Guest Essay by Kip Hansen
Prologue: This is the fourth in a series of essays that will discuss ongoing scientific controversies, a specific type of which are often referred to in the science press and elsewhere as “Wars” – for instance, The Salt Wars. This essay covers the Obesity Epidemic, aka The Obesity Wars. The purpose of the series is to illuminate the similarities and differences involved in each of these wars. Warning: This is not a short essay. Dig in when you have time to read a longer piece.
Trigger Warning: This essay is about obesity – the condition of being fat or overweight. It is about being overweight, body size, fatness; it is about all the problems that accompany that condition. If reading about these topics will cause you any emotional distress or make you feel unsafe or threatened in any way – stop reading here.
Stephen Hawking is a very smart guy, a very very smart guy. But like some smart guys in other fields, he can make very foolish statements based on ideas that are commonly believed but almost entirely inaccurate.
In a video produced by Gen-Pep, a Swedish non-profit organization “that works to spread knowledge and get people involved in promoting the health of children and young people”, Hawking made the following statements:
[Important Note: Stephen Hawking, as you probably know, is and has been severely physically handicapped, suffering from ALS, and has been wheelchair bound since the late 1960s. His experiences with diet and exercise are not, by necessity, the same as for you and me. Neither human physiology nor human medicine are his fields of study. I do not know why he was called upon to make this promotional video for Gen-Pep.]
Hawking starts off by saying: “At the moment, humanity faces a major challenge and millions of lives are in danger…”
“As a cosmologist I see the world as a whole and I’m here to address one of the most serious public health problems of the 21st century.”
“Today, too many people die from complications related to overweight and obesity.”
“We eat too much and move too little.”
“Fortunately, the solution is simple.”
“More physical activity and change in diet.”
When Hawking says these things he is simply repeating the official opinions of almost every major medical and health organization in the world:
The US Surgeon General:
“… the fundamental reason that our children are overweight is this: Too many children are eating too much and moving too little.
In some cases, solving the problem is as easy as turning off the television and keeping the lid on the cookie jar.”
The UK’s National Health Service:
“Obesity is generally caused by eating too much and moving too little.”
The UN’s World Health Organization:
“The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:
an increased intake of energy-dense foods that are high in fat;
and
an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.”
The National Institutes of Health tell us:
“What Causes Overweight and Obesity?
Lack of Energy Balance
Overweight and obesity happen over time when you take in more calories than you use.
An Inactive Lifestyle
People who are inactive are more likely to gain weight because they don’t burn the calories that they take in from food and drinks.”
Of course, the NIH goes on to list the following as “other causes…”:
“Environment, Genes and Family History, Health Conditions, Medicines, Emotional Factors, Smoking, Age, Pregnancy and Lack of Sleep”
Everyone knows that the causes of obesity are eating too much and not exercising enough. All the major federal agencies, the United Nations, and the learned societies agree.
So how is this a Modern Scientific Controversy?
Simple: They are all wrong. Just how wrong are they on this issue? Just how wrong is Stephen Hawking on this issue?
Almost entirely wrong.
Bruce Y. Lee, associated with the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health, was so concerned by Hawking’s message that he was prompted to write an article for Forbes magazine titled “Stephen Hawking Is Right But Also Wrong About Obesity”.
Let me be perfectly clear: The obesity epidemic is a major challenge for medical science and public health because, quite simply, we have almost no idea whatever as to the true cause(s) of the phenomena, or, in another sense, we have too many ideas about the cause(s) of obesity.
In fact, Gina Kolata, in the Health section of the NY Times, says that Dr. Frank Sacks, a professor of nutrition at Harvard,
“…likes to challenge his audience when he gives lectures on obesity.
“If you want to make a great discovery,” he tells them, figure out this: Why do some people lose 50 pounds on a diet while others on the same diet gain a few pounds?
Then he shows them data from a study he did that found exactly that effect.
Dr. Sacks’s challenge is a question at the center of obesity research today. Two people can have the same amount of excess weight, they can be the same age, the same socioeconomic class, the same race, the same gender. And yet a treatment that works for one will do nothing for the other.”
Dr. Lee Kaplan, director of the obesity, metabolism and nutrition institute at Massachusetts General Hospital, is quoted by Kolata as saying:
“It makes as much sense to insist there is one way to prevent all types of obesity — get rid of sugary sodas, clear the stores of junk foods, shun carbohydrates, eat breakfast, get more sleep — as it does to say you can avoid lung cancer by staying out of the sun, a strategy specific to skin cancer.”
But wait, what about our beloved Stephen Hawking’s “Fortunately, the solution is simple. More physical activity and change in diet.”? Well, frankly, that is not just wrong, that’s utter nonsense.
Dr. Kaplan and his associates have identified, so far, fifty-nine (59) different types of obesity.
Dr. Stephen O’Rahilly, head of the department of clinical biochemistry and medicine at Cambridge University, and his group, have identified 25 genes “with such powerful effects that if one is mutated, a person is pretty much guaranteed to become obese.”
Many of these genetic disorders are on the rare side, but Ruth Loos and her team at the Icahn School of Medicine at Mount Sinai, have other evidence – that any one of 300 different genes may be involved in the tendency to overweight, and that each gene can add to the effect of the others—add to the genetic propensity for overweight and obesity. “It is more likely that people inherit a collection of genes, each of which predispose them to a small weight gain in the right environment….each may contribute just a few pounds but the effects add up in those who inherit a collection of them.”
There are more than three dozen available therapies (Dr. Kaplan claims to have 40 at his disposal) for overweight and obesity, and 15 different drugs. Using them is guided by experience and plain old-fashioned trial-and-error.
Bariatric surgery, in which the size of the stomach is physically altered by various means, is a drastic last resort for the profoundly obese.
Only the last mentioned treatment, bariatric surgery, is universally successful at bringing about a major and permanent reduction in the body weight of the obese.
In June of 2013, the American Medical Association announced that it had classified obesity as a disease. This event was covered by the NY Times – in the business–not science—section:
“The American Medical Association has officially recognized obesity as a disease, a move that could induce physicians to pay more attention to the condition and spur more insurers to pay for treatments.
In making the decision, delegates at the association’s annual meeting in Chicago overrode a recommendation against doing so by a committee that had studied the matter.
“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement. She suggested the new definition would help in the fight against Type 2 diabetes and heart disease, which are linked to obesity.”
“The vote of the A.M.A. House of Delegates went against the conclusions of the association’s Council on Science and Public Health, which had studied the issue over the last year. The council said that obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index, is simplistic and flawed.”
The move by the AMA was hugely controversial within the medical community. In fact, it prompted an editorial from the editors of the journal of the Australian Medical Association, Lee Stoner and Jon Cornwall, titled “Did the American Medical Association make the correct decision classifying obesity as a disease?”
“The American Medical Association (AMA) recently classified obesity a disease, defining obesity as having a Body Mass Index (BMI) measure above 30. This decision went against the advice of its own Public Health and Science Committee, and has sparked widespread discontent and discussion amongst medical and healthcare communities. The fact that this classification has been made has potential ramifications for health care around the world, and many factors need to be considered in deciding whether the decision to make obesity a disease is in fact appropriate.”
“Are we classifying obesity correctly?
“Before considering whether obesity should be considered a disease, we must question the suitability of BMI as a rubric. The assumption is that the ratio between height and weight provides an index of body fatness. However, there is an imperfect association between BMI and body fatness, and BMI does not and cannot distinguish adipose type and distribution. While total body fat is important, studies have shown that central adiposity (e.g., visceral fat) poses a higher risk for developing disorders associated with obesity than overall body fatness. There are superior anthropometric indices of central adiposity, including waist-to-hip ratio, yet BMI continues to be the criterion owing to previous widespread and historical use despite its obvious shortcomings. Using the BMI tool, incorrect clinical categorisation of “overweight” or “obese” is common. Therefore, this editorial accepts that the AMA has selected an imperfect tool for classifying obesity, and will hereafter focus on the theoretical notion of obesity.”
“Undeniably, obesity is a risk factor associated with a clustering of complications, including hypertension, hypercholesterolemia, and type 2 diabetes, each of which independently and additively increase cardiovascular disease risk. However, obesity is exactly that—a risk factor. Being obese does not necessarily equate to poor health, despite the hormonal alterations that are associated with high body fat. Strong evidence has emerged suggesting that an adult may be “fat but fit”, and that being fat and fit is actually better than being lean and unfit.”
The Australian Medical Association’s editorial wraps up with this:
“Conclusion
Obesity has reached pandemic proportions, is strongly associated with myriad co-morbid complications, and is leading to a progressive economic and social burden. However, being obese does not necessarily equate to poor health, and evidence suggests individuals may be fat but fit. Perhaps most importantly, labelling obesity a disease may absolve personal responsibility and encourage a hands-off approach to health behaviour. This knowledge raises the question of morality, as individuals must now choose whether they will invest effort into maintaining a healthy lifestyle in order to free society of the healthcare burden associated with obesity. Given the myriad issues surrounding the decision to classify obesity in this way, perhaps a new question should be posed in order for society to continue this discussion: who benefits most from labelling obesity a disease?”
And what about a cure? Is it possible, short of radical invasive surgery, to help an obese person permanently lose enough weight to become a normal weighted person?
If the learned societies, and Stephen Hawking, are correct in stating that obesity is as simple as eating too much and exercising too little, then the obvious cure is to take obese people, feed them less and exercise them more.
Let’s go back and look at the results from Dr. Frank Sacks, professor of nutrition at Harvard, and his study “Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates”.
Results
At 6 months, participants assigned to each diet had lost an average of 6 kg [13 lbs], which represented 7% of their initial weight; they began to regain weight after 12 months. By 2 years, weight loss remained similar in those who were assigned to …[the four diets, ranging from 6 to 9 lbs]…Among the 80% of participants who completed the trial, the average weight loss was 4 kg [ 9 lbs]; 14 to 15% of the participants had a reduction of at least 10% of their initial body weight. Satiety, hunger, satisfaction with the diet, and attendance at group sessions were similar for all diets; attendance was strongly associated with weight loss (0.2 kg per session attended). The diets improved lipid-related risk factors and fasting insulin levels.
Digging in a little more, we find that:
“At 2 years, 31 to 37% of the participants had lost at least 5% of their initial body weight, 14 to 15% of the participants in each diet group had lost at least 10% of their initial weight, and 2 to 4% had lost 20 kg [45 lbs] or more (P>0.20 for the comparisons between diets).”
These are serious weight loss diets, closely supervised, with group and individual reinforcement sessions, for 2 years. Only 2 to 4% of the participants lost truly substantial amounts of weight that would reclassify them as normal weight persons. The rest of the participants lost those easy first 10-15 pounds in the first six months, but after a year, they began to regain their lost weight, despite staying on the diet and receiving group counseling, to end up with average loss, for 80% of the participants, of 9 pounds [4 kg], after two years of supervised dieting.
Let’s see what these results mean for those suffering from obesity:
I’ve added three colored dumbbells, showing just what a permanent 10% reduction in body weight means for three sample obese patients. Two have managed to move from Morbidly Obese to Obese, and one is still Obese. We have not considered the more extreme cases, which are not rare – persons weighing > 286 lbs. You can picture for yourself what the loss of 9 lbs would represent for you or someone you know who is far too heavy.
The real finding is that under a strict diet, most people can generally (but not always) lose 10-15 pounds if they are supported by counseling (professional or family). With care, these people can keep most of those extra pounds off. This benefits those whom who (h/t jsuther2013) are classified Overweight, but not generally those that are truly Obese, who remain obese after this weight loss. Nonetheless, medical bio-markers do improve even with these fairly small weight loses. Whether this improvement in bio-markers adds up to improved health and longevity is not known.
It is important to note that the above chart is based on the metric BMI which is under serious doubt within the obesity research community.
25 genes guaranteed to make you obese; 300 genes that add to each other to pack on pounds; 56 different types of obesity; 15 drugs; 40 therapies; three or four surgical approaches…definitely not simple, Mr. Hawking.
But that’s not all.
Erin Fothergill’s “Biggest Loser” study found:
“In conclusion, we found that “The Biggest Loser” participants regained a substantial amount of their lost weight in the 6 years since the competition but overall were quite successful at long-term weight loss compared with other lifestyle interventions. Despite substantial weight regain, a large persistent metabolic adaptation was detected. Contrary to expectations, the degree of metabolic adaptation at the end of the competition was not associated with weight regain, but those with greater long-term weight loss also had greater ongoing metabolic slowing. Therefore, long-term weight loss requires vigilant combat against persistent metabolic adaptation that acts to proportionally counter ongoing efforts to reduce body weight.”
What this means is that a person’s body fights back against weight loss and adapts its base metabolic rate to burn fewer calories while resting in an apparent attempt to regain weight lost by dieting and thus maintain a set weight point under conditions of lower caloric intake. This study was such big news that it is featured in the New York Times’ “Medical and Health News That Stuck With Us in 2016”.
Eleonora Ponterio and Lucio Gnessi, in their study “Adenovirus 36 and Obesity: An Overview” report that:
“…the data indicating a possible link between viral infection and obesity with a particular emphasis to the Adv36 will be reviewed.”
Thus, the Obesity Epidemic might be just that, an infectious epidemic.
In a study titled “Trim28 Haploinsufficiency Triggers Bi-stable Epigenetic Obesity”, Andrew Pospisilik and team found that there are titillating hints that epigentics may play a role in determining who is fat and who is lean, even when they generally share the same genes (closely related individuals) , or in the case of identical twins, exactly the same genes.
No, the obesity epidemic is far from Hawking’s, “Fortunately, the solution is simple.” And the solution to obesity is orders of magnitude more complicated than “More physical activity and change in diet.” In fact, universally reliable solutions to the problem of obesity do not yet exist.
There is nothing clearer from obesity research than that the simplistic policies of the federal health agencies and the learned societies – all of which were summarized by Stephen Hawking — “Eat Less & Exercise More” are totally inadequate to address the problem and are not based on scientific evidence. The “Eat Less & Exercise More” policies include the war on sugar and the war on soda – they cannot and will not make a clinically important difference in public health.
Summary:
- The kernel of truth in obesity studies is that consuming more calories (food energy) than one expends can lead to weight gain–energy stored as fat.
- Reversing this does not lead to a remedy for obesity – eating less and exercising more is not a cure for obesity.
- The reality of the problem of obesity is vastly more complex and only vaguely understood at this time.
- Current public policy on obesity is almost universally based on #1 above, ignoring #2 and #3. Thus, this public policy – no matter how strenuously enforced through education, indoctrination, regulation of the food industry, punitive taxation, etc will not resolve the Obesity Epidemic.
- On a positive note, the recommendation that people “eat less and exercise more” will not hurt anyone [with the rare exception of the profoundly underweight, the anorexic, etc] but, in general, will actually improve most people’s health even though it may have no effect whatever on their weight status.
- The Obesity Wars share the common feature seen in other modern scientific controversies — public government agencies and scientific [and medical] associations forming a consensus behind a single solution, one known to be ineffective, to a complex problem – uniting in a broad effort to enforce the ineffective solution on the general public through regulations, laws, and mis-education.
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Author’s Comment Policy:
I have utilized only a tiny fraction of the information I have collected on this topic in the writing of this essay. Readers familiar with the literature on the topic will notice this immediately. This is not due to ignorance or laziness on my part – I have been constrained by the necessity of keeping the essay to a readable length, without unduly stretching the patience of you, my readers.
I realize that many readers here will want to move on immediately to discuss the Climate Wars – one of the distinctive science wars of our day. I ask that you please try to restrain yourselves
The last essay in the series will be an attempt to lay out a coherent pattern of modern science wars and maybe suggest ways that the different science fields themselves can break these patterns and return their specific area of science back to the standards and practices that should exist in all scientific endeavors.
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Recent studies (notably http://www.nature.com/ismej/journal/v7/n4/full/ismej2012153a.html) have demonstrated unequivocally, using Koch’s Postulates, that the presence of Gram-negative bacteria (specifically Enterobacter cloacae) in the human gut is linked to obesity, that suppression of these bacteria in the gut mitigates obesity, and that introduction of these bacteria into the gut (of mice) directly causes obesity. The mechanism is traced to the lipopolysaccharides in the cell walls of the bacteria which are released into the human body upon the death of these bacteria. The lipopolysaccharides are among the most potent known agents that trigger tissue inflammation, which itself is associated with hypertension, type-2 diabetes, and arthritis, and may be associated with several other chronic disorders.
Yet no list of ‘risk factors’ for obesity I have ever seen acknowledges the possibility that an infections agent may be involved.
Obesity remains in the same medical dark age as ‘gastric ulcers’ before the discovery of the role of Helicobacter pylorii.
tadchem ==> There are tantalizing reports from a lot of micro-biome studies — the one you mention involved one human subject and multiple dietary treatments.
It will be interesting to see if this, or other, hypotheses of infectious obesity hold up in the long run.
Kip: Another good topic might be cholesterol.
See the Framingham Study or http://www.gaiam.com/discover/430/article/cholesterol-may-not-cause-heart-disease for starters, if you’re interested.
Ron Konkoma ==. Thanks for the suggestion and the link — I have followed that topic for years….
Sorry if this has been covered in the comments before, but right now I don’t have time to read them all. I wanted to post a comment while this was fresh.
First, skinny people should not be allowed to publish anything about obesity. (g)
Aren’t many cases of obesity, or even people being somewhat overweight, due to the hardwiring in our brains? So much of this, IMHO, can be traced to, if not obsessive compulsive disorder, then obsessive compulsive tendencies. Overeating, smoking, alcohol abuse – lots of behavior tendencies. Nature works hard to ensure that diversity gets passed on, as some of it might be valuable in the future. Genes that carry on obsessive compulsive tendencies might be especially valuable – think Bill Gates or Steve Jobs. How much is overeating due to this? Now think about the label – obsessive and compulsive. How much free will do we have if we are governed by obsessive compulsive brains?
On simple example. Ask any obese person if they would rather not be as fat as they are. Would there be even one that would say no, that they prefer to be obese? So, why are they so obese? Doesn’t it just seem so simple, and doesn’t this point to exactly why this is so difficult?
As for Stephen Hawking, how can someone so smart be so dumb?
Kermit ==> “Aren’t many cases of obesity, or even people being somewhat overweight, due to the hardwiring in our brains? ” If they knew, we could cure all the obese people….but they don’t — that’s one of the take homes messages.
My muscle content is not of such ratio for realistic rationalization.
Kip. Excellent and thought provoking as usual. It’s probably worth mentioning that the “US Obesity Epidemic” was exacerbated in 1998 when “they” arbitrarily redefined the Obesity Scale roughly 6 or 7 percent to the thin side. That’s important to know if one wants to evaluate historic data. Want to reduce the “problem”? Why not start by moving the goalposts back to where the started from and then leaving them alone?
Don K ==> Thank you. The epidemic is, in part, caused by re-defintion — this is par for the course in many medical/health metrics — and a feature of Science Controversies in general. Moving the Bar is a standard tactic for making the Problem seem greater and more urgent, in order to garner more support ($$$) and agreement.
I’m just testing moderation—ignore this comment!
[Please use the “Test” column from the links at the top of the page. .mod]
Now I know…….
Put down the pies.
Some of us are more prone to gain weight so adjust your lifestyle accordingly. It’s a never ending battle if you gain weight easily.
The truth is most obese people eat too much and eat the wrong food. If you are over 280lbs then you are just eating too much, it is that simple. A big fat body needs calories to sustain it.
Exercise is not the solution controlling what you eat is
mark – Helsinki ==> You should have read the essay and the studies linked in it —
I’ve said before, IMO Hawking can’t communicate anymore — even with his close handlers. So statements supposedly coming from him actually aren’t — they’re coming from his handlers. I guess statements from “Stephen Hawking” get far more attention.
beng135 ==> That’s an interesting idea…..only a few people can understand him.
Fascinating article.
My thoughts:
Eat less, exercise more completely ignores the fact of what we are eating. What changes have occurred in our food supply from say the late 1970’s till today? Can’t be sugar, because we’ve had sugar in our diets since we discovered it. Can’t be fats, because again, we’ve had that in our diets forever too. What about those breads? Well bread has been around for tens of thousands of years. How about veggies and fruits? Nuts? Same thing. Meats? For tens of thousands of years humans have been eating what we are eating. So why are we fat and they weren’t?
#1 fallacy: humans were lean and healthy until 1980. Bull. Fashion trends bear witness to that. Someone mentioned Marilyn Monroe up thread. She was a size 14, what would be considered at size 22 today. That is just 1 example, there are many. I used fashion because it has a very long recorded history.
#2 fallacy: People ate better. Bull. Most of the population ate bread with some kind of watery broth and maybe a piece of salted or cured meat because that was all they could afford. Don’t believe me? Look at the stories, the expressions that linger in our culture. You don’t have a whole lot of prayer including a balanced diet of veggies, fruits and nuts, but you sure as heck have bread.
#3 fallacy: we know better what makes people fat. Bull. No we don’t. What we do know is that more people are fat when we change the scale. Or more people are thin when we change the scale. We decide who is fat or thin.
My point?
We can’t point to the past and say: “See? There were no obese people then!” And blame the obesity “seen” now on technology, advancements in transportation, lack of exercise, sedendary lifestyles..etc.
What we CAN do however is to start looking at our food supply and how IT has changed from the past…before pointing fingers and changing scales, lets start by looking at our food. How our meats are raised, how our veggies and fruits and nuts are processed, how are grains are processed AND our fats and sugars. Until we stop blaming the fat people for being fat on external factors, lets start by examining the food supply we are ALL eating. And examine in depth the stuff we ADD to our food.
It has been very nice to have fresh fruits and vegetables all year, with almost no seasonal fluctuations, with just a few exceptions. However, we don’t know if this is good for us, or bad. If I look up some medical problem, I can almost guarantee that part of the solution will include eating more fruits and vegetables, drinking less coffee and alcohol, and making sure that everything is low-fat. So, one thing that has changed from the past, is how much fruits and vegetables we eat, and the fact that we are not dependent upon local growing conditions. Lots of variables have changed, just in the last few generations.
Jenn Runion ==> People have been fat forever — some ethnics groups predictably get fat past middle age — food processing and food additives did not make classical greek women heavy…or Italian mothers….
I’m not too convinced by the “it must be something in the food” idea.
But ya never know, we certainly don’t have a real good handle on it.
“And examine in depth the stuff we ADD to our food.”
Also, let’s look at what we (accidentally or indirectly, usually) REMOVE from our food.
Oh yes that too. What natural element is removed and then replaced with a man made compound.
So what we ADD and REMOVE.
No matter how complicated the reasons are for being overweight that fact remains if you are starved you lose weight. I don’t recall any fat survivors from concentration camps.
What your weight should be is an entirely different question.
Adrian Ashfield ==> Yes, I have mentioned that it is easy to starve people and make them thin, but that does not, at the same time improve their health. One can totally prevent breast cancer by cutting off the breasts of all women as well — but it does not afford an acceptable solution.
Adrian Ashfield
No matter how complicated the reasons are for being overweight that fact remains if you are starved you lose weight. I don’t recall any fat survivors from concentration camps.
What your weight should be is an entirely different question.
It is basically the question why some peoble eat more than nescessary, and why others do not.
That bariatric surgery helps is a sure sign of the above.
Then you can reserch why some regulate their food intake so that they keep their weight and others have difficulties. A very simple advice, that seems to help, is using smaller tellers. It is so low tech, that few experts use it.
What a load of rubbish.
In the western world: In the old days poor people were thin. Now they’re fat. Because, nowadays even “poor” people can afford a supersized coke on a daily basis.
It’s really, really not complicated.
I’ve always thought that the conventional science behind CAGW and obesity/chronic disease were exact parallels – basically science gone wrong. Michael Mann is to CAGW as what Ancel Keys was to nutrition. The government is still the government. The EPA, NOAA and NASA are the USDA & FDA. The NAS is the NIH. I think that the people here completely understand how science has failed us when it comes to CAGW but don’t quite understand that the same thing can occur in a discipline like health and nutrition – it can and has.
I got a huge kick out of the idea that there are “obesity genes” that are lying in wait to make us fat (I know that sounds condescending, sorry about that). People proposing that evolution would develop a gene that puts us an evolutionary and competitive disadvantage simply should be a non-starter.
Obviously Hawking is looking at the situation incorrectly. Instead of asking “how” do we get fat (obviously because we take in more energy than we expend), he should be asking “why do we take in more energy than we expend”. That’s the important thing. And the idea that we can simply “eat less and move more” has been refuted by just about every study done trying to prove that it’s as simple as eating less and moving more. This is because it’s too simplistic to think that a calorie is a calorie, you need to consider all the biochemical actions that occur in our bodies. People think that our basal energy expenditure is a constant and this is simply not true. Starvation diets work for a little while but most people gain the weight back and a little extra because they aren’t fixing the real problem which is for most hormonal. There are many hormones that we know cause weight weight gain or suppress appetite, these hormones don’t contain any calories and yet they control our body fat percentage so it’s obviously not a matter of how many calories a person eats or how much they exercise. Fix the hormone issues and you’ll fix your weight problems.
Insulin is the main driver of fat storage, the more circulating insulin the more fat that is stored… period. The question people should be asking is how to fix a damaged system that is producing too much insulin due to insulin resistance in the cells. We become insulin resistant because over time we eat foods that cause our pancreas to produce insulin. This is a chronic condition, it takes decades for insulin resistance to develop in most people. Foods that a person thrives on for years like wheat, rice and other grains and even sugar are causing a slow drip of damage that ultimately manifests itself in insulin resistance, causing higher fasting levels of insulin in the blood. Essentially people are building up a tolerance to insulin just as an alcoholic does to alcohol, so it takes more insulin to do the job and the result is increased body fat. That is simple biochemistry.
Fortunately insulin resistance is reversible for most – the first step is to lessen the number of carbs you ingest. But unfortunately this probably isn’t going to fix the problem. Going back to the alcoholic example, you don’t get over an alcohol addiction just by lessening the amount you drink, you need to quit it entirely. It’s the same for carbohydrates and insulin – to reverse the damage as must as possible you need to implement an intermittent fasting protocol. A low carb diet, even if you get down to zero carbs, is still insulinogenic because protein and even fat produce an insulin response from the pancreas. The only way to reduce insulin levels to therapeutic levels is to not eat at all via an intermittent fasting protocol. Throw a 24 hour fast in a couple times a week as well as adopting a low carb diet and you will see your fasting insulin drop like a rock, as well as your body fat. Give it try, what can it hurt?
On a tangent here… the beginning of agriculture several thousand years ago saw the beginning of civilization as we know it. High-carb diets, including stuff like bread, reduce the number of calories that we need per day to maintain weight. Our hunter-gatherer ancestors had to spend all their energy hunting for their next meal. Cereal grains, in addition to providing some calories, greatly reduced the the extra calories we need. This meant that they had spare time to invent writing and other stuff, since they weren’t constantly searching for their next meal.
Major problem I have with this article: if bariatric surgery is the only 100% successful treatment to obesity, and all bariatric surgery does is make you eat less. I disagree with your conclusion based on your own statements. If you are right, and that is the only treatment with 100% success rate, then eating less (with our without surgery) is the only cure for obesity. Other things do play a factor in it, that seems to be obvious. But it seems to me like you said eating less won’t always fix obesity, then said it will 100% of the time. Both cannot be true.
I did enjoy the article regardless, as there was good information provided outside that.
Shawn ==> Shawn, think of it this way: Bariatic surgery is like physically enforced starvation — it makes it impossible for the body to ingest enough calories, enough food, to maintain a big body. There are serious health risks and downsides to this approach, so it is generally only used if it becomes apparent that not losing weight will kill you more quickly. Not quite as radical as cutting off a severely arthritic hand to cure the pain…..but not for those who just want to look pretty.
Kip
While I understand that Bariatric surgery is an extreme and enforced method of consuming less calories, it is still just a way of reducing food/calorie intake. So what I am not understanding is why you say a self reduction of food will not necessarily cure obesity, then you say Bariatric surgery will. People can reduce their own intake to those levels without Bariatric surgery. And in those cases how is it technically different from having the surgery?
Shawn ==> It’s not so much that I say it, it is that when they try to cure the severely overweight and obese by the ELEM method (calorie reduction and exercise) it does not work very well for the majority of patients.
That is what this whole essay is about — and that is why obesity is such a problem — they do not have an effective approach.
Bariatric surgery is not just a calorie reduction mechanism — it is based on what they discovered in treating wounded soldiers — if you blew away half their stomach with machine gun bullets, even the heavy ones became thin — in fact, could not gain weight. There are a lot of health downsides to the approach, which is why it is generally only advised for those that will die from obesity if they don;t lose weight.
I have a problem with these extremely fat peoble that can not move anymore. Someone must give them food, because they can not themselves go and buy it. I just wonder.
Anyway it is still interresting why some take in more than they need and others take in less than they need, and the most keep it balanced.
It is a distraction to focus on special food ingredients, more of that and less of that and so on, it is the total amount and why.
I would be interested in your thoughts on new microbiome research. Gut bacteria ecosystems seem to impact how food we eat is processed. I read Epidemic of Absence and many articles by the author, but still don’t have a sense of the research.
Gregory ==> In regards to “An Epidemic of Absence”, I’ll quote Abigail Zuger, M.D. who reviewed it for the NY Times “”A romance with anything [other than a living being], be it a pair of shoes or a scientific theory, is only asking for trouble, so seldom will the inanimate beloved live up to your besotted expectations.
The best scientists struggle with this prohibition daily, knowing that even the most seductive data may well disappoint. But premature enthusiasm is routine among others, patients and their doctors foremost among them, with journalists smelling a scoop not far behind.”
The field of study is so young that several doctors and medical researchers have fallen in love with the hypothesis — and become so blinded by love that they have lost the necessary disinterestedness required to carry out rational investigation of the subject…they are forever rushing here and there, exclaiming over things not yet explained, drawing hasty inferences and jumping wildly to conclusions not yet in evidence.
There may be something useful there — in the study of gut biome and other fellow travelers — but as far as I have seen, there is little there there yet.
Give it another ten years and we may have something to talk about.
Somebody else pointed this out, but I think it is worth repeating:
The percentage of Americans who are obese has gone from 12% to over 35%, between the 56 years from 1960 to 2916. The seeming now-popular claim that this is not just an energy balance issue seems to imply that something major has occurred in the human body’s structural evolution over the past 56 years, which would be an unprecedented evolutionary alteration in such a short time span, if we are to put major faith in this current claim.
The problem is NOT complex. The problem is simple. The SOLUTION is complex, because the structure of our modern society has made it so, even more so in the past half century.
. . . 1960 to 2016. By 2916, at the current rate, the human body will be a spherical blob.
So you’ll be writing about the FDA’s crusade against vaping, then?
Roger ==> Not too familiar with that one…what is their Kernel of Truth? Solving what Problem? with what Solution?
“The kernel of truth in obesity studies is that consuming more calories (food energy) than one expends can lead to weight gain–energy stored as fat.” Kip, that isn’t the kernel of truth. It’s equivalent to the Earth’s energy budget. It’s the important concept. Everything else is an example of the process- how the energy budget works.
It’s true that individuals metabolisms differ for many different reasons which you show aplenty, but as an aerobic athlete who has coached all ages from children to adults and skill levels from joggers to olympic qualifiers, I think most of the reason for our obesity epidemic is that people are eating more and exercising less. With all the statistics you have accumulated, I assume you have statistics that show that exactly that has happened the past several decades.
Doug ==> I know, weird huh? But the facts are the facts —
“The idea is just not very useful — Eat Less Exercise More — is a fine and helpful public health message — it just will have no effect on the Obesity Epidemic, because eating less and exercising more has been proven, even under very controlled conditions, not to cure the obese of their obesity and helps a very small percentage of the severely overweight. ”
It is a good thing to get kids and adults to get more exercise, if that’s what they want. In general though, if they are severely overweight or obese, it won’t help them in the long run — it won’t change their weight status.
Since moderate regular exercise (20-30 minutes most days of the week) seems to improve general well-being for most people, it’s a fine thing to do.
The public health hope is that the Eat Less Exercise More campaign will somehow prevent our youth from becoming obese later in life….but it is an unproven hypothesis. in the US we had had Presidential Physical Fitness campaigns, get out and play campaigns, etc continuously since the 1950s. ( I got an award in Jr. High for being able to climb to the top of a 20 foot rope hung from the ceiling of our gym — not many could do it.)
Have you, in your professional life, had success treating obesity or severe overweight with strenuous exercise? It apparently will work for roughly 2-4% of the obese population.
Kip,
I haven’t had the opportunity to work with the obese although I’ve given the idea some thought, but decided against adding personal trainer to my already overextended interests and responsibilities.
Let me ask you why there’s been such a significant increase in childhood obesity over past decades or why South Carolina, where I retired, has a significant obesity problem, but Colorado where I lived for 20 years does not. There are statistics about the lifestyles of South Carolinians and Coloradans including diet and exercise, Those statistics show that South Carolinians consume more calories (sweet tea is one big part) and get less exercise.
I’ve always enjoyed your WUWT guest posts and your many Dot Earth posts, but I think you’ve cherry picked your sources on this one to suggest that a basic energy balance doesn’t apply.
Doug ==> Apparently my usual communication skills are failing me or the entrenched idea about obesity is particularly strong,
I do not, and have not, “suggest[ed] that a basic energy balance doesn’t apply.” I have labeled it the Kernel of Truth in the obesity controversy because it is a basic truth of the field.
The controversy itself hangs on the facts:
1. If the Kernel of Truth is accurate, if it is a sufficient cause, then 2. Reversing that will be an effective and near-universal cure.
Eat Less Exercise More (ELEM) however, in practice, not only for the average Joe or Jane at home, but in carefully controlled and followed clinical trials, does not cure the obese or the severely overweight.
Why? If we really had the answer, we’d get the Nobel Prize in Medicine. So would anyone that could answer Dr. Sack’s question in the essay: “Why do some people lose 50 pounds on a diet while others on the same diet gain a few pounds?”
ELEM does work to help Sally Smith prepare for bikini season — she can usually drop those extra 10 – 15 lbs if she really tries — and she can keep them off through dedicated diet control and exercise. The second she is distracted, the pound will return and he body will resume its ‘preferred’ weight.
This is A DIFFERENT PROBLEM — it is not the same as the obesity problem.
All I can say is that “They are working on it.”
As for why Colorado has lower child obesity rates? Don’t know — but I’d like to. I will point out that the statistics on childhood obesity are hinky — CDC stats are far different than the National Conference of State Legislatures (which claims it gets their stats from the CDC).
Then there is this “data from CDC’s National Health and Nutrition Examination Survey (NHANES) published in the Feb. 25, 2014 issue of the Journal of the American Medical Association do show a decline in obesity prevalence in the 2-to-5-year-old age group from nearly 14 percent in 2003-2004, to just over 12 percent in 2009-2010, to just over 8 percent in 2011-2012.”
I got fat after a period of low activity due to a major injury (which included nerve damage). After the injury abated, I had a hell of a time dropping the weight and exercising. My Doc explained my body was fighting to keep the fat (sort of a famine response). Two things got me past this issue:
1. Cut carbs and sugars and added more fat to my diet (in particular that “Evil” saturated fat)
2. Started taking supplements, in particular zinc, magnesium, and pantethine (a form of B-5).
I got into pretty good shape using free weights and an exercise bike, but was still heavy. I was what you could describe as sort of fit-fat at 37% body fat (per a DXA scan I had done).
Based on a recommendation from someone I was talking to online, I checked out the ketogenic diet. Been on it for months now. I have painlessly dropped 25 lbs of fat (it took 3 weeks for my body to adjust to the painless point) and the workouts have gotten even easier. Blood work is fine (high HDL with a good HDL to total ratio). I cut out all fruit juice and sodas and try to limit my net carb intake to 50 grams or less (mostly green veggies).
If any of you are like me and have an issue with weight.. check out the ketogenic diet.
Newark –
I had a similar experience with a ketogenic diet back around 2002 after gaining weight while working for a corporation. Not only did we drop more than 40 pounds (still have the charts), maybe 10 or which came back, but something else changed. For my whole adult life, I would get drowsy if I sat still for more than ten minutes – meetings, driving the car, movies. It sucked and I had developed elaborate coping skills. After the diet, that problem just went away and never came back. Now I can arrive at LAX at 11PM, hop in a rental car and drive to SF for breakfast without a moment of sleepiness. When I want to sleep, of course I can, but now it is my choice. It was literally like being reborn. Suddenly I could do much more and enjoy life more than ever before.
This was a major puzzle until I started reading about the microbiome research that really took off after 2010. Although Kip is right that it is still early days, what is clear to me is that the diet essentially replaced my old microbiome ecosystem with a new one. We also cut out most of the sugar in our diet, not religiously, but mostly — cakes, pastries, sugar drinks, etc. – 200 years ago the average person consumed about 12 pounds of sugar a year. Now in the US, it is more like 120 pounds. Could be a problem? Ya think?
Poor diet and hunger in one’s childhood, plus genetic pre-disposition for obesity, often result in obesity.
In 1968 my father, a mathematician, signed a letter of protest against the Soviet occupation of Czechoslovakia. He was the only one of 11 signatories who did not recant afterwards. He was fired from all positions in the instutute and in the university, and, being a polyglot, had to provide for his family by doing translations (middlemen, of course, took their cut).
Until then I ate well, and was thin as a stick. After 1968 we became very poor, and could not afford any good food (socialism makes all high-quality things inaccessible to the general population without special connections: see current situation in Venezuela for typical reference). My German grandmother, who survived the worst years of hunger in Siberian exile during the WWII, became very worried about me being undernourished, and stuffed me with whatever was available, mostly potatoes and cheap macaroni.
And I became fat. I’ve been fat ever since — since that childhood occasional hunder and poor diet period, my metabolism stores calories in fat. Mind you, I was very phisically active when I was a young man: I spend days on my bicycle, I walked a lot (no honest working person in the USSR could afford a car) — still, according to the nonsensical American BMI index, I always have been overweight.
After findeing a political asylum in the USA, at first I didn’t know that much of the food products in supermarkets are full of growth hormones, chemical preservatives, and other additives counter-indicated for people with the pre-desposition for ovesuty. In a few years, I’ve become, according to the same BMI index, “morbidly obese,” though I usually eat no more, or even less, than any oother person (certainly never three meals per day — no more than two, one being very moderate); I bought a threadmill, but no amount of physycal exercise would really help. Cortisone shots administered by medical charlatans to hype up the costs of treatment for my joint inflammation (where a few pills of the simple anti-inflammatory drug did the job later), drove my weight to 372 pounds (my hight is 5’9″).
Later, alarmed by my weight, and by the quality of the supermarket foods, I started to pay much more attention to what I eat, and quickly lost 50 pounds. Now I am 55 years old, and feel more or less fine, though not athletically fit, of course. Further attempts to reduce my weight resul in weakness, fatigue, sleepiness, and some other emerging problems. I dropped these attempts.
I always suspected that Stephen Hawking often talks to his computer from his behind. Now I know for sure.
Alexander ==> Thank you for sharing your story with us. Stay well.
Although it appears at first glance that eat less exercise more should work for all. and does not what are we actually eating these days.
Firstly,
If we look at how society has changed and the food industry has followed.
Before the ‘great expansion’, in general, mothers stayed at home to look after the children which included cooking from basic ingredients. Now we have, in general, two working parents per household, the mother, typically, coming home from work, now chooses to cook pre-prepared meals which contain a variety of ingredients that she would never ever consider adding to the family food intake.
Secondly, are all calories equal? using a simple b@mb calorimeter to measure the calorific value of a gram of food appears to have no relevance to what a human being would do with that one gram of food. Are we fooling ourselves?
Thirdly, I understand (please correct me) that there is no natural food where a large amount of fat and sugar is present together. However, we buy ready meals which contain large combinations of fat and sugar and it appears that when we consume fat and sugar combined it defeats the ‘stomach full’ signal.
Food for thought?
the body uses most energy for maintaining temperature. To loose weight start by turning the temperature down in your home. Loosing weight by physical exercise is much more difficult.
When the wife complains the house is too cold, which is just about every day, I will tell her that’s because I’m trying to lose weight.
Why We Get Fat: And What to Do About It
by Gary Taubes
I was on prednisone for 2.5 years. After gaining 40 lbs in 3 months and becoming border line diabetic I read the book listed above. In one year I lost 40lbs, never exercised and was never hungry. The first 8 chapters are weight loss history while all the rest of the book contain medical facts. I now know that the medical “scientists” of the 20th century are just like climate “scientists” of today. It is not a diet book.