Obesity is (mostly) a Hormonal Issue: Let's Stop Pretending it's Solely About Calories

When doctors or nutritionists see someone with gigantism or acromegaly, is their first thought, “Clearly, that person just needs to grow less and shrink more”? No. Obviously not. Because it is clear—like, crystal clear, beyond-the-shadow-of-a-doubt, smack-you-upside-the-head clear that these conditions result from hormonal irregularities. You can no more control what results from the hormonal effects of a pituitary tumor hemorrhaging human growth hormone than you can control what results from the hormonal effects of a fourteen year old boy who found a special magazine hidden away in his dad’s nightstand. (Do kids still do that these days, or do they just find it on the interwebz instead?)

People with gigantism or acromegaly aren’t abnormally tall or large because they want to be, or because they somehow willed themselves to be. They are at the mercy of hormones. Like I said, to anyone with half a brain, this is obvious. No one questions this. No one blames these individuals for needing custom-made clothing or other accommodations. No one says, “Well, if they had just not grown so much…if only they hadn’t let themselves get so tall, they wouldn’t be in this situation.” “They'd be fine if they were just less tall and more short.” No one says idiotic things like this because people understand that this is not within someone’s control.

So why, then, when it comes to the outward, rather than upward, expansion of the human body, does it all of a sudden become about willpower, discipline, and “calories?” Why is not more widely recognized that the horizontal growth of the body results from hormonal irregularities just as the vertical expansion does?

Why do so few people get this?

"Calories Out" -- A Rant

I don’t like that I post so many rants, but what can I say? The nutrition world gives me lots to rant about. Lots. And if I may say, many of the emails I get from you, my beloved readers, specifically mention how much you enjoy my sass and snark. So, if sass and snark are what ye seek, then sass and snark are what ye shall receive! Especially when it comes to today’s topic.

I’ve written before about the complete and utter crapstorm that is the very concept of “calories.” (That post is from April 2014. I’ve acquired a lot of new readers since then, so if you’ve never read that one, do click on over and give it a whirl. It’s a good one, if I do say so myself.) 

Okay, so, calories.

When it comes to losing weight fat loss, we’ve heard over and over again that it comes down to one thing: calories in, calories out (CICO). (Or is that two things?) Or, rather, it comes down to weight loss reduced adiposity being the result when someone takes in fewer calories than they burn. People are so stubbornly wedded to this idea that “Woo” famously calls them CICOpaths, CICOphants, or CICOtards. (With apologies to the reader who took me to task for my “Don’t Be a Ketard” series title, which has been renamed “Being Fat Adapted Versus ‘In Ketosis.’”)

As you know, I try to be careful about how I phrase things. (Case in point: the crossed out stuff in the preceding paragraph.) Part of this comes from me being an English major and language nerd, and part of it comes from knowing that when we phrase things incorrectly, they may not even be relevant. For example, I try to say “accumulate adipose tissue” more often than I say “gain weight.” Because gaining weight and accumulating adipose are not the same thing. If you gain weight, that might be water, muscle, bone, or, for the truly crunchy/hippie among you, a pounds’ worth of leg and armpit hair. And I try to say lose body fat rather than lose weight, because you can lose water, muscle, bone, etc., and when the vast majority of us talk about “weight loss,” what we really mean—and what we really want—is fat loss.

The reason why I’m such a stickler for saying things a certain way is because saying them more precisely/accurately helps us frame discussions in a certain light. And the reason why I’m explaining to you why I’m such a stickler is because we are going to frame today’s discussion in a certain light. One that I don’t think gets anywhere near enough attention in the nutrition and health world (except from me). As far as I can tell, I am one of the only people writing about this particular thing in this particular way. (If I’m wrong, tell me in the comments and share links to relevant stuff you find.)

What the heck am I talking about? What is the point that’s taking me so much prep work and blathering to get to?