Medicine

At Stat News: Science has got obesity all wrong

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A science writer reflects on the way paradigms work:

I’ve been a science reporter for 40 years. I’ve wanted to assume that the experts I interview can be trusted to understand their subjects. Put simply, to get it right. But watching researchers in the field of obesity almost blindly follow a failed paradigm has led me to cross a line that few journalists ever do, to publicly embrace and promote a minority opinion that many in the obesity field think is quackery.

For nearly a century, obesity research has been predicated on the belief that the cause of the disorder “is an energy imbalance between calories consumed and calories expended,” to quote the World Health Organization. By this ubiquitous thinking, obesity is an energy balance disorder: People get fat because they take in more calories than they expend. They stay lean when they don’t.

This is the central dogma of obesity science…

People don’t get fat because they eat too much, consuming more calories than they expend, but because the carbohydrates in their diets — both the quantity of carbohydrates and their quality — establish a hormonal milieu that fosters the accumulation of excess fat.

Gary Taubes, “How a ‘fatally, tragically flawed’ paradigm has derailed the science of obesity” at Stat News (September 13, 2021)

The paper is open access.

If he’s right, a popular paradigm it was dangerous to doubt will come under fire.

28 Replies to “At Stat News: Science has got obesity all wrong

  1. 1
    polistra says:

    The simple mechanistic explanation hasn’t been heard much lately. Most people who discuss the subject, including science writers, understand that genes are part of the picture and a feedback ‘setpoint’ is the rest of the picture. The body insists on maintaining a fixed weight. When the setpoint is too high, changing input and output won’t help.

  2. 2
    Viola Lee says:

    As Polistra says, this is an out-dated and overly simplistic description of why people get fat. I don’t think anyone thinks it is a simple issue of calorie intake. Carbohydrate intake, of various sources, and insulin resistance are major factors being studied these days.

  3. 3
    Querius says:

    There a great reference in the article with a link to a paper published a few days ago in the The American Journal of Clinical Nutrition.
    https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqab270/6369073

    This information in the paper is compatible with my experimental diet that enabled me to lose 42 pounds in 6-7 months, maintain my weight loss, and resulted in my doctor taking me off of my diabetes medication. Woohoo!

    -Q

  4. 4
    jerry says:

    If anyone is interested in what causes obesity, then watch Giles Yeo. He’s the world expert on the topic.

    https://www.youtube.com/watch?v=GQJ0Z0DRumg

    https://www.youtube.com/watch?v=88tWJ1p5d4o

    I just came from a conference where about 1/3 of the young unmarried women (about half of attendees) were about 50-150 pounds over weight. This would not have been seen 50 years ago according to Yeo.

    We ate lunch and dinner at a nearby mall and must have seen over a hundred people both men and women over 300 pounds.

    Now maybe this is self selection for those who attended this conference and hang out in malls these days.

    Yeo gives the best explanation and it’s genes and processed foods and the types of foods. Basically it’s calories in and the types of calories that is the problem. Genes will affect one’s desire for food. The source of calories will affect one’s sense of fullness. And thus, desire to eat.

  5. 5
    johnnyb says:

    @Viola and @Polistra – I think the problem here is that there actually is quite a long span of time between two events which are presumed to occur simultaneously:

    (a) the data is available for X and everyone who has read the data agrees with X, and

    (b) experts in the field (including many you might expect to know this), and especially experts in tangential fields, switch to working according to X.

    I can almost guarantee you that most doctors (the people on the ground who are called on to make practical decisions with this kind of information) view weight loss as primarily a matter of diet/exercise, and treat it as such.

    Another instance of X that I’ve found is the realization that organisms can direct their own evolution. Many people working in molecular evolution are still completely ignorant of this even as a possibility.

    Did a video on this:

    https://www.youtube.com/watch?v=a5_4ihFK8v8

  6. 6
    Viola Lee says:

    Johnny writes, “I can almost guarantee you that most doctors (the people on the ground who are called on to make practical decisions with this kind of information) view weight loss as primarily a matter of diet/exercise, and treat it as such.”

    Why do you say that with such confidence? As Querius’s article points out, glycemic load and insulin resistance are metabolic factors that add to the foundational ideas that a diet low in processed food along with exercise is good for one’s health, for more reasons than just helping with obesity.

    So why do think you can “guarantee” that most doctors aren’t aware of some of these newer ideas?

  7. 7
    Querius says:

    Viola Lee @6,

    For one thing, of my present doctor and those I consulted with in the past, none of them knew about this information. All of them used the calories in/calories out model and advocated more exercise and caloric restriction, which obviously doesn’t work.

    At least my current doctor, although very skeptical, agreed that I could try it.

    So why do you think he’s still skeptical after my dramatic weight loss and blood tests returning to the normal range?

    -Q

  8. 8
    EDTA says:

    Within my lifetime, people have gone from mostly healthy weight to severely overweight. This has coincided with a great increase in sedentariness and taking in vastly more food of all types than necessary. Maybe someone can explain how a genetic change can some along that quickly (unless you are saying that overeating switches something in our epigenetics to make the problem worse.)

    What is most concerning is that I hear people using insulin resistance, genetics and so on, to set personal responsibility aside and keep eating as if there were nothing they could do about it.

  9. 9
    Viola Lee says:

    To Q: is your doctor skeptical that the steps you took improved your situation a lot? That’s too bad.

    To ETDA, I don’t think anyone is saying that biochemical, including genetical, reasons for some weight problems excuses one from the responsibility to eat well, exercise, sleep well, avoid excessive alcohol, etc, which are all known risk factors for obesity, diabetes, and poor health in general.

    FWIW, I had my annual medicare checkup today, which was a good experience, and we discussed my blood sugar level as indicated by a recent HA1C test, and the NP remarked that I didn’t appear to have much belly fat, and appeared to be handling my carb intake well, so I didn’t show signs of a metabolic issue with insulin resistance. She seemed well informed about all the issues we are discussing here.

    However, I hang out with a pretty progressive and medically literate crowd in a fairly progressive city, so perhaps the OP and johnnyb’s experiences are based on a different mini-cultural experience.

  10. 10
    Viola Lee says:

    For the record (on a record), this song opened my mind to extended improvisational music almost 55 years ago, and I’ve been a fan of the Grateful Dead and its extensions ever since. Just thought I’d throw this in for all the Deadheads on UD! 🙂 Viola Lee Blues

  11. 11
    jerry says:

    All of them used the calories in/calories out model and advocated more exercise and caloric restriction, which obviously doesn’t work.

    It has worked forever and still does.

    Yeo analysis of weight control

    It ain’t easy – brain controls wants based on hormones feedback

    Eat a little less -eat in moderation

    Food that takes longer to digest makes you feel fuller. Protein then fat then carbohydrate in that order provide feelings of fullness per calorie consumed.

    Don’t blindly count calories it’s caloric availability – for every 100 calories of protein only about 70 are available while for processed sugar it’s close to 97.

    Eat more unsaturated fats – plants and fish are higher in unsaturated fat.

    Don’t fear food – Must fit lifestyle- all diets work – must suit you and be able to be sustained

    Ways to increase basal metabolic energy expenditure- gain weight so obviously counter productive but changing body weight into muscle works. Also exercise works to increase energy expenditure which is why it is recommended for weight control

  12. 12
    Querius says:

    A friend of mine who started using my method already lost 25 lbs.

    But with regard to diet, politics, and Darwinism, actual evidence standing in front of someone doesn’t seem to bear much weight. So, I’ve noticed the following things after I lost so much weight (almost 90 pounds in 3-4 years):

    a. People noticed and complimented me. (thank you!)
    b. They asked me what I did to lose the weight. After I described my method, they’d tell me their own unshakable opinion about what really works.
    c. Then, they’d compliment me on my Determination and Willpower. I’d tell them that I don’t have any more D&W than anyone else.
    d. Finally, they’d express some skepticism about my method. With me standing there in front of them. Minus 42 pounds. And they’re skeptical? Go figure.

    -Q

  13. 13
    Eugene says:

    So what diet actually works?

  14. 14
    jerry says:

    So what diet actually works?

    Lots of them work.

    I suggest you watch Giles Yeo. He’s the world expert on diets. Here’s a video on his findings

    The Truth About Diets with Dr Giles Yeo

    I summed up these research findings above. He’s a geneticist and very entertaining too.

    https://www.youtube.com/watch?v=IgLyH2fybSQ

    Aside: there are calorie counting apps that help discipline you and also record offset calories from exercise. If you record everything you eat one starts to realize where the calories are coming from.

  15. 15
    ET says:

    Intermittent fasting works, especially when coupled with an active lifestyle. start with 12 hours of fasting a day and work up to 16 hours of fasting a day. And when you eat just do so until you are not hungry, not when you are full. Eat more proteins as that will help you stay in the not hungry mode.

  16. 16
    Querius says:

    Eugene,

    I strongly agree with ET that intermittent fasting works better than calorie restriction. This is true even when the caloric input is identical over a week with traditional (unsuccessful) methods. Apparently, it has to do with insulin levels and the five hunger hormones involved.

    Our bodies can be compared to hybrid cars that can operate on either electric or petroleum energy: our bodies can use either ketones (from fats) or glucose (from carbs/sugars).

    – When your body has glucose to burn, it uses this first. When your body runs out of glucose, it relies on stored fat in the form of ketones. This happens every night when you sleep, otherwise you would die.

    – When you consume any excess carbs and sugar, you have an insulin response that keeps your blood sugar level constant. But, as long as you have any insulin in your blood, your body won’t release ketones and you get fatter and fatter!

    – If you reduce your caloric intake, your body concludes that you must be in a famine and it responds by lowering your basal metabolism by as much as 30% or so to offset the caloric deficit. Thus over time, you lose weight only at the beginning of the diet and then gain back all the weight you lost despite your dieting. This was confirmed in a study of thousands of dieting women over a period of nine years IIRC.

    – With intermittent fasting, you don’t lower your basal metabolism, you don’t get hungry, and you don’t feel lethargic. Not feeling any hunger was my biggest surprise.

    BUT, you must slowly step into this diet for you to able to succeed. I can tell you more if you’re interested.

    -Q

  17. 17
    johnnyb says:

    @Viola –

    Two reasons I can almost guarantee.

    (1) Experience – my own doctor is heavily wedded to this idea.

    (2) General understanding of knowledge dissemination. It usually takes 20-30 years for a widely taught paradigm to be generally overturned in any profession. Occasionally there are exceptions (I think the ulcer turnaround was relatively fast), but, as I pointed out above, despite there being evidence since the ’90s of directed mutations, most molecular evolutionary biologists dismiss it. The evidence really turned up in the 2010’s and later, so I imagine that about 2030 it will be a relatively accepted phenomena among professionals.

    People rarely change their habits, and even more rarely their models of understanding. Even just knowing about endocrine issues in general doesn’t translate to actually translate into changing your practices as to what you recommend to others. You have to internalize it, and that takes a lot more time than people give it credit for.

  18. 18
    johnnyb says:

    As an example – I’m a computer programmer. The way I have historically stayed on top of things is by hiring new employees and asking them how we should do things. A decade ago we switched our company from PHP/Perl to Ruby-on-Rails because we had a developer just out of high school telling us how great it was. Without that, I would probably still be writing web applications with Perl code (not a good thing if you’re not on the inside of software development).

    Similarly, despite the explosion in source-code-management tools over the last TWO decades, most embedded software developers I’ve seen are still making folders and zip-files on their local computers for different versions. Trying to get them to use newer (and easier and more reliable) systems is like trying to get my kids to eat their vegetables.

  19. 19
    Querius says:

    Johnnyb @17,

    So true! I’ve been finding that out myself for my own persistent paradigms. They’re hard to shake!

    Sometimes it takes much more than 20-30 years.

    For example, it’s been around 100 years since the discovery of quantum mechanics, but materialism still exists despite experiments that show all reality is based on collapsing probability waves (wavefunction). Similarly, it’s been demonstrated that lift in wings doesn’t involve the Bernoulli effect, but the old model is still taught. There’s a ridiculous amount of evidence now against current origin-of-life theories, but they’re still taught in schools.

    Johnnyb @18,

    LOL! And I’ve had similar professional experiences. I’ve also seen that when something new and better emerges, without widespread acceptance or mandates, the old technologies and ways of doing things will creep back in and take over. People resist change, even when it’s for the better.

    -Q

  20. 20
    Lieutenant Commander Data says:

    The evidence really turned up in the 2010’s and later, so I imagine that about 2030 it will be a relatively accepted phenomena among professionals.

    Let’s not confound ideology (materialist dogma in biology ) with eating/working habits . First involves ignoring reason and truth ,second involves laziness.

  21. 21
    EDTA says:

    Johnnyb and Querius,
    Just be sure to watch out for software development “fads”, which actually do far more damage than good. Separating fads from improvements isn’t easy, because we do not have the luxury of controlled scientific tests to see which tool/methodology/language/etc. will actually bring more productivity.

    (This site is great! We can discuss software, dieting, and ID all at the same time! 😎

  22. 22
    johnnyb says:

    @EDTA – I fully agree. I actually try to stay a little bit behind for this very reason. One of my favorite essays is How it feels to learn JavaScript in 2016.

  23. 23
    Querius says:

    EDTA,
    Yep, same experiences here as Johnnyb regarding technology fads. Many of these fads replace some aspects of legacy methods and technologies, but result in not much of an improvement overall or, worse yet, what you gain in one area is lost big time in another area.

    I also agree on holding back from the “bleeding edge.” Some companies perform proof-of-concept tests or even run technologies in parallel for a while. While this is expensive, companies learn what critical factors emerge as a new technology matures.

    But truly significant breakthroughs are indeed frequently met with skepticism, political/organizational issues, and resistance to training (typically poorly done).

    -Q

  24. 24
    johnnyb says:

    I actually wrote an article about this not too long ago – Is Technology Running Backward?

  25. 25
    Silver Asiatic says:

    Things like some cutting-edge alternative energy which will end up costing more and being worse for the environment because consequences weren’t thought-through.
    Or self-driving cars – supposedly that was going to happen within a few years and now some are saying it’s virtually impossible.
    The biggest thing I see is machine-learning and predictive analytics which are claimed to be able to tell the future in business and investments — but show some surprising failures and can have disastrous results. Innovators on the cutting edge in those cases were overconfident in the new technology that supposedly didn’t require human knowledge.

  26. 26
    jerry says:

    An article in the Federalist on the prevalence of obesity. Some facts

    35 percent of residents in 16 states consisting of adults with obesity in 2020

    All states and U.S. territories in 2020 saw obesity rates exceed 20 percent

    42 percent of Americans nationwide were obese in 2017-2018

    long-term risks for heart disease, strokes, type 2 diabetes, and certain types of cancer, obesity as much as triples an individual’s chances for hospitalization from COVID-19.

    CDC data in March revealed 78 percent of those hospitalized with the novel coronavirus were obese or overweight

    More than 73 percent of U.S. adults aged 20 and older were overweight in 2017-2018

    nearly half of the nation’s children aged 5 through 11 now qualify as either overweight or obese.

    Nearly 46 percent of children aged 5 through 11 were reported obese or overweight following months of school closures, compared to 36 percent pre-pandemic.

    https://thefederalist.com/2021/09/16/states-where-a-third-of-people-are-obese-rise-to-16-nearly-doubling-in-two-years/

  27. 27
    Querius says:

    Johnnyb @24,

    Great article! Thanks for posting it.

    And every new technology has a learning curve that results in a productivity dip in the short term. Deploying too many technology changes and updates results in continual reduction in productivity.

    -Q

  28. 28
    Querius says:

    Jerry @26,

    Wow, that’s truly horrible! So I downloaded the latest 164-page FDA dietary guidelines:
    https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
    In it, I read

    Over time, eating patterns in the United States have remained far below Dietary Guidelines recommendations (Figure I-1). Concurrently, it has become increasingly clear that diet-related chronic diseases, such as cardiovascular disease, type 2 diabetes, obesity, liver disease, some types of cancer, and dental caries, pose a major public health problem for Americans. Today, 60 percent of adults have one or more diet-related chronic diseases (Table I-1).

    Gosh, I wonder why.

    Elsewhere they state that “About 74% of adults are overweight or have obesity.” Then, they recommend the following:

    Common characteristics of dietary patterns associated with positive health outcomes include relatively higher intake of vegetables, fruits, legumes, whole grains, low- or non-fat dairy, lean meats and poultry, seafood, nuts, and unsaturated vegetable oils, and relatively lower consumption of red and processed meats, sugar-sweetened foods and beverages, and refined grains.

    Same as usual. They go on to state

    The best way to evaluate calorie intake, in comparison to calorie needs, is by measuring body weight status.

    and

    Meeting the Dietary Guidelines recommendations within calorie needs can help prevent
    excess weight gain at every life stage and support overall good health.

    and

    In addition, the high percentage of the population with overweight or obesity suggests that many people in the United States consume foods and beverages that contribute to a calorie imbalance, a situation more likely to occur with low physical activity.

    and

    Losing weight and maintaining weight loss is not a simple task. It requires adults to reduce the number of calories they get from foods and beverages and increase the amount expended through physical activity.

    Same old calorie restrictions with greater exercise program that doesn’t work. Their big dietary villains are (1) Added sugars, (2) Saturated fat, and (3) Sodium.

    And they continually blame people for failing to follow their guidelines.

    -Q

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