“Bariatric Surgery: The Solution to Obesity?” (New Yorker) shamelessly cheerleads for surgical modification of the human body to deal with changed environmental conditions:
“We are meant to fast and feast, like the other carnivores,” I once overheard a flight attendant say to another on an overnight plane. “But there’s always a feast around.”
Given enough time is it possible that the human body would evolve to avoid weight gain even in the presence of unlimited food? Do thin people have more children than fat people, for example?
In the meantime the author claims that we can actually save money on healthcare by cutting into the abdomens of anyone who shows signs of gaining weight:
Bariatric surgeries, which can cost as much as thirty thousand dollars, are covered by many major insurance companies. (Most studies suggest that the expenses are recouped within two to three years, because the surgeries avert future obesity-related medical expenses.)
What do readers think? Can this be right? Maybe we do need to speed up evolution because we aren’t adapting fast enough to the continuous casino and cruise ship buffets. But is surgery the answer? Why not wait a few years for CRISPR to be perfected? Modify our genes so that donuts don’t taste good anymore.
Related:
- Obesity, population growth, global warming, and the role of veterinarians
- Whales, Technology, and Obesity
- American Economic Association Meeting in Boston (scroll down to the article on free school breakfast)
- Expanding preschool = expanding waistlines?
Four plausible theories about the obesity epidemic:
(1) Society is rich enough, especially in the area of food abundance, that most people can eat as much as they want without it costing enough to slow them down
(2) The science of making food tastier and more appealing while being less satiating has advanced to a dangerous degree
(3) changing gut flora has given most people digestive systems that behave differently than they used to
(4) Society has made being fat so much less unacceptable and difficult than it used to be that a lot more people allow themselves to overeat to the point where they develop an addiction to it
I think all of them contribute, but my money’s on (3) as the biggest factor.
@Joseph: for most of human history being fat was not only acceptable but preferred. The preference for thinness is a recent phenomenon and was only possible when food insecurity became a thing of the past in the West sometime in the last century.
As for fertility, having a low BMI depresses fertility in women, e.g. professional athletes.
Fazal, what you wrote only explains why obesity is more looked down upon than it was 100 years ago. It does nothing to explain why obesity is actually so much more prevalent than 50 years ago, which is the question at issue. At most, it rebuts my fourth hypothesis, but it doesn’t really, because I am comparing now with 50 years ago when thinness became preferred, not with earlier food-insecure societies.
Sounds like a grand idea until you pause to consider higher suicide rates in bariatric surgery patients. See, for instance
http://www.medscape.com/viewarticle/852616
Could it be the anti-depressant resistant depression? E.g. https://www.psychologytoday.com/blog/the-antidepressant-diet/201403/depression-after-gastric-bypass-surgery
On the other hand, current (almost) conventional wisdom is that caloric restriction is one of the better paths to increased longevity (at least in monkeys?). See, e.g.
http://www.nature.com/articles/ncomms4557
Most surgery functions at a very understandable, mechanical, level. You have kidney cancer, remove the kidney, no more cancer. Heart not getting enough blood, widen an artery. Problem solved.
Bariatric surgery is somewhat mysterious. You lose weight as a side effect of the surgery. That it works is undeniable – look at the high rates of patient satisfaction post surgery. Yet it seems to bother many people.
What if you thought of obesity as a disease, maybe something having to do with a malfunctioning appendix. Same health consequences as obesity. The cure would be an appendectomy but with the same side effects as bariatric surgery. What would you think of the surgery then?
I lived in New Zealand for 6 months. While there I made a conscious effort to exercise more, but no conscious diet change. My parents came to visit during my last month there, and it was then that I noticed for the first time that they were eating more than I was eating at dinner- really for the first time ever (I’m 5 inches and 50 pounds more than my father). Then I realized my appetite had decreased while I was there – theirs had stayed the same.
About 2 weeks after I moved back to the US, still running miles a day, I noticed my appetite increased substantially. It made me wonder what in the American diet makes us eat so much more, and made me pay more attention to what I eat. This plays into Joseph’s explanation 2) above.
Brian – Bariatric surgery is not a mechanical mystery – a smaller stomach means you can’t eat as much, and will cause pain (dumping syndrome) if you do. Also, if part of the surgery involves bypass of some gut, there is less gut to absorb food, and so it has the same effect as eating less. People who have too much intestine removed for other reasons (cancer, etc.) have the same weight-loss and malnutrition effects (Short-gut Syndrome).
G. Ranma – Bariatiric surgery unlikely causes suicide/depression. It’s that depressed people eat more., so you’re pre-selecting for patients who are already at higher risk for suicide.
Corn-based diet and sugary soda drinks, introduced in early childhood. especially dangerous for the poor and uneducated.
Please note that surgery can only slow down evolution, if we want to evolve towards eating less. Also, we are not carnivores but omnivores. Like chimps, for example.
If I had to make a guess, I would say that we started out by stealing kills by throwing rocks at lions on the savanna.
While it is better to be somewhat overweight than underweight, history too seems to look down on the grossly fat. Gluttony is a mortal sin, for example, and good Christians used to fast one or two days a week, during Lent, etc. (It appears to vary. Wikipedia tells me Copts fast a full 210 days per year.)