Over on Scholars and Rogues, there is a blog post entitled, Should we be mean to fat people? You bet.

One thing that the writer claimed was that "Less than 1% of all people have a medical reason for obesity like thyroidism or Cushin’s syndrome."

They referred to an article in WebMD that used to make this claim (but doesn't anymore). I wrote a very long response in the comment, and I'm repeating it here:

Obesity is a serious problem in the United States and we should all be working together to find ways to reduce obesity. However, my concern is that this article is more likely to have negative effects than positive effects.

First, let’s look at some numbers. According to the CDC, “About one-third of U.S. adults (33.8%) are obese.” http://www.cdc.gov/obesity/data/trends.html#National According to the U.S. Census, the adult population , the adult population in the United States in 2009 was 232,438,000. http://www.census.gov/compendia/statab/2011/tables/11s0007.pdf That works out to approximately 77.5 million obese adults in the U.S. If the WebMD article that was quoted is correct, there would still be over three quarter of a million people that suffer from obesity because of medical conditions. I am not sure that a course of action that could do harm to these people, as illustrated by EmmaZahn’s comments is particularly ethical, whether or not we are sworn to the Hippocratic Oath.

Yet even that statistic needs to be questioned. WebMD has since updated the page to say “a small percentage of cases excess weight gain is a symptom of another disease”. They cite hypothyroidism as one possible cause. Yet according to Jack DeRuiter (2002). “Thyroid pathology” (PDF). Endocrine Module (PYPP 5260). Auburn University School of Pharmacy. p.16, “the overall incidence is about 3% of the general population”. Granted, there may be some cases of hypothyroidism that don’t result in obesity, but this number alone is enough to make WebMD’s numbers questionable.

The National Institute of Health also mentions polycystic ovarian syndrome (PCOS) as another call of obesity. “PCOS is a condition that affects about 5–10 percent of women of childbearing age. “http://www.nhlbi.nih.gov/health/dci/Diseases/obe/obe_causes.html

Another cause that WebMD cites is Cushing’s syndrome. Massachusetts General Hospital says, “An estimated 10 to15 of every million people are affected each year”. http://pituitary.mgh.harvard.edu/cushings.htm.

The MGH article also starts off talking saying “Cushing’s syndrome is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol”. Cortisol is a hormone produced by the adrenal gland in response to stress. This points back to the role of poverty in obesity. I would encourage people to check out Development and Psychopathology (2001), 13: 653-676 “Can poverty get under your skin? Basal cortisol levels and cognitive function in children from low and high socioeconomic status” http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid... “ The results revealed that low SES [socioeconomic status] children from 6 to 10 years old present significantly higher salivary cortisol levels when compared to children from high SES. “

Another important issue is what is available for good food. As a starting point, I would encourage people to start off with the article in Health Affairs, “Following Federal Guidelines To Increase Nutrient Consumption May Lead To Higher Food Costs For Consumers”, http://content.healthaffairs.org/content/30/8/1471.abstract : “We found that increasing consumption of potassium—the most expensive of the four recommended nutrients—would add $380 per year to the average consumer’s food costs. Meanwhile, each time consumers obtained 1 percent more of their daily calories from saturated fat and added sugar, their food costs significantly declined.”

This is complicated by the issue of food deserts, area where healthy, affordable food is difficult to obtain in the United States. I encourage people to check the USDA Food Desert locator. http://www.ers.usda.gov/data/fooddesert/fooddesert.html

I have none done the research to back this up, but I suspect that you will find there are high correlations between food deserts, areas of poverty and areas of unmet medical needs.

Returning briefly to the WebMD article, it mentions depression as another cause of obesity. Being poor, stressed out, in areas where it is difficult to obtain healthy affordable food can easily contribute to situational depression. So can having people be mean to you.

So, if you are really interested in addressing problems of obesity in the United States, start with something meaningful, like fighting poverty, or making health affordable food more accessible. Follow it up with making sure that people have good opportunities to exercise, by making sure health recess is available in schools and that people have parks, trails, and other safe areas to walk in their neighborhoods.