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An obesity specialist reveals four overlooked contributors

A recent study in the Journal of the American Medical Association should serve as an eye-opener to any American who has ever struggled with their weight — but not for the reason the researchers suggest. To me, an obesity specialist, the study serves as a stark reminder of both society’s and health care’s gross misunderstanding of the obesity epidemic.

In short, the JAMA study found that more Americans than ever before are dieting these days, and yet weight continues to trend up. According to the research, the number of people dieting in 2015–2016 increased by 23% compared to the number dieting in 1999–2000. In fact, in 2016, nearly half (42%) of adults in the U.S. went on some sort of diet. There were sharp decreases in reported candy and sugar consumption, along with sharp increases in reported vegetable consumption.

That type of dieting should help combat the ongoing obesity epidemic, right? Actually, trends indicate quite the opposite. During the same time frame in which dieting behavior increased, weight among adults in the U.S. increased by 4.6%. The study’s authors explained this discrepancy by assuming that people must be dieting incorrectly or giving it a “minimal level of effort.”

Hogwash, I say.

Proper obesity treatment is multifaceted, and diet and exercise are only a small part of the solution.

The findings of this study are of no surprise to obesity medicine physicians. I meet with individuals every day who are doing everything right — eating healthy, exercising daily — and still seeing their weight trend up.

The cause of the obesity epidemic is far more complex than a calories equation. It is the result of interactions between environmental, behavioral, psychological, medical, genetic, and microbiomic factors. Proper obesity treatment is multifaceted, and diet and exercise are only a small part of the solution.

People have a hard time accepting the notion that weight loss is more complicated than a willpower game, but science shows us that this is the case. Here are four causes of obesity (which contribute, I’d say, to somewhere between 10% and 40% of the obesity epidemic) that demonstrate that weight is about much more than diet.

Viral obesity

Adenoviruses are a group of common viruses that cause cold symptoms. One strain, adenovirus 36, is three times more prevalent in adults and kids who struggle with their weight. When you infect mice and monkeys with adenovirus, they gain weight without eating more than their noninfected counterparts. Of course, viruses are not the only explanation for the obesity epidemic, but evidence continues to mount that they represent a key source.

Circadian obesity

Night work and decreased sleep affect both your metabolism and appetite hormones. Sleep insufficiency decreases leptin (a hormone that diminishes hunger) and increases ghrelin (a hormone that stimulates hunger). When people switch from morning shifts to night shifts, their metabolism drops by 2–5%. Asking people who are sleep-deprived and work nights to lose weight with sheer willpower ignores the biological disadvantage that goes along with their lifestyle.

Drug-induced obesity

Weight gain is a common side effect of many widely used drugs, including many antidepressantscorticosteroidsanti-seizure medicationsallergy medications, and others. While the weight gained as a result of taking some of these medications may be as little as a few pounds, this adds up on a population level. More importantly, these medications make it very hard for people to lose weight and keep it off. One study found that people who take medication that has weight gain as a side effect are 37% less likely to achieve a 5% weight loss when they enroll in a weight loss program as compared to those not taking weight-promoting drugs.

Chemical obesity

There are many chemicals commonly found in plastics, cleaning supplies, and cookware that have been linked to weight gain. The most common ones are bisphenols, phthalates, atrazine, organotins, and PFOA. A recent study found that children with obesity have higher concentrations of urinary bisphenols (a common ingredient in plastic). Researchers at the University of California, Irvine have shown in multiple studies that mice and rodents exposed to these plastics gain weight. The really bad news is that exposure to chemicals can be passed down to your offspring by altering expression of your genes.

This list of contributors to the obesity epidemic is only the beginning — there are many other complicating variables. Simply put, this epidemic is far more complex than our food choices. The causes of obesity listed above help shed light on the fact that while Americans may be eating healthier and dieting more, nationwide struggles with weight gain persist. This isn’t happening because people are making a “minimal level of effort” as they diet. Rather, there are myriad forces at play — many of which frequently go ignored.

It’s high time for us to start treating obesity as a complex disease that requires multifaceted treatment. Diet and lifestyle fads that masquerade as solutions won’t solve this considerable challenge. Instead of pointing fingers at people with obesity and calling them lazy, it’s time we start treating this disease like the medical epidemic it is.