Obesity is worsening not because of patients’ failures, but because of medical science’s failure to understand it. Depending on old tactics to deal with the problem is an expression of ignorance. The rising epidemic indicates not only that ignorance is catching up to us, but more importantly that we are on the wrong track.
When I deploy the comment that obesity is not a problem we understand, it causes consternation for most everyone. “Of course we understand obesity,” they say. The problem is obvious: the abundance of food inspires eating too many calories, additives that enhance taste and preserve shelf life are bad for you, and the population in general is too sedentary. It’s a simple math problem: too many calories in + not enough calories out = getting fat. It’s so obvious, how could it be anything else?
Obviousness has nothing to do with accuracy. Obviousness is a judgement based on superficial observations, not a statement of understanding. Prior to the 1980s, stomach ulcers were “obviously” caused by stress, type A personalities, and too much alcohol. When scientists discovered that the common bacterium H. pylori was an important player in causing peptic ulcer disease, it blew the doors off obviousness. “Obvious causes” dwindled to “notable conditions” of the disease.
The point is when we think something is obvious, we stop looking for better explanations and double down on inadequate yet pervasive beliefs instead. If H. pylori’s role were not discovered, then many patients with peptic ulcer disease would be dealing with this “chronic disease” and struggling with “lifestyle changes” that may or may not reduce recurrence rather receive a short, curative course of antibiotics. Strength of a belief does not make something true.
I think ignorance about obesity resembles that of peptic ulcer disease before H. pylori’s identification. Although H. pylori’s role in peptic ulcer disease isn’t as clear cut as we like, the main difference is obesity doesn’t have an identifiable cause-and-effect relationship to any causative agent. Once we accept that the cause of obesity is
unknown, only then can we recognize that cause-and-effect thinking is too simple to deal with the apparent complexity of diseases like obesity. In other words, the first step to understanding disease is to abandon judgementalism.
The idea that “too many calories in + not enough calories out” illustrates the assumed cause-and-effect relationship. Since the cause-and-effect relationship fails to explain human behavior that apparently leads to obesity, scientists think they’ll have better luck finding it in DNA’s behavior. In today’s interpretation, DNA and gene expression are or follow a mysterious algorithm to produce a complicated system of causes-and-effects. Finding the “glitches” will promote development of therapeutics to “fix” nature’s errors.
No, it won’t. You can’t solve a calculus problem with arithmetic. The complexity of research outcomes screams this problem which science ignores. Instead, the modern
approach is to circle back on the failed cause-and-effect mentality that ramrods lifestyle education and inspires a wild goose chase looking for broken cellular processes to “fix” with logistically-demanding and expensive drugs.
It’s time for medical science to stop thinking it must save patients from their “bad” choices. It’s time to recognize it can’t save patients this way. It’s time to rethink how we think about disease all together.
It’s time.
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