Wednesday, April 23, 2008

Fat. So?

Oh, a while ago I wrote up a review of a book by Gina Kolata, a New York Times science writer. I never did anything with it, so why not, I'll post it here.

Rethinking Thin

In the mid 1980’s, I worked as a research assistant at the University of Pennsylvania’s Obesity Research Group. It’s been a long time since I’ve had any interest in the details of obesity research, but it got my attention when I saw that Gina Kolata, a New York Times science writer, wrote Rethinking Thin. This is a book which pulls together decades of human and animal research on the causes, treatments, and repercussions of being overweight. In the book, she followed four patients enrolled in a two-year research study at Penn’s Obesity Research Group, now called the Center for Weight and Eating Disorders. The group’s name has changed, some of the researchers however, have not, and it’s always fun to read a book when I can put faces and stories to the names.

The book itself is the history of obesity research, coupled with glimpses of our views about weight in the last century or so. Is it complete? I really don’t know. What I do know is that as I read the book, I was inspired to reconsider certain beliefs I’d held about weight and weight control. I also, however, could think of many examples of people who defied the principals that the author puts forth as new truths.

Kolata begins with the discovery of Jean Anthelme Brillat-Savarin, a French lawyer, who published The Physiology of Taste in 1825. Brillat-Savarin wrote that the treatment of obesity mandates, “a more or less rigid abstinence from everything that is starchy or floury.” This was a preview of the Atkins diet, nearly 200 years ago, and perhaps the start of an endless series of diet fads. Kolata moves on to discuss the practice of “fletcherizing,” named for Horace Fletcher, also known as “The Great Masticator,” who advocated that chewing food one hundred times per minute was the key to the perfect weight and all-around good health. After years of chewing, America was introduced to calorie counting by Fisher and Fisk in their 1916 book How to Live. Around this time, Americans became consumed with being thin and young girls started to diet and exercise to lose weight. The stories continue: the first obesity surgery occurred in 1911 when a Philadelphia surgeon removed 12 pounds of adipose tissue from a patient’s abdomen. The 1920’s saw skinny flappers and the first bathroom scales and full-length mirrors. The diet club, TOPS, was started in 1948. There were diet drinks, diet pills, diet contests-- Kolata describes it all.

Almost every woman wants to be thinner, the author tells us. Miss America has gotten taller and thinner. Jennifer Anniston weighs in at 110 pounds, too light for her 5’5” height. And it’s hard to be fat: fat people make less money and are treated with shame and disgust, sometimes being subjected to public humiliation. Their medical problems are all attributed to their weight. 91 percent of formerly fat people in one survey chose having a leg amputated (hypothetically!) over being obese again.

Kolata continues with a careful look at more recent research in the field—both human studies regarding the etiology, transmission, and treatments of obesity, and animal models in search of chromosomes and hormones that contribute to or control both appetite and body weight. She reports on twin studies, diet studies, research on those who’ve been starved and those made to gain weight.

The four patients/research subjects in the Penn study are revisited throughout in short chapters. There weight loss progress is noted, their optimism waxes and wanes as the pounds drop and come back. They are here, I believe, to make the book more palatable to the lay reader; it is otherwise a recital of research studies with a fair number of pages devoted to the search for a fat mouse gene and hormones which might, but so far don’t, hold answers to the problem of obesity. The Penn patients’ stories are dealt with rather superficially. They weren’t particularly distinctive or compelling and they blended in the author’s desire to show that sustained weight loss is a nearly hopeless goal.

Dr. Albert J. Stunkard, the Director Emeritus of the center, gets his own chapter in Rethinking Thin. He is presented as intelligent, insightful, determined, and inquisitive in his nearly 50 year- long quest to understand obesity. It’s good to know he hasn’t changed since my days as his college student.

Kolata wrote this book with what appears to be clear agenda, she has a message she wants to get out there. It goes something like this, and I’ll list it as bullet points:

· Obesity is not caused by underlying psychological problems or a lack of motivation to be thin.

· Weight is genetically determined (or at least not environmentally determined) and this is supported by adoption and twin studies. Individuals have a narrow weight range, a set point per se, and it is difficult for them to vary from this by either gaining or losing weight; it is even more difficult, if not close to impossible, for them to maintain a weight either above or below the set point range.

· There is are organizations, including diet industries, academic centers, and federal agencies which are invested in propagating the belief that it is unhealthy to be overweight and imperative that Americans eat less, eat healthful foods, and exercise more. Kolata quotes Eric Oliver, a University of Chicago political scientist, “If you are on the political right, obesity is indicative of moral failure. If you are on the left, it means rampaging global capitalism.”

· People are fatter. No one knows why, and interventions aimed at changing diet and behaviors do not change weight. Kolata repeatedly mentions a $20 million, intensive 8 year study done with high-risk Native American children—the study, she says, has mostly been ignored.

· Studies that broadcast the health risks of being overweight are flawed and it seems that overweight people have decreased mortality according to more recent studies. As Americans have gotten taller and heavier, they’ve also gotten healthier with longer life spans and fewer chronic illnesses.

The Penn Study finished after two years on a low note. The dieters had long ago stopped losing weight and had regained much of what they’d lost. They were disenchanted and disappointed though perhaps transformed to a better place of acceptance.

And the book itself? It was a quick and entertaining read. I did have the sense that the author was on a mission to change our views and preconceptions about weight and all that we believe to be unquestionably true about the evils of obesity. At moments, Kolata swerves towards sensationalism, and it’s clear she’d like us to decide that fat is beautiful.

Maybe she’s right and maybe we will.