Why do we get fat

Chapter 18 Why does the body become "like" fat?
As I said, critical thinking about "why we get fat" is by no means original to me.Dating back to 1908, German physician Gustav von Bergmann first applied the term "lipophilicity" -- or "fat-loving" -- to describe the various parts of our body Preference for storing fat.In fact, what I have said in this book is basically derived from von Bergman's ideas, which are modern developments of his theoretical foundations.Today, one of the highest awards of the German Society of Internal Medicine is named after von Bergmann.

Von Bergmann's straightforward view of obesity, which he believed to be a dysregulation of pathways that metabolize excess fat, led him to study the regulation of adipose tissue.I've cited many of his observations before that some tissues in our body are markedly "lipophilic" and eager to accumulate fat; others are not.He is wise to point out that such attribute differences not only exist between organizations, but also vary from person to person.Just as some parts of the body are prone to hair growth and others are not; some people have more hair than others, some people have less hair than others; These people's bodies are clearly more "lipophilic".These people usually begin to gain weight very early, and there is nothing they can do about it.Those whose bodies are not lipophilic are thinner, and it is difficult for them to gain weight despite their efforts.

In the late 20s, von Bergmann's idea of ​​lipophilicity was carried forward by Julius Bauer at the University of Vienna.Bauer was a pioneer in the application of genetics and endocrinology to clinical medicine when these disciplines were still in their infancy.At that time, few doctors could imagine using genetic characteristics to judge human characteristics and diagnose diseases.Bauer understood the relationship between genes and disease better than anyone else, and he spent a lot of energy trying to make American doctors see clearly the mistakes in Louis Neuberger's "perverted appetite theory" hypothesis.

Newberg insists that genes, if they play a role in obesity (which he is skeptical about), may simply give obese people an irrepressible urge to eat more.Bauer counters that the only way genes cause obesity is not by controlling brain impulses, but by directly affecting the regulatory properties of fat tissue itself."Genes regulate lipophilicity, and this regulation then determines how our energy intake and energy expenditure are governed," Bauer said in the article.

Bauer believes that fat tissue in obese people is similar to malignant tumors.Both have their own agendas of aggressive expansion, he explained.Tumors are driven to grow and spread, regardless of how much a cancer patient eats or moves.In people prone to obesity, fat drives adipose tissue to grow and expand, as does tumors.This type of fat pays little attention to what other parts of the body are doing and what cooperation they need before completing the goal of expanding the territory.Bauer wrote in 1929: "Aberrant lipophilic tissue, even in conditions of nutritional deficiencies, preys on food. It maintains its fat stores, perhaps ignoring 'replenishment' demands from other tissues .It's a state of confusion, where adipose tissue lives only for itself, without consideration for the development of the whole living body."

By the late 20s, the lipophilicity hypothesis of von Bergmann and Bauer was almost universally accepted in Europe.Then it became popular in the United States. When Bauer died at the age of 30 in 1979, the medical journal "The Lancet" wrote for him: "His English version of the lecture notes was greatly welcomed by the British and American medical circles at that time."

However, in the next decade or so, this concept disappeared.Doctors and researchers who didn't die in World War II or flee Europe (Bauer left the continent in 1938) had to deal with more urgent matters than losing weight.After the war, the new generation of doctors and nutritionists in the United States began to fill this research gap. They were enamored of Neuberger's "abnormal appetite" logic theory, which may be related to their prejudice against the theory of punishment and retribution for gluttony and laziness.

Anti-German sentiment in postwar medicine may have been understandable, but it did not help medical progress.After the war, American weight loss experts and authorities turned a blind eye to the medical literature from Germany, although it was the Germans and Austrians who laid the foundations and completed the work in nutrition, metabolism, endocrinology, and genetics, all of these areas related to weight loss. A large number of extremely meaningful studies.By the time psychologists and psychiatrists took over the field in the 20s, obesity officially became an eating disorder—a benevolent way of saying it, really, as a character flaw.Henceforth, all hopes that the authorities would notice the regulation of adipose tissue itself have been in vain.

After the war, some research doctors still occasionally came to the same conclusion.Bruch, a leading authority on childhood obesity in the 20s, still believed that defects in the regulation of adipose tissue might be responsible for obesity, and publicly expressed her bewilderment that her colleagues ignored the idea so much.

It wasn't until 1968 that Gene Mayer discovered that the fat volume of different body types was related to different hormone concentrations in the blood, and suggested that subtle differences in relative hormone concentrations might be what made some people fat while others were thin.In other words, hormone concentrations may determine whether adipose tissue is lipophilic, as suggested by von Bergmann and Bauer.

One of the most insightful postwar experts on the question of why we get fat happened to be an authority on hormone imbalance—Edwin Astwood of Tufts University. In 1962, he served as the president of the American Academy of Endocrinology, and gave a speech entitled "The Legacy of Obesity" at the annual meeting of that year.Astorwood attacked the idea that overeating leads to obesity.He describes this theory as "the culprit behind our overeating."As far as I know, his speech was as good as any on why we get fat.His presentations are factual (always a good idea) and unbiased (also a good idea).

Astorwood begins by pointing out that it is clear that our propensity to be fat and to stay thin is largely determined by our genes, like a kind of inheritance that is passed down from generation to generation.If genes determine our height, hair color and foot size, why not believe that "genetic heritage" determines our body shape?

But if genes do control our body shape, how do they do it? In 1962, biochemists and physiologists took a giant step toward identifying how body fat precisely regulates the body, as we'll discuss later.Astwood saw bioregulation as the definitive answer, as did his predecessors von Bergmann, Bauer, and Bruch.Today, dozens of enzymes and various hormones have been identified as factors affecting fat accumulation, some of which are responsible for liberating fat from adipose tissue and others for putting fat in adipose tissue.Overall, the amount of fat stored in any individual or body part will be determined by the balance of these regulatory forces.

Now, suppose that these adjustments go awry.

Suppose, that the release of fat or its oxidation (i.e. the body uses fat as fuel) is somehow hindered, or that the storage or synthesis of fat becomes prevalent, what happens?Lack of food is the cause of hunger, and fat is food for most parts of the body.It's easy to imagine a slight nutritional disturbance leading to a voracious appetite.

But in my opinion, how hungry and salivating an obese person feels is beyond the comprehension of skinny doctors...

This theory is enough to explain why diets fail so badly, and why most obese people suffer so much when they restrict their diets.This theory is also of great interest to our friends, the psychiatrists, who can always find all sorts of prejudices about food, and think that it is the temptation of food that makes obese people dream.If we can't eat enough, who can not be haunted by cravings in the brain for various foods?Hunger is so terrible that it is called the three worst nightmares of human beings along with plague and war.In addition to physical discomfort, the psychological pressure brought about by obesity, as well as the ridicule and ridicule of thin people and other people in society, endless criticism, accusations of overeating and lack of "willpower", there are endless The sense of guilt makes obese people feel worse.There is reason to believe that it is these emotional distress experienced by obese people that biases psychiatrists.

In order to understand obesity and why we get fat, we have to understand what concepts Astorwood understood and what obesity specialists embraced before World War II and then stalled after.Gluttony (eating more) and laziness (moving less) are just side effects of any regulation disorder; however subtle the disorder is, it also diverts large amounts of calories to adipose tissue for storage.Before long, we may actually have the urge or need to seek help from a psychiatrist when we are tormented.It’s not emotional distress that makes us fat, it’s the unchangeable fat that comes with it, the hunger, the sense of loss, the humiliation of being accused of bulimia and the alleged lack of “willpower” that makes us emotionally distressed.

(End of this chapter)