Hey guys, Dr. Garth here again,

I also posted the following under the congentital disease thread, but I thought since it is such an important topic, I would lead it off as a new thread. I love the debate over whether obesity is a disease or a way of life, it is my favorite to discuss and probably one of the most pertinent issues in medicine right now. Is it nature or nurture? It is blogs like this that I hoped the show would spark.

Sparold posted that he/she was incensed when I "implied" that genetics played a large role in obesity. Let me be clear, I am not implying this I am outright stating this as a scientific fact. There are mounds of research on this topic, too lengthy for me to state but lets look at a few. I think the most telling article was a dutch study following adopted children They found that even if a child was adopted at birth and grew up in a home with skinny parents, the child's weight correlated ONLY with its biological parent and not at all with the family it grew up in. Can you get any clearer than this. This study flat out stated that the environment the child grew up in had nothing to do with whether they were fat or thin and this was completley determined by the biological parents they may not even know existed. This was further supported by a twin study showing that identical twins separated at birth achieved virtually the same weight when they grew up irregardless of the environment in which they grew up.

Now we have of course gotten more complex studies that have actually mapped the gene that leads to obesity, often called the thrifty gene. Its exact mechanism of action is not completely clear but there is definitely some role in hunger.

Someone stated that if they ate the amount that people in the show ate then they would also be obese, thereby implying that these people just eat too much. The problem is more complex than that. I will tell you that you couldn't possibly eat as much as an obese person eats if if you tried as hard as possible to do it. This experiment has also been done. When a skinny person tries to eat high calorie diets their body basically revolts. Their metabolic rate speeds up and they develop food aversion. They cannot keep it up over a long period of time.

Yes obese people eat more, but they do so not out of a lack of will power but due to the fact that their genetics codes for higher production of hormones that make them hungrier than the average person. Medical science is currently studying a slew of hormones (ghrelin, leptin PYY, MOPC) that control hunger. Science is definitely showing that satiety(satisfaction and lack of hunger) is definitely controlled by these hormones and the response varies among people based on genetic disposition.

Now you can give all the opinions you want but I ask for 1 scientific paper that can refute the claim that their is a genetic predisposition to obesity. I have searched and studied and am yet to find one.

I am so passionate about this issue because I believe obesity is the last bastion of prejudice. Society thinks that obesity is a disease of the fat and lazy. Doctors face this disease by telling patients just eat less. However, diets fail in 97% of obese patients. Studies have shown that obese people revert into a starvation mode when they are in a diet. Their metabolic rate slows and their ghrelin, a hormone that makes you hungry, elevates. They are genetically destined to fail a diet. And because of this skinny people treat these patients as failures, and they in turn feel like failures and this is just not right.

If you look at my patients post op you will see people who exercise, eat well, and are active fantastic "skinny" people. They just needed this tool to overcome their genetics.

Now Sparold brings up a good point. Our genetics have not changed in thousands of years but we are getting fatter every year. You have to remember that we actually were relatively starving until about 100 yrs ago with the industrial revolution. Before that time food was scarce. In fact some have postulated that we derived the "thrifty"(obesity) gene in order to prevent starvation, and those who had this gene were better survivors so they propagated the gene.

With the industrial revolution came easily available food that was always present. And this has gotten worse through the years. Processed food is a continually growing industry that has thrived over the past 20 - 30 years. Easily available high caloric food has grown by leaps and bound. Think of McDonalds. There may have been a few in the city you grew up now there are a few just in your immediate neighborhood. We eat out about 70% more than 30 years ago and the food we eat is less healthy. In fact there are those who believe that hunger is driven by nutritional deficiency, and our diets are less and less nutritious every year. Our soil is depleted of vital nutrients (a whole other topic) when we even eat food that grows in soil. So our environment has fueled our genetic predisposition to eat as much as possible.

So you have lets say a family, lets call them the Smiths. Now lets go back thousands of years and the Smiths are roaming around looking for any food. When its winter, tough luck, they starve. Now lets say John Smith is born with a genetic defect such that he can eat more than the others and he has a slower metabolic rate so he can store more calories as fat. Well John Smith and his offspring have a better chance of survival than the other Smiths because they are more likely able to survive famine. Now go forward to the industrial revolution. The Smiths are a hungry lot, have been for years, but they have stayed lean because eventhough they were hungry there just wasn't that much food to eat. But now all of a sudden they move to a city and there is a lot of food. So they eat more than some, maybe they are slightly larger. Come the 70's they are eating even more because Cracker Jack came out on the market. Now fast forward to the 2000's and there is easily available, and cheap, high caloric food. And they are still hungry but man they can eat more. and what is there to stop them eating? For 5$ they can eat 1500 calories at their local taco bell, all the time trying to scratch that 1000 year old itch we call hunger.

Sound far fetched? You can have all the opinions you want, but science may beg to differ.

Someone on the blogs who I blieve was a dietician said it best when she stated that being 50lbs overweight may be a lifestyle issue, but being 100 lbs overweight is a disease.

Garth

This is another great example of why those of us who are patients of Garth's find him to be an amazing surgeon. He understands not only the medical science behind obesity, but he also fights for understanding of us and our issues. I was truly blessed when I found Garth's practice and had him for my surgeon.

Thank you, Garth, for being an amazing surgeon and, even more importantly, a wonderful, caring person! YOU ROCK!

Hey, Dr. G, thanks for the interesting information on obesity. I am a social worker, primarily working with youth, and I do run across the obese teenager now and again. Good information to have. I was wondering, since so many have posted in response to Rose's plight, if you all might want to set up a donation sight, to have folks donate the funds to have her surgery done. Just a suggestion. Thanks, again. Angela

Doc, the article you posted in the other thread was long and people may have missed this critical study.

"A few years later, in 1990, Dr. Stunkard published another study in The New England Journal of Medicine, using another classic method of geneticists: investigating twins. This time, he used the Swedish Twin Registry, studying its 93 pairs of identical twins who were reared apart, 154 pairs of identical twins who were reared together, 218 pairs of fraternal twins who were reared apart, and 208 pairs of fraternal twins who were reared together.

The identical twins had nearly identical body mass indexes, whether they had been reared apart or together. There was more variation in the body mass indexes of the fraternal twins, who, like any siblings, share some, but not all, genes.

The researchers concluded that 70 percent of the variation in peoples' weights may be accounted for by inheritance, a figure that means that weight is more strongly inherited than nearly any other condition, including mental illness, breast cancer or heart disease."

Weight is more strongly inherited than mental illness, breast cancer or heart disease. Nobody disputes the genetic component of these disorders but for some reason everyone who is overweight is claimed to be lacking will power. Does the bipolar mania patient lack willpower too? How about Shaquille O’Neal? Does he lack the willpower to be short?

Thanks Doc.

I agree with u 50/50. My father struggles with his weight. My mother struggled with her weight and learned to starve herself until the day she died. All my siblings have struggled their whole life with their weight. I was always the heaviest but now I am the thinnest because of my surgery But I also learned about starving myself and have a niece in recovery too for bulimina. (Other members of my family are in recovery for addictive behaviors.)

So while it is in the genes for the body- the mind learns how punish itself for failures how every it wants. Be it eating to cover the pain up- starving itself-buliminic-your mind controls how you handle those genes. (I have done a poor job of it cause if I had done a good job I wouldn't have needed the surgery.)

I am most impressed that you Doc are actually reading these boards and responding. I did send an email to you concerning my fight with bulimina since my surgery.

This message has been edited. Last edited by: kim g,

Okay Doc so I agree with you 50/50. I have a family who has sruggled with their weight their whole life. Like me some are even in recover for eating disorders. So it may be in my genes but it is also my decision to eat or purge my pain away. My other sisters have been skinny but have had to work at their whole life so they didn't get the Card butt and hips.

So I accept that I not ever be super skinny but I also accept I made the decision to eat myself into hiding or same and purge myself if I felt guilty. Those things weren't in my genes.

I also sent you an email so maybe you can help me with the whole eating disorder thing I have after my surgery.

I am a case of nature vs nurture and proof that quite a lot of obesity obviously deals with nature. I am adopted and everyone in my adoptive family has always been thin, but not me.

I was always made to feel horrible at being overweight, even with my adopted mother begging me and trying to "encourage" me to lose weight by promising me money, books, gifts, whatever. It caused me to hide away and steal/eat more food than before and I continued to gain more and more weight.

About 8 years ago, I was able to meet my birth mother and I was literally shocked at how my body mass and shape mirrored hers almost identically, as well as my 1/2 sister. The genetics was obvious when the three of us stood side by side.

Interestingly enough, my birth mother is the product of continued poverty and I believe poverty also is a proponent of obesity. It seems like it would be the complete opposite, but as we all know, it's the junk food that is the cheapest food to buy and people affected by poverty obviously have to shop as cheaply as possible.

Genetics has to play a significant part in obesity. I had every reason not to be obese growing up, but as hard as I tried, it was impossible to avoid gaining weight. My obesity is a combination of genetics and of course, the addiction I have towards food as a means of comfort for my depression.

I agree with Dr Garth 100%.I have suffered from obesity most of my life as did my father and much of his family. I have tried may diets and weight loss products and lost weight only to gain it and more back when the insatiable hunger became too great to bear. I am the mother of 2 children. My oldest is overwieght, but not obese (yet). My youngest is 17 is 6 foot tall and weighs over 300 pounds. I have also seen the insatiable hunger that Dr. Garth spoke about in both of my children. I have a sister that is 4 years older than I am. She had always been the "skinny" one in our family. She now is morbidly obese, just as I am. I am 5'3" tall and weigh 290 pounds. I have lost 50 pounds since January. Only because of severe back pain that threatens to put me in a wheelchair. I have been contemplating WLS for years, but have finally found the courage to follow through with it when I recently was diagnosed with severe reflux disease. I know that this will not be the cure all for my obesity, but will give me a chance at a normal life. My husband who is also morbidly obese and is looking at hip replacement, is comptemplating WLS,too. So my children were doubly cursed by genetics.I just wished that more people, including the medical profession, would believe that obesity is inherited just as any other genetic disorder.

What a great topic! Thanks for posting the articles for us. I am also impressed that Dr. Garth is not only reading these things, but taking the time to respond!

S/P Lap RNY 6/5/07

children adopted at birth and grew up in a home with skinny parents, the child's weight correlated ONLY with its biological parent and not at all with the family it grew up in. Can you get any clearer than this.

Dr. Garth,
Let me start by saying I love your show. I especially enjoy watching you and Big D interact. A father/daughter surgical team did my surgery and you remind me of them. I had lap RNY 8 months ago and have lost 150 lbs. (From 340 to 190) Although it has been anything but the easy way out, I wouldn't trade the last 8 months for anything in the world. I'm actually getting back the life that someone my age (37) should have.
Now, back to the quote. I found the study with the adopted children interesting. I was adopted at 3 months, actually an underweight baby. My adopted family has many obese people, including my brother who is actually the biological child of my adopted parents. (They were told they would never conceive, and he was born 10 months after my adoption--go figure!)Unfortunately, he is built exactly like my dad and uncles. We were raised in the same house and both grew up to be morbidly obese adults. I know nothing about what I inherited, but I find it hard to believe that the food-oriented lifestyle we were both raised with isn't a major factor.

Dr Garth,
First let me say, I love your show. I am thrilled to hear your views on adopted children and weight issues. I have two adopted children and I was..260 pounds... i have lost 80 pounds so far with diet and exercise over the last 2.5 years...I realized i was showing my bad habits to children (and i ended up with a terrible arrythmia and ef on my first echo of 29%!!!)...i have never been an awful eater ...but never ever exercised and ate out (fast food ) at least 2 or 3 times a week just for the convenience of it. One of my children's birth mother was quite heavy i understand...and the other quite thin...and they had mirrored that in past...but now with our better habits my son who was heavier has lost 30 pounds while growing 4inches taller. So nurture vs nature is very interesting to me.
and as a nurse in a very busy practice i fight with insurance companies all day ...every day. i feel your pain.
i just hope someone will work as hard for me when i try to get my excess skin removed due to weight loss.
btw ..my ef is now 40% and arrythmia under control...

bella

Dr Garth, I totally believe that there is a link between genetics and obesity (both my parnets are overweight and so am I). After having RNY on 6/6/07 I now worry about my kids. One has some of my eating habits. Right now he's a healthy weight but I worry about later. I don't want my kids to go down the path I did. How do you help your kids to get past the genetics? Right now I just keep them active and try to teach them healthy choices while they are young. Anything else I can do?

Dr. Garth, I believe you are preaching to the choir I think most very overweight people believe there is a genetic component. As someone said it is up to us to decide how to fight out genetics so it is in part a choice as well.

I have spent most of my life rebelling against my genetic trend towards obesity. I did not want to admit that it was harder for me than for other people to lose weight. I ate what I wanted when I wanted and told myself that I couldn't live the way I would have to live to lose weight. It just seemed like endless suffering every day to me. I don't see other people suffering like that to stay thin and the idea that I would have to was something I rebelled against.

Now that I'm 30 and have two children I'm starting to realize that is a very immature mindset. I have to take what was given to me and make a life worth living out of it. If that means I need to work harder than other people, so be it. It is worth it to stay on this earth a little bit longer and be there for my kids.

I have always had a terrible lifestyle, sedentary and filled with junk food. My mouth is full of gold crowns, yet I never gained more than 20 extra pounds. NOT genetic?? Think again, people. It's definitely genetic. I obviously have the "wasteful" gene.

I feel almost guilty sharing my side, but here goes. Both my parents were skinny when they married. My two sisters and I can eat whatever we want and hardly gain weight. As stated before, most of my friends are extremely overweight, as are their parents. They try like crazy to lose weight, to no avail. Again, biology plays a huge factor. If they ate the way I did, they would gain 20 lbs. I see this play out time and again and my friends even remark how little they eat and still gain weight. The gene pool is interesting. Here's an interesting tidbit. My size 5 daughter just got married and her husband's sister is 18 and 100 lbs. overweight. My daughter wonders how things will play out when she has children. I'll keep you posted.

I think it is mostly nature with 20 % nurture and 5 % society that we live in. I know research since I am a Medical Librarian.

Both sets of my grandparents were heavy not obese. I was actually heavier than they were. Same with my parents they are both on the heavy side but not morbidly obese as I am.

I had been toying with the idea of getting WLS for several years now. Watching your father & yourself helped me make the decision to go for it. (Lap Band) I am still nervous but I am ready. I had a minor setback due to sever gastritis and I am hopefully getting banded in 11 days (as long as my Gastroenterologist okays it after another upper GI in 8 days)! Thank you for allowing them to film the Davis Clan.
I want to thank YOU and your family for doing this and helping me change my life.

THANK YOU!

Keydi

PS Are you a Daddy yet? If so what is the little ones name?

Hi, Dr. Garth!

I'm not really persuaded that all obese people eat more, either. For example, according to dinewise.com, a person of my height, weight, age and activity level should maintain weight at 2,500 calories a day.

Most days, I stay around 1,800 to 2,000 calories, focusing mostly on protein (if I eat carbs, I will get cravings and my blood sugar soars). I slip occasionally and go as high as 2,500, but it's exceedingly rare that I go above that. And I gradually gain weight. I did manage to lose a lot of weight in college, but that was eating less than 1,000 calories a day, dancing for an hour and a half three times a week, and walking at least 2 miles every day. After college, I settled into a nice desk job, and started eating more normally, and the weight crawled back on, more every year.

I have heavy friends who obsess about food, who can't have a conversation without eventually talking about food, and I'm sure that after we eat out, they go home and eat some more. That's not me. I really don't eat or think about food much when I'm not eating. I could definitely exercise more, but I try to do at least 1/2 a day of light to moderate exercise, usually walking, horseback riding or something like that.

I know there are people like me, who honestly don't abuse food, and who can't seem to keep the weight off. For us, bariatric surgery may be the only way to keep our calorie intake low enough that our slow metabolisms can handle the load.

Thanks for advocating for us, and standing up for us when know-it-alls get stupid and judgmental.