Of Epidemic Proportions, Expanded Edition 2019 (January 2, 2019)

Of Epidemic proportions cover
ISBN: 979-0-57-879227-9

Of Epidemic Proportions: The Art and Science of Obesity, Expanded Edition, 2019, is a compilation of 101 scholarly blogs and a comprehensive index on the daunting science of obesity and weight control. Originally written over the past eight years for the psychologytoday.com website, these blogs are lavishly illustrated with hundreds of spectacular art images from some of the world’s leading artists.

INTRODUCTION, by the Author

Image of man walking on treadmill while scientist monitors

Image taken from: Mathematical Models: Obesity by the Numbers (Blog 99)

Of Epidemic Proportions: The Art and Science of Obesity, initially released in March 2018, had been a collection of 93 scholarly blogs on the daunting science of weight control that I had written over the past seven and one-half years for the website of psychologytoday.com. This first edition, of limited release and not for public sale, received considerable acclaim from those special friends and colleagues to whom I had sent my book. Many people had expressed a wish to purchase additional copies.

In response, I have decided to release this expanded version, now with 100 blog entries, an epilogue, and a comprehensive index, and make it available for wider distribution by offering it for sale on Amazon.com. Still by no means all-inclusive and undoubtedly idiosyncratic, this personal compilation focuses on many aspects of obesity that have intrigued me since I wrote, as senior author, The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance (2010, American Psychiatric Publishing, Inc.) I remain humbled, though, by the complexities and limitations of obesity research and gratefully acknowledge those exceptional investigators among you who emphasize the importance of scientific rigor, transparency, and reproducibility in this field and strive to rectify this challenging situation. It is to you that I dedicate my expanded version.

Image of a painted skinny man called The Edict by Max Ehrlich

Image from: Crossing the Thin Line to Starvation: Caloric Restriction (Blog 87)

Image of Fish Market a painting by Joachim Beuckelaer

Image from: A Point of Order: Nutritional Prescriptions and Food Sequence (Blog 96)

Image of Triumph of Death, by Jan Bruegel the Elder, late 16th century

Image from: A Bone of Contention: Osteoporosis and Weight (Blog 52)

Though I have changed, and in numerous instances, supplemented many of the original art images that accompany each blog, I have still chosen to keep the essays, with a few exceptions, as initially published and maintain the order of their original date of publication. Of course, this means that some of the information, particularly from the earlier blogs, may need updating by the reader.

Sylvia R. Karasu, MD
Clinical Professor of Psychiatry
Weill Cornell Medicine
New York City
January 2019


  1. Sorting Through the Information Explosion about Weight
  2. Havoc with Circadian Rhythms: “Light Pollution” and Weight
  3. “Did You Ever See a Fat Squirrel?”
  4. The “Holiday Creep:” Seasonal Weight Gain
  5. The Body’s Damage Control: That’s the Way the Cookies Crumble
  6. ‘Tis Better to Have Lost and Regained Than Never to Lose at All
  7. Sticker Shock: Can We Make Temptation Less Tempting?
  8. From Snake Pit to Snake Oil: Diet Regimens
  9. Strictly from Hunger: The ABCs of Insuicient Food
  10. A Glass Half-Full, A Glass Half-Empty: How Much Water to Drink?
  11. Frayed, Frazzled, at the End of Your Rope: Stress & Weight
  12. Calling a Spade a Spade: Should A Physician’s Weight Matter?
  13. We Hold These Truths to Be Self-Evident: The Obese Candidate
  14. A Time for Every Purpose: The Science of Chronopharmacology
  15. Measure for Measure: A Madness in the Method for Weight Control
  16. The Unbearable Heaviness of Being: Considering Bariatric Surgery
  17. Liposuction: The Most Unkindest Cut of All?
  18. What Exactly is Cellulite? “Cottage Cheese” Thighs
  19. Lead Us Not Into Temptation: Science & the Marshmallow Test
  20. String Theory: Attach Incentives to Assist in Weight Control
  21. Special Delivery: What Can Brown (Fat) Do for You?
  22. A Bitter Pill to Swallow: Grapefruit Juice and Medication
  23. Supersizing and the Tyranny of the Soda Police?
  24. Fatal Flaws: Determining Who Is Overweight and Who Is Obese
  25. Double-crossing the Double Helix: Weight & Genes
  26. A Towering Babel: Structural Frameworks for Weight
  27. Weight: A Flu Shot in the Arm, A Shot in the Dark
  28. Strengthening Ties that Bind: Weight Control
  29. Weight Control: The Biological Brain, The Psychological Mind
  30. Searching for Magic Bullets: Weight-Control Medications
  31. Top Ten Reasons Why We May All Be Getting Fatter
  32. The Obesity Paradox: Is There an Ideal Weight for Health?
  33. Are We Sugar-coating Sugar Substitutes?
  34. Gut Reaction: Can G.I. Bacteria Cause Weight Gain or Weight Loss?
  35. The Hare and the Tortoise: Aesop’s Fable and Weight Loss
  36. The Medicalization of Weight: Are We “Disease Mongering?”
  37. Heavy: Uneasy Lies the Fat that Wears a Crown
  38. Human Bondage: America’s Not So Magniicent Food Obsession
  39. Great or Not Such Great Expectations: Weight Loss Goals
  40. ‘When the Bough Breaks’: Excessive Weight Before Pregnancy
  41. It’s Not Exactly Better Living through Chemistry
  42. College Weight Gain: Debunking the Myth of the ‘Freshman 15’
  43. When the “Proof of the Pudding” Is Not in the Eating
  44. The Myth of “Nutritional Precision:” What Do We Really Know?
  45. Healthy Obesity: An Oxymoron?
  46. “What Hath Night to Do with Sleep?” Night Eating Syndrome
  47. The Puzzling Condition of Pre-diabetes
  48. Fat Shaming and Stigmatization: How Far Is too Far?
  49. “What Potions Have I Drunk?” Concerns about Diet Supplements
  50. Down the Rabbit Hole: When Medication Leads to Weight Gain

  1. From the Frying Pan into the Fire? Saturated Fat and Health
  2. A Bone of Contention: Osteoporosis and Weight
  3. Holding a Mirror Up to “White Hat Bias” in Research
  4. When Healthy Eating Turns Unhealthy: Orthorexia Nervosa
  5. Why Out of Sight Really Is Out of Mind
  6. Of Epidemic Proportions: The Primary Colors of Obesity
  7. “Suicient Unto the Day:” The Complexities of Satiety
  8. Food Cravings: Those “Torments of Expectation”
  9. Smoking and Weight: Those “Burnt-out Ends of Smoky Days”
  10. Cancer Risk and Weight: Our Body and “Pathologies of Space”
  11. The Self “Loathsome Gluttony” of Binge-eating Disorder
  12. The Melancholy of Anatomy: Excessive Weight and Depression
  13. A Point of Reference: Weight and the Concept of Set Point
  14. The Quicksand of Self-deception: The Nocebo Effect
  15. Some Philosophical Musings on Food
  16. Toward a ‘Knowledge of Causes… and All Things Possible’
  17. The “False Creation” of Body Image Distortions
  18. Illusions and “Troubled Senses” of Body Dysmorphic Disorder
  19. The Double-Edged Sword of Alcohol Use
  20. In Nutrition, Where Does Science Stop and Fantasy Begin?
  21. The Care and Feeding of Myths: Breastfeeding and Weight
  22. Adolphe Quetelet and the Evolution of Body Mass Index (BMI)
  23. Marijuana and Weight: A Plant With Virtues to Be Discovered?
  24. Body Weight in the Time of Climate Control
  25. Advise and Consent
  26. The “Electrochemical Persuasion” of Neuromodulation
  27. Is Extreme Childhood Obesity ‘Nutritional Neglect’?
  28. Interests Conlicted: A ‘Wicked Problem’ in Medical Research
  29. The Brittle World of Peanut Allergy
  30. Sugar by Any Other Name? Low Calorie Sweeteners
  31. Behind the Smoke-Screen of Vaping: E-Cigarettes
  32. Salt Intake: Taking Advice With That Proverbial Grain
  33. Of March and Myth: The Politicizing of Science
  34. The “Furry Test Tubes” of Obesity Research
  35. The Gambler’s Fallacy in Research
  36. “Cholesterolphobia” and Eggs: What Do We Know?
  37. Crossing the Thin Line to Starvation: Caloric Restriction
  38. The ‘Soy-ling’ of Our Food: The Versatile U.S. Soybean
  39. Time Present and Time Past: Obesity and Chronobiology
  40. Frozen: What Do We Know about Cryolipolysis?
  41. The Long and the Short of It: Sleep Duration and Health
  42. The Handwriting on the Wall: Menu Labeling
  43. Sleepers Awake! Obstructive Sleep Apnea
  44. Chocolate: Glorify or Demonize?
  45. Nuts with Benefits
  46. A Point of Order: Nutritional Prescriptions and Food Sequence
  47. The “Disiguring Mayhem” of Cancer Cachexia
  48. The Body as Metaphor: Social Class and Obesity
  49. Mathematical Models: Obesity by the Numbers
  50. “On the Margin of the Impossible”
  • EPILOGUE: “The Marrow of Zen” and a Beginner’s Mind
  • Acknowledgments
  • Index
  • About the Author

Praise for Of Epidemic Proportions

“Of Epidemic Proportions is gorgeous, and I’m awestruck by how you did it. How did you find those illustrations and how extraordinary that you used them with your blogs? This is one of those situations where the whole is greater than the sum of the parts. Really, this book is a treasure, and I am honored to have a copy.”

Marion Nestle, PhD, MPH,

Paulette Goddard Professor of Nutrition, Food Studies, and Public Health, emerita, at New York University and author of Unsavory Truth: How Food Companies Skew the Science of What We Eat

“What a brilliant and beautiful book! I think every physician and weight/nutritional counselor who deals with health and weight should read this.”

-Sander L. Gilman, PhD, JD,

Distinguished Professor of the Liberal Arts and Sciences and Professor of Psychiatry, Emory University, and author of Diets and Dieting and Obesity: The Biography

“Unique among books on obesity, Of Epidemic Proportions is a virtual tour-de-force. Visually stunning art images and well researched scientific essays.”

-Steven B. Heymsield, MD,

Professor of Metabolism & Body Composition, Pennington Biomedical Research Center, Louisiana State University and President, The Obesity Society

“With her wit, lucidity and deep insight, Sylvia Karasu’s Of Epidemic Proportions is a gift to readers. This is a scholarly work like no other, providing her cumulative wisdom on the science of weight control in a collection that is as much a work of art as a popular science book.”

-Kenneth J. Rothman, DrPH, MPH, DMD,

Distinguished Fellow, Research Triangle Institute and Professor of Epidemiology, Boston University and author, Modern Epidemiology, 3rd edition

“Dr. Karasu’s writings are erudite, thought-provoking and engrossing, challenging us to engage our thinking at the intersection of science, history and culture. I am delighted to keep a copy of her extraordinary and beautifully illustrated book at my desk. It is a tour de force.”

Judith A. Salerno, MD, MS,

President, The New York Academy of Medicine and co-author, The Weight of the Nation, companion book to the 2013 Emmy-nominated HBO documentary series

“A terrific read. Provocative and evidence-based—the best combination.”

-Cass R. Sunstein,

Robert Walmsley University Professor, Harvard Law School, and co-author of Nudge: Improving Decisions about Health, Wealth, and Happiness and the author of the forthcoming How Change Happens.

Praise (continued)

“Obesity is one of the sentinel epidemics of our time. In this humane book, Dr. Karasu offers a breadth of perspectives about the causes and consequences of the obesity epidemic, bringing to our understanding of the issue wisdom and imagination. We will not solve obesity through simple solutions alone. The ideas offered in Of Epidemic Proportions are an important step towards building a better intellectual architecture about the real scope of the challenges presented by the obesity epidemic.”

Sandro Galea, MD, DrPH, Dean, Robert A Knox Professor, School of Public Health Boston University, author of Healthier: Fifty thoughts on the Foundations of Population Health

“Of Epidemic Proportions: The Art and Science of Obesity by Dr. Sylvia Karasu presents her many blogs in a single volume. These cover an eclectic series of topics dealing not only obesity, but also wellness, lifestyle, emotional health, and many other topic issues. Each blog is well researched, authoritative, and beautifully illustrated, including many great paintings. I am confident the reader will find this collection to be informative, entertaining, and both intellectually and visually pleasing.”

Antonio M. Gotto, Jr., MD, DPhil, Dean Emeritus, Weill Cornell Medicine, Provost Emeritus for Medical Affairs, Cornell University

“The book is remarkably thoughtful and rich in content, offering much to reflect on and peruse. The author, through a series of lively, well-researched and beautifully written essays, takes on pressing concerns for health and behavior. Moreover, she has been able to find works of art to illustrate and reinforce her messages. This is a visually and intellectually compelling read.”

Margaret A. Hamburg, MD, Past Commissioner of the Food and Drug Administration (FDA) and President of the American Association for the Advancement of Science (AAAS)

“Of Epidemic Proportions: The Art and Science of Obesity is a remarkable work—visually and intellectually very compelling, the type of work that begs to be looked at. I am delighted to place it on display in the Oskar Diethelm Library, where scholars, practitioners, and historians will be able to peruse it.”

George J. Makari, MD, Professor of Psychiatry and Director of the De Witt Wallace Institute for the History of Psychiatry at Weill Cornell Medicine and author of Soul Machine: The Invention of the Modern Mind

“This lavishly illustrated and beautifully written book brings new insights into the complex areas of eating, weight management and obesity. Dr. Karasu blends extensive knowledge of psychiatry, the humanities, and mind/body interactions to bring a fresh and most welcomed perspective to the multiple inluences that interact in the complex area of obesity…”

James M. Rippe, MD, the Founder and Director of the Rippe Lifestyle Institute and Editor-in-Chief, American Journal of Lifestyle Medicine and author, Lifestyle Medicine, 3rd edition

“I love the intersection of art and science. This book reminds us of how much the inspiration and creativity of both can combine to motivate new insights. Dr. Karasu’s images and blogs help us to put perceptions of our bodies in perspective and to understand the epidemic of obesity.”

-Barbara Jean Rolls, PhD, Professor and the Helen A. Guthrie Chair of Nutritional Sciences, The Pennsylvania State University and author, The Volumetrics Weight-Control Plan