david berreby – the obesity era-1

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The obesity eraAs the American people got fatter, so did marmosets, vervet monkeys and

mice. The problem may be bigger than any of us

by David Berreby 4,700 words Read later or Kindle

The previous belief of many lay people and health professionals that obesity is simply the result of a lack of

willpower and an inability to discipline eating habits is no longer defensible. Photo by Karen Kasmauski

David Berreby is a

science writer and the

author of Us and Them:

The Science of Identity

(2008). He lives in New

York.

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Years ago, after a plane trip spent reading Fyodor DostoyevskysNotes from

theUndergroundand Weight Watchers magazine, Woody Allen melded the

two experiences into a single essay. I am fat, it began. I am disgustingly fat. I

am the fattest human I know. I have nothing but excess poundage all over my

body. My fingers are fat. My wrists are fat. My eyes are fat. (Can you imaginefat eyes?). It was 1968, when most of the worlds people were more or less

height-weight proportional and millions of the rest were starving. Weight

Watchers was a new organisation for an exotic new problem. The notion that

being fat could spur Russian-novel anguish was good for a laugh.

That, as we used to say during my Californian adolescence, was then. Now,

1968s joke has become 2013s truism. For the first time in human history,

overweight people outnumber the underfed, and obesity is widespread in

wealthy and poor nations alike. The diseases that obesity makes more likely

diabetes, heart ailments, strokes, kidney failure are rising fast across the

world, and the World Health Organisation predicts that they will be the leading

causes of death inallcountries, even the poorest, within a couple of years.

What's more, the long-term illnesses of the overweight are far more expensive
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to treat than the infections and accidents for which modern health systems were

designed. Obesity threatens individuals with long twilight years of sickness,

and health-care systems with bankruptcy.

And so the authorities tell us, ever more loudly, that we are fat disgustingly,

world-threateningly fat. We must take ourselves in hand and address our

weakness. After all, its obvious who is to blame for this frightening global

blanket of lipids: its us, choosing over and over again, billions of times a day,to eat too much and exercise too little. What else could it be? If youre

overweight, it must be because you are not saying no to sweets and fast food

and fried potatoes. Its because you take elevators and cars and golf carts

where your forebears nobly strained their thighs and calves. How could

you dothis to yourself, and to society?

Moral panic about the depravity of the heavy has seeped into many aspects of

life, confusing even the erudite. Earlier this month, for example, the American

evolutionary psychologist Geoffrey Miller expressed the zeitgeist in this tweet:

Dear obese PhD applicants: if you dont have the willpower to stop eatingcarbs, you wont have the willpower to do a dissertation. #truth. Businesses

are moving to profit on the supposed weaknesses of their customers.

Meanwhile, governments no longer presume that their citizens know what they

are doing when they take up a menu or a shopping cart. Yesterdays fringe

notions are becoming todays rules for living such as New York Citys

recent attempt to ban large-size cups for sugary soft drinks, or Denmarks short-

lived tax surcharge on foods that contain more than 2.3 per cent saturated fat, or

Samoa Airs 2013 ticket policy, in which a passengers fare is based on his

weight because: You are the master of your air fair, you decide how much

(or how little) your ticket will cost.

Several governments now sponsor jauntily named pro-exercise programmes

such as Lets Move! (US), Change4Life (UK) and actionsant (Switzerland).

Less chummy approaches are spreading, too. Since 2008, Japanese law

requires companies to measure and report the waist circumference of all

employees between the ages of 40 and 74 so that, among other things, anyone

over the recommended girth can receive an email of admonition and advice.

Hand-in-glove with the authorities that promote self-scrutiny are the businesses

that sell it, in the form of weight-loss foods, medicines, services, surgeries and

new technologies. A Hong Kong company named Hapilabs offers an electronic

fork that tracks how many bites you take per minute in order to prevent hasty

eating: shovel food in too fast and it vibrates to alert you. A report by the

consulting firm McKinsey & Co predicted in May 2012 that health and

wellness would soon become a trillion-dollar global industry. Obesity is

expensive in terms of health-care costs, it said before adding, with a

consultantly chuckle, dealing with it is also a big, fat market.

And so we appear to have a public consensus that excess body weight (defined

as a Body Mass Index of 25 or above) and obesity (BMI of 30 or above) are

consequences of individual choice. It is undoubtedly true that societies are

spending vast amounts of time and money on this idea. It is also true that the

masters of the universe in business and government seem attracted to it, perhaps


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C

because stern self-discipline is how many of them attained their status. What

we dontknow is whether the theory is actually correct.

Higher levels of female obesity correlated with higher

levels of gender inequality in each nation

Of course, thats not the impression you will get from the admonishments of

public-health agencies and wellness businesses. They are quick to assure usthat science says obesity is caused by individual choices about food and

exercise. As the Mayor of New York, Michael Bloomberg, recently put it,

defending his proposed ban on large cups for sugary drinks: If you want to lose

weight, dont eat. This is not medicine, its thermodynamics. If you take in more

than you use, you store it. (Got that? Its not complicated medicine, its

simplephysics, the most sciencey science of all.)

Yet the scientists who study the biochemistry of fat and the epidemiologists

who track weight trends are not nearly as unanimous as Bloomberg makes out.

In fact, many researchers believe that personal gluttony and laziness cannotbe

the entire explanation for humanitys global weight gain. Which means, of

course, that they think at least some of the official focus on personal conduct is

a waste of time and money. As Richard L Atkinson, Emeritus Professor of

Medicine and Nutritional Sciences at the University of Wisconsin and editor of

theInternational Journal of Obesity, put it in 2005: The previous belief of

many lay people and health professionals that obesity is simply the result of a

lack of willpower and an inability to discipline eating habits is no longer

defensible.

onsider, for example, this troublesome fact, reported in 2010 by

the biostatistician David B Allison and his co-authors at the

University of Alabama in Birmingham: over the past 20 years or

more, as the American people were getting fatter, so were

Americas marmosets. As were laboratory macaques, chimpanzees, vervet

monkeys and mice, as well as domestic dogs, domestic cats, and domestic and

feral rats from both rural and urban areas. In fact, the researchers examined

records on those eight species and found that average weight for every one had

increased. The marmosets gained an average of nine per cent per decade. Lab

mice gained about 11 per cent per decade. Chimps, for some reason, are doingespecially badly: their average body weight had risen 35 per cent per decade.

Allison, who had been hearing about an unexplained rise in the average weight

of lab animals, was nonetheless surprised by the consistency across so many

species. Virtually in every population of animals we looked at, that met our

criteria, there was the same upward trend, he told me.

It isnt hard to imagine that people who are eating more themselves are giving

more to their spoiled pets, or leaving sweeter, fattier garbage for street cats and

rodents. But such results dont explain why the weight gain is also occurring in

species that human beings dont pamper, such as animals in labs, whose dietsare strictly controlled. In fact, lab animals lives are so precisely watched and

measured that the researchers can rule out accidental human influence: records

show those creatures gained weight over decades without any significant

change in their diet or activities. Obviously, if animals are getting heavier along


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with us, it cant just be that theyre eating more Snickers bars and driving to

work most days. On the contrary, the trend suggests some widely shared cause,

beyond the control of individuals, which is contributing to obesity across many

species.

Such a global hidden factor (or factors) might help to explain why most people

gain weight gradually, over decades, in seeming contradiction of Bloombergs

thermodynamics. This slow increase in fat stores would suggest that they areeating only a tiny bit more each month than they use in fuel. But if that were so,

as Jonathan C K Wells, professor of child nutrition at University College

London, has pointed out, it would be easy to lose weight. One recent model

estimated that eating a mere 30 calories a day more than you use is enough to

lead to serious weight gain. Given what each person consumes in a day (1,500

to 2,000 calories in poorer nations; 2,500 to 4,000 in wealthy ones), 30

calories is a trivial amount: by my calculations, thats just two or three peanut

M&Ms. If eliminating that little from the daily diet were enough to prevent

weight gain, then people should have no trouble losing a few pounds. Instead,

as we know, they find it extremely hard.

Many other aspects of the worldwide weight gain are also difficult to square

with the its-just-thermodynamics model. In rich nations, obesity is more

prevalent in people with less money, education and status. Even in some poor

countries, according to a survey published last year in theInternational

Journal of Obesity, increases in weight over time have been concentrated

among the least well-off. And the extra weight is unevenly distributed among

the sexes, too. In a study published in the Social Science and Medicine journal

last year, Wells and his co-authors found that, in a sample that spanned 68

nations, for every two obese men there were three obese women. Moreover, theresearchers found that higher levels of female obesity correlated with higher

levels of gender inequality in each nation. Why, if body weight is a matter of

individual decisions about what to eat, should it be affected by differences in

wealth or by relations between the sexes?

Chemicals ingested on Tuesday might promote more

fat retention on Wednesday

To make sense of all this, the purely thermodynamic model must appeal tocomplicated indirect effects. The story might go like this: being poor is

stressful, and stress makes you eat, and the cheapest food available is the stuff

with a lot of empty calories, therefore poorer people are fatter than the better-

off. These wheels-within-wheels are required because the mantra of the

thermodynamic model is that a calorie is a calorie is a calorie: who you are

and what you eat are irrelevant to whether you will add fat to your frame. The

badness of a bad food such as a Cheeto is that it makes calorie intake easier

than it would be with broccoli or an apple.

Yet a number of researchers have come to believe, as Wells himself wroteearlier this year in theEuropean Journal of Clinical Nutrition, that all

calories are not equal. The problem with diets that are heavy in meat, fat or

sugar is not solely that they pack a lot of calories into food; it is that they alter

the biochemistry of fat storage and fat expenditure, tilting the bodys system in


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favour of fat storage. Wells notes, for example, that sugar, trans-fats and

alcohol have all been linked to changes in insulin signalling, which affects

how the body processes carbohydrates. This might sound like a merely

technical distinction. In fact, its a paradigm shift: if the problem isnt the

number of calories but rather biochemical influences on the bodys fat-making

and fat-storage processes, then sheer quantity of food or drink are not the all-

controlling determinants of weight gain. If candys chemistry tilts you toward

fat, then the fact that you eat it at all may be as important as the amount of it you

consume.

More importantly, things that alter the bodys fat metabolism is a much wider

category than food. Sleeplessness and stress, for instance, have been linked to

disturbances in the effects of leptin, the hormone that tells the brain that the

body has had enough to eat. What other factors might be at work? Viruses,

bacteria and industrial chemicals have all entered the sights of obesity research.

So have such aspects of modern life as electric light, heat and air conditioning.

All of these have been proposed, with some evidence, as directcauses of

weight gain: the line of reasoning is not that stress causes you to eat more, butrather that it causes you to gain weight by directly altering the activities of your

cells. If some or all of these factors are indeed contributing to the worldwide

fattening trend, then the thermodynamic model is wrong.

We are, of course, surrounded by industrial chemicals. According to Frederick

vom Saal, professor of biological sciences at the University of Missouri, an

organic compound called bisphenol-A (or BPA) that is used in many household

plastics has the property of altering fat regulation in lab animals. And a recent

study by Leonardo Trasande and colleagues at the New York University School

of Medicine with a sample size of 2,838 American children and teens foundthat, for the majority, those with the highest levels of BPA in their urine were

five times more likely to be obese than were those with the lowest levels.

BPA has been used so widely in everything from childrens sippy cups to

the aluminium in fizzy drink cans that almost all residents of developed

nations have traces of it in their pee. This is not to say that BPA is unique. In

any developed or developing nation there are many compounds in the food

chain that seem, at the very least, to be worth studying as possible obesogens

helping to tip the bodys metabolism towards obesity. For example, a study by

the Environmental Working Group of the umbilical cords of 10 babies born in

US hospitals in 2004 found 287 different industrial chemicals in their blood.

Beatrice Golomb, professor of medicine at the University of California, San

Diego, has proposed a long list of candidates all chemicals that, she has

written, disrupt the normal process of energy storage and use in cells. Her

suspects include heavy metals in the food supply, chemicals in sunscreens,

cleaning products, detergents, cosmetics and the fire retardants that infuse

bedclothes and pyjamas.

Chemicals and metals might promote obesity in the short term by altering the

way that energy is made and stored within cells, or by changing the signals in

the fat-storage process so that the body makes more fat cells, or larger fat cells.

They could also affect the hormones that spur or tamp down the appetite. In

other words, chemicals ingested on Tuesday might promote more fat retention


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L

on Wednesday.

Its also possible that chemical disrupters could affect peoples body chemistry

on longertimescales starting, for instance, before their birth. Contrary to its

popular image of serene imperturbability, a developing foetus is in fact acutely

sensitive to the environment into which it will be born, and a key source of

information about that environment is the nutrition it gets via the umbilical cord.

As David J P Barker, professor of clinical epidemiology of the University ofSouthampton, noted some 20 years ago, where mothers have gone hungry, their

offspring are at a greater risk of obesity. The prenatal environment, Barker

argued, tunes the childrens metabolism for a life of scarcity, preparing them to

store fat whenever they can, to get them through periods of want. If those spells

of scarcity never materialise, the childs proneness to fat storage ceases to be

an advantage. The 40,000 babies gestated during Hollands Hunger Winter of

1944-1945 grew up to have more obesity, more diabetes and more heart trouble

than their compatriots who developed without the influence of war-induced

starvation.

Its possible that widespread electrification is

promoting obesity by making humans eat at night,

when our ancestors were asleep

Just to double down on the complexity of the question, a number of researchers

also think that industrial compounds might be affecting these signals. For

example, Bruce Blumberg, professor of developmental and cell biology at the

University of California, Irvine, has found that pregnant mice exposed to

organotins (tin-based chemical compounds that are used in a wide variety ofindustries) will have heavier offspring than mice in the same lab who were not

so exposed. In other words, the chemicals might be changing the signal that the

developing foetus uses to set its metabolism. More disturbingly, there is

evidence that this foetal programming could last more than one generation. A

good predictor of your birth weight, for instance, is your mothers weight

at herbirth.

urking behind these prime suspects, there are the fugitive

possibilities what David Allison and another band of co-

authors recently called the roads less travelled of obesityresearch. For example, consider the increased control civilisation

gives people over the temperature of their surroundings. There is a

thermoneutral zone in which a human body can maintain its normal internal

temperature without expending energy. Outside this zone, when its hot enough

to make you sweat or cold enough to make you shiver, the body has to expend

energy to maintain homeostasis. Temperatures above and below the neutral

zone have been shown to cause both humans and animals to burn fat, and hotter

conditions also have an indirect effect: they make people eat less. A restaurant

on a warm day whose air conditioning breaks down will see a sharp decline in

sales (yes, someone did a study). Perhaps we are getting fatter in part becauseour heaters and air conditioners are keeping us in the thermoneutral zone.

And what about light? A study by Laura Fonken and colleagues at the Ohio

State University in Columbus, published in 2010 in theProceedings of the


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National Academy of Sciences, reported that mice exposed to extra light

(experiencing either no dark at all or a sort of semidarkness instead of total

night) put on nearly 50 per cent more weight than mice fed the same diet who

lived on a normal night-day cycle of alternating light and dark. This effect might

be due to the constant light robbing the rodents of their natural cues about when

to eat. Wild mice eat at night, but night-deprived mice might have been eating

during the day, at the wrong time physiologically. Its possible that

widespread electrification is promoting obesity by making humans eat at night,

when our ancestors were asleep.

There is also the possibility that obesity could quite literally be contagious. A

virus called Ad-36, known for causing eye and respiratory infections in people,

also has the curious property of causing weight gain in chickens, rats, mice and

monkeys. Of course, it would be unethical to test for this effect on humans, but it

is now known that antibodies to the virus are found in a much higher percentage

of obese people than in people of normal weight. A research review by

Tomohide Yamada and colleagues at the University of Tokyo in Japan,

published last year in the journalPLoS One, found that people who had beeninfected with Ad-36 had significantly higher BMI than those who hadnt.

As with viruses, so with bacteria. Experiments by Lee Kaplan and colleagues at

Massachusetts General Hospital in Boston earlier this year found that bacteria

from mice that have lost weight will, when placed in other mice, apparently

cause those mice to lose weight, too. And a study in humans by Ruchi Mathur

and colleagues at the Cedars-Sinai Medical Center in Los Angeles, published

in theJournal of Clinical Endocrinology and Metabolism earlier this year,

found that those who were overweight were more likely than others to have

elevated populations of a gut bacteria called Methanobrevibacter smithii. Theresearchers speculated that the bacteria might in fact be especially good at

digesting food, yielding up more nutrients and thus contributing to weight gain.

The researcher who first posited a viral connection in 1992 he had noticed

that the chickens in India that were dead of an adenovirus infection were plump

instead of gaunt was Nikhil Dhurandhar, now a professor at the Pennington

Biomedical Research Centre in Louisiana. He has proposed a catchy term for

the spread of excess weight via bugs and viruses: infectobesity.

o one has claimed, or should claim, that any of these roads less

taken is the one true cause of obesity, to drive out the false idol

of individual choice. Neither should we imagine that the

existence of alternative theories means that governments can stop

trying to forestall a major public-health menace. These theories are important

for a different reason. Their very existence the fact that they are plausible,

with some supporting evidence and suggestions for further research gives the

lie to the notion that obesity is a closed question, on which science has

pronounced its final word. It might be that every one of the roads lesstravelled contributes to global obesity; it might be that some do in some places

and not in others. The openness of the issue makes it clear that obesity isnta

simple school physics experiment.


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We are increasingly understanding that attributing

obesity to personal responsibility is very simplistic

This is the theme of perhaps the most epic of the alternative theories of obesity,

put forward by Jonathan C K Wells. As I understand his view, obesity is like

poverty, or financial booms and busts, or war a large-scale development that

no one deliberately intends, but which emerges out of the millions of separate

acts that together make human history. His model suggests that the best Russiannovelist to invoke when thinking about obesity isnt Dostoyevsky, with his self-

punishing anguish, but Leo Tolstoy, with his vast perspective on the forces of

history.

In Wellss theory, the claim that individual choice drives worldwide weight

gain is an illusion like the illusion that individuals can captain their fates

independent of history. In reality, Tolstoy wrote at the end ofWar and

Peace (1869), we are moved by social forces we do not perceive, just as the

Earth moves through space, driven by physical forces we do not feel. Such is

the tenor of Wellss explanation for modern obesity. Its root cause, he proposed

last year in theAmerican Journal of Human Biology, is nothing less than the

history of capitalism.

I will paraphrase Wellss intricate argument (the only one Ive ever read that

references both receptor pathways for leptin and data on the size of the Indian

economy in the 18th century). It is a saga spanning many generations. Let's start

with a poor farmer growing food crops in a poor country in Africa or Asia. In a

capitalistic quest for new markets and cheap materials and labour, Europeans

take control of the economy in the late 18th or early 19th century. With taxes,

fees and sometimes violent repression, their new system strongly encourages

the farmer and his neighbours to stop growing their own food and start

cultivating some more marketable commodity instead coffee for export,

perhaps. Now that they arent growing food, the farmers must buy it. But since

everyone is out to maximise profit, those who purchase the coffee crop strive to

pay as little as possible, and so the farmers go hungry. Years later, when the

farmers children go to work in factories, they confront the same logic: they too

are paid as little as possible for their labour. By changing the farming system,

capitalism first removes traditional protections against starvation, and then

pushes many previously self-sufficient people into an economic niche where

they aren't paid enough to eat well.

Eighty years later, the farmers descendants have risen out of the ranks of the

poor and joined the fast-growing ranks of the worlds 21st-century middle-

class consumers, thanks to globalisation and outsourcing. Capitalism welcomes

them: these descendants are now prime targets to live the obesogenic life (the

chemicals, the stress, the air conditioning, the elevators-instead-of-stairs) and

to buy the kinds of foods and beverages that are metabolic disturbers.

But thats not the worst of it. As Ive mentioned, the human bodys response toits nutrition can last a lifetime, and even be passed on to the next generation. If

you or your parents or their parents were undernourished, youre more

likely to become obese in a food-rich environment. Moreover, obese people,

when they have children, pass on changes in metabolism that can predispose


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the nextgeneration to obesity as well. Like the children of underfed people, the

children of the overfed have their metabolism set in ways that tend to promote

obesity. This means that a past ofundernutrition, combined with a present

ofovernutrition, is an obesity trap.

Wells memorably calls this double-bind the metabolic ghetto, and you cant

escape it just by turning poor people into middle-class consumers: that turn to

prosperity is precisely what triggers the trap. Obesity, he writes, likeundernutrition, is thus fundamentally a state of malnutrition, in each case

promoted by powerful profit-led manipulations of the global supply and quality

of food.

The trap is deeper than that, however. The unifying logic of capitalism, Wells

continues, requires that food companies seek immediate profit and long-term

success, and their optimal strategy for that involves encouraging people to

choose foods that are most profitable to produce and sell both at the

behavioural level, through advertising, price manipulations and restriction of

choice, and at the physiological level through the enhancement of addictiveproperties of foods (by which he means those sugars and fats that make

metabolic disturber foods so habit-forming). In short, Wells told me via

email, We need to understand that we have not yet grasped how to address this

situation, but we are increasingly understanding that attributing obesity to

personal responsibility is very simplistic. Rather than harping on personal

responsibility so much, Wells believes, we should be looking at the global

economic system, seeking to reform it so that it promotes access to nutritious

food for everyone. That is, admittedly, a tall order. But the argument is worth

considering, if only as a bracing critique of our individual-responsibility

ideology of fatness.

hat are we onlookers non-activists, non-scientists to

make of these scientific debates? One possible response, of

course, is to decide that no obesity policy is possible,

because science is undecided. But this is a morons

answer: science is never completely decided; it is always in a state of change

and self-questioning, and it offers no final answers. There is never a moment in

science when all doubts are gone and all questions settled, which is why wait

for settled science is an argument advanced by industries that want no

interference with their status quo.

Making policy, as the British politician Wayland Young once said, is the art of

taking good decisions on insufficient evidence. Faced with signs of a massive

public-health crisis in the making, governments are right to seek to

dosomething, using the best information that science can render, in the full

knowledge that science will have different information to offer in 10 or 20

years.

The issue, rather, is whether the government policies and corporate business

plans are in fact doing their best with the evidence they already have. Does the

science justify assuming that obesity is a simple matter of individuals letting

themselves eat too much? To the extent that it is, policies such as Japans

mandatory waist-measuring and products like the Hapifork will be effective. If,


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on the other hand, there is more to obesity than simple thermodynamics, some of

the billions spent on individual-centred policies and products may be being

wasted. Time, in that case, to try some alternative policies based on alternative

theories, and see how they fare.

Todays priests of obesity prevention proclaim with confidence and authority

that they have the answer. So did Bruno Bettelheim in the 1950s, when he

blamed autism on mothers with cold personalities. So, for that matter, did theclerics of 18th-century Lisbon, who blamed earthquakes on peoples sinful

ways. History is not kind to authorities whose mistaken dogmas cause

unnecessary suffering and pointless effort, while ignoring the real causes of

trouble. And the history of the obesity era has yet to be written.

Published on 19 June 2013

Article topics:Food,Health,Individualism
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david berreby – the obesity era-1

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