Is it biology? Lifestyle? Why not both (and more)?

I foreshadowed this post last week, when I began my ripostes to Dr. Chris Ochner, a good guy and respected researcher on obesity, a particular interest of mine. I just want to emphasize, again, that this isn’t about Ochner; it’s about ideas that are well evident in public debate. Our interview, and the aftermath, have provided opportunities for further discussion.

Q:  What’s the thing that you wish everyone would just get right? A: “Understanding that obesity is maintained by biological factors. It’s not a lifestyle choice once someone has been obese for some time.”

Ochner’s position on this fascinates me, because when I advocate for the existence of food addiction, I am saying specifically that food addicts have a biochemical sensitivity to some substances that others don’t, that their “obesity is maintained by biological factors.” So we agree, right?

Not exactly. At the core of my most-presented speech is the notion that in the years when I addressed my obesity through dieting and exercise alone, I lost about 350 pounds and gained back every one. My conclusion is that while my solution must include biology, it must also be broader.

“Lifestyle,” to me, is as good a term as any for the broader solution. One example of it is engagement in community. “To lose weight, join a community,” is not standard advice, but it has been crucial to me.

For years, the communities were food- and dysfunction-based, found in rehab, therapy, and support groups. It has since become broader, such as my five-year participation in a cooperative community garden. Yes, quite literally, being in a garden group is one of the ways I maintain my body weight, but I’m not going deeper into that point here.

Another lifestyle choice has been to “resign from the debating society,” as someone put it. During my worst years, I maintained stridently that I understood all facets of my situation, so I didn’t need your input at all, so STFU. I was tied for most unreachable, unteachable, irascible SOB in town, all but insistent on maintaining my prison of fat and misery — while wishing I weren’t so screwed up. Nice package, huh?

Ochner's not alone when giving lifestyle choices a free pass. I see it stemming from the same place as the nutritional dictum that no one need give up their favorite foods, and as the Health At Every Size movement, whose philosphical pillar is that the fault lies in society's intolerance, rather than in individuals' choices. Even in cases where biology has dealt a cruel (or merely inconvenient) blow, I'm responsible for accepting and then dealing with the cards I've been dealt.

The foremost flaw I see in Ochner’s statement — which, again, is not uncommon in the mainstream, which is what makes it worth discussing — is the very separation of biology and lifestyle. We are submerged in a culture that seeks to break everything down to one thing — “low fat,” “high fiber,” “tastes great/less filling” — but that's not how life is.

Isn't it obvious that everything is interconnected? Doesn't that argue we should consider both biology and lifestyle, as well as other factors?



It is my opinion that sustained obesity is chemically driven. Overeating may be started psychologically, but then physical processes take over. Much of my recovery is due to changes in my beliefs, hence behaviors. Beliefs need to change along with reworking of cognitive dissonance. Think something would taste great and saying no thanks is cognitive dissonance. Thinking or saying that it is more damaging to me than tobacco or calling it a poison is mentally compatible with no thanks, as is that processed eatable products are not human food.

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