What Are the Causes of Obesity?

To the Editor:

Re “Scientists at Least Know What Doesn’t Cause Obesity,” by Julia Belluz (Opinion guest essay, Nov. 27):

Having practiced clinical dentistry and clinical nutrition for 40 years, I almost fell off my chair when I read this essay. Calling obesity a chronic condition rather than a chronic disease is a mistake!

We know that obesity is a combination of genetic and epigenetic factors. People are eating highly processed, pesticide-laden foods with excessive amounts of high-fructose corn syrup, salt, junk fats and various added sugars.

Factors like sedentary lifestyles, poor access to unprocessed foods in urban settings, lack of exercise, junk food advertising, poor eating habits, emotional eating and consuming too much fast food are additional causes of American and worldwide obesity. All of these factors can cause genetic mutations, add stress to our endocrine system, increase systemic inflammation and activate predispositions to all chronic disease.

Moreover, the end game of years of chronic obesity includes chronic diseases like heart disease, cancer, diabetes and nonalcoholic fatty liver as well as fertility issues.

We have had an epidemic of obesity in America for the past 50 or 60 years. This short timeline in our human genetic evolution makes it impossible to handle the changes in our Western diet. Our metabolism is not prepared to handle what our industrialized culture did to our food chain for the past three generations.

Sadly, obesity has now defined Western civilization — that is, “better living through food chemistry!”

Stanley E. Kacherski
Hopewell Junction, N.Y.

To the Editor:

Thank you, thank you, thank you, Ms. Belluz! This is the first mainstream article I’ve seen that addresses these issues involving obesity in an accessible and up-to-date manner.

I’m in my late 60s and have recently been diagnosed with lipedema — a chronic condition of excess fat that I’ve likely had since my teens. That’s 50 years of mistakenly assuming that I struggle with obesity because of a flaw in my character and am a failure because I cannot diet and exercise away the fat.

It’s been horrifying to learn that — while well meaning — so many doctors are clueless about these realities. In my case, I’ve been overwhelmed by what I’ve learned. I’m sad, angry and very grateful that I have insurance and access to a top-notch specialist.

Susan Milrod
West Hollywood, Calif.

To the Editor:

Big Food plays a crucial role in the ever-spreading obesity epidemic in the United States and abroad. Multinational corporations increasingly use sophisticated chemistry and technology to engineer food to appeal to our instinctual desires for sugar, fat and salt.

Julia Belluz rightly mentions banning “junk food marketing” in schools and school vending machines. But enhanced education about nutrition, and attention to corporate practices and advertising, are vital as well.

Governments may be “accused of being nanny states” if they regulate, but without such action, national medical and public health costs will continue to soar. Heightened recognition and appreciation of these additional factors, and of the larger costs of inaction, can help stymie this growing pandemic.

Robert Klitzman
New York
The writer is a professor of psychiatry and director of the bioethics masters program at Columbia University.

To the Editor:

I appreciate this essay’s emphasis on the fact that a person with a larger body is not an issue of personal responsibility, choice, laziness or any other individual characteristic. And the author is absolutely correct that fat shaming is harmful and stigmatizing.

However, the anti-obesity researchers that this author cites have an underlying assumption that being in a larger body is bad, and that in fact we are in the midst of an “obesity epidemic.” But is this actually true? The author herself says that “not everyone with obesity goes on to develop its associated complications, which include cancer, Type 2 diabetes, high blood pressure, heart attack, stroke and premature death.” So what if being in a larger body is correlated with some of these negative health outcomes, but is not actually the cause?

Furthermore, what if all of the interventions that we’ve been pursuing in the past 20 to 40 years to combat this “epidemic” have actually led to worse outcomes for the population, including fat shaming and weight stigma; chronic dieting, which leads to weight cycling, which does lead to bad health outcomes; and driving people of all ages, genders, shapes and sizes to have unhealthy relationships with food and their bodies, including but not limited to full-blown eating disorders?

Given everything we know about how harmful our “war on obesity” has been, we must start looking more critically at the science on this issue, and start questioning the assumptions of anyone using the term “obesity epidemic.”

Rachel Shands
St. Paul, Minn.

To the Editor:

We may not know precisely what has caused the recent increases in obesity rates. But we do know that obesity is a symptom of the larger challenges families face in America and that smart, equitable policy changes can help reverse the trends.

Food policy successes in two programs point the way forward.

A little more than a decade ago, nutrition standards were updated for the school meal programs and for the federal W.I.C. nutrition program. Healthier school meals are now associated with a reduced risk of obesity among children in poverty. The healthier W.I.C. food package is associated with a drop in obesity rates among participating children. Together, these programs serve millions of children.

We can build on this momentum by putting the health of children and families at the center of our policies. And committing as a nation to addressing community conditions like housing, dignified employment at a living wage, clean air and water, and access to health care and healthy food, all of which we know influence whether a child can grow up healthy and at a healthy weight.

Jamie Bussel
Princeton, N.J.
The writer is a senior program officer at the Robert Wood Johnson Foundation.

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