A medical review of the documentary Why Are We Getting So Fat?
Originally a 2016 episode of Horizon on the BBC, this documentary is now available to a broader audience on Netflix. The star is Giles Yeo, Ph.D., a geneticist who works at the University of Cambridge. Dr. Yeo has a droll style that engages the viewer despite periodic scientific forays into genetic minutia. Apropos to his whimsical nature, he structures his documentary as a lighthearted road trip.
The tagline states that Dr. Yeo wants to dispel “misconceptions about living with obesity,” and he does this by interviewing people to discuss their struggles with weight. His subjects come off as insightful but broken, well summed up by this quote:
“A lot of fat people, we put on a good façade. But inside, we’re crying.”
Dr. Yeo’s empathy for his obese subjects is commendable, but his defense exposes his bias. He focuses entirely on science-based causes, ignoring the multifactorial etiology of obesity even as his subjects do not, often admitting to stress eating, poor dietary choices, or a lack of exercise. Nevertheless, his scientific investigations are worth exploring.
Cambridge
We begin with Dr. Yeo’s research in Cambridge into the genetic variant FTO, an “obesity gene,” which affects the brain’s sensitivity to appetite hormones released from the gut and fat cells. All fascinating, until his decision to perform a silly “study” of dubious scientific value. Dr. Yeo tests obese subjects for FTO, tells those individuals who test positive, and then secretly records how much food they eat in a buffet spread immediately after.
Not surprisingly, these told that they tested positive eat less, but will this have a significant impact in the long run? Not even Dr. Yeo thinks so, as he admits that he worries about his girth yet has never tested himself for FTO.
Wales
We drive next to Wales to discuss bariatric surgery, which reduces the stomach size but also alters hormone secretions. How significant is the alteration of hormone secretions to weight loss? To explore this question, researchers test a cocktail of “hunger hormones” that mimic the physiological after-effects of gastric bypass surgery. Sure enough, there is a 20% reduction in caloric intake in the first meal after the injection.
So will this lead to a new treatment that doctors can prescribe? Maybe not, as they do not discuss how long the effect lasts or the cost of these injections. Also never discussed is the issue of food choices made by the subjects, an oversight repeated in every scenario throughout the documentary.
Providence, Rhode Island
Instead, we move on the Providence, Rhode Island (on our road trip, having driven over the Atlantic) to discuss gut bacteria. We meet a woman who gained four stone (54 lbs to American viewers) over 2-3 years after she received a stool transplant from her obese daughter to treat C. difficile colitis.
Could the change in gut bacteria explain her weight gain? Researchers have started human trials using stool transplants from lean donors, monitoring GLP-1 as a surrogate marker, to answer this question. Unfortunately, we move on before getting any results.
Never fear, I googled it. I found one study that showed a potential benefit and another study that did not. Yep, sounds about right. The literature on obesity treatment is rife with ambiguity. Could this be because the etiology of obesity is multifactorial?
London
Driving next to St. Thomas’ Hospital in London (returning across the Atlantic in his magic car), we explore the link of individual bacteria to weight loss. The stools in a set of twins revealed the bacteria Christensenella to be significantly more prevalent in the stool of the thin twin compared to her obese twin. Does this suggest causation? No proof of that as yet. That doesn’t stop the ever-optimistic Dr. Yeo from making this conclusion:
“I am confident that this battle against obesity will be won one day.”
Possibly, eventually, but not until we have an honest discussion of all factors. Despite addressing what he calls an obesogenic environment awash in fast food restaurants serving highly processed foods, Dr. Yeo proceeds to accept this reality as inevitable, making no effort to buy his dinner elsewhere. Watching the star of the documentary on obesity chow down on highly processed foods makes me decidedly less confident.
Conclusion:
Documentaries that address obesity and focus only on food choices run the risk of blaming obese people for their weight. This documentary suffers from the other extreme. By focusing only on genetics and diminishing or even dismissing other factors, Dr. Yeo has failed to answer his own question.
Why are we getting so fat? Obesity is a multifactorial problem involving food choices, exercise, stress/anxiety, and genetics. The documentary does an excellent job addressing the genetic aspects that contribute to obesity. But to find an answer to his question, you will need to look elsewhere.
More support that Dr. Yeo is correct about the lack of compassion given to obese people: Here are the first two comments at TheDailyMail.com following their review of this episode. Comments were cut & pasted from the website so expect derision and poor grammar:
“Of course it’s genetic fat people are stupid people and stupidity is genetic – too stupid to even tot up a few calories”
“Fabulous,just what fat people need,another’reason’why they’can’t’lose weight….”
Always heartening to see how polite Brits are just as horrid on the internet as everyone else.
Why Are We Getting So Fat? is available for streaming on Netflix.
About the Author
David Z Hirsch, MD is the pen name of the author of the award-winning novels Didn’t Get Frazzled and Jake, Lucid Dreamer, both available for purchase on Amazon or may be read for free with Kindle Unlimited. Didn’t Get Frazzled is also available on Audible.
He is an internal medicine physician with an active practice in Maryland.
Check out my other reviews:
A medical review of the documentary Cowspiracy
A Medical Review of the documentary End Game
A medical review of the documentary Fed Up
A medical review of the documentary Feel Rich
A medical review of the documentary Forks Over Knives
A medical review of the documentary Heal
A medical review of the documentary In Defense of Food
A medical review of the documentary The C Word
A medical review of the documentary The Magic Pill
A medical review of the documentary Sugar Coated
A medical review of the documentary Super Size Me
A medical review of the documentary What the Heath
And the video 5 Netflix Health Documentaries Worth Streaming
