Likelihood of Success

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Just too fat

Posted by Ron Coleman on January 1, 2008

Glenn Reynolds links to this article about the latest “key” to obesity. It says that “a protein called brain-derived neurotrophic factor (BDNF) is critical in mediating satiety in adult mice,” so, naturally, it’s only a matter of time till someone finds a way to put the stuff in a brightly-colored pill, and then once again we’ll all be able to fit into those molded plastic seats on the subway, right?

Of course not. It’s a little more complicated than that. On the way home from afternoon shul that I heard this on NPR. Bear with me — it’s a little long, but really very interesting, and it hits all the notes:

Cox: This is Donny Wong. He’s a London-based pharmaceutical analyst who specialises in the obesity field. He says drug companies are throwing huge portions of their R and D budgets at obesity-related research.

Wong: “There are over 400 compounds that are listed in databases that are in some point of development.”

Cox: Pfizer and Merck are working on their own versions of cannabinoid receptor antagonists. Other companies are trying to improve on a drug that prevents fat absorption. There’s also research into a gut hormone that may control appetite.

But all these drugs come with concerns about side effects. In fact, Acomplia is not available in the United States because the FDA is concerned that the drug may cause psychiatric problems. In clinical tests, a handful of people on Acomplia developed depression or suicidal thoughts. Wong says those kinds of outcomes are a real risk for drugs that tinker with the brain.

Wong: “The centrally acting drugs oftentimes have centrally acting side effects, and that’s really a huge area of concern for physicians. “

Cox: Some day there may be a drug that that produces significant weight loss with no serious side effects. But Barry Popkin thinks that’s still many years off. Popkin heads a global obesity center at the University of North Carolina. He says a person’s metabolism depends on so many internal and external factors; pharmaceuticals will never be able to address them all.

Popkin: “These drugs, if we find them, are going to be very expensive and have to be targeted in very complex ways, possibly related to your genetic makeup and affecting small populations at a time. And the world can’t afford that. “

Cox: Well, the developing world can’t.

Popkin: “It might be like HIV, where the drugs benefit everybody in the UK and the US and a tiny portion of people in Asia, the Middle East, Latin America and Africa are benefited. But this is a much bigger problem than HIV. We’re talking about 1.3 billion people, possible 1.6 billion already being overweight and obese. “

Cox: Some scientists are looking for obesity drugs that could help the world’s poor. Mike Cawthorne gives me a tour of his lab at the University of Buckingham in England.

Cawthorne:… and you can see how obese these rats are.

Cox: “They’re huge. “

Cawthorne: “Yes.”

Cox: The rats are on a high-fat high-calorie diet. But other rats on the same diet don’t get fat. That’s because they’ve been given the hormone leptin, which is believed to control metabolism. Cawthorne’s grand vision is to develop a leptin additive to infant formula that would prevent obesity in later life. Think of it like a vaccination, that could be globally distributed.

Cawthorne: “We happily give a vaccination to prevent infectious disease . Perhaps leptin supplements may one day be regarded as similar to a vaccination where we’re actually programming to prevent disease.”

Cox: Mike Cawthorne’s research indicates how far science may go one day to respond to the world’s growing obesity problem. Leptin supplements would permanently alter a child’s natural physiology.

Yet some argue that’s exactly what we need to do. They say our natural physiology is out of whack with the unnatural world we have created, full of computers, cars, and 24-hour convenience stores. That’s what Ilya believes. He’s the man who lost 90 pounds while taking Acomplia. To him – a well-off American – the idea of using drugs to readjust his own physiology sounds attainable and desirable.

Ilya: “The way we’re wired over millions of years of evolution is that if something’s not chasing us we don’t run. And we’re built for periods of not having food around us, so if there’s plentiful food we eat it. And in fact the foods we’re drawn to are the highest in caloric content because we need to store up that energy. And so I think it’s very, very difficult for us to live in an environment that is so rich in food that is so caloric, and I don’t think that it’s fair to expect anyone to just have the willpower to avoid it. And so if we need drugs to help rewire us after millions of years of evolution, I think that’s actually not a bad thing.”

Cox: Illya’s thinking underscores a tension that runs through the debate over what to do about the world’s rising obesity rate. Should we change our bodies – reprogram them with drugs? Should we change the environment, with laws that subsidize healthy foods and control advertising to children? Or should we change our attitudes and simply accept that in this new century, a larger body size is the new normal?

Well, that’s a fairly silly way to end what had up till then been a pretty learned conversation. The issue is not just body size — if it were we’d all say let people make their choices. So what if real life came to resemble a Botero painting? Hit the mall sometimes and it seems as if it already does, at least from the lower-middle-class down. But obviously “body size” does not deal with the question of health, nor of the economics of health. I also think you can ask a serious question about this sentence, which raised my eyebrow when I heard it: “I don’t think that it’s fair to expect anyone to just have the willpower to avoid it.”

It’s not “fair”? Of course it’s “fair.” It’s just, you know, hard.

My point is that, sorry Glenn — sorry everybody! — it doesn’t look like the magic bullet is coming along any time soon. I struggle with my desire for food, as do most people in middle age, especially those of us a little more inclined to exercising our gray matter than shaking up our avoirdupois. And it’s nice to feel, and to know, that it isn’t really a moral failing as such to be overweight… as such. There is a point, after all, where everyone has to be “fair” to himself and draw the line and behave — with food as with everything else. This is part of what it means to be an adult, after all.

We must try just to be one adult at a time — it’s cheaper than buying two bus tickets.

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6 Responses to “Just too fat”

  1. jan said

    Ahh, so everything boils down to “it’s all my fault”. It usually is, so I’m not surprised. 😉

  2. Brian said

    Yup, those fatties just need to get off their asses and exercise.

    Just like those damn depressed people who mope around. Brain-receptor-schmain-receptor. Bunch of gobbleygook for whiny people not getting what they want.

    And don’t get me started on those paraplegics who can’t walk….

    /sarcasm

    Now, to the real story.

    In a decade we have moved from an industrial agrarian society to an informational and service society. Our need for calories has dimished, but our appetite has not. Couple that with cheap calories and you get an obese society.

    Until you turn off the brain receptors for appetite, nothing is going to stop this problem. It’s a basic need (like breathing, sex, etc) that cannot be easily controlled.

  3. Brian, did you read the post? Do you actually have something to add to the discussion? The fact that you compare voluntary overeating to being a paraplegic suggests you don’t. I acknowledged your serious point both by quoting a researcher and endorsing the view myself that it’s very, very hard to turn off the eating impulse, or to ignore it. But (a) it’s not impossible, and (b) it’s one thing to be over your ideal weight, and another thing to become a big, fat person. Because at (b) the vast majority of people are not even trying. And we owe it to ourselves and our families to try.

  4. jaymaster said

    Brian,

    Breathing, I’ll agree.

    But sex as a basic need that can’t be controlled? No way.

    Are you 13 years old?

  5. Here in AZ, we have two local Indian tribes, and all of them tend to be very large people. It’s not uncommon for even the women to be six feet tall and 300 lbs.

    Old photographs and drawings from the 19th Century, however, show them to be tall, but slender. The general conclusion is the modern diet is the culprit. In Territorial days, they didn’t have the refined flours and sugars we have now.

    I don’t know what the answer is. I do know, from my own experience, that when my kid was a baby I didn’t start him om solid foods until he was a year old. Back in the 70s there was a theory that you could keep the baby from developing fat cells that way.

    I’ve always had a weight problem, even as a kid, so I wanted to avoid that with Sean if I could. Thirty years later, he doesn’t have a weight problem, and never has.

    But then I’ve always cooked from scratch, and only recently started using convenience foods. My mother, OTOH, hated to cook, and if it came in a can or a box we had it for dinner. ;>)

    Lotsa, lotsa factors in this issue…

  6. […] World favorite. I’ve juxtaposed two different press treatments of the topic here at Likelihood of Success. Waddle over and take a […]

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