Genetics and diet cause obesity. The Pima Indians in Southwest Arizona have one of the highest rates of diabetes in the nation. Diabetes and obesity were unknown to these Indians prior to the coming of the white man and his white bread. Their cousins, who live in Northern Mexico, have the same genetic background, don’t have the rich diet that Americans have, and they also don’t have a problem with being overweight.

Or, are your genes making you wear larger Jeans?

Those of you who are nature versus nurture types might think—ah ha, the problem is clearly environmental, but it is not.  The predisposition of Pima Indians toward being overweight is genetic.  Add that to a diet filled with lots of sugar and delicious fat, and you have obesity.

The teleological reason for this is in what we call the “feast or fast gene.” The reasoning goes like this—while Arizona is a great place to have a winter vacation, it is a desert.  So, thousands of years ago people had to scrape out a living in the desert.  Famine was not uncommon.  Those who were blessed with a feast/fast gene had the ability to store great quantities of food (as fat) in times of plenty.  When the famine struck, those little skinny guys didn’t make it, but those with the feast/fat gene did.  Generations later the children of those who survived have bodies that are particularly well suited to storing fat during good times and surviving during the famine.  Now I have a secret to tell those survivalists who have basements full of canned goods.  Obesity is the best protection against famine.  Someone can steal the food out of your basement, but if you store your reserves as fat—well, then again there was the Donner Pass Party.

Then we entered the era of modern transportation, fast food, and television.  No more famines, at least not in the United States.  So, now some people simply store, and store, and store.  These are the ones who become obese.

What is the best remedy?  More famines?  Well, some government bureaucrat might think so, but it probably won’t become policy.  Leaders in the Zuni Nation came up with one of the best remedies I have heard of.  They took a group of young school kids and started them on a program of running and exercise.  What a wonderful model.  Remember, exercise is the great equalizer—and this program will instill healthy values in children that will pay dividends later.

Now the academic people will point to some interesting research with various proteins, other genetic studies, and hold a long and boring discussion about obesity.  But suffice it to say, there is clearly a genetic predisposition to be overweight.  This predisposition is boosted by our modern sedentary lifestyle, which has a bountiful supply of calories in concentrated and delicious forms.

The ultimate question is this—will modern science someday find a pill, or shot, or something that will decrease that trend?  I hope so, but probably not in our lifetime.  I would love to save patients the scar and hand them a pill.  Meanwhile, read my books.

Not A Disclaimer…but this is only advice from a weight loss surgeon


I am a physician, but I am not your physician.  While my advice in this writing is simple, easy to follow and is based on years of experience as a weight loss surgeon, it cannot take the place of your doctor, the one who sees you, examines you, and knows your insides.  The same is true for physicians, friends, and other health care workers who you meet in restaurants, bars, and the internet or on the street.  Trust your doctor.  If he disagrees with me—well, go with his recommendations.  You are paying for his advice about you.  You can get a second opinion if you don’t trust your doctor’s advice.  In fact, if you don’t trust your doctor’s advice, maybe you should get another doctor.  If you are my patient, then trust what I say in here as absolute gospel and have this writing burned on the fleshy tables of your heart.