Monday, July 2

The Skinny on Being Fat

Why IS it that some people are fat and others are not?

Dr. Jeffrey M. Friedman, head of the Laboratory of Molecular Genetics at Rockefeller University, said:

...if you think about it in general terms, you can explain differences in weight in the population based on three possibilities. possibility would be that the obese lack will power; this is a point of view favored by lean people, I generally find.

The second possibility that people consider is that we live in a toxic environment and that it's the environment's fault.

And then the third possibility is that there are biological drives that lead us to eat what we eat, and ultimately weigh what we weigh, in the same way as some of us are tall and some of us are short, others of us are destined to be heavy and others lean.

...I think most moderate scientists believe that of course that all three can be relevant, but that biology has really an underappreciated role in accounting for difference in weight, and we know a lot about the system now and so I think there's a powerful set of data that supports that point of view.

{Ira Flatow: So when people are fat and they're overweight, there is a major genetic factor here. It's not as simple as saying "I have no will power" or "I tried the diet, doesn't work." There could be real hard wiring that's the problem.)

Dr. Jeffrey Friedman: ...some of the most powerful evidence that this is a biological problem and not a "behavioral one" (in quotation marks) is genetics. And so there are a number of ways to assess the genetic contributions to a trait. It turns out if you look for obesity it is probably the second most heritable trait, second only to height, with which it is quite close. Based on estimates that can be done by analyzing twins, 80 percent of the variability in weight can be accounted for by genetic factors.

Good grief! 80%? That's.... huge. So much for the just 'eat less exercise more!' solves-all-fat line.

Friedman points out that the belief in leanness is a modern thing, and implies that the expectation that everyone should be thin is itself nonsense:

...Historically, being obese was the desirable body habit as so. If you go to museums… all the rich people in Egypt would pay extra money to have extra chins put onto their sculpture. Rubenesque figures were the vogue in the 1700s. Renoir's characters were all heavy. In aboriginal societies the chieftains were all quite obese. For reasons that -- you all have as good an idea about as I do I guess –- things changed here about what our views of what was attractive in the 60s and it set up an idealized view of what people should weigh and who they should be that just isn't matched by our genetic endowment.

...The problem is not that small amounts of weight that improve health can't be achievable; I think it can be. The problem is that's not what most obese people want or the public wants. The public wants to be normal weight. And so I would much prefer to see that the dialogue and the issue center on improved health and achievable goals rather than setting up some societal construct that says everybody has to be perfectly wonderfully thin, a wish that really runs counter to almost everything science has to tell us about this problem.

I think people should make their best efforts but recognize, but not be prejudicial about the fact, that for many people most of the things you do aren’t going to work. And so my argument is not "we shouldn’t think about the problem, we shouldn’t address it." The issue has to do with "what are we going to do about it." And so I would argue what we shouldn’t do is fall back on simple nostrums like "eat less, exercise more."

And here he talks a little more about the weird social stigma that obesity has, and how illogical it is from a medical science perspective:

I think that to the extent that increased weight has health consequences, people should do their best. It certainly is a good thing to be fit. And it is a good thing to eat a heart healthy diet. And it’s probably a good thing to make one’s best efforts to keep one’s weight under control. So that means not doing much different than what Hippocrates would have recommended. But I think at the same time we have to recognize that those measures are rather limited in their efficacy and that to make the leap therefore that people who are not successful at keeping their weight off are at fault is just wrong headed. And there are all kinds of attributes about each of us that might draw the next person to draw a conclusion about them. But to draw conclusions about obese people, I think, is unenlightened to say the least about what their personal characteristics are.

(Ira Flatow: So to stigmatize them is sort of making fun of the situation that they don’t have much control over.)

Dr. Jeffrey Friedman: I think that’s right and the ironic thing is that I think the more of an outlier one is for weight, the more obese, the more difficult it would be to actually normalize weight. And so if anyone should be stigmatized it would be someone like me who could easily lose 10 lbs. and doesn’t. I think for the people who are really significantly overweight, it’s just who they are -- to a very, very large extent.

... It’d be much better to forget about the stigma and assume people weigh what they weigh, and then encourage people to do what they can to improve their health.

Back to Genetics, he said:

...So when you see a very obese person walking down the street there’s a very, very significant possibility that that individual just has a genetic alteration that makes them so.

(Ira Flatow: So all those years when you saw a very obese person and they said, "I have a glandular problem," they were telling the truth in a certain sense genetically speaking.)

Dr. Jeffrey Friedman: Well I think so. They just didn’t know which gland.

Then he got into some interesting stuff about how the functioning of a morbidly obese body is in many cases simply working differently than others. He used gastric bypass patients for this example.

(Question from the audience 1: When someone has a surgical intervention such that a massively obese person of, let’s say, 400 lbs. or 500 lbs. removes part of his colon and attains a weight more normal to his size, for his height. Does that rewire the person or does that then remold itself into the norm and the body strives to achieve the larger weight yet again?)

Dr. Jeffrey Friedman: ...there’s another feature of this surgery that people, I think, ignore, and it’s this: when you do this procedure you limit the intake of a person to about 700 calories a day. Just so you know, none of you could consume 700 calories a day for very long; it is a very small number of calories. Despite that fact, these people still end up being clinically obese at the other end of the procedure. They lose a lot of weight but they would still on average be definable as significantly obese on average after the procedure.

Now think about it, they’re eating 700 calories a day and they’re still obese. I mean if that doesn’t say that there’s something metabolically different about the obese than the lean, I don’t know what does.

Geez. Me neither.

I can tell people, "I have tracked 3-4 weeks, repeatedly, of my food intake, and my BMR is allegedly like 4000 calories a day minimum, and I'm eating usually <1200 calories a day IF that, AND lowcarb... and not losing weight." And plenty of them think I'm lying. I've actually had people suggest that if only I'd keep a food diary like they do in weight watchers (note: I *do*, or how could I be 'tracking' it??) that surely I would see all kinds of calories I didn't know about. As if 3,000 calories is easy to hide, for someone who has to work hard just to successfully eat 1000-1200 calories a day! My biggest problem is getting my butt into the kitchen to eat anything at all. So it's not like I'm grazing through fields all day and might 'forget' that 'Oh yeah, I ate 3 pizzas or something while grazing through the lettuce greens!', sheesh!

A reference was given me once of a Dr. Phil (I think) episode, where he tells this woman claiming the same thing that she defies the laws of nature, and then "discovers" from her husband that she is drinking thousands of calories a day in soda that she "didn't think counted." What a setup. She's an idiot, yes, but I felt the producers worked hard to find some way to invalidate that and maintain the calorie-myth ... tabloid journalism, essentially.

It's basically insulting. I mean, I've had people argue what they are sure about on-paper. They heard it, or read it. Or, they are a fairly normal metabolism bodybuilder who gained weight from sheer overeating after leaving high school sports or something, and hence when they quit overeating and started working out again, it fell off. It is just not the same.

They think it's a mathematical impossibility. I wish someone would find a way to communicate to the metabolic system how bad it is at math. I'm getting weary of people who would not doubt my intelligence or integrity on any other issue, acting like they're sure I must be lying or deluding myself about what I eat, because they just can't understand the calorie-math and why pounds aren't dropping off me at the speed of light.

The more quantity of food and more often I eat, as long as it isn't excessively of course, the more I lose weight. It's hard to do, after my whole adult life of eating once daily in the evening.

If they’re consuming 700 calories every day they’re going to be expending more than that. And so what you would find, you would expect to see is as long as they’re that imbalanced they’re going to keep losing and losing and losing and losing. That’s not what happens in these people; they plateau and they stop losing weight at what is definable as a significantly obese level. Now, if I had that procedure you probably wouldn’t see me in profile anymore because I would just get so thin. That’s not what happens to these people and it appears that in the face of reduced intake the body shuts down caloric expenditure and they can’t lose any more weight.

But it's all about the 'basal metabolic rate' right? How much exercise you get? He pops the balloon of what I call The Calorie Lie: the belief that to maintain obesity once must eat huge quantities of calories.

This is what sets me off most about conversation with people who seem to assume that every day I proactively DO SOMETHING to STAY fat. Sheesh!

Now this next part is pretty depressing, if eye-opening. This actually goes back to what Jonny Bowden was saying about how they used to measure the detail 'calories burned' by exercise, and it varied radically by person and was way outside what was 'assumed'. According to Friedman, people who are obese and lose some weight (whether this is because they are obese or, more likely I just assume, this is part of WHY they are obese) actually burn FEWER calories in order to maintain the SAME weight as someone else who did not lose weight to get to the same place:

Dr. Jeffrey Friedman: So it turns out – and this was some lovely work done by Jules Hirsch here at Rockefeller [this study, published in the New England Journal of Medicine in 1996, measured the metabolism of people who lost weight through a precisely controlled diet] --] it turns out they burn many fewer calories than you would predict based on their newer weight.

So let me put a finer point on this. Imagine you’re 250 pounds. and you lose 100 lbs. to 150 lbs. Now you ask how many calories does that person burn compared to someone who started out at 150 pounds.They burn like 300 or 400 calories fewer per day when they’re at that reduced weight. Now think about it. That person is hungry and now can only eat fewer calories than the equal weight person to maintain that weight, despite the fact that they weigh the same amount.

So just like Jonny said about how the calories burned in exercise was not consistent between different people, here Friedman makes clear, that even on a daily overall metabolic ratio (not just a limited exercise event), the amount of calories burned is not consistent between different people of the same weight. So Jane and Nancy, if eating the same things, and exercising the same amounts, may result eventually in a fat Jane and a slim Nancy, with no apparent behavioral difference.

And it's possible that this "biases against Jane keeping that weight off." Because eating identical food with identical exercise at the same body weight at point 1, a year later, Jane would be at least 36.5 lbs heavier. Multiply that by a few years and you have a very fat Jane, who never once needed to ingest pounds of bon-bons regularly in order to end up morbidly obese.


(Ira Flatow: What about the other parts that control metabolism? Is it true that some people burn food faster and so it’s not the brain part and it’s just their thyroid, or whatever it is?

Dr. Jeffrey Friedman: A very classic study was done about 15 years ago by a guy named Claude Bouchard. And Claude gathered up a set of identical twins and overfed them 1,000 calories a day for 84 days. And he asked what happened. So these people were in a room, they were given calories, they were forced to eat 1,000 extra calories a day; they should have put on a lot of weight. Some people put on a lot of weight, other people put on hardly any weight at all.

And when they looked, the twins were highly similar to one another, suggesting that there was some genetic predisposition to either put on weight or not put on weight when you were given extra calories. The people who didn’t put on weight activated metabolism because of metabolic circuitry and didn’t put on the weight. And this observation that some people can eat whatever they want and never put on weight and other people put on weight just by looking at it has been more or less proven based on that study, which actually was observed as far back as the 1700s.

Friedman said, regarding the twin studies, that the opposite variant of twins had also been studied, and it STILL comes out to being, at root, a genetic predisposition to gain weight or not, overwhelmingly, not environmental:

...they were then redone with identical twins reared apart compared to fraternal twins reared together. So you’re actually biasing against the identical twins so now the hereditability falls from 80 percent to 70 percent. Still 70 percent -- and the other 30 percent could not be accounted for by the environment for those kids.

And finally, he referred to studies on adopted children, to see if it's entirely about the environment provided by parents, e.g., take a fat mother, with fat children assumedly from "the environment she raises them in," if you put a kid with different genetics in there, will they also be fat?

Another way to look at this, actually, is to take kids who are adopted and ask on average, do they resemble their adoptive parents or their biological parents, making the assumption that some go to one environment, others to the other. They, to a very large extent, resembled their biological parents independent of the environment that their adoptive parents provided.

Well, that's pretty much a measure from all three angles you can measure it, and in every measure, it comes out to be overwhelmingly a matter of genetic predisposition, more than just food intake or exercise.


I don't really want to believe this. It sorta makes me want to cry.

And of course, it goes greatly against what we are all indoctrinated with from our dietary plans of choice.

It is not 100% genetics. It is not a 100% failure of people to keep weight off. It's just... 70-80% genetics, and 95-98% failure.

Can I be one of the 2%? Can I modify my eating habits, exercise and lifestyle that the 20-30% can balance out the rest? Can I be the freak of nature that actually succeeds?

Damn. I hope so.

Am I delusional? Probably. The alternative might be suicidal, so it's all I've got.



Sweet Tart said...

After reading Rethinking Thin and then delving further into this subject I cannot stop thinking about the implications of the research. I think that the only way that we will see an end to this "crisis" is by letting the truth about weight and dieting start to finally come out. The myths propagated by the diet industry, scientists and doctors (who should know better!) that we just need to eat less and exercise more and the problem will be solved are outrageous. They also get in the way of looking for real solutions. And (gasp!) it may be that the real "solution" is realizing that people come in all shapes and sizes and there's nothing wrong with that. That we should be pursuing healthier lifestyles instead of a certain size is a radical idea to some people, but certainly makes sense in light of what the research is telling us.

As a person who's been able to lose a great deal of weight and maintain for the most part, I know that I am one of the lucky ones (by the values of our society which I don't necessarily agree with) but that it doesn't come without a cost. I have to work harder than naturally slender people to keep myself at a weight that still leaves me in the "overweight" BMI category, and feeling like my body is not quite okay. I have learned to live in a constant state of deprivation which has come to feel like normal.

Regina Wilshire said...

...the third possibility is that there are biological drives that lead us to eat what we eat...

The very real and very present biological drive is crystal clear if we look to animal models first (and human epidemiological data models and/or clincal trials investigating diet second).

In aminal models, where studies have been designed to specifically examine "eat/stop eating" in insects, mammals and such, the driving force is meeting required amino acids (protein) animal provided a limited protein (low density options) will overeat until they reach their protein requirement, even if it means eating excess of their energy requirements; give protein rich options and they stop eating when they reach their protein intake requirements, even if the caloric density is lower than needed. It's fascinating stuff because when you dig into it, it makes sense from a biological perspective and mechanistic view of biology - without EAA the organism will slowly fail and eventually die because almost every process in the body requires EAA's.

Then looking to human data and studies - low-carbohydrate diets, where protein and fat is allowed ad libitum (at will) does two incredibly important things - spontaneously reduces calorie intake (effects of CCK and PYY) in the dieter despite an often higher (than habitual) intake of meat, eggs, etc. and in parallel blunts hunger to provide satiety and maintain a reduction in calories without much effort.

Looking over epidemiological data, on dietary patterns in various countries, a pattern emerges - those who consume the highest percentage of protein in their diet (and often the highest absolute levels too) have the lowest rates of obesity and heart disease. Coincidence? Well, correlation is not causation, but it's very intriguing when we compare those countries (Japan, France, Italy, Spain, Iceland, Sweden, etc.) with the US and UK (both with higher obesity rates and higher incidence of CVD/CHD)

If we also look at published data from weight loss trials comparing low-fat diets to low-carb diets another interesting observation is found - as subjects begin to rebound and gain weight back, their protein consumption is paralleling downward - they lose weight with higher intakes of protein and begin to gain as protein decreases again back to almost habital (baseline) levels....but in the longer term studies where subjects have been able to maintain a carbohydrate restricted diet for about two years (diabetes studies), protein remains stable while weight loss continues and stable as it levels off into a maintaining mode for weight.

I'm still working on a paper about this, but it is very intriguing to me....and blows the whole idea of willpower - if consumption of EAA is a driving force, no level of willpower will override the biological imperative over the long term; and it will highlight the real effect of a toxic environment that has been created that makes meeting EAA that much harder today than ever before with so much junk food that is a poor source of protein.

PJ said...

That's really interesting, both of you. Regina, what if some ethnic groups actually *require* MORE of something like certain aminos? I mean, just like some people require more sunlight, or require many fewer carbs, or whatever. So like, if natives needed amino X and for whatever obscure reason they needed 2x as much as the average person, it would almost engender a chronic overeating habit from the biological impetus to get critical nutrition.

I wonder if carb addiction actually fools some primal part of the body-brain that thinks because of the high sugar response, that it has a much greater chance of getting something it needs from something like that, maybe because sweeter things were always fresh for example (fruits don't keep). You know, kinda like, "hijacks" some natural function of the body that pushes us toward high-carb food because it was rare, fresh and precious, and maybe the more the body needs some element, the more it would push toward that (eg the greater the deficiency the more the 'sugar' craving vs. food in general).

Which reminds me of someone once saying that you never hear of anybody binging on broccoli.

Just thinking on paper.

Dreamboat said...

The more quantity of food and more often I eat, as long as it isn't excessively of course, the more I lose weight.

From my reading of low-carber's bulletin boards over the years, I've learned this is often true. People speculate about it having some effect on "getting your metabolism going." I'm not sure they really know why, just that it does seem to work that way.

Thanks for the very interesting commentary on this interview.

Sherrie said...

Hey Regina :)

With your comment on protein requirements and satiation I am a little unsure with this. Obviously to eat less protein then our bodies need especially during calorie restriction and/or exercise is a bad idea but for me I don't find it satiating.

What I mean by that is during my weight loss phase of LC I always ate over 100g a day of protein and I didn't have problems with my appetite. But I found if I ate a protein heavy meal say a big whole chicken breast and salad I would still be very hungry. But if I loaded it with fat and fibrous veggies I was fine. I still find I have to load everything with fat and veggies.

Hey PJ :)

I found this quote below from your post interesting. Yeah genetics play a large part of it but I was also thinking and of course this could be partly genetic too (eg at what level of restriction your body reacts too, natural build etc) but the gist of that quote seemed to hint to me that it could have been the actual act of the diet itself that may have caused the difference in metabolism at 150pds.

I wonder what the diet he was speaking of was like? Was it very low in calories, fat and protein? Did they lose a lot of muscle mass? Were their fat/muscle/bone ratios similar?

Dr. Jeffrey Friedman: So it turns out – and this was some lovely work done by Jules Hirsch here at Rockefeller [this study, published in the New England Journal of Medicine in 1996, measured the metabolism of people who lost weight through a precisely controlled diet] --] it turns out they burn many fewer calories than you would predict based on their newer weight.

So let me put a finer point on this. Imagine you’re 250 pounds. and you lose 100 lbs. to 150 lbs. Now you ask how many calories does that person burn compared to someone who started out at 150 pounds.They burn like 300 or 400 calories fewer per day when they’re at that reduced weight. Now think about it. That person is hungry and now can only eat fewer calories than the equal weight person to maintain that weight, despite the fact that they weigh the same amount.

PJ said...

Hi Sherrie, I agree, it did sound like it was 'the dieting' or 'coming from a higher weight' that seemed to make the diff in the lesser calories burned at the same weight. But it's kinda hard to say that had meaning without hearing of a study on that specific thing. It'd be hard to test for. In the example, someone of a fairly normal weight had dieted down from morbid obesity (lost 100 lbs), and was compared with another person of normal weight. One would almost want a way to compare a person prone to obesity at their high weight, not a dieted-down-to weight, with someone not obese... but that's kinda not possible unless you could see into the future for which people actually became morbidly obese (and even then the factor that helped might not be present/active earlier).

It seems like one of the twin studies speaks to this though when it shows some people gaining weight on extra calories and others not, and that tracked to the twin (genetics) not to the calories themselves. I suppose what they'd really need to test would be twins where one of them had lost weight to attain the same weight as their twin, and then compare their BMR at that weight. I can see how this would get really expensive and complicated at the research level!

Regina I'd thought you meant specific aminos in protein but now I think you just meant protein in general. But I wonder if certain aminos or minerals or even trace elements, lacking, could drive eating. Given that much of our culture is chronically lacking something, it seems like there'd be more people who got fat than those whose base metabolism (genetically) was less-equipped for survival and did NOT gain on extra calories. But protein would sure make sense. One thing lowcarb really highlights is how little protein there is in almost any food except the few base 'real foods' that lowcarb allows. You wipe out meat, nuts, dairy, and that's pretty much it (unless counting 'partial' proteins in veggies, legumes and so on count). The carbfest of the modern world has incredibly little protein involved. What it makes you wonder though is if kids don't get enough protein doesn't it screw up growth?

ST it does seem almost surreal, the "institutionalized prejudice" against obesity and obese people -- given that science ALREADY KNOWS what the hell is going on. It seems like the real problem is that many scientists and momst doctors are mostly ignorant of modern science (which is unfortunate), and apparently the educational norms of the medical industry doesn't choose to use modern information, which combined with the overwhelming marketing muscle of drug companies, magazines and newsletters funded by them, etc. makes the average doc unlikely to get real info unless they hunt it down on their own.

Anonymous said...

PJ said:

"But I wonder if certain aminos or minerals or even trace elements, lacking, could drive eating. "

I've said this many times. There is no 'food' in our food. Many people chronically overeat in a desperate search for adequate nutrition. Especially if you eat the recommended SAD. Not enough fat, not enough protein, and since hardly anyone ACTUALLY eats the recommended amount of veggies, going instead for apples, bananas and orange juice, not enough vitamins and minerals either.

I think that's a lot of the 'average' overweight USerican's problem. Too much food, not enough nutrition.

That doesn't explain special cases like PJ and me. Although PJ was actually thin until her 20s or something. I've never even been in the same room as thin.


Linda said...

While I was reading this post, I was thinking this is my life! I need to loose about 70 lbs. and just can't seem to do it no matter how hard I try or what diet I do. I was doing Atkins for the last two months but went off last week while on vacation. I had lost eight lbs. in the first four weeks and zero in the last four even though I stuck to plan. I gained back the eight lbs. I struggled so hard to loose in just one short week.

Any way I will give it another shot starting on the 1st of August - maybe I will succeed this time.

I do believe that genetics plays a very big part in my weight problem. My mom had gastric bypass to "solve" her problem and I don't want ever want to need to do the same.