OBESITY—WHERE IS THE REAL SOLUTION?

William R. Ware, PhD - Editor

In 2007-2008, 68% of American adults were overweight and 33.9% obese. While the rate of increase appears to have decreased somewhat, this in no way diminishes the seriousness of this problem nor its potential impact on public health and the cost of health care.[15]

Four papers appeared in the January 2010 issue of the American Journal of Clinical Nutrition summarize a recent symposium called “An Integrative view of Obesity.” When one reads these papers looking for the latest in solutions to this epidemic, there seems to be little that is new.

The classic notion that decreasing calories and increasing exercise is a major part of the answer appears alive and well, and the goal post are now set such that for the obese, a weight decrease of 10% is considered clinically important as measured by small decreases in the risk of chronic diseases. If one is 69 inches tall and has a BMI of 40, the corresponding weight is 286 lbs, and the individual is on the threshold of morbid obesity. A loss of 10% is about 29 lbs, which still leaves the person obese.

To be classed as not obese an in fact not overweight, the target would be about 180 lbs. The loss of an additional 77 lbs appears to be exceedingly difficult, and even the 10% reduction is not easy for many to either achieve or maintain.

In a talk that was described as anchoring the symposium, George Blackburn emphasized the energy gap, i.e. the energy consumed compared to the energy expended. He called for public health measures which include decrease in caloric intake, improving the macronutrient content of diets, and increasing physical activity. In the published paper,[16]

Blackburn states that decreasing fat intake should be of particular concern in any lifestyle intervention, and his discussion of maintaining fatfree mass, while indicating the merits of higher protein diets, does not mention the matter of carbohydrates and carbohydrate metabolism. Other speakers also emphasized the role of the use of portion control and daily physical activity.[17]

These notions go back to the 18th century, but the obesity epidemic is very recent.

Of all those who have researched these topics, the independent researcher Gary Taubes, seems to stand out as one who has looked with great care at the totality of the literature to date, is not burdened by nutritional mythology or dogma, and appears to truly engaged in an unbiased search for the truth.

His research is summarized in the 600-page book “Good Calories, Bad Calories, Challenging the conventional wisdom on diet, weight control, and disease.” (Knopf, New York, 2007). This book extensively and comprehensively documents the following conclusions regarding obesity (pp. 454):
• Obesity is a disorder of excess fat accumulation, not overeating nor sedentary behavior.
• Excess calories do not cause one to grow fatter and expending more energy than we consume does not lead to long-term weight loss—it leads to hunger.
• Fattening and obesity are caused by an imbalance in hormonal regulation of adipose tissue and fat metabolism.
• Insulin is the primary regulator of fat storage, with high levels favoring accumulation and low levels favoring release of fat from fat tissue for use as fuel.
• By stimulating insulin secretion, carbohydrates cause obesity and make us fat. By decreasing carbohydrate consumption, individuals will become leaner.
• By driving fat accumulation, carbohydrates increase hunger and decrease the amount of energy expended on metabolism and physical activity.

These are generalizations of a vast amount of research. He of course is not advising against exercise. And obviously specific exceptions can be found, but these general conclusions are directly opposed to the conventional wisdom fashionable in nutritional circles and mainstream medicine and evident in the above symposium.

Critics may well wave banners stating that the First Law of Thermodynamics, like Horace Rumpole’s wife, must be obeyed, but they should realize that within the confines of this law, human biochemistry and in particular metabolism is exceedingly complex, and oversimplification can lead down a blind alley. Until the hypothesis advanced by Taubes is considered seriously, there is probably no hope that the problem of obesity will be solved.

It can even be argued that it will never be solved for political, social and psychological reasons. In addition, the problem needs a more sophisticated solution than simply condemning couch potatoes, drinks with high sugar content and calorie-dense junk food, although these actions are certainly defensible.

Taubes’ book seems like a breath of fresh air in this field and is highly recommended. He does not appear to “cherry pick” sources, discusses conflicting evidence, and the weight of the evidence he presents, some of which goes back several decades or more, appears devastating to the conventional wisdom.

Sources:
(15) Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and Trends in Obesity Among US Adults, 1999-2008. JAMA 2010 January 13;2009.
(16) Blackburn GL, Wollner S, Heymsfield SB. Lifestyle interventions for the treatment of class III obesity: a primary target for nutrition medicine in the obesity epidemic. Am J Clin Nutr 2010 January;91(1):289S-92S.
(17) Heber D. An integrative view of obesity. Am J Clin Nutr 2010 January;91(1):280S-3S.

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