So glad you mentioned this. The goal should be compression of morbidity.
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I would disagree with that part of your comment and agree with later comment about appetite. It’s very clear to me that obesity runs in families. There is almost certainly a genetic predisposition. A genetic difference in hormones or the brain’s reaction to hormones.
GLP1’s make this an interesting argument. After someone starts a GLP1, they lose weight by eating less. Has their environment changed? The same foods are still available. The same type of foods are still eaten.
If someone comes from a family of very tall people, but they starve as a child and don’t end up tall, then height has no genetic factor?
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It mostly comes down to overeating, so I’d argue genetic. The current environment certainly makes it easier though.
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Obesity runs in families due to common behavior. I think there may be some lack of clarity around genetics vs. epigenetics. I’m simply pointing out, and correctly so, that a genetic factor doesn’t suddenly come up in 2 generations - which is what we’ve seen with obesity. It is plainly scientifically incorrect, and impossible to see major changes in DNA in short periods of time across populations. It however is completely feasible (and is the case here) that we can see major changes in behaviors and choices in this time period.
The issue is lifestyle change, which runs in families, processed and hyperpalatable foods, behavioral patterns of inactivity, lack of education and implementation of healthy choices. Naturally these factors run in families. There are epigenetics that come with this, and I think that may be the reason why you think genetics are a factor. Epigenetics are certainly a factor, certain behaviors, including those of your parents while pregnant with you certainly can effect gene expression. This however isn’t genetics -the DNA isn’t changed.
Epigenetics can be modified by behaviors and other factors.
You’ve made my argument perfectly on the GLPs - they lose weight due to interacting with their environment differently on a GLP. Nothing changed with their DNA as a result (their epigenetics certainly do). Yet they lose weight. So eating too much is the cause, not some issue with their DNA. Additionally, GLPs in isolation should not be given as recurrence of obesity is assured if not as part of a comprehensive lifestyle change, which leads to epigenetic changes and patterns that then allow weaning of the drugs along with a change in lifestyle.
At the end when we wean someone significantly or completely off a GLP1 … their DNA is unchanged … what changed? Their lifestyle choices … along with their weight.
Your last point on height of a child - again, the issue isn’t the DNA it is the interaction with the environment. Choices or availability of nutrients … I don’t think that point has anything to do with this discussion on obesity which is partially epigenetic change related to choices/parental choices - but there is no situation in which we see a genetic change in just a few generations - yet obesity has gone for a very rare condition 3 generations ago, to the norm now.
Other factors such as PFAs and BPAs may be affecting this - but again - that is environment, not DNA.
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Is it possible that a specific gene could make people much more susceptible to hyper-palatable foods that weren’t available 2-3 generations ago?
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@DrFraser i didn’t intend to start a long disagreement. We’ll have to agree to disagree. There is no doubt in my mind that most of our physical traits are inherited. I doubt there is any requirement of time, for a predisposed genetic risk factor to show itself when the environment changes in a way to allow it.
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Absolutely. However, we don’t really see this in practicality. Part of my medical practice is my wife, who is certified in nutrition, weight management, holistic nutrition. So this is stuff I deal with every day.
The same folks who brought you Tobacco, moved over to processed foods many decades ago. Their formula is simple - if you’ve not heard of it, it is called SOS (Salt-Oil-Sugar). Essentially, foods in nature will have only one of these or none of these. Mix any 2 of these, and you have a hyper-palatable food.
They work for a high % of the population. It’s simple food science, not some rarity of genetics. It is food addiction, and you will eat more of any given food that has at least 2 of these present in significant quantity.
@KarlT - I agree - I love your input, and love having another EM Physician on the board. Sitting in the ER right now in Nashville TN waiting for the onslaught as I work every Saturday and Sunday - day shift, to avoid the shift work (days and nights) which is a definite killer - probably as bad as smoking.
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Thought I was “lucky” - generally healthy since birth, exercised, ate well (mostly!), escaped teenage epilepsy - but young onset Parkinson’s got added to my dance card last year at 53. Some of you got pocket aces, others were dealt trickier cards. I’m here to make the best of the years I have left with the disease, since I probably will not die from it.
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