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Causes of morbid obesity

The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that in many cases a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.

Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather, they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.

Contributing factors

The underlying causes of severe obesity are not known. Many factors contribute to the development of obesity; these factors may be genetic, hereditary, environmental or metabolic, and may be affected by other conditions such as eating disorders. There are also certain medical conditions that may result in obesity, such as intake of steroids and hypothyroidism.

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Genetic factors

Numerous scientific studies have established that your genes play an important role in your tendency to gain excess weight.

  • The body weight of adopted children shows no correlation with the body weight of their adoptive parents who feed them and teach them how to eat. Their weight does have an 80 percent correlation with their genetic parents, whom they have never met.
  • Identical twins, who have the same genes, show a much higher similarity of body weights than do fraternal twins, who have different genes.
  • Certain groups of people, such as the Pima Indian tribe in Arizona, have a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups.

We probably have a number of genes directly related to weight. Just as some genes determine eye color or height, others affect our appetite, our ability to feel full or satisfied, our metabolism, our fat-storing ability and even our natural activity levels.

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The Pima paradox

The Pima Indians are known in scientific circles as one of the heaviest groups of people in the world. In fact, National Institutes of Health researchers have been studying them for more than 35 years. Some adults weigh more than 500 pounds, and many obese teenagers are suffering from diabetes, the disease most frequently associated with obesity.

Interestingly, however, one group of Pima Indians living in Sierra Madre, Mexico, does not have a problem with obesity and its related diseases. Why not?

The leading theory states that after many generations of living in the desert, often confronting famine, the most successful Pima were those with genes that helped them store as much fat as possible during times when food was available. Now those fat-storing genes work against them.

Though both populations consume a similar number of calories each day, the Mexican Pima still live much like their ancestors did. They put in 23 hours of physical labor each week and eat a traditional diet that is very low in fat. The Arizona Pima live like most other modern Americans, eating a diet that consists of about 40 percent fat and engaging in physical activity for only two hours a week.

The Pima apparently have a genetic predisposition to gain weight. And the environment in which they live—the environment in which most of us live—makes it nearly impossible for the Arizona Pima to maintain a normal, healthy body weight.

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Environmental factors

Environmental and genetic factors are obviously closely intertwined. If you have a genetic predisposition toward obesity, the modern American lifestyle and environment may make it more difficult to control weight.

Fast food, long days sitting at a desk and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage.

For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.

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Metabolism

We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn and you gain weight; burn more calories than you ingest and you lose weight. But now we know the equation isn't that simple.

Obesity researchers now talk about a theory called the "set point," a sort of thermostat in the brain that makes people resistant to either weight gain or weight loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.

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Eating disorders and medical conditions

Weight loss surgery is not a cure for eating disorders. There are also medical conditions, such as hypothyroidism, that can cause weight gain. That's why it is important that you work with your doctor to make sure you do not have a condition that should be treated with medication and counseling.

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