# Royal Society: Causes of obesity: theories, conjectures and evidence



## Eddy Edson (Oct 17, 2022)

Big international symposium happening at the moment with the leading researchers in the field: https://royalsociety.org/science-events-and-lectures/2022/10/causes-obesity/

Live stream:


----------



## Eddy Edson (Oct 18, 2022)

More convenient page, with links to program and videos of the individual presentations: https://causes-obesity.royalsociety.org/


----------



## Ditto (Oct 18, 2022)

I had a glance but I'm too lazy to read through it all. I know in my case obesity is caused by sheer greed. No ifs nor buts.


----------



## Drummer (Oct 18, 2022)

I am pretty certain that I became overweight due to numerous conversations which were basically
'That diet is making me feel unwell and my weight is shooting up'
'You are doing it wrong. Go away and do it properly from now on'


----------



## Eddy Edson (Oct 18, 2022)

Ditto said:


> I had a glance but I'm too lazy to read through it all. I know in my case obesity is caused by sheer greed. No ifs nor buts.


IDK but I'd say it's much more likely that you're like a zillion other people & it's more a matter of Nature having done a crap job with the engineering of your hunger control circuits which you don't have much control over.

If you haven't already. I'd try to have a conversation with yr doc about semaglutides - best Wegovy, Ozempic otherwise, if you can get either of them.  They work by improving those hunger control circuits.


----------



## Eddy Edson (Oct 19, 2022)

A great presentation by Kevin Hall on why we've ended up with a food system dominated by ultra-processed food, from about the 2 hr mark.






During the 20th century the world did a great a job of avoiding a Paul Ehrlich-style Malthusian disaster, using technology to increase food supply (mainly carbs + fats, less so protein) way faster than population growth; supercharged by govt policy from the 1950's to subsidise massive increases in soy and grains.  => Huge amounts of cheap basic inputs for cheap, convenient, tasty UPF.  But in hindsight it was overkill, solving Malthusian problems before they actually emerged, at extreme costs to population health and the environment. 

He also discusses briefly his landmark 2019 experiment, showing people eating way more UPF than minimally processed, not linked to differences in carbs, protein, fat, sugar, fibre, salt, perceived palatability ... 

So what is the mechanism? "A Rohrshach test", with everybody bringing in their prior opinions to answer the question, without actual evidence.  He himself has no firm opinion on possible mechanisms. His group is working on a new experiment to try to get some evidence-based answers.


----------



## Eddy Edson (Oct 19, 2022)

Eddy Edson said:


> A great presentation by Kevin Hall on why we've ended up with a food system dominated by ultra-processed food, from about the 2 hr mark.
> 
> 
> 
> ...


Also Herman Pontzer at round 5.30 on "Paleolithic Perspectives"


----------



## Ditto (Oct 19, 2022)

Eddy Edson said:


> IDK but I'd say it's much more likely that you're like a zillion other people & it's more a matter of Nature having done a crap job with the engineering of your hunger control circuits which you don't have much control over.


I do have control over it though. I could eat low carb all the time and be satisfied and feel great and be healthy and never ever hungry. I don't do that. I choose to wake up and think "Eggs on toast" ...


----------



## Eddy Edson (Oct 20, 2022)

Ditto said:


> I do have control over it though. I could eat low carb all the time and be satisfied and feel great and be healthy and never ever hungry. I don't do that. I choose to wake up and think "Eggs on toast" ...


Why is that, do you think?

Maybe yr body knows that the idea that low carb will lead you to fairyland is just nonsense


----------



## Ditto (Oct 20, 2022)

Eddy Edson said:


> Why is that, do you think?
> 
> Maybe yr body knows that the idea that low carb will lead you to fairyland is just nonsense


It isn't nonsence for me but you know ymmv is always the case. I feel on top of the world doing low carb and all my minor ailments such as crushing acid reflux etc go away completely. I know it works for me I'm just too lazy to keep to it.  I don't know why I just like eating. I think I'm just one of those people that likes things too much, bit sybaritic maybe. I can go into raptures over a new book by a favourite author or the prospect of weeding or anything really.  Eating is just another fabulous enjoyment which is too readily available, at least the gardening depends on the weather, nothing ever stops me eating! I see this is another me me me post from Janet Bird, apologies for the boring.


----------



## Eddy Edson (Oct 20, 2022)

Ditto said:


> I think I'm just one of those people that likes things too much, bit sybaritic maybe. I can go into raptures over a new book by a favourite author or the prospect of weeding or anything really.


Anyway, that's a lovely characteristic, so good on you. Opposite of boring!


----------



## Eddy Edson (Oct 21, 2022)

Nice top-level thoughts on the meeting: https://conscienhealth.org/2022/10/obesity-causes-so-just-fix-the-it-already/

_Frustration or amazement. Take your pick. John Speakman brought a close to three days of some of the best presentations ever on the causes of obesity and summed things up nicely:

“The causes of obesity turn out to be exceedingly complex. Although I’ve learned a lot, we’ve not reached any sort of conclusion about what it is.”

The truth of this complexity is either exciting or frustrating. Literally thousands of genes can contribute to a person’s susceptibility. Just about everyone thinks that the evolution of our food supply has contributed to obesity, but it is exceedingly complex in its variety and composition. So no one has yet demonstrated which aspects of it can really explain the rise. And food is not the only contributor.

It’s also plain to see that the clinical identification of obesity is still very rudimentary because BMI is such a simple and crude signal for the problem. We are most surely dealing with a collection of clinical problems – not just a single condition. More complexity.

In this complexity, we can see an exciting opportunity to explore this large problem, break it down, and solve it methodically, piece by piece.
_
_Tobacco vs Hypertension_​_In the face of all this complexity, though, another impulse is to look for analogies in other problems that have challenged public health. Tobacco is a favorite. In summarizing the meeting, Sir Stephen O’Rahilly cautioned against relying on that template:

“I don’t think tobacco control is a very good analogy for obesity because eating food is not the same as smoking a rolled up piece of a single plant material.

“However, there are better public health analogies. When I was a junior doctor in London and Dublin, our wards were full of people suffering the end-stage consequences of uncontrolled hypertension – intracranial hemorrhages, heart failure, renal failure. That problem has pretty much disappeared. We did it slowly and gradually over 40 years. It was a combination of public health measures and smart, safe pharmacotherapy.”
_
_Just Do Something_​_The impulse to act now and assess later is irresistable. In the closing discussion Professor Jonathan Wells articulated it quite well:

“My feeling is there’s still a gap between the kind of obesity research that’s done and the kind that is actually going to have an impact. Prevention is better than cure. We don’t want people to gain excess weight. We want to have a food system in which people can eat healthily and not actually become fat.”

The impulse he expresses will not fade. Nor will the drive for a better understanding of this problem. We can only hope that these distinct motivations can work in a complementary way. With sufficient curiosity, scientists can learn to distinguish what has an effect from the many efforts to date that have had none.

At the same time, we can drive toward a better fundamental understanding of this complex problem – causes, cures, and prevention measures that work._


----------



## everydayupsanddowns (Oct 21, 2022)

Eddy Edson said:


> The truth of this complexity is either exciting or frustrating. Literally thousands of genes can contribute to a person’s susceptibility. Just about everyone thinks that the evolution of our food supply has contributed to obesity, but it is exceedingly complex in its variety and composition. So no one has yet demonstrated which aspects of it can really explain the rise. And food is not the only contributor.
> 
> It’s also plain to see that the clinical identification of obesity is still very rudimentary because BMI is such a simple and crude signal for the problem. We are most surely dealing with a collection of clinical problems – not just a single condition. More complexity.
> 
> In this complexity, we can see an exciting opportunity to explore this large problem, break it down, and solve it methodically, piece by piece



Great summary. And I think it bears out what we see in forum discussions.

Evidence Based Medicine using PICO (population, intervention, comparator, outcome/s) based studies is always going to struggle with this level of complexity, because searching for *the way* to advise the ‘population’ breaks down when you can’t actually single out who is who, and whether _that thing_ will actually work / be sustainable / have the desired effect / not have unintended consequences for any one individual.

A range of options to try (dietary, phamacological, emotional, phychological) seems inevitable. Try this… see if it works. If not try this…


----------



## 42istheanswer (Oct 21, 2022)

I'm glad they mentioned genetic factors. There is a very clear gender divide in terms of ease of gaining weight in my family and it does frustrate me when people make comments that suggest they think weight gain is only down to factors that people can change.


----------



## travellor (Oct 21, 2022)

Maybe it's just that we've changed socially more than evolutionary.
Food is massively cheaper, social care is much improved to help feed those that can't feed themselves for whatever reason, storage has improved so food spoilage is decreased. 
Snacking has become a normal part of life, cafe culture is common.

Then exercise and labour have changed.
Far less physical activity is any level of society, from driving to the office or digging a hole.

I type this sitting on the sofa in front of the TV, having eaten a hot breakfast, (comfort as it's wet and cold outside), rather then possibly just a bowl of cereal then walking to the post box to post my letter into whatever comments column into whichever paper I'd be corresponding with before the internet.
(And if we hadn't invented the internet, I'd probably still consider driving  now as it's raining, and even that is easier. Push button start, auto, power steering, servo brakes, as opposed to pulling out the choke, coughing and spluttering for the first mile or two, waiting for the demisters to warm up, heavy steering, heavy brakes, manual gearbox..)


----------



## 42istheanswer (Oct 21, 2022)

Don't most of us still have the manual gearbox? I do, found it very strange the one time I've driven an auto. Though I did pay extra to get cruise control installed so I can give my right leg a break on longer journeys. Otherwise my legs really ache when driving (probably something rheumatic or similar but I've never bothered trying to pursue a diagnosis)


----------



## travellor (Oct 21, 2022)

42istheanswer said:


> Don't most of us still have the manual gearbox? I do, found it very strange the one time I've driven an auto. Though I did pay extra to get cruise control installed so I can give my right leg a break on longer journeys. Otherwise my legs really ache when driving (probably something rheumatic or similar but I've never bothered trying to pursue a diagnosis)



I prefer autos now, I've had one or two before, but my motorhome is manual, so I chop and change regularly.
But the auto is a really, really, really lazy car.
It's 4x4 as I off-road in it, so, hill descent, variable front back drive or full transmission lock, cruise control, speed limiter, brake assist, automatic lights, wipers, climate control, parking camera, ultra sonic sensors, all sorts of flashing lights and beepings....
Great for cruising down motorways as well.
Very much different to my first Hillman.
I feel more incentive to use it where I would have walked before when cars were just harder to use.


----------



## everydayupsanddowns (Oct 21, 2022)

42istheanswer said:


> I'm glad they mentioned genetic factors. There is a very clear gender divide in terms of ease of gaining weight in my family and it does frustrate me when people make comments that suggest they think weight gain is only down to factors that people can change.



I heard estimates of 40-70% of a person’s propensity to gain weight can be genetically influenced. I forget the source, but it was a fascinating thought. 

Anything from the sorts of tastes that appeal, to appetite and satiety, to what actually happens to the calories and macro-nutrients  that are consumed, and how easily (and where) adipose tissue is deposited.


----------



## NotWorriedAtAll (Oct 23, 2022)

Ditto said:


> I do have control over it though. I could eat low carb all the time and be satisfied and feel great and be healthy and never ever hungry. I don't do that. I choose to wake up and think "Eggs on toast" ...


If you had keto bread that would be absolutely fine.  I have eggs on toast often.  I had chicken paste (home made) on melba toast with loads of butter for breakfast.  It was extremely filling because of the butter and the high fibre and protein and so by lunchtime I wasn't particularly hungry and just had a single piece of toast and a bit more of the paste for lunch with some water.
You can eat all the things you like if they are made with the right ingredients.
I will be sharing my white bread recipe on my Facebook page today. When I've done it I will message you the recipe, method etc.

It is easy to make and then slice up and freeze the slices so you can have a piece of toast when you want one without having a whole loaf enticing you from the breadbin.


----------



## Ditto (Oct 23, 2022)

NotWorriedAtAll said:


> If you had keto bread that would be absolutely fine.  I have eggs on toast often...


Thank you but it wouldn't help. I don't eat because I'm hungry. I'm not really sure why I do eat all the time, except that I like eating. That's why I think it's an addiction. Must stop it though.


----------



## Eddy Edson (Nov 22, 2022)

Great NYT OpEd on the meeting: https://www.nytimes.com/2022/11/21/opinion/obesity-cause.html

_LONDON — A select group of the world’s top researchers studying obesity‌ recently gathered in the gilded rooms of the Royal Society, the science academy of Isaac Newton and Charles Darwin, where ideas like gravity and evolution were once debated.

Now scientists were arguing about ‌‌the causes of obesity, which affects more than 40 percent of U.S. adults and costs the health system about $173 billion each year. At the meeting’s closing session, ‌John Speakman, a biologist, offered ‌‌this conclusion on the subject: ‌ “There’s no consensus whatsoever about what the cause of it‌ is.”

That’s not to say the researchers disagreed on everything. The three-day meeting was infused with an implicit understanding of what obesity is not: a personal failing. No presenter argued that humans collectively lost willpower around the 1980s, when obesity rates took off, first in high-income countries‌, then in much of the rest of the world. Not a single scientist said our genes changed in that short time. Laziness, gluttony‌‌ and sloth were not referred to as obesity’s helpers. In stark contrast to a prevailing societal view of obesity, which assumes people have full control over their body size, they didn’t blame individuals for their condition, the same way we don’t blame people suffering from the effects of undernutrition, like stunting and wasting.

The researchers instead referred to obesity as a complex, chronic condition, and they were meeting to get to the bottom of why humans have, collectively, grown larger over the past half century. To that end, they shared a range of mechanisms that might explain the global obesity surge. And their theories, however diverse, made one thing obvious: As long as we treat obesity as a personal responsibility issue, its prevalence is unlikely to decline._


----------



## Vonny (Nov 23, 2022)

I blame the introduction of the television remote control. Followed by out of area shopping malls. I now like to shop on foot, in my village, at the greengrocers, butchers, bakeries etc, just like the good old days.


----------



## Spathiphyllum (Nov 24, 2022)

Vonny said:


> I blame the introduction of the television remote control. Followed by out of area shopping malls. I now like to shop on foot, in my village, at the greengrocers, butchers, bakeries etc, just like the good old days.


Seriously, research shows that changes in our 'built environment', together with our transport systems, are one of the two main causes of 'the obesity epidemic'. In the past, people got far more exercise because they walked more, and they could walk more because villages, and town or city neighbourhoods, had a mix of houses/flats and local shops-- and not cafes and takeaway shops but "greengrocers, butchers, bakeries etc".

And then governments started encouraging widespread ownership and use of cars, and created an obesogenic landscape-- residential developments with out-of-town 'superstores' miles away, and poor public transport.

So, yes, building policy and transport policy, on the one hand, and food policy, on the other, have created an environment in which it can be hard not to be unhealthily overweight and unhealthily sedentary.

Genes, though, are a dangerous red herring. [The mental picture makes me laugh-- something like a big red piranha? ... But as I was saying ...] Our genes have not changed significantly in the past 40 years-- but overweight and obesity have shot up. For example: in England, in 1980, 6% of men and 9% of women were obese; the figures for 2019 were 27% and 29%. (https://ukhsa.blog.gov.uk/2021/03/04/patterns-and-trends-in-excess-weight-among-adults-in-england/ ) That is shocking, and genes did not cause that increase.

And although the current environment can make it hard not to be unhealthily overweight and unhealthily sedentary-- it is not impossible. What we need to do-- while putting pressure on government to change housing/transport policy and food policy-- is to provide much, much more psychological and social support and encouragement for people to lose weight and get more active.


----------

