[Chapter 4] Weird Types of Obesity

Conditions "Eat Less Move More" Could Never Fix...

Are we going to blame the top half on undereating and the bottom half on overeating? – Gary Taubes

[Image of woman with Progressive Lipodystrophy from Taubes’ book: Why We Get Fat: And What to Do About It]

We all know the places where we’re prone to get fat. Our bellies, chins, thighs, etc. Although we subconsciously acknowledge that there’s a diversity in how different people fatten, we don’t think about it much.

The Banker Model certainly doesn’t care. It says: if you overeat, you will get fat, by hook or by crook.

So a big-boned kid may get a double-chin. A post-menopausal mom who stops running because of a knee injury gains weight on her thighs. The biker who pounds down Coors Tall Boys gets a beer belly.

Who really cares how such obesity presents?

The Banker Model acknowledges that the precise places we are prone to fatten will be determined by hormones, genes, and other factors. But the root cause? Eating too much/not moving enough. Don’t overcomplicate it. Just eat less and move more.

That’s the full depth of the CICO analysis. The peculiarities of where people fatten are irrelevant. Just live a virtuous life of restraint and productivity. The fat will take care of itself.

Yet once again, in the spirit of good science, let’s probe deeper.

You might not know this, but obesity is a diverse disease. Our fat tissue can grow erratically in bizarre ways that have highly specific patterns.

Consider three examples:

· Cushing’s Syndrome, a cortisol disorder. Characterized in part by rapid weight gain, a “moon” face, and a fatty pad known as a “buffalo hump” between the shoulders.

· Lipohypertrophy, fatty lumps that grow around the sites of insulin injections in diabetic patients.

· Progressive Lipodystrophy, a rare disorder in which fat is simultaneously lost in the face, neck, and upper body AND GAINED in the hips and legs.

I could list dozens more such examples, in both humans and animals.

The Banker Model is useless in helping us understand what’s happening.

In Cushing’s Syndrome (or other fat tissue disorders, such as POMC deficiency, Bardet-Biedl syndrome, Alström syndrome, etc.), I guess you could make the case that “overeating” is still fundamentally what causes the characteristic fatty deposits. Perhaps the disorder just determines the pattern—the directional shunting of calories into fat.

Then again… really? If that were the case, you could simply starve Cushing’s patients, and they wouldn’t develop the moon face, etc.

Does anyone think that would work? NO. Do doctors prescribe “eat less move more” treatment for Cushing’s and similar disorders? NO.

Hmm.

Even more peculiar is the fat-deposits-growing-at-the-site-of-insulin-injections example. It seems clear that insulin is critical to this fat accumulation—common sense, right?—but how does that square with CICO logic? Insulin makes you just a little hungrier, I guess, and then (somehow) directs the fat to grow… right at the site of the injections.

Weird. Sit with that a bit.

But by far the wildest observation is progressive lipodystrophy. It gives us an example of people who become clinically emaciated in the upper halves of their bodies and clinically obese in their butts and legs.

Saying that again for those in the back row:

These people get profoundly skinny AND obese AT THE SAME TIME.

Trying to explain this with calories-in-calories-out is like dividing by zero. I just can’t wrap my head around an answer that would make sense.

As Gary Taubes put it: if overeating can’t explain localized obesity, why use it to explain generalized obesity? Obviously, there’s something else going on here.

[NOTE: Since I wrote this section, I learned that it was the progressive nature of Progressive Lipodystrophy that got researchers thinking about CNS involvement (among other issues), In other words, they thought that they could explain PL by the nervous system overstimulating lipolysis down to the waist. Wild idea. You’d think a more parsimonious explanation would be—there’s something wrong with the fat tissue itself. But most researchers in the field are so hung up on calories-in-calories-out—in other words, that overeating is always the cause of fat gain—that they HAVE to believe the brain is always in charge.]