As a formerly chubby kid -- and the daughter of someone who has struggled with his weight my entire life -- I'm personally curious about obesity. My own experience taught me that when I ate too much, I gained weight. Despite being a very active tomboy, my body still, stubbornly, tended towards chunky.
In college, I dabbled in vegetarianism, got better asthma medications, and joined a sports team that inspired and required almost religious devotion. And despite my inexplicable fondness for central New York's middling beer, Genny Cream Ale, I did thin out. I now eat well and exercise frequently; I concluded years ago that the formula "calories in/calories out" is the solution to weight gain. If you eat less and move your body more, you can overcome obesity. But what if I'm wrong? Or put another way: What if I am not entirely right?
Obesity's perniciousness and prevalence astonish me. A staggering number of overweight American children now have fatty liver disease most associated with late-stage alcoholism -- even as obesity rates among preschoolers seem to have finally leveled off. And China just surpassed the United States in rates of obesity-related diabetes. Now 114 million Chinese have the disease and -- as enigmatic as a fortune cookie's wisdom -- researchers don't know why Asians are more prone to Type-2 diabetes at much lower body mass indexes than either whites or blacks. There's a lot we don't know about obesity and its many complications, but our scientific uncertainty has not produced a concomitant reluctance to judge others.
The Wall Street Journal reported recently that University of New Mexico psychology professor Geoffrey Miller was formally censured after tweeting that obese people don't have the willpower to finish doctorate degrees. He claimed his tweet was related to his research; it was not. It was simply his unkind and wholly unfounded opinion.
A riveting TED talk given by Dr. Peter Attia -- a former surgical resident at Johns Hopkins -- directly confronts his own judgment. Attia describes his reaction to an obese patient who came into the ER one night suffering from a foot ulcer so severe that it required immediate amputation -- a cruel complication of Type-2 diabetes. Attia explains that he silently judged his patient: If she had only taken better care of herself, this wouldn't have happened to her. He confesses: "As a doctor, I delivered the best clinical care I could, but as a human being, I let you down. You didn't need my judgment and contempt. You needed my empathy and compassion." Dr. Attia boldly identifies a phenomenon that doctors -- scientifically-oriented as they are -- would certainly be loath to admit, let alone discuss: bias.
Johns Hopkins researchers recently published a provocative study in the journal "Obesity" that suggests doctors tend to be nicer to thinner patients than their obese counterparts. The study's 200 recorded conversations between doctors and high blood pressure patients show no differences in the amount of time doctors spent with overweight patients versus slender ones. And the topics discussed showed no statistical variance. But when the tenor and richness of the conversations were studied, researchers discovered that doctors showed more empathy and warmth in their conversations with thinner patients. They weren't harsh or negative with overweight patients, stresses lead author Dr. Kimberly Gudzune but, she explains, "They were just not engaging patients in that rapport-building or making that emotional connection with the patient."
What haunts Dr. Attia about his own subtle judgment of obese patients is that it may prevent them from seeking much-needed critical care, and worse, that his biases may get in the way of good science. Dr. Attia left his career as a surgeon to explore the relationship between diet, insulin resistance, and obesity. He asks: "What if we're fighting the wrong war, fighting obesity rather than insulin resistance?" He hypothesizes that insulin-resistance may be a cause of obesity and not vice versa, as is currently assumed. He explains it this way, "[W]hen insulin says to a cell, I want you to burn more energy than the cell considers safe, the cell, in effect, says, 'No thanks, I'd rather store this energy.'" Fat cells do not have most of the complex cellular machinery found in other cells, he reasons, so it is probably the most secure place in which to store that energy.
It is just a theory, but as Attia says, "I can't afford the luxury of arrogance any more, let alone the luxury of certainty."
Like Attia, other researchers are redefining the landscape of obesity research. A recent study strongly suggests that gut bacteria could be a significant factor in battling obesity. In the study -- published last week online in the journal Science -- mice received gut bacteria from human twins. Those receiving gut cells from the obese twins gained weight; those receiving guts cells from the lean twins stayed lean. Researchers across the country have hailed the study as the most significant evidence to date that gut bacteria has a role in causing obesity. The study most excites scientists because, given the right diet, mice that had gained weight from "fat" gut bacteria could change their gut bacteria by being injected by cells from a lean twin. The gut bacteria do battle and the lean cells win.
We all have friends and relatives who clearly eat substantially more calories than they consume through exercise. And we all know coworkers and neighbors who have lost significant weight by doing the hard work of changing eating and exercise regimens. Even so, it seems time to concede that our approach -- if we are to make a significant dent in the epidemic -- must be multi-pronged. This requires putting aside our bias -- both personal and scientific -- to effectively attack the disease. After all, obesity is indiscriminant in its ravages.