19 June 2010

Why are fat people fat?

Dr Grumble's clinic is increasingly full of increasingly fat patients. They are so fat that we no longer have standard chairs in the Grumble clinic. Instead we have ginormous chairs so that fat people don't feel awkward and, well, fat. Our managers insist on this. It is about respect for patients. The obese should be allowed to be comfortable about their size. The downside is that normal-sized people end up looking like Tom Thumb which is not exactly respectful either. But at least small people can still sit down. Grumble's fatties can no longer fit between the arms of a standard chair. Regardless of the need to offer respect to fat people, the extra large chairs are now essential. Last week even one of the special chairs could no longer take the strain and broke. It is not the first time this has happened. We have a big, big problem.

Many years ago Dr Grumble was appointed to work for the Queen's physician. Unfortunately this famous personage had a heart attack not long before Dr Grumble was due to start working for him. As a result he took the decision to retire early and Dr Grumble only actually worked for him for one day and that day, being January 1st was a Bank Holiday. Why your last day at work should be January 1st Dr Grumble has no idea but doubtless there was some good reason. Dr Grumble remembers it because this one day enabled him to put the great doctor's name on his CV. It looks good to have worked for the man who was Head of the Royal Medical Household. Retirement is said to be good for a doctor's longevity. Despite the problem with his coronary arteries, the Queen's physician went on to live to the age of 89 and by some strange quirk of fate died on the Queen's very own birthday.


The man who beat anorexia.

It was as a result of the precipitate changes resulting from the unexpected retirement of the Queen's physician that Dr Grumble found himself with effectively no job and so it was that he ended up working instead for an esteemed professor. It was he that taught Dr Grumble why fat people are fat.
"Why are fat people fat, Grumble?" asked the prof on Grumble's very first ward round. This was a bit of a fast ball for the ignorant Grumble who had only just started working in endocrinology. Grumble responded by muttering something about hormones.

"Nonsense," shouted the esteemed professor in his dour Scottish accent. "Fat people are fat because they eat too much." Grumble thought about this for a moment and although even the most ignorant reader might think that perhaps the professor might have a point he did think he should query this wild accusation. By then, you see, Grumble had listened to countless fat patients who had told him that all they ever ate was the odd lettuce leaf. So Grumble, perhaps unwisely, spoke up and asked what evidence the professor had for such a wild accusation.

"Fat people have fat pets," he said.
Whether this is still thought to be true or not Grumble does not know but it is a study that could easily be repeated at the vets. All you need to do is weigh the animal, weigh the owner and see if there is a correlation. Grumble's informal observations suggest that fat people do indeed have fat pets. The question is an important one. If fat people really have fat animals then it must be the case that fat people are fat because they choose to eat too much just as they choose to feed their dogs too much. It is to do with the behaviour of fat people and nothing much else.

Why do people eat too much? What have we done to create this enormous and worsening problem? Are we doing our population a favour by giving them extra large chairs so that they don't actually feel fat? Have we been right to allow the proliferation of fast-food outlets so that you can stay in your armchair and phone for a pizza? Is it right to give VAT relief on the electric vehicles which propel people, too fat to walk, at great speed through our shopping malls without burning a single extra calorie? Is it right that we go everywhere by car and have it washed at the weekend in a great machine at the service station?

When Dr Grumble was a child we had hardly any of these things. The world has changed. Our society has colluded with our primitive urges to gratify ourselves. Have you never noticed all those ads that tell you that "you deserve it to yourself" or some such nonsense. Don't listen. You might think you deserve a treat but you don't need it. You really don't.

And amongst the things we don't need is too much food. Industry, always just out to make a buck, has conspired to use every opportunity to entice us to buy highly palatable grub that will make us fat. Look at the underhand tactics they use. Think of all those enticing fattening things they lure you with while you wait idly at the checkout with your screaming children in tow. And, as part of another sleight of hand to get us to spend more, portions are getting bigger and bigger. Understand that you are being manipulated. Don't play along with it.

But lets get back to reality. The curmudgeonly Grumble may be able to discipline himself and maybe even his offspring but many cannot. They feel happier in denial hiding behind the cheery smile of the man who beat anorexia. But, please, all this is now beyond a joke. What should we do about it?

66 comments:

Witch Doctor said...

Give every school a beautiful garden (not some kind of utility plot) tended by teachers and pupils all year round. Raise seeds, take cuttings, sell plants to help fund each project.Turn gardening into biology, art and design, cookery, business and entrepreneurial lessons.

Grow fruit, herbs and vegetables and give them free to children and their families. Sell the rest at the school gate or to local shops.

But encourage them, above all, to eat chocolate. It is a vegetable after all!

And so exercise, fresh air, diet, and the seeds of a lifetime of happiness are all incorporated into learning without any preaching at all about what is good or you.

Anonymous said...

"Why your last day at work should be January 1st Dr Grumble has no idea but doubtless there was some good reason."

If you started work in 1950 do you retire 31st December 1999 or 1st January 2000? The latter makes your entry on the list of Royal Physicians/plaque/carriage clock look like you did a year longer.

Becca said...

Scrapping VAT relief on mobility scooters would be a bit rough on all the people who for whatever reason are now reliant on them to get around.

Doctor Zorro said...

Absolutely right. My response to people who tell me "It's my glands doctor" is "Yes, your salivary glands"
I Don't worry about it to much as in a way the obese, like smokers or heavy drinkers, are doing their bit towards redressing the demographic imbalance. Whenever I see I have a patient to deal with who is over 80, I know it is a reasonable expectation that they will be thin.

Dr Grumble said...

Scrapping VAT relief on mobility scooters would be a bit rough on all the people who for whatever reason are now reliant on them to get around.
__________

GPs do sometimes, I am told, have a bit of a dilemma over this one. As far as I know, to get the VAT relief you need a GANFYD. GPs are reluctant to say that just being fat is a medical condition that entitles you to tour the shopping mall on in a reinforced electric buggy with tax relief. Some might take the view that if obesity is a medical condition the treatment would actually involve walking to the shops rather than being conveyed.

In reality by the time people get this fat they have often worn out knees or hips or have backache which might provide the justification. And, if you want to know the truth, people that fat can never lose weight and sustain the weight loss. Unless they have bariatric surgery. That anyway is the general rule.

Julie said...

I remember one time listening to a speech given by a person who works in the food trade and writes for Grocer. She said that people used to consume far more calories than they do now, but it was getting burnt up by hard manual work. She was actually quite convincing. Maybe the answer is more exercise; we have become a very sedentary society. I like WD's suggestion. I would personally like councils to stop selling off parkland to build houses on; that is a big problem as well.

Sam said...

people that fat can never lose weight and sustain the weight loss

Why Dr G?

Dr Grumble said...

For some reason, Sam, they are utterly incapable of sustaining any weight losing strategies. Of course, if you are so fat that you have worn out your knees exercise is no longer an option and if you just sit around all day you don't actually need much food to put on weight.

I am an amateur in this field but my own feeling is that the enormously fat people are a group whose very fatness demonstrates their inability to lose weight. If they had ever been able to lose weight as a result of being able to see the problem and adopt a solution they never have had the problem in the first place.

I can understand why somebody who is not a doctor can find this perplexing but you do have to realise that, as the Northerners say, there is nowt so queer as folk. Understanding this is important when it comes to relating to these patients. They have a problem which you really cannot solve by telling them how to deal with it even though it may seem that way to a lay person. As I say, the nearest thing we have to a solution is surgery.

Dr Grumble said...

Of course, Julie, the Grocer writer was absolutely correct. We have this concept of three meals a day plus elevenses and tea. It all made sense if you had a day hewing coal in the mines with just a pick or a day on the farm with nothing to help you but a carthorse and that only if you were rich.

In the late 60s I visited the Black Forest. Farming in Europe at that time was much more primitive than in the UK with lots of very small farms and less mechanisation. I distinctly remember watching an old man cut the grass on a whole mountainside using just a scythe. My children have probably never even seen a scythe. Certainly not in action. That is how the world has changed. We used to need all the food we could get and we are essentially programmed to eat all the food we can get. Now even the poorest people in the developed world can afford more food than they need. (I am not sure that what you hear about poor people not being able to afford healthy food is true. Certainly it makes no sense to me. You could swap a bar of chocolate, sorry WD, for an apple and make a profit.)

Prisoner of Hope said...

Perhaps the question is too narrow? Obesity is one example of an increasing tendency for overindulgence. This trend is a self delusional and compensating mechanism for an unfulfilled life. Other visible examples include alcoholism and drug dependancy - less visible examples include addictions to gambling and pornography.
You are right to bemoan the advertising industry's manipulation of this to sell stuff that "promises" to transform unhappiness by satisfying a manufactured want. "Because you're
worth it"always strikes me as a cruel distortion of "because you're worthless"

Governments also rely on similar deception by appealing to "aspirations". Herbert Marcuse believed all these techiques to be examples of "Surplus Represssion". They have together replaced religion as the opiate of the people. A more sceptical, questioning population might not only be less fat, drugged, drunk and unhappy but might be more likely to do something about the corrupt self serving career politicians that benefit most from a celebrity and fashion obsessed culture.

Legislation is obviously not the answer - too many vested interests to want to open that can of worms. As j.k. Galbraith observed about the culture of contentment only an unlikey rebellion by the structural underclass will challenge the vested interests of the contented majority.
So over indulgence - in all its
forms - is what our society and economy will continue to rest upon for the future. So we will just have too get used to those large chairs!

Dr Grumble said...

I fear, Prisoner of Hope, that you are correct in every way.

Sam said...

There has to be a reason why the body gains the weight lost back so quick!

"there is nowt so queer as folk."

You hit the nail on the head here Dr G! We're all different, and we all have a 'queer' bit of something somewhere. So, that current approach that obesity is all about excessive eating, lack of excercise and is always the individual's fault is blinkered and will never lead to a universal cure. Otherwise, why was obesity rife in ancient Egypt, for example? There was no McDonald's then - and they had to plough the land to eat, so they excercised!

I think that unless science and medicine unite in considering your assertion that'we're all queer' and begin to treat obesity for what it really is, a 'disease' like any other - and hence, remove the current blinkers and approach the problem from 'every' direction, including 'it may not be their fault', that a cure to that terrible 'illness' will be found.

Dr Grumble said...

You are the expert on Egypt, Sam, but one thing is clear: there was wealth in ancient Egypt. You need a society with surpluses to create what ancient Egypt created. Plainly the people at the top of that sort of society would not have been slaving away. I would doubt that the common man who was building the pyramids or working on his farm to feed the fat pharaoh would have been fat. I worked in Ethiopia for a while. Outside the cities fat people just did not exist. There was too little food and too much physical work.

McDonalds brings the sort of nutrition that in ancient times was only available to pharoahs to the common man. There are a few accounts of morbid obesity in people from ancient times. The tyrant Dionysius of Heraclea probably had obesity hypoventilation syndrome.

Sam said...

I don't know about that Dr G! Poorer people eat more bread/fat; whether from animal or vegetable because it's cheaper. So I don't know if your assumption re wealthier is fatter is right (unless famine, as was in Ethiopia is a reason for leaner figures)- too black and white for me!

Usually, like yourself, prefer to forget about shades of grey and take a direct approach to simplify matters 'most of the time' so as not to complicate things and avoid unnecessary hesitations that can greatly hinder progress - an approach which always works best for me and I would recommend it to anyone 'most of the time' - but not with obesity where I think every aspect needs to be thoroughly explored as it may not be totally the individuals concerned's fault after all.

:-)

Anonymous said...

Why are fat people fat?
Well maybe as one of these mythical beasts I could offer opinion!
First off some history – I have gained, lost and regained 10 stone plus on 4 separate occasions, and I have just started another 18 month diet!
Let me burst some myths first
1. Fat people need to learn that eating too much causes weight gain – no shit Sherlock! There can’t be fat person left in Britain that isn’t aware that more calories in than burnt off makes people fat. We understand the basic biochemistry, but the fact that so many fail to lose weight and keep it off means that the solution is – a bit more complicated than that.
2. Fat people need more exercise – well as someone who cycles 10 hilly miles to work every day , no matter what their weight is, i’d just like to point that exercise helps but its not a panacea it is – a bit more complicated than that!
3. Fat people are addicted to fatty foods, they need to learn how to cook, understand nutrition etc, etc. Well as someone who can tell you the calorie content of every item in your trolley without reading the packet, who cooks from scratch nearly every day, and hasn’t eaten in McDonalds in 20 years, I think I can say – it’s a bit more complicated than that!
What doesn’t help / is virtually guaranteed to cause weight gain
1. Lectures on the need to lose weight
2. Hectoring us about the effect of the obesity crises on the NHS
3. Calls for a fat tax, tax on fatty food etc.
4. Articles about what a lot of lax, immoral, ill disciplined slackers we are.
5. Discrimination / harassment, both verbal and physical, state sanctioned or from some kid on the street.
6. I could extend this list but I think you will have got my drift by now.
Why don’t diets work?
1. Because they are just the reverse side of the overeating / food obsession coin. You are still plagued constantly by the desire to eat, you are just exercising the supreme mental control that long term dieting demands.
2. Why can’t you apply a bit of self control and moderate your eating after you have lost the weight? Because it demands the kind of all exclusive excessive control that is impossible to maintain if you wish to be part of society – i.e. you can’t change jobs, move house, have any family issues, be threatened with redundancy, study a course, have a relationship, go out, have a holiday etc. Any thing that causes you not to be 100% focused on your weight will lead to – all the weight piling back on.
Why do people want bypass surgery
1. Because being overweight is absolute misery
2. To get some relief from the constant, never ending daily battle with food – no matter what size you are at the time.
3. Why go for bariatric surgery – because getting the right bit of your intestine removed means that you are no longer hungry, that the incessant pounding of your conscious mind by your brain demanding food will stop. Simple!

Sam said...

"A bit more complicated than that"

When you went for all these diets Anonymous, did anybody explain to you what 'moderate eating' means after you lost the weight? Or why does your body piles on back the fat so quick as if it were in a state of panic?

Doesn't the very idea that the body panics mean there is lots more to it than eating less and excercising? Otherwise, what do you mean by 'a bit more complicated than that'?

And I do sympathise with you, what torment you have to put up with must be a vicious struggle on it's own, let alone having to cope with the cause as well! ... but where there is a will ... so, stop thinking of yourself as a 'beast' and think positive, as this alone might help you reach your desired weight - and keep it

Good luck with your new diet :-)

Anonymous said...

The gross problem here is a detachment from what the morbidly obese often cope with. Often they are people who are unfulfilled in everyway we are not, they have no decent jobs (they are certainly not doctors), they have unfulfilled social lives and few meaningful goals in life. How do we manufacture these feelings which lead to high self-worth leading to a 'I'm too good to be ruled by in its simplest form, the energy of C-H bonds.

Sam said...

You are right, it's mainly discrimination that leads to that circle spinning beyond control. I never thought of it this way before! chin up - and I sincerely hope you do succeed this time.

:-)

Anonymous said...

I was doing the shopping the other day & noticed how I was surrounded by hugely fat people waddling around, often accompanied by a herd of equally tubby kids. Not sure why they weren't at school - it wasn't half term. Perhaps they had been excused games due to obesity. Anyhoo . . .

On reaching the checkout, the solution was staring me in the face. They should have turnstiles *on the way in*, not at the exit. Those of excess girth would thus be prevented from entering & thereby inflicting harm to themselves and others around them. It could be done on Elfin Safety grounds, surely. "It's for your own protection . . yadda yadda yadda. Simples!!

OTOH, it doesn't bother me. If people want to eat too much, smoke, drink etc., then that's their privilege. If they are shortening their lives then they are actually helping the world by reducing its population - it needs to be cut by two thirds, so maybe this is nature's way of restoring balance.

It doesn't make any sense, though, for the taxpayer to be funding treatment in the absence of the self control of a diet. Any treatment should be conditional upon taking the first step.

Stop treating them as victims!

Ray.

Anonymous said...

Thanks for your comments Sam, but I don’t think of myself as a beast, my comment about mythical beasts was merely a reference to the fact that this debate tends to be had by people who have either never experienced a weight problem or are one of the 5% who manage to lose the weight and keep it off. People like me are the norm as far as obesity goes, but our thoughts on the issue are rarely heard. My self-esteem is also pretty high, I am a professional, I have a degree, two post graduate degrees, I am fluent in a second language and I’m currently studying a part time biology degree for fun. My life is pretty fulfilled, I’m not materialistic, my passion / aim in life is to develop the greatest all round world view of science and the arts possible in this day and age (think Leonardo de Vinci) so you see I have goals as well. – do I conform to the stereotype of the obese then?
“Didn’t someone ever teach you about eating in moderation?” – Have I read about the theory? Yes of course, but most obese people don’t start out throwing thousands of extra calories down their throats, they and I gain weight at a fairly steady rate. Maintaining weight loss requires constant vigilance as I said before, if life gets in the way at all (job change, house move, family issue) then the type of vigilance required is lost and the weight returns. My weight gain rate by the way is about 200 calories per day – or roughly 3 hob nobs.
“Doesn't the very idea that the body panics mean there is lots more to it than eating less and exercising? Otherwise, what do you mean by 'a bit more complicated than that'?” What I mean Sam is that at the basic biochemical level it’s a balance between energy in and energy out, but what stops average weight people form overeating? What enables your body to recognise and maintain the absolute correct balance of energy in / energy out, after a very small overeat on a daily basis would pile on the weight over a few years e.g. overeat by 100 calories a day and you have gained 10 pounds in a year, do that for 10 years and you’ll be joining me on a diet – so what stops that happening in thin people? 100 calories is really not much food, (roughly 1 chocolate hob nob) I would challenge you or any thin person to be able to estimate by eye on a continuous daily basis the exact calorie content of what you are eating, you can’t – so how do you maintain that balance if it is not a conscious act? Answer that and then you might find the cure to obesity (and I’ll pay you big money!) I know people in this weight conscious world will go on about monitoring their weight and losing it when they put weight on etc. etc, I’m not interested in them, I’m talking about the people who eat, don’t monitor their weight and never gain a pound? Find out how their bodies regulate the intake and we might have the beginning s of a solution. (Oh and just to bust a fat families myth while I’m at it, half my family – nan, brothers, father etc are exactly like this.)
As for the other anonymous comments I’ve read on here today well – lets just put them in the – virtually guaranteed to make you fat people fatter column, so well done anon you are part of the problem.

It’s a bit more complicated than that

Sam said...

I actually thought I was talking to you all along Anonymous 10.29 - Indeed I do not like stereotyping of any kind, but believe in the individuality and value of every person in society.

And, I do find your achievements and interests impressive and that has nothing to do with how heavy or light you are because we all come in all shapes and sizes. As I said before, none of us are perfect.

I feel, however, and I think you may agree, that there more to obesity than eating and I sincerely hope medical science will pursue all avenues and finds a cure in the near future.

Best regards :-)

Anonymous said...

having lived and worked in chicago i can tell u a lot of it is environmental

if you just dont have access to public swimming pools, no paths to walk on and you really cannot go anywhere without driving

large malls and the only food options available are unhealthy

even for a cynical brit like me its easy to see why it takes a real rebel to be fit and healthy in that kind of environment

we are not that extreme yet

A New Kind of GP said...

Lots of interesting stuff in these comments!
As a GP my focus is helping people make positive changes to make their lives healthier, to prevent illness, to reduce risks.

I think that "Anonymous" - the one posting on 20 June at 20:57 - there are so many of you! - hit the nail on the head with the repeated comment "it's a bit more complicated than that".
I would agree.

Although the basics can be boiled down to "eat less, move more" this ignores the huge inescapable factors of:-
- understanding the importance of weight loss
- having confidence in acheiving weight loss
- perseverance
- positive attitude
- mental health
- healthy self-esteem

I had a patient once, a few years ago, who had been to see my wonderfully enthusiastic practice nurse for several consultations for dietary advice and monitoring of her weight. I knew her well, as she had several health problems that were complicated by her obesity. We just plugged on with adding more drugs to lower her blood pressure, more drugs to control her glucose levels, etc. One day, I was talking to the nurse over coffee - she had just seen our mutual patient, and said how she wished we could help her break through. I agreed to see her next time with her. Instead of talking about diets, calories, orlistat, sibutramine and aerobic exercise, we went back to her childhood and her upbringing, to get some idea of when she had become fat. Slowly, it all poured out. She had married young and unhappily - it was a very abusive relationship. She ate and ate and became obese. I reviewed her medical records and could find no mention of her unhappy late teens - she had self medicated with calories. I think it was very likely that this patient's block was due to the secondary gain that she got from maintaining her obesity. Her size and sexual unattractiveness were her defence mechanisms. Tearfully she admitted that she was actually scared of losing weight.

So many cases of obesity (note I am not saying all) are linked in with issues of low self-esteem, shame, control (by self and others) and much of this is well hidden, often from the patient him/herself.

Much work has been done on influencing health behaviour change and a key starting point in all this research is the importance of developing rapport with the patient. This is something that salesmen are acutely aware of - they are taught elements of NLP to help them understand their client's needs and desires in detail. In the GP consultation with an obese patient, the GP needs to recognise the stages of contemplation that a patient needs to go through before he/she recognises the importance and feels they have the confidence to make the change. But first the GP needs to understand and empathise with why the patient is obese - understand and empathise with the faulty logic of secondary gain - the persistent use of unhelpful strategies developed perhaps in childhood that provide transient comfort - We as GPs are privileged to be in a position whereby we can use our skills at rapport with patients we know well and who trust us.

Often the patient him/herself is unaware of these but getting that patient to realise that the GP understands that "it's a bit more complicated than that" is a big step towards dealing with the problem.

Dr Grumble said...

Yes, New Kind of GP, but all the evidence is that however hard everybody tries long term successes are few. Eventually practically all of them put on weight again.

Environment must have some effect. That is why the population is getting fatter. If you have to walk to school as I did and the school meals are sad as mine were, you are not going to put on as much weight as you might if you are driven to school and have machines in the school dispensing sugary goodies and a burger outlet across the street.

the a&e charge nurse said...

Dr Grumble - Dr Crippen always reserved great contempt for those respiratory physicians who approached lung cancer with a certain form of therapeutic nihilism.

You say, "however hard everybody tries long term successes are few. Eventually practically all of them put on weight again" (if we look at obesity purely from an evidence perspective).

Does such a statement imply that medical approaches to obesity are simply wrong headed, or, like the respiratory physicians that so irked Dr Crippen, is it possible to speculate that obesity has almost has as few positive therapeutic possibilities as advanced lung cancer?

I was very interested in New kind of GP's observations but leaving aside the self-medicating with food hypothesis, I think there is a simpler, and perhaps more banal explanation?

I suspect the overwhelming majority of patients (who are obese) have been brought up in homes where their own parents have been rather too liberal with crisps, pop, sweets and sugar/salt saturated main meals.

As everybody knows if addictive patterns of behaviour are established early enough (in this case an addiction to salt & sugar) especially when combined with elements likely to exacerbate the problem (sedentary life style, etc) then such patterns may be very difficult to break in later life?

Anonymous said...

It’s a bit more complicated than that!

A new kind of GP – I agree that psychological issues can lead to some people becoming obese, but as you say its definitely not the case for all.

Dr G your argument thus far seems to be that fat people are weak willed lazy slobs for whom no intervention other than surgery seems to work. They (unlike thin people) are adversely affected by an environment that encourages them to eat more and exercise less and so we should ban the school run and fast food restaurants
Well – it’s a bit more complicated than that!

1. Obese people existed in the 60/70’s, despite walking to school /work and the lack of fast food outlets. (me!)

2. We don’t all live on takeaways and fast food – some of us cook fresh food from scratch. (me!)

3.We aren’t all couch potatoes – some of us cycle to work, and deliberately don’t have cars in order to build more exercise into our daily lives. (me!)

4.Some of us have no health problems (me!)

5.Some of us are able to exercise considerable personal restraint – (believe me when I say that losing 10 stone on 4 separate occasions, shows a considerable amount of will power and restraint.)

So to conclude, you have demonstrated to date that;

•You can do nothing to help your obese patients apart from surgery.

•You have no realistic solution to the problem.

•Writing demeaning and patronising articles does not help.

Well done you are part of the problem not the solution!

Research Dr G, RESEARCH is the answer – find out the biological reasons why thin people don’t get fat and how without monitoring their weight in any conscious way, they maintain a normal body weight. Solve that problem and you will find a cure to obesity.

Anonymous said...

A&E Charge Nurse,

please for the love of god not the fat families thing again!

bangs head on wall again and again and again.

the a&e charge nurse said...

Can we be clear anonymous (10:11) - are you simply referring to your own experience, or obesity amongst populations?

This item highlights trends in childhood obesity which are increasing, and correlate with increases in adult obesity.
http://www.parliament.uk/documents/post/pn205.pdf

The same patterns are replicated internationally.

You seem reluctant to explore the effect of parental behaviour on children (eating habits being just one sphere of course) - now an amateur psychologist might frame this as a form of denial?
http://en.wikipedia.org/wiki/Denial

the a&e charge nurse said...

Incidentally, this item claims;

Obesity tends to run in families.

A child with an obese parent, brother, or sister is more likely to become obese.

Genetics alone does not cause obesity. Obesity will occur only when a child eats more calories than he or she uses.

Children's dietary habits have shifted away from healthy foods (such as fruits, vegetables, and whole grains) to a much greater reliance on fast food, processed snack foods, and sugary drinks.

These foods tend to be high in fat and/or calories and low in many other nutrients.

Patterns associated with obesity are eating when not hungry and eating while watching TV or doing homework.

Low family incomes and having nonworking parents are associated with greater calorie intake for activity level.

The popularity of television, computers, and video games translates into an increasingly sedentary (inactive) lifestyle for many children.

Children in the United States spend an average of over three hours per day watching television. Not only does this use little energy (calories), it also encourages snacking.

Fewer than half of children in the United States have a parent who engages in regular physical exercise.

http://www.emedicinehealth.com/obesity_in_children/page2_em.htm

Anonymous said...

A&E charge nurse,

I have read some of the things you have written before on Dr Crippens old blog for instance, and I have to say that I find it sad that you would demean yourself by resorting to the kind of rhetorical nonsense that is an accusation of denialism, in a debate like this. How is someone supposed to reply without looking like they are in denial? the fact that they can’t says little about them don’t you think?

Lets try a few possible responses and see what happens shall we, just to illustrate the point?

•Both my parents are average weight – liar you are in denial! My research links prove it.

•Both my parents are obese – see obesity runs in families you are just copying their behaviour – I knew it all along, my research links prove it.

•1 parent is thin and 1 parent is obese – you just copied your obese parent, you are in denial I knew it all along, see my research links.

Need I say any more about denialism?

Now your research studies –

Thanks for putting in the links, I have read all this stuff before it wasn’t very enlightening stuff was it?

what can we conclude from this about obesity?

•Some obese people come from obese families? –No shit Sherlock, but not all it would seem unless there has been a population explosion among the obese in recent years (perhaps sex is the cause?)

•Some obese people lead sedentary lives ? – and so do some thin people, your point is?

•only obese people play computer games- don’t make me laugh!

Need I go on?

Obesity must get more statements written about it containing basic logical fallacies than any other subject I know!

Now for the love of all that is holy lets stop with the amateur psychology, the logical fallacies and the blatant stereotyping and start researching the real cause - start by finding out what makes thin people thin, despite them having all the same life style factors as the obese. Then you will find a cure for obesity.

the a&e charge nurse said...

Thank you anonymous (12:09) - let's start by agreeing that evidence can be interpreted (or twisted) in a number of ways.

You end by suggesting we can find a "cure" for obesity ...... an interesting phrase.

My own view (FWIW) is that obesity, like anorexia, is not, in the main, a disease although serious health problems can arise arise from it.
I think this is true of 'addiction' in general - in the sense that there is NO proven physiological basis that consistently predicts what people eat, drink or inject in to themselves.
In short we continue to medicalise existential problems (eating, or not eating, drinking too much, injecting heroin, etc).

If we accept such a premise, and I dare say many won't, we are moving into the murky waters of attempting to understand why people make certain choices from an existential perspective.

In such circumstances we are probably limited to observations about the prevalence of certain phenomena (in certain populations), as well as identifying those factors which correlate positively with behaviours being measured.

From this process conclusions can be drawn (albeit tentatively sometimes) and perhaps advice can be given that might reduce the level of risk, assuming, of course, we accept that obesity is a problem in the first place.

As to 'denial' - my original comment had more to do with your dismissal (out of hand) of the effect of certain eating habits within families.
I'm sure there have been similar arguments about children brought up in the home of smokers?

Of course not all children brought up in the home of smokers end up smoking themselves, but like children of obese parents, the risk of following in their parent's footsteps are significantly higher;
http://www.heartforum.org.uk/Policy_childhealth_childsmoke.aspx

Anonymous said...

A& E Charge nurse
Yes I think we can agree that evidence can be used and abused anyone.

"My own view (FWIW) is that obesity, like anorexia, is not, in the main, a disease although serious health problems can arise from it.
I think this is true of 'addiction' in general - in the sense that there is NO proven physiological basis that consistently predicts what people eat, drink or inject in to themselves. "


1.I wouldn’t class obesity or anorexia as addictions – I haven’t read any evidence to date that suggest it is.

2."There is no proven physiological basis that consistently predicts what people will eat, drink or inject into themselves" – to date although genetics have established a number or allele combinations for a genetic vulnerability to obesity etc etc.

"In short we continue to medicalise existential problems (eating, or not eating, drinking too much, injecting heroin, etc)."

1.I have no idea what you mean by "medicalising existential problems" in this context. If you mean medicalising what some people currently refer to as life style issues, then we will have to differ. Like I say thin people live the same life styles and they are thin.

2.Where exactly is the line between a life style issue and a health problem? Life style issues often seem to be shorthand for anything someone disapproves of.

"If we accept such a premise, and I dare say many won't, we are moving into the murky waters of attempting to understand why people make certain choices from an existential perspective."

3.Again I have no idea what you mean about existential perspective, but if you mean why people make certain lifestyle choices? then what is murky about that? Why do you drink water, is it a lifestyle choice or biological imperative?


"In such circumstances we are probably limited to observations about the prevalence of certain phenomena (in certain populations), as well as identifying those factors which correlate positively with behaviours being measured."

1.Err no ! we could start to understand the biological basis behind it.

"From this process conclusions can be drawn (albeit tentatively sometimes) and perhaps advice can be given that might reduce the level of risk, assuming, of course, we accept that obesity is a problem in the first place."

1.Why tentatively, they could be a whole lot more useful than the current useless advice.

"As to 'denial' - my original comment had more to do with your dismissal (out of hand) of the effect of certain eating habits within families.
I'm sure there have been similar arguments about children brought up in the home of smokers?"

1.Slaps head!

A New Kind of GP said...

Thank you Dr G, and Anonymous (22Jun 10.05) for your replies to my comment.

I think that the basic issue with this question is that there is no simple answer. Medical research works best when the problem is not as massively multi-factorial as the obesity question.

I think we delude ourselves when we claim that it can all be boiled down to one cause and one solution. We know that this doesn't work.

The problem with obesity is that the multiple factors that contribute to it extend well beyond the comfort zone of medical researchers. They include the social, the behavioural, the psychological, the cultural, the economic, the political, the environmental etc etc.

Medical research struggles when there are more than a few variables to consider, even when these are fully within the experience of researchers. Look at pharmaceutical drug trials that often cost millions but require such careful selection of patients to demonstrate fairly small differences in outcomes.

So, I believe that in the same way that the causes of obesity are multifactorial, there has to be a recognition that any meaningful interventions will have to be wide ranging and complementary.

A New Kind of GP said...

EXERCISE and MUSCLE to FAT RATIO

Writing purely from a personal perspective on one narrow, but probably vitally important aspect of successful weight loss - exercise - I believe that it is necessary to appreciate how difficult it is for obese patients to exercise effectively with respect to weight loss.

My own BMI is well within the healthy range and I believe that the many miles I walk each week, the regular runs and my weight training at the gym all help me maintain this. As Dr Grumble described, my exercise pattern was established at a young age, with walking to school and a healthy upbringing in the country.

I would however seriously struggle if I had to wear a fat suit with an extra 25kg around my middle - my regular four mile run would be a real trial, I certainly wouldn't manage the weight training sessions I do, and a walk into town would get me seriously sweaty and short of breath. And this would be with the sort of well developed musculature, chest and heart that an obese patient wouldn't have.

My gym sessions and runs are still challenging - there would be little point in them if I didn't push myself. But my muscle to fat ratio puts me at a huge advantage compared to an obese patient. I can do so much more and so much more easily than a fat person. Furthermore, even when I am slouched on my sofa later in the evening, my muscles are still burning calories at a much greater rate than a person whose BMI is 40+. Even though it sometimes does not feel like it, the calories in, energy out principle has become a way of life for me, and most of the time feels like I am coasting along whereas for a fatter person it still feels as if they are trying to start a car going up hill in 3rd gear.

Tosper said...

Why do thin women become fat after the menapause?

That should tell you all something! - That it's not all about eating and excercise, at least.

Anonymous said...

".....ignorant Grumble who had only just started working in endocrinology. Grumble responded by muttering something about hormones."

Perhaps the young Dr Grumble was not so far off the mark with his initial mutterings, at least with regards to some cases of obesity....

Thanks to the British Thyroid Association, Britain's thyroid guidelines are draconian as compared to those of just about every other country in the Western world.

In the UK, guidelines state that you only get treatment when your TSH rises above the magic number of 10.

In just about every other country in the West (think USA, Canada, France, Germany, Spain, Italy Belgium, Holland, Sweden etc,), you can expect treatment with a TSH of 5 and upwards, and some countries (Germany & Sweden) even treat patients with TSHs as low as 2.5 and 3.

There are cases in this country where people with TSHs of 15 and upwards (plus positive antibodies) and a mass of clinical symptoms (including weight gain/obesity) are not getting treated due to the backwards way that endocrinology in this country is practised.

If you want to make a difference to at least some of the cases of obesity in this country, perhaps you could start by asking some serious questions about why UK endocrinologists recommend guidance that ends up keeping people fat (and ill) for extended periods of time before allowing treatment.

Just think of all the money that could be saved on Orlistat prescriptions if hypothyroidism was properly diagnosed and treated in this country.

Hungry said...

I am overweight. Over the years, my weight has gone up, down, up...

At a size 20 I was able to pass an army fitness test. Now, thinner, I can only run a few yards, although I do walk every day because I don't have a car.

I only stay thin when counting every calorie and recording it immediately in a book. As soon as I stop doing that, I start getting fat again. I have little or no sensation of being full after eating. I have little or no recollection of what I have eaten even twenty or thirty minutes later.

So I count my calories and keep eight (yes, eight) dress sizes in my wardrobe and try to fight the hunger. I can eat 3000 calories a day and still feel miserably hungry. When my willpower gives way and I can't withstand the sensation of hunger any more, I eat more, and when I can cope with it, I eat less.

I suppose that the bottom line for me is that I'm not emotionally strong enough all the time to cope with feeling hungry. I don't know how "normal" people do it.

Dr Grumble said...

When I was a young doctor I was taught that men who had what in those days we called impotence had a problem in their mind. Now we have a pill for it we don't hear this often. The patients I see on this pill are not the young ones. They are the older ones with illnesses. It was never in the patient's head - not in most cases anyway.

If fat people could stop themselves eating so much they would not be fat but this does not mean problems in the patients' head are the root cause of the problem. I have patients who cannot put on weight. They are thin but their thinness is not apparently due to overt illness. They are just people who never get fat.

I would not be a bit surprised if we eventually find out that there is some circulating hormone that we do not yet understand which is driving hunger in fat people - or, perhaps, just some fat people.

The story about fat people having fat pets is not really consistent with this hypothesis which is why I have remembered it all those years. To me it does suggest that there is an important behavioural element to obesity. But this may not apply to all fat people. Fatness may have multiple different causes.

But please understand that I am certainly not an expert on obesity. I know I do not understand it. I have a strong feeling that the experts don't either.

Anonymous said...

So you know little about obesity and suspect that there will be a medical cure for some in the future but yet you still feel its ok to write the this -

"The curmudgeonly Grumble may be able to discipline himself and maybe even his offspring but many cannot. They feel happier in denial hiding behind the cheery smile of the man who beat anorexia. But, please, all this is now beyond a joke. What should we do about it?"

What exactly do you expect the man to do, hide in his house waiting for you to find a cure? hang his head in shame, until the medical profession finds out how to deal with his problem? How about congratulating him on his psychological adjustment and ability to deal with a problem for which medicine has no cure yet? you and your colleagues should be signing him up to give classes on mental well being for the obese not trying to belittle him, to further a rant.

Your failure as a medical profession to deal with this problem is no excuse for you to write patronising and demaeaning articles about those that the medical profession cannot help at this period in time. - Jez stop blaming the victim.

Anonymous said...

What is with the fat pet story?

How can you seriously be writing that as part of a debate on obesity? and what would it actually tell you if it were true?

Are animals immune from weight gain?
-Certainly not judging from experiments on rats.

Do all animals gain weight when excess food is left out for them?
-er no they don't some remain thin others put on weight just like humans. What should this tell you Dr G.?

Why would some animals gain weight? when they arn't affect by advertising?
- perhaps all that money being wasted tackling food adverts might have been better spent elsewhere don't you think?

For a man of science I despair frankly!

Oh and as for me, i'm obese at present,
-the pet i've had from birth is a perfect weight (according to the vet - it "made his day to see such a fit and healthy animal")

whilst the stray i adopted is classed as overweight, but this is not an uncommon problem in strays -

- perhaps only obese prone animals become strays? or only obese people take in strays?

Come on Dr G -admit it this is just bull!

Anonymous said...

HI Hungry,

"When my willpower gives way and I can't withstand the sensation of hunger any more, I eat more, and when I can cope with it, I eat less."

God I know that feeling, giving up smoking is a walk in the park compared to this!

Interestingly when a certain section of the small intesting is removed in some gastric bypass operations, all those feelings of intense hunger and the compulsive urge to eat go.

-Which rather suggests that some kind of signalling system involving the small intestine maybe involved in promoting obesity.

I think further research is being done in the USA, as a result of this finding. Interestingly not all sections of the intestine are equal in this regard and if the right section isn't removed the urge to eat remains.

the a&e charge nurse said...

"How about congratulating him on his psychological adjustment and ability to deal with a problem for which medicine has no cure yet" - an undiscovered disease, eh, anonymous (08:35) yet one that has attained epidemic proportions in just a few decades?

Even 50 years ago nobody bothered collecting stats on obesity - why?
http://news.bbc.co.uk/1/hi/health/7151813.stm

Anonymous (21:45) you blame mismanagement of thyroid problems - have you compared rates of obesity between the UK and Germany, a country you cite with a far lower threshold for thyroxine? According to these item even the Krauts are launching their own obesity campaigns, perhaps because they have been labeled the fattest nation in Europe;
http://news.bbc.co.uk/1/hi/health/6639227.stm
And;
http://www.globalpost.com/dispatch/commerce/091125/obesity-epidemic-fattest-countries

I think we need to think very carefully before we go down the 'my body made me do it' line of thinking?

Dr Grumble said...

Expert though I am not, there are a lot of puzzling things going on which even those in the know do not undertand. Instant cures of diabetes following gastric bypass surgery is one. This is plainly nothing to do with the patient's psyche and everything to do with the physiology of the gut.

As for fat animals I did once have a lab alongside Mike Stock and Nancy Rothwell. They had no difficulty making their rats fat by just giving them a plentiful supply of food from the cafeteria. If you put humans in the environment we were designed to live in you don't see any fat people. There just isn't enough food around.

The question then arises as to whether the humans who get fat when food is in plently are just greedy compared with those who do not or whether they are perhaps driven by some mechanism that is making them much more hungry than those who stay slim. It does seem to me that if fat people have fat pets it might be more behavioural than to do with, say, how hungry fat people feel. But even if fat people on average do have fat pets it does not mean that the mechanism is the same for all fat people. And, in any case, it does seem that there are thin people who do not have to try to be thin. They are plainly not controlling their urges. Their urges to eat are enough but no more than is necessary to keep them at the right weight.

Anonymous said...

A&E Charge Nurse,

I know absolutely nothing about TSH (please remember there is more than 1 anon poster on this site) but the poster suggests that;


"In just about every other country in the West (think USA, Canada, France, Germany, Spain, Italy Belgium, Holland, Sweden etc,), you can expect treatment with a TSH of 5 and upwards, and some countries (Germany & Sweden) even treat patients with TSHs as low as 2.5 and 3."

You then go on to site this post and compare German obesity levels to the average in Europe. What does that tell us

1. Nothing - abosolutely nothing.
2. Perhaps I should pick out the Swedes who are not the most obese in Europe?

Obesity wasn't measured 50 years ago - true (at last we can agree)

But obesity did exist 50 years ago. So your point is what?

Obesity rates have increased - true, according to you its fat families and the bad role model they present to their kids.

Well in that case, the increase in obesity must be due to a population expolosion amongst the obese. According to evolutionary theory only the fittest survive and reproduce, so the obese are the new sex gods and thin people are going to be wiped out!

Please lets stop with the faulty logic and knee jerk reactions, you are better than this A&E charge nurse!

And using the term krauts!
- smacks head repeatedly

Anonymous said...

"It does seem to me that if fat people have fat pets it might be more behavioural than to do with, say, how hungry fat people feel."

Why?
Lets accept your premise for a moment -

Could it not be the fact that they constantly feel hungry all the time that leads to them giving their pets more food than necessary?

the a&e charge nurse said...

"please remember there is more than 1 anon poster on this site" - yes, I know anonymous (9:40) that is why I include times to differentiate one from the other.
Incidentally is it really too much trouble to invent a moniker?

"You then go on to site this post and compare German obesity levels to the average in Europe. What does that tell us" - that the thyroid hypothesis is likely to have a negligible effect on the the overall population of obese people in any given country (probably).

"But obesity did exist 50 years ago. So your point is what?" - prevalence has changed dramatically, that's what people so worried about.

"Obesity rates have increased - true, according to you its fat families and the bad role model they present to their kids" - yes, the RISK of obesity is likely to be greater for many children once they are repeatedly exposed to certain foodstuffs.
It's one of the reasons schools have taken a firmer role in health education and policing children's lunch boxes.

"Please lets stop with the faulty logic and knee jerk reactions" - well, I'm giving my honest opinion (as it stands today).
In an area with uncertainty I accept I might be wrong BUT I need something more robust on which to shift paradigm - or put another way I do not see the harm in minimising the effect possible causative factors with the proviso this may not work in ALL circumstances.

You don't like the term Krauts, so how about 'the hun', instead - don't forget there IS a world cup on so perhaps we are allowed amnesty on one or two politically incorrect phrase?

Anonymous said...

A& E charge nurse

"You then go on to site this post and compare German obesity levels to the average in Europe. What does that tell us" - that the thyroid hypothesis is likely to have a negligible effect on the the overall population of obese people in any given country (probably)."

1. If you recall the original poster on TSH said SOME cases of obesity!

2. I dont recall any statistical analysis of thyroid problem prevalence data by country in your post - so the evidence YOU cited on German obesity levels still contributed nothing to the debate.

"the RISK of obesity is likely to be greater for many children once they are repeatedly exposed to certain foodstuffs."

-So now its food?
-I thought it was their parents?
-How do you explain obese kids with thin parents?

"In an area with uncertainty I accept I might be wrong BUT I need something more robust on which to shift paradigm - or put another way I do not see the harm in minimising the effect possible causative factors with the proviso this may not work in ALL circumstances."

I see perhaps we could have agreed on that if it wasn't for this

"I was very interested in New kind of GP's observations but leaving aside the self-medicating with food hypothesis, I think there is a simpler, and perhaps more banal explanation?

I suspect the overwhelming majority of patients (who are obese) have been brought up in homes where their own parents have been rather too liberal with crisps, pop, sweets and sugar/salt saturated main meals."

In an area of uncertainty you seem mighty certain!

As for the Hun - Grow up!

the a&e charge nurse said...

"So now its food? -I thought it was their parents?" Pedantic, anonymous (10:44) very pedantic - hair splitting hardly advances your objection to my comment, does it?

You know perfectly well what I mean - the same line of argument can be applied to the children of alcoholics or smokers.
Nobody is suggesting that ALL children adopt the same dysfunctional pattern as their parents when it comes to drinking, smoking or eating too much, but compared to children without these influences a significantly higher proportion follow in their parents steps (an inconvenient fact you have continually chosen to ignore).

If you do not want to go down that road perhaps you can give us YOUR explanation as to why so many adults and children are obese?

Sam said...

Dr G,

Can you please summerise the main findings/points of Michael J Stock work on obesity? ... because it is hard to ubderstand for a non doc/scientist like me.

Thank you :-)

Hungry said...

I think that there are different reasons for different people being overweight and that if research is to have any usefulness at all, it will have to work out what those different reasons are.

In my case, the desire to feel better short term outweighs my desire to feel better long term. I think that this is a problem with a lot of people with unwanted habits, including some people who drink, use drugs, self harm (which I used to do), under- or over-eat (which I do), under or over exercise (which I used to do), gamble etc.

I wonder whether the world we live in encourages this?

Or could there be some obscure explanation like pollutants affecting us?

Meanwhile, I sit here tonight looking sadly at my food diary and concluding that if I want to hit my target I only have 300 calories before bedtime. However, I regard tomatoes as free food (only two cals for a cherry tomato) so I shall have a couple of big handfuls of them and a mug of chocolate. But oh for half a dozen mugs of chocolate plus a bar of dark chocolate. I really want those feel-good chemicals.

Dr Grumble said...

Having admitted I am not an expert in this field, Sam now requires a synopsis of the work of Rothwell and Stock!

I am really not the person to ask but they were interested in looking at energy balance and found that if rats eat too much they burn off more energy. The problem initially was making animals fat but this problem was solved when it was discovered that if you feed a cafeteria diet to rats they eat about 80% more and get fat. But young rats don’t gain much weight because they expend more energy. Older rats gain weight rapidly. But even the older rats expend more energy than controls. This process depends on the ambient temperature.

It is too complicated for poor old Grumble but they were interested in trying to understand this process. Where was this energy going? Was it the energy used in digesting the food or laying down fat? Or was it from the activity of brown fat which in some animals and young humans makes heat to warm the animal up in the cold.

Fat people often think they have a slow metabolism. (There’s a comment above about when to treat hypothyroidism which may relate to this.) The reality is otherwise and it is this sort of thing that Rothwell and Stock were trying to get a handle on.

Are you out there Dame Nancy? Has poor old Grumble got it right?

Sam said...

"Sam now requires a synopsis of the work of Rothwell and Stock! "

... and why the exclamation mark, eh?!!!

It was 'you' who put what's his name on 'your' reading list, wasn't it?!!!! So you knew people, including non scientific, will read it!! And would want to understand?!

... now down to business .... :-)

OK, so rats will produce more energy the more food they eat, more so if that food is junk, and more so for the younger ones, who because of this, they won't gain so much weight as the older ones - but this varies according to the 'room' temprature ... and the colder, the more food they eat, the more energy produced, but they wanted to know where this excess energy was going. One assumption that it goes into building 'a brown fat layer' to protect the animal from the cold.

Why is that controversial though? The article you referred to says that M Stock was fought for these findings - why?! They make perfect sence to me! ... and of course, the more food you eat, the more energy needed to digest!

... what happened after Dr G? Why did Stock become popular again? I am finding this fascinating!

Dr Grumble said...

I can't really tell you much more, Sam. Rothwell and Stock just happened to have a lab next to mine. I was working in a completely different area. Mike was a very nice man. I just wonder if perhaps he was too nice. It's tough world in science. Nancy always seemed to be beavering away in the lab and I scarcely knew her. I would never have guessed that one day she would be a dame and invited to talk on Question Time. As it happens I have heard her speak fairly recently. She moved into a new area - stroke. She picked up some lead from the obesity work and decided to change track. Quite a story there I would think but I really don't know any more.

Sam said...

Thank you Dr G, only science changes it's mind all the time and I do wonder if some scientist will come back with findings relating slow metabolism to weight gain soon! Was maybe this was 'a' reason Dame Stock changed the course of her research? She met a dead end after her husband's death and couldn't prove, beyond doubt, that metabolism and size are 'not' related?

... and that the beauty of scientific research Dr G, it's like is like Sherlock Holmes! It never seazes to search for clues - then amaze! :-)

Dr Grumble said...

Whoa! It was Mike Stock and Nancy Rothwell. Mike was the professor and Nancy the junior partner. Nancy, the quiet one who beavered away in the lab is now Dame Nancy. As I said I didn't really know her at the time but I have heard her lecture since and she too comes over as a very nice person.

Sam said...

My mistake, I thought they were married!

And of course she is nice! She's a distinguished scientist of repute, that's why she's now a Dame.

But even distinguished scientists do meet a stumbling block sometimes, and the admirable thing is that they persevere; rise to the challenge, even switch areas of interest as I understand she's now studying stroke.

... and you had your lab next door?! You must be a distinguished scientist too Dr Grumble! :-)

Anonymous said...

the a&e charge nurse said...

"So now its food? -I thought it was their parents?" Pedantic, anonymous (10:44) very pedantic - hair splitting hardly advances your objection to my comment, does it?

Er yes it does actually –lets see now you said

“ yes, the RISK of obesity is likely to be greater for many children once they are repeatedly exposed to certain foodstuffs.”

That is not the same as saying that it is all the fault of fat parents is it?

1.In fact that could go some way to explaining why thin people can have obese children, (unless you really do believe that the rise in obesity is caused by obese sex gods?)

2.Further if exposure to certain food stuffs increases the risk of obesity in children, then what is the mechanism for this? Is it an addictive chemical in the food for instance? (I feel a law suit coming on!)


“You know perfectly well what I mean - the same line of argument can be applied to the children of alcoholics or smokers.”

Er I wouldn’t bank on that if I were you!

The problem with stretching your analogy to drinkers and smokers is that it is far easier to understand why the children of non drinkers and smokers take up the habit. All those attractive role models on the television, wide scale social acceptance, the wild boy rebel image etc etc etc.

But as far as obesity goes, role models for obese children of thin parents are pretty thin on the ground, and your certainly not going to get respect from your peers for being a rebel - more likely a punch in the gob!

"Nobody is suggesting that ALL children adopt the same dysfunctional pattern as their parents when it comes to drinking, smoking or eating too much, but compared to children without these influences a significantly higher proportion follow in their parents steps (an inconvenient fact you have continually chosen to ignore). "
- how many more times and in how many different ways can i say;

1.If the current rise in obesity is all down to fat parents explain the increase since the 1950’s – I mean a comparatively small (compared to today) numbers of obese people must have been at it like rabbits!

Perhaps you can give us YOUR explanation as to why so many adults and children are obese?

1.I don’t claim to have one, I just object to half baked illogical "evidence".

2.I humbly suggest that we apply proper scientific principles instead of cod psychology and do some more research. (lots more)

In the meantime, just until we are sure, perhaps we should abandon all the handwringing and moral outrage? its certainly proved useless as either a preventative measure or a dietary aid.

the a&e charge nurse said...

Perhaps you can give us YOUR explanation as to why so many adults and children are obese?
I don’t claim to have one.

OK that much we agree on - in the sense that there is no single explanation for obesity in every case.

But do you have a view on this - this is the battleground as I see it?
http://www.dailymail.co.uk/news/article-1289376/British-children-getting-fatter-twice-rate-Americans.html

Anonymous said...

the a&e charge nurse

said..."But do you have a view on this - this is the battleground as I see it?
http://www.dailymail.co.uk/news/article-1289376/British-children-getting-fatter-twice-rate-Americans.html"

Sorry i'm not quite sure in what sense you are referring to here?

Could you please clarify? -Although I wont be able to respond before sunday.

the a&e charge nurse said...

Accepting the usual provisos with any item in the Daily Mail this reports claims claims - They (British children) are getting fat almost twice as quickly as American youngsters as they eat double the amount of sugary and savoury treats.

Independent research company Datamonitor said average annual spending on sweets and chocolates for children in this country is £372 - equivalent to around 850 Mars bars. That is more than double the £150 for American youngsters.

The amount spent on savoury snacks such as crisps is put at £73.24 in the UK, compared with £39.51 in the U.S.

British children also eat more sugary breakfast cereals, ice cream and ready meals. More than one in three British children aged five to 13 are already overweight or obese.

But that figure is predicted to soar at a rate of 2.1 per cent a year through to 2014, far higher than the 1.3 per cent annual rise expected for the U.S. - by 2014, some 38.6% of UK youngsters - a total of 2.5million - will be too heavy.

Social changes may be largely responsible for rising childhood obesity. For example, with more mothers going out to work or unused to cooking, children often live on takeaways or ready meals.

If they are looked after by grandparents, they may be indulged with unhealthy treats. An analysis of 12,000 three-year-olds suggested the risk of being overweight was 34% higher if grandparents cared for them full time.

At the same time youngsters are taking less exercise but spending more time watching TV, playing computer games and on the internet.

In short - what has changed are eating patterns which seem to be culturally driven rather than by a novel disease process.

Anonymous said...

A&E Charge Nurse

The article suggests that British children are becoming obese at twice the rate of American children

1.But evidence suggests that increases in childhood obesity rates in America are levelling off, so any country still in the upward curve of the trend will have higher rates of increase than the Americans. So you would expect British children to be getting fatter at a faster rate than the Americans.

2.The article implies that British children are getting fatter at a faster rate than the Americans because they eat more sweets, but

•Evidence also suggests that fat British kids do not eat more sweets than thin British kids (they eat more fat and protein), which would suggest that eating sweets per se is not the cause of obesity.

“In short - what has changed are eating patterns which seem to be culturally driven rather than by a novel disease process.”

1.Given that thin people are also affected by the changing cultural pattern –why are there still thin people?

2.Changes in behaiour could lead to the emergence of any number of “novel disease processes”? e.g. cancer from pesticides.

3.Weight gain in response to illness and brain injury are recognised medical phenomena. So weight gain can be caused by a disease process.

4.Weight gain can be caused by chemicals e.g. the well documented side effect of some medicinal drugs.

5. Genetic variation alters the patient’s response to a wide range of medicinal drugs (chemicals), surely genetic variation could account for a range of responses to new ways of producing and preparing foodstuffs , for example, an allele combination that causes a failure to accurately monitor the intake of certain food stuffs?

I would say that there has been a move towards the industrialisation of food production and preparation in the last 50 years or so, at the same time there have been societal changes, these are correlated with a rise in obesity.

But correlation is not causation and more research is needed.

Tosper said...

"encourage them, above all, to eat chocolate. It is a vegetable after all!"

So is suger!

leymoo said...

Semi topic hijack:
I had Jaundice, and had lost a large amount of weight due to gallstones. I was weak, unable to work and barely able to get to the shops (before I was overweight - I was cycling 20 miles a day communting - but aerobically fit and strong).

The amount of people who said "wow, you look great!" when I was days before my ERCP and looked *awful*.

We need to stop simplistically associating weight loss with health and weight gain with the opposite.

Dr Grumble said...

Whether you start out fat or thin weight loss should always raise concern. I teach that if fat people lose weight you should worry that they might have cancer. Sometimes people think I am joking but I am not.

incurable hippie said...

I was always either underweight or normal weight, my whole life. Then, since starting to take olanzapine rapidly skipped by overweight to land at obese within a few months.

It's not a short-term treatment, I've been on it for years, I've been obese for years.

I had to make a choice between stopping taking the pills, losing weight and becoming unwell, or keep taking the pills, stay fat and stay relatively well. Sensibly, I chose the latter.

Such is the stigma of being fat that many people choose the former. That's shocking and depressing.

I can either be fat and miserable about it, or fat and ok with it, or even happy with it! The latter two make for a better life.

Dr Grumble said...

The effect of these drugs is a clear demonstration that there are things beyond a patient's control that can affect their weight.