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?"

Comments

moderation

[192939495969798999]

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.

He May Be But You're Not Helping

[eldavojohn]

It's done wonders for me. I think that's the number one problem with diet plans these days. People assume that since it worked for them it will work for everyone else. I don't think that's the case.

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 ... well, Hindu.

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.

Re:He May Be But You're Not Helping

[raddan]

Medicine will continue to be a non-science no matter how hard the community tries. This is untrue. While there are many questions which science is ill prepared to investigate, this is not one of them. Science cannot answer questions about metaphysics, mysticism, and so on, because those subjects have nothing for the tools of science (thesis, antithesis, and synthesis) to work on.

Medicine is complex. But that doesn't stop or discourage scientists. The world is complex. Science has always, and will always, face this issue. Medicine is a perfect subject for the application of science. Do physicists give up because certain things are not directly observable? Those working in public health have to work with what they're given.

I would much rather my doctor give me advice based on years of compounded peer-reviewed research than an opinion based on anecdote. Because, without science-- that's what you're talking about.

strawman logic

[mugnyte]

"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.

The "medical community?"

[physicsboy500]

I have a big gripe with saying the "medical community" or stereotyping the entire medical field as saying diet and exercise is the only component to obesity.
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."

Perhaps it's worth investigating...

[Spy der Mann]

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.

Re:Perhaps it's worth investigating...

[badasscat]

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.

Ok, here's your scientific study:

Asians eat carbs with almost every meal (rice, noodles). They are thinner than us. End of story.

Excess calories make you fat. That's a law of physics; I have no idea why some people dispute it. It's like arguing with the law of gravity. The only question is whether calories coming from different sources are absorbed more slowly or quickly, but the end result is the same unless you're exercising to stay in shape. A calorie is a unit of energy and if that energy is not used, it must be stored. Energy doesn't just disappear into thin air; when you consume it, you either use it or you store it.

And I really don't think there are any scientists out there saying otherwise; I don't know of any scientist saying "eating fat makes you fat" or even "eating carbs makes you fat". The only time that's ever said is in the context of certain types of high-fat or high-carb foods generally being higher in calories, which is true. Although again, Asians eat plenty of fatty meats along with their carbs and they're still thinner than we are. The reason is they just eat less. Which means fewer calories.

Not rocket science. And we've got all the knowledge we need.

Re:Perhaps it's worth investigating...

[cbr2702]

"Excess calories make you fat. That's a law of physics; I have no idea why some people dispute it. It's like arguing with the law of gravity. The only question is whether calories coming from different sources are absorbed more slowly or quickly, but the end result is the same unless you're exercising to stay in shape. A calorie is a unit of energy and if that energy is not used, it must be stored. Energy doesn't just disappear into thin air; when you consume it, you either use it or you store it."

This would require human waste to have no caloric value.

Re:Perhaps it's worth investigating...

[sitarah]

"Calories in, calories out. It's so easy!" You are missing the point and the reason all these low-carb, low-fat, low-whatever suggestions exist. Calories in, calories out works in a lab environment where you can measure intake, consumption methods, and waste precisely. You cannot do that with humans. There are too many variables.

1) You don't know what your calories out are.

You have no idea what you are really burning, standing around, unless you get a battery of tests performed to check your metabolism, lung function, and body heat during any given activity.

There are a ton of things that affect your metabolic rate; your core temperature, insulin levels, sugar sensitivity, allergies, your inclination to fidget, whether you are building muscle at a given time, whether you are healing wounds or recovering from sickness. There has even been researching suggesting that 3 months of consistent exercise actually changes your energy consumption at a mitochondrial level. Did you know soy and broccoli reduce the level of iodine in your body and therefore inhibit metabolic function?

2) You don't know what your calories in are.

You know what the government knows about broccoli: that if you light it on fire, it burns at x rate, and it leaves behind x waste. They extrapolate its structure from there. That has nothing to do with how well your body actually digests the food and uses that energy. You could have an extremely acidic stomach, or lock up calories with excess fiber, or drink too much and hurry food through your intestinal track before you can extract all its energy.

You also don't know how well-marbled their test steak was, how saturated with water their chicken breast was (did you know supermarket chicken is injected with saltwater?), or how aerated their whipped cream was. This will all lead to a difference in caloric value. These little differences all add up.

These diet plans that discard certain foods do so with the idea that we might be able to find a diet that works by minimizing a variable; eat fewer carbs to reduce insulin levels, isolate sugar sensitivity, eat less wheat to minimize allergies, eat less meat to reduce hormones, salt, and saturated fat, etc.

Asians are genetically different; they have different musculatures (they might have smaller thighs, for instance, meaning they burn less calories because that's a very large muscle group), different insulin levels, they may produce heat differently than Europeans due to their environment. There's also cultural differences; less dairy, more lean meat, etc. You're just not making an apples to apples comparison.

Re:Perhaps it's worth investigating...

[TrekkieGod]

Calories in, calories out works in a lab environment where you can measure intake, consumption methods, and waste precisely. You cannot do that with humans. There are too many variables.

You don't know what your calories out are

You don't know what your calories in are

Which would be a great point if I was trying to determine exactly how much I should eat to lose 10.3 lbs in 35.7 days. However, I don't need anywhere near the precision you're talking about there. There aren't "too many variables." There's only one variable that matters: Calories. So I don't know exactly how many calories the broccoli I'm eating or the meat I'm eating has. However, those tests are pretty good estimates in telling me the calorie density of foods, and I can substitute more calorie dense foods (like chocolate cakes) with less calorie dense foods (like fruits) and know that I'm eating less calories. Then I can weigh myself and see if I'm losing weight. If I'm not, I can eat less and / or exercise more (use up more calories) until I do start losing weight. It will work. Guaranteed. Because the only thing that matters is that I eat less calories than I use up and I will lose weight. It doesn't matter what the exact numbers are.

And I lost 50 lbs recently by doing just that. And my roommate lost 100 lbs by doing that. And another friend lost about 40. I don't know anyone who actually stuck with said method and didn't lose weight. And if I did know someone, and verified it, I'd tell him to go claim James Randi's prize, because it would be a physics-defying supernatural event.

Now to be fair, it can be complicated, because of the psychological aspects of dieting. Dieting sucks, and if you don't stick with it, it won't work. I have cravings for chocolate cakes and I hate fruit. So any diet that gives you a little cheating room and is based on substituting calorie dense foods with less calorie dense foods is likely to be more successful then diets that give you extremely small portions of food and don't allow you to ever have days off, simply because I'm not likely to have the willpower to stick with that second diet. In addition, you need to make sure you're getting your proper nutrition from whatever diet you're at if you want to remain healthy.

So, there are diets that are better than others, but the losing weight equation just boils down to calories.

Yes and no.

[Valdrax]

Calories make you fat, regardless of whether they come from fat, sugars, or starches.

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:

1. Does eating certain types of food allow for the intake of more calories before being satisfied? (e.g. Pork vs. chicken; fruit vs. Twinkies)
   
2. Do certain foods increase hunger? (i.e. Effects on insulin and other hormones)
   
3. Do certain foods have other health issues than weight? (e.g. Saturated vs. unsaturated fat; sugar-intake & diabetes.)
   

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.

Re:Ugh...

[RobFlynn]

You basically said it here -- the "diet" doesn't matter so much -- if people would stop eating foods that suck and if they'd get up off their butts sometimes, then they will be healthier.

My mother has been overweight for some time. She has a medical condition which caused it. She ate well and exercised and she was still overweight. She just couldn't do anything about it. Doctors prescribed her some medication to help the issue, but itcaused all kinds of problems, so she went off it. She gained the weight back. People like that are pretty much the only ones I feel sorry for when it comes to weight.

Hell, I could stand to lose a good 30lbs myself. And ya know what, I'm the one to blame? I'm a computer programmer that sits around eating crap all day. That's my fault. I also used to be very fit, and that was also my doing. I ate well, actually, more than I eat now, and did a little bit of exercise.

It just takes a little effort and common sense. Most people want the magical easy solution...

Re:Ugh...

[NeutronCowboy]

You're like every customer who calls into customer support: they know the symptoms, are vaguely aware of the underpinnings of the machine and are absolutely convinced they know what the issue is.

Do yourself a favor, and treat your next interaction with your doctor like a call with tech support: understand that they know more about how the system is supposed to work than you, understand that you know more about how your system works than them, transfer that knowledge to them, and be patient while they wade through the standard troubleshooting steps (did you reboot your machine? do you get enough sleep/vitamins?).

You'll actually have a chance of getting some use out of them, and live a better life.

Re:Ugh...

[pragma_x]

As for being fat. If you eat like a predator, you'll have a body like a predator. If you eat like a herbivore, you'll look like one.

I know this is tongue in cheek, and I tend to agree, but it made me think. I sure do want some BBQ right about now.

To be fair about it, predators also eat the bone, blood, organs, entrails and even the ruminate inside. They need to since flesh (muscle and skin) doesn't have the mineral and vitamin content an animal needs to survive.

So, be sure to have a nice slice of kidney pie, bone meal, some chitins, and liver with that hamburger! Yum-o.

Honestly, you'll get farther eating like the omnivore you are: meat, vegetables, herbs, fruit and few processed carbs and sugars.