So Big

America is obese.  So we hear each day.  Our kids are obese.  Weight is leading to early death, destroying the future of adolescents and young adults.  The epidemic of diabesity will destroy American competitiveness – 30 year olds with diabetes don’t work so well – and bankrupt the Treasury through higher Medicare costs.

Yet simultaneously people say they can’t lose weight.  They do “all the right things.”  They count calories.  They exercise.  They eat vegetables.  Yet unlike the “reality TV stars” they can’t seem to lose weight.

The truth is that weight is not only more complex than depicted, but should not be public health enemy #1.  Just like our “war on drugs” is a disaster, our approach to weight is foolish and misguided – though profitable for many.  And we can learn this from an old form of weight loss.

Nematodes

There’s a fast way to weight loss.  It’s intestinal infection.  Parasites will cause weight loss.

But not the way most people think.

In many cases intestinal parasites produce an inflammatory response that turns off people’s desire to eat.  In turn, the decreased appetite turns production of leptin, a hormone that normally tells us to stop eating.

But wait a second – how does decreased weight and decreased appetite make for less leptin production?  Shouldn’t our desire to eat come back when lots of weight has been lost?

It should. But things are a bit more complicated that single up-down feedback mechanisms.  And that holds many implications for how we view weight.

The Study

The work was carried mainly at the University of Manchester in animal models.  The researchers wanted to know why weight loss would help mice get rid of parasites.

Some of what they found was:

1. There are two separate weight loss scenarios.

2. The first is controlled by cholecystokinin (CCK) – a hormone from our gut lining cells that normally signals we’ve had enough to eat.  Except in this case the CCK was produced by inflammatory T cells.

3. The second weight loss reaction is controlled by tumor necrosis factor alpha (TNFa), also produced by T cells, in this case coming more from muscle.

4. By changing weight, leptin secretion was decreased – rather than it’s normal increase with weight loss.  And that helped get rid of the nasty critters because leptin is also a proinflammatory substance – and you want to downregulate immunity to help rid the body of parasites.

So what we have here is basically the world pulled upside down:

A. Weight loss helps control infection.

B. Gut hormones controlling weight pop out of inflammatory T cells.

C. Reversing the normal response to weight loss – a major stress – decreases inflammation and helps animals get much better.

Remember leptin?  When it was “discovered” a couple of decades ago in mammals it was going to be the ultimate weight loss drug.  Just inject it and the mice stop eating, so it should work that way in humans, right?

Not so fast.

Some Truths About Weight

What these studies should tell us about weight is something the media does not want us to hear:

1. Weight is multiply determined by many different systems involving hormones, inflammation, the brain, infection, muscles, physical activity, and body clocks, just to name a starting few.

2. What lowers weight in one context may increase it another.

3. Weight can be used as a weapon to control infection.  Conversely, infections, as in some kinds of adenoviruses, can later lead to weight gain and obesity (yes – you can get a cold that may eventually make you obese.)

4. Controls on weight and eating involve a dizzying variety of social, economic and behavioral factors ranging from the color of your dining room; the size of your friends; how cities are laid out; how foods are marketed; your cultural background; how much sugar you take in at different points of the meal; whether you move before or after meal.

The Way Forward

Johnny One Note Solutions Will Not Solve America’s Obesity Problem.  Period.

You can get people to eat lots of vegetables – organic or otherwise.  You can get them to go to gyms three times a week.  You can train them to get enough sleep to become functional when they wake.

These items will help.  But they will not solve the weight “crisis.”

Because weight is not the issue.  Health is.

The health of a population is its physical, mental, social and spiritual well-being.  Using weight as the single proxy for these more important measures is both foolish and self-defeating.

In order to get and stay healthy, people have to continually regenerate themselves.  Their immune systems and brains, muscles and guts have to learn, increase their knowledge, and evolve smarter ways to exist and thrive in endlessly changing environments.

The goal should be health.  If you want to use a single statistic, look at longevity – not weight.

And by that measure the US picture is a disaster.

To get a healthy population we will need a sea change in attitudes on health:

That seeing is not believing, as in recognizing that thin, “athletic” looking models may be living on sugar and cigarettes and harboring so much abdominal fat as to put themselves at risk of diabetes and early death.

That a healthy economy requires a healthy population – sick people don’t work well, and stressed people get sick, which costs a heap of money in decreased productivity and higher health care bills.

That a healthy population requires a healthy environment.   Biological systems – like us – constantly have to regenerate themselves.  And that if we make our environment a toilet and cesspool it will make the plants and animals we are dependent upon sick – cutting off our long term survival.

That social support is a critical part of social, political, and physical health.

Finally that weight should not be goal but simply the byproduct of creating a healthier civilization where everything children ingest is not laced with high fructose corn syrup; where antidepressants and antibiotics are not welcome in the water supply; where cities are manageable and socially and physically nutritive greenspace is cherished.

Otherwise you won’t control the national weight – or any other health measure you care about.

Including the health of the society itself.
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