January 23, 2016

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A recent paper in The New England Journal of Medicine describes the use of surgery to reduce the weight of grossly fat adolescents between the ages of 13 and 19, who are more numerous both absolutely and proportionately than ever before in human history. A single detail caught my imagination: One of the youths included in the study had a body mass index of 88. To give some idea of the scale of this obesity, a person of six feet would have to weigh about 650 pounds to achieve such a BMI.

The question arises as to how so immense an accumulation of flesh, by comparison with which Falstaff himself was almost anorexic, is achieved“€”if achieved is quite the word for it.

Needless to say, there is an ideological debate over the nature of obesity such as this. Is it an illness in itself (independent of its ill effects on health), or is it a sign of personal failing and moral degeneracy? Clearly no one has a BMI of 88 without having eaten too much, but what caused him to eat too much? A bad character or bad circumstances?

“€œWhat caused him to eat too much? A bad character or bad circumstances?”€

Almost certainly the youth with the BMI of 88 was fat from early childhood. It is extremely likely that his mother overfed him from infancy. And one of the consequences of obesity is that the sensation of satiety”€”of having eaten or drunk enough”€”is physiologically reset so that it occurs later than ideally it should. If the mother gives the child too much sustenance early in life, he will grow up fat. Furthermore, the mother is in control of what the child eats for many years. She constantly countenances, reinforces, and encourages the tendency to overeat. In these circumstances, it is not easy to condemn the adolescent out of hand, even if early physiology is not entirely destiny.

What, then, of the mother (or other principal caregiver)? Not long ago, I read a book about the role of sugar in the epidemic of Richter-scale obesity in the world. The author recounted the story of a Hispanic mother in America whose child was grossly obese by a very early age. The mother, having read the advice of the Surgeon General, or of some other authority, that orange juice was good for children, deduced that, since you can”€™t have too much of a good thing, she should give her child a gallon of juice a day.

Against such stupidity the gods themselves, that is to say the public-health authorities, struggle in vain. But where does such stupidity come from? Are we to treat it as a natural fact, as the default setting of mankind as it were, or is it a social product, the result of some kind of conditioning? If you gave the Bushmen mothers of the Kalahari, who had had no previous contact with settled civilization, ad libitum access to orange juice, would they give their children a gallon of it a day, or would their innate common sense prevent them from doing so?

The experiment cannot be done, of course, and so we may choose the answer that we prefer. The members of subsistence societies given sudden access to practically limitless food do tend to binge and grow fat: I knew of one such society in which half of the population developed Type 2 diabetes (to which it was also genetically susceptible). But all societies do not grow fat at the same rate when food ceases to be scarce; the rate depends on culture as well as availability. Whenever you arrive in an Anglo-Saxon country, you are immediately struck by the sheer numbers of human mastodons. But the members of practically all societies are growing fatter.

I saw the signs of this a little over twenty years ago in Thailand, for example. I happened to be near a school when the children were let out. They immediately began to consume sugary drinks of various artificial colors, pink and blue, and not coincidentally were becoming pudgy, though most Thais seem by nature slender.


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