Obesity: Five Take-Home Messages That Might Challenge Your Assumptions

Last fall I attended the Cleveland Clinic’s 10th Annual Obesity Summit, a conference I like to go to whenever I can. During the event, I live tweeted snippets from various expert speakers. Given the complex nature of overweight/obesity,* I thought it might be interesting to expound on some of them.

  1. Preventable Chronic Disease

Notice the above tweet does not say “50% of obese U.S. adults.” Regardless of our number on the scale, half of us could better our health by improving our diet and physical activity, no medication required. For example:

  • We could lower our risk of type 2 diabetes by eating less sugar and more whole grains and vegetables.
  • We could increase our bone density by doing weight-bearing exercise and eating foods rich in calcium and vitamin D.
  • We could lessen cell damage that leads to cancer, heart disease, and Alzheimer’s by eating foods rich in antioxidants like berries, beans, and apples.
  1. Best Diet Out There?

The speaker’s point was not to say the Mediterranean Diet is the best diet for weight loss and weight maintenance. Rather his point was that no matter how effective a diet is, if we can’t adhere to it—for example, a diet that’s too restrictive—we won’t maintain weight loss. But since the Mediterranean Diet is tasty and easy to stick with, it’s a good “best diet” candidate. Plus, studies support its heart-healthy benefits.

  1. Hormonal-Induced Resistance to Weight Loss

That complicates the equation of calories in minus calories out, doesn’t it? Our bodies do not like change. They want to maintain homeostasis. So when we lose weight, our bodies go into preservation mode and try to gain it back, making continued progress that much more difficult.

Furthermore, when we reach a certain BMI through dieting, we may not be able to eat as many calories as someone who’s always been at that BMI.

  1. Obesity and Infection

Research animals infected with adenovirus-36 (Ad36) had a 60-100% increase in body fat, even though they ate the same amount as animals not given the virus. In another study, 30% of obese people had antibodies to Ad36 virus compared to 11% of normal-weight people.

This shows just how complex the issue can be, which leads nicely to the final tweet:

  1. Obesity Is a Multifactorial Disorder

We need to resist the simplistic assumption that the individual alone is responsible for overweight/obesity or that weight loss is as simple as eating less and exercising more. In the past 30 years, the obesity rate has more than doubled in adults and children. It has quadrupled in adolescents.

People didn’t suddenly lose their willpower since the 1980s. Certainly we’re more sedentary than we used to be, a product of both our built environment and our increased reliance on technology. We’re also bombarded with addictive food high in fat, sugar and salt, and we cook less of our meals at home. Plus, our portion sizes have ballooned, along with the number of advertisements that entice us.

But research suggests there is even more at play, including genetic, hormonal, infectious, social, and even chemical factors (e.g., BPA).

One thing is clear, however: a multifactorial problem requires multilevel interventions. Only when we target all the forces behind obesity will we see any lasting change. Yes, the responsibility ultimately falls on the individual, but to ignore these other forces is to invite failure.

After all, how has it been working for us so far?

I created this word cloud through WordItOut.com.

Word cloud created by me at WordItOut.com.

*Note: I use the term “obesity” in my writings because it is the medical word for the condition and its meaning tends to be universally understood. It is not, however, my favorite word—I find it clinical and rather cold. My apologies to those who feel the same.

*     *     *

standing color cropped tiny for blog postsCarrie Rubin is a medical thriller author with a background in medicine and public health. For full bio and a list of her books, click here.

245 Responses to “Obesity: Five Take-Home Messages That Might Challenge Your Assumptions”

  1. joey

    Surely this is true. I for one, know many women who never exercise, eat as they please and gain NO weight. On the other hand, I know women who eat a fair diet and actually participate in triathlons but stay thick. There has to be much more to it than in and out. Granted, in and out is necessary, but there’s more to it.
    I tend toward clean eating.
    My id wants soda all day, but I just let her have the one. Maybe 12 oz, maybe 32, but just the one. It breaks her heart, but she’s trying. lol

    Like

    • Carrie Rubin

      My college son likes soda too and drinks more than I wish he would. I tried. Sigh. But he drinks diet without the sugar, so at least there’s that.

      At the root it’s calories in – calories out = weight. The problem is, all these other forces factor into the equation, making it a more complex math problem than we thought!

      Liked by 1 person

      • joey

        The fake sugar gives me chronic headaches and migraines as well as muscle aches. I thought I had a flare, and it turned out to be Diet Pepsi. 😦 I’m happier now, but not as thin. Thank goodness for seltzer! 🙂

        Like

        • Carrie Rubin

          Yes, the sugar substitutes have their own issues. Too much of those have been linked to ill health too. Guess it gets back to everything in moderation.

          Liked by 1 person

  2. jncthedc

    We share a common understanding of health and weight management. I retired from active practice in 2014 and continue to share information and strategies to contend with the various factors influencing behavior and outcomes. I don’t want to use your site to promote my writings. If you have an interest, clicking on my picture will bring you to my profile and blog site. Wishing you all the best creating greater awareness and helping people overcome the obstacles they face.

    Like

    • Carrie Rubin

      It’s nice to be able to pass on information through our writing, isn’t it? Can often reach more people that way than we do behind the scenes. Thanks so much for reading!

      Like

  3. Jilanne Hoffmann

    Other than pregnancy and the five years following, I have wandered between 125-135lbs. Pretty good for being 5’5″ and shrinking. But there is always something in the back of my head thinking about what I’ve eaten during the day and what I can “afford” to eat the rest of the day, depending on whether I’ve exercised more or less, etc. I know this is an extremely complex topic, but I do think that people tend to overestimate the calories they use during exercise and underestimate the calories they eat and drink. When my son opted to stop playing soccer in favor of other, less aerobic sports, in one year he went from being in the 50th percentile for weight and 99th percentile for height to upper 90s for both. I don’t think this is a coincidence. And once that happens, it’s hard going back. At my son’s USF baseball camp last summer, they sold piles and piles of candy to kids, ostensibly to raise extra money for the college baseball team that runs the camp (really? a private university doing this to our kids???). We won’t be paying for that camp again. Yes, we as a population, are more sedentary. Yes, processed foods are engineered to keep people eating and feel less satisfied. Yes, sugar and fat surrounds us at every store we enter. Portions have ballooned. And I often feel like I’m losing the “let’s talk about this and read the label” battle with my son. I hope a little is getting through. I hadn’t heard about ad36. It is an interesting factor and should not be ignored, but 70% of those obese animals didn’t test positive for that virus. I still go back to research about the Native Americans on the Gila River Indian reservation. Obesity and diabetes sky-rocketed when their diet and exercise levels dramatically changed within a generation. Here’s a link to a story done by CBS on the Pima. Yes, it’s from 2004, and the “thrifty gene” is being targeted. Since then, the Pima got some of their water rights back and they’re starting to grow their own food again. http://www.cbsnews.com/news/why-is-america-so-fat/

    Can you tell this is one of my hot buttons? 😀

    Like

    • Carrie Rubin

      I’m happy to know it’s someone else’s hot button too!

      Our environment is hugely responsible. Our genes haven’t changed, so the ability to store fat for future times of lean that suited us beautifully in cavemen days now only hurts us.

      “And once that happens, it’s hard going back.”—That’s so true. Just gets back to the fact that prevention is always key.

      Thanks for sharing your thoughts!

      Liked by 1 person

  4. ParentingIsFunny

    Great of you to get this info out to more people. I’ve heard a lot about this growing trend toward more and more obesity. It’s nice to see someone doing something about it by spreading more info.

    Like

    • Carrie Rubin

      Thank you. I’m trying to do my small part. It’s not that I don’t think as individuals we don’t have to take responsibility–we do; it’s that I want to make aware how difficult that task can be given our environment and these other forces. Addressing these issues will make an individual’s journey less rocky.

      Liked by 1 person

      • ParentingIsFunny

        You could do separate posts on the different risk factors in more detail. I know you’ve done that with the salt and butter content in foods and the psychological connection. That was fascinating. You mention social factors here. You could expand on that one. Just a thought, if you need more blog fodder. 🙂

        Like

  5. Sharon Yvonne

    Thanks for the information. A healthy lifestyle is alway on my mind. I want to live a long and active life. 🙂

    I look forward to more of you content. Following you now 🙂

    Like

  6. BunKaryudo

    I appreciate that in your post (and in Eating Bull, now that I think about it), you avoided oversimplifying the problem of obesity. You must surely be right about there being numerous causes requiring thoughtful and coordinated solutions.

    In my own case, the biggest attraction of snack foods is not really the taste so much as their convenience. I need something quick and easy I can eat while working. My BMI is still okay (24.5), but I’m worried about the direction. It keeps edging up, never down. It was 19.5 for a long time.

    Somebody suggested munching on celery while at my desk is a good idea and won’t make my hands sticky, so I’m going to try it. I just hope the crunching noise doesn’t result in angry stares from everybody else in the vicinity.

    Liked by 1 person

    • Carrie Rubin

      Crunch, crunch, crunch. “Hey, does anyone else hear that?” your colleagues will ask.

      The issue is complex for sure, and although it ultimately falls on the individual, we need to approach it from all sides. ‘Cause what we’re doing so far isn’t exactly working.

      Thank you for your kind words about Eating Bull. By the way, I’m curious, did your review ever go through (I remember you saying you submitted it from your ereader)? I ask because recently I left a review for an author directly from my ereader, and at first it didn’t show up. A couple days later when I was about to go post it directly, it did. I’m wondering if this is an Amazon glitch and if I should contact them about it. I hate to think people take the time to leave a review and then it vanishes on them. :/

      Liked by 1 person

      • BunKaryudo

        I’m not sure where my original review went, Carrie. I did spend some time trying to figure it out before, and then I got sidetracked and it, er, kind of slipped my mind. (Sorry!)

        Anyway, I have just tried writing a short test one again. This time there was a message that thanked me for my review and said it usually takes up to 48 hours for it to appear on Amazon. I don’t remember seeing that message before, so maybe that’s a good sign.

        If nothing turns up in the next day or two, I’ll get back in touch to let you know.

        Like

  7. Cathy Ulrich

    Great post, Carrie. I just finished reading “Eating Bull,” and I loved it! Very, very well done. You did a fantastic job of portraying the many complexities of overweight/obesity and the issues within the food industry, health care and social issues all within an amazing thriller.

    If I were to pick any food that I think is bad/unhealthy that I simply love – I’d say it’s French Fries. Having grown up in the South where fried food was a staple, I do love me some fries. I’m not really a big fan of sweets (not even sweet tea 🙂 ), and I probably go to a fast food restaurant for lunch twice a year, so I have very little exposure to them, but I do allow myself a small order from time-to-time. And when I do, I enjoy them and then move on.

    My husband and I cook fresh food at home most of the time – dining out for a “date night’ usually once a week. And I make enough for those dinners to have as lunch leftovers. And we cook a lot of fresh vegetables and meats. So, I don’t really even have to think much about weight loss.

    I think as health care workers, we have a responsibility to educate whenever we can without sounding preachy. You do a good job of this, as do I with my patients. It’s a key piece of the puzzle. Oh and another thing: I read somewhere that medical students get about four hours of education about diet during their entire medical training. Now THAT’s a place where things need to change…

    Like

    • Carrie Rubin

      Oh yes, med students need more nutritional and weight-management training then they get. It’s getting better, but there’s still a long way to go. It’s one thing to learn how to treat the health consequences of obesity, it’s another to know how to properly approach the condition overall.

      I’m the opposite of you–I enjoy a treat, but I can pass on fried food. But everything in moderation, right? And you live in one of the healthiest states out there. Coloradans are definitely doing something right!

      And thank you so much for your kind words about my book! I appreciate you letting me know, and I’m so pleased you enjoyed it. Parts with Darwin weren’t easy to write–they go against what I’m saying here–but though he made me cringe, I wanted to present all sides, because some people do think like him (but luckily not to his extreme!). Thank you again! Have a great day. 🙂

      Like

  8. aFrankAngle

    Such a complex issue and you’ve shown the dangers of generalizations and assumptions while providing useful clarifications. For me … sweets and snacks have a magnetic effect.

    Like

    • Carrie Rubin

      Thank you. I like my daily sweet too, but so far I’m able to keep things in moderation. If that stops, then I guess I’ll have to get the goodies out of the house.

      Hope you’re having a nice blog ‘break.’ Spring is finally here in Ohio. Yay!

      Liked by 1 person

  9. Letizia

    The baguette calls to me and it’s hard to ignore but I try to ignore it as often as possible 🙂

    Like

    • Carrie Rubin

      I hear you. I so wanted a fresh, doughy baguette from my market last night with dinner, but I held back. I know I’d eat too much of it. Guess my post inspired me too. 😉

      Liked by 1 person

  10. Daniel Nest

    Definitely sweets for me as well. I eat pretty healthy stuff otherwise, but I do have a sweet tooth, so saying no to cookies and ice cream is a challenge. Thanks for sharing more about the obesity factors – it’s never as clear-cut as people would like to believe!

    Like

    • Carrie Rubin

      No, it isn’t, is it? And if it was as simple as telling people just to eat less, we’d all be skinny minnies. Clearly that method isn’t working, so we need to up our game.

      Now, did somebody say ice cream?…

      Liked by 1 person

  11. roughwighting

    I wish everyone could read this post. I’m tweeting it, for sure. People want a ‘one-answer’ solution, like ‘people are obese because they eat too much.’ But it’s so much more than that. I believe your book Eating Bull showed these multi-facets to the problem.
    Growing up, my mom would never ever consider taking us to McDonalds or any fast food place. But they weren’t as prevalent as they became in the 70s and 80s. Now, I feel sorry for kids who are raised on fast food and have no choice about how their bodies will react.
    Me? I will not (CAN not because I WILL not) give up sugar. So I try and contain it to one piece of chocolate or cookie a day. :-0

    Like

    • Carrie Rubin

      “Now, I feel sorry for kids who are raised on fast food and have no choice about how their bodies will react.”—Yes, so true, because once the weight is gained, it becomes very difficult to get it off. Best to prevent it in the first place, even as early as during pregnancy (gestational diabetes in the mother can predispose an infant to obesity). It’s a complex issue for sure, and while it’s so easy to tell people just to eat less, if that worked, we wouldn’t be where we are now! Clearly we need to approach it system-wide.

      Thank you for your kind words and for sharing the post! And I’m with you–haven’t been able to give up my daily treat (and not sure I want to). But I can eat it in moderation so so far, so good. 🙂

      Liked by 1 person

  12. Gastradamus

    Everything you said about obesity in this article is interesting, I’m not sure if I agree with it all, but its a interesting perspective. I would really like someone with your background to check out my stories at gastradamus. I explore topics that need to be stood up for, from one writer to another, stay in shape.

    Like

  13. Sue Slaght

    Carrie this certainly is a multi-faceted issue. Now that we have fast food laden with salt, fat and sugar can the clock ever be turned back? Or will it be a continual marching forward of increasing obesity numbers? M0re questions than answers I think.

    Like

    • Carrie Rubin

      Good question. Some of the food industries are making changes–trying to lower the fat, sugar, salt content–but we’ve become so used to the tastes, it will be a challenge. Plus, they’re not exactly going about it speedily. Without regulation, they don’t have to do it. At this point, it’s voluntary. I hope they do the right thing.

      Liked by 1 person

  14. Smaktakula

    Well-said. I have mixed feelings on this issue. I know that there are so many factors that help to determine a person’s size that are completely beyond the individual’s control. As you say, it isn’t the individual’s decisions alone that make him fat, but at the end of the day it’s his responsibility.

    Life doesn’t deal out its cards evenly. Some kids are born to palaces in Dubai and other kids in a Kinshasa slum. Some people are brilliant, others are freakin’ idiots. Body size is like that, too. And it’s right that we should, as we do with poverty and education, strive to make our country (and the world, where we can) into a healthier place. Until we achieve those things, however, we have to work with what we’re given.

    Overcoming our limitations is what makes humans really great, I think. Knowing that James Earl Jones overcame a stammer to speak the way he does really inspires me. That lovable little runt Muggsy Bogues (5’3″!) played in the NBA for a zillion seasons. Overcoming fatness is a similar, day-after-day victory.

    Where maybe you and I disagree a little in our thinking is that I think we’ve become a little too squishy about overweight people. They’ve (or perhaps ‘we’ve’, since I’m not Mr. Slim & Trim myself) become almost like a protected class. Yet at the same time more and more health professionals are sounding the alarm about the dangers of obesity. You’ll note how society counters many other perceived ills with shame. I’m not a fan of shaming anyone, but maybe if we were just a little less hands off “you’re great just the way you are!”, I think that would be better.

    Again, though, I found this very enlightening. Especially about the chubby virus. Didn’t know it was catching.

    Like

    • Carrie Rubin

      Great perspectives, as always. I don’t think we disagree too much on the issue. I still think weight loss is the goal. There are too many health consequences for it not to be. But people are learning that unless one accepts themselves first, it’s difficult to make lasting changes. So instead of keeping on doing the same things over and over without getting different results (insanity definition, right?), we probably need some new perspectives from which to approach it.

      But it ultimately does indeed fall on the individual, and you’re right–it’s a day-after-day victory (and trial). But there is much we can do to help people reach their goal. The Cleveland Clinic’s approach has been amazing (I’m not affiliated with them–just attend some of their conferences). They’ve gotten rid of all sugar-sweetened beverages in-house and serve healthy meals. That plus the wellness activities for their employees has resulted in impressive weight loss among their staff. They’ve approached the problem system-wide with great success. That’s the focus of public health–approach an issue from a whole rather than just the individual. As both a clinician and a public health proponent, I’ve been able to deal with it from both viewpoints, which is a plus.

      Thank you for your thoughtful response!

      Like

  15. Katie

    I am unable to recall the last time I went a day without a square of a chocolate bar. I have started to eat it with breakfast (great with coffee!) instead of dinner. Since moving to the 85% dark, I have rationalized that it is now a health food :).

    Like

    • Carrie Rubin

      It’s pretty much a combination of the reasons in bold there, especially our obesogenic environment. Food everywhere. Even impulse food buys at the hardware store checkout. It’s an interaction of all these factors that has spiked the numbers, including the fact we don’t move around like we used to, thanks to technology.

      Like

        • Carrie Rubin

          Very different. Think back when you were a child–there were not king-sized candy bars and giant sodas everywhere you turned. And that’s just part of it. Suburban sprawl has led to poor walkability and bikeability and made residential areas far from business areas so that a car is the only option. There’s so much more, I could write a thesis on it (and I have 🙂 ), but that’s a start.

          Like

  16. NancyTex

    This is clearly a more complex issue than just: move more and eat less. Thank you for shedding light on just how many factors contribute to this epidemic.

    Like

    • Carrie Rubin

      Thanks for reading, Nancy. I know you’ve done your share of work getting healthy and fit. And with a hectic schedule to boot. Thanks for the share on Twitter!

      Liked by 1 person

  17. My Inner Chick

    As always,
    thank you for this MOST important, life-changing education, Carrie.
    I, for one, need to take better care of myself.

    Like

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