The Cause of Obesity?

[zimney3pt]

We seem to be victims of our advances.

WALL-E come to mind anyone?


Another problem with looking at the weight number. Is that a person's weight is made up of two primary things can change with diet and exercise - muscle and fat. I think this is an important distinction that needs to be made. In studies that discuss weight loss, do they look at body composition changes or just weight loss? There will be significantly different biological and metabolic process changes in comparing an individual that loses 30# of fat compared to a person that loses 15# of fat and 15# of muscle. Both lost 30# of weight but there is a distinct difference between them.

[Jon Newman]

Originally Posted by Ben Sabo

Hi Jon,

So, how do we know which came first? Did the internal/external cue switch the gene on, or did the activated gene determine which cue the individual would be more likely to respond to? Is there any way to know for sure? This is a sincere question, btw, and I think it embodies the issue I have with the argument Anoop's scientists have made.

I'm too ignorant to be able to answer that question but I'm doubtful that it is an either-or situation. In the case of C. Elegans, the behavior change followed manipulation of the amino acid.

[Diane]

Originally Posted by zimney3pt

Is that a person's weight is made up of two primary things can change with diet and exercise - muscle and fat. I think this is an important distinction that needs to be made. In studies that discuss weight loss, do they look at body composition changes or just weight loss?

There is a lot of other stuff in there, in any humanantigravitysuit: smooth muscle, organs, lots of other things/structures that are mesodermal, which also will be subject to the changes that the far-away dorsolateral prefrontal cortex in the organism they inhabit is trying to make. They are represented by other parts of the nervous system, certain nuclei at least, which are likely to try to mount a counteroffensive, wrest control of the hypothalamus away from rostral zones. And no one is discussing the other flora and fauna in there that is not human but which still tries to make a living by chemically defending its right to exist. I'm thinking of all the gut bacteria that absolutely love sugary treats. I read somewhere long ago that when added up, that's a good 4 pounds of non-human riding around in the gut. In some guts, probably a lot more! Bone, blood weigh quite a bit I should think. The brain weighs something, and is largely fat, so it will try to save itself too. Everything has to be allowed to change/adapt, or else nothing will ever change.

[zimney3pt]

Diane, you are right there is lots of other stuff that changes.

My poorly articulated point was that if you lose 30# your bone mass, brain, peripheral nervous system, blood, lymph, other organs probably aren't significant (from a mass standpoint) component of that number, it is primarily adipose tissue and skeletal muscle loss that make up that number.

[Diane]

Has the mitochondria issue been raised yet?

Something about more of them coming along with exercise, not just in muscle but also in brain.

Something about mitochondria and obesity.

It kinda suggests that mitochondria are important, that if you create an experience for the body that demands more of them be born, more probably will. I think it's good to remember that they are symbionts with human cells; they have their own genome and reproductive capacity. If we don't have them we end up with fatal deficit diseases. If we have lots of them, we, too, could be Lance if we wanted.

A cell is a universe all onto itself. Organized star dust.

(Kory, sorry if you thought I was suggesting your point was poorly articulated - not intended. I just wanted to make the canvas larger, so the thinking could broaden out past voluntarily contractile meat, and its close cousin, blubber, there to thermodynamically protect us.)

[zimney3pt]

Kory, sorry if you thought I was suggesting your point was poorly articulated

No, that was my own conclusion.

I think you and others make great points to the depth, height and width of the canvas from many different biopsychosocial elements from the gene to the cell to the gut flora and hormone changes and beyond with our cultural influences. Obesity/weight gain (like pain) is amazingly complex and so many people suffer from it.

[Diane]

More thoughts about mitochondria: They come only from your mom.

Here are excerpts from Gray's Anatomy online, about adipocytes and mitochondria.

Adipocytes (lipocytes, fat cells)

"Adipocytes occur singly or in groups in many, but not all, connective tissues. They are numerous in adipose tissue (Fig. 2.10). Individually, the cells are oval or spherical in shape, but when packed together they are polygonal. They vary in diameter, averaging 50 μm. Each cell consists of a peripheral rim of cytoplasm, in which the nucleus is embedded, surrounding a single large central globule of fat, which consists of glycerol esters of oleic, palmitic and stearic acids. There is a small accumulation of cytoplasm around the nucleus, which is oval in shape and compressed against the cell membrane by the lipid droplet, as is the Golgi complex. Many cytoskeletal filaments, some endoplasmic reticulum and a few mitochondria lie around the lipid droplet, which is in direct contact with the surrounding cytoplasm and not enclosed within a membrane. In sections of tissue not specially treated to preserve lipids, the lipid droplet is usually dissolved out by the solvents used in routine preparations, so that only the nucleus and the peripheral rim of cytoplasm surrounding a central empty space remain."

"In neonates, a special form of adipose tissue known as brown fat is present in the interscapular region and may be more widespread. Brown fat is characterized by the presence of a large cell type in which the fat is present as several separate droplets (multilocular adipose tissue) and not as a single globule (typical of unilocular adipose tissue), and the mitochondria have unusually large and numerous cristae. These deposits of fat are concerned with heat production, mediated by mitochondria.

The mobilization of fat is under nervous or hormonal control: noradrenaline (norepinephrine) released at sympathetic nerve endings in adipose tissue is particularly important in this respect. No new adipose tissue is formed after the immediate postnatal period and accumulation of body fat, as in obesity, is due to excessive accumulation of lipid in existing adipocytes, which become very large. Conversely, weight loss results from the mobilization and metabolism of lipid from adipocyte stores, with the consequent shrinkage of the cells."

Sounds to me like we depend on whatever mitochondria we have in muscle, and in nerve (see above) to mobilize/shrink post-natal blubber.

[anoopbal]

Is that a person's weight is made up of two primary things can change with diet and exercise - muscle and fat. I think this is an important distinction that needs to be made. In studies that discuss weight loss, do they look at body composition changes or just weight loss?

No. And there is where research is moving towards. This is one of the reasons why they think the risk of mortality is lower in obese when fitness is taken into account.

And most body composition measures are two compartment models: fat mass & fat free mass. That means they can only measure those two compartments. So your organs, bones, water , glycogen, muscle all go in to the fat free mass component. So you are kind of right.

[MaxG]

Originally Posted by anoopbal

These are just rough estimates which most researchers would agree.

Your nitpicking about the details about any phenomenon doesn’t magically make the phenomenon disappear. Questions like how does fat cells sense how much fat they have and how precisely the set point are only great questions for future studies.

If you reread my post, I was not nitpicking at any details.
I was posing questions: where is the set point?
When is the set point established? Can it not change during the course of several years or due to behavorial changes?

I just got you and Ben confused. I am sorry.

No worries.

It is not hard. If you have looked at diets and weight loss, they are widely used. Even the common advice of keeping a journal to record your food patterns (self monitoring) is born from cognitive behavioral strategies. I have even wrote an article about it.

The point is we have studied and tried left and right different strategies. Most people who say thing like ahh it was lack of planning, they took only 550 calories are just not familiar with what is going on in the field.

That is a straw man argument, as I have not said anything along those lines. You extrapolated these assumptions about my standpoint from the use of my word "planning".
When I said planning, I did not mean keeping a food log, adjusting macronutrients, etc.
"Faulty planning" would be not considering your personal needs, drive, cravings, habits, motivation and adjusting your weight loss strategies to best leverage these components to your advantage.

Again, I don’t see anything in your arguments. You are just looking at the minority and trying to explain for the majority. Exceptions don't change the generality.

What exceptions?
The people that lose weight and keep it off are an exception, sure.
They prove though, that is is possible to do just that.

The question is, why do most people fail in keeping off the lost weight.
Restricting your eating habits is hard. Eating is a fundamental part of everyday life and restricting aspects of of everday-living is much, much harder than simply adopting a new habit (like flossing teeth twice a day or whatever).
That a lot of people fail at this, to me, is merely proof that it really is that hard to accomplish.

If your assertion is true, then obese people lack discipline or cannot change habits and behaviors. There is no other way to slice it even if you are trying hard not to come across that way. If it is true, this will be such shattering discovery worth the Nobel prize in the field of psychology!

If you truly believe that no behavorial change has to take place to lose weight I don't know what to say.
Considering the fact, that a failure to stick to these changes (for whatever reason) might be a reason for a lack of weight loss success is far from insulting to obese people, IMO.

That said, I think we are all here to engage in stimulating discussions.
We are all adults and I'll say it again: I would appreciate it if you stopped your derogatory/insulting remarks as well as skipping requests by me and ignoring whole parts of my posts. I'm not here for a rhetoric victory, I'm assuming you aren't either.

I also repeat my request from yesterday, when refering to cognitive-behavorial approaches to weight loss:

Please refer me to the ones you are talking about. It is hard to comment on this statement without knowing what we are talking about.

I would be sincerely interested in reading about them.

[anoopbal]

I would be sincerely interested in reading about them.

There are lot of studies and reviews. These are standard treatment procedures for obesity just like diet and exercise. Any obesity textbook has all these approaches. Here is a few:

J Am Diet Assoc. 2007 Jan;107(1):92-9.
Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference?

Current practice guidelines for management of overweight and obesity recommend a program of diet, exercise, and behavior therapy for all persons with a body mass index (calculated as kg/m(2)) of at least 30 (and those with body mass index > or =25 plus two weight-related comorbidities). In this tripartite treatment--often referred to as lifestyle modification--behavior therapy provides a structure that facilitates meeting goals for energy intake and expenditure. Although standard behavior therapy reliably induces mean weight losses of approximately 10% of initial weight, these reductions are difficult to maintain. Some authors argue that a shift in focus from behavior change to cognitive change will improve long-term results of lifestyle modification programs. This review describes, in detail, the standard behavioral treatment of obesity and compares it with an alternative treatment model that is based in a cognitive conceptualization of weight control. A review of the literature suggests that the differences between standard behavior therapy and cognitive-behavioral therapy of obesity lie more in their underlying theories than in their implementation. Empirical comparisons of the long-term effects of these approaches are needed.

Best Pract Res Clin Anaesthesiol. 2011 Mar;25(1):11-25.
Medical and surgical treatment of obesity.
Kissane NA, Pratt JS.

The prevalence of obesity has reached epidemic proportions. Conceptualization of obesity as a chronic disease facilitates greater understanding its treatment. The NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity provides a framework by which to manage the severely obese--specifically providing medical versus surgical recommendations which are based on scientific and outcomes data. Medical treatments of obesity include primary prevention, dietary intervention, increased physical activity, behavior modification, and pharmacotherapy. Surgical treatment for obesity is based on the extensive neural-hormonal effects of weight loss surgery on metabolism, and as such is better termed Metabolic Surgery. Surgery is not limited to the procedure itself, it also necessitates thorough preoperative evaluation, risk assessment, and counseling. The most common metabolic surgical procedures include Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion. Surgical outcomes for metabolic surgery are well studied and demonstrate superior long-term weight loss compared to medical management in cases of severe obesity.

Cognitive-behavioral therapy for weight management and eating disorders in children and adolescents.
Wilfley DE, Kolko RP, Kass AE.
Eating disorders and obesity in children and adolescents involve harmful behavior and attitude patterns that infiltrate daily functioning. Cognitive-behavioral therapy (CBT) is well suited to treating these conditions, given the emphasis on breaking negative behavior cycles. This article reviews the current empirically supported treatments and the considerations for youth with weight control issues. New therapeutic modalities (ie, enhanced CBT and the socioecologic model) are discussed. Rationale is provided for extending therapy beyond the individual treatment milieu to include the family, peer network, and community domains to promote behavior change, minimize relapse, and support healthy long-term behavior maintenance.

And you can find all the studies here: http://www.ncbi.nlm.nih.gov/pubmed/

[Jon Newman]

Originally Posted by Diane

(Good one Kory! And so true!)

One thing that has not yet been discussed is the idea of microbiome. It isn't just our own genes we have to deal with. There's a huge "environmental" influence from inside our own bodies. Well, gut tube to be more precise.

Anyway, this thread has inspired me to write a blogpost, Over the hump, about my own anti-obesity efforts.

Hi Diane,

I just got around to reading your blogpost. Great stuff. Good job. And happy belated birthday.

[MaxG]

Anoop, or anybody else with more intimate knowledge of the scientific status quo in obesity research:

Are there studies analyzing ghrelin/leptin levels in people losing weight gradually vs. suddenly?
Especially a year or so post weight loss?

Same thing but for longevity of weight lost?

[anoopbal]

Happy New Year 2012 to everyone!!

Hi MaxG,

No. And I don't think we will see any difference. Leptin is regulated mainly by your body fat levels. It is mainly released from your fat cells. And if it indeed there was a difference, we would have seen tremendous success for Low calorie diets compared very low calorie diets.

I am guessing you agree with the biological basis of obesity, but not with the maintenance part. I hope we can agree that modest weight loss of even 5-10% have shown clinically significant benefits even in obese people.

If we can the question becomes a bit more manageable. Lose 5-10% of your body weight. It is good enough to see a lot of improvements in health. There is no scientific reason to get back to a normal BMI and going OCD trying to maintain it. If you are more concerned about the cosmetic aspects, then go for more, but it will be extremely hard for the majority.

It will be a good discussion about how to maintain the 5-10% weight loss.

[caro]

http://jcem.endojournals.org/content/95/11/5037

http://www.medscape.com/viewarticle/728449

http://hal.archives-ouvertes.fr/docs...aum_1_.pdf.PDF (in french)

http://www.sfrms-sommeil.org/IMG/pdf/Fiche_sommeil.pdf (in french)

http://www.plosmedicine.org/article/...l.pmed.0010062

http://erj.ersjournals.com/content/22/2/251.abstract

[anoopbal]

Here is an interview with the author of 'the Fat Trap' article on NPR radio: http://www.npr.org/2012/01/03/144627...ork-against-us

Dr. Frank Arthur made some good comments about the bioogical basis of obesity.

[MaxG]

Originally Posted by caro

http://erj.ersjournals.com/content/22/2/251.abstract

Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment

1. I.A. Harsch 1 ,
2. P.C. Konturek 1 ,
3. C. Koebnick 2 ,
4. P.P. Kuehnlein 1 ,
5. F.S. Fuchs 1 ,
6. S. Pour Schahin 1 ,
7. G.H. Wiest 1 ,
8. E.G. Hahn 1 ,
9. T. Lohmann 1 and
10. J.H. Ficker 1

1. 1Medical Dept I, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen and 2German Institute of Human Nutrition, Dept of Intervention Studies, Bergholz-Rehbruecke, Germany

1. I.A. Harsch, Medical Dept I, Friedrich-Alexander University Erlangen-Nuremberg, Division of Respiratory Medicine and Division of Endocrinology and Metabolism, Ulmenweg 18, D‐91054 Erlangen, Germany. Fax: 49 91318535025. E‐mail: igor.harsch@med1.imed.uni-erlangen.de

Abstract

Serum leptin and ghrelin levels were investigated in patients with obstructive sleep apnoea (OSA) syndrome before and during continuous positive airways pressure (CPAP) treatment and compared with body mass index (BMI)-matched controls without OSA.
Male patients (n=30) with OSA (apnoea/hypopnoea index=58±16, BMI=32.6±5.3 kg·m−2) underwent CPAP treatment. Fasting leptin and ghrelin were measured atbaseline and 2 days, and in the case of leptin 2 months after initiation of treatment.
Baseline plasma ghrelin levels were significantly higher in OSA patients than in controls. After 2 days of CPAP treatment, plasma ghrelin decreased in almost all OSA patients (n=9) to levels that were only slightly higher than those of controls (n=9). Leptin levels did not change significantly from baseline after 2 days of CPAP treatment, but were higher than in the control group. After 8 weeks, leptin levels decreased significantly, although the BMI of the patients showed no change. The decrease in leptin levels was more pronounced in patients with a BMI <30 kg·m−2.
These data indicate that the elevated leptin and ghrelin levels are not determined by obesity alone, since they rapidly decreased during continuous positive airways pressure therapy.

Though this is a very special patient population, this would indicate to me that there might be possible ways to alter leptin/ghrelin levels independent of bodyfat gain/loss, no?

[Diane]

Just saw this from Neurotic Physiology blog: Sad lonely lady rats may really eat their feelings. Rats were raised in circumstances that prevented interpersonal socializing. SciCurious points out that:

"Previous studies have looked at boy rats. And they found no major differences in WEIGHT. These studies looked in girl rats, and found major differences in depressive like behavior (which has been seen in male rats as well), but also found big differences in weight and food intake. And weight and food intake could have many other effects. It's not just enough to look in males anymore. With depressive disorders and anxiety disorders higher in women, it's about time we looked to the lady rats."

[Diane]

Check out the eating disorder known as orthorexia.

[MaxG]

It seems like given too many options for something we are evolutionarily primed to expect to have rather little of (food) often gives way to either giving in to feeding instincts (just in case there won't be this much food around later) or trying to supress this instinct through establishment of strict rules as to what food is acceptbale to eat and what isn't (an overexaggerated version of "don't eat the red berries hanging low on that bush, they are bad for you").

Freud might have likened this to a struggle between the "Es" and the "Über Ich".
Instincts vs. perceived behavioral guidelines... But it's early and I haven't had my coffee yet...

[Diane]

This has to be here:
Gut microbe networks differ from norm in obese people, systems biology approach reveals

Wow, think about it. It's a micropsychosocial inner-environmental context. It's like a zoo in there, and we're the supply wagon for it.

[Diane]

This looks interesting:
BED-head and obesity - food for thought
.. about binge-eating-disorder.

[Diane]

My blogpost about personal obesity/weightloss. To be brutally honest..

[Diane]

What Beatrice Golomb thinks about metabolic syndrome.
Excerpt:

For factors that relate at both extremes to MetSyn—e.g. short and long sleep duration—the energy disruptive one will prove to cause MetS, and the energy supportive one to serve as a fellow adaptive consequence.

[Diane]

I saw this and thought of this thread! Love the picture. I doubt it's actually historical, but I like it anyway. From:
"Study of the Day: Like Obesity, Weight Loss Can Be Contagious"

I agree with the article - I find myself melting away with other melting-away women these days. Not that it doesn't require some focused effort, but I'm learning that swimming with other like-minded/bodied fishes in a school is easier than trying to do it all by myself.


Image: Everett Collection shutterstock

[Diane]

This excellent program (posted earlier by curious) talks (in part) about stress's contribution to obesity, and to its distribution on the body. More stress in a subordinate situation -> more abdominal fat.

[Diane]

Hey Anoop - check this out:Manipulating Molecules in Heart Protects Mice On High-Fat Diets from Obesity, Affects Metabolism

Wow.

[natdocpg]

I have spent the last couple of weeks exploring the various sites on the internet that relate to insulin resistance, low-carb dieting, and the Paleo way of eating etc.( I have had to break out my physiology and biochemistry books to follow some of the discussions as you would expect since my courses were many years ago and the details of the Krebs cycle escape me these days! ) The debate about the causes of obesity rages on out in cyberland, but one thing seems to be coming clearer, calories in/calories out is nowhere as straightforward as it would intuitively seem because, much like the neuromatrix, there is a black box between input and output, our old friend the brain. I now read a very interesting blog by a PhD, Stephan Guyenet, whose interest is the neurological control of our body fat mass and I offer the link here as further grist for the mill http://wholehealthsource.blogspot.ca/

[Diane]

Check it out: Complex World of Gut Microbes Fine-Tune Body Weight

[ian s]

http://www.guardian.co.uk/business/2...-making-us-fat

I was treating a dietician lecturer the other month and we got talking about the issues around obesity (obsession with individual responsibility and ignoring wider issues) than this appeared ...well written I thought ......

[Diane]

Maybe obesity is merely a matter of Akkermansia deficiency. It's a jungle in there...