IS OBESITY A DISEASE?

Recently, the TV show 60 minutes ran a program during which it was claimed that, rather than a matter of willpower, obesity was an inborn physical malady, suggesting that, left untreated, it is beyond anyone’s ability to alter. For many years, others had made similar claims, including many of those who themselves are obese. If this assumption were correct, many overweight people would be provided an excuse to avoid any purposeful efforts to control their eating habits by reducing their caloric intake, a rationale that would allow them to remain obese and avoid any conscious attempts at weight control! Recently a new drug, semaglutide (marketed under trade names of Wegovy, Ozempic, and Rybelsus) has been introduced to control type 2 diabetes, but even in the absence of diabetes, it shows the ability to cause weight reduction. This new pharmaceutical approach has lent further support to the idea that obesity is a disease subject to drug therapy, much the same as other diseases such as cancer and heart disease.

I freely admit, through many years of medical practice, that overweight is extremely resistant to modification; however, the underlying premise that it is a genetic or physical disorder is not supported by the facts. If obesity were an immutable physical disorder, why was it not prevalent in this country—or most others—fifty or more years ago? At last count, 74 percent of U.S. adults and 35 percent of children are now overweight or obese. Moreover, why is obesity rare in countries with differing diets, such as Japan? And numerous studies have also shown that Japanese and other foreigners, who move to this country and acquire our eating habits, become obese at alarming rates.

But experimental data adds credibility to the idea that, rather than resulting from genetic or immutable factors, caloric intake is subject to both food preferences and environmental influences. Recently, in 2019, a study by researcher Kevin Hall made headlines when it reported that ultra-processed foods led people to overeat and gain weight. Unlike most studies, this one had been able to measure precisely what people eat and how many calories they burn. That’s because its volunteers spent several weeks in a laboratory. Minimizing psychological factors, they basically just put the food in front of the subjects and said, “Eat as much or as little as you want.” Twenty subjects were offered largely unprocessed foods for two weeks and then ultra-processed foods for two weeks. They found that the ultra-processed foods caused an excess consumption of 500 calories and a two pound weight gain, in comparison with the unprocessed food diet that resulted in fewer calories consumed and a loss of two pounds. Even the researchers were surprised, for they were not expecting to see such a huge effect since the meals in both diets had equal amounts of carbohydrates, sugar, fat, protein, and fiber, which are the nutrients that people have suggested as drivers of obesity. But there was a key difference between the two diets: Beverages aside, the ultra-processed food diet had nearly twice the “calorie density” of the unprocessed food diet. Calorie density is the number of calories in a given portion or a given bite of food. Other studies have also shown that people consume fewer calories when they’re offered foods with fewer calories per bite. For instance, in a 2007 study, women with obesity were randomly assigned to either eat less fat or eat less fat and eat more fruits and vegetables for a year. The group that ate extra fruits and vegetables lowered their calorie density, and after a year, the fruit-and-veggie eaters had lost more weight than the other group, and they reported being less hungry. This means that bulking out ones diet with fruits and vegetables is a successful means to help control weight. The difference in calorie density is large, amounting to about 2 calories per gram in the ultra-processed diet versus 1 calorie in the unprocessed diet. This difference in calorie density may help explain why the ultra-processed food eaters ate more calories than the unprocessed-food eaters.

So why do we to overeat today? As we evolved, extra pounds provided a means to to put on lots of body fat to defend against periods of famine, a trait that could make the difference between life and death. But this idea is no longer valid, and attitudes have changed: For about the psst 50 years, when the industry changed the nature of our food,”Companies are all about maximizing the allure of their products,” says Michael Moss, a Pulitzer Prize-winning former New York Times reporter whose book is titled Hooked: Food, Free Will, and How the Food Giants Exploit Our Addictions.”One definition of addiction is a repetitive behavior that some people find difficult to quit,” says Moss. This provides a major reason why obesity seems so persistent and resistant to control. Addiction or not, it’s clear that companies keep pushing us to eat. “Companies take advantage of our baked-in urge to keep eating because they want to sell as much as possible, so they have scientists who spend their time devising formulas that create the biggest attraction in the brain—the biggest wow,” says Moss. This results in products that are usually highly calorie-dense, brain satisfying, and less expensive than their healthy alternatives.

Another contributing factor is speed of consumption: In a 2019 study, people ate ultra-processed foods faster than the unprocessed foods, meaning that eating rate can make a difference. Unprocessed foods often take more chewing, and its the resulting delayed consumption that may contribute to reduced caloric intake.

Snacking should also be considered: The food industry has created more and more products that encourage us to snack during the day. Companies became very adept at ultra-convenience—that is, food you can eat while you’re doing something else. When that happens, your brain is not paying attention to the signals from your stomach that are telling us that it is filling up. In one study, people ate about 35 per-cent more pizza and 70 percent more macaroni and cheese while watching TV than while listening to music, driving us to eat when not hungry, and hunger should always play a central role in causing us to eat.

WHAT TO DO

One way to minimize ultra-processed foods and cut calorie density: load your plate with fruits and vegetables. Adding vegetables and fruits to dishes gives us bigger, more satisfying portions. We eat with our eyes and our brains. If a plate looks half empty, that sets us up to feel hungry. One example can begin with a sandwich with whole-grain bread, containing less fatty meat, adding mustard instead of mayo, and bulking it up with vegetables-tomatoes, peppers, onions, and lettuce. You’ll end up with a sandwich that’s bigger and more likely to fill you up. Although oils, nuts, and other high-fat foods are calorie dense, you don’t have to go low fat if you eat enough fruits and vegetables. And stick with water, coffee, tea, or other calorie-free drinks. It’s easy to get rid of soda or other caloric beverages because there are so many other options. And cook your own food whenever possible. For that protects you from the stratospheric calorie counts in most restaurant offerings, whether it’s sit-down or fast food. What you cook can be better than what’s served by the food giants.

From this information, I conclude that obesity remains largely subject to personal control, clearly pointing toward each individual’s need to choose the kinds and amounts of foods consumed. The drugs, noted above, are expensive, and do offer a short-term aid to weight reduction, but for long-term weight control, everyone needs to modify his/her eating habits rather than blaming inborn or genetic factors that are presumed immutable and beyond individual control.