Letters

Regulation of body weight is social skill

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7139.1246a (Published 18 April 1998) Cite this as: BMJ 1998;316:1246
  1. J S Garrow, Emeritus professor of human nutrition
  1. The Dial House, 93 Uxbridge Road, Rickmansworth, Hertfordshire WD3 2DQ

    EDITOR—Wilding's clinical review on obesity treatment repeats an important error: “Body weight is very tightly regulated … for example a daily excess of 100 kcal (418 MJ) … would result in a 4 kg weight gain in a year.”1 It would not, as those of us who have tried experimental overfeeding can testify.

    An extra 418 MJ intake causes an immediate increase in metabolic rate, and in the steady state a weight gain of 4 kg would cause an increase in maintenance energy requirements of about 209 MJ/day in women and 212 MJ/day in men,4 so only a fraction of the excess intake would be stored as excess fat. The error is important, because Wilding suggests that controlling obesity involves finding a specific group of people with poor regulation of intake and correcting their metabolic error. In fact, most of us have poor physiological regulation of energy intake, which is why body weight in adults typically fluctuates between maxima and minima that are 10 kg apart.5 In our society, regulation of body weight within a desirable range is a social skill, so I believe that the best hope for preventing and treating obesity depends on fostering these skills rather than discovering new hypothalamic neurotransmitter drugs.

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