It is New Years Day, and around the world millions of over-weight people are making the resolution to lose weight. Popular culture harasses us with the myth that our weight is caused by our weak will power, if only we would eat less and exercise more then we would be skinny and beautiful like the good people.
The good news to the overweight is that you are not fat because you have weak will power. Your will power is no different from that of anyone else. The despicable treatment you receive from society is scientifically and statistically not your fault. The bad news to you dieters is that the science is pretty clear: you have very little chance of having any long-term weight loss. About the best that a typical overweight person can hope to achieve is to work harder than everyone else to stop becoming more overweight.
So why is there this myth that being fat comes from having low will power? It comes from the discredited idea of the human body as a consistent machine, where food going in and output by exercise has the same effect on everyone. This is not true. Each person has a different response to food and a different response to exercise, and these responses dictate their "set-point" weight.
It is in your genes
Geneticists are able to directly measure the component of any trait that is genetic through comparing the shared variability in genetically identical twins versus "normal" (genetically different) twins. The advantage of this approach is that it is able to take into account the shared environmental influence from conception, and so measures the pure genetic component of any trait. A disease such as Multiple Sclerosis has a genetic component of around 25%, and is considered to be a genetic disease even through largely unknown environmental factors dictate ~75% of the risk. For weight, the genetic component is ~60%. So the difference between you and that super-model is 60% due to the genes you inherited.
If you are among the most obese, or have been obese from a very young age (under 10), then the genetic component of your obesity is often 100%. At these extremes many people have simple inheritable defects which will cause severe obesity, guaranteed. The best known examples of this are mutations in the leptin and leptin receptor genes. Leptin is a hormone that is secreted by fat cells after you eat and travels to the brain where it suppresses your appetite. People with mutations in leptin or the leptin receptor simply never feel "full" after eating, regardless of how much they eat they feel like they are starving. Resisting over-eating for an hour is heroic, for a day it is impossible. We can mutate the same genes in mice and see the 100% heritability of obesity.
It is from your early childhood
So 60% of your weigh is programmed in your genes. Well, you can still control the other 40%, right? Wrong. Another 25% is the variability is set from the early childhood experience. That is 85% of the variability locked in by the time you can make your own food choices. To put that in context, the genetic component of height is 80%.
And when scientists say early childhood, they mean early. One of the most powerful influences over weight is maternal imprinting during foetal development. Obesity rates in the Netherlands are quite low, except among the cohort of people conceived during the Dutch Famine of 1944. In these people, the uterine environment reprogrammed their genes for famine mode, in a process known as epigenetics. This "epigenetic" modification does not change the sequence of the gene, but changes the function for the life-time of the individual, while being (mostly) reset in the next generation. The effect of the epigenetic change is that the person's metabolism is wired for famine for the rest of their life, always hording calories as fat. When a person conceived in famine then goes on to live in famine this is an advantage, but when there is a mismatch between the food availability of the mother and the food availability of the offspring, the epigenetic imprinting results in obesity. Experiments in rats show that this is not just a famine-related phenomenon - simply giving rats a normal diet during pregnancy predisposes the young to obesity if they have a high-fat diet after weaning.
It is in your intestines
Another way your childhood environment programs your future weight is through changing the bacterial colonies that live in your gut. It has been shown that obese people and mice both have a higher proportion of Firmicute species bacteria compared to Bacteroidetes species bacteria in their gut. Firmicutes are much better at breaking down roughage into digestible food, so having more Firmicutes means you get more calories from the same amount of food. Experimentally, you can make a skinny mouse overweight simply by transferring gut bacteria into it from an obese mouse - nothing has changed about the diet or the genetics, but the mouse starts to put on weight.
That last 15%...
Well, I can still control 15% of my weight, right? No. What the data says is that 15% of the variation in weight is controlled by adult environmental factors. So 15% of the difference between your weight and the average weight is affected by everything some from your diet, exercise, stress, smoking, infections and every other non-genetic influence you can think of.
Despite this, overweight people can lose weight. Semi-starvation diets, strict exercise programs and surgical intervention can have an effect, and even quite dramatic changes in weight can occur. We should be clear though, this is not just a matter of adopting the lifestyle of a skinny person. For an obese person to lose weight they need to exercise much more than a skinny person and eat much less, and the whole time an obese person will feel hungrier and tireder, in fact demonstrating much more "will power" than a "naturally" skinny person. Again, this is scientific observation, based on measuring hormones levels rather than just asking people how hungry they are - obese people produce lower levels of leptin from the same meal, so chemically they feel the effects of starvation on a diet that naturally skinny people enjoy.
So weight loss can happen. But then something quite unexpected takes place - the weight starts to go back on, a kilo here and a kilo there until you are back to your own weight. This will happen despite having an identical lifestyle to a naturally skinny person. The reasons for this are complex, but it appears that being overweight leaves a permanent alteration on your body. If you do lose weight your body desperately attempts to put it back on. Hormonal changes mean you crave more food than someone naturally at your weight, by contrast your body becomes more efficient at scavenging calories so you need to eat 10% less than someone naturally at your same weight. How long does this effect last? Well, we don't really know, since the studies haven't gone out long enough. We do know that the effects last at least 6 years after you lose weight, and they may be permanent. A series of studies done on those rare few who manage to keep their weight down long-term show common characteristics: obsessive OCD-levels of calorie counting, constant feelings of hunger and permanent semi-starvation diets.
Your body has a natural weight
The final verdict is that your body has a natural weight. The skinny person next to you has no right to look down their nose at you, your will-power is the equal to theirs, it is your body that is different. That is not to say you should just give up. If your body is prone to weight gain, just maintaining your current weight over the years is a major challenge, and losing 1-2 kg over the span of a year is a major achievement (and may be easier to maintain than large weight drops). These achievements will result in real health benefits so they are worth striving for, the problem is that they are psychologically unsatisfactory. To be fat, work hard all year to lose 1-2 kg that no one notices and still be seen as fat by your colleagues and friends is devastating. Overweight people need to spend more effort on their body than the naturally skinny, and still get derided for it. Unfortunately, we just need to suck it up, be mentally stronger than the skinny people who never had to fight their body, and battle to keep our weight down one kilo at a time.
The light at the end of the tunnel
For those who are overweight today, we know there will be a life-long battle with no silver bullet. There is, however, a light at the end of the tunnel for future generations. The more we know about obesity the better we can limit it. People think that "genetic" means unchangeable, bar genetic engineering. This is not so. Any figure for genetic contribution is limited to the particular environment that the measurements were done in. So today 85% of our weight may be programmed through genes and early environment, but by changing the environment the genetic effect could be reduced or even eliminated. Particular additives that trigger cravings in people genetically prone to weight gain can be banned from common foods, removing the genetic effect. Early intervention programs could prevent the epigenetic reprogramming that leads to later weight gain. Think of it this way, a genetic susceptibility to alcoholism has a huge effect when alcohol is everywhere, but no effect if alcohol is absent. The same is true for our genetic programming to be overweight. Careful research and well-designed public health policies altering food regulation and activity levels could dramatically reduce the obesity levels in future generations. I, for one, sincerely hope that our children will not have to suffer through year after year of broken New Year's Resolutions.