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David Katz, M.D.

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Obesity, Demystified

Posted: 04/30/10 05:18 PM ET

I believe most people understand that epidemic obesity is overwhelmingly accounted for by too many calories in, too few calories out. But in many quarters, there is surprising resistance to that notion.

There is resistance among my academic colleagues who seek 'the obesity gene.' To me, that seems a bit like looking for the 'fish out of water' gene to explain the breathing difficulties of...a fish out of water. Every gene that makes a fish a fish is guilty of the charge.

Similarly, a lot of the genes that make us Homo sapiens -- who survived through all the ages when calories were scarce and hard to get and physical activity was unavoidable -- explain why we succumb en masse to obesity in a modern world where physical activity is scarce and hard to get, and calories unavoidable. My prediction is that when the inventory is done, the genes that make us get fat under conditions of modern living will prove to look a lot like the genes that make us human.

There is resistance, as well, among the conspiracy theorists who think some nefarious intent must be behind it all. And there is resistance among the environmentally devout, who are convinced this is all due to industrial chemicals, hormones, and antibiotics. In fact, following a recent talk at Lincoln Center to some 1200 aspiring nutrition professionals, one asked me why I had left the issue of environmental pollutants out of my presentation.

My view has long been, and remains: once we account for that portion of the obesity epidemic that is readily explained by too many calories in, too few out -- if there is any left to explain (and I don't think there will be much!) -- then I will be interested in exotic theories, from hormones, to industrial chemicals, to the microbiota of our GI tracts, to adenovirus S36.

And while I was confident in this stance all along, I am one increment more so following a recent report in the New York Times regarding the rapid progression of obesity and diabetes in Qatar. The whole case is beautifully summed up in one paragraph:

"Like other oil-rich nations, Qatar has leaped across decades of development in a short time, leaving behind the physically demanding life of the desert for air-conditioned comfort, servants and fast food."

Period, end of story.

It matters that there is no great mystery behind epidemic obesity, whether its victims live by purple mountains' majesty, upon the fruited plane, or on the sands of Qatar. It matters that the mystery of epidemic obesity is explained, everywhere, in just the same way. It matters, because even the tough can't get going so long as they remain lost and befuddled.

We can't begin to fix what we don't understand. Fortunately, we understand the causes -- and thus the cures -- for global obesity, and the chronic disease attendant upon it.

The forces conspiring to impose the global health threat of obesity upon us will be difficult to change but they are unmysterious. Conditions of modern living account for, and demystify, obesity. The explanations are...everywhere. So, too, are the opportunities to do something about it!

 

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I believe most people understand that epidemic obesity is overwhelmingly accounted for by too many calories in, too few calories out. But in many quarters, there is surprising resistance to that noti...
I believe most people understand that epidemic obesity is overwhelmingly accounted for by too many calories in, too few calories out. But in many quarters, there is surprising resistance to that noti...
 
 
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HUFFPOST SUPER USER
LukeTunyich
Biomechanics and Health
08:27 PM on 05/03/2010
Quote: “I believe most people understand that epidemic obesity is overwhelmingly accounted for by too many calories in, too few calories out.â€

Till 2005 people involved in research, treatment and prevention of obesity didn’t know that metabolic waste contain calories. (A significant amount of energy in food intake leaves body as metabolic waste.)

Even today, the majority obesity researchers, including almost all medical practitioners, and medical science researchers, paediatricians, dieticians, physical therapists and exercise therapists are not aware about that fact. http://www.biomechanicsandhealth.com/calories.htm

For the majority of people it is unbelievable to think that in the twentieth and twenty-first century that humans can make such a misconception; the energy balance model simply a matter of energy in and energy out is accepted because leading obesity scientists didn’t know that the some amount of energy leave the body as metabolic waste. http://www.biomechanicsandhealth.com/energybalance.htm

Quote: “There is resistance among my academic colleagues who seek 'the obesity gene.â€'

Genetics research related to obesity is a waste of time and money. It needs to bear in mind that all theories about weight gain whether they are based on “hormoneâ€, Genetics†etc. is made by people who have been learned in medical schools that “unused calories body storage as fat mas for later use.â€

The first essential step in solving obesity crisis is to confront with the fact that the basic science of obesity is wrong.

Luke Tunyich
http://www.biomechanicsandhealth.com/
07:52 PM on 05/03/2010
The obesity crisis is certainly multifactoral. As a Registered Dietitian, I have heard just about every excuse in the book as to why people "can't" make the necessary changes to improve their quality of life and overall health. We, as a society, crave instant gratification and we have taught ourselves that everything should be easy. The truth is this: losing weight and changing your lifestyle is very hard. It takes determination and a plan for success. We must experience discomfort to come out better on the other side. For more information, visit www.thefriedchickendiet.com
11:58 AM on 05/03/2010
I'm a firm believer in "keep it simple, stupid." Searching out ever more complicated reasons for obesity clouds the issue and makes it easier for people to blame and blame and blame. Losing weight can seem difficult and even overwhelming, but if you REALLY and truly account for every single calorie and don't go over the recommended number on a consistent basis, it's not only possible, but inevitable. Simple.
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ChaCubed
Republicans: the Antichrist
12:42 PM on 05/03/2010
Black and white. Either or. No room for both. And a belief that addressing yourself and others as "stupid" is a good thing.

I don't agree. :)
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HUFFPOST COMMUNITY MODERATOR
Atchka
Fierce, Freethinking Fatties
01:15 PM on 05/03/2010
Because if there's one thing we've learned about the human body, it's that its processes are simple and easily defined.

(Shall I turn off the sarcasm alarm now?)

Peace,
Shannon
08:15 PM on 05/03/2010
Years ago, my husband was 60 lbs overweight at one point before I met him.
One day, he was fed up with his weight and decided to lose it.
He stopped eating fast-food and started commuting by bicycle.
He incorporated exercise into his lifestyle and started cooking for himself.
In a few months, he was at his lowest adult weight and felt great.
Exercise needs to be fun, it needs to be enough to make you short of breath for a sustained period of time and it needs to be consistent.
I don't think it is easy, but it is possible.
Atchka-please look at the WHO site again. Obesity is not a healthy state of being.
Don't give up just because it is difficulty.
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HUFFPOST COMMUNITY MODERATOR
Atchka
Fierce, Freethinking Fatties
01:14 AM on 05/03/2010
In short, the rebuttal to Dr. Katz's article is that even if obesity were 99% due to a CI/CO imbalance, you haven't answered the question of why there is that imbalance in the first place. Psychological? Chemical? Hormonal? Pharmacological?

In other words, it's complicated.

Anyway, it's great to see so many rational, educated voices out there on the subject.

Finally.

Peace,
Shannon
Atchka.com
FierceFatties.com
04:09 AM on 05/02/2010
I know that this is comment #222 and therefore shall likely never be read, and nor have I read the other comments (I am about to do so) but I cannot tell you how infuriated this column made me. While I am not obese -- I have a lot of empathy for those who are because there but for the grace of God..... I am twenty or so pounds overweight, and my eating habits are pristine (more so now as I have been diagnosed with high blood sugar, but they were good before), and I exercise every day of the week. Every day. I am so tired of this oversimplification. I have no idea as to the reason for my blood sugar swings -- though I am naturally quite regimented at this point. All I can say is that the writer of this column sounds as though he has a healthy physiology (and good for him) and therefore has no comprehension or compassion for those of us who are not playing on the same field as he is genetically blessed to have. But I hardly think that this doctor has the rights to judge us with such sanctimonious confidence. I would defy him to attempt to subsist on the regime on which I am, and to gauge his success. Open invitation.
05:06 PM on 05/02/2010
There are lots of people who eat well and are still a little overweight. However, there are FAR more people who are overweight because they eat too much. The problem is the majority of people who have poor habits blame their extra weight on genetics or a medical condition rather than owning up to their lifestyle choices. I used to be overweight because I ate too much. I joined Weight Watchers and have maintained a healthy weight for a few years now. If you look at obesity rates now as opposed to 50 years ago, they have skyrocketed. The majority of people are like myself and overweight because we eat lots of processed food. It is time for people regardless of their natural size to eat better portions of healthier food. I agree that this article oversimplifies the situation but I would all argue that for the majority of overweight people it has to do with calorie consumption.
05:26 PM on 05/02/2010
Ilovemyprez: my response to both you and Cia2 below. Am writing this in case you receive alerts! ( : I don't know if a comment to a thread alerts all of the writers on the thread?
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05:08 PM on 05/02/2010
I read your comment and am in agreement with you when you say the writer of this article sanctimoniously over-simplifies the problem. He attempts to avoid contradiction by labeling those who have a different experience as "resistant." His words suggest that he has no immediate - and certainly no intimate - experience on which to draw and that he has willfully pre-judged the situation in which others find themselves. It may be the case, as he argues, that many individuals suffering from obesity are able to address their problem effectively by decreasing caloric intake and increasing activity. What I know for sure is that that formula has not worked in my case. Nor does the opposite approach work in the cases of those on the other end of the spectrum who are underweight and find themselves unable to gain and maintain weight despite drastic increases in caloric intake. It is disappointing to me that Huffpo chose to run the column of "a person obstinately or intolerantly devoted to his or her own opinions and prejudices," which is how Merriam-Webster defines "bigot."
05:26 PM on 05/02/2010
Ilovemyprez and Cia2:

Thank you for your thoughtful replies; both were greatly appreciated. Also, Cia2, thank you for that definition of bigot -- it really expanded in scope the idea I had about this word and its meaning. Yes. I don't know. You both could be right. We could all be right. Frankly I am baffled. What I remember about growing up in the 1970's were huge pancake breakfasts, desserts after dinner, and no one but bodybuilders belonged to gyms, and people were not so overweight as we are today. At least where I live in California, people don't eat as much as they used to and we exercise much more -- and yet, and yet..... and yes I know, Ilovemyprez, that when I diet and exercise (especially for me the exercise part), I do manage to feel and look better. But it is a constant trial, constant work, and feels more like a battle of "containment" than anything else. Meanwhile my blood sugar continues to rise and the insulin resistance does seem to stymie the weight loss. It just leaves so many of us frustrated and confused. I appreciate your thoughtful answers very much, and wish both of you brilliant alive health and happiness now and in the future!
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HUFFPOST COMMUNITY MODERATOR
Mensch99
02:57 AM on 05/02/2010
I think this article oversimplifies the obesity issue.
I believe many people continue to eat because their bodies are starving for certain (possibly not yet discovered) nutrients.
Our bodies cry for nutrition so we pile on another burger. Not helpful.
These nutrients are not found or have been destroyed in processed or fast food.
We are becoming a nation of obese people starving for nutrition.
03:41 PM on 05/02/2010
"We are becoming a nation of obese people starving for nutrition." - that's it in a nutshell - I've written that simple, to the point sentence down. As we continue to be set up for failure by industries that have multi-billion dollar empires at stake to keep us fat, coming back to your statement is what we all need to do. Dr. Mark Hyman has an excellent article focused on dairy that talks about the government's food pyramid from the 80's and 90's encouraging us to eat 8 - 11 servings of bread, cereal, or pasta per day - maybe the single greatest cause of the current childhood obesity epidemic. A person consuming a days worth of calories from "white food" will not be ok, no matter what the good doctor believes! But then, that's part of the problem with the way most doctors are trained - if the numbers are ok, you're ok - no matter how much you're suffering. Doctors need to understand that we are more than the sum of our parts, more than a mathematical equation.
08:10 PM on 05/03/2010
Mensch99-Your comment makes so much sense. Even when people take eat lousy, but take vitamins, they lack many micro-nutrients. That is a really interesting insight.
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E4B32787
US Gov: The best that money can buy.
01:02 PM on 05/01/2010
It seems to me the gist of the article is "...obesity is overwhelmingly accounted for by too many calories in, too few calories out. ... Period, end of story."

Without mention of the M word, metabolism, we haven't reached the end of the story. Some foods are metabolized differently. For example a Princeton University study found "Rats with access to high-fructose corn syrup gained significantly more weight than those with access to table sugar, even when their overall caloric intake was the same. "
http://www.princeton.edu/main/news/archive/S26/91/22K07/

The study found that sugar, as opposed to HFCS "must go through an extra metabolic step before it can be utilized." If so, it would seem to me that the extra energy required to metabolize the sugar leaves less energy remaining to be stored as fat.

So, I don't think a simple calorie count explains the story. The difference in the energy required to metabolize certain foods needs to be taken into account. I have a feeling that the metabolism differences account for the success of the low carb diet for some.

I've gone HFCS free since reading the study.
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Artemis34
Women can vote against the GOP or against their ow
12:02 AM on 05/02/2010
And have you tried to avoid High Fructose Corn Syrup? Since I've been looking for it on labels I'm surprised to find it in practically everything...in salami, really!

And HFCS is creeping into products overseas too. I used to be relieved not to have to avoid it traveling abroad and am alarmed now to see it in many more products.
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E4B32787
US Gov: The best that money can buy.
10:44 AM on 05/02/2010
I wasn't paying attention to HFCS until I read the article. After I did, I checked what I was consuming, and the Blue Bunny frozen Chocolate yogurt was sweetened with HFCS and ketchup. Those were the two sources with volume on HFCS. I stopped the frozen yogurt and cut the ketchup over to Hunts HFCS free ketchup. I notice it in my bread, after sugar and honey. With 1g total sugar/slice, I don't think that I'm dealing with a lot of volume of HFCS.

I watch my sugar too. Regular yogurt, sweetened with sucralose. I have a big bag of sucralose (generic Splenda), and a big bag of stevia to put in things like coffee.

I think as taxpayers, we're subsidizing HFCS, which makes it cheaper than sugar.
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MorganT
10:53 AM on 05/03/2010
Not to mention the pesticides and chemical herbicides that are present in your food, not just your produce unless you eat organic. These molecules are foreign to the body, and a lot are read as hormones instead of just things that need to be eliminated, they screw with your body's metabolic functions as well.
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ChaCubed
Republicans: the Antichrist
11:57 AM on 05/01/2010
Yes. Even when the topic is too much weight and how to lose it, there are many aspects of health: physical, emotional, personal, relationships, work, ethics - and many variables of how we think about ourselves, treat ourselves, think about others, and treat others, and we are all healthier or less healthy when comparing different aspects within ourselves or others. Ideally, we would all be mindful of this whenever we are talking to ourselves or someone else.
09:13 AM on 05/01/2010
I do think though that sometimes we over-complicate it. Definitely not ALL obese people are obese because of an unhealthy lifestyle. But there's no denying that, while not all, the majority of obese people could drastically benefit simply by shifting to a healthy lifestyle. Obviously the problem is often that there are physiological reasons why a healthy lifestyle is so difficult to achieve for some.
08:46 AM on 05/01/2010
Recently, I heard an interview on National Public Radio with a young man who, at one point, weighed 400 pounds. He recounted his meetings with nutritionists regarding his weight gain, but they were largely ineffective even with family support. When the interviewer inquired why he felt they were ineffective, the young man replied that the nutritionists -- much like Dr. Katz -- took a purely physiological viewpoint of his obesity and never addressed the emotional/cultural issues behind his weight gain. Until he tackled the psychological issues behind his overeating, he stated, he could not successfully put into practice the habits of proper nutrition.

So while the good doctor inadvertently fuels the American Scapegoat approach to difficult issues even while he rejects them, I know in my experience that poor emotional health, whether it comes from abuse or mental illness, is a significant instigator of weight gain and strips the sheen off of his pat and snappy repartee.
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RhiannonRings
Childfree and loving it!
10:44 AM on 05/01/2010
Thank you! Overeating is often the same as alcoholism or drug addiction, it can be a way of self-soothing terrible emotional a/o psychological wounds.
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E4B32787
US Gov: The best that money can buy.
12:48 PM on 05/01/2010
Some eating is addictive. At work recently, someone brought in donuts. A line formed of people to get their donuts. I saw diabetics in line. They weren't hungry. They ate the donut because when one eats a donut, one feels "good". When a cigarette smoker smokes, the nicotine makes the smoker feel "good". I don't see a difference. At the very least, it can be addictive like. That means it needs to be treated like an addiction.

All food is not the problem. Once I framed it in my mind as an addiction, I identified the couple of culprits, and now avoid them.

I also think that over thousands of years, famines have programmed the species to pile on reserves in anticipation of the food shortage that now doesn't occur. I don't think it is necessarily always the result of poor emotional health. There are likely muliple factors, and an approach needs to be individually tailored to the factors.

In my case, there was the additional medical condition of hypothyroidism.
08:21 AM on 05/01/2010
An interesting video on the growing epidemic .http://www.youtube.com/watch?v=dBnniua6-oM " Sugar the bitter truth"
08:38 AM on 05/01/2010
Try this link the connection between sugar and obesity ' http://www.youtube.com/watch?v=dBnniua6-oM
08:20 AM on 05/01/2010
Losing and maintaining weight loss isn't rocket science and there are far too many gimmicks out there. It really just takes the commitment to change the way we eat, for life instead of just for a short while until we lose a few pounds. I've tried low carb diets. In fact, I did low carbs for 15 years, and yo-yo'd up and down for the entire time. At the end of those 15 years, I yo-yo'd up to a very substantial weight gain. For me, low carbs don't work because I love carbs. Eating less carbs only caused me to binge on carbs when I could no longer do without. I finally found a diet that doesn't demonize carbs. It is possible to eat a low calorie diet and still eat carbs while enjoying delicious meals. The Carb Diet ( www.thecarbdiet.com) worked for me. At 56, I look almost as good now as I did in my 30s, and certainly as in my 40s. It’s just a matter of finding out what works for the individual and the will to change.
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05:21 PM on 05/02/2010
I congratulate you for having found an approach that works for you. I have not been as fortunate and continue to search for the missing pieces of the puzzle. I cannot agree with you that "losing and maintaining weight loss isn't rocket science" because I have never found anything more difficult. I would gladly check myself into a hospital to have doctors observe my reaction to foods if I thought they could be helpful, but based on what I've seen, even the most well-intended docs (and I do not include Katz in that group if this article is an indication of how he approaches patient issues) would be overwhelmed by the complexity of the problem. In my case there are so many different issues that it is difficult to find ways to address them all at the same time since putting out one fire makes another flare.
04:36 AM on 05/01/2010
Sugar is an addictive drug. Yet sales are uncontrolled and we feed it to our kids at every meal, as rewards for good behavior, in schools. I even see "mothers" feeding it to babies in strollers.

Addicting kids to sugar should be considered child abuse!
03:33 AM on 05/01/2010
Thank you! I'm tired of hearing people make excuses...
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Artemis34
Women can vote against the GOP or against their ow
03:21 AM on 05/01/2010
BTW, on the comments on sleep apnea and snoring, the reverse can be true as well.

Can't get adequate rest due to sleep apnea / snoring -> decreased energy -> decrease ability to exercise -> increased weight.