Jules Hirsch, a physician and scientist who helped reframe the modern understanding of obesity by demonstrating that people do not become fatter or thinner simply by indulging in or depriving themselves of food, a finding that supported biochemical explanations for a condition long attributed to personal weakness, died July 23 at a hospital in Englewood, New Jersey. He was 88.
He had complications from a circulatory ailment, said a nephew, Norman Silber.
“The biggest misunderstanding in medicine,” Hirsch once said, is that anyone who wishes to be slim can become so. For decades, as a professor at New York’s Rockefeller University and as a physician at its hospital, he observed obese patients who shed pounds but failed inevitably to keep them off.
He was regarded as a leader among researchers who approached obesity as a medical condition, rather than as the product of psychological frailty. Popular and even some professional explanations had long held that people overate to assuage stress or soothe unhappiness or because they had insufficient willpower.
Hirsch, by contrast, supported the view that biochemical conditions in the body predispose certain people to become fat, thereby placing them at risk for obesity’s frequent accompanying health problems, such as heart disease and diabetes.
“Obese people,” he told The New York Times, “are born with a handicap.”
Beginning in the early 1960s, Hirsch observed that fat cells increase or decrease with changes in weight, and that obese people generally have bigger fat cells and more fat cells than lean individuals. Those discoveries and others opened the door for other scientists to investigate communication between fat cells and the brain, said Rudolph Leibel, a professor at Columbia University College of Physicians and Surgeons and a researcher in the area of obesity and diabetes.
By the late 1980s, studies had linked obesity to metabolism, or the chemical process by which the body converts food into energy. By that time, and into the next decade, Dr. Hirsch, Leibel and other researchers were conducting a study at Rockefeller University that would significantly enrich scientific knowledge of that connection.
The study included 18 overweight men and women and 23 people who had never been obese. They lived for periods of months or years at the university, where Hirsch and his team monitored their activity and controlled their diet to increase, decrease or maintain their weight.
The study, published in the New England Journal of Medicine in 1995, was surprising because it showed that participants, obese and lean, tended toward a set weight — whether high or low. When they got heavier, their metabolisms increased to burn calories more quickly, pulling them back to their original weight. When they lost pounds, their metabolism slowed down, as if in an effort to return to the earlier weight.
The researchers observed, furthermore, that when obese patients lost weight, they exhibited signs of anorexia or starvation. The study was significant, said Leibel, because it helped explain why obese people who lose weight struggle so mightily to keep it off. It also indicated the importance of weight maintenance, he said, beyond initial weight loss.
Hirsch once described himself as “really in the doldrums” because of the difficulty of treating obesity. Obesity “isn’t laziness,” he told the Chicago Tribune. “People who are obese know they are obese and they try not to be, but we don’t have the wherewithal yet to help them.”
Jules Hirsch was born in New York City on April 6, 1927. His mother, a housewife, and his father, a tailor and shopkeeper, were immigrants from Eastern Europe.
He grew up in Asbury Park, New Jersey, received a medical degree at 21 from what is now the University of Texas Southwestern Medical Center in Dallas and served in the Public Health Service before joining Rockefeller University in 1954.
His marriage to Constance Pendergast ended in divorce. His wife of four decades, Helen Davidoff, a psychoanalyst, died in 2010. Survivors include two sons from his first marriage, Joshua and David Hirsch.
Hirsch chaired a National Institutes of Health panel about obesity in 1985 and compared the risks of the condition to those of smoking. “We want the average American to know that obesity is a disease — it is not a state, like loneliness,” he said. “It is a disease and carries an increased risk of mortality. It deserves to be treated and considered just as seriously as any other illness.”
He recognized that it is hard to lose weight but encouraged people to try. “They will feel miserable,” he told the Times. “But if they can do it, they will be better off.”
Hirsch disapproved of crash diets, instead advocating simple changes that were sustainable, such as taking the stairs rather than the elevator or decreasing meal sizes.
He was described as deeply caring toward his patients, whom he considered collaborators more than subjects, and conveyed to them his conviction that obesity was a biological problem, like high blood pressure or high cholesterol. “That perspective,” Leibel said, “gave relief to many of them, because for the first time they heard from an authority in this field that it wasn’t a personal failure on their part.”
A burden was lifted, Leibel said, when they heard that they “had a problem that was real and not of their own making, that these issues were not created by them, but rather that they were the victims.”
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