Obesity is not simply a matter of eating too much, but often has a genetic basis
Obesity was often attributed to a lack of willpower, but Sadaf Farooqi, Professor of Metabolism and Medicine at the University of Cambridge, discovered that the cause often runs much deeper: in our genes. Farooqi, a pioneer in the field of obesity research, will deliver the 30th Anatomy Lesson on Thursday at the Concertgebouw.
Over 25 years ago, Sadaf Farooqi began her research into obesity in England, at a time when scientific focus was mainly on the link between obesity and diabetes. At that time, obesity was just beginning to emerge as a significant issue in the United Kingdom. Over the years, obesity has become a global health problem, and is now often referred to as an obesity epidemic. With an impressive body of publications, Farooqi, now a professor of metabolism and medicine at the University of Cambridge, has changed our understanding of this chronic condition. Obesity is not necessarily caused by a lack of willpower to lose weight, but has a genetic basis. Folia spoke with her ahead of the Anatomy Lesson.
The Anatomy Lesson is an annual public medical lecture in the Concertgebouw at the intersection of medicine and society, organised by Amsterdam UMC and de Volkskrant. The tradition, now in its 30th year, is based on the guild of surgeons in the 16th and 17th centuries, who held a public dissection for laypeople every year.
There is said to be an obesity epidemic. But is that the right terminology?
‘The word “epidemic” is a bit strange in this context, as it is often used for infectious diseases and transmissible conditions. What it refers to, however, is the high number of people with obesity, which continues to rise in regions like America, Europe, and the Middle East. I don’t have the exact figures for the Netherlands, but the percentage of people with obesity is lower here than in the United Kingdom, where I mainly conduct my research. There, between 15 and 20 percent of the population has obesity.’
‘Obesity is a common chronic condition. It is characterised by an excessive accumulation of body fat, which leads to serious health risks, such as an increased risk of cardiovascular diseases, type 2 diabetes, and certain forms of cancer. What we focus on is finding ways to both prevent and treat obesity. But in order to do that, you first need to understand how the system works. And that’s what our research is all about.’
What was a breakthrough in your research into the genetic causes of obesity?
“The major discovery was the identification of the hormone leptin in mice in 1994, and later in humans in 1997. It showed that a single hormone can play a crucial role in regulating your weight. If you don’t produce leptin, or produce it in very small amounts, you end up in a constant state of hunger. People with a genetic defect in the gene responsible for producing leptin therefore have a much stronger drive to eat, which leads to obesity.”
“To demonstrate this, I studied children with obesity who we knew produced little to no leptin. One of the experiments we did was called the buffet meal experiment. A long table was laid out with all sorts of treats, worth around 5,000 calories. We invited the children to eat as much as they wanted, of whatever they wanted. Afterward, we treated them with the hormone leptin, and saw that they ate much less from the same buffet than before. With this experiment, we showed how crucial leptin is in determining your appetite.”
What are some common misconceptions about obesity that you would like to correct?
“For a long time, people thought that willpower and self-discipline were the only ways to cure obesity. They thought that if people simply ate less and moved more, obesity wouldn’t be a problem. Or that people could always fully control their hunger. Of course, we can sometimes suppress our appetite voluntarily, but when there’s a strong biological drive, it becomes incredibly difficult. What we now know is that genes play a major role in our appetite and weight.”
“Furthermore, obesity is often quickly seen as an individual problem, while it is very much tied to how our society is organised. Do people have enough time and space to exercise? And is the food available to them good and healthy? When it comes to national policies, two things need to happen. Policy measures aimed at improving the health of the population should focus on food, as the increase in our food intake is driving obesity. At the same time, we must recognise that some people are more predisposed to gain weight than others, and some people have a greater appetite. It is therefore unrealistic to treat everyone in the same way and expect them to adhere to any new policy or guideline. We need to understand that some people are more susceptible to weight gain and likely need more attention.”
What message would you like to convey to young researchers starting their careers in medicine?
“It’s very important that all medical students and doctors keep an open mind. The best teachers are often the patients themselves, at least if you keep listening carefully to them. In a time when there is an increasing amount of research, guidelines, and rules, we must continue to listen to the patient in order to come to the best solutions and insights.”
“To illustrate this further on the matter of obesity: there are stories of children with obesity who were placed into care because their parents were blamed for their children’s obesity. Doctors, social workers, and others thought the parents were not taking good care of their children, while the children’s genes were the real cause. So try to look beyond the medical issue, question things, and don’t draw hasty conclusions. Your research can change lives.”
