Excess weight is not always the result of eating too much or not exercising enough

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I had the radio on in the car this morning and was listening to a discussion involving a 32 stone (450 lb/200 kg) man who was complaining that he was not getting the medical care he needed (surgery, basically) to allow him to lose significant quantities of weight. Inevitably there was a backlash from listeners who were fully paid-up members of the calorie control club who urged him to ‘exercise more and eat less’ (fatty). Some commentators were a bit more understanding, and expressed the opinion that for weight control is a complex animal, and that weight loss can be difficult to achieve for some people, despite their best efforts.

Now, I am sure that some individuals misreport how much they eat and how active they are (either consciously and/or unconsciously) and perhaps are simply gluttonous and/or lazy. But I also believe that some individuals genuinely have enormous difficulty losing weight despite applying the ‘eat less/exercise more’ mantra. For example, it has been my experience over the years that individuals suffering from hypothyroidism (low thyroid function) often have considerable difficulty shifting weight despite doing the ‘right thing’. This problem is compounded by the fact that the conventional blood tests for diagnosing this condition are far from foolproof (see here for more on this), as well as the fact that the conventional medical treatment for this condition (levo-thyroxine) often fails to have the desired effect.

So, when someone walks into my practice and tells me of their genuine ‘battle’ with weight, my tendency is to believe them, and to see what we can do to identify and correct whatever underlying issue might be ‘jamming the works’.

A fate would have it, I got in the car again later in the day and turned on the radio to hear this story being discussed. In short, some scientists have found that in some obese children, the issue appears to be a genetic one. Specific gene aberrations appear to lead some children to overeat, apparently. And, according to the interview I listened to, these children do not metabolise food very effectively either. In this radio item Dr Sadaf Farooqi (one of the originators of this research) also made the point that other known genetic glitches predispose to obesity. She also mentioned, if my memory serves me correctly, that there may be other aberrations that we simply have not identified yet.

What can we learn from this? Well, for one, our understanding about the causes of overweight and obesity in some people is clearly far from complete. And these findings also challenge the quite widespread belief that those seeking to lose weight need to exert more self control in terms of their diet, and while they’re at it get up off their ‘lazy fat arses’. For some people with metabolic disturbance, these approaches simply won’t work to any meaningful extent. And when they don’t work, that doesn’t mean that the person is necessarily lying about how much they’re eating and how active they are.

Next time you see a clearly overweight individual (maybe you), just remember that their excess weight may not be their ‘fault’. A bit more compassion for (and less judgement of) individuals with a weight issue would generally be a good start in terms of revamping our approach to obesity.

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