eats a big fried breakfast every morning and drinks copious amounts of red wine on the couch every evening. Height 5ft 8. Weight 144 lbs. You do the math!

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