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The Obesity Epidemic — Is Medicine Scientific?
An anonymous reader writes "An award-winning science author, Gary Taubes, has written a book that pans the medical community's treatment of the obesity epidemic. What is interesting is that it looks like the medical community is behaving in a very unscientific manner. Taubes points out that the current medical orthodoxy — that consuming fat makes you fat and exercise makes you thin — has no basis in research. In fact, all the available research points in quite another, and more traditional, direction. Here's the (excellent) podcast of an interview with Taubes on CBC's 'Quirks and Quarks.' So, has medicine become a non-science? Is it mostly a non-science? Somewhat?"
Not more of this low-carb propaganda bullshit. Calories make you fat, regardless of whether they come from fat, sugars, or starches.
The laws of probability forbid it!
There's money to be made. Stop interfering.
what about eating in moderation with exercise? Why does it have to be so extreme, i.e. no sugar, no fat, "no" something?
The recommended amount of exercise is 30 minutes per day -- it's actually a fair amount, if you're biking or jogging 30 minutes per day, and eating in moderation, i.e. let's say within the FDA guidelines for diet, and you're still overweight, then you might have a medical need for weight treatment. Otherwise, try all of those things first.
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To answer the questions of the summary, I don't think it will ever be an untainted science so long as the government, businesses & religion stick their noses in it. Couple that with the difficulty of applying the scientific method to humans (average life span of 75 years and ethical problems) and I think you'll see why medicine is a 'non-science.'
Patents, legislation & belief in what is good for you are what ruin medicine. Look at all the Hindu medicine that was ignored by the West for the longest time because it was
Medicine will continue to be a non-science no matter how hard the community tries. The public's assumptions and beliefs that "Since I can eat McDonald's every day and be thin, everyone should be able to" merely exacerbates the situation.
I eat whatever I feel like and I'm in great shape. This is not the case with the majority of Americans.
My work here is dung.
"For 50 years, the advice on dieting has been very clear..."
Um, hardly. This kind of sentence attempt to draw the reader into a sense of agreement from their most-remembered anecdotes so that the rest of the premise is seen as new. But in reality, fad dieting advice is all over the map and has been since it was part of pop culture, which goes back a *long* way. Spoonful of mercury, anyone?
The only good dieting advice has been through a good understand of one's own body. Allergies, lifestyle, location, education, economics, etc all play roles in what chemicals you put in your and how you burn energy.
This book's position is just another in the lineup of positions taken about the human GI system and energy usage. There are many strategies, both workable and not. Unless you know yourself well, no change is a worthwhile change - its all so much guessing.
Additionally, one has to ask the philosophical question...is the goal to eat yummy/available food or live [potentially] longer lives? There's no one answer, really.
OK, who doesn't recommend whole grains and avoiding sweets for overweight people? The quacks are all over the place, but I think we know (and have known) that vegetables & whole grains are the way to go.
-Dave
So, has medicine become a non-science? Is it mostly a non-science? Somewhat?
You think this article is about "medicine" in general? This is about a tiny branch of medicine dealing with nutrition and public health.
FTA:
For the last thirty years, medical advice on obesity has been very clear. Eat less and exercise. But what if that was all wrong, a big fat lie, as Gary Taubes would put it? or In fact, according to Mr. Taubes, everything the medical profession advocates, in terms of eating and exercise, is at best a waste of time, and at worst, may actually be killing us. Of course medical advice is clear. Exercise does make you healthier and stronger. It helps your immune system and metabolism. It is true that you should only exercise the amount you are able, and that over-exercising can put added and unnecessary strain on important organs which can be dangerous. One thing that the medical field is learning though is that a good portion of your body shape is due simply to genetics. The "medical community" has not been caught up and derailed by the "diet and exercise" bandwagon. They are currently doing more and more research into the amount we are affected by our own genes.
There are some doctors who do not have the absolute latest information and they will sometimes claim that diet and exercise are the only thing that is making someone larger and there are (of course) a few scam artists trying to make a buck off the "simple little pill" or "this is the only piece of equipment you need to be thin" commercials and insatiably people will fall for it.
The point is, the medical field is right in giving this person that advice. He should eat less, he should exercise. It WILL make him healthier. It may not make him look like Brad Pitt, and he (probably) always be larger than normal, but just because a component of obesity is genetics does not mean everything to do with obesity is genetics. It also does not mean the "medical community" is stuck in the stone age with "non science."
The original generic sig.
Not more of this low-carb propaganda bullshit.
I understand your anger, but the issue here is whether the low-carb propaganda is really bullshit or not. It is a matter that should be investigated, otherwise those dismissing it as bullshit would effectively act as anti-low-carb zealots, instead of following the scientific method.
Also, we have to wonder why the US (the country where the Food Pyramid originated) is also where the "fatness" phenomenon originated, and why the countries that start to follow the "american way of life" (fast food, sedentary life, high-calory carb snacks) tend to follow american's fatness. This phenomenon, at least country-wise, behaves like an epidemic.
This is absolutely true. You can't dispute the fact of this statement taken in isolation. In isolation.
However, it's a fine example of blinding yourself to the causes. The questions at the heart of the debate between low-carb and low-fat diet proponents are the following:
So just saying calories are calories is like saying BTUs are BTUs and putting heating oil in your gas tank in the hopes of getting better MPG.
If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").
Isn't it possible that your weight loss is due to "cutting out enormous amounts of carbs and sugars," including the 1k calories and soda, and not to the extra olive oil and cream? Congrats on losing the weight, I don't want to undercut that, but the subject line of your comment seems like a bit of a logical leap.
Is medicine science? Sometimes.
Being married to a medical student who's going through a year of trying different specialties has been very illuminating. Some specialties, like pathology, are almost entirely scientific. Others, like orthopedics are largely mechanical, as are most surgical specialties. Specialties like family practice and pediatrics involve a fair bit of science, but also depend heavily on personal interactions. And of course every physician, just like every person, is subject to their bias.
My wife and her fellow medical students frequently talk about how for your first two years of medical school you're taught science, and for your last two years of medical school you're taken through the hospital and told how everything you just learned is useless.
If medicine could be reduced to a set of scientific rules, it could be practiced by robots. Until that happens, we're stuck with our un-scientific doctors.
Mod my comments down. It'll be fun.
By increasing my exercise, hitting a minimum of 10,000 steps a day, consuming less "sweets" and smaller portions of food, I have lost 20+ over the last three months. I have worked to lose the weight in a manner that creates a sustainable eating and activity style for life.
This has been working for me. Who knows about you, but I suspect that with some self-discipline and a change of habits, most people could lose weight.
On this point, I read a great humorous book (true story) about a man's effort to lose weight: http://conservativebooktalk.com/2007/10/22/one-third-off-by-irvin-s-cobb/
Nor is he a research scientist. He is an author, and his goal seems to be to sell books, not to add anything to the scientific community.
I have found that if I eat more calories than I burn, I lose weight (and vice versa!), no matter what kind of calories they are. When I go on long hiking trips, or field exercises with my military unit, I'm very active and burning more calories than I take in, and I lose weight. Conversely, when I sit at home for a week and eat turkey and watch football, I gain weight.
Incidentally, if you have a problem with your plumbing, then it's clear that an auto mechanic probably won't be able to give you good advice; if you have a problem with your plumbing, you should talk to a plumber. In the same way, if you want information about your body, you should probably get it from your doctor, rather than some random person who had a Bright Idea and wrote a book about it.
Everything you list there simply says that doctors are required to know stuff. Ostensibly that stuff is derived from scientific studies, but knowing a fact derived via science is not at all the same thing as knowing how to do science.
Science is about observation, forming hypotheses, building good experiments to validate them, performing those experiments, and using statistical methods to reason about the implications of the results of your experiments.
Just because you remember a bunch of things you are taught doesn't mean you know science. If you don't have some backbone of researchers doing science to verify the stuff you think you know, it's not science, it's just stuff.
Science would be to actually test how well diets and/or exercise work on a group of people. And over and over for decades such studies have shown that the weight lost is very small, and what weight is lost isn't maintained. That goes for studies of animals too. That's science. And it is true that most clinicians ignore that science and give advice based on a hypothesis that has been for the most part falsified by in vivo studies.
The reason the hypothesis fails is because the system that's been blackboxed regulates fat homeostatically. Just like hydration, carbon dioxide levels, and temperature are regulated - fat mass is also regulated - largely through hypothalamic monitoring of circulating leptin and insulin levels.
What most people don't understand - because they don't plug numbers into the equation - is how closely the body has to maintain the energy balance. A 1 or 2% overage or underage will rapidly lead to massive obesity or death by starvation. So there's a very powerful and very finely tuned system that controls how much we eat and how much we expend by monitoring our fat mass. This is true of the very fat and the very thin. It makes sense when you think about it, but most people don't.
So the body aggressively tries to maintain homeostasis - that is keep fat mass within a given range - by adjusting appetite, metabolism, the relative deposition and breakdown of lean mass and fat mass, and the various forms of physical activity. You have some conscious control over some of these factors, but when you start falling outside the comfortable range - whether or not you are still "fat" - you are fighting homeostatic controls that are very hard to keep at bay long term.
(Generally people who are well below their comfortable range feel extremely hungry, tired and slothful, cold, depressed, etc. And most of all they become obsessive about food. As you can see these are all the body's ways of trying to encourage a positive energy balance. And it's no way to live.)
This kind of mechanims is why it would be very difficult to maintain dehydration indefinitely without drinking. And this is also why it's easy to hold your breath for 10 seconds, but not 3 minutes.
Most fat people - like most thin people - are staying within their range - and most who aren't trying to lose weight and thereby weight cycling maintain remarkably stable weights - just higher weights than we would like.
The real long-term solution to obesity will probably come from finding ways to manipulate the set point so that individuals with dangerously high weights don't have to live their entires lives battling (for the most part futilely) powerful internal regulatory controls just to maintain a weight loss. It is possible that the set point can also be prevented from going too high - but that too is just a hypothesis at this point, and how that can be accomplished isn't clear.
But that understanding among obesity researchers is why most of the focus on obesity is now on prevention in children. And why the research is targeting earlier and earlier ages - including the prenatal environment. I'm not entirely sure that that's a clear-headed strategy because as of yet there have been no interventions shown to be successful at preventing obesity in children either. But there is less evidence than in adults that the project is futile.
Medicine is becoming more scientific, thus he emphasis on scientifically trained doctors. It didn't used to be that way though. Medicine is a very old profession, predating rigorous science. There's still a lot of medical knowledge that isn't strictly scientific, but we haven't gotten around to studying scientifically yet. There are also a lot of older physicians and surgeons (particularly surgeons) around who may not have as good a grounding in scientific method.
It's definitely not the case with anybody educated in the last decade though. I'm on the science side of clinically oriented research and we work side by side with practicing clinicians. When they argue they cite papers and large studies.
I wouldn't dismiss everything he says out of hand, but it's important to note what the weight of the available evidence says, and not just the 5% of it that he cites (sometimes wrongly) in support of his thesis. Unfortunately, those seeking a simple classification of all foods into unequivocal "good" and "bad" categories are probably never going to be satisfied with the state of the science.
On a final note, I'd caution against anyone who has all of the answers but says that the "research establishment" is involved in some sort of massive, sinister conspiracy to suppress them. Things just don't work that way.
I'm sorry, but yes you are. Given the context of the discussion, it's pretty ridiculous to bring up calories from sources we can't digest. They're irrelevant.
-Doctors are more than happy to mandate strict entry requirements, but not require that they be routinely re-tested based on the latest science.
-Why there's so much subjectivity in medicine (why doctors can disagree on treatment).
Let's use slashdot terms. The MDs are the engineers and the Med PhDs are the physicists. An engineer needs to learn physics, but in designing buildings day-in, day-out, he may rely on specific products that were even the subject of marketing (concrete, fasterners, etc.) and may have to listen to the needs of the ignorant patients (in other words, the architects). He has to make his own effort to keep knowledge current, may rely on his own rules of thumb that other engineers disagree with, and sometimes the most competent engineer falls behind the cutting edge. And yes, he can make mistakes, and there are incompetent ones.
But damn if the buildings aren't solid.
He espouses the notion that lower cholesterol levels are not healthier. That statement is so much total bunk that it is on the order and level of other statements like "Smoking doesn't cause cancer" "The earth is flat" etc.
Conclusive proven evidence shows that the lower your cholesterol or the more you *lower* your cholesterol, the lower the risk of heart disease related events etc. Not even worth our time to discuss. A frank waste of time and valuable intertubes!
True - at least calorically (sp?). Certainly not taste-wise.
The same is true for fats, proteins etc, it isn't a simple case of calories in and calories out, they all push specific chemical processes which have specific effects on the body and it's function. If the balance is wrong, people become malnutritioned. Replace calories supplied by sugar with calories supplied by proteins and there is an entirely different effect on the body.
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