Social exclusion, stigma, guilt, and shame have been the cornerstone problems of obesity1. This guilt and shame caused by societal stigma leads to binge eating, depression, and social exclusion2. These social sequelae have been fostered by a mistaken general assumption that one size fits all when it comes to weight control, which has led to prejudice, hostility and inappropriate treatment3.
Given the very wide metabolic variation that does occur between individuals, any approach obviously must be tailored to each individual’s unique body metabolism. Most weight management approaches consider calories in and calories out since a chronic imbalance in this area leads to weight gain, but individuals are treated by public health professionals as though these differences do not exist. While Resting Metabolic Rate (RMR) comprises 50%-80% of energy expenditure in adults4, this key measure of metabolism is seldom used in treatment decisions, nor in advising patients of the possible origins of their weight problems. For the past 10 years, technology has advanced to the point that indirect calorimetry of RMR can be measured cheaply and readily5.
Metabolic Factor (MF) measure was first introduced by Davis et al.6 This new metric is simply calculated by dividing RMR by current weight. For example, an individual with an RMR of 2,000 and a weight of 200 will have a MF of 10. Davis et al6 found differences in MF based on people’s weight. Obese people had an average MF (with standard deviation in parenthesis) of 8.3 (1.5) while the MF of overweight individuals was 10.6 (1.5) and of normal weight people was 12.8 (1.9). These results point to the possibility that MF may have significant influence on an individual’s weight, especially considering the strong negative correlation between MF and weight (r = -0.63). People with a lower Body Mass Index (BMI), between 30 and 40, had slightly higher Metabolic Factors of 8.3. Another study used information taken from a German database of 2,105 people6. Their overall sample had a Metabolic Factor of 9.3. Individuals with a BMI less than 18 had Metabolic Factors of 11.2 while it was 10.4 for BMI 18-25, 9.1 for BMI 25-30, and 8.1 when BMI was over 30. These results point to Metabolic Factor as a possible strong contributor to a person’s weight. According to Foster et al7 of 80 obese women with an average BMI of 38.9, the Metabolic Factor for this group was 7.6. Studies continue to show that obese people have much slower metabolisms, typically fifty percent slower than normal weight people, but measurement has been difficult8-10.
A study by Davis and Indelicato11 demonstrated that even with massive post-surgical weight loss, obese people did not have significant changes in Metabolic Factor. The initial weight for the 18 participants was 326.3 pounds (91.3). Post-surgically the average weight dropped to 229.3 pounds (48.0) (p < 0.01). They still have very slow metabolisms as measured by Metabolic Factor at 8.5, compared to normal weight subjects, as measured in an earlier study, of 12.3. These results indicate that subjects who lost on average of 99 pounds, still have metabolisms which were only 69 percent of normal, meaning that after all the weight loss and surgery, they would have to continue eating only 69 percent of normal to maintain that weight.
The finding of the strikingly high negative correlation between Metabolic Factor and weight (r = -0.63, p < 0.001) demonstrates how large a role metabolism plays in weight, possibly accounting for up to 40% of the variance in weight. The only rational conclusion is that obesity is largely a function of metabolism and that, in large part, the true disease of obesity is the stigma that society places on those who are overweight. Public health professionals must seek to reduce this stigma and help reduce the consequences, which follow any stigmatization, namely shame, prejudice, guilt and depression. Sometimes the true epidemic may not be of obesity but of the attitudes toward those who are overweight. Cure those attitudes, seek ways to better understand metabolism and what causes variances in it, and true progress will be made, but treat the stigma first.
- Conradt M, Dier JM, Schlumberger P, Rauh E, Hebebrand J, Rief W. Who copes well? Obesity-related coping and its associations with shame, guilt, and weight loss. J Clin Psychol. 2008;264(10):1129-44.
- de Zwaan M. Binge eating disorder and obesity. Int J Obes Relat Metab Disord. 2001;25 Suppl 1:S51-5.
- Wang L. Weight discrimination: One size fits all remedy? Yale Law J. 2008;117(8): 1900-45.
- Ravussin E. Low resting metabolic rate as a risk factor for weight gain: role of the sympathetic nervous system. Int J Obes Relat Metab Disord. 1995;19 Suppl 7:S8-S9.
- Rosado E, Kaippert V, Santiago de Brito R. Energy expenditure measured by indirect calorimetry in obesity. In A Ali Elkordy (Ed), Applications of Calorimetry in a Wide Context-Differential Scanning Calorimetry, Isothermal Titration Calorimetry and Microcalorimetry. 2013:309-22.
- Davis B, Indelicato J, Kuiper N. Metabolic factor: A new clinical tool in obesity diagnosis and weight management. Arch Medical Biomedical Res. 2014;1(2):47-53.
- Frankenfield DC, Rowe WA, Smith JS, Cooney RN. Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc. 2003;103(9):1152-9.
- Foster GD, Wadden TA, Mullen JL, Stunkard AJ, Wang J, Feurer ID, et al. Resting Energy Expenditure, body composition, and excess weight in the obese. Metabolism. 1988;37(5):467-72.
- Seidell JC, Muller DC, Sorkin JD, Andres R. Fasting respiratory exchange ratio and resting metabolic rate as predictors of weight gain: the Baltimore Longitudinal Study on Aging. Int J Obes Relat Metab Disord. 1992;16(9):667-74.
- Katzmarzyk P, Perusse L, Tremblay A, Bouchard C. No association between resting metabolic rate or respiratory exchange ratio and subsequent changes in body mass and fatness: 5½-year follow-up of the Quebec Family Study. Eur J Clin Nutr. 2000;54(8):610-4.
- Davis B, Indelicato J. Stability of metabolic factor before and after bariatric surgery. Obes Surg. 2016. [Epub ahead of print]