Obesity a misunderstood disease

In 2013, the American Medical Association officially recognized obesity as a disease, five years after the Cleveland Clinics’ medical director for Employee Health defined it as such for all workers there. But in the past 13 years, there’s not been much of a shift in the understanding of what causes obesity — not in the general public, in people who contend with the condition or in the practice of medicine. Most people still think of obesity as a character flaw caused by consuming too many calories and not getting enough physical activity. But it’s much more complex than that.

A study analyzing National Health and Nutrition Examination Survey data found that even though U.S. adults’ BMI increased between 1988 and 2006, the amount of calories adults consumed and the energy they expended were unchanged. It also appears that the quality of calories consumed is as important a consideration as the total quantity. And genetics only explains about 2.7% variation in people’s weight, according to a study in Nature. That all adds up to this: The two most common explanations for obesity — calories in, calories out and family history — cannot, by themselves, explain the current epidemic.

So what are the other factors contributing to the obesity epidemic? Harvard’s T.H. Chan School of Public Health says “prenatal and early life influences; too much television watching; too little physical activity and sleep; and our food and physical activity environment are major influencers.”

That means if what your mom ate before you were conceived and while pregnant and if your first food experiences as an infant were unhealthy, your body became predisposed to obesity in childhood and as an adult.

In addition, living in an environment that is hostile to outdoor physical activity contributes to obesity. And a toxic food environment where there’s a high-density of fast-food outlets and a lack of stores selling fresh foods fuels it too.

There’s also what’s called the obesogen hypothesis. It suggests that chemicals in our environment (called obesogens) promote obesity. The culprits? Hormone disruptors in receipts, plastics, personal care products and foods; antibacterials in cleaning products; pesticides that leave residue on foods and in the air; and other contaminants in water and air.

Clearly obesity is a disease caused by many factors — biological, genetic, social, environmental and behavioral. So where does that leave you and how can you use this information to achieve a healthy weight?

Just as you would work to prevent or treat heart disease with lifestyle changes and perhaps medications, you can do the same for obesity. Here’s a six-step plan from Drs. Oz and Roizen’s book, “YOU On a Diet.”

1. Measure your waist with a tape measure placed at your belly button. Keep a record and work toward having your waist measure half your height.

2. Clear your fridge of foods with added sugars and syrups, simple carbs, red and processed meat, and egg yolks. Swear off fast and fried foods. Stick with whole grains and complex carbs in vegetables and fruits. Experiment with cooking — there are some great ideas at; search for “weight loss.”

3. Aim to walk 10,000 steps a day. Get at least 60 minutes of activity daily. Limit sitting-down time — and get up every 30 minutes for a stretch and jumping jacks.

4. Adopt a healthy sleep routine — seven to eight hours nightly, in a quiet, dark, cool room.

5. Avoid endocrine-disrupting chemicals. Refuse register and ATM receipts; say no to perfumed products and unnecessary use of antibacterials. Replace plastic used for food storage with glass, parchment and wax paper. Limit your use of canned foods, even those that are labeled BPA-free; the substitute isn’t any better. Opt for furniture that isn’t treated with a flame retardant.

6. Talk with your doctor about your weight — you’ll have to bring it up. Also ask about good-for-you forms of resistance training and what medications might help you achieve and maintain a healthy weight.

Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into “The Dr. Oz Show” or visit

(c)2021 Michael Roizen, M.D.

and Mehmet Oz, M.D.

King Features Syndicate

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