The five conundrums

By John DiTraglia - Contributing Columnist

It’s time to review the 5 conundrums. It’s been awhile. The mysteries of obesity can be organized into my 5 conundrums. I don’t have the answer to these conundrums but when we do, it will provide an understanding of this problem that could allow us to fix it. All of the fat science columns can each be organized under one of these conundrums or the 6th conundrum, which is why we keep harping on diet and exercise when that has been proven to be so unhelpful.

Conundrum 1. Weight, like height, is very genetic. It runs in families. Then how could there be an epidemic of obesity in less than one generation? It takes many generations to change the genetics of a population. Studies have shown very conclusively that obesity is 80% explained by your genes. But it is probably 100%. If you are very obese and everybody else in your family is skinny, well then you must be a mutant or adopted.

This conundrum pertains to other things. We have also all gotten taller than our parents but it seems like we have gotten fatter than taller. There is an epidemic of asthma and allergies in less than one generation too. Intelligence is very genetically endowed but kids today are found to be much smarter than 100 years ago. So the answer is that obesity is genetic and conversely environmental. That’s not an understandable answer. There is a thing called epigenetics that can happen to a parent and then get passed down to kids that we have discussed but I don’t think that resolves this conundrum entirely either.

2. Why does biology seem to defy the first law of thermodynamics which says that energy cannot be created or destroyed? Every calorie you eat has to go somewhere. Studies have shown that mice and humans, especially humans that have been dieting to lose weight, get and stay obese in the same number of calories that skinny ones eat.

3. There is a set point that must be in your brain somewhere that controls your weight. People go back to the same weight after they get sick or pregnant or diet…. People stay the same weight for many years in a row even very obese people. Yet sometimes people get fat who weren’t before. The set point is reset. How can you reset something that then gets set again?

4. Why does intestinal obesity surgery work so well? It doesn’t work by keeping you from eating or keeping you from absorbing the calories you do eat. If it did work like that then it wouldn’t work, or it would kill you. Yet it causes you to reset your weight about one third less.

5. Finally, why are we living longer and having fewer heart attacks, if we are all getting fatter and that’s supposed to be so unhealthy? This question is not as simple as it might first appear because we have also accomplished so many other things – treatment of high blood pressure, cholesterol, type 2 diabetes, stents and coronary bypass surgery, increased exercise, less smoking – that fixed the heart attack epidemic to a large degree while the obesity epidemic got much worse.

But maybe this conundrum is less conundrumical.

It should be easier to understand how obesity happens than to figure out why the universe exists. There should be a clue here. All of the answers to the conundrums should fit together somehow. Are we getting closer?

By John DiTraglia

Contributing Columnist

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- [email protected] or phone-354-6605.

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- [email protected] or phone-354-6605.