The stigma attached to obesity has been an accepted practice of American society for a long time.

Heck, even those who should know better often embrace the simplistic thinking that obesity is merely the result of an individual’s lack of willpower.

But research is increasingly revealing that the obesity stigma is misplaced and counterproductive. Michelle Berman, MD noted this awhile back in this post on KevinMD.com:

Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease?

The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine.

There is also substantial evidence that some people lose control over their food consumption and exhibit other behaviors (e.g. tolerance, withdrawal)  that may meet diagnostic criteria  .   .   . for substance dependence.

Arya Sharma, MD picks up on this line of thinking in this recent KevinMD.com post:

Recently, I attended a scientific symposium on addictions. One of the books I picked up at that conference  .   .   .  is A. J. Adams’ “Undrunk: A Skeptic’s Guide to AA”. [.  .  .] The definition [of alcoholism] reads as follows:

Alcoholism is a primary chronic disease with genetic, psycho-social and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol despite adverse consequences and distortions of thinking, mostly denial.

Let us look at this definition of alcoholism and see what aspects of it (if any) apply to obesity.No doubt, as readers of these pages know, obesity is most definitely a chronic condition, whose development and manifestations are influenced by genetic, psycho-social and environmental factors. In some cases obesity may be more genetic, in others more psycho-social and sometimes purely environmental, but certainly, obesity would fit the bill as far as this statement goes.And yes, obesity is often progressive and fatal. [.   .  .]This may not seem as obvious as in the case of the alcoholic who dies of liver cirrhosis or totals his car (and himself) whilst DIU, but when you start looking at the many ways in which obesity can kill you, from heart attacks to cancer, there is no doubt that obesity is fatal (often after ruining most of your life first – another similarity to alcoholism).

Clear Thinkers favorite Art De Vany does an excellent job of explaining the physiological underpinnings of overeating in his recent book, The New Evolution Diet: What Our Paleolithic Ancestors Can Teach Us About Weight Loss, Fitness and Aging (Rodale 2010). The following oversimplifies De Vany’s explanation, so definitely read the book if you are interested in this subject.

But the essence of De Vany’s point is that the brain needs glucose – generally supplied by carbohydrates or body fat – in order to live and thrive. Thus, the brain signals that it needs more glucose, which triggers our desire to eat carbohydrate or for the body to use body fat to fulfill that need. The body (specifically the pancreas) generates insulin to absorb the ingested glucose into the bloodstream.

So far, so good. However, DeVany explains that most people who become obese fall into a sort of negative feedback loop in which they become insulin and leptin insensitive (leptin is a hormone that signals to the brain that hunger has been satisfied).

This is bad for a variety of reasons (inflammation on a cellular level, etc), but it is particularly damaging in regard to obesity – the body ends up generating excess insulin, which it stores as fat, and the brain becomes desensitized to leptin, which makes it much more difficult to satiate hunger.

Thus, insulin and leptin insensitivity cause a negative feedback loop in which the consumer becomes conditioned to being continually hungry (the brain is constantly hungry and signaling that it needs glucose), the consumer eats high-calorie, processed (and readily available) carbohydrate to fulfill that hunger, the body produces more insulin that it needs to absorb the glucose, the body stores the excess insulin as fat, the body rarely uses body fat to fuel the brain, and then the process starts all over again, partly because of the consumer’s increasingly insulin and leptin insensitive nature.

In short, willpower really doesn’t have that much to do with it. Physiological impulses do.

Stated simply, it’s hard to lose weight if you are always hungry.

As De Vany explains in his book, the solution to this obesity syndrome is to become insulin and leptin sensitive – and, thus, fat adaptive – through eating lean meats, vegetables and fruits and avoiding calorie-laden processed foods, as well as exercise and recreation that promote maintenance of lean body mass. Toss in some intermittent fasting (12-16 hours of no food, most of which occurs during sleep) a few times a week to help control cellular inflammation and you have the blueprint for a healthy lifestyle.

However, the more important message that DeVany delivers is that the social stigma attached to obesity is inhumane and counterproductive. That stigma drives obese people to “quick fixes” such as fad diets and excessive exercise routines, both of which rarely result in sustained weight loss.

Rather, the key to overcoming the compulsion toward high caloric food is to educate the consumer to understand the physiological underpinnings that drive the consumer’s compulsion and then to address those physiological issues.

In short, less stigma and better education equals less obesity and better health.

Sounds like a good trade to me.