Dr. Ochner Weighs In on Michael Prager’s Blog

Rainbow sherbet ice cream

Michael Prager, author of Fat Boy Thin Man, carried on a conversation throughout several blog posts with Dr. Christopher Ochner, a research scientist concerned with obesity and nutrition. One of Dr. Ochner’s accomplishments was to become, in 2009, the youngest member of Columbia University’s College of Physicians and Surgeons to be in charge of an independent research lab. Currently, Dr. Ochner can be found at the Icahn School of Medicine at New York’s Mount Sinai Hospital, where he is an assistant professor in the fields of pediatrics, adolescent medicine, and psychiatry.

Dr. Ochner sees two major factors against us in the individual and collective struggle against obesity. Temptation is everywhere, and the food environment is disproportionately full of trans fats and unnecessary sugar. The other problem is that humans developed along the lines of a creature that stores as much energy as possible. Life is uncertain, and for hunter-gatherers, the food supply could be intermittent, so we store up fat to carry us through the lean times.

A seasonal fluctuation from fat to thin and back again is not the best way to go through life, but it did keep humans from starving. However, that was then and this is now — a now that is frighteningly shot through with paradox. How, as a species, did we become so big and so unhealthy at the same time?

Dr. Ochner characterizes his theory as reductionist, saying,

[O]besity is maintained by biological factors…. I believe everything comes down to chemistry in the brain…. The obesity epidemic is not a result of massive binge eating but progressive, passive overconsumption.

In another post, he emphasizes the importance of knowing the difference between what causes obesity and what maintains it:

We are all biologically predisposed to becoming obese in an obesogenic environment, with only about one-third of us able to resist. That said, I believe that the vast majority of individuals have the ability to not become obese, with lifestyle choices accounting for a hefty percentage of the variance in body weight.

But on the other hand, he also insists that lifestyle change alone is not sufficient, because of all the other forces working against us. And the “lifestyle choices” paradigm leads to fat blaming and shaming. Dr. Ochner says:

The expectation that individuals should be able to simply change their eating and activity habits to achieve and sustain a healthy body weight perpetuates the stigma that individuals with obesity are lazy and lack willpower…. In fact, what we (the “experts”) have been offering them for the past 20 years (i.e., “eat less and move more”) is just plain insufficient to overcome the potent biological drives to restore an individual’s highest body weight. The assumption that lifestyle change alone should be sufficient is at best incorrect and may in fact have adverse consequences.

Dr. Ochner expressed the idea that people are locked into following the “American diet,” which basically means consuming as much as they like of anything they want. In his view, it is pointless to tell people to cut out their most-loved yet most problematic foods, because they are not going to do it anyway. To him it appears that the best answer is to discover how to make these beloved foods better for us.

The most overweight Dr. Ochner has personally ever become was about 15 pounds over his present weight of 150. Having identified ice cream and M&Ms as his downfall, he refuses to let them in the house, because he would consume every bit immediately. But he doesn’t ban them entirely, leaving open the possibility that they can be enjoyed elsewhere. In this way he differs from both Dr. Pretlow and Michael Prager over the necessity of giving up the most irresistible problem foods.

Your responses and feedback are welcome!

Source: “Food could be considered an addictive substance,” MichaelPrager.com, 06/13/14
Source: “The doctor replies again: Once obese, it’s tough to escape,” MichaelPrager.com, 08/01/14
Image by Ruth Hartnup

2 Responses

  1. One aspect of living in an obesogenic environment that isn’t discussed enough is how we are encouraged to practice lifestyle choices that maintain us to be obese. Food marketers have done a tremendous job in making unhealthy food appeal to us on an emotional level. We are reminded that food is “happiness,” “tastes like comfort” etc. This helps camouflage the end of result of our food choices – illness.

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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