Letters The science of obesity

Am I missing something in the essay on the science of obesity?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3010 (Published 22 May 2013) Cite this as: BMJ 2013;346:f3010
  1. Ben Bradley, general practitioner1
  1. 1Meuchedet Health Care Organisation, Ramat Beit Shemesh, Israel
  1. bdbradley70{at}hotmail.com

Taubes contrasts two obesity hypotheses—excess energy intake versus a “hormonal disorder.”1 It becomes clear, however, that the second theory is not about a disorder, but about excess consumption of carbohydrates causing obesity, with insulin implicated as the mechanism. A disorder normally means pathology of a particular system, or “a derangement or abnormality of function; a morbid physical or mental state” according to an online medical dictionary. This means there is no disorder here, just normal biochemistry. So why the apparent insistence on the disordered nature of this theory?

The two theories seem to be excess consumption of calories versus excess consumption of carbohydrates. Given that a large part of calorie intake is made up of carbohydrates (recommended to be 45-65%),2 these theories aren’t worlds apart, so why are they presented as being so?

Furthermore, given that both theories concern overconsumption, presumably they involve the same causative mechanism with regard to appetite? In that case, the presumption that pathological appetite mechanisms underlie this disease seems odd. Human levels of consumption have as much to do with availability of food as with physiological drivers of appetite. I for one don’t need to be hungry to eat when food is available. Or am I missing something again?

It seems worrying that someone who is already convinced that obesity is due to an unidentified disordered environmental stimulus causing excess carbohydrate intake, and in turn causing a disordered hormonal response, is leading an organisation with vast resources to go looking for these mechanisms. And this is despite perfectly adequate explanations being explicit and implicit in his article.

Please tell me I’m missing something.

Notes

Cite this as: BMJ 2013;346:f3010

Footnotes

  • Competing interests: BB needs to lose a little around the midriff.

References