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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?"
From personal, scientifically-measurable experience, I can tell you that gaining and losing weight isn't a matter of 'good calories' or 'bad calories'. It's a matter of calories. Burn more calories than you consume over a period of time, and you will lose weight. Burn fewer calories than you consume over a period of time, and you will gain weight. Yes, it's that simple. I suggest you all put down this claptrap, and read The Hacker's Diet by former AutoCAD developer and AutoDesk VP John Walker. It's done wonders for me.
My blog
When it comes to the current thinking on nutrition, there is a definite point to what he's saying.
But to say that Exercise has no effect on weight loss is just plain wrong. Exercise changes the way your body processes the food you put into it (or, more accurately, your body adapts to the amount of exercise that you get). Building muscle causes you to require more calories in your diet to support that muscle. And building stamina causes you to burn a lot of calories in the process. And if you want to venture into the unscientific realm, consistent exercise helps to stabilize your mood and makes you less prone to food cravings (the cravings for sugary foods and for fatty foods are based in imbalances in Serotonin and Dopamine levels).
There is a dire need to re-examine everything we know about a healthy diet. People get so worked up about things like trans fats while completely ignoring the elephant in the room (high-fructose corn syrup). Everyone I know who's given up corn syrup, to the extent that it's possible in the US, has lost a minimum of 10 lbs.
But to suggest that exercise isn't a vital part of a healthy lifestyle is wrong, and potentially very dangerous.
"Don't blame me, I voted for Kodos!"
I lost 25 pounds after I simply cut out bread, potatoes, and sugar from my diet.
In the mean time, I added a gallon of olive oil every 60 days and a pint of cream a week.
Tho fit already (sports twice a week, regular walking and exercise) I started developing diabetes (of course my mom and grandparents had it so I'm kinda doomed there). Despite cutting out enormous amounts of carbs and sugars (I was previously drinking 1,000 calories of soda a day), I continue to slide in the bad direction on my blood sugar. It's not diabetic yet but it is just a matter of time.
My diet consists of large amounts of vegetables, meat courses, almost no grains (2-3 ounces a day tops).
I think people have different needs based on their genetic history.
I agree that a lot of "science" these days is opinion, hysteria, or someone's hidden agenda.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
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.
I don't have time to LTTFP, but I know what worked for me. I was morbidly overweight, and I tried a number of things to get rid of it, including the traditional low-fat + exercise regimen. What finally worked was to eliminate or drastically cut high-glycemic carbs from my diet (rice, pasta, potatoes, bread, sugar, and the like). That, coupled with moderate exercise (walking 1 or 2 miles) helped me to drop 90 pounds in about a year.
I believe there is a relationship between high glycemic carbs, blood glucose spikes, and insulin, which will cause certain body chemistries to convert and store much of that intake as fat.
Wish I had discovered this 15 years ago.
Proverbs 21:19
This thread is ripe for turning into a flame-fest, but you may want to do at least some casual reading on what insulin is and the processes the body goes through to process fats, proteins and sugars. There's a thousand variables involved in how the body processes raw materials it takes in and what it does with the materials it creates from them. No combination of those will result in your blanket statement.
Some people can get all they need to run their bodies on a lot less calories than others.
I can raise my burn rate for several days by playing hard sports for three hours. People comment that I feel like I have a fever.
My friend who has developed problems after a life time of being thin has low thyroid and other hormone feedback systems. And she is always hungry- constantly. Even when she eats, she will be hungry again a while later. And not eating does not cause the hunger to fade like it does for me- it just gets stronger.
I have another friend who has the *reverse* problem. He is slowly losing weight (like a pound a year) despite eating heavily and it is getting kinda critical. He has a messed up endocrine system too.
Some people are messed up so that any exercise just destroys muscle (they do not get stronger).
I wish people would not be so judgmental about these things.
Some people eat because they are sad- some were raised and trained on bad food- some were never trained to enjoy physical activity. Some people have hyper metabolisms that allow them to eat heavily and still remain thin.
And there is some evidence recently that fat people die less of many diseases. The anti-fat attitudes stink of group-think gone bad.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
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.
I use the Physics Diet.
It has to work, because it's physics.
He makes the extraordinary claim that Official Nutrition has been getting it wrong for the last 40 years. However, he provides and discusses a solid body of relevant and eminently respectable (Lancet, JAMA, NEJM, etc..) citations to support his claim. Color me 95% convinced.
He notes that the application of the first law of thermodynamics (the slogan is "A Calorie is A Calorie") to a homeostatic dissipative system like the human body is beyond simplistic. It is simply wrong.
The core of his thesis is that a cellular-level metabolic disorder caused over time by consumption of concentrated and rapidly available carbohydrates, and the insulin spikes they provoke, is the cause not only of obesity but also of type II diabetes. Briefly, fat cells become too good at extracting glucose from the blood and storing it. This results in cellular-level semi-starvation in other body tissues, expressed at the organismic level by eating more and exercising less.
He depicts the high level of investment in the competing "gluttony & sloth" model of obesity which exists in our medical establishment and in our culture. Indeed, from his portrayal this viewpoint is very close to being an ideology rather than a theory, in that dissenters are cast into outer darkness rather than refuted.
He discusses the personalities and politics involved in the alleged disastrous wrong turn, and points up some interesting coincidences involving what research gets funded, and what research doesn't get funded, by for example sugar producers.
I'm intentionally being very brief. If you have a personal stake, read this book and form your own conclusions.
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phunctor
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").
The recommended advice of replacing fats with carbohydrates was repeated so often and so forcefully by everyone, that it's now printed on the back of almost every box of food in the country, in the form of the "USDA food pyramid". It was so often repeated that when I was a child (in the 1970s) things like wonder bread with a bit of margarine were considered health foods (lots of carbs, no saturated fat).
I had always assumed that the medical community had done large-scale long-term studies demonstrating that such a diet led to an increase in lifespan, a reduction in disease, and a loss of unhealthy pounds. Apparently, such studies were never done.
But then the massive Harvard Nurses Heatlh Study was performed, ending in the mid-1990s. In that study, researchers followed 40,000 nurses for decades, in what was the largest and most comprehensive study on human nutrition ever. The study found that replacing fats with carbohydrates had absolutely no effect on longevity or disease. Furthermore, replacing butter with margarine (the standard dietary advice for decades) led to no benefit either. IIRC, the only nurses who lived longer and had less disease were those who ate nutrient-dense monounsaturated fats like almonds and cashews.
As a result of the Harvard Nurses Health Study, researchers in nutrition quietly dropped their assumptions about dietary fats causing disease.
I still can't believe it. The standard dietary advice from 1960 to 1990 must have been the single largest pseudoscientific load of crap in modern history. What a colossal embarrassment. If the USDA publicly admits that it was mistaken then it will be a long time before people trust it again.
I've been following the south beach diet for a couple of months now, and I have already lost a significant amount of weight. I don't follow it exactly, I use it mostly as a framework than anything else. It makes a lot of sense, and the scientific explainations of why it works makes sense as well. For those who don't know what it is, it's basically cutting out all highly processed foods from your diet and to stick to whole grains and whole unprocessed (ie not from a box) food.
It's not really a "diet" in the traditional weight-watchers sense. It's a change in eating habits, and I really think it could benefit a lot of people. Besides the weight loss, I feel like I have more energy and things like heart burn, which I suffered from regularly, are nearly eliminated.
I got nothin'
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...
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Rob Flynn
Pidgin
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.
Those who can, do. Those who can't, sue.
After having read the majority of the threads it seems that everyone on Slashdot thinks they are a nutritional expert. Somehow I don't think that is the case.
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 agree with my tribal elder's wisdom from the ages. (aka Citation needed.)
"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."
Why only eating? Why not acting? Chase down those animals yourself (with no tools); that'll improve your body.
This post written under Gentoo-linux with an SCO IP license.
You seem to forget a tiny inconvenient fact about predators: they don't get their fat from the local store. They have to RUN, sometimes all day, in order to get something to eat. Just buying some fat shit in Wall Mart, eating it in front of the TV, then turning in to a late-night slashdot session, for sure WON'T make you look like a Cheetah. Sure, you should train your body to get its energy from fat. However, the only way to do it is to EXERCISE, with the correct heart frequency and for a prolonged time periods (at least one hour per exercise, at least 3-4 times a week). I've been running for the past 8 months. I feel WAY better, my waist circumference has decreased significantly, my heart frequency is now around 60-65 (was: 75+), and my blood pressure went 10-15 points down. I don't go out of breath by going 2-3 floors by stairs any more. Actually, I even barely notice it. I really don't believe I'd have seen the same effect if I just started "eating like a predator" instead. I'm still over 100kg though, but I'm working on it.
1. Muscle must be fed. Fat doesn't. Strength training builds muscle, which if nothing else consumes calories all the time, just much less at rest.
2. What goes in must either be used or go out. If I eat 6 pounds of food a week, and manage to consume 3 pounds of that as energy, eliminating 3 pounds as indegestible waste (you know what I mean), I neither gain or lose. If I work harder, or replace fat with muscle, I need more energy. It comes from somewhere.
3. If I eat less, I will eventually lose weight. The key word is 'eventually'.
4. If I work more, and don't change my diet, I will eventually lose weight.
5. The equation is, eat less, work more, and be patient. My body may well try to hoard resources in response to the apparent famine or starvation of not so much food.
6. Keep a balanced diet. Not feeding your body nutrients, especially calcium and trace elements, is very bad.
7. Portion control. Just do it.
8. Keep at it. Patience.
9. Drink plenty of water.
10. Read items 1-9 regularly and heed.
deleting the extra space after periods so i can stay relevant, yeah.
Sure... provided you have no real understanding of the processes involved.
The common, simplistic explanation of nutrition is that you consume food, which your body then breaks down, releasing the energy of chemical bonds, which your body then uses as fuel. We measure the energy released in a unit called calories.
This description is fine, and it suffices for most day-to-day discussions of food, with one caveat: It's fiction, almost from top to bottom.
Just for starters, when nutritionists talk about calories, they're not really talking about calories like a physicist would. They're really talking about "food calories," which I believe are equivalent to kilocalories. This may be a minor point, but it serves to illustrate that if you think nutrition science maps directly onto physics, you are wrong.
Second, and more importantly, any good college chemistry instructor will tell you that the body does not "release energy" from the chemical bonds in food. Chemicals form bonds because the bonded compounds are the lowest-energy state for those particles. In other words, it takes energy to break a chemical bond, not the other way around. Digestion allows us to extract energy from food because we break down certain chemical bonds and cause those chemicals to form other, different bonds -- bonds with an even lower energy state than the original form. Our bodies can then take advantage of the surplus (and exactly how is still another story).
If you understand this, it should be obvious that digestion can be a fairly complex process, not all food is equal, and you can't measure the "calories" in a food as if you had a gas gauge.
Breakfast served all day!
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.
My girlfriend happens to be a doctor, and currently works in a 'obesity clinic', and she is going for a PhD in public health, with a focus on obesity, and she left me with the impression that:
- Real medicine never was a 'real' science. It's absolutely shocking how many publications, treatments and diagnosis are based purely on 'gut feelings', or incoherent theories. Just pull up any statistics on malpractices, and be shocked. No other 'science' could get away with so many errors, after such a long time of experimenting. This happens in part because medicine is a rather unique applied science: there're a lot of psychological factors, and incredible amount of measuring errors, a gigantic level of complexity and tons of historic 'baggage' that doctors have to face every day.
- Medicine is getting a lot better in this aspect - there seems to be a relatively new way of thinking (in the medical community, at least) called "Evidence based medicine", which, if i understood correctly, could be basically summed up as applying scientific principals to the medical processes
- Obesity in specific is extremely complex. Almost everything you do has some influence on you body-weight and composition. Of course the laws of thermodynamics apply to human beings, too, but there are a gazillion factors that influence just how exactly the body deals with excessive calorie intake, or lack thereof, ranging from genetical to psychological and social factors. Just a basic example would be that if you simply stop eating for a week, you usually lose LESS weight compared to if you start 'snacking' all the time, eating 5 little meals a day (basic theory behind this sems to be that the body switches to 'emergency mode' if there's no food around, trying to save as may energy reserves as it can)
- Most theories seem to me to be a wild mixture of anecdotal observations mixed with biochemistry, somehow resembling Freudian theories - they are coherent in them selves, but lack a level of 'scientific interconection' to other knowledges. So it's quite common for a specific theory in obesity to me contradictory to a theory of e.g. neuroscience. As long as both theories "kind of" work, it doesn't seem to be a top priority to resolve that discrepancy (in contrast to what i have observed in 'hard sciences'). AS far as I can tell, thee's no real proof or reason why Whiskey shouldn't be as bad as Vodka in a diet, yet (here, at least) it's common knowledge that whiskey's ok, but vodka will make you fat - and as long as this works, it doesnt matter that much why this happens, or if it happens at all.
Scares the hell out of the cat, though...
When I eat like a Predator, I grow claws in front of my mouth and and have iridescent blood. Also, I click a lot when I talk... I should probably have that looked at.
My family taught me something when I was young and came to America, and miraculously became pudgy... "they have sugar in EVERYTHING here", so we cooked at home, and ate at home a lot, and bought mostly the basic building blocks of food, and... (ding ding) made it at home. There was never a shortage of sweets in the house, or of food. And once we dropped the soda pop and store bought cookie fads, our fat content dropped.
:) Salads, etc. My diet is as varied as it gets, and yet I'm in good shape and I've lost weight. Interesting? I was shocked. I have had two to three week breaks in my exercise routine, and yet no weight gained, and I lose little to none of my conditioning. (First day back I usually run half a mile, but I can get back to two to three miles a day the next day... shocked the life out of me since I was so used to what the idiots in school taught us. Seems almost everything school teaches can be thrown out once you graduate... preferably before. Including the lack of a good warmup before exercise, which is what destroys so many people's joints.) Strangely enough, I have "healthy levels" of the following. "Blood Sugar", "cholesterol", "blood pressure", "heart rate", with no murmurs, no palpitations and roughly no issues whatsoever.
Here's the catch. I work out and jog (swim, bike, etc, that's beside the point), but I do it to keep myself physically strong and resilient. I don't exercise to lose weight. It didn't really work, all it did was convert some of the fat to muscle. The rest went away as I began to eat regular healthy meals and cut down on the crap food to once a week or less. (Never cut the nasty stuff completely, or the cravings will find another way to surface, psychologically speaking. We're human and we're tempted, find a way to replace your cravings with something less nasty, that'd be it.)
My secret? I eat at least an egg a day, regular tea and hot chocolate, sausages or meat once a day
Rule #1? Live a good, healthy and complete life, stop struggling for shit you don't need, and stop fighting battles that don't gain you anything, not even satisfaction (which is more important than people think.)
Rule #2? Stop living with fear. Fear is the only thing you should fear, if anything at all. If something you do makes you "afraid", find out why, and get rid of the problem, don't just suppress the symptoms. Oftentimes fear will simply be some choice you make that you don't understand. Fear is among the worst stressors out there, yet few realize this. Getting into a fight with your boss and walking out of a job without fear is better than living each day at that job constantly afraid that you'll lose it someday and that you won't make payments on that brand new SUV you didn't really need (or want) or that three story house that only you and several ghosts live in (or whatever it is that keeps turning on the lights each night.)
All in all, remove fear by understanding what causes it and deal with it. That and discover the things that satisfy and please you, and surround yourself with those things. Often they are cheaper than you can imagine. Short of hunting and fishing, I have VERY few expensive hobbies. My garage is bigger than my house, as is my shop. Most of my "toys" I built myself, and will continue to do so. I use my life as an example, merely because I've been through all the problems many complain about, and have found ways to complete the needs behind each problem without rushing into a marriage or running into the arms of the nanny state or going on clinical drugs. Do I still have issues? Hell yeah. If I was perfect, I wouldn't be human.
" What luck for rulers that men do not think" - Adolf Hitler