BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence?

[Connie Stapleton PhD 342]

I’m guessing most of us understand that the disease of obesity is a complicated one. There are a number of factors that contribute to obesity. Some of these factors you may be very aware of; others you may be surprised about. Some of the causes of obesity are things you cannot do anything about; other causes of obesity are things you can influence.

BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence? (Part One of Three)

I’m guessing most of us understand that the disease of obesity is a complicated one. There are a number of factors that contribute to obesity. Some of these factors you may be very aware of; others you may be surprised about. Some of the causes of obesity are things you cannot do anything about; other causes of obesity are things you can influence. It’s important to recognize the difference. Why? For starters, you can stop beating yourself up over the things you can’t do anything about. It’s also important that you focus on putting forth effort where it will get you the best results! It’s essential for both doctors and those suffering from obesity to have a mutual understanding of these causes of obesity and which people can influence, so that:

1) Doctors can develop or increase empathy for the struggles of those suffering with obesity. When doctors better understand that many people with obesity have struggles that go beyond fighting their biology which negatively impact their weight, the doctors can more compassionately and appropriately address these issues and refer patients to see other professionals, if need be.

2) People struggling with their weight can evaluate the numerous factors impacting obesity and work toward accepting those things they cannot influence. In addition, they can take responsibility for putting forth effort into those aspects of their struggles with weight that they can positively impact.

All righty, then! Let’s look at three of the main contributing factors of obesity and then talk about each one, emphasizing what, if anything, each person can do to have a positive impact on their weight.

Genetics

Culture and Environment

Metabolism

Genetics

Obesity definitely has some genetic determinants, as researchers have clearly discovered. If there are a lot of obese people in your extended family, you have a better chance of being obese than someone from a family without a history of weight problems.

Although there are many more obese people in the current population than in previous generations, this cannot all be linked to genetics. The genetic composition of the population does not change rapidly. Therefore, the large increase in obesity reflects major changes in non-genetic factors. Listen to this… According to the Centers for Disease Control and Prevention (2002): “Since 1960, adult Americans have increased in height an average of 1 inch but have increased in weight by 25 pounds.” So in 50 years, the human species has grown taller by only an inch but heavier by 25 pounds. That tells us there is more than genetics influencing weight gain in this country.

PATIENTS: Even if you have a genetic predisposition for obesity, there are other factors involved, including the food choices you make and whether or not you exercise on a regular basis. Some of these behavioral factors are habits learned in your family, so what appears to be a genetic predisposition may be a familial pattern of unhealthy habits that can be broken.

DOCTORS: Remind yourself that patients cannot “eat less/move more” and have any effect on their current genetic makeup. Acknowledge to patients their genetic predisposition for obesity in a compassionate manner. Help to gently educate them about the factors affecting their weight that they can influence. Do so in a “firm and fair” way, providing encouragement rather than admonishment.

Culture And Environment

In addition to one’s genes, a person’s culture and environment play a large role in causing people to be overweight and obese.

The environment and culture in which you were raised impacts how and what you eat. Some people were taught to eat everything on their plate and couldn’t get up from the table until they did so. Others never sat at a table for a meal but watched television while they ate. Some kids are fed well-balanced meals while others exist on fast food or microwaved mac and cheese with hot dogs. In some cultures, simple carbs make up a substantial part of every meal. In other cultures, fruits and vegetables are consumed regularly. When you are a child, you’re not in charge of buying the groceries or providing the meals. You did learn, however, about what and how to eat from those with whom you lived. And guess what that means? How you feed your children is what they will think of as “normal” and will most likely be how they eat as adults. (I’m always concerned when weight loss surgery patients tell me their kids are “just fine” even though they eat the same unhealthy foods as the obese parent. It’s only a matter of time before the kids start to gain weight and have health problems as a result of their unhealthy diet and learned eating behaviors.)

PATIENTS: Although your genetic composition cannot be changed, the eating behaviors you learned in your family, from your culture, or developed on your own can be changed. You alone now determine what kind, and how much exercise you do and what and when you eat. Your behavior is completely within your control. Work toward accepting the fact that you are in charge of, and responsible for, your behavior and every food choice you make. For every choice, there is a consequence, positive or negative. And NO EXCUSES! It doesn’t matter how busy you are, whether you get a lunch break at the office or whether you have to cook for a family. Even if you have five kids in different activities and spend your life taxi-ing them from one place to another, you are the adult and you are responsible for how you eat and how you feed your children. It takes a very responsible person to acknowledge, “Although I have a genetic predisposition for obesity, I am responsible for making healthy choices about my eating and exercise. For me and for my children.” Focusing on what you do have control over rather than that over which you are powerless, leads to believing in your capabilities. So take charge and make positive changes happen!

DOCTORS: Engage your patient in a discussion about the cultural and environmental factors that helped shape their current food choices and exercise behaviors. Empathize with them, noting they are going to have to put forth consistent effort to change years of bad habit formation. Encourage them to get support, whether it is from friends with a healthy lifestyle, a health coach, a personal trainer, or the use of free online exercise videos. Help them set a short-term, reasonable goal and set an appointment with you to follow up. Remember, docs: That which is reinforced is repeated. Reinforce even small steps forward you see in your patients. This can go a long way in encouraging them to continue making healthier choices. A step forward is a step forward. Notice and praise every single step forward your patient makes!

Resting Metabolic Rate

Resting Metabolic Rate (or RMR) is simply the energy needed to keep the body functioning when it’s at rest. In other words, RMR describes how many calories it takes to live if you’re just relaxing. Resting Metabolic Rate can vary quite a bit from one person to another, which may help explain why some people gain weight more quickly than others. And why some people seem to find it more difficult to lose weight than others. There are some factors related to metabolism that you can’t change, but there are actually some that you can influence and change.

Things you cannot change about metabolic rate:

• Metabolic rate decreases with each passing decade, which means the older you are, the slower your metabolism gets, making weight loss more difficult.
  
• Sorry ladies - Men generally have a higher metabolism, meaning they burn calories more quickly than women.
  
• You can inherit your metabolic rate from previous generations - which can be a benefit… or not.
  
• An underactive or overactive thyroid gland can slow down or speed up metabolism.
  

Some things you can do to influence your metabolism and burn more calories include:

• Eat small, frequent meals.
  
• Drink ice Water.< br>
• You can boost metabolism temporarily with aerobic exercise.
  
• You can boost metabolism in the long run with weight training.
  

PATIENTS: I’ll bet you didn’t there was much of anything you could do that would increase your metabolism. I’m hoping you choose to implement the ways you can help your body burn more calories. And what do you know? They are completely consistent with healthy post-op behaviors that you’re supposed to do anyway:

1) Eat small, frequent meals. CHECK.

2) Drink water (so add ice and boost that RMR). CHECK.

3) Engage in exercise, both aerobic and weight bearing. CHECK. There’s no reason NOT to anymore! (That’s a slogan from a really old commercial…) The point is, your specific RMR is both something that is unique to you, and that will slow down with age, is gender-influenced, and can be affected by thyroid issues. Accept the things you cannot change and DO the things you can to get the most out of your own, unique RMR. You DO have choices! Opt not to make excuses and JUST DO THE THINGS YOU CAN!

DOCTORS: I’m pretty sure that educating patients is in your job description. Even though you have an allotted set of minutes during which to accomplish all your goals with a patient, point out the ways they can boost their metabolism while you’re looking into their ears, or hitting them on the knee with that little hammer. Present it as a, “Hey! Guess what I was reminded of today?” sort of thing. It’ll probably be absorbed better than a mini-lecture. Leave yourself a sticky note in the patient’s folder to bring it up in your next session… and then a new educational point for the next meeting, along with the small goal you set with them so you can be sure to praise them for their efforts!

Patients and Doctors and all Allied Health Professionals: We need to work together to do the following:

1) End Fat Shaming

2) End Blaming

3) End Lecturing

4) Encourage reciprocal AWARENESS and ACCOUNTABILTIY

5) Encourage reciprocal EDUCATION and DISCUSSION

6) Encourage reciprocal GOAL-SETTING and FOLLOW-UP

Stay tuned for Part Two of BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence?

[Inner Surfer Girl 12,015]

Excellent!

[4MRB4PHOTO 3,899]

Thank you for posting this.

[Connie Stapleton PhD 342]

@@4MRB4PHOTO Thank YOU for commenting!

@@Inner Surfer Girl Thanks so much! Appreciate you reading it!

[OKCPirate 5,323]

Dr. Stapleton,

I'm really not nit picking, but why would you call obesity a "disease" as opposed to a "condition." I think a case can be made for those who really messed up their internal set points with years of yo-yo dieting it might be akin to a disease, but for some it is choice.

The disease model is used in a number of complicated dependency issues, and while I agree there are some complicated brain issues with compulsive behaviors which can get so out of control that human rational will power is ineffective for creating change, for some though this is used as an excuse for inaction.

It is an important semantic difference to me. It's what makes WLS a tool to me, not a magic wand or cure. I still have to work the program to get the results. Something for consideration, rhetoric, labels and words matter.

[MrsSugarbabe 727]

I concur with @OKCPirate.

[Inner Surfer Girl 12,015]

For me, I have truly come to see obesity as a disease. Especially in that it is not a moral failing or a defect of character. It is a physical disease.

[OKCPirate 5,323]

For me, I have truly come to see obesity as a disease. Especially in that it is not a moral failing or a defect of character. It is a physical disease.

I agree, it is not always a failure of morality or character (though for some it is). Obesity I think it is more akin to a broken bone, or something which requires physical therapy. We don't blame the victim, and understand there is self work required for recovery. The danger with the "disease model" thinking is that when we think "disease" we either go "get pill get cured" or "it is incurable." Possibly too simplistic in the analogy, but I think it is sound.

The research is growing on causes of obesity and more and more we are realizing that there are many factors which contribute to this problem, from genetics, bad marketing of food, and many things about the body we didn't know or understand. I get it. I'm just throwing out a caution flag on the rhetoric.

[Alex Brecher 10,498]

Connie, Thanks for this great article! I love the way that, for each of the causes, you explain the implications for patients and the implications for each. It is so important for patients to take responsibility where possible, and understand and forgive themselves for the external factors that they cannot change. For doctors, it is so important to work with patients and encourage them to make lifestyle changes as necessary, but also to avoid blaming patients for things that aren’t their fault.

I think it is also worth mentioning that feeling sorry for yourself for whatever unlucky genes you got doesn’t help. I always think about metabolism and how some people have much faster ones than others. While it may seem (and be) unfair that John Doe gets to eat 500 calories a day more than you, don’t try to keep up with John Doe and rationalize it by saying, “I deserve it.” Just like you should not compare your own rate of weight loss to that of others post-op, it does no good to compare your metabolism to that of others. It’s an individual situation and journey!

[Alex Brecher 10,498]

@OKCPirate and @MrsSugarBabe, I agree that there are many ways to describe “obesity,” and various descriptors have various connotations associated with them. The American Medical Association recognizes obesity as a disease.

[Tssiemer1 549]

I never felt fat shamed by my doctors but EVERYTHING was blamed on my weight. "Oh you fell down two flights of stairs and have herniated discs. It's because your fat. Lose some weight."

[Connie Stapleton PhD 342]

@OKCPirate

Sorry for the delayed response. You posted, "Dr. Stapleton, I'm really not nit picking, but why would you call obesity a "disease" as opposed to a "condition." I think a case can be made for those who really messed up their internal set points with years of yo-yo dieting it might be akin to a disease, but for some it is choice.

The disease model is used in a number of complicated dependency issues, and while I agree there are some complicated brain issues with compulsive behaviors which can get so out of control that human rational will power is ineffective for creating change, for some though this is used as an excuse for inaction.

It is an important semantic difference to me. It's what makes WLS a tool to me, not a magic wand or cure. I still have to work the program to get the results. Something for consideration, rhetoric, labels and words matter."

The reason I describe obesity as a disease is because the American Medical Association refers to it as such. And clearly, there are numerous physiological issues at play when obesity is present, regardless of the particulars. People have opinions about this on both sides of the fence. I understand what you are saying and if the semantic difference is important to you, then I would stick to what you're comfortable with. I wholeheartedly agree that WLS is not at all a magic wand or a cure. Maintaining a healthy weight requires a great deal of consistent effort and defining obesity as a disease or not doing so does not change that fact. Similarly, if one has cancer or asthma or any number of other diseases/ailments, in order to obtain the most favorable outcomes, consistent effort and the choice for healthy behaviors is necessary. Thank you for your insights and observations.