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By Gina Kolata, New York Times Science Writer
Selected Book Quotes
“Why are people fatter now than they used to be? ‘That’s the sixty-four-thousand-dollar question,’ [obesity researcher Jeff] Freidman says. Others, including Jules Hirsch at Rockefeller University agree. ‘I don’t know, and no one else does, either,’ he says.” Rethinking Thin by Gina Kolata (Farrar, Straus & Giroux, 2007)
“In fact, the only method that routinely leads to long-term weight loss for most people is surgery.” Rethinking Thin
“[UC Los Angeles sociologist Abigail] Saguy said, the moral panic over obesity played into the decline of the welfare state and the increasing emphasis in American society on personal responsibility. It introduced a socially acceptable venue for demeaning the poor and, especially, black women and Mexican-Americans, who are more likely than affluent whites to be fat, she said.” Rethinking Thin
Don’t read this book…..unless you are firmly committed to controlling your weight. If you’re not, it will shake your confidence. And that’s not good—or in my opinion warranted. Gina Kolata reviews the research and concludes that the war on obesity is lost. “No matter what the diet and no matter how hard they try, most people will not be able to lose a lot of weight and keep it off,” she writes. The quest to be thin is a “false hope.” That’s true for some people, I agree. The vast majority, however, I believe, can control their weight to a substantial degree.
This is a difficult book on which to comment--perhaps I should leave it to others--because it goes against my experience and basic optimism. I will tell a little about the book and give my take on some of the studies that Kolata relies on most heavily; I’ve written about most of them before. And then leave it to you to decide whether to read the book and make your own assessment.
History of Dieting
Gina Kolata does an excellent job of presenting a massive amount of detailed and often complicated material; she’s a good writer and very thorough.
I liked her review of the history of diets and dieting. “Diets date back to at least the time of the ancient Greeks,” she tells us. Her exploration of the various permutations of the low-carb diet is timely and revealing. The low-carb diet was around long before Dr. Robert Atkins told the world about it; it first became popular with the publication in 1825 of The Physiology of Taste, “one of the most famous books ever written about food.”
She relates how calorie counting came into vogue, the introduction of the bathroom scale and the full-length mirror, and other methods of monitoring food intake and physical change. It is fascinating stuff, all with the underlying message that nothing really works very well.
Moving back and forth between theory and individual struggle, she structures the book around the experiences of some participants in a two-year study comparing the Atkins diet and a standard low-calorie diet. As you can imagine, it’s an emotional roller coaster, from success to failure to resignation.
Kolata’s main focus, however, is on the modern-day science of weight control, beginning with Ancel Keys’ classic experiment on conscientious objectors during World War II.
Keys carefully selected 36 emotionally balanced, normal-weight men, motivated by the desire to avoid military service, cut their food intake in half and had them walk 22 miles a week. “It was the sort of regimen that obese people often undertake when trying to lose weight,” Kolata observes. (Emphasis mine)
Needless to say, it worked. They lost 25% of their weight in six months. Their calories were then increased and they regained the lost weight in three months. Over the next nine months, they were permitted to eat all they wanted.
“The results,” Kolata writes, “were shocking.”
While they were dieting, the men were obsessed with food; they couldn’t think about anything but food and eating.
“The men, previously so emotionally healthy, suffered bouts of depression, irritability, and mood swings. They lost interest in sex—all they cared about was food.”
Metabolism dropped to 40% of normal, temperature dropped, and heart rate slowed. “It was as though their bodies were doing everything possible to conserve calories,” Kolata observes.
When the dieting stopped, and the “refeeding” got under way, the men had problems. “Normal meals were no longer enough,” Kolata relates. “They would eat a huge meal and say they were still hungry.” They were ravenous, insatiable.
One man had as many as 5,000 to 6,000 calories, Keys reported, but he “started ‘snacking’ an hour after he finished a meal.” Some of the men consumed 8,000 to 10,000 calories a day.
This experiment is essentially the first piece of scientific evidence in Kolata’s case that diets don’t work.
To me, it simply shows that starvation diets don’t work. No emotionally healthy, normal weight man or women would voluntarily cut calories in half. And no informed obese person should either. Age old survival mechanisms are activated. Like night follows day, extreme diets are followed by bingeing.
As Walter Willett, MD, a Harvard professor of epidemiology and nutrition, explained in the May 28, 2007 issue of Newsweek: "If you do something extreme in your diet, you will likely lose weight in the short term. But it's not going to be something you can live with for the rest of your life, and so it's bound to fail."
There’s more, of course. The next two studies were sometime later and go to whether weight problems are inherited. Are overweight and obesity a product of nature or nurture?
Twins and Adoptees
Albert J, “Mickey” Stunkard, an obesity researcher at the University of Pennsylvania, undertook to determine whether body weight is inherited using the adoption registry in Denmark. The registry, originally developed to study mental illness, was perfect, because it contained every adoption between 1927 and 1947, including the names of the biological parents and the heights and weights of the people in the registry. The study included 540 adults, average age 40, almost all of whom had been adopted in the first year of life and raised apart from their biological parents.
The results, published in 1986, were quite impressive: “The adoptees were of the same fatness as their biological parents, and their fatness had no relationship to how fat the adoptive parents were.” Stunkard and his Danish colleague found that “80 percent of the offspring of two obese parents become obese, as compared with no more than 14 percent of the offspring of two parents of normal weight.”
A few years later Stunkard conducted another study using the Swedish Twin Registry, which included 93 pairs on identical twins who were raised apart, 154 pairs of identical twins who were raised together, 218 pairs of fraternal twins who were raised apart, and 208 pairs of fraternal twins who were raised together.
In a paper published in the New England Journal of Medicine in 1990, Stunkard and his colleagues reported that the identical twins had nearly identical body mass indexes, whether they had been raised apart or together. There was more variation in the fraternal twins, who, like any siblings, share some, but not all, genes. They concluded that “70 percent of the variation in people’s weights may be accounted for by inheritance, which means that a tendency toward a certain weight is more strongly inherited than nearly any other tendency.”
Stunkard said the study “confirms with an even more powerful message than before that genetics play a major role in determining body weight.”
Importantly, Stunkard added: “The results do not mean that people are completely helpless to control their weight. But they do mean that those who tend to be fat will have to constantly battle their genetic inheritance if they want to reach and maintain a lower weight.”
My interpretation: The battle is hard for some people, but it is not lost. Most people do not have obese parents and, therefore, are likely to have more control over their weight. The fat people we see walking down the street, on TV and elsewhere do not all have fat parents—and most of them are probably not doing all they reasonably can to control their weight. Most people were not born to be fat. And for most people, the war is not lost.
Let’s move on to another attention-grabbing discovery in the science of weight control.
In May 1994, after a long and tedious search, obesity researcher Jeff Friedman isolated the ob gene, named for a mutant strain of massively obese mice known for their voracious appetite. Ob is pronounced “oh-bee” for “obese.” Due to a defective gene ob mice receive no stop-eating signal; they just keep eating. The ob gene expresses a molecule or hormone that tells mice to stop eating when they are full. Friedman named the molecule “leptin,” from the Greek word leptos, meaning “thin.” “The idea is that in the absence of leptin, you’re fat, so leptin keeps you thin,” Friedman told Kolata.
This was very exciting, because it raised the possibility that lack of leptin may be the cause of obesity in humans. Friedman said discovering the ob gene “was the closest thing to a religious experience I ever had.”
To make a very long story short, a girl was born in 1989 with no leptin. No one knew it at the time, however, because it was five years before Friedman discovered leptin, and longer before it was determined whether humans have leptin.
“By the time she was four months old,” Kolata writes, “it was clear that something was seriously wrong with her appetite—she was insatiable. Whatever food she got, she ate, and whatever she ate was not enough.” Her weight soared to 40 pounds at one year. At six, she weighed 130 pounds, “twice the average for a child her age, and her thighs had gotten so big…[that she had to have] liposuction to enable her to walk.” She kept eating and her weight continued to climb. At 8, she weighed 190.
“The girl’s doctor could not figure out what was wrong,” Kolata writes. “There was one hint, however. Her uncontrollable urges to eat bore an uncanny resemblance to the behavior ob mice.” That wasn’t much help at the time, because no one knew what was making the ob mice so fat. That changed when Jeff Friedman discovered leptin, but the girl was still in for a long wait. It’s a big jump from mice to humans.
As it turned out, humans do make leptin, but years of research and millions of dollars in development costs showed that leptin is not the panacea for obesity in humans. “The great hope for leptin has not held up,” obesity researcher Jules Hirsch told Kolata. “It doesn’t look like what’s wrong with human beings is a deficit of leptin.”
It did, however, cure the young girl. She began receiving daily leptin shots when she was nine years old. “She became the first success, the first proof that it is possible to correct a genetic defect and thereby cure obesity,” Kolata relates. “After a week of leptin injections, she was a changed person, eating no more than her siblings….Her weight plummeted.” She became “a slender, graceful girl.”
“The girl continues to take leptin, and she has effortlessly maintained her normal weight,” Kolata reports.
Kolata says a few other children and adults who lack leptin have also returned to normal weight. For the most part, however, results have been disappointing.
My take is that it appears that body weight has a genetic component; but ob mice and people like the girl with no leptin are extremely rare. Mice and people who have no control over what they eat are genetic anomalies. The environmental element in body weight remains a powerful force. Nature matters, but so does nurture.
As Mickey Stunkard told Kolata, “The genes that make people fat need an environment in which food is cheap and plentiful.” Jeff Friedman added, “These days, children, and adults, can easily get enough food for their genes to direct them to grow as fat as they can be.” (Kolata paraphrases)
My take: We’ve all heard the old saying, you can lead a horse to water, but you can’t make it drink. I believe that applies to weight control. Whether we partake of all the cheap, plentiful--and fattening--food readily available is within our control. Plenty of inexpensive, healthy, tasty and non-fattening food is also available. For most of us, the choices we make--diet and exercise--determine whether we are fat or lean.
Finally, here’s one more interesting--and I believe telling--issue raised by Gina Kolata.
Obesity a Good Thing
Citing work by Robert Fogel and others, Kolata says there’s evidence that “the healthiest weights are the ones deemed overweight.” Fogel, a Nobel laureate in economics, (based on records of 45,300 Union Army soldiers and others) found that “populations grew healthier [as] they grew taller and fatter.”
Kolata asked Fogel, “Could that mean that the obesity epidemic is actually a good thing, with heights increasing because of better nutrition and freedom from disease, and with weights increasing, too, to allow the average person the best possible health?”
“We don’t know that yet,” Fogel responded. “It’s a reasonable hypothesis, but a lot of this is playing your hunches. I tend to be, ‘Well, maybe.’ I certainly would not forecast it on the basis of what I know, but I also would not rule it out.”
Based on what she says in the Epilogue, Kolata’s hunch is that being fat is probably a good thing. The following excerpts indicate her thinking, or perhaps rethinking.
“Higher weights could be an unintended consequence of the nation’s better health, or maybe even a contributor to it,” she opines. “Maybe whatever is pushing up the average weights of the nation might be for the best.
“...National data say that we now consume less fat and more fruit and vegetables. But, of course, we’re fatter.
“Or what about the idea that we are not more sedentary, in an era that has seen the explosive growth of gyms, surges in the number of people running marathons or going on charity bike rides that can last for hundreds of miles or even walking in shopping malls early in the morning before the stores open?
“I'd like to think also that as the population gets fatter, there might be a rethinking of the risks of a few extra pounds. When health data have not supported the alarmist cries of a medical disaster in the making, could society perhaps let up on the beleaguered fat people?”
There’s more, but you get the idea. Kolata’s answer to her own question is pretty clearly, “Well, yes.”
What’s your hunch? Is being fat a good thing? Is it a sign of robust health?
* * *
Our friend Peter Murphy alerted me to Gina Kolata’s book. I’m glad he did, because it’s sure to stir up plenty of discussion and controversy. At the time, he had only read Kolata’s article in the New York Times about most of the main studies presented in her book. I’d like to tell you where Peter, who has struggled with being overweight most of his life, came down on the article; because it's my thinking in a nutshell:
“I'm not so sure about the conclusions of these studies. I think that your philosophy of eating the right kinds of things, not sitting down to any meal hungry, plus a schedule of weight training and aerobics that plans for success is the way to combat life-long obesity--regardless of what your genetic ‘destiny’ may be.”
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