By GINA KOLATA

Published: June 8, 2004

Ask anyone: Americans are getting fatter and fatter. Advertising campaigns say they are. So do federal officials and the scientists they rely on.

But Dr. Jeffrey Friedman, an obesity researcher at Rockefeller University, argues that contrary to popular opinion, national data do not show Americans growing uniformly fatter.

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Instead, he says, the statistics demonstrate clearly that while the very fat are getting fatter, thinner people have remained pretty much the same.

Let it be said that Dr. Friedman, a Howard Hughes Medical Institute investigator and the discoverer of the gene for leptin, a hormone released by fat cells, is not fat. He is tall and gangly, with the rumpled look of an academic scientist.

As an obesity researcher, he might be expected to endorse the prevailing view that obesity in this country is out of control. But Dr. Friedman said he was outraged by the acceptance of what he sees as a hurtful myth, one that encourages people to believe that if you are fat, it is your fault.

The obesity arena "is so political, so rife with misinformation and disinformation," he said.

Dr. Friedman points to careful statistical analyses of the changes in Americans' body weights from 1991 to today by Dr. Katherine Flegal of the National Center for Health Statistics. At the lower end of the weight distribution, nothing has changed, not even by a few pounds. As you move up the scale, a few additional pounds start to show up, but even at midrange, people today are just 6 or 7 pounds heavier than they were in 1991. Only with the massively obese, the very top of the distribution, is there a substantial increase in weight, about 25 to 30 pounds, Dr. Flegal reported.

As a result, the curve of body weight has been pulled slightly to the right, with more people shifting up a few pounds to cross the line that experts use to divide normal from obese. In 1991, 23 percent of Americans fell into the obese category; now 31 percent do, a more than 30 percent increase. But the average weight of the population has increased by just 7 to 10 pounds since 1991.

Dr. Friedman gave an analogy: "Imagine the average I.Q. was 100 and that 5 percent of the population had an I.Q. of 140 or greater and were considered to be geniuses. Now let's say that education improves and the average I.Q. increases to 107 and 10 percent of the population has an I.Q. of above 140.

"You could present the data in two ways," he said. "You could say that the average I.Q. is up seven points or you could say that because of improved education the number of geniuses has doubled."

He added, "The whole obesity debate is equivalent to drawing conclusions about national education programs by saying that the number of geniuses has doubled."

Not everyone agrees.

"It' s one thing to talk about statistics and another to talk about what's happening to individuals," said Dr. Marion Nestle, a professor of nutrition, food studies and public health at New York University. "Everyone notices that there are more overweight people now."

Dr. Friedman, however, begs to differ. The statistics let scientists get beyond impressions and focus on the evidence.

He is, in a way, an unexpected figure to insert himself into the highly charged politics of obesity. He left clinical medicine in 1980 after discovering that his true passion was the laboratory. By 1981, he had begun his scientific career, and within a few years he was taking on what seemed like an impossibly onerous task, finding a gene whose absence made mice grow massively obese.

He keeps mementos from those days. He still has the purchase order, from December 1986, for the first batch of mice he used for the experiment. Hanging on his office wall is a framed strip of white paper with black blotches, the data that on Sunday morning, May 8, 1994, revealed he had found the gene that he named leptin.

"To me, those data are as beautiful as the Mona Lisa," he said.

Over the years, Dr. Friedman says, he has watched the scientific data accumulate to show that body weight, in animals and humans, is not under conscious control. Body weight, he says, is genetically determined, as tightly regulated as height. Genes control not only how much you eat but also the metabolic rate at which you burn food. When it comes to eating, free will is an illusion.

"People can exert a level of control over their weight within a 10-, perhaps a 15-pound range," Dr. Friedman said. But expecting an obese person to decide to simply eat less and exercise more to get below the obesity range, below the overweight range? It virtually never happens, he said. Any weight that is lost almost invariably comes right back.

The same goes for gaining weight in general, Dr. Friedman argued. A person who has the genes to be thin is not going to get fat because portion sizes increase. It makes no scientific sense, he said.

But isn't it true that we can decide to eat or not, choosing to skip dinner, say, or pass up dessert? Isn't that free will? Not really, Dr. Friedman said. The control mechanisms for body weight operate over months, even years, not day to day or meal to meal.

"People live in the moment," he said. "They lose weight over the short term and say that they have exercised willpower," but over the long term, the body's intrinsic controls win out. And just as willpower cannot make fat people thin, a lack of it does not make thin people fat.

No one, he says, can consciously calibrate their food intake as precisely as the body does naturally. Most people's weights remain steady, within about 10 pounds, year in and year out. But when people count calories, they typically err by about 10 percent. For someone who eats 750,000 calories in a year, that 10 percent error would add up to 75,000 calories, or about 25 pounds.

Obesity, Dr. Friedman says, is a problem; fat people are derided and they have health risks like diabetes and heart disease. But it does no one any good to exaggerate the extent of obesity or to blame the obese for being fat.

"Before calling it an epidemic, people really need to understand what the numbers do and don't say," he said.

http://www.nytimes.com/2004/06/08/h...HJOTaYVwujG7OWQ

To me 7 to 10 lbs. weight gain for a population is huge.

Does the doctor believe that the human genome has changed since 1991 to cause the weight gain?

I'd say it hasn't changed, but what we're eating has changed a bit. Plus the population is aging too, you tend to put on weight as you age.

I found that article very refreshing. It's nice to hear that some people are realizing that fat people aren't just undisciplined, lazy slobs. There's something metabolic happening that isn't entirely under our control. Or at least, it isn't according to current wisdom.

I believe the case he is trying to make is that possible degree of obesity is always determined by genes. I think his words are being twisted around to make it sound as if he is trying to say obesity is an immutable condition/state, like hair color/texture when this is probably not what he meant. If this is what he is trying to say, then he must also be saying that obesity is either a) a genetic defect which needs a cure like any other congenial defect, or b) a harmless state of the body to be in. Obviously b can't be true since any objective person can see obese weight negatively impacts health. Therefore, he must either be of the view that obesity is a genetic/birth defect which there is no known medicine or treatment for, or that obesity is a genetic/birth defect which will or will not become manifest depending on the sort of lifestyle and environment taken on by those who possess the genes.

Personally, I think he believes the latter. The case he is probably trying to make is that morbid obesity is an exclusive condition. Only those who have the genetic potential to develop a condition which results in the symptom of obesity can develop it. If we follow this line of thought, then the logical conclusion is that the frenzy over the "obesity epidemic" is foolish. If only those with the genes to become very obese can become very obese, there is no epidemic looming on the horizon and we've worked ourselves up over nothing.

I don't think he is trying to say that it if you have "obese genes" you are destined to become obese. If it were true that weight was not at least partially influenced by environment, how would it be possible for the nations collective weights to change with the lifestyle of the decade? If weight wasn't at all effected by choice and environment, then obviously this would not be possible. Basically all he is trying to do is debunk the myth that obesity is exclusively a matter of willpower. People look at obese people and see disgusting gluttons who eat more than they need, when consciously desiring to overconsume really isn't part of the equation. Trust me, as someone who has been obese, the food you eat feels like you are eating "just enough", even though to everyone else it may appear that you eat a lot.

He believes one's long term pattern of eating & weight are regulated by the endocrine system. I tend to *completely* agree with this. This may deceptively sound as if he is trying to say one has no choice what so ever in whether or not become obese & their weight. I don't think he believes or is saying this. If we lived in a vacuum it might be true, however our respective endocrine systems have to interact with the environment. Therefore, environment must to at least some degree influence our weight.
Any decent scientist familiar with the concept of variability knows the difference between a potential outcome and a destined one. There are traits partially influenced by environment, partially by genetic potential (such as possible hair length or possible fat weight or possible muscle tone) and then there are traits which are exclusively determined by genes and are your genetic destiny (an immutable characteristic such as race or sex which is completely uninfluenced by environment falls under this category).

The difference between the two classifications is whether or not a trait is responsive to & malleable by environmental variables - genes which are part of our genetic potential respond to environment, genes which determine our genetic destiny does not. No matter what environment you are in, no matter what you do, no matter how you are raised, you are always going to be the sex you were born and the race you inherited. However, depending on numerous environmental factors, your hair length, muscle tone, and weight can be different... but how that difference manifests is tightly controlled & regulated by your genetic potential.

Let me give an example. You could be born with the genetic potential to be a wonderfully gifted concert pianist. You have the genes which result in highly efficient/ integrated communication between brain hemispheres, for manual dexterity of fingers, for noticing & following complex patterns, for picking up on slight deviations of pitch & volume of sound, etc. These are all traits which are determined by genes. They are also traits which, when clustered together, give one the genetic potential to be a phenomenal classical musician. However, the genetic potential isn't enough to make you a pianist. You need to be in an environment which develops that potential. Unless you are from a young age familiarized with a piano, the potential will never come into fruition. Those who were born without the potential you had, yet exposed to the piano, won't become gifted pianists either... they might be "decent" but they never will be as good as those with a greater potential than they had could have been. Only the child with the potential AND the environment which develops that potential will become the prodigal classical pianist.

It's like that with obesity. Some people are born with the genetic potential to become obese, and some people are not. Someone without the potential will never reach the high weights that the morbidly obese do, even if they tried. Their food & weight regulation mechanisms would kick in, stopping them, and eventually they would stay around only at their highest weight potential (which, for most people, is only overweight and no where near morbid or super morbidly obese). However, for those with the genetic potential to become very obese, whether or not they fulfill this potential depends on environment.

Therefore, it seems the key to solving obesity is isolating & controlling the environmental variables which result in those predisposed fulfilling their high-weight potential. This is where the obesity research should be focused: finding out what triggers obesity and what promotes low weight. Obviously making a conscious effort to restrict energy doesn't work, as weight is regulated by hormones not will power or desire. Eventually your hormones will win. The key to beating obesity is finding out what exactly is mucking up your hormones, causing you to both retain fat, not burn fat, and desire an excessive quantity of food, and feel hungry with small amounts of food.

This is where low carb enters the picture. I believe the most common environmental variable which promotes the expression of obesity genes is a high refined carb diet. Relatively few people have the genetic potential to do well on a high carb diet, and of those who lack the potential there are some with genes which say " you will do HORRIBLY on these kinds of foods". I believe the overwhelming majority of those prone to super morbid & morbid obesity get that way only because somewhere, somehow, there is a metabolic weight-regulation feedback loop which is being damaged by the high glycemic diet. In other words, those people who do get very obese are that way because they have the genetic potential to become insulin resistant, and they are eating a diet which allows that potential to be fulfilled.
There are probably other types of genes with a different set of environmental variables, but I COMPLETELY feel that the problem of morbid & super morbid obesity is most of the time actually a problem of genetic susceptibility to having a compromised sugar metabolism.

I know this is definitely true in my case. I went from maintaining a morbidly obese weight effortlessly, to maintaining a relatively normal weight effortlessly. The only thing I controlled for was quantity of sugar. Sugar was the variable which triggered an expression of my tendency toward insulin resistance induced obesity. When the sugar is reduced, metabolic integrity is restored, and my body can once again regulate & normalize its food intake & weight. Millions of obese people share my experience, greatly reducing or curing the expression of their morbid obesity.

What confuses me is the information you get from gp and why has it changed with regard to how much you should weigh. About 8 years ago I spoke to my doctor about loosing weight, I said I wanted to be about 8 1/2 stone. I got a stern lecture from him about how that was much to little and to be healthy I should be between 91/2 and 10 1/2 stone. Move forward to 2002 I went to a new doctor who gave me a lecture about my weight saying that I should ideally weigh between 81/2 and 9 1/2 why the drop in weight ideals?

Paula, I don't know why the recommended weights dropped in the UK, but over here it's because of the insurance companies and their mortality/morbidity studies.

i agree...it's insulin resistance that does that. i think the doctor is being a bit myopic, focusing too much on the role genes play in obesity and minimizing other factors that play a larger role than he's admitting. he also arguing semantics here. should we say that the amount of obese people double or that there was a 7% increase in weight for the population of an entire nation. doesn't matter how you slice...it's appalling!

I'd say he missed the point. Most of the weight gain happened between 1970 and 1995. By 1997, North American's were pretty well cramming down all the french fries, potato chips, cakes, cookies and soft drinks they could in one day. Although Canadians only consume per capita about 60% of the amount of soft drinks Americans do, our fruit juice consumption is amost double. Yep, 6 or 7 pounds sounds right, but count 10 lbs. per decade between 1970 and 2000.

I think he needs to put the statistics book down and look around at what those numbers can mean.

If the midrange people are "only" 7-10 lbs heavier, fine, but that could be accompanied by the other diet related abnormalities such as high blood pressure, insulin resistance and diabetes, PCOS, abnormal lipid profiles, heart disease, etc. Surely he doesn't argue that we're facing increases in THOSE conditions, especially diabetes.

He's dismissing the average weight increase saying that it's only the very obese category that has significantly increased: I think that still says something about our food trends, society, etc. The basic conclusion I draw is that the thinnest people are still kind of lucky - probably just young with nicely functioning pancreases; the midrange people aren't getting away with it the way they used to, and high range people are really getting hit hard. You can argue the definition of "epidemic", but it's still something to be alarmed about.

Let's say there was a new virus running rampant. Yes, it's going to affect the people with compromise immune systems first and hardest. But that doesn't mean it should be dismissed as a skewed statistic. It would still be considered a serious problem that potentially affects everyone.

So if you look at it like that, with obesity as a symptom, it's still fair to say that we've got a problem here.

And, of course, I vehemently disagree with his assertation that you have a genetically pre-programmed weight. You have a genetically pre-programmed metabolism. The fact that there are TRENDS in weight gain prove this. If we were pre-programmed to be at a specific weight, there would be no significant increases or decreases across the generations, because we'd all weigh in the same way our parents and grandparents did. We inherited their genes, right?

ItsTheWoo, I agree with what you said, so I hope you're right about him being somewhat misquoted.

Good post, I completely agree.

I think what the doctor was mostly trying to say is that those who become very obese aren't necessarily more gluttoneous or more lacking in willpower than those who become only moderately overweight, or those who stay thin naturally. The body's weight & food intake is regulated tightly by the endocrine system. There is this myth that losing weight is all in the mind, and any time someone wants they can will themselves thin, when it is simply not true.

The sad truth is that too many people look at obese people and see someone who chooses to eat more than they need, a glutton. Obesity is looked on as a disease of choice like smoking. As someone who has been very obese, I can tell you that is not true at all. Emotional problems aside (in which over eating is intentionally taken on, and used self-destructively like food restriction), no one will eat more than their body asks for over a long term trend.

When I was fat, I felt like I was eating just enough to avoid feeling hungry or deprived. In objective reality, I was eating far too much. The reason there was a disparity between how my body responded to the food I was eating (this isn't enough!) and the amount I actually was eating (2500+ calories) was because of my genetic predisposition to sugar metabolism problems. I believe complications of insulin resistance caused my body to have no ability to perceive adequate food intake, differentiate it from excessive food intake, and had a very diminished ability to elicit catabolism from body fat. When People talk about about having "fat genes" I think what they mean is people being predisposed to having errors in the food intake & weight regulating feedback systems. Most of the time, these are errors which are exacerbated by, if not completely caused by, a high glycemic diet.

I agree we do all have the option to choose which possible genetically predetermined weight our body will be at by altering our lifestyle & environment, however when you don't have any idea how to fix what's wrong it's hard to make a change that produces a long term productive benefit. One of the reasons I never tried to restrict my food intake via dieting (before I discovered LCing) was because I knew I didn't have the "willpower" to battle my natural need for food. I would just gain it all back I thought, so I never bothered. Only on low carb is it possible for me to not be obese, and that's because carbs were the environmental catalyst triggering the expression of my inherited tendency toward metabolic abnormalities when consuming such a diet. Low carb puts me on the lower end of my genetically predetermined weight range. Even though I ate way more when I was fatter, I feel much more physically satisfied with the food I eat now. I also have no problem feeding off of my body should food be delayed, whereas before food restriction was met with hypoglycemia. Eliminating sugar from my diet straightens out my body's weight & food regulating systems.

You probably agree with all of this as you are a LCer yourself, however I think it is worth mentioning again for everyone to see. I think a lot of dieters - even low carbers - don't "get it", and buy the bunk that weight is 99% in your control. This is of course not true, and so when they don't get the results they want by eating intelligently & exercise, they do unproductive things like initiate a radical starvation diet/cheat/blame/binge cycle. I see it on this very sight every day. The difference between a woman who has a high weight of 300 pounds and a woman who has a high weight of 150 pounds when eating the same types of foods is rarely because the 300 lb woman wants to eat more than she needs relative to the 150 lb one. When environmental factors such as lifestyle & diet composition is controlled for, weight levels & food intake between people is 100% genetic.

I think its a combination of things (environmental and genetic). First off, look at the OB mouse. It gets fat in the presence of adequate food whereas the normal mouse doesn't. Why is that? Maybe the OB mouse is lacking hormones that signal the brain to stop eating because its got plenty of fat stored. Maybe the OB mouse is getting too much of a hormone that is signalling to eat. I don't think the OB mouse is a lazy, undisciplined slob whereas its skinny friend is morally superior. To associate such platitudes to mice is... well, ridiculous. Yet people do it to fat people all the time.

Now, OB mouse might be superior in a food deprived environment, but its gonna have a huge problem in any environment where food is plentiful.

So yes, I'd say that obesity in the era where we have plentiful food and not a lot of need for physical activity is a genetic problem.

I also think the doctor is saying that we are really like the OB mice. We can't control our endocrine systems through sheer will-power. It's like deciding that *you* and not your bladder will decide when you get to pee. So you decide you'll only pee once a day, while drinking oodles of water. Ummm... good luck! I think your bladder will win this war.

So, I'm betting/hoping that a certain diet can out-smart my endocrine system and the genetic issues I have with being overweight. Sure do hope so!

Why is obesity the primary focus? Obesity is only one manifestation of metabolic syndrome. The focus on obesity has caused people to think that obesity is the problem and losing weight the solution, when metabolic syndrome is the problem and lowering insulin resistance is the solution. Some people respond to insulin resistance with obesity and others do not. How an individual responds to insulin resistance has a genetic component. Some are programmed to respond with obesity, others are not. The point is that all the responses to metabolic syndrome are dangerous, and all are avoidable through controlling insulin resistance by low carbohydrate eating.

Some Asian doctors, for example, have complained that the definition of obesity should be lowered for people of Asian descent since they tend not to respond to insulin resistance with morbid obesity. This tendency has lulled people into believing that because they are not obese, they don’t have a problem with metabolic syndrome, when, in fact type II diabetes is pandemic in China.

Dr. Friedman is an obesity researcher, not a metabolic syndrome researcher. He’s looking at the problem through a particular lens and is ignoring what his lens does not allow him to see.

Ceberezin, you make good points. I (Caucasian) am the adoptive mother of a Korean son - he's slim, muscular, and I'm sure eats a horrible diet away at college. His LDL is sky-hi, triglycerides low - I don't know what to make of this.

Is the pandemic nature of China's type II diabetes a new development? Surely our fast food hasn't penetrated terribly far there. Is it the rice?

Thanks for your comments.

Minna

Your son is young, so his insulin resistance is still probably low despite a poor diet. But insulin resistance catches up with all of us in equally dangerous ways, whether that is obesity or type II diabetes. I try to convince my college age son to limit his carbs to 100 gms/day, but with little effect (Aw Dad...there you go again!).

My information about China came from a letter to the New England Journal of Medicine several years ago. It did blame the prevalence of metabolic syndrome on the rice based diet. Type II diabetes is hardly new there, but only now getting noticed. On a recent trip to India, I was shocked to learn that India, with its primarily vegan diet, has the highest incidence of heart disease per capita of any country. Everywhere I went in India, I saw people injecting themselves with insulin.

Woo, you are a beautiful and intelligent person!

Gaea, how I wish that I had made that first post. What a great job!

I think I love you!

And I also really appreciate, and value, the excellent, logical, persuasive and cogent posts that are being made on this board.

Just wish we had a way to share it with a bigger part of the world which is struggling with these issues day by day.

I know, I know.

If frogs had wings, etc.