What Really Causes Obesity and Weight Bias

  1. NY Times 11/21/22: Scientists Don’t Agree on What Causes Obesity, but They Know What Doesn’t
  2. B Rosen. Practical Gastroenterology, October 2022, pg 32-42.: Open Access (PDF): Reducing Weight Bias in GI Practice to Improve the Clinician/Patient Relationship

In the NY Times article, a few key excerpts:

  • “Scientists were arguing about ‌‌the causes of obesity, which affects more than 40 percent of U.S. adults and costs the health system about $173 billion each year. At the meeting’s closing session, ‌John Speakman, a biologist, offered ‌‌this conclusion on the subject: ‌ “There’s no consensus whatsoever about what the cause of it‌ is. That’s not to say the researchers disagreed on everything. The three-day meeting was infused with an implicit understanding of what obesity is not: a personal failing.
  • “No scientist spoke of any of the supposed fixes that fill diet books and store shelves‌‌, with the exception of the carbohydrate discussion. There wasn’t serious dialogue about cleanses, diet apps‌‌ or intermittent fasting. No one suggested that supplements could help people lose weight or that metabolisms need boosting. The sole presenter on the gut microbiome argued that the human trials in obesity to date have mostly disappointed.”
  • “Researchers have repeatedly found fat shaming promotes weight gain and harms. At least some of obesity’s negative health consequences are thought to be driven by stigma and discrimination, which results in poorer health care. “

In the Practical Gastroenterology article, the article stresses that being overweight does not in itself confer bad health outcomes. “There is an abundance of epidemiological research showing that “obesity” is associated with longer survival with diabetes, cancer, and cardiovascular diseases than thinner people with the same diagnoses….The main assumption made in weight-centric healthcare that contributes to and perpetuates weight bias is that higher weight is synonymous with poorer health. While much research exists
that correlates fatness with disease states, causation cannot be assumed. Often, these studies neglect to control for factors such as fitness level, activity, nutrient intake, weight cycling, socioeconomic status, and experienced or internalized weight bias…In all BMI categories, sedentary behavior was linked with mortality.”

Other key points:

  • “Weight cycling increases inflammation, and inflammation increases the risk of many diseases”
  • Moving away from using weight as a determinant of health and instead focusing on health behaviors “to achieve health rather than weight loss” may be a better model.

My take: In children and adults, these articles suggest that the best current approach is to focus on health behaviors (consuming healthy foods, and increasing activity) rather than weight and stop thinking of obesity as a personal failure.

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Chattahoochee River near Azalea Road