Please Explain: Obesity

Friday, July 31, 2009

According to recent studies, about 1/3 of Americans are obese, and between 1998 and 2006, the obesity rate rose 37% in this country. Obesity-related illnesses accounted for an estimated $147 billion in 2008, nearly 10 percent of all U.S. medical spending, according to the Centers for Disease Control. On today’s edition of Please Explain, we're looking into the causes of the dramatic rise in obesity and the health risks that come with it. We're joined by Dr. Louis Aronne, Clinical Professor of Medicine at Weill-Cornell Medical College-NY Presbyterian Hospital, and Director of the Comprehensive Weight Control Program, and Dr. Kelly Brownell, Director of the Rudd Center for Food Policy and Obesity, Yale University.


Dr. Louis Aronne and Dr. Kelly Brownell,

Comments [41]

Jgarbuz from Queens, NY

My last point, Dr. Atkins did NOT die of a heart attack, but slipped on the ice and died of the fall at age 74. He was a cardiologist who had worked with over 40,000 patients and the "diet" business came much later. What Atkins was saying was essentially that people should eat only those foods that were available to our ancient ancestors some 50,000 years ago, when man was a hunter-gatherer, and before wheat and rice even existed. There was no such thing as being an obese hunter-gatherer. Such could not have survived. Of course, in addition we must also avail ourselves of vitamins and nutrients that were not always available then. Man evolved over hundreds of thousands of years long before sugar (except the natural kind found in berries)and most high carbohydrate foods were even developed. And certainly eons before the development of the processed "foods" industry just recently created over the last century. Heart disease and obesity are the side effects of the modern processed food industry. These maladies did not even exist a few centuries ago except amongst the very wealthy who could afford such "luxury" foods.

Aug. 01 2009 02:07 AM
Claire from NYC

I didn't think the guest meant that thyroid disorders were "overused as an excuse" for obesity... My impression is that he thinks obesity LEADS TO thyroid disorders... and then, the whole system gets more and more out of whack, and the person is prone to becoming even more obese.

On another note, I reject the idea that "diets don't work." My personal experience is that my thin friends are basically lifetime dieters, who watch what they eat and cut back if they gain even a small amount.

Jul. 31 2009 04:28 PM

#37: glad you found something that works for you for now. But on this:

"Oh and one other point: Exercise is a very small part of the weight loss / obesity equation."

I'm afraid it's a rather large part. I say that as someone who cared for overweight and obese patients in a clinical setting.

Please note that when you limited "carbs" from your diet, the most likely benefit was the restriction of very dense carbohydrate sources, such as sugar and refined grains.

Sugar and highly refined carbs were more likely your problem, rather than "carbs" in general. To restrict carbs entirely, you would need to restrict vegetables and fruits, which are essential to proper nutrition.

I've seen what happens to inactive patients - higher risk of Type II Diabetes (even at normal weights) and of course Type II Diabetes goes hand in hand with heart disease and other serious illnesses more often than not.

"If anything, exercise makes you consume more carbs thereby countering its effect on weight loss."

That might be true if you don't yet know how to feed yourself. (It's not as if they teach you in school, so how should you know?) Come home from the running field and have a nice big bowl of stir-fried broccoli rabe with fresh garlic and ginger. Takes only a teaspoon of oil to prepare.

As someone who's worked in the health care field, I noticed a real difference in outlook between active and inactive patients. I've also seen what happens to people who "follow" Atkins. (Most people don't have the discipline for "real" Atkins, so it's a bit of a misnomer to call it as such.)

One last note: I strongly recommend Dr. David Kessler's "The End of Overeating." It's a fascinating read, and really takes this to a more comprehensive level. Also, anything by Michael Pollan.

Jul. 31 2009 03:51 PM
Richard L. Gordon from E. Northport, L.I.

Leonard, Your guest Dr. Brownell dismissed your question about whether mind related factors play a role in obesity and whether this would be a productive avenue to pursue.

I suggest that an expert from The Center for Mindfulness at the U. Mass Medical Center might have provided an entirely different perspective on the subject. For example, I think that teaching meditation to kids in school might be an effective way to reduce obesity in this generation, not to mention perhaps helping with other unrelated societal problems.

Jul. 31 2009 02:43 PM
Skeptic from Lower East Side

Oh and one other point: Exercise is a very small part of the weight loss / obesity equation. How many overweight people do you see at the gym regularly? How many overweight marathon runners are there? If anything, exercise makes you consume more carbs thereby countering its effect on weight loss. Exercise is not required to lose weight. I've done it. I stopped going to the gym for a month, but lowered carb content to see what would happen. Guess what? I effortlessly lost 2-3 pounds per week.

Jul. 31 2009 02:40 PM
Skeptic from Lower East Side

Lilly prince, I find it disturbing that you would perpetuate a lie about the death of Dr. Atkins. He died from a head injury as a result of slipping on ice, not from heart disease.

Carbs drive insulin which drives fat accumulation. It's textbook Endocrinology 101. Lessen carb intake and you'll decrease body fat composition. Stop torturing yourselves. Try it just for a couple of weeks. It really works.

Jul. 31 2009 02:25 PM
lilly prince from Boston, MA

Carbohydrates don't make you fat. Not being sufficiently physically active (or burning off more calories than you consume) makes you fat. You need carbohydrates - carbs are where our bodies get fuel and energy from. Refined carbs, like white bread, white pasta, etc. aren't that great for you because they are simple sugars and burn up fast, but they are not the cause of obesity. Overeating and not exercising is what is making America fat.

P.S. Dr. Atkins died of a heart attack - what does that say for his diet? The Atkins diet is probably the absolute worst diet out there.

Jul. 31 2009 02:10 PM
jawbone from Parsippany, NJ

Further comparison: When I still had remaining thryoid tissue after my surgery, but before the ablation treatment to kill off the remnant cells, I experienced being on Synthroid AND having those remnant cells put out natural thyroid hormone (due to Thryrogen shots, so I did not have to go hypothyroid).

My conclusion is that natural thyroid hormone must have some micro ingredients which are different from the synthetic version. But that is pure conjecture.

It was splendid! Not only revived sex drive, but energy "just there" to be used. However, the most amazing thing to me was that my tendency toward indecision was gone for those 3-4 weeks (all the good effects gradually declining, btw): I got more done in those few weeks than I'd accomplished in the preceding six months--or so it seemed.

But, simple decision making, looking at something in the garage and being able to decide then and there whether to keep it, store it, donate it--with no time spent on whether it might be useful, etc., really was amazing to me. Things were just so clear, graspable.

This effect on my brain, my "self"ness, my "mind" made me also much more sympathetic to a friend who suffers from bipolar disorder. While I'd intellectually known that he didn't deliberately do the things he did when either manic or depressed, I had not fully realized how powerful our bodies are over our "minds." Over "us."

Now, I can still get ticked when my friend calls at 3AM bcz he's hyper, but I do understand more what's happening to him.

Also, when I have low energy days and somewhat better energy days, I find that writing, organizing is much more difficult on the low energy days, easier of the better eneryg days. I still haven't fully learned to not beat myself up for not "getting it together," but I'm working on it. And certainly extend that understanding to my friend.

Jul. 31 2009 02:09 PM
BrettG from Astoria NY

I'm surprised no one's mentioned Dr. David Kessler's book & his sugar, fat & carbohydrate mix @ fast food & other eateries.

Plus, stop subsidizing corn for oil, shortening & animal feed. Then ban antibiotics in healthy food animals. If we were eating 1950's food, even frozen we'd be eating better than we are now. Stop Frankenseeds & limit insecticides.

Jul. 31 2009 02:02 PM
Mary Catherine Donnelly from nyc

Simply eat REAL foods. Fruits and vegetables will never make a person overweight. We need to help and educate people to eat what grows naturally and we need to stand up against the advertisers and even the medical community that misinforms people about food. For example, eating a 400 calorie avocado is much better than a chemically made "protein bar" that is 250 calories. We need to re-shape, so to speak what real food is, that there are affordable and fun ways to eat well and we need to support our farmers to help us make these choices.

Jul. 31 2009 01:58 PM
Amy from Manhattan

And to Jgarbuz, the problem w/low-carb diets--as w/many other diets--is that they're oversimplified. Just as there are good & bad fats, there are good & bad carbohydrates. Complex carbs, e.g., whole grains, are much healthier than refined carbs, & it also depends on what else is in the foods they occur in. I'm glad your diet worked for you, but you say yourself you're doing more than eliminating carbs. And different diets work/don't work for different people.

Jul. 31 2009 01:57 PM
JJ from Brooklyn

The dr contradicts himself - ' people cannot be blamed bc of their environment, bc they go into a 7-11 and buy junk food'... But that is their choice! i live in the same cities as 'those' people and i don't live on pork rinds and kool aid and candy bars. I also don't drink beer every night after work. Personal choices DO matter!

Jul. 31 2009 01:57 PM
Wayne johnson from Brooklyn

Why not just stop eating meat and dairy? Better for the planet,our health,the creatures we kill .

Jul. 31 2009 01:55 PM
Mary Pagones from New Jersey

Given the environment, and the rate of obesity in the U.S., perhaps a better question is why everyone isn't overweight--what qualities make people resistant to obesity?

Jul. 31 2009 01:55 PM
Alberto from NY NY

I'm sick of the food and pharmaceutical industry placing the responsability of obesity on the consumer. Americans are suffering this obesity epidemic and yet they're tortured by mixed messages from the media.

Jul. 31 2009 01:53 PM
Alvin from Manhattan

Most "heavy" people I meet ignore the second part of the old chestnut "Diet and Exercise". I've spoken to several nutritionist friends, and they all same the same thing: calories in minus calories out determines weight gain or loss. If all you're doing is cutting your calories, your body compensates by reducing your metabolism. You must exercise. In addition, certain types of exercise (weight training, for example) will increase your metabolic rate even after you're done. Mix up your exercise types, and DO IT.

Jul. 31 2009 01:52 PM
Claudia Weissberg from Brooklyn

As a Type 1 diabetic, I know that all diabetes is not curable with weight loss, as one guest said. I'm tired of Type 2 diabetics being lumped in with Type 1.

I'd also like to hear discussion on how the treatments for diabetes (insulin and pills), cause weight gain themselves.

Jul. 31 2009 01:52 PM
jawbone from Parsippany, NJ

Due to a thyroidectomy, I've had the opportunity to experience some of the effects of varying levels (or usage by my body?) of thyroid hormone.

After my first ablation treatment, I was exhausted, dosage of Synthroid was changed up to 150mcg, I had interesting heart palpitations (minnow flopping inside my chest feeling), brought down to 137mcg.

Suddenly, and I mean very quickly, my energy level was back to what I remember my energy level to have been when younger. My body temperature rose to closer to "normal," and, for whatever reason, I lost weight. I did not change my diet (my life is a diet), but weight just came off. I lost over 30 pounds and was within 12 pounds of my moderate goal (not high school weight, however, but much closer).

Then, I had my annual whole body scan. After getting two Thyrogen shots to allow thyroid stimulating hormone to be produced for the test, I felt immmensely tired and also had the mean munchies. Since I was doing a low-iodine diet, I was able to not eat too much, body managed to gain weight, along with holding water.

My endo told me I'd get back "in synch"--hasn't happened. Weight went up inexorably, unless I stopped eating (which I can't keep up very long). Energy has not returned, but I have days of more, then less; days I cannot be awakened by three alarms in my bedroom.

It's kinda depressing. I had 9 months of weight loss and energy; now two years of low, uneven energy.

I have an HMO with limited endos who handle thyroid cancer patients, so have little choice of doctors, alas.

But--I have seen myself when "synching," as my endo put it, and myself not. I don't know how to get back in synch, nor does my endo know how to get me there. Scream!

Jul. 31 2009 01:51 PM
Amy from Manhattan

Leonard asked (facetiously, I assume) after the break if a frog in the throat could be related to obesity. I doubt it, but obesity *is* often related to sleep apnea--maybe the guests could comment on that?

Jul. 31 2009 01:50 PM
Anonymous from westchester

I am a generally thin person, but every bite I eat seems to expand my stomach. Most of the time I look pregnant. Sometimes almost 6 months pregnant. Is there any reason for this and can I do anything about it?

Thank you.

Jul. 31 2009 01:49 PM
mozo from nyc

#17 Sunshine -- Thank you!

Jul. 31 2009 01:46 PM
Alaina from Weehawken

Is your guest saying simply that thyroid disorders are overused as an excuse, or that they don't exist? I and my mother are both hypothyroid, and we have some trouble controlling our weight (more say, than I did before this set in for me two years ago). I am still able to maintain a healthy weight by eating well and exercising, but I am concerned because there are many doctors who practically deny the existence of thyroid disorders, which have symptoms far beyond weight gain and do require treatment.

Jul. 31 2009 01:46 PM
LM from Long Island

Sunshine. You are so right. We need to get back to eating foods that are fresh and not processed out of all recognition!! Food Inc has a lot to answer for.

Jul. 31 2009 01:45 PM
Margaret Curry from Manhattan

I believe you are missing the point here. What about addressing the disease of obesity and the other aspects of it other than scientific or medical: what about emotional issues? Food as a learned life coping mechanism, like alcoholism. Food as a mood-enhancing substance that become a deadly addiction. Food is merely the symptom of many other issues. When will our society embrace obesity as a disease with other recovery needs other than merely addressing the physical? I lost a loved one to this disease and I believe it is in part due to the ignorance and prejudices and lack of knowledge about this disease.

Jul. 31 2009 01:45 PM
Nils from Brooklyn

On a recent trip to the Virginia Beach/Chesapeake area I was reminded, as I often am when I leave NYC, of the dearth of easy access to good, real food options. And I'm not talking about health food -- just real food. The restaurants were all chain restaurants or fast food drive-thrus. Markets did not sell fruit or nuts. Everything is processed. I can't say how happy and proud I am to live in a city where it's exceedingly easy to make good food choices, and how depressing it is to see that a large part of our country lacks the same opportunities. Also, how great is it that our indigenous fast food -- pizza -- really isn't all that bad for you (in moderation, of course)!

Jul. 31 2009 01:44 PM
Sunshine from Bushwick

It is about time we have a discussion about the FOOD THAT IS BEING PUT OUT THERE. Food, Inc? have you seen it? can you imagine what kinds of things that are now putting in our food. for our kids that are CHANGING our metabolism ans our cells. At what point will this conversation be introduced to our health care crisis,i don't know. Cuz it probably is at the core

Jul. 31 2009 01:42 PM
jgarbuz from Queens, NY

To eric of NJ

Probably a study funded by the sugar lobby. How did Duke do with tobacco studies? :)

Jul. 31 2009 01:42 PM
Caitlin from Jersey City

What do the guests think of surgical means for weightloss, such as gastric bipass?

Lonnie, BMI was developed in the early to mid 1800s, somewhat earlier than the invention of the fashion model.

Jul. 31 2009 01:39 PM
eric from jersey city

Splenda? A Duke Study conducted in rats fed Splenda-containing “rat chow”, revealed a 50% reduction in “good” bacteria, an increase in intestinal pH, and enhanced expression of enzymes that affect drug metabolism. According to the “Citizens for Health” this study also suggests that Splenda “contributes to increases in body weight.”

It should come as no surprise that an artificial sweetener may have harmful, or potentially harmful effects. Splenda my be the sequel to the transfat story…. and we all know how that turned out.

quoted from:
"The inside skinny on celebrity diets and celebrity weight loss"

Jul. 31 2009 01:38 PM
eric from jersey city

splenda? A Duke Study conducted in rats fed Splenda-containing “rat chow”, revealed a 50% reduction in “good” bacteria, an increase in intestinal pH, and enhanced expression of enzymes that affect drug metabolism. According to the “Citizens for Health” this study also suggests that Splenda “contributes to increases in body weight.”

It should come as no surprise that an artificial sweetener may have harmful, or potentially harmful effects. Splenda my be the sequel to the transfat story…. and we all know how that turned out.

quoted from:
"The inside skinny on celebrity diets and celebrity weight loss"

Jul. 31 2009 01:36 PM
mozo from nyc

I am a native New Yorker but have lived in various states (currently in Florida for work reasons). Mt personal experience is that you will find less obese people in NYC than in other parts of the US.


I think for two reasons. One, New Yorkers do a lot more walking than their country cousins. If you don't have car down in Florida, you cannot go anywhere, even it's to get a gallon of milk or a loaf of bread. Two, access to nutricious food. The restaurants down here are full of food with carbs and fat.
I will sadly add that the restaurants where I am are simply awful with the exception of some BBQ places (tastes good but will make you fat in no time). I cook all the time.

Jul. 31 2009 01:35 PM
Jonahan from Manhattan

I'm extremely skinny since birth. I complained to my the YMCA on 14 St, that they don't have any weight gain programs for me, just for weight loss, and they told me that I must be sick and should go the the hospital to be checked...

Jul. 31 2009 01:28 PM
Jgarbuz from Queens, NY

I fully agree that in addition to maintaining a low carb diet, one must drink plenty of fresh water, do a reasonable amount of heart-pounding exercises, including some yoga-style stretching, a little bit with weights, some jumping or running, etc. A half hour a day should be more than enough if done right. Also, some vitamin supplements can help. But at the core must be a strict carbohydrate restricted eating regime, though are days when you can "splurge" provided you go back on the wagon immediately. I eat lots of meat, turkey franks, eggs, butter, as well as blueberries, cucumbers and other zero or low carb foods.Sugar is STRICTLY VERBOTEN (as well as bread, cake and other high carb foods) and Splenda is liberally used to replace the need for sweets. Again, lots of water must be consumed as well. It's not really terrible once you get used to it and realize that sugar and other carbs, just like tobacco and drugs, is the enemy of good health, a decent weight and vigor.

Jul. 31 2009 01:11 PM

That was in response to Maldo from Manhattan.

Jul. 31 2009 01:08 PM

you should fist take a look at the charms and you will notice they are obese by popular standard. you seem to show ignorance about anthropology ( cultural and social ), as well as the latest in nutrition and obesity research.

Jul. 31 2009 01:06 PM
Anne from NYC

Would your guest address the following questions? Thank you!
(1) Is it possible to be "fat and fit" and not have increased risk of heart disease, diabetes, etc.?
(2) Is it realistic to expect that some people with genetic predispositions can ever be truly "normal weight" without some degree of overweight? How much of a health risk do they still have?

Jul. 31 2009 01:06 PM
Maldo from Manhattan

Thank you, Phyllis. Another example of this lack of education about nutrition is Jgarbug's claim that carbohydrates are to blame for obesity. Sure, they are partly to blame, especially in light of all the high-fructose corn syrup needlessly included in so many commercially processed foods. But exercise is key to maintaining a healthy body weight. Too many Americans don't exercise at all. It seems like they find walking, for instance, humiliating.

Jul. 31 2009 12:56 PM
Phyllis from NYC

Maldo, there is indeed an epidemic of "severe lack of education" in this country.

Jul. 31 2009 12:43 PM
Maldo from Manhattan

sr, did it ever occur to you that the fertility symbols you mention aren't obese, but instead are PREGNANT?
Which leads me to a point about obesity: a lot of it seems to stem from a severe lack of education.

Jul. 31 2009 12:40 PM

the studies out there are very contradictory, some say slightly over weight people live longer and healthier life than normal or below normal weight, there is also questions raised about BMI. it does not take into factor muscle mass. just to name some.
If evolution gave us a better chance of survival by accumulating more fat, why should we be dictated by the fashion industry and the popular media how a person should look like. i see pre-historic fertility charms portraying clearly obese females, and i also see voluptuous female figures depicted in all kids of art through the ages. and my question is who decides what is normal weight?

Jul. 31 2009 12:32 PM
Jgarbuz from Queens, NY

The reason for increased obesity? CARBOHYDRATES. That's it. I've been on the so-called "Atkins diet" radically controlling my intake of carbs to less than 60 grams of carbs a day for over a dozen years, and at age 62 can fit into slacks I wore in college. If you are serious about cutting off your fat, cut out the carbs instead.

Jul. 31 2009 12:09 PM

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