Good Calories, Bad Calories

Bergmann and Julius Bauer, the “noted Vienna authority on internal diseases,” as the New York Times called him, were the two most prominent proponents of the lipophilia hypothesis, but only Bauer wrote about the hypothesis in English, attempting to influence how obesity would be perceived by physicians in the United States. Bauer’s expertise was in the application of genetics and endocrinology to clinical medicine, a field he arguably pioneered in a 1917 monograph entitled Constitution and Disease. Bauer had taken case histories from 275 obese patients and reported that nearly 75 percent had one or both parents who were also obese. He considered this compelling evidence that the condition had a genetic component, which in turn implied the existence of genetically determined hormonal and metabolic factors that would bestow a constitutional disposition to put on excessive fat. “The genes responsible for obesity,” Bauer wrote, “act upon the local tendency of the adipose tissue to accumulate fat (lipophilia) as well as upon the endocrine glands and those nervous centers which regulate lipophilia and dominate metabolic functions and the general feelings ruling the intake of food and the expenditure of energy. Only a broader conception such as this can satisfactorily explain the facts.”

Lipophilia, as Bauer observed, has nothing to do with energy balance. Where we accumulate fat is regulated by something other than how much we eat or how little we exercise. Someone who has a double chin, fat ankles, or large breasts but is lean elsewhere, or the women of African tribes who have the characteristic fat deposits of the buttocks known as steatopygia, did not develop these fat deposits by eating too much. Rather, as Bauer wrote, “A local factor must exist which influences the fat deposition in particular regions independently of the general energy balance or imbalance.” If a person becomes emaciated above the waist and then, a few years later, obese below it, as in these cases of progressive lipodystrophy, how can the obese half be blamed on overeating? And, if not, why does overeating become the cause when the obesity exists above the waist as well? The difference between local lipophilia and generalized obesity, Bauer observed, is one of distribution and not quantity.

Whatever mechanisms lead some parts of the human body to be more or less lipophilic, Bauer argued, exist to different extents in individuals as well. Those of us who seem constitutionally predisposed to fatten simply have adipose tissue that is generally more lipophilic than that of lean individuals; our adipose tissue may be more apt to store fat or less willing to give it up when the body needs it. And if our adipose tissue is so predisposed to accumulate excessive calories as fat, this will deprive other organs and cells of nutrients, and will lead to excessive hunger or lethargy. “Like a malignant tumor or like the fetus, the uterus or the breasts of a pregnant woman, the abnormal lipophilic tissue seizes on foodstuffs, even in the case of undernutrition,” wrote Bauer in 1929. “It maintains its stock, and may increase it independent of the requirements of the organism. A sort of anarchy exists; the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism.”