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

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.

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

  1. Ted Hutchinson 7 December 2009 at 10:27 pm #

    When I read about this study I was perturbed by the interpretation that our future may be set in stone by our genes. It implies there is nothing whatsoever we can do to change those genes or prevent our predestined fate.

    However, I think in practice some of the more recently modified genes can be modified back again to the norm.

    Here is an example of how high omega 3 input can modify the predisposition to obesity.
    Developmental Programming of Renal Glucocorticoid Sensitivity and the Renin-Angiotensin System

    and another showing the mechanism by which omega 6 modulates the genes that promote inflammation.
    Dietary Fats Omega-6 and Omega-3: Impact Your Inflammation Gene

    I’m sure right now we are imprinting the next generation with the consequences of maternal low vitamin D status, low omega 3 status and low magnesium levels apart from the adverse consequences of obesity. We can do something about all these scenarios.

  2. Beth 7 December 2009 at 10:53 pm #

    Here in the states, we have a daytime talk show that gets its ratings thru trashy subjects (like “Is My Man the Father of My Sister’s Baby?”). One of their favorite subjects is very overweight toddlers. It’s heartbreaking!

    While I’m a big believer of the problems with the standard American diet, it seems very clear that there is something else going on with a 5-yr-old who weighs over 200 lbs. When I saw this study this AM, I was hopeful for these kids’ parents.

    Now that said, the report I saw suggested this level of genetic issue was fairly rare. I’m leaning towards believing that diet composition is the real villain here.

    BTW, here’s a link to the report of a study that Lustig referred to in his Sugar: The Bitter Truth video:


    Key stat: “From 1980 to 2001, the increase in overweight infants ballooned 74 percent.”

    Now there could be something prenatally going on with the mother’s diet as Jamie suggests, or maybe it has to do with the sugar in formula as Lustig suggests. One thing it isn’t is gluttonous and/or lazy infants!!

  3. Methuselah - Pay Now Live Later 8 December 2009 at 1:12 am #

    When I read stories about genetic causes of obesity or overeating, I always note the absence of discussion about WHAT is being eaten. It is my belief that the genes in question affect the ability of people to regulate their appetite with a standard western diet – a diet which is high in carbohydrate, which has been implicated in appetite regulation disruption. I wonder what the results would look like if we controlled for diet? I imagine that to at least some extent, maybe to a large extent, the effect of this gene would be mitigated by the consumption of a hunter gatherer diet.

  4. Jamie 8 December 2009 at 2:46 am #


    This might be a case of epigenetics at work. I think there is sufficient evidence about now to suggest a mechanism whereby the diet & lifestyle of parents are effectively pre-programming their kids for obesity right from the gun.

    Rather than blaming the child for being fat & judging them, perhaps the judgement should be reserved for their parents. Living a lifestyle that is potentially flicking switches on genes coding for obesity, in an environment conducive to obesity anyway, and expecting any offspring to not suffer the consequences is fairly irresponsible I would suggest.

    It is very interesting when I do talks on this very topic, to see the possum in the headlights expression on the faces of parents or potential parents when you explain to them the preconception implications of their lifestyle choices & the potential outcomes for their children. Nobody wants to knowlingly breed defective kids, but then few young adults want to have to factor that into their life when they are abusing alcohol, drugs, food, & living a sedentary lifestyle.

    An interesting topic indeed.

  5. getfatgetthin 8 December 2009 at 1:56 pm #

    Obesity and diabetes (T2DM) are close to my heart; I carry too much weight, and have struggled to regulate BG. That said, I have, to date, successfully avoided recommendation of drug prescriptions by my GP. ….

    The trend towards weight gain is readily observable …
    … crude maths extrapolates the diagnoses of 7 million cases of T2DM in the period 2009 – 2015.

    ..I’m sorry, IMHO one doesn’t get to 32 stone without ingesting more food than is good for you. ..

    I’m so with Ted. I believe enlightenment lies in the development of an ‘inflammation hypothesis’ … … …Put simply, the problem is a breakdown in (physiological) regulation, (.. hmmn.)

    The scandal of our time is …

    The trouble with attributing causality to genes is adoption of the view, ‘I’m fat because of my genes’, or the false hope of a satisfactory and consequence free genetically engineered intervention or therapy. That said, what passes between our lips will determine genetic expression. Inflammation will determine genetic expression (in concurrence with Jamies’ view on Epigenetics).

    … Feeding kids toast spread with margarine looks like a bad start to life.

    What is it that stands in the way of mainstream appreciation and progress?
    Might, the problem be a breakdown in satisfactory regulation?

    (Read more)

  6. Peter Silverman 8 December 2009 at 2:49 pm #

    Reminds me of the photo in Gary Taubes’ book where the woman is emaciated from the waist up but fat from the waist down. Can’t be about calories for her.

  7. Anna Salvesen 8 December 2009 at 11:38 pm #

    Something about modern life is switching on or off genes in many of us.

    I can see it in my own family. My grandmother, born in 1919, though poor, had an excellent homegrown farm diet , but when she grew up, she “escaped” from that hard life and adopted “easy” industrial food as much as she could. My maternal grandfather died at at 50 in 1959 from heart disease, so of course everyone in the family jumped on the American Heart Association’s bandwagon and cut their naturally saturated fats, poured on the vegetable oils, bumped up their carbs, and gravitated toward anything with a “heart healthy” label.

    No one in my family feared diabetes; it simply wasn’t in the family history. Forty years later though, diabetes shows up with a bang. My sister barely passed her GTTs during her two pregnancies; her babies were both large (suspicious of GDM) and her tests probably wouldn’t have passed the tighter test range now. In 1998, to my great surprise (and everyone else’s) I was diagnosed with gestational diabetes that turns out probably not to be not gestational but chronic & permanent Impaired Glucose Tolerance; I was only about 5-10 pounds overweight (BMI 23.5 or so). The same year my maternal uncle and cousin (his son, like me, born in early 60s), were diagnosed with Type 2 diabetes; and a few years ago, my mom, near the end of her 25+ year night-shift registered nursing career (very Vit D and sleep deficient!!!), was diagnosed with Type 2 diabetes.

    The only explanation I can come up with is that for something about life since 1940 has switched on one or more of our genes and messed with our glucose regulation.

  8. Angie 11 December 2009 at 8:52 pm #

    The fundamental flaws in the overeating/underexercising model are laid out clearly in Gary Taubes ‘Good Calories, Bad Calories’, and whilst there are clearly genetic variations in the propensity to accumulate adipose tissue, these variations would be of negligible significance in a society without refined carbohydrates.

    The ghastly low fat-high carb public health experiment conducted at all our expense, over the last several decades, (and with increasing impetus in the last thirty), along with the galloping incursion of sugar (or HFCS) into manufactured foods is responsible. I am with Taubes on this – the principle of Occam’s razor applies. The mechanisms are pretty clear, and the need to go searching for other explanations just so many Ptolomeic loops.

  9. Hilda Glickman 11 December 2009 at 9:21 pm #

    Anna, I was interested to read about the change to a ‘healthy’ diet. I am afraid that you got it wrong, Vegetable fats such as sunflower oil etc (olove oil OK) are worse than sat fat and processed so much that they are nothing like anything found in anture. A high carb diet is not the way to reduce heart disease either. See Dr Myhill’s site on the web for Paleo diet.

  10. Jill H 16 December 2009 at 1:31 am #

    Much of the food advertised on television and aisle upon aisle of foods in supermarkets is not there for the health of our children but more driven by profits in the food industry. There has been much research carried out that shows that British school children are eating a diet high in the wrong kinds of fats and sugar – full of processed simple carbohydrates. It can be argued that in evolutionary terms in a very short space of time our food supply has fundamentally changed. Nutritionists like Caroline Walker campaigned tirelessly for an improvement in childrens’ quality of food. She wrote ‘Good food is part of the joy of life. Good food, farmed, grown and made well, creates beautiful landscapes, respects wildlife and encourages pride in work. The culinary arts are part of civilization’. I do believe there is much that we can do to help halt this obesity epidemic in children. A start might be to get food manufacturers to behave more responsibility. A survey by the Food commission found that during 22 hours of advertising, of the 219 ads surveyed only one was for fruit or veg. The rest were dominated be pre-sweetened cereals, confectionary, fast food, soft drinks, ice cream, lollies and savoury snacks.

  11. Margaret Wilde 17 December 2009 at 11:24 pm #

    All that is normally necessary to lose weight is to eat less salt/sodium. This is a drug-free, cost-free course of action. There are no hunger pangs and no adverse side-effects. It requires no visits to the doctor or to the gym and it WILL work.

    Lose weight by eating less salt! – Go on! – Try it!

  12. Mack Parnell - Personal Trainer (London) 14 June 2010 at 10:54 am #

    If you look back at statistics over the years of how much bigger the average person is now and how much more of a problem obesity is now than it was 50 or even 100 years ago this makes me think that genes dont play much of a part in it as is talked about here. I really think the major problem is the food we constantly have on offer and the massive melting pot of mixed messages we have out there of what is making us fat. If you were to do a completely healthy shop in my local supermarket you would only use about 30 percent of the food isles. The rest are just crammed full suggary, fatty, salty and sweetner full foods. This makes it very tricky to leave the shop without anything unhealthy especially if you are uneducated about food.

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