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Modern science versus the stigma of obesity

Nature Medicine volume 10, pages 563–569 (2004)Cite this article

Obese people, who are already subject to adverse health effects, are additionally victimized by a social stigma predicated on the Hippocratic nostrum that weight can be controlled by 'deciding' to eat less and exercise more. This simplistic notion is at odds with substantial scientific evidence illuminating a precise and powerful biologic system that maintains body weight within a relatively narrow range. Voluntary efforts to reduce weight are resisted by potent compensatory biologic responses. This article will review some of this evidence, together with promising avenues of research. Further progress in understanding and treating obesity will come not from repetition of anachronistic preconceptions but rather from the rigorous scientific approach that has driven advances in so many other areas of medicine.

People often reserve their harshest judgments for those conditions about which the least is known. So, mental illness was once thought to be sign of the devil incarnate, ulcer disease was a result of an inability to deal with stress, colitis was a disorder of the high-strung and AIDS was a personal failing. Even cancer was a disease imbued with shame, with the afflicted hidden from view and seldom spoken of. Substance abusers and compulsive gamblers are now appropriately considered to have disorders that require treatment. In these and other instances, advances in our understanding of the underlying pathology have led to a greater acceptance of those affected by these conditions. There is, however, an unfortunate exception to this trend.

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Figure 1: Leptin resistance and obesity.
Figure 2: The neural circuit regulating food intake and body weight.
Figure 3: Biochemical pathway regulating cellular fatty acid metabolism and energy expenditure, showing the mechanism underlying increased fatty acid oxidation.

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Acknowledgements

The author thanks E. Ravussin, Bruce Schneider and S. Heymesfield for critical comments, and S. Korres for assistance in preparing this manuscript. This work was supported by a grant from the US National Institute of Diabetes and Digestive and Kidney Diseases. The author is an inventor listed on the patent for leptin and might receive a portion of the royalties, through a Rockefeller University licensing agreement with Amgen, should leptin become a commercial product.

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    Jeffrey M Friedman

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Friedman, J. Modern science versus the stigma of obesity. Nat Med 10, 563–569 (2004). https://doi.org/10.1038/nm0604-563

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