Reply #31: I had a doctor tell me that diabetes was less of an on / off

[KurtNYC]

condition and more of a range of impairment. He really described the disease in a different way than I had heard it described elsewhere. He said that anyone who is more than 30 pounds overweight is in an insulin-resistant state. My father was diagnosed as borderline diabetic and he avoided medication with diet and exercise. So your story is one more for that collection.

But I also wanted to share something else with you. There are people with metabolic issues which lead to weight gain inspite of very low calorie intake:

One of Atkinson’s most memorable patients was Janet S., a bright, funny 25-year-old who weighed 348 pounds when she finally made her way to U.C.L.A. in 1975. In exchange for agreeing to be hospitalized for three months so scientists could study them, Janet and the other obese research subjects (30 in all) each received a free intestinal bypass. During the three months of presurgical study, the dietitian on the research team calculated how many calories it should take for a 5-foot-6-inch woman like Janet to maintain a weight of 348. They fed her exactly that many calories — no more, no less. She dutifully ate what she was told, and she gained 12 pounds in two weeks — almost a pound a day.

“I don’t think I’d ever gained that much weight that quickly,” recalled Janet, who asked me not to use her full name because she didn’t want people to know how fat she had once been. The doctors accused her of sneaking snacks into the hospital. “But I told them, ‘I’m gaining weight because you’re feeding me a tremendous amount of food!’ ”

The experience with Janet was an early inkling that traditional ideas about obesity were incomplete. Researchers and public-health officials have long understood that to maintain a given weight, energy in (calories consumed) must equal energy out (calories expended). But then they learned that genes were important, too, and that for some people, like Janet, this formula was tilted in a direction that led to weight gain. Since the discovery of the first obesity gene in 1994, scientists have found about 50 genes involved in obesity. Some of them determine how individuals lay down fat and metabolize energy stores. Others regulate how much people want to eat in the first place, how they know when they’ve had enough and how likely they are to use up calories through activities ranging from fidgeting to running marathons. People like Janet, who can get fat on very little fuel, may be genetically programmed to survive in harsher environments. When the human species got its start, it was an advantage to be efficient. Today, when food is plentiful, it is a hazard.

http://www.nytimes.com/2006/08/13/magazine/13obesity.html?ex=1156305600&en=dad82cae64682d3a&ei=5070

That article goes on to talk at length about viral theories. But what is clear so far is that there are people who are far less able to influence their body size due to factors we are only beginning to understand.