The SHN #91: What's Behind the Obesity Epidemic?

Welcome Back to The Synergetic Health Newsletter! 

February 18th, 2025. Greetings from Da Nang! Today’s special edition is self-explanatory!

🌪️ The Perfect Storm: How Energy Balance, Genetic Food Drive, and Metabolic Health Shape the Obesity Epidemic

The obesity epidemic is one of the most pressing public health challenges of our time, with over 40% of American adults classified as obese or overweight. While the causes of obesity are often debated, the interplay between energy balance, genetic predisposition, environmental factors, and metabolic health offers a clearer picture of the crisis.

As someone who spent 15 years as a personal trainer and immersed in the world of fitness and nutrition, I’ve seen firsthand how emotional this issue is. While I still believe that the calories in, calories out model is a useful general framework for weight management, it’s not the whole story. Over time, I’ve come to appreciate the nuances of metabolic health, hormonal balance, and other factors that influence weight. This post will explore the role of energy balance, genetic food drive, and the bioenergetic view of health, while also incorporating alternative perspectives that add depth to the conversation.

The Role of Energy Balance

At the core of the obesity discussion is the concept of energy balance—the relationship between calories consumed and calories expended. This principle has been foundational to weight management: if you consume more calories than you burn, you gain weight; if you burn more than you consume, you lose weight. For many people, tracking calories and macronutrients works. Small tweaks to intake and expenditure can lead to predictable results, whether the goal is fat loss or muscle gain. But for other people, because of adherence reasons or otherwise, it doesn’t work.

So, energy balance is not the whole story. While it provides a useful framework, it doesn’t account for all the factors that influence metabolism, appetite, and fat storage. This is where genetic food drive, metabolic health, and other variables come into play.

Genetic Food Drive: A Piece of the Puzzle I Long Ignored

Genetic food drive refers to the biological tendency to consume more calories due to heightened appetite and reduced satiety. Genes like FTO, MC4R, and LEPR seem to play a role in regulating appetite and metabolism. Individuals with certain genetic variants are predisposed to overeat, which becomes an even bigger issue in today’s environment of easy access to energy-dense, highly palatable foods.

For those with high food drive, the urge to eat is stronger, and the ability to feel satisfied after a meal is diminished. This genetic susceptibility is present from birth, as highlighted by the Behavioral Susceptibility Theory (BST), which suggests that some children are biologically wired to overeat when presented with food opportunities. However, genetics alone cannot explain the rapid rise in obesity rates. This is where the environment, metabolic health, and other factors come into play.

The Obesogenic Environment

The modern food environment has undergone dramatic changes over the years, creating what researchers call an obesogenic landscape. The widespread availability of cheap, highly processed, and energy-dense foods is a major driver of the obesity epidemic. These foods are engineered to be hyper-palatable, combining high levels of fat, sugar, and salt to maximize taste and appeal. They are also convenient, affordable, and aggressively marketed, making them difficult to resist.

The industrialization of the food system has led to the production of foods with "supernormal appetitive properties," designed to override our natural satiety signals and encourage overconsumption. Snacking has become ubiquitous, and eating out—often at restaurants serving oversized portions—has become the norm.

The Bioenergetic View: Obesity as Metabolic Dysfunction

The bioenergetic view of health, championed by figures like Ray Peat and others, offers a perspective on obesity that goes beyond calories. This approach argues that obesity is not simply a matter of caloric excess but rather a symptom of underlying metabolic dysfunction. According to this perspective, modern diets and lifestyles have disrupted our natural metabolic processes, leading to hormonal imbalances that promote fat storage and hinder weight loss.

Polyunsaturated Fats (PUFAs)

A central tenet of the bioenergetic approach is the avoidance of polyunsaturated fats (PUFAs). While the calories in, calories out crowd often argues that PUFAs are only problematic, as far as its role in weight gain, because of their calorie content, the bioenergetic view suggests there’s more under the hood. Proponents claim that PUFAs:

• Inhibit thyroid function

• Promote inflammation

• Are unstable and prone to oxidation, potentially causing cellular damage

This perspective highlights the importance of the type of fat consumed, not just the quantity. They also point out that this process plays out over many years and won’t necessarily be seen on the scale in the short term— questioning some of the shorter term studies on PUFA’s impact on weight management.

Carbohydrates and Thyroid Function

The bioenergetic approach emphasizes the importance of carbohydrates for metabolic health. Carbohydrates help convert the inactive thyroid hormone (T4) into its active form (T3), and adequate carbohydrate intake can help maintain optimal thyroid function. This is why the bioenergetic view encourages the consumption of easily digestible carbohydrates, particularly from sources like fruits and honey, to support metabolic health.

Thyroid Function

The bioenergetic community places significant emphasis on thyroid health as a key factor in obesity. They argue that:

• Many people have undiagnosed hypothyroidism

• Even subclinical thyroid issues can contribute to weight gain

• Supporting thyroid function through diet and lifestyle can help combat obesity

This focus on thyroid health underscores the importance of hormonal balance in weight management, a factor often overlooked in conventional discussions of obesity.

Stress and Cortisol

The bioenergetic approach recognizes the role of stress in weight gain. Chronic stress leads to elevated cortisol levels, which can:

• Promote fat storage, especially around the midsection

• Interfere with thyroid function

• Disrupt blood sugar balance

Certainly, managing stress has to be considered as a part of a holistic approach to weight management.

Alternative Perspectives on Obesity

While the bioenergetic and mainstream "energy balance" perspectives are well-known, there are other explanations for the rising obesity rates that deserve attention. These alternative viewpoints highlight the complexity of the issue.

Environmental Toxins and Endocrine Disruptors

Some researchers argue that environmental toxins, particularly endocrine-disrupting chemicals (EDCs), play a significant role in the obesity epidemic. These chemicals can:

• Interfere with hormonal signaling and metabolism

• Promote fat storage and disrupt appetite regulation

• Examples include bisphenol A (BPA), phthalates, and certain pesticides

While this is likely not a major causative element to the modern obesity epidemic, it nonetheless is worth mentioning in the discussion— as the proliferation of these substances has done damage to our biological systems and adds fuel to the fire.

Microbiome Dysbiosis

The health of your microbiome has also emerged as a potential factor in obesity. Alterations in gut bacteria composition may influence metabolism and energy harvesting, with certain microbial populations promoting weight gain. Factors like antibiotics, diet, and stress can affect the microbiome, suggesting that gut health plays a role in weight management.

Circadian Rhythm Disruption

Disruption of natural sleep-wake cycles and eating patterns can contribute to obesity. Circadian biologists emphasize the importance of maintaining proper light/dark cycles, getting sunlight exposure, and avoiding artificial light at night. Insufficient sleep is associated with increased appetite and altered metabolism, while shift work and irregular eating schedules can disrupt hormonal balance.

Exposure to artificial light at night affects metabolic processes, highlighting the importance of maintaining a healthy circadian rhythm. Seeing early morning sunlight, exposing your body to the full spectrum of the sun’s rays during the day, and limiting artificial light at night are all worthwhile behaviors. It continues to be my belief that this is the most under appreciated aspect of health, feel free to peruse my past newsletters for in-depth discussions on this topic.

Epigenetic Factors

Epigenetic modifications, which can be influenced by environmental factors, may play a role in obesity. Early life experiences, ancestral experiences, and maternal nutrition can affect gene expression, and these changes can be passed down to future generations. For example, studies of the Dutch Hunger Winter and Holocaust survivors have shown that periods of famine and extreme stress can lead to epigenetic changes that influence metabolism and fat storage in subsequent generations. These findings suggest that obesity risk can be shaped by factors beyond genetics and diet, including the experiences of our ancestors.

Socioeconomic and Cultural Factors

Social and cultural influences play a significant role in shaping obesity rates. Food deserts—areas with limited access to affordable, nutritious foods—are a major barrier for many communities. In these areas, convenience stores and fast-food outlets often outnumber grocery stores, making it difficult for residents to access fresh produce, lean proteins, and other healthy options. This lack of access disproportionately affects low-income communities, where economic constraints further limit food choices.

Economic factors further compound the issue. Healthy foods are often more expensive than processed, calorie-dense options, making it challenging for individuals with limited financial resources to maintain a balanced diet. Additionally, economic constraints can limit opportunities for physical activity, such as gym memberships, sports programs, or outdoor spaces for exercise.

The "Social Determinants of Health" Argument

A term often thrown around by critics of initiatives targeting seed oils, pesticides, and environmental toxins is the "social determinants of health." These critics argue that focusing on dietary components or environmental factors misses the bigger picture—issues like poverty, education, housing, and access to healthcare are the primary drivers of health disparities, including obesity. They contend that without addressing these systemic issues, efforts to combat obesity through dietary changes or toxin reduction will have limited impact.

While it’s true that social determinants of health play a big role in shaping obesity risk, this argument often dismisses the importance of addressing dietary and environmental factors altogether. The reality is that both approaches are necessary. Systemic issues like poverty and food insecurity must be addressed, but so too must the quality of the food available in our environment. For example, even in communities with access to grocery stores, the prevalence of highly processed, hyper-palatable foods can undermine efforts to eat healthily. Similarly, exposure to endocrine-disrupting chemicals and other environmental toxins can exacerbate metabolic dysfunction, regardless of socioeconomic status. We can all be on the same team.

Stress and Mental Health

Chronic stress and mental health issues are increasingly recognized as contributors to obesity, in addition to stress’s role in raising cortisol like mentioned earlier. Stress can lead to emotional eating and disrupted sleep patterns, while mental health conditions may affect appetite regulation and food choices. The use of certain psychiatric medications can also promote weight gain, further complicating the relationship between mental health and obesity.

Intrauterine and Early Life Influences

Factors during pregnancy and early childhood may predispose individuals to obesity. Maternal obesity, diabetes, or smoking during pregnancy can increase offspring obesity risk, while rapid weight gain in infancy may program future metabolic patterns. Early exposure to antibiotics may also alter gut microbiome development, highlighting the importance of early life interventions in preventing obesity.

The Role of Modern Pharmacology

Given the complexity of the obesity epidemic, modern pharmacological interventions like Ozempic (semaglutide) and Tirzepatide offer solutions. These drugs, known as GLP-1 receptor agonists, work by reducing food drive and increasing feelings of satiety, making it easier for individuals to control their calorie intake.

Semaglutide, for instance, can lead to an average weight loss of 15.2% over 104 weeks, with 77.1% of participants achieving weight loss ≥5% from baseline. Tirzepatide has shown even more impressive results, with participants losing up to 22.5% of their body weight in clinical trials.

However, these medications are not without side effects. The most common adverse events are gastrointestinal in nature, including nausea, vomiting, diarrhea, and constipation. These side effects are typically mild to moderate and often subside over time. More serious but rare side effects include the risk of thyroid C-cell tumors, acute pancreatitis, and gallbladder problems. Despite these risks, the overall safety profile of these drugs is considered favorable, especially when weighed against the health risks associated with obesity.

Emerging treatments offer even more promise. Retatrutide*, a triple hormone receptor agonist, has shown remarkable results in early trials, with participants losing an average of 24.2% of their body weight over 48 weeks. Orforglipron, an oral GLP-1 receptor agonist, could provide a more convenient alternative to injectable medications, potentially improving patient adherence.

The risk-reward profile of these medications can be favorable for a large segment of the population struggling with their bodyweight. The side effects of obesity—ranging from diabetes to heart disease—are far worse than the potential side effects of these drugs. For individuals with high food drive who struggle to control their eating habits through diet and exercise alone, these medications can provide a solution.

I’ve listened to both sides of this debate since the introduction of this new class of drugs and, while I don’t love the idea of having to use drugs to deal with obesity, I do believe that they are useful tools in the right context. It took me awhile to come around to the idea there is more to the discussion than just people unable to keep their hand out of the cookie jar, and that obesity is at least partly a “neuro-hormonal disease.”

It’s important to note that those that choose to take these drugs engage in a weight training program and eat sufficient protein to prevent muscle loss which can occur in tandem with fat loss.

*If I was obese I would be taking Retatutride. I actually will likely microdose it sometime in the future, based on the findings and science discussed in this article and in other places, to improve body composition, metabolic health, and liver health.

The Importance of Conscientiousness

In addition to genetic and environmental factors, conscientiousness—a personality trait that influences an individual's ability to plan, organize, and delay gratification—plays a role in weight management. Those with high conscientiousness are more likely to make healthier food choices, stick to a diet, and maintain an exercise routine, even in the face of high food drive.

However, for individuals with low conscientiousness and high food drive, the obesogenic environment presents a significant challenge. While improving conscientiousness is important, it is not always sufficient to counteract the powerful combination of genetic predisposition and environmental factors. This is where pharmacological interventions can play a role, providing solutions for those who struggle to manage their weight through behavioral changes alone.

How Do We Move Forward?

To effectively address the obesity epidemic, we need to take a 360° approach that incorporates insights from many different perspectives. This includes:

1. Pharmacological Interventions: Utilizing drugs like Ozempic and Tirzepatide to reduce food drive and support weight loss when appropriate and when other solutions fail to produce results.

2. Behavioral Changes: Encouraging individuals to improve their conscientiousness and make healthier food choices.

3. Environmental Modifications: Reducing the availability and marketing of energy-dense, hyper-palatable foods, especially in certain settings like schools.

4. Metabolic Support: Addressing underlying metabolic dysfunction through dietary changes, such as reducing PUFAs and supporting thyroid health.

5. Gut Health: Promoting a healthy microbiome through diet and being cautious about too much antibiotic use.

6. Circadian Rhythm Optimization: Encouraging healthy sleep patterns, sunlight exposure, and reduced artificial light at night.

7. Early Life Interventions: Supporting maternal health and early childhood nutrition to reduce obesity risk.

8. Education and Support: Providing individuals with the knowledge and resources they need to manage their weight effectively.

Conclusion

Energy balance, genetic predisposition, environmental factors, metabolic health, and behavioral tendencies have all played their role in the obesity epidemic. While energy balance provides a useful framework, it doesn’t account for all the factors that influence weight gain. Genetic food drive, metabolic dysfunction, and the bioenergetic view remind us that obesity is not just about calories but also about hormonal balance, cellular energy, and environmental influences.

Combining these insights with alternative perspectives on environmental toxins, circadian rhythms, and gut health, we can develop a more holistic and effective approach to tackling this health challenge. Whether through tracking calories, optimizing metabolic rate, or using pharmacological support, the goal is to find a strategy that works for the individual—because there’s no one-size-fits-all solution to obesity.

If you are looking to lose weight and are unsure of the best way for you individually to move forward, I’m happy to throw some guidance your way. Just reply to this email.

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