Alabama Bariatrics & Minimally Invasive Surgery

Bariatric Diet Orbera Gastric Band Sleeve Gastrectomy Gastric Bypass

W. Jay Suggs, MD, FACS, FASMBS
Madison, Huntsville, and Decatur
Phone: (256) 274-4523
Fax: (256) 203-8791

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Since the utilization of the scientific method, people have been debating how much nature and nurture determines the outcome of an individual.

From Nature, there are genetic predispositions to diseases like Type 1 Diabetes, or Cancer, and without a highly professional geneticist there would be no outside intervention that can alter what comes with a genetic predisposition.

From Nurture comes the formation of habits, such as the development of personal preferences and the language you speak based upon the area you were born in and who spoke to you when you were a baby.

In the case of Morbid Obesity, there has been a lingering accusation in the air that the nurturing of bad eating and exercising habits were the sole cause of excessive weight gain.  But entertain for a moment…what if it isn’t true? What if it was a byproduct of a genetic anomaly?

What is Morbid Obesity, Again?

            Morbid Obesity is the condition in which the afflicted party has a severe enough adiposity to the point in which it is life threatening. The average threshold to determine morbid obesity is 100 lbs. over the BMI standard. While the BMI standard isn’t always accurate, the measurement combined with the adiposity is usually a strong enough indicator whether someone is morbidly obese.

When someone is morbidly obese, several life threatening, and debilitating side effects ensue such as Type 2 Diabetes, heart disease, high blood pressure, arthritis, some cancers, sleep apnea, trouble breathing, and difficulty walking. The less debilitating but life altering side effects of morbid obesity includes: a lower sex drive, infertility, social ostracization, lack of sleep, teasing and bullying by family members and medical discrimination from doctors.

            Most of the social consequences for morbid obesity, or really any sort of fat gain in general, is a byproduct of hundreds of years of stereotyping that has been buried in both the root of its symptoms and the public interpretation of what it stands for.

The Nurture Argument for Obesity

            When someone generally talks about someone who is overweight or morbidly obese, there are two ways in which most people breech the subject. The first way would be the need to call them “lazy” or” without any will power”. The second would be to either feel sympathetic towards the obese person or pretend that the condition does not exist and never speaks of it again. Either way, these behaviors are rooted in shame. They only difference is that one is more outspoken about the fact that Obese people are considered “disgusting” by the public.

But where did the stigma come from? What is societally shameful about being obese aside from the average health condition? Was it always this way?

            There is both a medical reason for this association and a historical one.

            The medical reasoning behind the stereotype that “obese people are lazy” comes from the outward signs of sleep apnea a condition attributed to morbid obesity. The sufferer is not able to breathe while sleeping, meaning less oxygen in the brain during the sleeping process. This cuts short the feeling of being well rested for the obese person thus making them visibly tired in public.

            The societal reasoning behind the thinking that obesity is tied with laziness comes with the original diagnosis of obesity in the West. Adiposity was in vogue during the Greek and Roman Empire, because being fat was an association with being wealthy. However, when the noticed side effect was a lack of fertility, it became less of a positive statement and a disease that is only afflicted by people of royal status.  After ages passed, when the idea of a republic or a parliament was more appealing than a sole monarchy, kings were seen less as someone appointed by God to rule and more like a despotic tyrant that was greedy for riches and food while the people starved. Morbid Obesity became a sign of excess, and ever since it has been societally associated with laziness, greed, and a lack of moral character.

But is behavior the only thing that determines Morbid Obesity? Is it as simple as telling someone to put down their fork and run a couple of miles? This is what scientists and rational thinkers asked themselves as they saw Obesity become an epidemic.

What is Morbid Obesity? Maybe, it isn’t just motivated by behavior?

The Nature Argument for Obesity

            We have learned a lot about ourselves once we were able to create the tools to study the patterns of mother nature. We learned that we were made of things called cells, that contained little strands of instructions that told them to grow, change, and reproduce until they died. We also learned that these instructions determined everything about ourselves.

            Inside DNA is the literal essence of distilled life. The genes inside determines how we look, how we react to things, the diseases we are immune or susceptible to, and our basic talents.

            So, when we were able to study our own genetics, we wondered, “Was there a genetic reason behind the ways we behave? Is there some sort of genetic mutation that may be the reason behind Morbid Obesity?

As of 2006, more than 41 sites on the human genome have been linked to the development of obesity when a favorable environment is present. In plain English, it means that through years of human evolution, people who were genetically able to store fat were more likely to reproduce. How is that possible if Obesity causes a decrease in fertility?

It is possible that the carriers of these altered genes were not able to be used during times of extreme famine.  These plump people that did exist had an advantage against the threat of starvation…Until it was no longer needed.

After society became industrialized and food began to become mass produced, it became more available to the public. Thus, eliminating the need for fat storage.

But DNA does not stop when we tell it to. If it has a pattern from genes, it will keep following instructions until it lasted no more. Leading to the Obese epidemic of America.

So, What is Morbid Obesity? Is it a disease or a Bad Habit?

Many studies conclude that it is a combination of both genetic instruction and the reinforcement of unhealthy habits.  The genetic half of Obesity makes it possible in the first place, and the learned behaviors by both the Western fat and carb saturated style of food and the bombardment of easily accessible advertising for unhealthy products.

The only way to get past obesity is to attack it on both ends. To investigate both how mutant genes determine the risk of death by Morbid Obesity and a controlled environment where healthy habits and coping mechanisms for emotional distress can be learned.  

If you feel as though you are morbidly obese, talk to a gastric bypass surgeon or someone who you think will cover both the genetic side of things and the behavior side of things too.

Keywords: What is Morbid Obesity?