Rethinking Weight
Hey, maybe it's not a weakness. Just maybe. . .it's a disease
But even when limitless food is available, not everyone gets fat. In a series of studies of adult twins in Quebec who ate a high-calorie diet designed to produce weight gain, results between sets of twins were vastly different. Some twin pairs gained three times as much weight and fat as others. "We know there are genetic factors," says Jules Hirsch, professor emeritus at Rockefeller University, "but obesity may be a multistep process." Hirsch says an overabundance of fat cells leading to obesity may be the result of gene-environmental interactions that occur in infancy or in utero, leading to vastly different responses to food in adulthood. The story of the offspring of women who survived the Dutch winter famine of 1944-45 may be a case in point. Babies born to women who suffered severe undernutrition early in their pregnancies tended to have more fat and become obese more readily as adults. But the offspring of women who were undernourished late in pregnancy tended to be leaner and have less fat as adults. Clearly, says Hirsch, there is a great deal more to learn about how obesity develops.
Even scientists who basically accept that obesity is a sophisticated biological problem feel that treatment has to consider the powerful roles of social organization and psychology. Take the case of the bottomless soup bowls.
University of Illinois nutrition and marketing professor Brian Wansink sat student volunteers in front of bowls of tomato soup in his lab and told them they were involved in a "taste test." Some of the students' bowls were normal. The others had bowls that automatically refilled from a hidden tube in the bottom. The students with the bottomless bowls ate an average of about 40 percent more soup before their brain told them they were full. "Biology has made us efficient at storing fat," says Wansink. "But obesity is not just biology; it's psychology. We're not good at tracking how much we eat. So we use cues--we eat until the plate is empty, or the soup is gone, or the TV show is over."
Indeed, research shows that people eat more in groups and with friends than they do when dining alone. Simply eating with one other person increases the average amount eaten at meals by 44 percent. Meals eaten with large groups of friends tend to be longer in duration and are as much as 75 percent bigger that those eaten alone. Eating with someone, suggests John DeCastro, the author of these studies, probably leads to relaxation and a "disinhibition of restraint."
Viewing obesity principally as a biological disease worries Wansink because he fears it will remove personal control and shift blame to someone else. But doctors who treat overweight patients say that thinking of obesity as a disease would simply make more treatment available. Most obesity programs rely on personal responsibility to put into action behavioral techniques designed to achieve greater control over biology. "Most of our treatment is still based on modifying choice," says GWU's Frank. "But underneath it all you've got to recognize why it is so difficult to eat less and lose weight. It doesn't make it easier, but it takes it out of the world of willful misconduct."
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