March 11th, 2013

What we don’t know about obesity could fill a book—and has

The New England Journal of Medicine has published an article that sounds both interesting and brave, about obesity’s myths vs. what we actually know.

I write “sounds” because the article itself is behind a firewall, and I’ve only read this NY Times piece describing it. But it’s a rare thing for a medical article to try to explode the common “wisdoms” about obesity that are not based on much of anything except some correlations.

Here’s the gist of the article:

MYTHS

Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.

Set a realistic goal to lose a modest amount.

People who are too ambitious will get frustrated and give up.

You have to be mentally ready to diet or you will never succeed.

Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Ideas not yet proven TRUE OR FALSE

Diet and exercise habits in childhood set the stage for the rest of life.

Add lots of fruits and vegetables to your diet to lose weight or not gain as much.

Yo-yo diets lead to increased death rates.

People who snack gain weight and get fat.

If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

FACTS — GOOD EVIDENCE TO SUPPORT

Heredity is important but is not destiny.

Exercise helps with weight maintenance.

Weight loss is greater with programs that provide meals.

Some prescription drugs help with weight loss and maintenance.

Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate.

Personally, I’ve long been impressed by how much garbage is out there about weight loss. My own observations?

(1) There’s a difference between overweight and obesity, and it’s not even clear that the first has negative health consequences.

(2) The path to overweight and/or obesity is different for different people, and there is no universal remedy.

(3) In fact, remedies are very difficult to come by, and it’s not because of some moral weakness or lack of willpower in overweight people. Losing weight and keeping it off is very, very hard for most overweight or obese people.

(4) Nevertheless, it’s easier for men than for women, and for young people than for the middle-aged. This is for physiological, not psychological, reasons.

(5) Many people who are overweight do not eat more than many thin people, or exercise less.

38 Responses to “What we don’t know about obesity could fill a book—and has”

  1. fmt Says:

    I don’t know how you could “observe” #5 without spending 24 hours a day following people around with a scale and a notepad. I know I’m likely to eat more when no one is looking.

    I was in Brooklyn yesterday and saw almost no fat people. Yet, here in a rural upstate backwater, they are everywhere you look. Maybe geography plays a role.

  2. Occam's Beard Says:

    (3) In fact, remedies are very difficult to come by, and it’s not because of some moral weakness or lack of willpower in overweight people.

    Of course it is. How many fat people does one find in areas suffering from famine? How about in concentration camps? When exigent circumstances substitute for willpower, the wide rides lose weight. Every. time.

    Q.E.D.

    (5) Many people who are overweight do not eat more than many thin people, or exercise less.

    What the secret of the thin? Tapeworms? Grossly inefficient GI tracts? Or have the overweight somehow overthrown thermodynamics?

    Calories absorbed (to allow for tapeworms, etc.) > calories used —> obesity. As simple as that, and as ineluctable as gravity.

    Sorry for the asperity shown above, but I do get tired of hearing pseudoscientific mumbo-jumbo excuses for obesity, and assorted half-based pop sci self-help books on why “it’s not your fault.” Of course it is. Who else is feeding them?

    Two choices: People need to eat less, exercise more (i.e., do something about it), or accept being obese (and not whine about how it’s not their fault). Either one works for me.

  3. JJ formerly Jimmy J. Says:

    Oh boy, here we go again. Weight control – one of the major issues of our society. Okay, I’ll weigh in again because I have some anecdotal evidence to share.

    Some people, my wife is one, are born with a metabolism that is perfectly suited to living in lean times. She can maintain her weight at about 1100-1200 calories per day. To lose weight she has to eat less than 900 calories per day. And she is not an inactive person. She is active doing housework, gardening, walking, and going to the gym. Of course, this is, as they say, anecdotal evidence. But it is my guess that some percentage of people have this genetic tendency to have a low basal metabolism. 1200 calories a day isn’t much food. 900 calories is even less.

    We wouldn’t know this if I hadn’t gotten involved in bodybuilding at age 63. I had always been able to lose weight fairly easily up to that point, but to get really lean for contests I had to watch my diet very closely. (I could lose weight by eating 1800 calories/day and maintain at 2400.) My wife had put on about 25 extra pounds between age 55 and 62, so when I got lean, she decided she wanted to do something to lose her pounds as well. That involved getting her basal metabolism checked and then realizing that she would have to go to 900 calories a day. That meant one poached egg and a half an orange for breakfast. A protein shake and a small tossed salad dressed with vinegar and just a touch of olive oil for lunch. Dinner was a very small serving (4 0z.) of chicken, beef, fish, or turkey, a steamed vegetable, and some sugar free jello. She would often have only a protein shake. That sort of eating, in this society, requires real discipline.

    We kept at it for the five years I competed in bodybuilding. When I quit bodybuilding we tried to eat sensibly (But indulged in eating out a lot. {:>( ) and continued to go to the gym and stayed active. However over a period of the next six years I gradually gained 40 pounds and she had regained her 25 pounds. We realized that we needed to start exercising eating discipline again. It took us longer to lose and neither one of us has gotten back to the condition we were in in our sixties. I weigh 185, which was my best weight for body building contests, but now have about 15 pounds of unwanted fat because, in spite of regular weight lifting, I have lost 10-15 pounds of muscle over the intervening 7 years.

    Neither one of us has the energy to do as much as we did, so we have had to watch our diet even closer. Both of us now have slightly compromised kidney function and that means less salt (very few prepared foods) and more water (Less coffee, tea, and soda) ) than most people drink. We have to eat to live, not live to eat.

    From my experience I do know that I do better on a higher protein, lower carb diet even though many people don’t do well on it. (That one’s for you, neo.) I also know that the discipline of counting calories and getting in the gym regularly is something that most people are not willing to do. MY wife and I often wish we could do away with it and just live the way we did in our 20s. (Youth, it’s wasted on the young.)

    Possibly some people would benefit from having their basal metabolism checked and a program of education to show them how much and the types of food they need to eat in order to maintain or lose weight. Then again, maybe not.

    OC said, “How many fat people does one find in areas suffering from famine? How about in concentration camps? When exigent circumstances substitute for willpower, the wide rides lose weight. Every. time.”

    Yes and those who had a naturally higher basal metabolism were the first to die because they had few fat stores to begin with.

  4. MBE Says:

    In November 2012 I read a book called “Why We Get Fat and What To Do About It” by Gary Taubes – I read it after coming across numerous references to it on Instapundit (and I gather Glenn Reynolds is also following it now) . Four months later I am fitter and trimmer than I have been for more than twenty years, and I’m full of energy (with all the calories in fat, burning fat gives you a real buzz).

    Taubes digs into the science and physiology behind gaining and losing fat. He explains, very clearly, what causes fat cells to hold fat (ie hold the fatty acids that should be circulating through our body providing energy) and to NOT hold fat. It doesn’t just happen magically: it is a process driven by two particular enzymes, which are in turn activated (or deactivated) by Insulin levels.

    Insulin, and the fat retention or release it controls, is a survival mechanism which enables our bodies to store vital fat (the single most important thing in our diets) while we burn the sugars from carbohydrates, which in evolutionary terms were periodic foods for ancient hunter-gather humans. The Agrarian age from 5,000+ years ago brought increased carbohydrates into our diet, but the Modern Age – say the last two-three generations – has made carbohydrates (and particularly sugars) an everyday, dominant part of our diet.

    Our body’s physiology struggles with this onslaught of carbohydrates, and the consequences vary: obesity, high blood pressure, asthma, diabetes (including Diabetes 3 – Alzheimer ’s disease) and heart disease etc). People vary in how they react, but the overall consequence is an unhealthy population, especially as the people age and their cellular insulin resistance increases (ie as you get older you produce more insulin, and put on more weight). The exercise that keeps you trim while younger is no longer sufficient as you age.

    As Taubes says, you can do lots of things to lose weight, but the ONLY thing which will work in the long run is to reduce carbohydrate intake – especially as part of the daily diet. Binge eating carbs every so often is better than eating them each day (I still eat my ice-cream, but irregularly!).

    The litmus test to use when talking how to control weight is this: does the advice demonstrate an understanding of what causes fat cells to hold or release fatty acids (glycerides), or causes glycerides to convert to triglycerides (permanent fat)? If it doesn’t start with that understanding, the advice will probably be hit-and-miss guessing. Understand the physiology, and it becomes easy to figure out what to do to control weight, and a host of other related issues (eg my decades-long Asthma disappeared after a week of cutting out carbohydrates, and hasn’t returned).

    A high carbohydrate diet, particularly with simple carbohydrates such as sugars, cause the body to act like a parasite, sucking glycerides (what we [should] use for energy) out of our bloodstream and into fat cells for storage: Obese people don’t get fat because they eat too much, they eat too much because they are starving because of this fat accumulation process, and if they diet too much (but still eat carbohydrates) they will compensate by becoming lethargic.

    Calories themselves are pretty much irrelevant: it’s all about where they come from. Put simply, calories from protein and fat are good, calories from carbs are bad (Taubes’ more technical book, which I haven’t read, is called “Good Calories, Bad Calories”, “Why We Get Fat….” is the simplified version for us non-medical types.).

    Taubes’ work is comprehensive, and deals with the increased cholesterol consequences of a high-fat diet.

    Following Taubes’ guideline has changed my life, and I’ve finally beaten that gross middle-age waistline bulge – in 4 months. I can’t recommend it highly enough if you are getting desperate and what to take control of your health.

    The other thing is how easy it is – I eat as much as I want when I want. What I did find very surprising is, once you cut out carbohydrates, just how little you feel like eating and need to eat. You also find after a while that eating carbohydrates becomes less enjoyable (unless it is ice-cream!) because they make you feel so heavy afterwards. That tiredness after a meal, especially lunch?: its carbohydrates causing insulin levels to rise, causing glycerides (energy) to be sucked out of your system.

    Reading Taubes’ book, and trying out what it recommends, has made me realise that the science around food health is largely pseudo-science, and it actually made me think of global warming science: more activist than real. Taubes goes through the science in some detail, and while it can be a bit tedious at times, it is important to understand the “why’s” behind what is right and wrong.

  5. neo-neocon Says:

    It’s interesting to me how many people persist in being so very certain about things that are just not true.

    We’ve discussed this stuff over and over in comments, and I have no interest in fighting the same boring fights. Taubes in particular–his boosters come to every single thread about weight, and I refer you to all the previous times I’ve talked about him (do a search, but here’s one discussion that focused on it).

    As far as how much thin people eat vs. how much heavier (not obese) people eat, not only is the fact that thin people do not necessarily eat less than fat people supported by research (see this, and even this from Taubes, and all sorts of research about setpoints), but there is plenty of evidence that being slightly overweight is healthier. I’ve written about that research before, too.

    As far as why I say that I’ve observed that thin people do not necessarily eat less than fat people, I know plenty of both and have lived with them for long periods of time, including having roommates, and I have personally observed it under circumstances where I pretty much know exactly what they’re eating on a daily basis.

    As far as the Taubes diet goes, also please look at this comment of mine, and the entire thread. And see this,/a> about Atkins.

  6. neo-neocon Says:

    Occam’s Beard:

    Your simplistic thinking shows an ignorance of the complexities of the topics of weight, hunger, weight regulations, and weight loss.

    Please see my above comment for some links.

    But also, on the topic of willpower, the research on setpoints is relevant.

    And what happens to people when they starve (as in concentration camps) is completely irrelevant. No one is saying that if fat people starve they don’t lose weight; of course they do. This has nothing to do with willpower. Surely you’re not suggesting people should literally starve themselves, and that would be demonstrating the proper willpower they need to lose weight? That is absurd. Our entire physiology is geared to not allow us to starve, and to suffer when we do. No sane person would starve voluntarily.

  7. Occam's Beard Says:

    Your simplistic thinking shows an ignorance of the complexities of the topics of weight, hunger, weight regulations, and weight loss.

    And yours, neo, shows an ignorance of thermodynamics, which trumps all of the above and renders them irrelevant, which was my point. It is rather like saying a point I might make about gravity was irrelevant because I’m ignorant of the complexities of astrology. Being in the house of Cancer with Scorpio rising doesn’t change the inverse square dependence of gravitational attraction.

    Here’s my point in a nutshell:

    It is not possible to put on weight without eating more calories than one expends. Or do you dispute that? Is there some mystical physiological phlogiston of which I’m unaware?

    No one is saying that if fat people starve they don’t lose weight; of course they do. This has nothing to do with willpower.

    Has nothing to do with willpower? What does if have to do with, then?

    You’ve missed my point, which is that obesity does not result from “hormones” or any other pseudoscientific rubbish one hears blamed, but rather from caloric intake with respect to caloric expenditure. It is so important, so fundamental, I will say it again:

    It is not possible to put on weight without ingesting more calories than one expends.

    To lose weight, fat people don’t have to “starve,” the emotionally loaded term you used several times above. They’re presumably not going for the Dachau or even the supermodel look. They just need to eat less.

    Simple, really.

  8. Occam's Beard Says:

    The perfect analogy: people who claim that they can power their cars on water, or some such. No amount of fiddling with the timing, fuel injectors, or whatever else, will ever allow an engine to run on water. Electrons flow downhill to the terminal electron acceptor, which in our world is almost always oxygen. There’s no getting around it, regardless of the source of those electrons (gasoline, hydrogen, natural gas, whatever).

  9. parker Says:

    Genetics has to play a role. I weigh about 6 pounds more than I did 57 years ago. My wife is petite. We both exercise less than we did just 5 years ago due to arthritic knees. We both have healthy appetites. Our children are lean.

    However, except for those who have glandular disorders, I have to agree that “thermodynamics” can not be ignored.

  10. Occam's Beard Says:

    MBE, no offense, and I haven’t read Taubes’s book, nor do I intend to, but if this is a faithful representation of his views, then it’s pseudoscientific claptrap, as I’ve long suspected. There are too many scientific errors to catalogue them all in detail, but

    1. carbohydrates have been a crucial source of energy since … forever (and are one to this day for all primates);

    2. the maladies you cited are almost all diseases of old age, not carbohydrate ingestion, and life expectancy is now almost twice that in 1900 (when it was mid-forties), so naturally the incidence of these diseases (and cancer, for the same reason) has gone up. Major cause of death in 1900? Tuberculosis.

    3. obesity has only become a problem in the last two generations at most; look at photos of high school kids in 1970 to see the truth of this;

    4. Fatty acids are NOT glycerides; they are long chain (>= C4) carboxylic acids. Conjugation of fatty acids to glycerol (1,2,3-propanetriol, i.e., a trihydroxy compound) yields glycerides (fatty acid esters of glycerol), most of which exist as triglycerides (i.e., all three hydroxyl groups esterified to fatty acids).

    5. Sleepiness after eating results from diversion of blood flow to the GI tract; nothing to do with carbohydrates.

    My guess: if this is a faithful representation of Taubes’s views, then as I have suspected he is a charlatan, who moved from physics (where there is no money as a popsci author) into weight loss (where any rubbish will sell). If that be true, he is a worthy successor to Carl Sagan, or an upmarket version of Kevin Trudeau.

  11. Don Carlos Says:

    I will briefly weigh in as a retired MD.

    There are myriads of shared physiologic mechanisms (the functional equivalent of OB’s thermodynamics), but there are variations, which still fall into the ‘normal’ range.

    To mess with one variable may result in altering the many other physiologic variables to different degrees in different individuals.

    It is biologically dangerous and fallacious to invoke a single Law (e.g. thermodynamics) as the single, common thread pulling on all physiologic variables to the same effect in a population of individuals. Cushing’s disease causes obesity of a certain type, to different extents in different individuals; hypothyroididm causes a different obesity pattern. Try thermodynamic fixes on them? Good luck. We figured out the etiologic variable in each condition long ago, but there may be many more, akin to undiscovered comets which we never knew existed but will be whizzing by in just a year or two.

    As Rumsfeld said, “We don’t know what we don’t know.” As to obesity of the alleged exogenous variety, I leave it at that: we don’t know what we don’t know.

  12. Don Carlos Says:

    OB-
    why don’t you read up on ghrelin as a starter. A fairly recent discovery.

  13. neo-neocon Says:

    Occam’s Beard:

    In your response you seem to actually misunderstand each of my points. You are arguing apples and oranges. I am talking not about how many calories a person takes in, but rather the mechanisms of hunger, satiety, and appetite regulation, as well as the fact that pound for pound people require different amounts of food to sustain their weights, depending on an enormous number of factors which, as Don Carlos has said, are very poorly understood.

    You are ignorant of what it is that you are ignorant of, which is plenty.

    Sorry if that sounds harsh, but it is absolutely true, I’m afraid.

    You may notice I never said a word about hormones, although it happens to be the case that women (pound for pound) require less food than men, in part because of hormonal influences, in part because their body percentage tends to be composed less of muscle, and probably for many many other reasons.

    I’m really tired of people being so holier-than-thou about weight. If you are naturally thin, or if you have found a solution that works to control your weight if you’re not naturally thin, I’m happy for you. But don’t extrapolate from that to everyone else.

    Just as one of many examples of how complex it is, take the way setpoints appear to work, a mechanism by which the body defends a particular weight and resists efforts to change it in either direction. That’s just one tiny bit of how complex the system is.

  14. Pat Says:

    In 1998 I weighed 220lb and failed a stress test. Because of a change of jobs, I got the opportunity to walk to work. Three miles a day got me down to 190lb without any other changes. During a contracting layover, my wife convinced me to use a treadmill to substitute for the walking I’d been doing. I did that, but it was so boring, I started jogging and walking.

    Eventually, I could run for 30 minutes on the treadmill without dying. Bear in mind that I had been a complete couch potato for 30 years.

    So, I started running a 3 mile loop around my neighborhood. Then I saw a 5K race advertised on TV and I thought to myself, I can do that. So, I did. And it was a blast. So I did a bunch more 5Ks, then 10Ks, and then a half marathon.

    Then I graduated to marathons. My life now has two cycles – winter training for a spring marathon and summer training for a fall marathon.

    It turns out that this couch potato was good enough to qualify for the Boston marathon three times. I could never have imagined such a thing was possible when I took the first steps: walking to work.

    p.s. I had to undergo another stress test quite recently. It was sort of fun watching an accumulating group of nurses ask, “does it hurt yet?”.

  15. Jim Nicholas Says:

    I offer this not as a prescription or advice but as the experience of one person that may or may not be of use to someone else.

    I had not paid any attention to my weight until, at age 30, I was told by the army doc that I was overweight. At 172# and 5’9 1/2″ I had to accept that he was right. I got a bathroom scale and weighed myself each morning, which I have done for the past 53 years. Over a period of 24 months I ate less of my regular diet and lost 30#. I have remained at 142# since. If my weight increases by a pound, I just eat less until it falls back to 142. I had a sedentary job and never found an exercise program that didn’t bore me, and so that was never a part of my weight-maintenance effort.

    The price of this regimen? My wife is an excellent cook and I enjoy eating. Therefore, it is rare that I get up from the table without knowing I would have enjoyed a few more bites.

  16. Occam's Beard Says:

    Cushing’s disease causes obesity of a certain type, to different extents in different individuals; hypothyroididm causes a different obesity pattern. Try thermodynamic fixes on them?

    Interesting, but irrelevant, since we’re not talking about these specific and recognized pathologies that affect fat distribution, but rather overall obesity. And in any case, by your lights, there should’ve been some blimps waddling around Dachau, which surely must have had some sufferer’s from Cushing’s disease in that population. But no blimps were in evidence. Why? Be specific in your answer. My answer: how much you eat (at given activity level) determines how much weigh. Period.

    why don’t you read up on ghrelin as a starter

    Is that what phlogiston’s called now? A mystical substance for inclusion in thermodynamic calculations? Delta G = delta H – T delta S – delta Ghrelin? (For information, is Ghrelin an intensive or extensive variable? If intensive, what’s the extensive variable? And vice versa.)

    Ghrelin (a hormone – gadzooks!) is involved in regulation of appetite. It’s a factor in determining how much a person eats. It is presumably the sole factor in determining how much an animal eats.

    As a voice crying in the wilderness, shouting out to the cognitively disenfranchised, who desperately want to avoid confronting the harsh reality, I say yet again:

    It is not possible to put on weight without ingesting more calories than one expends.

    I notice that no one has rebutted this assertion (or indeed even addressed it). With your failure to do so, you are implicitly validating it.

    It is not possible to put on weight without ingesting more calories than one expends.

    Not possible.

    Face it. Accept it. Believe it. Live it. I know you’d like to believe otherwise. I know you want to believe otherwise. But I am showing you the way. It’s harsh, but it’s the truth. If you’re fat, it’s your fault. The good news: you can do something about it. It’s all up to you.

    You are ignorant of what it is that you are ignorant of, which is plenty.

    Funny, I was just about to say the same about you. How much you weigh depends on how much you eat versus how much you burn. Period. Anyone who thinks otherwise is deluded, and ignorant. I’ll say it yet again, without fear of successful contradiction:

    It is not possible to put on weight without ingesting more calories than one expends.

    The only response I want to read: how one can gain weight without ingesting more calories than one expends. Miss me with all other responses, because they’re worthless, and I try not to step in them when I see them on the sidewalk. A given person ingests 2000 calories a day, expends 3000 calories day, and over a three month period gains weight. Explain: [over to you].

    Taubes aficionados: face it. You’ve been had. OK, you’re not stupid enough to get hosed by the likes of Kevin Trudeau, and are doubtless finding lots of uses for that opposable thumb, but on the other hand (sorry), you did take Taubes seriously. But the good news is that I have some magic weight-loss beans that you can buy at a discount. Yes! Eat these ordinary-looking beans, which are only $29.95 for five of them, and watch the pounds melt away, effortlessly! Operators are standing by …

    Here’s the bottom line: your life is in your hands. No one else’s. Take charge of your own life, make your own decisions, and accept the consequences of those decisions.

    Adulthood, I believe it’s called.

  17. Occam's Beard Says:

    There are myriads of shared physiologic mechanisms (the functional equivalent of OB’s thermodynamics)

    It is biologically dangerous and fallacious to invoke a single Law (e.g. thermodynamics) as the single, common thread pulling on all physiologic variables to the same effect in a population of individuals.

    So physiology does not conform to the laws of thermodynamics? Living systems are somehow special? Vitalism is making a comeback? At what point does a system become free of thermodynamic laws? Whole organisms? Cells? Organelles? Coacervates? Micelles? Macromolecules? Face it: physics/chemistry > biology. If something is “biologically dangerous and fallacious” and yet sound in its physics and chemistry, then the biology is wrong. But that would hardly be surprising, since most of the biomedical literature is crap, as we both know.

    It is intellectually dangerous – indeed fatal – to believe that biological systems are fundamentally different from any other, or to treat them any differently. Biologists in general, and applied biologists in particular, need to be reminded, that vitalism has long since been disproven. There is nothing magical or mystical about living systems. Nothing. Until proven otherwise, at least. So let’s lose the mysticism, and give Deepak Chopra a rest. Until and unless thermodynamics is overthrown (or at least expanded), anything that does not comport with thermodynamics is, in a word, wrong, unless supported by abundant rock hard evidence. And since such evidence is not forthcoming …

  18. Anna Woodford Says:

    I am totally agree with you, but weight-loss surgery could be a dangerous step to reduce your weight, yes you are very true that regular exercise and workout can help you a lot to reduce your weight.

  19. fmt Says:

    Bless you , OB, for sticking with it. I usually throw up my hands and say “Believe whatever you want.” In this world, social science trumps physical science.

    The world produces 50% more calories per capita than it did a little over 100 years ago, and people no longer labor physically as they did. There’re gonna be some fat people, and the reason is apparent.

  20. Sergey Says:

    Self-regulating systems like human (or animal) bodies are notoriously hard to understand and even harder to predict their reactions for external factors. Qute possible that in general this is beyond competence of scientific method entirely.

  21. MBE Says:

    I seem to hit a nerve with you Neo, but having read through your back-story links, I think you actually miss the point of Taubes, as do the commentators in the linked articles (the Scientific American one was very unscientific).
    A point to make is that that it is not a case of one-shoe-fits-all. People vary and there are always exceptions. Similarly the solution for one person does not necessarily mean it applies to all. The key point Taubes is trying to make, and makes very, very clearly, is that there is a basic physiological process that occurs when we eat, and if we are experiencing problems arising from our diet, following through how that process works is the place to start. If obesity is the issue, then look at the process that makes the body retain fat. Understand it, and then decide how to react to it (or what works for you) – Taubes is very clear that different people will need to find different solutions. He doesn’t actually advocate a diet (his inclusion of Atkins is as a requested example).
    The starting point is genetics – this is all important as it is the blue print of your body design. If that design says you are stocky, heavy, plump – whatever – then tough luck because that is what you will be. You can starve yourself for a temporary change, but short of surgery, nothing will trim you down permanently. Following Taubes’ advice and dramatically reducing won’t make you thin, it will simply remove the excess fat over your “design” level. As he makes clear, the best result you will ever get is to be returned to your genetically planned design shape, whatever it is
    I note your comments that being a bit overweight isn’t necessarily a bad thing, and I heartily agree – I’m not interested in becoming thin, I just want to be trim, and that’s a relative thing – I don’t care about a few extra pounds, I just don’t want to be fat.
    Until about the age of 40 I was very slim, and over the following ten years put on a lot of weight. My biggest weight gain occurred during a period where I was dealing with a chronic loose gallstone problem and had to go on a fat-free diet (I never had my gallbladder removed, and once you know what to do, gallstones are actually quite easy to deal with). When you see “low-fat” on foods, it usually means they are high sugar, and it really had an effect. That experience certainly made me very receptive to Taubes message re carbs and fat.
    I got the message loud and clear that the low carb approach doesn’t work for you, although you note you did lose weight under Atkins (I’ve actually never read or followed Atkins – Taubes is more about what to avoid rather than what to eat, other than the importance of fat and protein). Some people do have quite a severe reaction to dropping carbs, and whether the solution is to do it slowly or that it will simply never work for them, is probably genetic. Taubes does discuss this, and candidly comments it’s an area which needs more research – like a lot of this area does. He likens the problem addiction, which may or may not be correct – I would suspect it is in the right direction.
    The key issue however is obesity and that fact it is regarded as a societal problem, and a generally recent problem. Interestingly, historically it was a problem for the wealthy, whereas now it is more an issue for the poor. Taubes attempts to explain obesity in mechanical terms, and I have yet to come across any counter argument that actually tackles his central point that insulin controls fat retention, and that insulin levels rise and fall in conjunction with carbohydrate intake – it’s an extremely fundamental point. Finding a way to make that work if reducing weight is desired is a different matter, and while Atkins is one approach, it’s not the only one – it’s a matter of finding what works for you.
    A practical problem is that it is actually hard work to have a varied, low carb diet – most available foods contain lots of carbs.
    But bear in mind that not everyone is the same, and individuals as well as populations, will vary. People have different metabolisms. Obesity is a reaction to a high carbohydrate diet that SOME people have – but not all. Diabetes will affect some, high blood pressure other, heart disease others, and others will have no distinguishable effects at all; while some poor souls will get everything going wrong, and maybe they are so hyper-sensitive not much will help them. Just like tolerance to milk, it is very clear that some populations have a tolerance to carbohydrates, and others don’t.
    Taubes may not be absolutely right on every point, but his ideas make a lot of sense, and are based on 100 years of scientific research – he hasn’t just made it all up by himself.
    It was interesting reading two of your back-linked articles re Taubes. The Scientific American one basically said, “I’m not sure about most of it, and I eat a lot of carbs but I’m not fat, so it actually doesn’t really make sense” – which is not an uncommon response. And it’s also quite irrelevant once you accept people vary, and not everyone who eats unhealthily (which may describe a great many of us) gets fat, albeit that can also change as we age.
    The other article about Fat was little better – citing many “studies” which basically disproved Taubes views on fat – but providing no details . In writing a rebuttal, these types of writers should be proving their points, not just stating what we must believe. The main point of the rebuttal however completely misses Taubes point on low density cholesterol (LDH), being that there is no evidence that it is a problem UNLESS it is accompanied by a high carbohydrate diet. In the absence of high-level carbs it is actually unclear whether LDH is a positive thing (like HDH) or neutral.

    Occam’s Beard:
    lol – no offense – I’ve trimmed very nicely these past few month’s so disagree all you like!
    Some clarifications however:
    Re Carbs a crucial source of energy since day one – yes of course they have been. The insulin reaction to carbs, causing fat to be stored when carbs are eaten, is proof of that. We are adapted to maximising the availability of carbs by using the energy from them first, and that adaption highlights how fundamental carbs have been to human development. The modern problem is that we are now overloaded with carbs, and many people react in an adverse manner: some become obese. Others react in different ways. What was a survival mechanism is now, for many people, a disadvantage.
    Re Maladies and old age etc – yes and no. We will die of something and aging will bring on a range of health issues. That actually isn’t relevant because we aren’t talking about, say, every single case of heart disease. We are talking about the cases where the disease occurs as a reaction to diet, just as might be the case with cigarette smoking (not every smoker gets heart disease or lung cancer either). A high carbohydrate diet appears to trigger a range of reactions in many people that weren’t apparent in earlier generations – obesity, heart disease, diabetes, asthma etc – noting that there may be other reasons as well, including that we live longer.
    Fatty Acids and glycerides – my oversimplification. Read Taubes, he explains it thoroughly (which is why I would expect his detractors to be able to be detailed in their pointing out of errors).
    Sleepiness after eating – NO. Try eating a carb free meal. I have and the difference is very noticeable, amazingly so.
    I’d suggest reading Taubes (especially the more detailed “Good Calories, Bad Calories”) before labelling him a charlatan. There is a reason why so many people like me sing his praises.

  22. MBE Says:

    I forgot to make one thing very clear – if you go very low carbs, you MUST increase your fat intake (and salt). I wonder if people who react badly to a low carb diet do not commensurately increase their fat intake. Protein on its own, for any extended period is quite bad for you and will eventually make you quite sick. You must have carbs and/or fat – just preferably not carbs continuously, and not fat and carbs at the same time.

  23. Don Carlos Says:

    Good ol’ OB writes:
    “Ghrelin (a hormone – gadzooks!) is involved in regulation of appetite. It’s a factor in determining how much a person eats. It is presumably the sole factor in determining how much an animal eats.”

    I am sincere with my “good”; I respect most of what OB has written on this blog over time.

    But he seems to have little understanding, or tolerance, of the complexity of biological systems (animals or people), has not chewed on what, for example, ghrelin is, and what all it does or does not do. He writes, “a hormone-gadzooks!”, “a factor”(in people), “presumably…the sole factor” (in animals).

    Ahhh, the purity of physics! compared to the muddiness of biology. I simply earlier cited ghrelin as an attermpt at an eye-opener, but that has not worked.

  24. Occam's Beard Says:

    First off, I apologize for my intemperate tone of last night.

    But to clarify, by “sole factor” I wasn’t over-simplifying the physiology, but meant that appetite (and the availability of food) pretty much determine whether and how much an animal will eat, whereas with humans one would hope for the involvement of some higher cognition.

  25. neo-neocon Says:

    MBE: well, that may be what Taubes himself says (although it’s not what I’ve heard him say in my admittedly not in-depth exposure to him), but it’s most assuredly not what most of his disciples (and I use that word purposely) say when they come on blogs and tell everyone how simple and easy it is to lose weight and keep it off.

    MBE excepted, of course!

  26. neo-neocon Says:

    Occam’s Beard,

    I don’t usually psychologize about commenters here, but your responses last night made me wonder whether there’s someone close to you who’s overweight and with whom you are frustrated and/or about whom you’re worried. It would explain the anger—or, as you say, your “intemperate tone.”

    At any rate, what I believe is operating in the field of weight control has nothing to do with what I want. Actually, I would love for you to be correct, because then losing weight would be a simple matter, and anyone could do it by just eating a reasonable amount of food.

    You may have missed the part where I said in earlier posts that I’m not fat, and have never been fat. Nor do I eat more than about 1400 calories a day on a regular basis, and I exercise daily and fairly vigorously. Nevertheless, I’d love to be more slender and lose about 10 pounds, but I’m not willing to eat about 900 calories a day for the rest of my life, which is what it would take to do so and keep it off, given the way my body seems to want to cling to those ten pounds. And I’m not about to become a marathoner or weightlifter, in part because of the back and arm injuries I’ve had and lived with for over two decades.

    I really am not sure why you are arguing so vigorously in an attempt to prove a point with which I never disagreed, and with which I don’t think anyone else here disagreed, either. For an individual, as far as I know, you are completely correct that “it is not possible to put on weight without ingesting more calories than one expends.” I never said otherwise.

    The important parts of that sentence, however, are the “ingesting” part and the “expends” part. People who don’t have eating disorders normally ingest a certain amount because of internal signals of hunger and satiety, and it is that mechanism that is extremely complex and variable among individuals, and the signals of which are difficult to fight against because they are very often experienced as nearly-continual hunger. People also expend different amounts, depending not only on activity level (of course!) but a person’s individual metabolism, which is affected by a host of other complex factors such as heredity, age, hormones, medications, and muscle mass, just to name a few. So the balance of ingestion and expenditure that creates the conditions for overweight are hardly a simple matter, and vary greatly among individuals.

    And the combination of the abundance of food readily available (a long-held dream of mankind, and much preferable to intermittent involuntary starvation) combined with our modern conveniences such as cars (not having to labor so hard being another long-held dream of mankind) most definitely has contributed to the growth of overweight in this country and elsewhere. But nevertheless we are living a lot longer than we used to—in part, perhaps, because mild overweight (the more common kind) does not seem to have the deleterious effects many people think it does.

    Maybe I’ll write another post about this stuff, to make it more clear.

  27. sergey Says:

    Occam, your reasoning is very common among physicists, actually overwhelmingly so, but, nevertheless, it is flawed. Complex systems do not violate principles of physics, but transcend them by clever use of them. If you have stated that the laws of thermodynamics require that gaining weight means that a person must spend less energy than he/she gets in terms of calories consumed, I would agree with you. But we are talking not about gain/loss, but about stable state. And a fat person can spend the same amount of energy consuming the same amount of food as a thin one. Actually, she need even more food to keep energy balance because she would make more work walking the same distance and doing the same chores. (More mass to move.) And the intensity of metabolism is also very different among different people. Organism is a self-regulating system, it sets its own goals and pursues them with canny ingenuity which the person who owns this organism simply can not defeat. Just imagine a thermostat-regulated black box which energy input and ability to regulate its energy output by passive (insulation of variable efficiency) and active measures (ventilation). If you have no access to thermostat knob, you will not be able to regulate its temperature simply by reducing available energy input. It can keep energy balance in a wide range of available energy flow at different temperatures, set up by its own regulation goals.
    The same is true for Earth climate, for example. If the climate system is self-regulating, it can keep temperature in a narrow range no matter what. Simple physical considerations however true are not enough for understanding of the behavior of self-regulating and self-organizing systems. I even dare to say that at certain level of complexity their behavior can not be understood by scientific method, because cause-effect relationship is not open to observation and experimentation anymore: causation becomes internal, too, and understanding of these internal working can be beyond our reach.
    That is why all social sciences are junk, and this is why all social engineering schemes fail so miserably.

  28. sergey Says:

    It is high time to acknowledge that some systems simply are not controllable and attempts to control them, if applied too vigorously, can only destroy them. Human soul is a good example, and even animal organisms belong to this category too.

  29. Jim Nicholas Says:

    I am puzzled by the disagreement, and its intensity, with the statement by Occam’s Beard that any discrepancy between the intake and expenditure of energy results in a change in the storage of that energy in the body in the form of fat.

    I think he and all of us agree that many factors affect the intake of food and the intensity of the desire to take in more or less food. And I think he and all of us agree that many factors affect the expenditure of energy, including not only our willingness to expend more or less energy but also our different metabolic rates.

    If we are all willing to acknowledge the complex interaction between the factors influencing both the intake and the expenditure of energy, why the opposition to the idea that an imbalance, no matter what the causes, results in more or less storage in the body of that energy in the form of fat?

  30. neo-neocon Says:

    Jim Nicholas:

    Who has disagreed with that statement of Occam’s Beard? I haven’t seen anyone disagreeing with it. I certainly haven’t, as I explained in great detail here.

    Now, I can’t say I’ve read every word of every single comment here, but I’ve certainly skimmed them, and I just don’t see any disagreement with that one point of Occam’s. What I see is him fighting mightily against phantoms he believes are disagreeing with him.

    The disagreements with him are on other things—such as the complex factors that go into appetite and satiety regulation, and the wide variations among individuals on how much food they need to maintain a certain weight, and what weight their body signals them to maintain without the feeling of hunger.

  31. Occam's Beard Says:

    I don’t usually psychologize about commenters here, but your responses last night made me wonder whether there’s someone close to you who’s overweight and with whom you are frustrated and/or about whom you’re worried.

    Good thing, neo, because there’s no one who fits the bill. My annoyance stems from being confronted repeatedly with (what I at least consider to be) irrationality regarding obesity, and encountering “poor me” whining and carefully nurtured victimhood instead of either a plan for action against obesity, or acceptance of it (either of which I respect). In the academic context it’s like encountering someone who bemoans the fact that he is not a straight A student, but spends his time playing video games.

    Re your personal situation, neo, I never presumed you were overweight (in fact, never thought about it all, either way). I was addressing the proposition in the abstract.

    Nevertheless, I’d love to be more slender and lose about 10 pounds, but I’m not willing to eat about 900 calories a day for the rest of my life

    Nor should you. Sounds like you’re doing fine, and at a healthy weight. But that’s not the point, which is that if you did want to lose weight, you’d have to eat less and/or exercise more.

    I really am not sure why you are arguing so vigorously in an attempt to prove a point with which I never disagreed, and with which I don’t think anyone else here disagreed, either.

    I was arguing it vigorously because it is the proposition from which all else follows. If one accepts it, one obviates the need to address setpoints, hormones affecting appetite, or indeed anything else. Sure, these things affect whether one feels hungry or not, and how easy or difficult it is for one to lose weight, but they have no bearing on weight in and of themselves. That comes down solely to caloric intake versus caloric expenditure.

    People also expend different amounts, depending not only on activity level (of course!) but a person’s individual metabolism, which is affected by a host of other complex factors such as heredity, age, hormones, medications, and muscle mass, just to name a few.

    Sure. But that’s not relevant to the issue, which is why an individual is obese, to which the answer is “because he consumes more calories than he expends.” You’re addressing above the factors that predispose to consuming more calories than he expends. That’s a different issue.

    I would draw the analogy to gravity. Sure, falling feathers experience more air resistance than falling bricks, and therefore fall more slowly, but the point is that both fall. Gravity controls.

  32. Occam's Beard Says:

    I think he and all of us agree that many factors affect the intake of food and the intensity of the desire to take in more or less food.

    Of course. The operative word in that sentence is “desire.” That implies volition, which is where we came in. Those attributing obesity to physiological mechanisms are implicitly vitiating the role of volition in the phenomenon.

  33. Occam's Beard Says:

    Organism is a self-regulating system, it sets its own goals and pursues them with canny ingenuity which the person who owns this organism simply can not defeat.

    Simple physical considerations however true are not enough for understanding of the behavior of self-regulating and self-organizing systems.

    This is sort of a neo-vitalist perspective, methinks. At what stage of self-regulation and self-organization does God’s grace descend on a system and make physical considerations inadequate for understanding them?

    Seriously, think this one through, Sergey. The paradoxes start coming thick and fast.

  34. neo-neocon Says:

    Occam’s Beard:

    It may be the proposition from which “all else follows,” but it’s not the one in contention, and the contention occurs because of disagreement on other important propositions down the line. Your later propositions (the one that are in contention) do not by any means follow inevitably from the first one. So why keep defending that one non-controversial proposition as though other people had disagreed with you on that?

    See this for more.

  35. Don Carlos Says:

    I am going to sign off on this topic with a final clinical comment: The inevitable tendency to gain weight (fat) in middle age may be the body’s way of preparing for the inevitable final struggle (or struggles) that results in death. An energy banking process.

  36. neo-neocon Says:

    Don Carlos: yes, I’ve noticed that the very very old tend to lose both appetite and weight, and that’s usually not a good sign at all. Having some reserve adipose prior to that is probably a good thing.

  37. pbird Says:

    Fascinating comments. I appreciate all the material here for consideration.
    I think of it as a sliding scale. Hard to explain, but true that different things affect different people differently and it is miserably true that things other than intention control weight. I am quite heavy and have also lost great amounts of weight. I know what works for me. The point is that actually eschewing sugar and flour and foods made from them DECREASE the desire for food in the long run and that fat and protein satiate quickly. The trick is to hang on and have the heart to not eat the quick and cheap and easy stuff all over the place.
    Sometimes there is no money and you have to eat something. That something is usually the wrong thing.

  38. pbird Says:

    Fastest way to lose weight, control carbs and calories. Next fastest control carbs. Least effective, control calories.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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