What do babies and smoke detectors have to do with treating obesity?

Walk through this scenario with me:  There’s a tired screaming baby in an apartment.  There’s a woman trying to get the baby to stop screaming. The woman is (understandably) distressed about the baby’s screaming.  Occasionally, she can get the baby to stop screaming for a minute or so by giving her a bottle or rocking her, but after a brief moment the baby starts right up again.  Terrible, right?  Here’s the problem.  Although the woman is working hard to soothe the distressed baby, she hasn’t stopped to think about why the baby is screaming.  If she did, she might realize that the baby is screaming because the apartment’s smoke detectors are beeping and beeping and beeping – very loudly and repetitively and this awful ruckus is preventing the tired baby from being able to take her nap.  Let’s say the woman eventually realizes the source of the baby’s distress and she starts trying to silence the smoke detectors.  She grabs a stepstool and goes from room to room, pushing the silence buttons.  This works briefly, but by the time she gets to the last one, the first one is wailing away again.  And the baby is still crying.  She throws up her hands in frustration.  At this point, it might be obvious to you, but give the poor woman a chance to go there too!  To truly solve the problem, the woman needs to dig deeper and figure out why the smoke detectors are beeping. When she does this, she realizes that the smoke detectors are wailing away because there is something burning in the oven and smoke is accumulating on the ceiling.   Now she can do something!  If she gets the charred dinner out onto the patio and gets some windows opened, the smoke will begin to clear. Once that happens, the smoke detectors will stop wailing.  Once the smoke detectors stop wailing, it will be much easier to soothe the distressed baby and the ultimate goal (of getting the baby to stop screaming and go to sleep) will be much easier to accomplish.  It might not happen instantaneously, but it’s effective – certainly more effective than just repeatedly trying the bottle and the rocking and the shushing.  

Treating obesity by counting calories is like trying to soothe a crying baby. Semi-effective every once in a while (for a brief period of time) but not effective long-term.  Why?  Because it isn’t addressing the underlying problem.  We have been calorie counting for over a hundred years and all of this effort has done nothing to make a dent in this obesity epidemic. We have come up with lots of ways to work on our counting skills – apps and spreadsheets and labels and points.  We’ve spent a lot of time, energy, and money trying to figure out how to motivate people to count better.  Yet, despite our efforts, the rates of overweight and obesity keep getting worse – year after year.

Recognizing this, a lot of institutions and people have made the shift to treating things like emotional eating and food cravings and boredom eating.  Not a terrible idea – better than more rocking and shushing, right?  This concept is like attacking the beeping smoke detectors – putting energy toward fixing the obvious things that are contributing to the problem.  Unfortunately, as much as seems more productive, it’s still not enough.  Despite working on these issues, we still aren’t moving the needle on the obesity epidemic.  Why?  Because things like emotional eating and out-of-control eating are ultimately symptoms of a bigger problem. They were created in response to something else and pushing the silence button on them doesn’t work long-term.  

So, what is the ultimate driver?  What is creating the smoke that is causing the smoke detectors to wail?  For the great majority of us, the source of the problem is metabolic dysfunction.  Metabolic dysfunction that is the result of the shift in our food environment.  Our food environment has shifted dramatically in the past 60 years – from a system of whole foods, mostly made in kitchens to a food system primarily made up of ultra-processed foods that are made in a factory and warmed up in a kitchen or, even easier, edible without the need for a kitchen!  Our macronutrients have shifted slightly, which is probably part of the problem, but the bigger problem is what foods are being eaten within each macronutrient category.  

We have to start working on getting rid of the mess in the kitchen and clearing out the smoke.  We have to work on the quality of our food.  Then we can effectively address the smoke detector racket and eventually get that poor baby calmed down.  This is where a lot of doctors in the field of Obesity Medicine are doing. We are working upstream of the crying.  Sometimes it’s not very obvious – after all, there are lots of people out there claiming they can calm a screaming baby – and those hacks (even if they only work for a second) seem to be magical and effective – and they are a lot easier to sell than the difficult process of removing the disaster from the oven and opening the windows.  In the long game, however, they are essentially wasted effort.  

Shifting our food environment back to something that our bodies can tolerate – a pattern of eating that does not result in metabolic dysfunction will stop the smoke.  It’s not sexy or fast or simple – and for a lot of people, it’s a lot of hard work.  And it takes time to get all the smoke out.  But that’s how we start turning the tide.  The smoke detector might keep beeping for a while. The baby might keep crying for a while. But once the smoke is cleared, we can start working on the beeping (the dysfunctional relationships we have with food) and fixing those will allow us to effectively soothe the baby (get the weight off).  

Let me know what you think about this analogy.  When I lecture to residents and medical students and medical groups, I talk about this in terms of laws of thermodynamics and energy storage and hormonal triggers.  However, when I bring it up outside of academia, people’s eyes tend to glaze over, and I lose them.  I want to find a way to help everyone understand the underlying problem and why we have to think outside the box in terms of treatment.  Until we understand cause and effect, we will keep spinning our wheels trying to treat the effect – wasting precious time and energy!

Until next time…

Courtney Younglove, M.D.

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