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Joseph J. Colella, M.D. Headshot

Skinny People Just Don't Get It

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America's appetite is out of control. Yes, we have an obesity epidemic. But far more disconcerting is the rampant lack of understanding and compassion for the daily, minute-to-minute struggle that the vast majority (two-thirds of American adults, to be exact) contend with being overweight or obese. To put it plainly, skinny people just don't get it.

Ron Rosenbaum's recent Wall Street Journal post purporting the virtues of the more sophisticated fatty foods such as roast goose, split-shank beef, and clotted cream is a prime example of this ignorance. First, I'd like to remind Rosenbaum that the very few of us who have the luxury (or interest, for that matter) of dining on such foods unfortunately do not have the genetic disposition or capability to indulge and quietly stop at the satiety point. Most people don't hit the "bliss point," fold their napkin politely and asked to be excused. They keep eating, and they won't stop until they have far surpassed feeling full.

The exponential escalation of America's appetite over the past 30 years can attributed to the proliferation of sugar in nearly everything we consume. For example, the Greek yogurt fad, driven by this idea that it's "good for you" is in actuality driven by sugar. Chobani's six-ounce container of Black Cherry yogurt contains 21 grams of sugar. While there is no general recommended daily allowance for sugar -- ironically, this is because there is no known nutritional value to sugar -- most health professionals would advise people to limit their intake of simple sugar to 12 teaspoons or 40 grams per day (based on a 2,000 calorie per day diet).

With this in mind, that yogurt is quite an indulgent snack. It's no foie gras, but you get the point. Human beings are programmed to overeat, and exposure to this Western dietary pattern of sugar and fat merely exacerbates this inclination. The viscous cycle of overconsumption begins with fat, which triggers inflammation, which then causes cellular damage, epigenetic alteration, increased appetite, insulin and leptin resistance and weight gain. For most people, this means major weight gain. And, for an alarming few, it means eating to the "the point of no return" -- a point where surgery is their only option to lose weight.

In my practice, I've operated on more than 3,000 patients, many of whom would fall into the category of extremely obese (those with a BMI greater than 60), and I can tell you this: They don't wake up saying they want to be fat. And they don't dream of sampling delicacies with the 2 percent of us who can enjoy food and stay thin.

Is the answer to the problem banning super-sized foods or pushing food manufacturers to discontinue their optimization practices? I don't know. What I do know is that we need to stop applying the "Biggest Loser" mentality to weight loss, where berating someone into vomit-induced exercise wins the prize. People need compassion, education and encouragement to turn away from sugary, prepackaged foods in favor of lean proteins and complex carbohydrates instead.

Joseph J. Colella, M.D., F.A.C.S., is an internationally recognized robotic and bariatric surgeon, having performed more than 3,000 bariatric surgical procedures. He is currently the director of robotic surgery at St. Margaret Hospital at the University of Pittsburgh Medical Center (UPMC) and is an assistant professor of surgery at the University of Pittsburgh Medical School. He is a founding member on the Board of the Clinical Robotic Surgery Association, an international association of the world's premier robotic surgeons. Dr. Colella has published numerous professional articles on topics including anorexia nervosa, traumatic vascular injuries, infertility, and bariatric surgery and nutrition.

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