Lifestyle Choices

When I was a child growing up in Portsmouth, the naval town on the south coast, and we saw someone who was grossly obese, my mother would say pityingly, in a knowing stage whisper, ‘Trouble with their glands, dear.’ In those days Portsmouth was full of sailors of all nationalities and anyone who was very fat was unusual. Now, when I go back to my home town forty years later, the sailors have all gone and people who are very overweight are so common as to be unremarkable. The attitude to these heavyweights has also changed. They are no longer the subject of pity, but of a kind of loathing. Fat today says greedy, slothful and self-indulgent. As I will show you, hormones and obesity and intimately bound together. Trouble with your glands is indeed part of the obesity equation, including a gland that has only in the last decade been discovered to be secreting hormones — fat itself.

The world is facing an epidemic of obesity. In the UK alone, over a thousand people a week die prematurely from the complications of obesity. Being obese doubles your chances of getting bowel and breast cancer, ups the likelihood of osteoarthritis, especially of knees and hips, and causes Type z diabetes, hypertension, strokes and heart attacks. We are big, and getting bigger. In fact, according to the 2004 House of Commons Health Select Committee Report on Obesity, the proportion of the UK population that is obese has grown fourfold in the last twenty-five years, the fastest rate of increase in Europe. In Nordic countries there has been no such change, although it may be beginning.

Contrary to belief, we don’t actually eat that much more than people did fifty years ago in energy terms, although the proportion of our fuel that we obtain from fats and sugars has increased. Actually, according to latest data, we eat less. The main difference is that we exercise much less. There are far fewer manual jobs. We now go to work to sit down, and go home to be active. We work further away from home, which means that we don’t walk or cycle to get to work any longer. If you live in the US, cities are ribbons along highways with seemingly no means of walking anywhere. In Britain, children are no longer expelled on to freezing games pitches five times a week. They may do as little as forty minutes of compulsory games a week — instead of five hours a week, with a few more at the weekend, as their parents did.

In the past, and in some societies still, being fat was associated with wealth and was an aspiration. Today, being fat is linked with lower incomes, a higher divorce rate and with increased rates of depression and suicide. Patients being treated for obesity report that they would prefer to be blind or deaf than to be obese again. In 1997, a widely reported study by psychologists revealed that 15 per cent of women and II per cent of men would be prepared to sacrifice five years of life if only they could die slim. Discrimination against the obese is pervasive. The psychologist J. R. Staffieri, in what has become a classic study of childhood stereotypes, reported young children describing silhouettes of an overweight child with words like lazy, dirty, stupid, cheat and liar. The view of the obese by the lean is that they have done it to themselves and there is little or no sympathy for them.

Being obese would have been bad news for the evolving human. It would have meant not being agile enough to run away from danger and being too fat would also have brought additional dangers from disease like heart attack or stroke. On the other hand, being too thin was equally bad news. For women, it would have meant no pregnancies, since this depends on having at least 18-22 per cent of body fat, and for both sexes insufficient fat reserves to cope with periods of hardship would have meant a high likelihood of death by starvation. Thus having just the right amount of fat — neither too much, nor too little — is crucial to our survival and the body has an extraordinarily complex system devoted to keeping weight (and thus body fat) stable, no matter what.

Despite the variations in our day to day food intake and rate of exercise, most of us do remain pretty much the same size. Even if we diet, we find ourselves inexorably putting weight back on until we are once again the ‘right’ weight. It’s a shame our bodies and our mirrors disagree on what ‘right’ is. By the time we reach old age, we are all heavier than we were in youth, but only by a stone or so, which creeps on insidiously as we age, although this isn’t the case in more primitive societies. To see true weight stability in action, you only have to see teenage boys troughing. Their food intake would shame a lumberjack, but despite them lazing about like beached seals in their bedrooms, most (but not all) of them appear to stay the same size. By now, you will not be surprised to hear that it’s a system driven by hormones — although they, of course, are only responding to our lifestyle.

The body is not much concerned by whether we can fit in size 12 or size 10 jeans. Its overriding need is to maintain a state of internal constancy, no matter what is thrown at it. Food intake, running a marathon, stress, cold, heat, thirst— whatever the challenge from the outside, on the inside the body’s challenge is to respond while keeping things exactly the same — or within a very narrow new range set by our activity. This internal constancy is essential in order to run body functions at maximal efficiency. Hormones are vital to this process, for they are constantly shuttling back and forth, carrying vital bits of information about internal change or, indeed, external changes, and being sent out with instructions to get things back on track. The relationships between the many hormones involved in this system are fantastically complex. We’ll concentrate here on those involved in the regulation of energy balance and of appetite. Energy that is excess to requirements is stored as fat.

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