April 22, 1929
Physician Louis Newburgh argues that obesity is indeed caused by eating too much--"a perverted appetite" or a "lessened outflow of energy" and transformed a physiological disorder into a character flaw.
The Nature of Obesity
THE NATURE OF OBESITY
L. H. NEWBURGH AND MARGARET WOODWELL JOHNSTON
(From the Department of Internal Medicine, Medical School, University of Mickigan, Ann Arbor) (Received for publication April 22, 1929)
The medical profession in general, believes that there are two kinds of obese persons-those who have become fat because they overeat or under-exercise; and those composing a second group whose adiposity is not closely related to diet, but is caused by an endocrine or constitutional abnormality. The first apparently scientific support of the hypothesis that obesity was often of endogenous origin, came with the finding that some obese persons had an abnormally low basal metabolic rate, on the basis of body weight. When, however, it was shown that the expenditure of energy is proportional to the surface area and not the weight, it was found that most such persons have a normal basal metabolic rate. However, it is true that there remains a small group of fat people whose basal rate is definitely low. Later writers maintained that a common cause of endogenous obesity was to be found in a lessened specific dynamic response to food. But the increase in metabolic rate caused by food is relatively small, so that a method possessed of a high degree of accuracy is needed in order to deal quantitatively with this phenomenon. Our prolonged study of this question has convinced us that the inherent error in the method to date, when it is applied to the human subject, is such that it precludes the possibility of making quantitative statements regarding the specific dynamic response to food in man. Other writers have attributed endogenous obesity to a constitutional anomaly of the cells which somehow lowers the rate of intracellular oxidations.
These considerations lead to the conclusion that the fundamental cause of endogenous obesity is not to be found in some type of metabolic abberation; but rather, that these individuals, in common with all obese persons, are the victims of a perverted appetite. In normal people there is a mechanism that maintains an accurate balance between the outgo and the income of energy. All obese persons are, alike in one fundamental respect,-they literally overeat.
The unspoken proposition is that if researchers could only figure out how to induce those of us who eat too much to rein it in, curb our out-of-control appetites, eat smaller portions, and refrain from reaching for the doughnuts, we’d lose weight or not fatten to begin with. This, again, evokes implicit judgments about why we might fail should we have the misfortune to remain fat. It’s not a failure in our bodies, not some hormonal or physiological phenomenon, that’s drove us (but not our lean friends or siblings) to amass fat. Rather it’s some behavioral quirk, whether moral turpitude, lack of willpower, lack of vigilance, or the sin of gluttony and/or sloth. That’s why we’re still fat. It’s not the expert advice or thinking that’s misguided. It’s us. This blame-the-fat-person, look-who’s-reaching-for-the-doughnuts thinking, the moral judgments and fat shaming, has always been embedded within this idea that obesity is caused ultimately by overeating. Here’s one of the many areas in this controversy in which it helps to know the history. This fat-shaming implication was institutionalized as far back as the 1930s by the University of Michigan physician Louis Newburgh, who was largely responsible for convincing decades of physicians and obesity researchers that obesity is indeed caused by eating too much—“a perverted appetite” or a “lessened outflow of energy,” as he put it—and not by some hormonal or physiological defect. Obesity, he and his colleague Margaret Woodwell Johnston wrote in 1930, is “always caused by an overabundant inflow of energy.” The cause is never an “endocrine disturbance”—that is, hormones—that would manifest itself as a tendency to store calories as fat rather than burn those calories as fuel. By Newburgh’s dictate, the cause is always some form of eating too much. This left open, though, the obvious question: What causes this overabundance? Or, rather, why don’t fat people voluntarily curb their appetites, curb the overabundant inflow, and not get fat? Is it only a question of willpower? This too requires an explanation (just as the NIH authority in Nutrition Action still has to explain why some of us eat too much in this food-rich environment and others don’t). Hence Newburgh, and all those who have come after him, transformed a physiological disorder into a character flaw. The overabundant inflow, said Newburgh, is the result of “various human weaknesses such as over-indulgence and ignorance.” My suspicion, and I hope I’m not doing the man a disservice when he’s no longer around to take offense, is that Newburgh’s thinking was strongly influenced by the fact that he appears to have been pencil thin. Even in cases that seemed obviously hormonal—the pounds of fat often gained by women, for instance, when they pass through menopause or after a hysterectomy, the surgical removal of the uterus—Newburgh refused to concede an explanation other than overindulgence and weakness. Endocrinologists who studied this “well known” phenomenon in animals had concluded by the late 1920s that a critical role for female sex hormones—particularly estrogen—in the process of fat accumulation was implied. Secrete less estrogen, as women do during this phase of their lives or after a hysterectomy, and fat will accumulate. It happens to female animals. Maybe it should be no surprise it happens to female humans, too. So this, at least, must be hormonal. Not so, insisted Newburgh. It’s all eating too much: “Probably she [the woman getting fatter as she goes through menopause] does not know or is but dimly aware that the candies she nibbles at the bridge parties which she so enjoys now that she is rested are adding their quota to her girth.” Very scientific, that.
Gary Taubes. The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating (Kindle Locations 635-640). Knopf. Kindle Edition.