Chapter Sixteen PARADOXES

Question 1

What does Artemus Ward’s quote suggest about obesity research?

Answer 1

It highlights the confusion and conflicting reports surrounding obesity research

This reflects the complexity and lack of consensus in understanding obesity.

Question 2

What is the paradox of obesity discussed in the text?

Answer 2

Despite knowing that obesity results from a positive energy balance, many individuals continue to overeat or remain sedentary

This raises questions about the motivations and biological factors influencing weight management.

Question 3

According to Marian Burros, what is the immutable scientific message about weight gain?

Answer 3

Those who consume more calories than they expend will gain weight

This is based on the laws of thermodynamics.

Question 4

How did Albert Stunkard describe obesity?

Answer 4

As a chronic condition resistant to treatment, prone to relapse, for which there is no cure

This emphasizes the complexity of obesity as a medical issue.

Question 5

What were the two hypotheses proposed by Jules Hirsch regarding obesity?

Answer 5

• Obesity is a result of willful self-gratification
• Obesity may have a biologic basis involving hormones or other biochemical systems

Hirsch argued that the lack of identified biological abnormalities led to viewing obesity as a judgment error.

Question 6

What does the text suggest about the role of sex hormones in fat deposition?

Answer 6

Sex hormones influence fat storage, with men storing fat above the waist and women storing it below

This indicates a biological aspect to weight gain beyond dietary habits.

Question 7

What did Hilde Bruch note about the inheritance of body types?

Answer 7

Fatness runs in families and is characterized by similar body shapes, akin to facial resemblance

This suggests a genetic component to body weight.

Question 8

How significant is the genetic factor in obesity according to Jeffrey Friedman?

Answer 8

It is equivalent to that of height and greater than that of almost every other studied condition

This indicates that genetics plays a crucial role in individual differences in body weight.

Question 9

What was Jerome Knittle’s finding about infants born to diabetic mothers?

Answer 9

They are heavier at birth and have a higher rate of subsequent obesity compared to infants of non-diabetic mothers

This suggests a potential metabolic predisposition to obesity.

Question 10

What concept did William Sheldon introduce regarding body types?

Answer 10

He categorized human bodies into three types: ectomorphs, mesomorphs, and endomorphs

This classification reflects different physical characteristics and predispositions to weight gain.

Question 11

What did the studies by Ethan Sims reveal about individual differences in weight gain?

Answer 11

Marked differences existed among individuals in their ability to gain weight despite similar caloric intake

This highlights the variability in metabolic responses to overeating.

Question 12

What did Claude Bouchard’s study with identical twins suggest about obesity?

Answer 12

Genetic factors are involved in the tendency to gain weight and fat

This supports the idea that genetics plays a role in obesity.

Question 13

What did Jean Mayer observe about obese mice when starved?

Answer 13

They could be reduced in weight but still contained more fat than normal mice

This illustrates that metabolic factors contribute to obesity beyond mere caloric intake.

Question 14

What is the historical context of obesity treatments mentioned in the text?

Answer 14

Obesity was historically treated with various unscientific methods, including extreme measures like bleeding and leeches

This reflects the evolving understanding of obesity as a complex condition.

Question 15

What was the impact of calorimetry on the understanding of obesity?

Answer 15

Calorimetry allowed for the measurement of energy expenditure and the relationship between food caloric content and energy used

This was crucial in developing modern nutrition science.

Question 16

What did Wilbur Atwater note about the advancements in nutrition science?

Answer 16

The amount of information gained in a short time by German chemists regarding metabolism and nutrition was remarkable

This highlights the rapid progress in understanding the science of nutrition.

Question 17

Who were the legendary German chemists involved in early metabolism and nutrition science?

Answer 17

Justus von Liebig, Max von Pettenkofer, Carl von Voit, Max Rubner

These chemists contributed significantly to understanding how organisms process macronutrients.

Question 18

What discovery did Max Rubner make regarding calories in macronutrients?

Answer 18

Fat has more than twice as many calories per gram as protein or carbohydrates

Rubner’s findings are foundational in understanding energy content in foods.

Question 19

What is the isodynamic law as proposed by Rubner?

Answer 19

A calorie is a calorie

This means that a calorie from protein provides the same energy as a calorie from fat or carbohydrates, although their metabolic effects differ.

Question 20

What does the law of conservation of energy state in relation to living organisms?

Answer 20

Calories consumed are either burned, stored, or excreted

This principle was confirmed by researchers like Rubner, Benedict, and Atwater.

Question 21

What are the three hypotheses proposed by Carl von Noorden regarding the cause of obesity?

Answer 21

• Diabetogenous obesity
• Exogenous obesity
• Endogenous obesity

These hypotheses have influenced obesity research for over a century.

Question 22

What is exogenous obesity according to von Noorden?

Answer 22

Obesity caused by an immoderate lifestyle driven by external factors

This suggests that overeating and lack of exercise are primary causes.

Question 23

What is endogenous obesity as defined by von Noorden?

Answer 23

Obesity caused by internal factors, regardless of lifestyle

This implies a genetic or metabolic predisposition to gain weight.

Question 24

What did Nathan Zuntz develop in 1892 that contributed to obesity research?

Answer 24

A portable device to measure oxygen consumption and carbon-dioxide respiration

This advancement allowed for indirect calculations of energy expenditure.

Question 25

What was the focus of Adolf Magnus-Levy's work in obesity research?

Answer 25

Measurement of basal metabolism at the hospital bedside ## Footnote This helped refine calorimetric technology for studying metabolism.

Question 26

What did Francis Benedict's 1915 studies reveal about energy expenditure?

Answer 26

There were huge variations in daily energy expenditure among individuals of equal weight ## Footnote This suggests that metabolic rates can differ significantly among individuals.

Question 27

What was Hilde Bruch's main conclusion regarding childhood obesity?

Answer 27

Excessive eating and avoidance of muscular exercise are key factors ## Footnote Her research highlighted psychological influences, particularly in the mother-child relationship.

Question 28

What was Louis Newburgh's stance on the causes of obesity?

Answer 28

He believed obesity was primarily due to a 'perverted appetite' and overconsumption of food ## Footnote Newburgh's views shaped the treatment of obesity in the post-World War II era.

Question 29

What did Newburgh argue regarding the role of endocrine disorders in obesity?

Answer 29

He rejected the notion that endocrine disorders were significant causes of obesity ## Footnote He emphasized that most obese individuals had normal thyroid function.

Question 30

What did Marian Burros state about the relationship between calories in and calories out?

Answer 30

It is a tautology based on the law of energy conservation ## Footnote This means the concept is inherently true but does not explain the underlying causes of obesity.

Question 31

What is the significant flaw in the statement that obesity is due to an imbalance of energy intake and output?

Answer 31

It does not explain what causes the imbalance ## Footnote Understanding the causes is crucial for addressing obesity effectively.

Question 32

What is overeating?

Answer 32

The consumption of more calories than are expended.

Question 33

Why is the statement that obesity is caused by an imbalance between energy intake and output considered a tautology?

Answer 33

It is implied by the law of energy conservation.

Question 34

What did von Noorden propose as the cause of the imbalance leading to obesity?

Answer 34

Overeating and deficient physical exercise.

Question 35

How are the terms 'overeating' and 'deficient physical exercise' applied?

Answer 35

Only to the overweight and obese.

Question 36

What is the implication of defining overeating for someone who is fat?

Answer 36

If someone is fat, then they have overeaten by definition.

Question 37

What analogy is used to illustrate the tautological nature of obesity explanations?

Answer 37

Saying 'alcoholism is caused by chronic overdrinking'.

Question 38

What question does the obesity research community often overlook?

Answer 38

Why isn't intake adjusted downward to match expenditure?

Question 39

What is the common behavior of overweight or obese individuals regarding weight gain?

Answer 39

They gain weight over long periods and then stabilize at a higher-than-ideal weight.

Question 40

What did Hugo Rony describe regarding caloric equilibrium in obese individuals?

Answer 40

An obese person maintaining weight at a high level is in caloric equilibrium, similar to a normal-weight person.

Question 41

What do studies show about the food intake of obese individuals compared to lean individuals?

Answer 41

Fat people, on average, eat no more than lean people.

Question 42

What did Durnin and Passmore conclude about the eating habits of obese individuals?

Answer 42

Fat people are not necessarily gluttons; some are truly abstemious.

Question 43

What paradox did James Boswell and Samuel Johnson discuss regarding obesity?

Answer 43

One man can be fat while eating moderately, and another can be lean while eating a lot.

Question 44

What is a significant question raised by the overeating hypothesis?

Answer 44

Why do people overeat or why are they sedentary if it leads to obesity?

Question 45

What is the implication of saying that the obese are less active than they should be?

Answer 45

It implies a judgment about personal willpower.

Question 46

What happens to the weight loss of obese individuals on semi-starvation diets?

Answer 46

Weight loss often stops or reverses itself.

Question 47

What does the phenomenon of bariatric surgery reveal about obesity?

Answer 47

It suggests a metabolic difference in morbidly obese individuals.

Question 48

What does Susan Sontag suggest about diseases caused by mental states?

Answer 48

They indicate a lack of understanding about the physical terrain of a disease.

Question 49

What did von Noorden suggest about the unnoticed gain of weight?

Answer 49

Weight is gained so imperceptibly that it goes unnoticed.

Question 50

What does Kelly Brownell suggest is a cause of the obesity epidemic?

Answer 50

A toxic food environment.

Question 51

What does Russell Wilder question regarding the toxic food environment?

Answer 51

Why do not all individuals become obese in this environment?

Question 52

What did Albert Stunkard argue about the overeating hypothesis?

Answer 52

It went astray by concluding that all obesity comes from overeating.

Question 53

Fill in the blank: The hypothesis that obesity is caused by the behavior of overeating implies a _______.

Answer 53

[character defect]

Question 54

What did Stunkard argue about the traditional view of obesity?

Answer 54

Stunkard argued that the view that 'excessive body fat results from an excess of caloric intake over caloric expenditure' misguides obesity research.

Question 55

How did Stunkard describe the physician's role in treating obesity?

Answer 55

He described it as merely explaining that 'semi-starvation reduces fat stores' and prescribing diets, waiting for results.

Question 56

What criticism did Mayer have regarding the cause of obesity?

Answer 56

Mayer criticized the notion that obesity is solely caused by overeating, stating it oversimplifies the issue.

Question 57

What did Mayer insist was a significant factor in obesity?

Answer 57

Mayer insisted that sedentary behavior, rather than gluttony, played a significant role in obesity.

Question 58

What did Stunkard believe about the treatment of obesity?

Answer 58

Stunkard believed that behavioral therapy could help obese patients endure semi-starvation without feeling judged.

Question 59

What was the popular theory regarding eating behavior in the 1970s?

Answer 59

The theory suggested that obese individuals eat too fast and are overly responsive to external cues to eat.

Question 60

True or False: Obesity was categorized as an eating disorder by the 1970s.

Answer 60

True

Question 61

What did Ravussin's research on the Pima suggest about obesity?

Answer 61

Ravussin's research suggested that Pima men who gained weight had a lower basal metabolic rate before weight gain.

Question 62

What did Hilde Bruch contribute to the understanding of childhood obesity?

Answer 62

Bruch initiated a 'revolution in thinking' about childhood obesity, investigating the inner compulsions of obese individuals.

Question 63

What was Bruch's primary conclusion regarding the cause of obesity?

Answer 63

Bruch concluded that obesity's primary cause is metabolic or hormonal, not solely behavioral.

Question 64

Fill in the blank: Bruch's research highlighted that _______ is a symptom of an underlying disturbance in obesity.

Answer 64

overeating

Question 65

What did Bruch observe about the permanence of weight loss in obese patients?

Answer 65

Bruch noted that weight loss was often short-lived and patients would regain weight quickly.

Question 66

What did Ravussin question about behavioral therapies for obesity?

Answer 66

He questioned their efficacy, pointing to the high rate of recidivism among obese patients after weight loss.

Question 67

What does the positive-caloric-balance hypothesis imply about obesity?

Answer 67

It implies that obesity is a result of consuming more calories than expended, neglecting other factors.

Question 68

What did Bruch's 1973 publication focus on regarding obesity?

Answer 68

It focused on the interpersonal and familial relationships contributing to obesity and dietary failure.

Question 69

What is a significant challenge in studying obesity according to Bruch?

Answer 69

A significant challenge is distinguishing between causes and effects in obesity development.

Question 70

What did the New York Times headline in 1974 suggest about obese Americans?

Answer 70

'Fat Americans: They Don’t Know When They’re Hungry, They Don’t Know When They’re Full.'

Question 71

What is the implication of the circular reasoning observed by von Noorden?

Answer 71

It suggests that diagnosing a retarded metabolism is based on the failure of weight control rather than clear evidence.

Question 72

True or False: Bruch believed that calorie restriction alone could effectively treat obesity.

Answer 72

False