A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

Do fat people get that way because of a hormone condition?

September 17, 2010

Dear Cecil:

People diagnosed as clinically obese are sometimes said to have a hormonal condition that makes them unable to lose weight even if they cut calorie intake to a minimum. Surely if you forced them to exercise while making certain their dietary intake and vital signs were healthy, they'd be slim and trim in a couple years. In the end, isn't obesity always in the mind and not in the hormones?

Cecil replies:

I see you're an adherent of the suck-it-up school of clinical analysis, Guy, which is my default attitude too. Overweight? Eat less and exercise more. Nervous and depressed? Get a grip. Spurting carotid artery? Nothing some finger pressure and a butterfly bandage won't solve. However, not everybody shares our gritty pioneer spirit. Thus we're obliged to plunge into the research literature. Not to worry: the laws of the universe are on our side.

There's no denying your main point: people lose weight when they burn more calories than they consume. It's the first law of thermodynamics — no matter what you hear about low calorie intake leading to metabolic shutdown, energy must be conserved. While outright coercion may not be the best way of going about it, you can make anyone lose weight if you get the input-output balance right.

The problem is your assumption that a medical condition is just an excuse. Sometimes it might be, but not always. Many medical problems can lead to weight gain, and some of these can legitimately be described as hormonal conditions. One relatively common example is hypothyroidism, which afflicts about five percent of the population. Essentially your metabolism slows down, meaning you're not converting enough food into energy — fatigue is a frequent symptom. You become less active, and assuming your eating habits stay the same, you gain weight.

Polycystic ovarian syndrome, or PCOS, which affects seven percent of women, can also lead to weight gain for reasons that aren't clear. Many women with PCOS are insulin-resistant: their cells don't absorb glucose as readily as they used to, and the excess gets stored as fat. Insulin resistance, which can lead to diabetes, is a fairly common problem linked to obesity. But it's simplistic to say insulin resistance makes you fat. On the contrary, though much remains to be learned, resistance is generally thought to be the effect rather than the cause of weight gain.

After that, relevant hormonal conditions get scarce pretty fast. Cushing's syndrome, caused by abnormally high levels of the hormone cortisol, can lead to specific types of weight gain including a round "moon face" or a "buffalo hump" of fat on the neck and upper back. Fortunately it's rare. Human growth hormone deficiency may result in increased body fat, but that's a rare ailment too.

It's now known that fat (adipose) tissue itself releases hormones that play a role in appetite stimulation and energy usage. Do these hormones make it more difficult to lose weight once you've gained it? Conceivably, but the subject is complicated and not well understood.

Sometimes medications can lead to weight gain. For example, about half of schizophrenic patients and two-thirds of bipolar disorder sufferers are obese due to a combination of illness-related factors and side effects from their antipsychotic medications. Depression can lead to obesity, and so can antidepressants, many of which list weight gain among possible side effects (although most manufacturers report that weight loss is more common). Those who take corticosteroids for asthma or other problems can put on weight as well. If these people stopped taking the problematic medication I guess they could lose weight, but which would you rather be, fat and happy or thin and sick?

Is obesity genetic? To an extent, yes. Research suggests 16 percent of the population has a version of the fat-mass- and obesity-associated gene, known as FTO, that increases one's propensity to put on the pounds. However, the amount of extra weight attributable to this gene is small, just seven pounds on average. Likewise, a few overweight folks have problems with their leptin receptor genes, which can lead to early obesity by suppressing the signals that tell the body it's had enough to eat. Roughly ten percent of us have an insulin-affecting gene that increases the risk of obesity.

Still, while medical or genetic conditions play a role, most serious students of the obesity epidemic are lining up with you, Guy: too much shoveled in, not enough burned off. Truth is, nowadays it's easy to get fat — all you have to do is eat what's put in front of you. The percentage of meals eaten away from home has doubled since 1978; during roughly the same period, restaurant portions have been supersized, and average U.S. food intake has increased by 200 calories per day.

Our ability to judge what food will do to our waistlines is notoriously bad. In one particularly appalling study from 2006, 193 consumers were asked to estimate, among other things, the calorie content of an order of cheese fries with ranch dressing. Average guess: 869 calories. Actual damage: 3,010 calories.

Today, one U.S. adult in three is obese, more than double the rate in 1980. You can't blame hormones for that drastic increase. Do we chalk it up to the American public's pathetic lack of willpower? My inner puritan says yes. However, there's no question that the masses are being hammered by a relentless outside force, namely the ever-present voice asking, "You want fries with that?"

Related Posts with Thumbnails

References

Barry, Colleen L. et al. “Obesity Metaphors: How Beliefs about the Causes of Obesity Affect Support for Public Policy” The Milbank Quarterly 87.1 (2009): 7-47.

Bessesen, Daniel H. “Update on Obesity” Journal of Clinical Endocrinology and Metabolism 93 (2007): 2027-2034.

Burton, Scot et al. “Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants” American Journal of Public Health 96.9 (2006): 1669-1679.

Chandon, Pierre and Wansink, Brian “The Biasing Health Halos of Fast-Food Restaurant Health Claims: Lower Calorie Estimates and Higher Side-Dish Consumption Intentions” Journal of Consumer Research 34 (2007): 301-314.

Christakis, Nicholas A. and Fowler, James H. “The Spread of Obesity in a Large Social Network over 32 Years” New England Journal of Medicine 357.4 (2007): 370-379.

Cohen-Cole, Ethan and Fletcher, Jason M. “Is obesity contagious? Social networks vs. environmental factors in the obesity epidemic” Journal of Health Economics 27 (2008): 1382–1387.

Diliberti, Nicole et al. “Increased Portion Size Leads to Increased Energy Intake in a Restaurant Meal” Obesity Research 12.3 (2004): 562-568.

Drewnowski, Adam “The Real Contribution of Added Sugars and Fats to Obesity” Epidemiologic Reviews (2007): 1-12.

Fava, M. et al. "Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment." Journal of Clinical Psychiatry 61.11 (2000): 863-867.

Foster, Gary D. et al. “Primary Care Physicians’ Attitudes about Obesity and Its Treatment” Obesity Research 11.10 (2003): 1168-1177.

Gharib, Hossein (Chairman) “American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children—2003 update” Endocrine Practice 9.1 (2003): 64-76.

Golden, Sherita H. et al. “Prevalence and Incidence of Endocrine and Metabolic Disorders in the United States: A Comprehensive Review” Journal of Clinical Endocrinology and Metabolism 94 (2008): 1853-1878.

Haskell, William L. et al. “Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association” Circulation 116 (2007): 1081-1093.

Kahl, Kai G. et al. “Visceral Fat Deposition and Insulin Sensitivity in Depressed Women With and Without Comorbid Borderline Personality Disorder” Psychosomatic Medicine 67 (2005): 407-412.

Kershaw, E.E. and Jeffrey S. Flier, "Adipose Tissue as an Endocrine Organ." Journal of Clinical Endocrinology & Metabolism 89 (2004): 2548–2556

Kolotkin, Ronette L. et al. “Impact of Obesity on Health-related Quality of Life in Schizophrenia and Bipolar Disorder” Obesity 16.4 (2008): 749-754.

Lansky, David and Brownell, Kelly D. “Estimates of food quantity and calories: errors in self-report among obese patients” American Journal of Clinical Nutrition 35 (1982): 727-732.

Maina, G. et al. "Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors." Journal of Clinical Psychiatry 65.10 (2004): 1365-1371.

Puhl, Rebecca M. and Heuer, Chelsea A. “The Stigma of Obesity: A Review and Update” Obesity (2009).

Scarpace, Philip J. and Zhang, Yi. “Elevated leptin: consequence or cause of obesity?” Frontiers in Bioscience 12 (2007): 3531-3544.

Smiciklas-Wright, Helen et al. “Foods commonly eaten in the United States, 1989-1991 and 1994-1996: Are portion sizes changing?” Journal of the American Dietetic Association 103.1 (2003): 41-47.

Vogelzangs, Nicole et al. “Depressive Symptoms and Change in Abdominal Obesity in Older Persons” Arch. General Psychiatry 65.12 (2008): 1386-1393.

Walley, Andrew J. et al. “The genetic contribution to non-syndromic human obesity” Nature Reviews - Genetics 10 (2009): 431-442.

Wansink, Brian and Chandon, Pierre. “Meal Size, Not Body Size, Explains Errors in Estimating the Calorie Content of Meals” Annals of Internal Medicine 145.5 (2006): 326-333.

Weber-Hamann, Bettina et al. ”Hypercortisolemic Depression Is Associated With Increased Intra-Abdominal Fat” Psychosomatic Medicine 64 (2002): 274-277.

Young, Lisa R. et al. “The Contribution of Expanding Portion Sizes to the US Obesity Epidemic” American Journal of Public Health 92.2 (2002): 246-249.

Recent Additions:

A Straight Dope Staff Report by SDStaff Ken,
A Straight Dope Classic by Cecil Adams
A Straight Dope Staff Report by SDStaff Doug, Straight Dope Science Advisory Board
A Straight Dope Classic by Cecil Adams
A Straight Dope Staff Report by SDStaff Chronos, Straight Dope Science Advisory Board
A Straight Dope Classic by Cecil Adams
A Straight Dope Staff Report by SDStaff Doug, Straight Dope Science Advisory Board
A Straight Dope Classic by Cecil Adams
A Straight Dope Staff Report by SDStaff ScottInLA, Straight Dope Science Advisory Board
A Straight Dope Staff Report by SDStaff Jillgat, Straight Dope Science Advisory Board

Send questions for Cecil Adams to: cecil@chicagoreader.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope! Your direct line to thou- sands of the smartest, hippest people on the planet, plus a few total dipsticks.

Publishers - interested in subscribing to the Straight Dope? Write to: sdsubscriptions@chicagoreader.com.

Copyright © 2017 Sun-Times Media, LLC.