Tuesday, April 10, 2012

Are fat people just lazy?

Are fat people just lazy? Or is it in their genes?

Let's look at an unlikely place for the answer: an AA meeting. If you get up and say "My name is Jane, and I'm not really an alcoholic, I don't drink that much..." they throw you out. They welcome you back, once you say "My name is Jane and I'm an alcoholic". The same should be true for fat people. And I'm using this politically incorrect term deliberately. Because unless you wake up to the reality, you won't be able to change that reality.
 AA have long ago realized that fact. And they have a 50% long-term success rate. That is, half the alcoholics who join AA stay dry for the rest of their lives. That's way more than what public health, clinical and commercial weight loss programs achieve with obese participants. We are happy if 10% of those who enter these programs achieve a 10% weight loss AND keep it for more than 2 years. It's that bad. Is it because of the genes? A study published recently in Nature Genetics, might supply another excuse to some overweight people. But before we look at this study, let's look at some other facts first.
One thing we all know for sure: if you are overweight, you obviously have taken in more calories than you have expended. Over quite some time, because it takes a while to accumulate all those energy reserves on your waist and hips. Boils down to one of the tenets of a universal law of physics that says: Energy can neither be destroyed nor miraculously created. Not even on your hips.
Now I know all the objections raised by so many overweight people, like "But, I hardly eat anything. How can I be fat? Even my friends say, from what you eat nobody can get fat." Believe me, I've heard them all.  And my heart sinks, when I do, because I know there goes the hopeless case. The Jane who goes to AA and tells them she is different. The study published in Nature Genetics might just deliver her the next excuse. Not because the researchers tell her so, but because some media genius might just read it the wrong way. As they often do. So, let's look a what the researchers say.
The researchers conducted a meta-analysis of some 14 genome wide association studies involving altogether 14,000 children, one third of which were obese. They found 7 genetic markers which correlated with obesity and which also turned out to correlate with obesity in adults. The beauty of looking at genetics in kids is, that they haven't been exposed to decades of lifestyles which may obscure such links. 
So, the results clearly point into the direction of some genetic signature predisposing a person to become obese. But having this signature doesn't mean you'll inevitably become obese. Because most kids who have the signature are not obese. It's only that this signature shows up a little more often in the obese kids than in their non-obese peers.  And there is one more thing, you need to keep in mind. Over the past 20 years the human genetic make-up hasn't changed at all. But the obesity rate in US kids has. In fact it has tripled during that period. And health behavior has changed, too. And so did our environment.
What makes me always frustrated in all this debate about genes vs. environment vs. behavior is my scientist colleagues' and the media's inability to educate their audience about the complete picture. Genes make up the blueprint to your organism. True. But they don't make that organism. Genes make proteins, but whether they make them or whether they are silenced into not making them, that depends on epigenetics, on the interaction with your environment, and on your behavior, which again is influenced by all the others. It is a very complex relationship, and I'm afraid, genetics will not help us, to solve the obesity epidemic. But neither will the stigmatization of the obese. 

What we need, is a way to help those who recognize their fatness as a resolvable reality, resolve it. That's why I'm working on the GPS tochronic health, because I know that once the health behaviors put you on track to chronic health and longevity, your overweight problem will resolve automatically. As a side effect. But only if the obese person works with us. 

So did that answer the question? You decide for yourself.    Print Friendly and PDFPrintPrint Friendly and PDFPDF


  1. Knowing the cause for the obesity is necessary to prevent the additional gaining of weight and to find the solution to lose weight. 90% of the obesity is due to unhealthy food practice and the less physical work to the body.

  2. AA does not have a 50% success rate... Seriously, where are you getting this?

    1. You have clearly wrong-footed me on this! Thanks for that. The interpretation of success depends on your definition: is only teetotaling the criterion or do we set it at a certain percentage of days without alcohol? Before I go on, here you find a very good paper which aims at coming to a clearer interpretation (http://www.scientificamerican.com/article.cfm?id=does-alcoholics-anonymous-work&page=2)
      Anyway, there is no guarantee that acknowledging the fact of being an addict will help you kick the addiction. But without acknowledging it, you are almost guaranteed to never kick it.

  3. My roommate is 350 lbs. and is lazy and unmotivated. I have lived there 6 1/2 months and have not met a single one of his friends as he stays home all day and only goes out to buy MORE FOOD. His diet is very fattening. He inherited his home and I find him to be lazy, rude and I think even has mental issues given how he throws food rotting around his living room for weeks. He is totally disgusting to me and I plan to move soon.

  4. I swear to God you better site the 50 percent figure for AA success because that is patently false. http://articles.latimes.com/2011/mar/03/news/la-heb-sheen-aa-20110302http://www.washingtonpost.com/wp-dyn/content/article/2010/08/06/AR2010080602660.html
    The rate is closer to about 5 percent which is WORSE than if you had just tried to quit on your own.

  5. Another thing that people seem to miss in interpreting results from these genetic studies is that a particular gene that correlates with obesity may even be responsible for predisposing someone to lazy behaviour as opposed to having a direct effect on the metabolism. So even blaming your genes would not eliminate the possibility of laziness.

  6. Dear Dr Kraushaar

    why have humans suddenly started to take in more energy than they expend on an epidemic scale approximately 40 years ago? Genes haven't changed so they developed a behavioural defect in that timeframe, is that what you are suggesting? Your statement about energy balance is descriptive not explanatory. It's like saying the reason for the heating up of the atmosphere (climate change) is that it’s taking in more energy than it expends. Nonsensical, but technically true.

    From your writing it seems that you are halfway there, but still cannot let go of the paradigm. Haven't you stumbled over Taubes' Good Calories, Bad Calories yet? It might give you an understanding of the conflicting observations, e.g. why it could be true that someone is eating little and still is fat instead of assuming that the patient is lying because your assumption going in is that he has a defect of the mind and his statements cannot be trusted. You can conceptualize the disease in a much more biological/physiological way and suddenly you can make sense of all the conflicting observations (e.g. obesity in non-toxic, non-obesogenic environments) and there's no need to blame the victim anymore in order to sustain your paradigm. You are a biomedical researcher after all, right?

    As an introduction I'd recommend his essay in the British Medical Journal and his column in Nature:
    Taubes, Gary: The science of obesity: what do we really know about what makes us fat? BMJ 2013; 346. http://www.bmj.com/content/346/bmj.f1050

    Taubes, Gary: Treat obesity as physiology, not physics. Nature 492, 155 (13 December 2012). http://www.nature.com/news/treat-obesity-as-physiology-not-physics-1.12014

    What do you think about the argument he puts forward?

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