Born To Be Fat?

On Larry King Live I heard you say that obesity is mostly a genetically influenced hormonal disorder with insulin as a central player. You made the point that obesity doesn’t stem from people eating too much or not exercising enough or not having any willpower. Does that mean that eating right and exercising won’t help with weight loss?

– July 13, 2010

No, it doesn’t, and I think you misunderstood the point I was making. What I believe is that individuals with a certain genetic constitution can develop insulin resistance if their diets include a lot of carbohydrate foods that carry a high glycemic load. Insulin, the hormone that facilitates the transport of blood sugar (glucose) from the bloodstream into cells throughout the body for use as fuel, is secreted by the pancreas in response to the normal increase in blood sugar that occurs after a meal. With insulin resistance, the normal amount of insulin secreted is not sufficient to move glucose into the cells – thus the cells are said to be “resistant” to its action. To compensate, the pancreas secretes insulin in ever-increasing amounts. This excess insulin drives the body to store fat and influences many other physiologic process.

I believe that most of today’s obesity epidemic is due to metabolic syndrome, a mismatch between genes and diet/lifestyle, with insulin resistance at its center. The hormonal imbalance in this disorder affects brain centers, prompting people to overeat and be underactive. In other words, the overeating and under-activity frequently associated with obesity are symptoms of an underlying metabolic disorder, but this fact does not excuse anyone from taking action once they recognize the mismatch.

Fortunately, you can restore insulin sensitivity by modifying your diet (to low- glycemic-load foods) and increasing your physical activity. This will eventually normalize hormonal influences on brain control of appetite and activity. And you will lose weight.

The discussion on Larry King was about the ideas of Gary Taubes, author of Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease. I agree with Taubes on the hormonal issues involved in obesity, but I disagree with his weight-loss recommendations: that we avoid carbohydrates and eat mostly meat, fish, fowl, cheese, butter, eggs and non-starchy vegetables. Instead, I recommend my anti-inflammatory diet, which isn’t a weight-loss diet (although you will lose weight on it if you don’t overeat and also get regular physical activity). I designed it as a way to stay healthy by addressing the chronic inflammation that underlies heart disease, many cancers, and Alzheimer’s disease. When you follow my anti-inflammatory diet, you eat animal protein two to three times per week – mostly as fatty, cold-water fish to reap the benefits of omega-3 fatty acids – and stick to carbohydrate foods that rank low on the glycemic load scale. I believe this is the healthiest way to eat whether or not you have the genetically driven hormonal disorder that can lead to obesity.

Andrew Weil, M.D.

More information the Condition Care Guide: Treating Obesity.

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