Friday, 30 April 2010

A question of size

Obesity. It's a touchy subject. From a medical perspective it should be easy to condemn, but when you're faced with actually confronting someone about their weight, it can seem anything but easy. The problems are multiple. For a start, the simple fact that you are making a negative comment about someone's appearance, means that it is never going to be comfortable. It can also be difficult to bring it up without appearing judgemental, without the patient feeling that you think they're either greedy or lazy... or both. Some of us perhaps are a little judgemental?

It's a question that I've often pondered. How much is the obese person to blame for their size? Perhaps instead it could be the fault of their parents, their school or their genes? Clearly the chocolate munching, burger swallowing type is out there, but I also regularly see exasperated patients who, despite a healthy sounding diet, just keep putting on weight. Are they lying to me ("I eat nothing but chicken and salad doctor, I swear") or are they somehow different?

I, for example, despite absolutely loving my food, am not overweight. I do eat a largely healthy diet, but I'll admit to pretty big portions and fairly frequent helpings of some really bad (ie delicious) things in addition. Sticky toffee pudding and any sort of crumble with custard are my absolute favourites. I exercise a fair amount, but even if I don't (commuting for 3 hours a day for 2 years during my training gave me a chance to experiment with that), I stay pretty much exactly the same size. It seems rather unfair, although of course I'm not complaining.

There's also the issue of weight loss. Why do some people struggle so much to lose weight? I know at least one GP who believes that whatever the excuses given, failure to lose weight is purely the result of a failure in will power. Those who don't succeed just don't want it enough, or perhaps aren't trying hard enough. I suppose that when it comes down to it, he's probably often right, but it does seem clear that there are some for whom weight loss is harder than others.

So far, research has not made things any clearer. Whilst there is little doubt that genetics are at least partially implicated, we are still very much in the dark as to the mechanisms involved. Studies to date have suggested that the role played by our genes may simply be in determining our psychological and behavioural attitudes towards food. There has been little evidence to support the theories that different people metabolise calories differently, or have inherited a different basal metabolic rate.

My own belief is that the majority of our eating behaviours come directly from the families in which we have grown up. After all, our parents are the ones who fed us in those early days and it's from them that we learn our earliest eating habits. Since it's well known that an overweight child is much more likely to become an overweight adult, perhaps it's a person's upbringing that is the biggest player in determining their adult size?

1 comment:

  1. Well at least you have, to some extent, an open mind about this vexed subject.

    I, and many others believe that obesity is increasing in society, due to nutritional factors beyond the control of the individual and that current thinking, is adding to the problem, not addressing it. We have, with some success advocated low fat, high carbohydrate diets. Success, in that many adopt it but few thrive, as is witnessed by the increases in obesity and attendant ills such as Diabetes. Advocates of 'five-a-day' have been found to be incorrect in the suppression of cancer, especially in women. Exercise, whilst useful in moderation is not a route to weight loss and many struggle despite very low calorie intakes. But most are not believed when they relate their dedication. There are in addition many new products, some hailed as 'healthy' others not, but with contents that are outwith the normal nutritional analogues, such as high fructose corn syrup. As you know this and other sugars (none 6 carbon) do not elicit an insulin response thus being sent straight for adipose storage.

    Low carb diets have a proven track record of success, but as they require the intake of saturated fats are still viewed by some who forget the science as akin to an instant heart attack. We need to treat these people (the obese) with respect and science not political dogma, as preached by the DofH which appears to be the food lobby in disguise.