Exploring the sense and nonsense of food and health

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The Obesity Epidemic: Why?

Diet and Health: With key to the calories. Lulu Hunt Peters, 1918

By Sally J. Feltner, PhD, RDN

In 2013, the American Medical Association House of Delegates approved a resolution classifying obesity as “a disease state with multiple pathophysiological aspects requiring a range of interventions.” We now accept the fact that obesity can lead to diabetes, heart disease, and cancer risks.

Today, 2.1 billion people – nearly 30% of the world’s population – are either obese or overweight, according to new data from 188 countries. The U.S. Centers for Disease Control and Prevention analysis said, “About 38 percent of U.S. adults aged 20 and older are obese as are more than 17 percent of children aged 6 to 11, federal data shows.”

“The global problem affects all countries, income levels, age groups and accounts for over 3-4 million deaths a year with estimated health costs of over $2 trillion a year.” (International Journal of Obesity).

There is no one cause. Many people still continue to blame the obese person’s lack of willpower and insist that if they just ate less and moved more, their weight would not be a problem. This may explain some cases of obesity, but how could more than 2 billion people worldwide begin to make poor choices about their food intake and allow themselves to become fat. Moreover, this upward trend earnestly began in the late 1980’s and has continued to the present. Obesity rates were just 13.4% in 1980 but reached 34.3% by 2008. So what happened to cause this sharp rise? – More than likely a lot of things.

In 2016, an article by Bruce Y. Lee, Associate Professor of International Health at Johns Hopkins Bloomberg School of Public Health succinctly describes his opinions on what factors changed to help create this epidemic. He states that obesity is a result of the breakdown of three major systems that include biological, social, and environmental factors.

Biological Systems

Our metabolic systems have been affected to some extent by non-stop dieting. A plethora of fad diets and exercise gimmicks grew into a huge obesity industry. Diet books topped Amazon and best seller lists while the supplement industry went berserk over worthless and sometimes dangerous weight loss aids. Americans responded and when surveyed, a large majority of respondents said they were “on a diet.”

Even TV reality shows (The Biggest Loser) resulted in weight loss that lowered the metabolism of almost all participants gained back their hard-fought  loss. As each weight loss attempt occurs, the cycle of weight loss/regain occurs over and over again. The body is threatened by a perceived starvation state and attempts to prevent it by putting forth metabolic and hormonal mechanisms to alleviate the threat. Obesity research has shown that nearly 95% of dieters regain their weight loss in a few years.

Social Systems

Social media, friends and family, cultural beliefs, TV advertising, and personal responsibility are all important in shaping our behaviors about eating, appearance, and body image.

Advertisements in the media have promoted the obesity epidemic by making claims that their products will magically transform your body into a svelte image and allow you to finally wear that bikini you bought years ago and that weight loss is easy. Most weight loss diets promise success by showing us before and after pictures of supposedly successful weight losers. What they do not say but disclaim in the small print that you usually can’t read is that results don’t always occur as presented. Most weight loss programs do not include an exercise component nor do they offer any behavioral counseling. Almost all have no disclosure about their success rates of weight loss and maintenance.

Environmental Systems

Determining what a healthy diet consists of is difficult enough – opinions abound and debates continue. This results in confusion and misinformation for the average consumer. They tend to give up on just what exactly is the best way to eat.

So many individuals are exposed to reliance on cheap foods found in the fast food industry. They may live in food deserts defined as parts of the country usually found in impoverished areas devoid of easy access to fresh fruit, vegetables, and other healthful whole foods. This is largely due to a lack of grocery stores, farmers’ markets, and other healthy food choices.

The food industry has been instrumental in developing ultra-processed foods that hardly resemble “real” foods. Snacking has become a national pastime and is dominating several of the inner aisles of the supermarkets. Snacks are abundant in every gas station, convenient store, or vending machine that tempt you to increase their profits.

Additionally, the food industry promotes the intake of sugar, fat and salt by attempting to reach what they call “the bliss point,” defined by the precise amount of sweetness that makes food and drink most enjoyable. You can find the results in the sugary cereals and sweetened beverage aisles in the supermarkets.

People do not cook anymore leading to procuring your meals outside the home. Restaurant portions have become gigantic compared to what they were in past decades. For example, a typical serving of theater popcorn was 270 calories (5 cups) in 1970 compared to now that is typically 630 calories (one tub). Some restaurant meals contain as many calories as we need in an entire day. The average U.S. intake increased 455 kcal/day, a 20% increase from 1970 to 2009. (Dr. Stephen Guyenet, The American Diet, 2012). From research studies we have found that the more food that is put in front of people, the more they eat. We now are familiar with the term “supersize” and the concept of “all you can eat buffets.”

The complexities of the obesity epidemic/pandemic are impossible to fully comprehend as well as their need to be “fixed” to reverse or at least slow down the trend. There are some solutions to accomplish this but they will require much cooperation between politics, community, medicine, research, government, and the public.

If America’s obesity trend continues at its current pace, all 50 states could have obesity rates above 44 percent by 2030, according to a new report from Trust for America’s Health and the Robert Wood Johnson Foundation. Although important, we need to stop just focusing on what we eat, but equally important on how we eat to fix what contributed to the epidemic in the first place.


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Obesity and Willpower?

DNA and Epigenetics

DNA and Epigenetics

It is becoming more apparent that the global obesity epidemic is due to many complex interactions between our genetic makeup, physiology  and environmental factors such as availability of cheap food, an abundant food supply and the types of foods we eat.  This interaction is referred to as epigenetics and discussed in a previous post HERE.



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Eat Less? Move More?

Two very  thoughtful discourses on the causes, attitudes, treatment and prevention of obesity. As we know more about the complexities of obesity, some still seem to want to  treat it with a simple solution: Eat Less, Move More. This approach does not seem to working very well and only appears to add to the bias against the obese patient.



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Do you want lemon with that?

Often, foodborne illness outbreaks never have the source of  the outbreak identified.  Perhaps it’s the innocent little lemon wedge in your tea or water?  The risk is small since bacteria are everywhere and their carriers are usually our hands – therefore,  hand washing is the best protection.  But is that little lemon wedge really necessary?  The studies in the article say maybe NO.



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Food Allergies: A Taste Could Be Dangerous

EpiPens are portable epinephrine-dispensing de...

EpiPens are portable epinephrine-dispensing devices which can be used to alleviate the symptoms of severe, acute allergies. (Photo credit: Wikipedia

A food allergy is an abnormal physical reaction of the immune system to a particular food. Food allergens are proteins that are not broken down during cooking or by enzymes in the body during digestion. In contrast, a food intolerance is an adverse reaction to a food that does not invoke an immune response, e.g. lactose intolerance.

When a food allergen enters the blood, it can cause a drop in blood pressure; when they are near the skin, hives can develop; when they make their way to the lungs, asthma can occur. The reactions can appear quickly as a few minutes after eating the offender. This may result in an anaphylactic reaction, which are severe, life-threatening reactions that cause constriction of the airways in the lungs which inhibits the ability to breathe.

Eggs, milk and peanuts are the most common sources of food allergies in children. In adults, shellfish, peanuts, tree nuts, fish, wheat, soy and eggs are most common. These foods together cause 90 percent of all reactions to food allergens. Some children will outgrow their reactions to milk and up to 20 percent of them outgrow a peanut allergy. Adults are rarely able to rid themselves of a food allergy once it is established.

Food allergies appear to be increasing.  See a previous post HERE.  The following article discusses some of the reasons they be on the rise.


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Eat Less – Move More – Is it that simple?

Weight and food blogs abound on the Internet and everyone from bloggers to related comments is passionate about which diet worked for them.  The great debate is right now is low carb vs. low fat.  There are the carbophobes, fatphobes, food faddists and the ever-present diet products, supplements and gimmicks.

Everyone has a theory even though I doubt many of them are biochemists, endocrinologists, or have degrees in human physiology.  Some people are just using common sense – how refreshing.  After trying to remember my biochemistry courses, I realized that I learned a little but just enough to make me realize that I basically know nothing about how and why we get fat.  What I have learned is that the process is very complex as well as losing the weight and keeping it off.

This is what I do know (subject to change daily):

  • We eat too much and move too little.
  • We eat too many processed foods containing the villains, sugar and fat (and salt).
  • Food is all around us in ways that humans have never experienced before.
  • We follow every fad diet that is out there hoping that this one will be the magic bullet we’ve been waiting for.
  • We eat too fast and never let our brains know we are full.
  • Our body weights and body types are influenced by our genetic makeup.
  • Our bodies try to protect us from starvation at all costs when we do diet
  • Some people remain thin.

Here’s what the current research  says:


Research has found that genes do play a role in obesity whether they increase the risk or decrease the chances that someone will become overweight and/or obese. In one study, 18 new gene variants were linked to obesity and confirmed the presence of 14 others.  Another study identified 13 gene variants that influenced whether fat appeared on the belly or thighs, helping to confirm our theories of apple or pear body shapes.  Among these genes, seven had a stronger effect on women than men (no surprise).

If a person has more of these variants, they have a greater risk of becoming obese, but it does not mean they will always become obese.  The genes appear to act in the brain in concert with environmental influences, i.e. whether they turn on or off and no one knows what those influences are (yet).  When mice with the same genetic makeup (inbred) were placed on a high-fat diet, some gain more weight than others.  When you exercise them by running on a wheel, some run more than others.  So animals with the same genes display different body weights and exercise habits.

Obesity expert Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said, “Let us by all means study our genes, and their associations with our various shapes and sizes,”  “But let’s not let it distract us from the fact that our genes have not changed enough to account for the modern advent of epidemic obesity — our environments and lifestyles have.”

The Environment

The best example lies with the Pima Indians who basically have a lot of genetic similarity.  One group lives in Arizona and 75% of them are overweight or obese and of them, 45% have diabetes type 2.  Another group lives in Mexico and most of them are not overweight and have a 6% rate of diabetes. Guess who has the healthiest diet – the Mexican Pimas. They eat real food and have to work a little harder to obtain it than their Arizona counterparts.  Arizona Pimas eat the typical American diet of fast food loaded with sugar and fat.  No surprise here.


We are just beginning to understand the role of hormones in weight regulation and eating behavior.  Leptin is the most studied but there are several others.  Leptin is produced by fat cells and tells the hypothalamus in the brain when the body has plenty of fat stores.  When people lose weight, their leptin levels also decrease.  The hypothalamus thinks the body is starving and promotes more food intake and less energy expenditure to prevent starvation. Hunger drives the individual to eat and thus weight maintenance is difficult.


Some interesting research suggests that in some cases a virus, primarily the adenovirus 36, causes obesity.  In animals (chickens, mice and non-human primates) this virus increases fat stores.  Thirty percent of obese people have antibodies to this virus compared to only 11% in non-obese people.

There is also some research suggesting that the kind of gut bacteria may influence your weight status.  Transplanting feces from a thin animal to a fat one reversed the obesity and transplanting feces from a fat animal to a thin one made the thin one fatter.  Diet, especially fiber can influence what kinds of bacteria reside in the gut.


Some medications can cause weight gain. In a new study, Australian researchers found that among more than 11,400 adults with high blood pressure and/or diabetes, those on some older beta-blockers weighed more, on average, and had larger waistlines. And in a study of 30 patients with high blood pressure, they found that people on beta-blockers generally burned fewer calories and fat after a meal.

So, weight gain and loss is not so simple after all as some say – eat less, move more may be true for some people, but for others, there are factors beyond their control that must be understood before they are judged too harshly for their weight status.