The obesity epidemic discussed in a balanced manner in this article.


HBO has a history of tackling serious American health-care crises. In recent years, the cable network has taken on addiction and Alzheimer’s to much critical acclaim. And now the network has turned its attention to another huge health problem: obesity and its enormous economic, emotional, social, and health cost on individuals, families, communities, and the country at large.

As Americans have gained weight in recent years, rates of diabetes, heart disease, stroke, and other obesity-related health problems have also skyrocketed. Rates of Type 2 diabetes (once known as “adult-onset diabetes”) are soaring among kids. And this is a generation of people that may well die at a younger age than their parents, largely because of medical concerns associated with excess weight.

These facts have become commonplace to those of us who have been paying attention. Still, The Weight of the Nation: Confronting America’s Obesity Epidemic serves as a clarion call…

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  1. I work almost exclusively with overweight and obese individuals, and I am so interested in how “quirks” of metabolism seem to happen every so often. Usually when I measure metabolism for someone, there is some logic that emerges and it is helpful with developing a successful plan of attack, but occasionally (perhaps 1 in 75) I am stumped by a number that completely defies what is happening.

    While I think that the calorie balance concept is the big picture most of the time, I am beginning to think that certain environmental causes (allergies maybe?) may be responsible for some disfunction in metabolic processes. What I know for sure is that human bodies are so complex, which makes all of this so interesting . . . and also frustrating, as there is no one correct formula.

    • You are correct! Your observation of 1 in 75 sounds important enough to publish in a scholarly article. You may have heard that diabetes is an “immune dysfunction” disease, which fits near your allergy estimation. When we study human genes, we find that for some genes differ considerably among humans. That is why humans respond differently to the same environmental insult. Some may be fine with a high sugar diet, while others will get diabetes or balloon into a super obese individual. You may be aware of the Peruvian study on how a small group of Peruvian individuals gained excess weight on an American diet vs their native diet; while neighboring americans on same diet did not gain that much weight.

      • So interesting! What really perplexes me is how to explain the imbalance in terms of calories. I have been working for over a year with a morbidly obese woman. She has a super attitude – very positive outlook – and we have a trusting enough relationship that I think she is accurate in her reports to me about calorie intake. After a frustratingly long plateau period (6 months or more), we measured her metabolism, which showed that she is burning about 2750 calories AT REST!! She says she has been diligent at maintaining an intake of about 1800 calories a day, and even a “binge” is nowhere close to 2750. She should be losing like crazy, and this test almost always makes sense. I have tested hundreds of individuals, and I have just assumed that when the math is so off, which is rare, the person must not be telling me everything. This woman has me thinking maybe there is something there that defies the usual logic. How can that be? It would have to mean that the calories coming in are somehow “ballooning” to a much larger number, because I am actually measuring her calorie burn. ??? Any ideas?

      • Kimthedietitian: We researched some articles to attempt to understand …calories coming in are somehow “ballooning” to a much larger number…

        We found a plausible answer, although other scenarios are quite possible.
        ….That study culminated with a 2006 Nature Genetics paper showing that tub-1 and another protein called bbs-1 comprise a neuroendocrine signaling pathway regulating fatty acid metabolism-related genes. When that pathway is perturbed, abnormal lipid accumulation ensues in the worm gut. Interestingly, human genes encoding BBS proteins are mutant in Bardet-Beidl syndrome, marked by obesity and mental retardation….
        This team of researchers are trying to explain obesity with analyses of their research observations. What they mean to say in the above statement is that a mutant gene may cause obesity, inspite of dieting and exercise. This gene breaks down fat when the protein it codes for is correctly produced. When the gene has a mutation, this pathway to break down fat is perturbed and lipid accumulation ensues. Meaning, fat accumulates.
        Since the human gene complex is not understood yet, therefore, we cannot pinpoint which gene may have a mutation in your 1in 75 cohort or this one woman in particular. It would be nice to know genetically, how she is different from the others. Then, with a few more cases like her, we may be able to form a complete picture of a person who remains obese inspite of a higher calorie burn rate to input rate.

      • Thank you for taking the time to respond in such detail! It is fascinating, and I will see what happens as I try testing a couple of scenarios. I find it so interesting, if this energy anomaly is real, because I can’t help but wonder where the extra calories are coming from to allow for the higher burn rate without weight loss. It seems like a contradiction to basic energy conservation laws, so something “out of the box” would have to be happening somehow.

      • Your passion is infectious. I would urge you to team up with a University partner to publish your observations in a scholarly journal so that your work becomes timeless.

      • Thanks for the encouragement. I will see where this takes me.

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