Four Tribes of Obesity


Recently Ted Kyle, chair of the Obesity Action Coalition and a writer on health issues, sorted out the schools of thought on obesity and divided commentators into three types. To quote him:

Healthies…People with obesity are to be treated with “informed compassion” that drips with condescension…Calls for attention to treatment of obesity are seen as reminders of unfortunate failures to prevent it.

Quants sing an unwavering hymn of “show me your data.” They provide regular and annoying reminders of how much we need to learn about obesity and keep asking for randomized, controlled trials that can be challenging to conduct.

Buttouts…Some of them are dealing with obesity on their own terms and some of them simply reject the construct of obesity as a disease. Others are studying it as a purely social phenomenon.

Kyle’s categories were amended by a reader called Reeger in the comments section of his page:

I believe you need a fourth category, “Trench Runners”…in the trenches every day, working, keeping their head down, helping where they can and running between the three tribes grabbing what bits of information and assistance they can to help those in need.

Michael Prager, ruminating on his own place in this or any other classification system, asserts that he knows one thing for sure – “not fat” is a lot better than fat, and he has been both, so he knows. Regarding public opinion, he says:

We all will be better off when fat stigma has gone. But I do not believe that when it is, the problem with fat will also disappear — shortness of breath, joint pain, inability to keep up were part of my reality that had nothing to do with what others thought of me.

Going back to Kyle’s ideas, apparently “Healthies” believe that everything about obesity is known, and it all boils down to calories consumed and calories expended, and there is not much room for nuance in their philosophy. The Quants, who love studies and crisply-documented lab results, are doomed to perpetual discontent because of medical ethics. Many experiments simply can’t be done on humans, lest a scientist wind up in the dock at Nuremberg.

Sometimes, all we have to go on is research gathered for other purposes. Data sets can be harvested and cobbled together into a meta-study in which every variable makes the findings more ambiguous. The other problem with the Quants is, even in an area where stricter experimental protocols are in place, Quants may not care for the results. For instance, in a piece titled “8 Ridiculous Nutrition Myths Debunked,” Kris Gunnars asserts that the low-fat diet is a big fat myth:

In this study, tens of thousands of women were placed on either a low-fat diet, or continued to eat the standard western diet like before….There is no evidence that low-fat diets lead to better outcomes….the low-fat diet is completely ineffective.

Based on what? Based on “the largest randomized controlled trial ever conducted on diet,” a seven and a half year study under the auspices of the National Institute of Health. Take that, Quants!

Your responses and feedback are welcome!

Source: “Three Tribes of Obesity,”, November 2014
Source: “On Ted Kyle’s “three tribes of obesity”,”, 11/14/14
Source: “8 Ridiculous Nutrition Myths Debunked,”, 05/22/13
Image by Sean MacEntee

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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.
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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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