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Saturday, June 22, 2013

Rethinking Thin - A Contrarian view of weight loss

Th just finished reading Gina Kolata's book "Rethinking Thin". I have always enjoyed her columns and now after reading this book, I realize that she has a significant contrarian streak. This book calls into question a number of assumptions widely held about weight loss, ideal weights, and the health benefits of weight loss. A major portion of the book tracks subjects in a University of Pennsylvania weight loss study. Their stories are very touching and they serve as a backdrop to educate readers on dismal science of weight loss. 

I was not aware of the substantial evidence supporting the genetic basis of weight ranges, including multiple twin studies. It seems that with few and rare exceptions, our weight ranges are predetermined. While it has been postulated that appetite control circuits of the brain may be influenced at key points in human development, there is little evidence that any dietary interventions can make much of an enduring difference for a given individual. Diets come and go and weight comes off only to be put back on. It appears to be one of the only universal findings in medicine.

There is no question that we now live in a world where food is much more abundant than any time in history. While there are places on the earth where hunger exists, even pockets in wealth countries, for the overwhelming majority of Americans, we do not spend our time being hungry because we cannot get enough calories. It is hard for us to understand the the words of the Lord's Prayer..."give us this day our daily bread". At the time this prayer was first uttered, most of humanity had great fears regarding the source of their next meal. That these concerns are no longer primary is not such a bad thing. However, the anxieties associated with an abundance of food and its ramifications has replaced the anxieties generated by concerns about where our next meal will come from.

I think few would desire to move back to an earlier state of scarcity. The question is what is the impact of the  change in weight distribution toward being heavier in the US population? Gina Kolata's book raises substantial concerns that there is conflicting evidence supporting a negative health effect on those arbitrarily defined as being overweight and even those who are classified as stage I obese. In fact, recent studies (JAMA article) supported a lower mortality for those classified as overweight.

Our biases which lead to our visions of idea weight are based upon limited science and evolving perceptions of beauty and health. The recent history of this evolution is nicely described in Gina Kolata's book. It is not rare that people admit to being offended by site of obese people,  and such strongly held beliefs bring to mind religious beliefs. As Jonathan Haidt describes in his book "The Righteous Mind", many of us are influenced by concepts of sanctity and we may be offended by behaviors or appearances which violate things we view as being holy. How can people violate the temple that is their body?

I could not help to draw parallels between those who appear to be predestined to weigh more than others and those who appear to be predestined to be attracted to the same sex. This week Exodus International issues an amazing apology for trying to "cure" homosexual individuals. While this ministry was active for almost 40 years, the leaders of this organization have recently come to an epiphany: Alan Chambers noted in the  LA Times:

"I am sorry that some of you spent years working through the shame and guilt you felt when
your attractions didn't change," Chambers wrote in a statement on his website. "I am sorry that I ... failed to share publicly that the gay and lesbian people I know were every bit as capable of being amazing parents as the straight people that I know. I am sorry that I have communicated that you and your families are less than me and mine."
Chambers, who is married to a woman and has two adopted children, told The Times he is still attracted to men and comfortably lives with that tension, but that others may be unable to do so. He said that 99% of people who went through gay-conversion therapy did not lose their same-sex desires.
You can't remake people into what they are not. It is not a matter of willpower or self control.  I can imagine that after this obesity madness runs its course a similar apology may be forthcoming.

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