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Modern science versus the stigma of obesity

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.

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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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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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