5 reasons why the discovery of the Fat Gene won't help you lose an ounce (and might cause you to gain weight!)

The headline: "Discovery of 'fat gene' raises hopes for fighting obesity"

The five reasons:

1) Mice! The study was conducted on mice, and most research on mice doesn't end up translating to humans.

2) Genetically engineered mice! The study was conducted on mice whose genes had been tinkered with, and findings from these studies are often even shakier, because no one really knows what these animals are. They're usually tinkered with in a way that's supposed to make their disorder more like a human disorder, but these imitation disorders rarely turn out to be good stand-ins for the real thing. And the resulting mice aren't exactly normal mice anymore, or at least breeds of mice that anyone is familiar with. So you just don't know exactly what to conclude from studies based on these critters. Very few practical treatments have come from studying these "transgenic" mice. (Which is not to say they aren't marvelous contributors to basic science, and we should all be big supporters of basic science. But basic science, by definition, won't do anything for you--not until someone figures out how to turn it into applied science.)

3) You're stuck with your genes. Even if the Fat Gene discovery translates to humans, what are we going to do with the knowledge that you have this gene? If you do have it, then presumably you're fat, but you probably knew that already, didn't you? There's gene therapy, in which you're injected with a virus carrying a gene that the virus can insert into your cells to replace the trouble-making gene. But gene therapy ran into some ugly problems in the early days just over a decade ago, and though more recent results have been encouraging, I haven't heard anyone in a position to know claim any gene therapy is likely to be widely available, or available for non-life-threatening conditions, any time soon, it's just considered too risky. The discovery of the Fat Gene might in theory lead to better diet and exercise advice based on knowing you had the gene, but that's unlikely--everything has been tried, diet-and-exercise-wise, we know what works and what doesn't, and it tends not to differ in major ways from person to person, regardless of genes. On the other hand, if a certain gene, or an overactive copy of a gene, were identified by itself as truly the major cause of being overweight, the goal would be to develop a drug that counteracts the effect of the gene. (Or if it's the absence or non-functioning of a gene causing the trouble, a drug that would work in its place.) In other words, discovery of the Fat Gene will lead to the Fat Pill! Except that...

4) ...Gene discoveries don't end up leading to good new drugs. Not so far, anyway, in spite of a few decades of trying. The problem, as many leading molecular biologists, including some who actually work for pharmaceutical companies, have told me, is that individual genes rarely cause problems by themselves, they usually work as a part of a network of hundreds of genes that work together to cause the problem. So taking a pill that counteracts the effect of the one gene wouldn't solve the problem. Even if the gene did mostly cause the problem on its own, any drug you take to try to counteract what the gene is doing would almost certainly end up interfering with the work of other genes, and with other functions that one gene is performing. In other words: side effects. That's why most drugs don't do much good for most people, and end up doing harm to some people. That's true even of drugs that make it to the market, and even of drugs that become best-sellers, let alone the thousands of experimental drugs that get washed out along the way.

5) Big gene discoveries rarely hold up. Just wait. In a couple of months, you'll see studies that show this gene doesn't seem to be a big deal after all. If you look for the studies, that is. The discovery that a previous discovery wasn't the big deal it was made out to be rarely makes headlines. Everyone either just forgets about the original big discovery, or mistakenly thinks it's still considered a big discovery. But you'll be ahead of the game, because now you know right off the bat why it's probably wrong to think of the Fat Gene as a big discovery. Although...

6) ...Maybe it really is the Fat Gene. Hey, sooner or later scientists will actually be right about one of these things. And I will have been wrong. It could be this time! Let's hope so. But in the meantime, please don't ease up on your commitment to staying healthy by eating sensibly and getting regular, enjoyable exercise in. If you do slip back to your old, unhealthy ways because you think science is going to save your butt, then all the discovery of the Fat Gene will probably have done is make you fat.

Scary cig pix are old hat elsewhere. Fried chicken next?

It's great that the FDA is trying to get gruesome, graphic, smoking-harm-related images on cigarette packaging. It's also about time, considering some other countries have been doing it for a while. I took this picture a few months ago about 60 feet outside of the US at the Canadian border crossing next to Vermont. This is a classic behavioral technique: Tweaking the environment to prompt desired behaviors, or discourage undesired behaviors. Let's get this done for cigarettes, and then move on to junk food. My whole interest in behavioral approaches to obesity was first prompted by a cancer researcher in the UK who told me he thought cans of Coca-Cola should be treated like packs of cigarettes. Enjoy!

What four new studies hint about fixing obesity

Four recent obesity-related studies have come out in the past few days that are worth taking a slightly closer look at. One reported that overweight people who have successfully taken and kept off weight tend to stick to structured exercise programs. Another found that male rats made obese and diabetic via high-fat diets tended to have diabetic female offspring, while male rats given normal diets did not--and since there was no general difference between the genes in the two groups, and because the mother rats in both groups were non-obese and non-diabetic and so couldn't have passed along anything different in utero, the explanation lies somewhere in environmental differences relating to the dad rats' different diets. (Yes, rodent studies usually don't translate well to humans, and this might well fail to translate, too, but for what it's worth it was an unusually simple and clean study, no genetic engineering or exotic behavioral manipulation or psychological interpretation involved.)

A third study found that people who live in areas where the Mediterranean diet (lots of "good" fat, lean protein, grains, vegetables and fruit, little saturated fat) is prevalent tend to keep weight off as they get older better than people in other areas--but (hallelujah!) the researchers and even (at least in this particular Reuters article) the reporter prominently note that it may well be behavioral and other environmental issues common to people who live on this diet that does the trick rather than the diet itself. The last study predicts US obesity rates have not peaked at about a third as other experts have claimed, and will continue to rise to hit 42 percent--and add that part of the problem is that hanging around with obese people tends to make it more likely that a person will herself become obese, so that the higher the obesity rate goes the more it increases the chance that it will rise further (up to a certain point).

I find all of these studies interesting in their own right, but the main reason I mention them is that all four highlight behavioral and environmental issues as being key to obesity rather than--or at least in addition to--the choice-of-food-types and the genetic issues that are often emphasized in studies. I hope I'm seeing a trend here. We can't get rolling on solving the obesity problem until we stop fixating on poorly understood physiological processes and on molecular biological factors that we can't do anything about, and start focusing on behavioral and environmental changes that we can start working on today. That's what got us into this fix, and that's what will get us out.

Is it all about the calories?

Does which foods you eat matter in weight loss?  I don't think any aspect of obesity and weight loss is more confusing, or more responsible for people's muddled thinking and poor choices in approaches to taking and keeping weight off.  Most of the answers we're given to this question fall roughly into what seem like two sharply contrasting camps.  The "it's all about the calories" camp (be warned, this link brings to you a nasty little article) suggests it doesn't really matter what you eat, you just need to eat small-enough amounts of it to not exceed the calories you're burning.  The "eat healthier foods" camp suggests that you will lose weight if you emphasize certain foods over others--some push fruits and vegetables, others "less-processed" foods, others less-calorie-dense foods, others low carbs, others low fat, and so forth.

Here's my take on it. (I've been interviewing many, many respected experts in the obesity field and reading quite a lot of studies and articles, so I'm not entirely shooting from the hip here, or at least not more than anyone else. Consider this a synthesis of what I've been finding out.)  The bottom line is that both camps are sort of right, but they're both a little misleading, too. It's true, you can lose weight eating anything if you keep portions small enough, and you can gain wait eating only vegetables if you eat enough of them. But most people are indeed more likely to keep the weight off if they lose it by emphasizing certain types of foods. That's because some foods more than others tend to push the various physiological and perhaps psychological buttons that will make it harder for you to keep control of your calorie intake. In the end, you'll still have to take in fewer calories than you're burning--but most people will find it easier to do that with some menus than with others.

So which foods should the would-be weight loser emphasize? There's a certain amount of disagreement on this question, to be sure, but a rough consensus of evidence and expert opinion favors cutting down significantly on sugar and refined carbs (like non-whole-wheat bread and pasta), taking it easy on fats (especially saturated fat, for other health reasons), eating good amounts of relatively lean protein (especially fish, chicken, and soy, prepared without much oil or butter, but beans, wheat gluten, egg whites, whey and pork can be good sources of lean protein, too), and eating lots of vegetables and reasonable amounts of fruit and other foods high in fiber.  Most experts don't advocate ultra-low-carb diets (or even counsel cutting down much on complex carbs like whole-wheat foods), and most don't think an ultra-low-fat diet is worth the trouble.  There are three main weight-control benefits to these recommended foods: They tend to be less calorie-dense, so they feel more filling per calorie and it's easier to meter how many calories you're taking in compared to a small, dense calorie-bomb like a piece of candy or fried chicken; they're less intensely stimulating to your pleasure systems, so you'll be less likely to feel compelled to pig out on them; and they tend to enter the bloodstream at reasonable rates, avoiding the blood-sugar spike-and-plummet effect you get from eating simple carbs that can lead to intense appetite swings.

Now having said all this, I'd like to point out that while eating "healthier" foods is a helpful and for most people important element of keeping weight off, I don't think it's necessarily the most important element, and it's absolutely not the only element, as is often implied by some weight-loss gurus.  Most people will not be able to keep much if any weight off just by trying to take in more healthy food, if everything else they do and everything else that's going on around them otherwise remains the same. For most people keeping weight off requires a full-court press via a "behavioral" approach, something I'll be talking a lot about here and elsewhere. Part of that approach also involves finding out which healthier foods work best for you in terms of being as satisfying as possible without pushing your appetite and cravings buttons. And it also involves being smart about the way you introduce these foods into your daily menu and make enjoyable habits out of eating them, and about how you regulate your intake of these healthier foods as well as of those less-healthy foods you may also want to take in in order to have a satisfying diet.

Does all this seem like a lot of work to figure out, put into action and maintain? Well, it can be, but if you get good guidance it shouldn't be all that hard. Even if it is a lot of work, the benefits people get out of losing excess weight in terms of their health and how they feel almost always seem worth the trouble. And if you do the behavioral approach right, losing and keeping off weight--especially if you lose it slowly, and try don't lose a large percentage of your body weight--need never be hugely demanding or uncomfortable, and in fact ought to be highly satisfying and in many ways enjoyable.

Oh, behave!--and lose weight doing it, says JAMA study

The Journal of the American Medical Association just published a two-year diet study that I think is well worth looking at--and please remember it the next time you read about how the seriously overweight can't lose weight and keep it off without bariatric surgery or drugs because they're programmed by their genes to be obese. What I especially liked about this study was that rather than focusing on gimmicky diets that call for nearly altogether cutting out some food group (e.g. carbs or fat), or loading up on some type of food (e.g. dairy, as pushed in another recently published study getting some press), or pushing significant calorie deprivation, it instead focused on a "behavioral" approach--that is, in educating participants in how to establish healthier, sensible, sustainable eating and exercise habits, and in providing ongoing support to encourage them to stick with the program. It was also a randomized controlled trial--the obese women who participated were randomly assigned to a "normal care" group that got fairly minimal support, or one of two groups that got much higher levels of support as follows:

The diet component of the program consisted of a nutritionally adequate, low-fat (20%-30% of energy), reduced-energy diet (typically 1200-2000 kcal/d) that included prepackaged prepared food items with increased amounts of vegetables and fruits to reduce the energy density of the diet. The approach was tailored so that participants could choose regular foods when preferred. Participants were encouraged during the initial period to follow a menu plan with prepackaged foods, which would provide 42% to 68% of energy for those who choose not to deviate from the plan. Regular foods, such as vegetables, fruit, cereal or grain products, low-fat dairy products, lean meat or the equivalent, and unsaturated fat sources were recommended to achieve the total prescribed energy intake. Over time, participants were transitioned to a meal plan based mainly on food not provided by the commercial program, although participants could choose to include 1 prepackaged meal per day during weight loss maintenance. Prepared foods and counselors were provided by Jenny Craig Inc (Carlsbad, California).

Increased physical activity was another program component; the goal was 30 minutes of physical activity on 5 or more days per week. Program material and counseling addressed attitudes about weight, food, and physical activity and included recipes and guidance for eating in restaurants, CDs and DVDs to increase physical activity, and online tools and support.

And what do you know, the participants who got the real treatments took off weight and by the end of the two years had kept it off.  

By study end, more than half in either intervention group....had a weight loss of at least 5% compared with 29%...of usual care participants....  More than twice the proportion of participants in the center-based and telephone-based intervention groups compared with participants in the usual care group...had a weight loss of 10% or more of baseline weight at 24 months....

As with all diet studies, there's plenty to be wary of, too.  It was funded (but not run) by for-profit weight-loss-program company Jenny Craig, which also supplied pre-packaged meals for the studies, and bias toward the funders may well have crept in there somewhere. Two years is typically taken as a standard for proof that a diet intervention helps keep weight off, but obviously it doesn't necessarily tell you how the participants will fare in the next two, or ten or forty years, and weight-losers, like smokers, need to be in it for the long haul in order to really raise their chances of having a long, healthy life, not just long enough to look good for their high-school reunion. The reliance on free pre-packaged food is a somewhat unrealistic model for the real world--though not completely unrealistic if we as a nation start getting more serious, as we should, about helping the obese get healthier. The treatment participants got $25 for showing up for clinic visits--getting paid to lose weight is a hot idea these days, but I don't think smallish payments make a big difference over the long term and fear it just confuses the issue. As the study authors themselves point out, one always has to wonder if the people who participate in a diet study are representative of the population, for example in terms of level of motivation and commitment. But on the whole, I thought the diet interventions were smart, and doable on a large scale in the real world, and it was great to see them produce these impressive results in what seems a relatively careful study.

It also didn't surprise me in the least--behavioral approaches to weight loss, including Weight Watchers, have been doing pretty well in studies on a fairly consistent basis for decades, unlike most other approaches.  So let's support more people who need to lose weight to be healthy in eschewing gimmicky and unsustainable diets, and in ignoring the toxic claims that they're genetically incapable of benefiting from any non-surgical, non-pharmaceutical intervention, and instead make it easier for them to get access to comprehensive behaviorally oriented weight-loss programs designed to take modest amounts of weight off gradually, comfortably and forever.