A fat inheritance

There are an increasing number of studies which point out to the link between obesity and genetics. This has given rise to the debate of nature vs nurture. We asked bariatric experts to shed light on the matter.

Expert speak

There are genes which are related to obesity and can increase the chances of being overweight. On one hand, there are certain syndromes through which genes can cause obesity directly and on the other hand, some people have genes but might not necessarily lead to obesity. Although it might be in the genes that a person can become obese it is not necessary that every person with genetic factors will become obese, says Dr Manish Motwani, Bariatric Surgeon, Aastha Healthcare. “It is said that genetics loads the gun, but environmental factors pulls the trigger. Thus, the main factor that causes obesity is lifestyle and the genes only initiates their response towards obesity,” he says.

Dr Ramen Goel, Senior Bariatric Surgeon and Director - Center of Bariatric and Metabolic Surgery, Wockhardt Hospitals, says that there are 18 types of genes that contribute to obesity however, it’s difficult to point out them out individually. Obesity is an inherited disease, it’s next to impossible to identify which genes in an individual are the cause of it. Very rarely in the case of monogenic obesity or syndromic obesity, which occurs like one in a lakh, it’s possible to identify which genes responsible for obesity. But you can’t pinpoint it for obesity alone, it’s for a combination of two to three things like mental retardation, thyroid issue, overall limitations. Syndromic obesity is very rare and can be identified clinically through genetic testing. And genetic testing is required when only clinically a syndrome is suspected. 

Dr Jayashree Todkar, Secretary, Obesity Surgery Society of India (OSSI) and Convener of Fight Obesity task force with Maharashtra Government, says that obesity consists of three major circles that intersect namely, genetic (smallest), environmental factors (medium) and metabolic (largest). Genetics gives exposure to predisposition to the storage diseases caused by metabolic problems, which are obesity and diabetes. Environmental factors include food habits and lifestyle, which can be controlled. Metabolism is energy utilisation of the body, if that goes wrong it may lead to chemical disorder and further obesity.

Due to scientific advancement, obesity in early phases can be treated medication but in later phases when the struggle becomes more, there’s no treatment and bariatric surgery comes as an effective tool to combat obesity.

What research says

Modern scientific research tells us that 60 per cent of obesity is due to genetic causes and 40 per cent is due to lifestyle reasons. What do our bariatric experts have to say on this? Dr Goel strongly agrees with this saying “Around 80 per cent of patients who opt for bariatric surgery, they eat small normal meals and not excessive junk. Whereas people who have a tendency to remain thin, eat a lot. It’s all predetermined.” He further adds that unofficially it is an accepted conclusion that the battle of the bulge has already been lost. There is too much emphasis on lifestyle modification, which has not resulted in substantial weight loss. The FDA in the US is rapidly accepting medicine as a way to treat obesity.

Dr Todkar believes that 60 per cent of obesity is related to metabolism and bariatric surgery is a fantastic tool which can improve metabolism and treat obesity. However, there are criterias to be considered for eligibility for bariatric surgery: first, when the BMI of a person goes above 37.5; second, a patient with a BMI of above 32.5 with obesity-related diseases like diabetes, fatty liver disease, etc, and thirdly, despite multiple attempts one above BMI of 30 is unable to shed weight, can be evaluated by a panel of bariatric experts.

Weight loss struggles

“In my opinion, those with tendency to gain weight will have to undertake extraordinary efforts to not gain further weight. And therefore, maintaining of weight should start very early on in life. It’s better that families in which obesity is common should ensure that their children’s weight is maintained early on than have them struggle with it for the rest of their lives,” advises Dr Goel.

Fat shaming is a crime

Obesity is the root cause of major medical problems. There are various diseases that are caused due to obesity like cancer, diabetes, high blood pressure and many more. Dr Motwani says, “Almost 70 per cent diabetics are obese and approximately 60 per cent of patients with high blood pressure are obese. So, if someone does fat shaming, it is a sign of poor mentality. In fact, we should go out of the way to help the person who is suffering from a disease like obesity and assist them in getting rid of it.”

Dr Goel vehemently criticises fat-shaming. “Fat shaming is a crime and immoral in any case. Just because the diagnosis is written on one’s body doesn’t give others to pinpoint fingers at people who are obese. Thin/ skinny people who assume that fat shaming fat people will improve their condition are wrong. Fat shaming works on the contrary, putting the person in a vortex of obesity, depression and further obesity.”

Indians and obesity

“Firstly, Indians have a genetic predisposition to obesity. In earlier times, we weren’t economically sound and many people wouldn’t have proper two square meals a day. But with economic progress coupled with genetic disposition to obesity, is what’s causing obesity to reach epidemic levels. Secondly, Indians eat a lot of carbs in their diet and very less protein. Also, rich fatty foods are seen as a sign of wealth and affluence,” says Dr Goel.