So what actually is wrong with fat-bashing? Everyone does it. Isn’t it a good thing to embarrass and ridicule people into healthy behavior? Well, yes. I guess. If it worked. The round of vitriol directed at Chris Christie for his weight is nothing which millions of persons with obesity haven’t experienced in their own families or workplaces or just walking down the street. The problem with telling a person with obesity to eat a salad and take a walk ,like the Washington Post’s Eugene Robinson did, is like telling a person with Parkinson’s disease to just stop shaking or a drug addict to just say no. It ignores the complexity of disease focusing only on the visible end point of a long and complex biological and social process.  

Given the context of the fat-bashing regarding New Jersey Governor Chris Christie, it is useful to revisit Dr. Jeffrey Friedman’s 2003 commentary, “Make War on Obesity, not the Obese.”  

Jeffrey Friedman and Douglas Coleman’s names came up this weekend as possible contenders for the Nobel Prize in Medicine. (They would have my vote if I had a vote) for their work in the discovery of leptin in 1994. Their work  revolutionized obesity research, showing how a hormone produced by fat tissue plays a key role in body weight regulation. 

Friedman’s commentary is still timely and deserves revisiting while obesity, especially extreme or severe obesity, is in the news. I think it remains one of the best scientific explanations of obesity and should give pause to anyone who wants to throw a stone or two.

 His major points are:

1. “There can be no meaningful discussion of obesity until we resist the impulse to assign blame.  Nor can we hold to the simple belief that with willpower alone, one can consciously resist the allure of food and precisely control one’s weight.“

2. The facts are these “(i) the increasing incidence of obesity in the population is not reflected by a proportionate increase in weight; (ii) the drive to eat is to a large extent hardwired, and differences in weight are genetically determined;  and (iii) obesity can be a good thing depending on the environment in which one (or one’s ancestors) finds oneself.”

3. The change in weight attributable to any recent changes in diet or a more sedentary life-style is much smaller than the enormous differences in weight, often numbering in the hundreds of pounds, that can be observed among individuals living in today’s world.”

4. “Twin studies, adoption studies, and studies of familial aggregation confirm a major contribution of genes to the development of obesity. Indeed, the heritability of obesity is equivalent to that of height and exceeds that of many disorders for which a genetic basis is generally accepted. It is worth noting that height has also increased significantly in Western countries in the 20^th Century.”

5. “In general, obesity genes encode the molecular components of the physiologic system that regulates energy balance. This system precisely matches energy intake (food) to energy expenditure to maintain constant energy stores, principally fat. That there must be a system balancing food intake and energy expenditure is suggested by the following analysis. Over the course of a decade, a typical persons consumes approximately 10 million calories, generally with only a modest change in weight. To accomplish this, food intake must precisely match energy output within 0.17% over that decade. This extraordinary level of precision exceeds by several orders of magnitude the ability of nutritionists to count calories and suggests that conscious factors alone are incapable of precisely regulating caloric intake.”

6.  “Feeding is a complex motivational behavior, meaning that many factors influence the likelihood that the behavior will be initiated. These factors include the unconscious urge to eat that is regulated by leptin and other hormones, the conscious desire to eat less (or more), sensory factors such as smell or taste, emotional state, and others. The greater the weight loss, the greater the hunger and, sooner or later for most dieters, a primal hunger trumps the conscious desire to be thin.”

7.  The increase in weight is not evenly distributed in the population. “In modern times, some individuals have manifested a much greater increase of BMI than others, strongly suggesting the possibility that in our population (species) there is a subgroup that is genetically susceptible to obesity and a different subgroup that is relatively resistant.”

8.  “Obesity is not a personal failing. In trying to lose weight, the obese are fighting a difficult battle. It is a battle against biology, a battle that only the intrepid take on and one in which only a few prevail.” A war on obesity, not the obese. [Science. 2003] – PubMed – NCBI.