their physical condition squarely on their behavior, which couldn’t be further from the truth.
There has to be a reason, of course, why anyone would eat more calories than he or she expends, particularly since the penalty for doing so is to suffer the physical and emotional cruelties of obesity.There must be a defect involved somewhere; the question is where.
The logic of calories-in/calories-out allows only one acceptable answer to this question. The defect cannot lie in the body—perhaps, as the endocrinologist Edwin Astwood suggested half a century ago, in the “dozens of enzymes” and the “variety of hormones” that control how our bodies “turn what is eaten into fat”—because this would imply that something other than overeating was fundamentally responsible for making us fat. And that’s not allowed. So the problem must lie in the brain. And, more precisely, in behavior, which makes it an issue of character. Both eating too much and exercising too little, after all, are behaviors, not physiological states, a fact that’s even more obvious if we use the biblical terminology—gluttony and sloth.
The entire science of obesity, in effect, got caught up in the circular logic of the calories-in/calories-out hypothesis, and it’s never been able to escape. Establishing the cause of obesity as something that has to happen when people get fat—take in more calories than they expend—prevents any legitimate answer to the question of why anyone would ever do such a thing. Or, at least, why they would do it if they weren’t driven to it by forces outside their control.
We have the same problem if we ask why diets fail. Why is it that obesity is so rarely, if ever, cured by what should be the simple act of eating less? If we suggest as an answer that fat people respond to food restriction just as fat animals do—they reduce their energy expenditure, while experiencing increased hunger (as Jeff Flier and Terry Maratos-Flier explained in
Scientific American
)—then we’ve opened up the possibility that the same physiologic mechanism that drives obese individuals to hold on to their fat in the face of semi-starvation might have been the cause of their obesity in the first place. Again, that’s not allowed. So instead we blame the failure of the diet on the failure of the fat person to stay on it. It’s a failure of will, a lack of the necessary strength of character to do what lean people do and eat in moderation.
Once overeating is established as the fundamental cause of obesity, blaming behavior—and thus a lack of character and willpower—is the only acceptable explanation. It’s the only one that doesn’t lend itself to further meaningful research and so, perhaps, the identification of a defect more fundamental still that would explain why people would willingly overeat if they had any choice—that is, why they really got fat.
This insidious logic began to pervade the scientific discussions of obesity in the late 1920s, courtesy of Louis Newburgh, a University of Michigan professor of medicine who would eventually become the most prominent American authority on obesity. Until Newburgh came along, most physicians who thought about obesity assumed that anything so intractable must be a physical disorder, not the end product of a mental state. Newburgh argued the opposite, insisting that those who got fat had a “perverted appetite,” which was (for the era) a technical way of saying that these individuals had an urge to consume more calories than they expended, and lean people didn’t. Newburgh based this conclusion on the fact that all obese people have literally to overeat to get fatter—which is true, of course, but irrelevant.
This left unanswered, as I said, the obvious questions: Why do people who get fat overeat? Why don’t these people control their urges? Why don’t they eat in moderation and exercise as lean people do? Well, the choices were no different in Newburgh’s era from
There has to be a reason, of course, why anyone would eat more calories than he or she expends, particularly since the penalty for doing so is to suffer the physical and emotional cruelties of obesity.There must be a defect involved somewhere; the question is where.
The logic of calories-in/calories-out allows only one acceptable answer to this question. The defect cannot lie in the body—perhaps, as the endocrinologist Edwin Astwood suggested half a century ago, in the “dozens of enzymes” and the “variety of hormones” that control how our bodies “turn what is eaten into fat”—because this would imply that something other than overeating was fundamentally responsible for making us fat. And that’s not allowed. So the problem must lie in the brain. And, more precisely, in behavior, which makes it an issue of character. Both eating too much and exercising too little, after all, are behaviors, not physiological states, a fact that’s even more obvious if we use the biblical terminology—gluttony and sloth.
The entire science of obesity, in effect, got caught up in the circular logic of the calories-in/calories-out hypothesis, and it’s never been able to escape. Establishing the cause of obesity as something that has to happen when people get fat—take in more calories than they expend—prevents any legitimate answer to the question of why anyone would ever do such a thing. Or, at least, why they would do it if they weren’t driven to it by forces outside their control.
We have the same problem if we ask why diets fail. Why is it that obesity is so rarely, if ever, cured by what should be the simple act of eating less? If we suggest as an answer that fat people respond to food restriction just as fat animals do—they reduce their energy expenditure, while experiencing increased hunger (as Jeff Flier and Terry Maratos-Flier explained in
Scientific American
)—then we’ve opened up the possibility that the same physiologic mechanism that drives obese individuals to hold on to their fat in the face of semi-starvation might have been the cause of their obesity in the first place. Again, that’s not allowed. So instead we blame the failure of the diet on the failure of the fat person to stay on it. It’s a failure of will, a lack of the necessary strength of character to do what lean people do and eat in moderation.
Once overeating is established as the fundamental cause of obesity, blaming behavior—and thus a lack of character and willpower—is the only acceptable explanation. It’s the only one that doesn’t lend itself to further meaningful research and so, perhaps, the identification of a defect more fundamental still that would explain why people would willingly overeat if they had any choice—that is, why they really got fat.
This insidious logic began to pervade the scientific discussions of obesity in the late 1920s, courtesy of Louis Newburgh, a University of Michigan professor of medicine who would eventually become the most prominent American authority on obesity. Until Newburgh came along, most physicians who thought about obesity assumed that anything so intractable must be a physical disorder, not the end product of a mental state. Newburgh argued the opposite, insisting that those who got fat had a “perverted appetite,” which was (for the era) a technical way of saying that these individuals had an urge to consume more calories than they expended, and lean people didn’t. Newburgh based this conclusion on the fact that all obese people have literally to overeat to get fatter—which is true, of course, but irrelevant.
This left unanswered, as I said, the obvious questions: Why do people who get fat overeat? Why don’t these people control their urges? Why don’t they eat in moderation and exercise as lean people do? Well, the choices were no different in Newburgh’s era from
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