What Really Makes Us Fat

Let’s face it. People feel the fat-antifat kerfuffle is a struggle between good and evil. Gluttony is bad! It’s not gluttony. It’s a disease! It’s not a disease. It’s genetics. It’s okay. It is not okay.  You haven’t read the latest positive waist trainer reviews. And so on and on.

Folks, we’re talking about biology. It could be all of the above and then some. “Then some” is actually my preferred answer and I’ll discuss it in a bit. But in the meantime, it’s worth remembering that none of the above are mutually exclusive. The answers vary from person to person and there is no single thing that is true for everyone, or even for one person all the time. As they say on Facebook, it’s complicated. In that spirit, it’s well worth looking at research that tells us about parts of the answer.

Gary Taubes writes about a study in the Journal of the American Medical Association (Ebbeling et al., 2012) on What Really Makes Us Fat:

[T]he study tells us that the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed. The fewer carbohydrates we eat, the more easily we remain lean. The more carbohydrates, the more difficult. In other words, carbohydrates are fattening, and obesity is a fat-storage defect. What matters, then, is the quantity and quality of carbohydrates we consume and their effect on insulin.

Chalk one up for the Atkins Diet, but don’t therefore assume the American Heart Association is “wrong” when it tells you to eat a low-fat diet of whole grains, fruits and veggies. The AHA is trying to help your heart. Their advice is perfectly good for your heart. The Atkins Diet is trying to help you lose weight. This research says it does. It says nothing about your cholesterol or the kidney-damaging effects of long term excess protein, especially in people with borderline kidney disease they may be unaware of.

The research shows an interesting piece of the obesity puzzle, but unless fat storage regulation is the biggest reason for obesity, it’s not actually going to deal with the epidemic. And the biggest causes can’t be fat storage regulation gone awry. Human physiology hasn’t changed in the last few decades. We have the same fat-storage hormones we’ve always had. Likewise, people have always wanted to eat too much. Nor have our genetics changed a whole hell of a lot in the last few dozen years. And yet obesity (as medically defined and meaning more than mere overweight) has gone from being a rather rare issue to being a problem for a third of all US adults.

The thing that’s missing in too many current discussions of the obesity epidemic is environmental effects. This is not a comment on the research, because that wasn’t its topic. But every single discussion for the general public needs to beat that drum until we all get it. Environmental factors are the only ones that have changed recently. Plus, that explains why we have an epidemic. Epidemics are public health issues, and they’re all embedded in the environment.

The reason it’s so important for everyone to understand the biggest causes is because obesity really is an epidemic, and it really is destroying the health of millions. It’s causing and will continue to cause horrible suffering in people who go blind or need amputations due to diabetic complications, or who become paralyzed after strokes. This stuff is no joke. Nor is it just a conspiracy by the fashion industry (although it’s that too). To the extent that obesity damages health, it’s vital — literally — to understand and fix the real causes and not to waste time on sacrificial food offerings to gods who don’t care.

I think two environmental factors stand out like sore thumbs.

  • Advertising for fat-making food and drink
  • Endocrine disruptor environmental pollution

You may not think of ads as an environmental factor, but what I mean by that is it’s out there, in your environment, and not something you control. You can’t simply ignore ads, no matter how many people blithely tell you to. Ads have their effect whether or not you pay attention. Your only real choice is to turn them off. An individual can choose to eschew most media, but on a population level, that’s not going to happen.

So we’re in an environment saturated with unavoidable messages to have fun with food. At the population level, some proportion of people some of the time will find themselves wanting that food, wanting that cola, and taking it. At the population level, some proportion of people get more calories than they otherwise would. And some proportion of them get fat.

It’s important to remember that getting fat, being a biological process, is not a simple matter of balancing calories in and calories used. Nothing in biology is simple. Calories in is a factor, certainly. If it wasn’t, you’d see fat people among famine sufferers.

But how the body stores fat stands right between the two halves of the equation. That is a complicated, hormonally controlled process we’re only beginning to understand. Insulin is one of those hormones, but only one. Sex hormones are also among the messengers that carry out the regulation. The starkest example of fat storage gone crazy is rare genetic conditions where the body’s hormones that promote fat storage are so active, they don’t leave enough glucose circulating in the blood for metabolic needs. Everything goes into fat, there’s too little left over for the business of staying alive, and the person is literally starving while putting on weight.

A big contribution of Ebbeling’s and her colleagues’ research is demonstrating the subtle effect of fat storage regulation that’s within the normal range. And since hormones are part of that process, hormone disruption can be expected to have a huge effect on fat deposition.

Which brings me to the second big environmental factor: a whole group of chemicals. They’re called hormone disruptors and they come from some plastics, pesticides, hormonal medicines, and so on. Those break down into hormone analogues and get into the environment. As I said in an earlier post on the Obesity Epidemic, if hormones help regulate energy balance, and if we’ve flooded the environment with bad substitutes for hormones, is it any wonder that people are having trouble regulating energy balance?

So, you may be asking, what does it all mean? What are we supposed to do about it? I’ve said it before so I’ll just say it again:

Like all public health issues, nothing less than a population-level approach will work. Dysentery, cholera, and typhoid are never wiped out by drinking boiled water. They’re wiped out by building municipal sewers. Smallpox wasn’t eradicated by avoiding smallpox patients. It was eradicated by universal vaccination. The individual actions aren’t useless. They just don’t change the widespread causes of the widespread problem.

Modern health problems like cancer and obesity aren’t going to be wiped out by eating fresh vegetables. Eating veggies is good, but it doesn’t address the basic problem. That’s going to take nothing less than a change to clean sustainable industry.

It’s almost enough to make you wish a mere diet really was all that’s needed.

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42 Comments on “What Really Makes Us Fat”

  1. quixote says:

    (WordPress is being super-flaky for me, so I may or may not be able to get back on if and when comments arrive. Piffle. I wish WP would get their servers fixed. This has been days.)

  2. HT says:

    My daughter is a prime example of what happens when the food supply is not adequately monitored – although thats just my opinion.
    I decided to work from home when my five year old daughter started to look like a beach ball. Her father who was supposed to be taking care of her and her brother was taking them to McDonalds every day for lunch. I kicked him to the curb soon after and made sure the kids were eating well, but alas it was too late for my daughter. Today, she has Celiacs – not something anyone in my family has ever experienced. She also has other issues, but Celiacs is the big one and leads to other health problems.
    Great post quixote – makes people think. And don’t get me started on Frankenfoods and MOnsanto – the truly original vampire corporation.
    When children are fed food that has been altered problems are sure to follow – of course they didn’t do studies on how it would affect humans long term did they? Today, Celiacs is being identified and it’s a much larger problem than the great minds thought it would be. My daughter cannot eat anything with wheat, rye, oats, corn. She also cannot eat any meat or fish or fowl. I love her very, very much, but it’s a bitch at family meals.

    • quixote says:

      That’s really tough, HT. You must be a very creative cook, to deal with those restrictions!

      Scientifically, though, it’s interesting. One child: McD’s early on, result: problems. Other children, similar genetics, less McD’s early on, not a problem.

      Wow. We need a study with a good sample size to see whether that’s more than a coincidence. Because if it is … well, wow.

  3. bostonboomer says:

    Hi Quixote,

    I’m glad you keep writing about this. One thing you don’t mention is thyroid problems–which can also be environmentally caused. I developed hypothyroidism because of a medication I was given in my early 30s. I gained a huge amount of weight in the space of one year before I went to an endocrinologist and found out about it and started taking some thyroid hormone.

    However my metabolism has continued to be slow, and although I’ve lost weight several times by dieting and even kept the weight off for years at a time, it hasn’t been possible for me to maintain a lower weight long-term. My temperature rarely goes above 97.5 or so and when I first get up it is sometimes as low as 96. Recently I discovered that if I took some supplementary iodine and thyroid stimulating vitamins and minerals I felt much better. I’ll have to wait and see if there is any effect on my weight.

    Another point is that there is quite a bit of research that shows that people who have been fat and lose weight often have negative health effects. I really think there needs to be some effort in our culture to stop demonizing fat people and blaming for all society’s ills. It actually is possible to be fat and healthy. And it is possible to be fat and still be a valuable contributing member of society. Yet fat hatred is the one prejudice that is still allowed–even encouraged–in American culture.

    • quixote says:

      One of the things that drives me nuts about discussions involving fat (well, if I’m honest pretty much everything drives me nuts these days) — one of the things is the conflation of moral worth and aesthetics and health. Gaaa. All totally different. All completely unrelated.

      Aesthetics: personal, nothing to do with anyone else, everybody should just shut up already. And that includes the entire ad industry.

      Worth: absolutely nothing to do with anything physical. You could be a chain smoker, have an unkempt lawn, and/or be 300 lbs overweight, or for that matter be terminally ill. It says nothing about your humanity, talent, kindness, or anything else that matters.

      Health: there are some fairly clear medical implications of specific things, like smoking or being very overweight. Those are worth thinking about, but, again, they have nothing to do with being within the normal range and healthy.

      I think it was in another comment thread here that someone pointed out the new diagnosis for people so obsessed with “health” it becomes a pathology itself: orthorexia nervosa.

      It’s good you had the smarts to notice and do something about the hypothyroid problem!

      • bostonboomer says:

        I’ve had the problem for more than 30 years. There’s not a lot I CAN do. It’s not curable. I didn’t realize until recently how serious a problem it is though, because once again, our society minimizes anything that might suggest that fat people are not evil and to blame for their body size.

  4. mjames says:

    Wow. Fascinating. Yet another problem with capitalism/free market run amok, that is, the ever-growing pollution of the environment. Also, good food costs a lot more than crummy food, and kids don’t get the exercise they need, that is, they should be running around for an hour a day during school and then again after school.

    The thyroid problem is one that Susie Madrak has been dealing with as well. I’ve read that there has been a significant increase in thyroid-related diseases, and I am worried sick over the radiation now in CA rainwater and tuna, something no politician seems the least bit interested in. Nuclear energy is the greatest, don’t you know?

    • bostonboomer says:

      Radiation is another reason to supplement with iodine, although you have to be careful about it.

    • quixote says:

      (Don’t know for sure about the tuna, but the amount of excess radiation in CA rainwater is a tiny fraction of the general background radiation we get from the Earth’s natural level, nuclear tests back in the day, and all those nasty reactors scattered around the globe. I’m in SoCal myself, so I’ve been keeping an eye on that news.)

  5. bostonboomer says:

    Here is an article that appeared in the Boston U. alumni magazine. It’s about a scientist who suspects that a number of food additives are contributing to obesity.

    Gary Taubes’ work annoys me, because I and many other overweight people tried again and again back in the ’70s with the Stillman/Atkins low-carb approach. Yes, you will lose weight if (a big if) you can followed the diet long-term. I give you about three weeks at the most before you’ll do anything for a piece of fruit. And once you go back to eating fruit and vegetables, you’ll gain back the weight you lost–at least that’s what happens to most people. If you like having a constant dry mouth, bad breath, and intense cravings, give it a try.

    It never seems to occur to most “normal” people that there wouldn’t be this massive diet industry if any of the millions of diets actually worked long-term. Most fat people have spent huge parts of their lives starving themselves and being very very hungry. That isn’t something that is sustainable, as the DC crowd keeps saying about the deficit.

    • bostonboomer says:

      Here is a shorter summary of some of the additives biochemist Barbara Corkey is suspicious of. Big ones for her are mono- and diglycerides and artificial sweeteners.

      She isn’t even dealing with the environmental toxins you’re talking about, Quixote.

    • quixote says:

      “there wouldn’t be this massive diet industry if any of the millions of diets actually worked long-term”

      Word.

  6. bostonboomer says:

    Quixote,

    After your last post on this subject I looked around and ended up buying this book: Weighing In: Obesity, Food Justice, and the Limits of Capitalism. Unfortunately, I haven’t read it yet. Here’s the description:

    Weighing In takes on the “obesity epidemic,” challenging many widely held assumptions about its causes and consequences. Julie Guthman examines fatness and its relationship to health outcomes to ask if our efforts to prevent “obesity” are sensible, efficacious, or ethical. She also focuses the lens of obesity on the broader food system to understand why we produce cheap, over-processed food, as well as why we eat it. Guthman takes issue with the currently touted remedy to obesity–promoting food that is local, organic, and farm fresh. While such fare may be tastier and grown in more ecologically sustainable ways, this approach can also reinforce class and race inequalities and neglect other possible explanations for the rise in obesity, including environmental toxins. Arguing that ours is a political economy of bulimia–one that promotes consumption while also insisting upon thinness–Guthman offers a complex analysis of our entire economic system.

  7. janey says:

    I’ve been saying for a while that it is not the food but what is in the food. Every time we eat a hamburger we are ingesting estrogen hormones and antibiotics. Girls are facing puberty earlier than ever and people are all heavier than they used to be. In the 70s, everyone seemed skinnier. Of course, it has been 20 years since we allowed our children out to play also.

    • janicen says:

      If it keeps getting hotter, none of us will want to spend too much time outside. My daughter and I were just talking about the fact that almost nobody we knew in Seattle was overweight while here in Virginia it seems more commonplace. Anecdotal I know, but all of us spent a lot more time with outdoor activities in Seattle where it didn’t get so hot and humid. This time of year in Virginia if you don’t get your outdoor activity in early in the morning, forget about it. It’s too hot later in the morning and afternoon and in the evening the bugs will eat you.

  8. HT says:

    I come from a family of 5 children. Four of us are what is considered “normal Size” i.e we don’t offend the fashion police mentality that has risen up in the last 20 years. My oldest sister is considered “fat”. We all grew up in the same house, eating the same food, doing the same activities. I’m 5foot 6 and weigh in at 130 lbs – the same as I was when I was 14. My sister is 5 foot and weighs in at 185. She is one of the most compassionate loving people I have ever met. I don’t give a damn what she looks like, I just want her to remain in my life. I think that is what people have to get beyond – looks are ephemeral, but character is forever.
    I wish that we didn’t have to have narcotics and antibiotics in our food chain because there are people like me who are sensitive to drugs of any sort.

  9. mjames says:

    Soy lecithin – which is all over the place – is a dreadful additive, especially for anyone with thyroid problems (many post-menopausal women). Soy is to be avoided if one is taking medication for hypothyroidism.

    • bostonboomer says:

      All soy products inhibit thyroid. So do lots of vegetables–broccoli, kale, spinach, and most of the cabbage family.

      • ecocatwoman says:

        Not wonderful news for me – hypothyroid & diabetic & I LOVE spinach, cabbage & soy. Of course, nearly all soy is GMO.

      • bostonboomer says:

        I know. I love broccoli, brussels sprouts, spinach, all that stuff. But I decided to try cutting them out for awhile. Peanuts also inhibit thyroid, but I refuse to give up peanut butter.

        • ecocatwoman says:

          I prefer my peanut butter wrapped in chocolate. In my alternate reality, Reese’s peanut butter cups have a required food group all their own. I am a very, very bad girl.

  10. ecocatwoman says:

    MORE PLEASE, quixote. This article was way, way too short. Yes, hormone/endocrine disruptors saturate our environment. Check out images of frogs with 6 & 8 legs and/or are hermaphroditic. But, hey, why believe in science? Why worry about the “canaries in our coal mine” that are showing how these additives are producing such damage? Humans aren’t frogs, right?

    I went to a lecture by Neal Barnard (PCRM) several years ago about his new book on diabetes. He blamed the fat in our diet for the diabetes epidemic, describing fat as coating our blood cells and not allowing insulin in, therefore keeping it in our system (or something like that). Anyway I had already noticed that as a diabetic my sugar was higher the morning after having a high fat dinner (mac & cheese for example) than after eating too much candy.

    I do agree that there are many factors, and again this isn’t a one size fits all world. Agree that the rise of television and all those damn ads and crap fast foods are the major change from when my generation were kids & the years in between. McD’s was a once a month treat (no Super Size meals then) and we had to drive about 10 miles to get to the closest one. And, of course, us kids played outside all weekend and rode our bikes to school or walked there. No concern over pedophiles grabbing us. But even though I walked to school every day unless it was raining, I was still a fat kid. And even as a vegetarian for 20 years, I still have high cholesterol. I have a damn cholesterol manufacturing body.

    • HT says:

      Very interesting Connie. My so called “fat” sister (I really, really hate that descriptor) is also diabetic. And she is 72 years old, so she also walked everywhere when she was young (as did I) yet she is big, and I am considered thin. I think that genetics has an impact, however I also believe that junk food (I consider genetically altered foodstuffs to be junk food) have played a huge part. P.S. we walked even when it rained, or during huge snow storms. We had to. Only one car and my dad used it to get to work.

  11. northwestrain says:

    High Fructose Corn Syrup — is in almost everything. Then there is the Genetically modified corn.

    A Princeton University research team has demonstrated that all sweeteners are not equal when it comes to weight gain: Rats with access to high-fructose corn syrup gained significantly more weight than those with access to table sugar, even when their overall caloric intake was the same.

    In addition to causing significant weight gain in lab animals, long-term consumption of high-fructose corn syrup also led to abnormal increases in body fat, especially in the abdomen, and a rise in circulating blood fats called triglycerides. The researchers say the work sheds light on the factors contributing to obesity trends in the United States.

    “Some people have claimed that high-fructose corn syrup is no different than other sweeteners when it comes to weight gain and obesity, but our results make it clear that this just isn’t true, at least under the conditions of our tests,” said psychology professor Bart Hoebel, who specializes in the neuroscience of appetite, weight and sugar addiction. “When rats are drinking high-fructose corn syrup at levels well below those in soda pop, they’re becoming obese — every single one, across the board. Even when rats are fed a high-fat diet, you don’t see this; they don’t all gain extra weight.”

    http://www.princeton.edu/main/news/archive/S26/91/22K07/

    I’m the canary in the mine when it comes to HFCS. Amazingly there is a ton of research about the real differences between cane sugar and corn sugar (what the corn industry wants HFCS to be called) — namely HFCS requires an liver enzyme for the body to digest HFCS. So the body knows the difference. I don’t have the gene for this enzyme — so HFCS can literally kill me. Not right away — but death due to liver failure is the result if I don’t read every label and know the fructose content of food.

    Boston University has a HFI (hereditary fructose Intolerance) Lab. Wikipedia has an expanded entry on HFI with links.

    There are also other milder genetic reactions to HFCS — yet the corporations who are trying to get HFCS are dismissing the health issues related to the poison which is in almost everything. Many medical doctors don’t or won’t recognize that this could be an issue with some of their patients.

    • quixote says:

      HFS is an interesting issue. Fructose digestion is regulated differently than glucose (the body’s “normal” sugar). The short version: it doesn’t trigger the “you have all the food you need now” reaction in your brain the same way glucose would.

  12. ecocatwoman says:

    One other thing: the incidence of thyroid problems & diabetes, especially in cats, has risen dramatically in the last 5 – 10 years. Cheap dry food & feeding only dry food is much like feeding our companion animals McDs for every meal.

    • northwestrain says:

      What’s amazing about cat food — cats aren’t supposed to be able to taste sweet. Yet I’ve found HFCS in many of the cat treats and in cheap cat food. Also there is that nasty preservative — I don’t remember the name but know it when I see it in the list of ingredients. Yes I do read ingredient labels for my furkids.

      Also there are the environmental contaminates you’ve mentioned before and which are mentioned in this post.

      From what I’ve read about the genetically modified plants — not that much research has gone into the long range side effects. These corporations have the money to buy positive news coverage and politicians.

      • ecocatwoman says:

        I’m with you on this. And, yes we should read the ingredients on all labels. Unfortunately, in my old age, I find those labels with microscopic print are nearly impossible for me to read. I buy only grain free dry for my cats. Unfortunately they refuse to eat high priced, better canned food & I refuse to buy expensive cat food that the dog eats. She gets her own high priced canned & dry food. Love my cats, but they are so damn picky. But, no beef nor fish, only chicken or turkey – no buffalo, rabbit, lamb or venison (or liver). I wouldn’t eat those critters when I was an omnivore, so I won’t feed it to the cats or dogs.

        Yeah, they can’t taste sugar but they prefer the food laced with sugar. And they are color blind, but I had one cat who would play with only 1 type of ball & it had to be PURPLE! I tried the same balls in every other color & she’d look at me as if to say, “what are you – stupid?”.

      • ecocatwoman says:

        This is a GREAT site & more on ethoxyquin: http://www.truthaboutpetfood.com/articles/misinformation-about-ethoxyquin-from-pet-food.html

        THANK YOU MONSANTO! Their motto should be: We’ll kill anything, even you and everything you care about, for profit.

    • HT says:

      I like that motto, but as you and everyone else knows, Monsanto would never use it. Truth in advertising is not on their agenda.
      One thing I’ve noticed lately – mainly because of my daughter’s Celiacs, they are now producing cat and dog food that is gluten free. I wonder if it really is, because I suspect that one of my kittehs has problems with gluten. I bought the gluten free stuff and she’s stopped throwing up. And I will not buy any companion food that is produced in the U.S. or anything that contains anything that comes from China. Just me of course, but my companions are more important than corporate profits. I’m now all canadian all the time. More expensive, sure, but worth it.

      • ecocatwoman says:

        I don’t recall seeing gluten free cat or dog food, but I’ll look. I don’t think the boutique pet stores I shop in carry any food made in Canada, but I’ll check. The big problem in the US now? All those family owned, high quality pet foods have caught the eye of the standard brands & those brands are buying out the family businesses. What was once trusted, high quality food is being processed in the same plants as the standard, common brands & sharing ingredients or at least risking contamination from the ingredients in standard brands. Once I retire, I’m going to try to go all raw for my critters. I tried it last year & half the cats liked it & the other half were NOT happy about it.

      • ecocatwoman says:

        Really? You don’t think Monsanto would switch to that motto? I’m crushed (snark!).

      • HT says:

        Nutram is canadian. Nutrience has a blub on it that indicates Canadian made, however, when one checks further, it is made in the U.S. false advertising for sure.
        I love your motto, just don’t think that Monsanto will feel the same, so don’t feel bad. You’re in good company (at least last time I checked in the mirror I was good company).

  13. Thank you again for this…like when you sent me that email about the hormones after my surgery, I really appreciate these post. Helpful, so helpful!