I think it’s a good idea to base public policy on the available science (that too many calories cause obesity, that too many people have this problem, and that it is killing us) than on our gut feeling about there being more to the story.

Pun intended.

Good reading at http://www.cdc.gov/nccdphp/dnpa/obesity/contributing_factors.htm

The first category includes you (and I feel fortunate to say, me, so take this comment with a grain of salt). The second category includes folks we’ve all seen regularly and knowingly put down way more than is required to be full, and the stereotypical example of an obese person ordering a mocha after lunch.

I don’t know where they fall in your hypothesis. My guess is they’re more likely to find something that’s 40% the calories, 80% as good, and still involves eating or drinking something (latte vs. mocha, rice vs. salad, slice of pumpkin bread vs. half a slice of it). A ton of calories are elective, so it’s hard not to see that adding up.

Also, your #3 inaccurately implies that the lower calorie item is less filling, and for that reason, I don’t think is very common.

But my guesses may be way off. My point is that your and my (and probably most R&G readers’) interactions with food are different than about half the population, and in ways that aren’t changing anytime soon.

(That said, it would be totally awesome if we could somehow have a system that put a little asterisk next to menu items whose calorie (or, more importantly for me personally, carbohydrate) count is much higher than you’d think. Seriously, 900 calories for a latte? Really?)

You’re dead on about the research. And nothing that you’re saying contradicts the fact that yes, people can lose some weight by cutting back on calories. But, unless they are naturally thin, it takes great and increasing effort to keep it off.

You can’t make a naturally thin person fat. You can’t make a naturally fat person thin.

A dietician’s take on this: http://junkfoodscience.blogspot.com/

And an entertaining group of cursing Chicagoans’: http://kateharding.net

When I say people get fat the way tall people get tall, perhaps a better comparison would be with a condition like pituitary gigantism. It might be possible to treat pituitary gigantism by putting the patient on a low-calorie diet. Without sufficient calories, you just can’t grow that tall. And people with pituitary gigantism eat a lot.

But a better solution is to cut out the tumor causing the gigantism. That doesn’t mean I think obesity is caused by tumors. I don’t. But I don’t think it’s caused by eating too much food, either.

We don’t know the etiology of obesity. I wish everyone in health care would say that over and over.

As for “willpower,” that makes me want to equate obesity with depression. Some people apparently overcome depression through nothing more than willpower. Prescribing willpower and positive thinking to a patient presenting depression, however, would be malpractice.

You said yourself that some people have a tendency to gain weight and some don’t. Shouldn’t we be trying to figure out what the difference between these populations is? Of course, this has been investigated already to some extent. Some things we do know: obese people don’t have poorer impulse control than thin people; they don’t have different psychological profiles than thin people on the whole; they do tend to have different populations of gut bacteria (whether this is a cause or effect is unknown).

You know, I think I get now why this bugs me so much. We have a real medical mystery here: a serious condition that affects millions of people and is on the rise. Instead of trying to figure out what’s causing the problem, though, we want to jump right ahead to the conclusion. That’s a shameful lack of curiosity.

Thanks for the conversation.

I don’t know that I’d use the term “mindless eating” to describe what I’ve talked about above. And I recognize that it’s easier for me to talk about habits and willpower than it is for you, because of our personal situations, even though a lot of people would still get upset over what I say. It was really difficult to get over the idea that I OUGHT to be thin because I eat so much more healthily than—well, pretty much anyone I know. But even though I carry out part of your tall-people-get-tall thing, since I gained weight in the first place because of thyroid disease, I always do come back to the idea of habits and willpower. And I think what we (by “we” I mean, I don’t know, healthcare professionals or the media or something) need to talk about more is how hard it is to change habits, and maybe how unfair it is that some people have a tendency to weight gain and others don’t, not “this isn’t about willpower”. And of course we have to continue avoiding the erroneous idea that overweight people have LESS willpower than thin people, because that isn’t true. It just takes EXTRA willpower to lose weight, or make any kind of significant change—but perhaps especially weight, because of the oft-pointed-out things about food being a necessity and an important part of culture and a coping mechanism for many people.

But if you think people get fat the same way tall people get tall—isn’t that like saying permanent/significant/purposeful weight loss is impossible? (Um, I don’t mean that confrontationally, or anything, just genuinely curious.)