1 March 2011,
 0

The problem with infusing a touch of the good ol’’ Nature and Nurture debate in an issue like obesity, diabetes (Type 2), or even addiction, is that it drives culpability in the purest sense – either the environment, and/or/and/with your innate characteristics (i.e. genes) are to ‘blame’. 

Journalists have snuggled into The Obesity issue, and perhaps the hand wringing will start to turn into rubbing. This controversial topic will not be resolved, not for a very long time. Trust me.

Not only because obesity is likely to be an enduring health issue, but it also acts as a barometer for judging people’’s political and moral beliefs – in other words, perfect territory for ˊcontroversial exposésˊ. However, this is my biggest gripe: I donˊt think obesity needs to pull on heart strings. If we cannot talk about overeating with the cerebral and somewhat removed stance of a scientist, we’’ll lose the ability to be rational. I read a flashy Saturday post in the Globe and Mail regarding Diabetes and Native Tribes in Northern Manitoba – so far, so anthropologically enticing – but the gist of the article was that the new change in environments in Northern Manitoba were entirely responsible for the exponential increase in Type Two Diabetes amongst the residents there. Here, we have a journalist who has created a clever throw back to the Nature and Nurture debate, and Iˊd like to explain why obesity is the last place (ever) to engage in philosophical debate. Obesity is real. The case of Natives’ extreme weight gain is the consequence of an astronomical environmental change paired with desire for consumption.

The argument regarding whether behaviours are innate or learned will get a rise out of even the most apathetic and/or appeasing individual. If pressed, a sloth would probably look up lazily and give his two cents.

Iˊll stand by my opinion, which is that some innate individual differences interact with the environment; some unlucky people suffer the consequences of both their genes and all cases the environment, and are now overweight. I’’m not saying obesity is 100% genetic, or 100% environmental. It i’s 100% behavioural, though, so let’s try and focus on that.

 

However, to relate to the matter at hand: if we accept that obesity is 100% environmental, well… how do we explain the fact that not everyone is obese?

…Let’’s assume that the environment is 100% responsible for the obesity crisis. Is the environment 100% responsible for alcohol addiction too? People seem to be far more united in their stance that addiction is ˊgeneticˊ. Moreover, I know quite a few people who enjoy drinks, who are exposed to advertisements for alcohol, who spend countless days in liquor stores (like wine merchants, sales reps, and liquor store owners), but are not alcoholic. We have a better understanding of alcoholism, and addiction, than for obesity at present. Perhaps better stated, we treat addiction with far more sympathy than we currently respond to obesity. This needs to change.

If You Have An Instance of Addiction in Your Family…
According to several public health websites, one of the first signs that you may be more vulnerable to drug dependency is if you have relatives who have suffered from addiction.

Thus it seems logical to advise those individuals who have alcoholism in their family to avoid drinking. While I’’m the first to whole heartedly agree that ‘variety is the spice of life’, and that puritanical avoidance of ‘spice’ is never a good way to have a fun time, there may indeed be some people who’se experimentation with alcohol begins at wine-in-a-box with Oreo chasers phase, only to careen straight through to a place where 12% beer starts to look attractive at 10 am. Other people, of course, are able to widen their palate from Oreo wine to a glass of Pinot Grigio at 8.00 pm, without the desire for a second round. These are the individual differences that make us so interesting, but guess what? As of today, I’’m not aware of a simple litmus paper test that will tell me whether ‘I’m the Pinot Grigio versus Grizzly Beer variety (for non Canadian readers, Grizzly is 12% beer that comes in litre bottles). A long story short: I take a lot of care with alcohol.

It does seem like there has been a collective shift in our understanding, and hence respect for addictive behaviour. Addictions are viewed as a hassle, something you just want to avoid – not some sign of personal weakness or feeble will.
I don’’t see a person who uses a pseudo scientific interpretation of genetics to avoid drugs or alcohol as a threat to society. I also don’’t view doctors who make recommendations such as: ‘’If alcoholism is in your family, you should take greater care’’ as eugenics pushing bigots.
I don’’t think you do, either. However, if we fill in ‘’overeating’’ or ‘‘binge eating’’ where I have placed ‘’alcohol’’ or ‘‘drug’ dependence’, well… the political landscape changes considerably. I think this is grossly unfair, and now I am going to explain a small component of the Genes and Obesity debate. Ultimately, this is a story about a horrendous quote taken from a science paper in 1962, and how it was used to convince us that we are all secretly racist.

The title, ‘How the Diabetes Linked Thrifty Gene Triumphed with Prejudice over Proof,’ boomed from Saturday’’s Globe and Mail. Say that five times fast. Perhaps I’’m recovering from jet lag, but I had to read the title a few times. OK, now I get it: scientists wrongly thought a gene for diabetes existed, and this idea was perpetuated by prejudice and not proof. Oh. OK.
…Ouch!
…Really?
British Scientists and Indians
I am taking out direct quotes and articles from said G&M article, so please follow along with the recount…

In 1999, we are told, a British scientist went up to Northern Manitoba to study the phenomena that the local population had five times the prevalence of diabetes compared to the rest of the Canadian population. Forgive my pettiness: why is the scientist’s’ nationality a priority, given that he is working with the University of Western Ontario…? Also, I’’d love to get my hands on the ‘British Medical Journal’ that published the zany finding about ‘Thrifty Genes in Manitoba Indians’ (that’s the Globe and Mail reference…). Clearly, this peer-reviewed piece didn’t include a single Canadian – when was the last time you referred to a Native Canadian as an Indian?

ANYWAY. The instance of PC unfriendly jargon is followed, though, by some pretty compelling statistics regarding the prevalence of diabetes in Native populations. It’’s not just the Ojibwa-Cree with the third highest rate of diabetes (Ojibwa-Cree would be the ˊManitoba Indiansˊ in the ominous ˊBritish Medical Journalˊ), but also that Arizonaˊs Pima Indians have the highest rate of diabetes, followed by the Nauru islanders of Micronesia and finally the Ojibwa-Cree Canadians at Sandy Lake who have the third highest rates of diabetes.
Scientistsˊ rationale that there might be a genetic component to this finding doesn’t seem all that far fetched: to be clear, Dr. Neel, an influential geneticist at the University of Michigan (not the British one working at the UWO), felt that genes were partly to blame. He speculated that genetic traits among the worldˊs prehistoric hunter-gatherers enabled them to store calories during times of feast in order to survive in times of famine. The idea is that genetic traits among the world’’s prehistoric hunter-gatherers enable them to store calories during times of feast and famine – those people with a ˊThrifty Geneˊ would be better at storing calories, hence their greater body mass, and apparently, native north Americans are particularly vulnerable to storing calories and also develop Type 2 diabetes.

My take, is that perhaps certain segments of the population are more sensitive to the rewarding effects of food, eat more food that is pleasant tasting, perhaps gain weight and thus develop resistance to insulin. Again, I haven’’t stated that I think there is an obesity gene, but my belief that certain segments of the population are innately more vulnerable to developing overeating habits (and next up, obesity) well – this puts me in the camp of the judge-y geneticists.

But again, this train of thought shouldnˊt be so far fetched, should it?

…The author goes on to claim there is absolutely no proof for this hypothesis, and that this load of Magical Thinking has been perpetuated thanks largely to Canadians racist perception of Natives. In essence, that scientists have tried to pull the wool over our eyes so they could publish articles about Manitoba Indians and their Diabetic Genes, made possible because we are all prejudiced.
Are you starting to get as angry as I was yesterday???

Why I am Angry
(Maybe THIS is what I should call my blog???)
Instead of taking the opportunity to explain how Type 2 Diabetes causes the host of health problems listed, we learn about how ˊSho-goh-wah-pee-nayˊ, the ˊsugar diseaseˊ is robbing Natives of their limbs, kidneys, and vision. How’s that for patronizing? Doesn’t translating Type 2 Diabetes as ˊthe Sugar Diseaseˊ reduce the Canadian Natives ever so slightly?

Look, I go to great lengths to conceal my bear hunting and seal clubbing stories when in dialogue with Heather Mills-types (see how fun it is to be cast as a backwards stereotype?) – So I can only imagine how enjoyable it is to read in the Globe and Mail that my native linguistic version of ˊType 2 Diabetesˊ has been simplified as The Sugar Disease. Indeed, this may be a direct translation – but ˊdirect translationsˊ can be problematic. Case and point: Guess what the direct translation of eggs is in Spanish?  Testicles. But I donˊt go around all day marvelling at how my Scrambled Eggs for breakfast (Huevos Rotos) could be mistaken for Broken Balls, now that I live in Spain. To me, including the ˊSugar Diseaseˊ line in the first few paragraphs makes the author look about as medieval as those British scientist writing about diabetes-prone Indians.

One more objection, and then I’’ll get to the point… as the article continues, we get various opinions from other well respected academics both in the field of evolutionary biology and sociology. The quotes that stick out in my mind come as follows…:

• ‘Jennifer Poudrier, an associate professor of sociology at the University of Saskatchewan a Métis who counsels native women on body image…dismisses it as “a colonial lens put on aboriginal history,” …“It makes people feel deflated and defeated,” “It detracts from a focus on the social context.”

Jeff Reading, director of the Centre for Aboriginal Health Research at the University of Victoria, calls the theory “potentially damaging” because “it discounts the social circumstances of poverty – it suggests that youˊd be okay if you didnˊt have faulty genes. But saying your genes are bad is not that helpful; itˊs just an excuse not to do anything about it.”
Wouldn’t knowing precisely about a marked vulnerability to a specific disease help you avoid it? Wouldn’t it be more motivating to know that you have a risk for an illness, one that is extremely treatable? For me, knowing that I could be predisposed to the rewarding effects of food (and modify my diet accordingly) would be empowering, not debilitating.

The biggest problem with the article, in my opinion, is the suggestion that the Eugenics movement is a motivating factor for this kind of research:
Mmm… the Good Old Days, a Nice Reference To Eugenics

‘In his landmark paper, published in the American Journal of Human Genetics in 1962 … Dr. Neel suggests running blood-insulin tests on “primitive hunters and gatherers.” He also includes a section entitled “Some Eugenic Considerations” in which he says that, if correct, his theory poses an ethical dilemma because “modern medicine makes it possible for diabetics to propagate,” allowing the disease to spread.

I have no idea how long it took to drudge up a quote where the terms ‘Some Eugenic Considerations,’ were printed. I am aghast at the comments regarding the liability of people with diabetes ‘propagating’. However, something tells me this juicy tidbit may have been the primary motivator for writing the article in the first place. ‘Ooo! Look how silly we were in 1962!’

Let’’s all agree: Dr. Neel’’s consideration for diabetes as a risk to society is ridiculous, baffling, and wrong. However, raising the question that there could be some innate factors that are related to higher sensitivity to the rewarding properties of food is hardly saying that we are going to screen food lovers from having children.

I said I’’d get to the point. I went through a pubmed search to find the precise genes that mark alcohol dependency. I am not a geneticist, but I spent over an hour trying to find evidence that there is a clear genetic marker of alcohol addiction… and guess what? There is yet to be a precise gene that expresses addictive behaviour for alcohol or even opiates. Pressing through the about.com articles with regard to strategies for children of alcoholics, we see the medical community admitting that not all children of alcoholics will develop alcoholism and ‘vulnerability varies from person to person’.

…So it’’s not actually water tight with regard to the association between relatives and further development of alcoholism. Does this mean the advice to children of alcoholics (to avoid alcohol) should be viewed as a conspiracy of fun robbing? Or social alienation?
No. The fact remains that as a society, we have learned enough about alcoholism to respect the careful boundaries that alcohol consumption requires (ditto for narcotics, and we’re catching up with prescribed things like Oxycodon and Tylenol 3’s).

It will be a very long time until the precise sets of innate factors that lead to addictive behaviour are totally understood. For those people who see a large component of their circle of friends or relatives developing overeating behaviour, the idea may be to treat food with the same kind of care and respect as we treat alcohol: a statement of fact is simply that palatable food seems to be so much more appealing to your clan, and as such, you are taking steps to avoid over consumption. I don’’t think this is a statement used to alienate your cultural background, or some way to further the objectives of Aryan Nationalists.

Finally, the G&M piece did mention one important ending quote:

‘Mount Sinaiˊs Dr. Zinman says it has “been a disappointment” that the genetic story is not simple. “At the end of the day, itˊs wrong to say there is a thrifty gene, but maybe there will be a thrifty genotype” – a collection of genetic traits that contribute to type 2 diabetes. Further, Dr. Zinman disagrees that this “stigmatizes” anyone, as the thrifty gene would have been a positive, protective trait if it existed.

“You have to be careful not to confuse the science with the politics.”’

Finally, I have found something with which I can say that I agree.
The problem with infusing a touch of the good ol’ Nature and Nurture debate in an issue like obesity, diabetes (Type 2), or even addiction, is that it drives culpability in the purest sense – either the environment, or your innate characteristics (i.e. genes) are to ‘blame’. Since we can’’t really control either, it’’s the largest, most compelling, most researched, most bloated cop out in the world.

Adopting either stance (100% environment, 100% genetic) on an issue that is as porous and non conforming as obesity, is bound to spell out disaster – either in the form of encouraging a cut to funding geneticists in the field of obesity research, or simply indulging societyˊs smug seethe of, ‘Well, I can eat a Blizzard every now and again- why can’t she? Oh that’s right, because the fat person is a product of a Dairy-Queen laden caloric cesspool (Environment rules all), or just inherently greedy (Genes)’.

So, before we do go back to the 15th century, please remember that claiming the Environment is 100% to blame is probably just as sinister as blaming your Genes. Maybe in 2060 weˊll look back at this article and smirk knowingly too.
M XOXO

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