Monday, December 13, 2004

Genetics and Social Issues

Ampersand at Alas a Blog posts a two part article on "What fat people and gay people have in common," here and part 2 here. The articles discuss the idea that being fat, like being gay, is genetically determined. The implication is that society should be changed to accept obesity much in the same manner that it should be changed to accept homosexuality. I'd like to propose a counterpoint to that theory: what if we're on the edge of a Darwinian alteration in environment, in which caloric efficiency is shifting from an asset to a liability?



The conclusions drawn in Ampersand's second article are broad:

"In theory, any fat person could become thin, if they only kept up what the New England Journal of Medicine called "extreme measures" - extreme low-calorie diets and tons of hard exercise - for the rest of their lives. (One formerly fat person who commented on the earlier thread, said that she exercises four hours every day).



By the same token, any lesbian or gay person could "not be gay," in the sense of repressing their real desires and marrying a person of the opposite sex. (Historically, how many lesbians and gays lived their entire lives like this? There's no way of knowing, but hundreds of thousands seems like a reasonable guess).



So in theory, every fat person and every queer person could choose "not to be." Just choose to eat as little as an anorexic, and exercise four hours every day, for your entire life. Just choose to repress your core sexual identity. Whatever it takes.



But in practice, some choices are so difficult that they can't reasonably be called choices at all.



And that is what fat people and gay people have in common."




The evidence in both articles is drawn from legitimate medical sources:

William Bennett, editor of the Harvard Medical School Health Letter, reviewed empirical weight-loss studies going back to the 1930s. He concluded that not one had been shown to produce long-term weight loss for more than a tiny minority of dieters (and most of the few who did lose weight, lost too little weight to turn an obese person into a non-obese person).

Data on the dietary treatment of obesity have been accumulating since 1931. Nothing in the chronicle suggests that worthwhile progress has been made by pursuing efforts to teach people more effective ways to restrict their food intake. There is now enough information to permit the prediction that results will be mediocre in the short run and after several years will be less than acceptable. ...

An important element of behavior modification is giving the client a model of his or her problem, one that focuses on eating behavior as the target for correction. An essential component of this model is the claim that it will be effective if the client believes it and acts accordingly. The model that appears to form the heart of most such programs, however, is at the very least seriously incomplete; there is good reason to assume it is simply wrong. In any case, the model has not produced results that would support claims of effectiveness. ...



The ethical questions that can be raised about research efforts also must be asked about the dietary programs for weight control that are carried on outside a research setting - commercial, hospital, or clinic-based, or self-help. Many such programs proffer treatment as though it were established as effective and safe. Nothing in the results published by research programs authorizes anyone to make such claims.


From an article in The New England Journal of Medicine:

Many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose....

Why is it that people cannot seem to lose weight, despite the social pressures, the urging of their doctors, and the investment of staggering amounts of time, energy, and money? The old view that body weight is a function of only two variables - the intake of calories and the expenditure of energy - has given way to a much more complex formulation involving a fairly stable set point for a person's weight that is resistant over short periods to either gain or loss, but that may move with age. ...Of course, the set point can be overridden and large losses can be induced by severe caloric restriction in conjunction with vigorous, sustained exercise, but when these extreme measures are discontinued, body weight generally returns to its preexisting level.


There's a question so often asked in queer-rights rhetoric, it's become a cliché: "Why would anyone choose to be gay? The point is, being a widely despised minority is not fun. It's not easy. It involves a lot of suffering, for many people. It's not something that most people would choose. (Although, thanks to the lesbian and gay rights movement, it is now easier for many lesbians and gays than it used to be).



By the same logic, why would anyone choose to be obese? Fat people are discriminated against in jobs, are widely seen as lazy and unattractive, and are taught a truly stunning level of self-hatred. It's not something most people would desire for themselves.



Peer-reviewed studies show that 92-96% of weight-loss plans fail over the long run - and those studies count anyone who takes off 10% or 15% of their weight as a "success." The failure rate would be a lot higher - I'd guess more like 99% - if the measurement of "success" for fat dieters was "this person is no longer fat." It's clear, I think, that weight-loss treatments don't work.




I accept the basic points proposed by Ampersand: that there is a level of genetics involved in one's weight "set point." I also agree that while with rigid control of diet and excercise obese individuals, absent certain medical conditions, can force their body to lose weight, but they will never turn themselves into "high metabolism" people.



But is that where the story ends?



It is apparent to me that we have traditional eating habits based on the active lifestyle of our recent ancestors. Three square meals a day, eating a hearty breakfast, these concepts are remnants of a time when the amount of work it took just to maintain a house and/or a farm was phenomenal. Catch and hitch up horses instead of turn the key on the car, beat rugs instead of run a vacuum cleaner, scrub, dry and hang your laundry by hand, walk the mile to the store, and see what kind of calories you burn. Look at the Amish studies for an official example. A second point: until modern times, if times turned hard it was difficult if not impossible to get help. Isolation in farm settlements, the lack of a government welfare system, and the negative view of "charity" all conspired to keep starvation a real possibility in earlier times. So the ability to burn calories efficiently, to make do with less, was a considerable asset.



In the last hundred years, we've had a radical shift to a sedentary lifestyle. Instead of getting our workouts naturally, we have to intentionally find time to exercise. We can't exactly go back to the Amish days, as I don't know anyone who has the time to do laundry by hand. Getting on the d*mn treadmill is the most time-efficient thing. But it requires conscious effort, and takes up the time we could be using to catch up on sleep, take care of kids, finish that the boss has been whining about, and so on.



The world in which we live has changed drastically toward a sedentary lifestyle, and it impacts those with a slow metabolism first. Where they used to have a genetic leg up, they now are disadvantaged. They've become obese, plagued with health problems, so we die earlier. They're viewed as unattractive and are therefore less likely to breed, put in the crudest terms.



Now, here's my radical conclusion:



In the end, WHO CARES?



There is a genetic component in weight loss, making it more difficult - but not impossible - for some people to lose weight. Why and how it happened is irrelevant, whether it's a darwinian shift or an inherent part of nature. When faced with a set of circumstances, there are really only three choices: accept it, ignore it, or change it.



Where did we ever get the idea that acceptance was the best option? That if we just accepted everything about ourselves, it would somehow solve all our problems? Some people are born with less intelligence, some with serious health problems. I got low metabolism. All that means is I need to find my own rules regarding exercise and caloric intake, and obey them. I could transform American society into a cult of the Rubenesque, and still have serious health issues to deal with, no matter how blissful I was with my french fries and chocolate ice cream. So I choose discipline, not because I'm brainwashed or prejudiced, because I am objectively healthier and have a h*ll of a lot more fun. You might think of it in terms of being deluded by the oppression of a thin-oriented society. I think of it in terms a rational response to a definable problem.

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