Why We Get Fat: and What to Do About It Part I

Welcome to the February book review! This month we will be looking at, “Why We Get Fat and What To Do About It” by Gary Taubes. This book lives up to its title. At the end of the book, we should have an understanding of how we get fat, as well as the diet that is the most useful for losing weight. He sifts through centuries of research and data to only give us the most valuable nuggets of precious metal. My review will distill his thoughts further so you are left a philosopher’s stone of sorts. I have read this book a few times, and it is well worth your time and effort.

I want to start with a quote from Taubes’ book, he was quoting a 1998 National Institutes of Health (NIH) report, “Obesity is a complex, multifactorial chronic disease that develops from an interaction of genotype and the environment,” they explained. “Our understanding of how and why obesity develops is incomplete, but involves the integration of social, behavioral, cultural, physiological, metabolic and genetic factors.”

During the course of his book, he talks about these effects on obesity. The point he hammers home the hardest is that obesity is not a disease of overnutrition, it is the most prevalent form of malnutrition. Obesity is not a case of thermodynamics or calorie-in, calorie-out, however, the research seems to point to it being a hormonal imbalance, with a strong genetic component. If our parents are fat, we are more likely to be fat, or we may have a harder time maintaining a healthy body weight.

This is a considerably quicker read than The Big Fat Surprise, however, do not judge this book by its size alone. It is jammed packed with nuggets of knowledge. These gold bombs come early and often. Taubes doesn’t even wait for the first chapter to start dropping them. In the introduction, he lays out the thesis for his book that he attempts to further prove throughout the book. One such quote is as follows:

The science tells us that obesity is ultimately the result of a hormonal imbalance, not a caloric one— specifically, the stimulation of insulin secretion caused by eating easily digestible, carbohydrate-rich foods: refined carbohydrates, including flour and cereal grains, starchy vegetables such as potatoes, and sugars, like sucrose (table sugar) and high- fructose corn syrup. These carbohydrates literally make us fat, and by driving us to accumulate fat, they make us hungrier and they make us sedentary.

During the first few pages, he also makes a connection to how the science of obesity research would have to evolve if it was subject to a trial in court. Most poignantly, even though the calories-in/calories-out and diet-heart hypotheses have both failed their supporters dug in their heels instead of ruling a guilty verdict. The quote from his book says it better than I could sum up:

Imagine a murder trial in which one credible witness after another takes the stand and testifies that the suspect was elsewhere at the time of the killing and so had an airtight alibi, and yet the jurors keep insisting that the defendant is guilty, because that’s what they believed when the trial began. Consider the obesity epidemic. Here we are as a population getting fatter and fatter. Fifty years ago, one in every eight or nine Americans would have been officially considered obese, and today it’s one in every three. Two in three are now considered overweight, which means they’re carrying around more weight than the public-health authorities deem to be healthy. Children are fatter, adolescents are fatter, even newborn babies are emerging from the womb fatter. Throughout the decades of this obesity epidemic, the calories-in/calories-out, energy-balance notion has held sway, and so the health officials assume that either we’re not paying attention to what they’ve been telling us—eat less and exercise more—or we just can’t help ourselves.

Much like Taubes, I have a hard time believing that the “common wisdom” to eat less and exercise more is true. I have seen friends and co-workers attempt to follow the US dietary guidelines, often times when they do they are left wrecked because of it. I have dealt with this myself, but instead of just calories, I also counted weight watchers points, then I started counting calories, points, and macros (plus sodium and fiber). I felt myself becoming addicted to the counting, but worst of all I felt like I was never full. At the time, I shrugged it off, since that’s what dieting is, right? No, it’s not just about the right magical amount of whatever number you are chasing then going for an extra run so you can get the points to cash them in for another Little Debbie’s snack cake. It is not about numbers, it is about eating the foods that will not cause the hormonal regulation that triggers the dysregulation; it is about eating foods that do not hijack your dopamine response. Because these foods seem to trigger addictive like tendencies making it that much harder to give up the sweet rewards.

So that was a minor tirade, sorry. The last part was not directly from Taubes’ book, but it was some research I have been doing on the neuroregulation of appetite, and the signals your body sends when you get a huge dose of super sweet things. Okay, back to “Why We Get Fat.”

This book is broken into two books, and I will be breaking this post into two sections as well. Book I is entitled, “Biology, Not Physics,” and the chapters I wanted to highlight are:

  1. Why Were They Fat?
  2. The Elusive Benefits of Exercise
  3. Thermodynamics for Dummies, Part 1
  4. Thermodynamics for Dummies, Part 2
  5. Head Cases

Book II is entitled “Adiposity 101,” and I will tell you the chapters I will be highlighting then.

  1. Why Were They Fat?

Now, let’s dive into chapter 1. Like in any good book, before telling us what to do, we must first understand why we need to make a change. Taubes approaches this by pointing out the flaws in nutritional science (much like The Big Fat Surprise does,) to illustrate that point he’s says, “[the] methods of science are supposed to guard against the adoption of false convictions, but these methods aren’t always followed, and even when they are, inferring the truth about nature and the universe is a difficult business.” In other words, scientists should be encouraged to follow the evidence no matter where it leads (even if it points a naughty finger at big business,) especially if it causes us to rethink our previously held beliefs. Science should be free from dogma and allow for open discourse. With all of this talk about what science should do, it begs the question, “Is science, more specifically nutritional science, like that today?” To answer that I want to preface with, I don’t want it to seem like I am coming down on all science because I am not. There is a lot of good science out there, but spoiler, there is also a lot of bad science that will confuse you. Taubes tackles this point head-on by saying:

In most of science, skeptical appraisals of the evidence are considered a fundamental requirement to make progress. In nutrition and public health, however, they are seen by many as counterproductive, because they undermine efforts to promote behaviors that the authorities believe, rightly or wrongly, are good for us. But our health (and our weight) are at stake here, so let’s take a look at this evidence and see where it leads us.

To be fair I can understand why, just think about how frustrated you would get if you article after article, each one contradicting the other. A few of my friends joke about it say, “So today barefoot running is bad, yesterday it was good. What will it be tomorrow?” This is a very valid point, however, we must keep in mind, that what works for me may not work for you. I can handle barefoot running since I have worked up to it, but if you do nothing but ware high heels and sit all day, I would not suggest going for a barefoot run or you will pull something. When you take up a significant change, to steal a phrase from Vinnie Tortorich, you need to ease into the change, then you need to go slower (or it was close to that.) Why do we need to slow down? Because change is hard; if you want to make it stick you need to do it slow and steady. I say all that to remind you why studies are important, but they are not the end all be all, because at best they are flawed by corporate backing, and at worst, they may not apply to you if they studied 80-year-old males when you are a 30-year-old female. This is why science should be skeptical because we cannot know all of the variables, This is why science should be a slow steady process that evolves as we learn more. If I hadn’t changed when my diet didn’t work I would not be writing this. Did I have to change my paradigm a bunch of times? Yes. Does that make me a hypocrite? No, because much like scientists should do, I adapted my hypothesis to fit the trends I was seeming in the data I was given. Will my hypothesis continue to evolve as my understanding and knowledge do? I sure as heck hope so!

With that said, why does all of the science talk matter? It matters because the current hypothesis about obesity is flawed, it is not about these magical things we didn’t know about until relatively recently called calories, it is not about us having “too much money, too much food, too easily available, plus too many incentives to be sedentary—or too little need to be physically active—[to] have caused the obesity epidemic.” It is not that at all. Because as Tabues reminds us, “One piece of evidence that needs to be considered in this context, however, is the well-documented fact that being fat is associated with poverty, not prosperity—certainly in women, and often in men.”

So if it is too much money or food that is too available. How can it be connected to poverty? To be fair, being overweight does not mean you are poor. But again in science, you seek to disprove yourself. To find out why outliers are there, which begs the question: “if the number of outliers becomes statistically significant enough to be included in the “normal” group, can they be outliers anymore? Or does your hypothesis need to change?

To prove that amount of outlier there has been, Taubes put together a quick write up about each of these so-called outliers that were, in some cases, dirt poor or struck by famine. Yes, like I mentioned above these outliers would be obese in the face of years of famine. Not getting any more or less food than the emaciated person next to them. Here is the list of cases that documented the obesity triggered malnutrition:

  • 1870 Pima
  • 1951: Naples, Italy
  • 1954: The Pima Again
  • 1959: Charleston, South Carolina 1
  • 1960: Durban, South Africa
  • 1961: Nauru, the South Pacific
  • 1961– 63: Trinidad, West Indies
  • 1963: Chile
  • 1964– 65: Johannesburg, South Africa
  • 1965: North Carolina
  • 1969: Ghana
  • 1970: Lagos, Nigeria
  • 1971: Rarotonga, the South Pacific
  • 1974: Kingston, Jamaica
  • 1974: Chile (again)
  • 1978: Oklahoma
  • 1981– 83: Starr County, Texas

I do not want to belabor this point much more, so I will end the discussion on chapter 1 with this: obesity is about far more than just the amount of calories you get or the how sedentary you are. It is about what that food does in your body that matters. Getting exercise is important, but it alone will not make you the picture of health.

  1. The Elusive Benefits of Exercise

With that segway, let’s dive into chapter 3 “The Elusive Benefits of Exercise” I love the story that starts off this chapter. Instead of a long quote, I will simply summarize it. You are invited to a dinner where you want to have an appetite. Like this is the last supper before you start a diet and you want to end up in a food coma. What do you do? Well obviously you’d forgo breakfast and lunch, why fill up on subpar food. What else would you do? Maybe you would do a super long or intense workout, so can work up an appetite… does that sound familiar? It sounds oddly like the current dietary guidelines, that says we should eat less and move more. Is that paradoxical to anyone else? Maybe it’s just me. Or not, especially since that is the same idea Taubes ended his anecdote with. Why are we consistently working up an appetite just to starve ourselves later?

Much like the lack of definitive proof linking excess calories and obesity, the science does not add up. This does not mean that there aren’t benefits to exercising because there are. Those benefits, however, do not seem to include sustained weight loss. This flies in the face of the current public policy, which is to get “Thirty minutes of moderately vigorous physical activity… five days a week.” The downside is, however, that the evidence is not as robust as one may think, in fact, these “experts could only say: ‘It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling.’”

I want to restate that last sentence again, “ So far, data to support this hypothesis are not particularly compelling.” Said another way: These scientists, were not willing to change their paradigm to fit with what the science points to, instead they dug their heels in and are not willing to compromise.

Instead of me just telling you how biased these scientists are, let’s see where the “eat less, do more” line of reasoning would bring us if we followed it to its logical conclusion. To illustrate that we will be diving into one the cited studies where a group of researchers studied the effect of exercise on health.

These scientists, Williams and Wood, were able to collect data on roughly 13,000 habitual runners during the case of the study they compared the weekly logged miles and their weight from year to year. “Those who ran the most tended to weigh the least, but all these runners tended to get fatter with each passing year, even those who ran more than forty miles a week—eight miles a day, say, five days a week.” For the group conducting the study, this seemed to suggest that:

…even the most dedicated runners had to increase their distance by a few miles a week, year after year—expend even more energy as they got older—if they wanted to remain lean. If men added two miles to their weekly distance every year, and women three, according to Williams and Wood, then they might manage to remain lean, because this might mean expending in running the calories that they seemed fated otherwise to accumulate as fat.

Before I continue quoting Taubes, I want to ask one thing. If we are fated to accumulate extra fat year after year, where were all of the overweight people throughout history? Obesity was not the epidemic it has become 50 years ago, and before that, it was even more uncommon. Just ponder that: why did it explode when it did? What would happen if we changed the way we eat to look more like our forebears? Digression over; now let’s look back at the study and see how much more we would need to run if we wanted to keep off the pounds as we age; if we followed the calories-in/calories-out model:

Imagine a man in his twenties who runs twenty miles a week—say, four miles a day, five days a week. According to Williams and Wood (and the logic and mathematics of calories-in/calories-out), he will have to double that in his thirties (eight miles a day, five days a week) and triple it in his forties (twelve miles a day, five days a week) to keep fat from accumulating. A woman in her twenties who runs three miles a day, five times a week—an impressive but not excessive amount—would have to up her daily distance to fifteen miles in her forties to retain her youthful figure. If she does eight-minute miles, a nice pace for such a distance, she’d better be prepared to spend two hours on each of her running days to keep her weight in check. If we believe in calories-in/calories-out, and that in turn leads us to conclude that we have to run half-marathons five days a week (in our forties, and more in our fifties, and more in our sixties …) to maintain our weight, it may, once again, be time to question our underlying beliefs. Maybe it’s something other than the calories we consume and expend that determines whether we get fat.

If gaining weight is more than just calories-in/calories-out, then how did we come up with that hypothesis in the first place? It all comes back to the idea we talked about when discussing chapter one, the quote I used was, “In most of science, skeptical appraisals of the evidence are considered a fundamental requirement to make progress. In nutrition and public health, however, they are seen by many as counterproductive…” To illustrate that point lets see just how these scientists interpret the data to get the outcome they want:

As for the researchers themselves, they invariably found a way to write their articles and reviews that allowed them to continue to promote exercise and physical activity, regardless of what the evidence actually showed. One common method was (and still is) to discuss only the results that seem to support the belief that physical activity and energy expenditure can determine how fat we are, while simply ignoring the evidence that refutes the notion, even if the latter is in much more plentiful supply. Two experts in the Handbook of Obesity, for instance, reported as a reason to exercise that the Danish attempt to turn sedentary subjects into marathon runners had resulted in a loss of five pounds of body fat in male subjects; they neglected to mention, however, that it had zero influence on the women in the trial, which could be taken as a strong incentive not to exercise.

I keep highlighting the abuse of the scientific method by nutritional scientist because we trust them for our dietary guidelines. If they fudge the numbers to fit their beliefs, then can we trust US guidelines they are influenced by these same people?

  1. Thermodynamics for Dummies, Part 1

Before we talk about our next chapter, let’s learn what thermodynamics is. It is broken into 3 laws, but right now we only care about the first one. The first law is also known as, “the law of energy conservation: all it says is that energy is neither created nor destroyed but can only change from one form to another. Blow up a stick of dynamite, for instance, and the potential energy contained in the chemical bonds of the nitroglycerin is transformed into heat…” It is all about chemical reactions, it is not about a dietary balance, to continue with what taubes was saying, “All the first law says is that if something gets more or less massive, then more energy or less energy has to enter it than leave it. It says nothing about why this happens. It says nothing about cause and effect. It doesn’t tell us why anything happens; it only tells us what has to happen if that thing does happen. A logician would say that it contains no causal information.”

Said another way, thermodynamic tell us that overeating causes us to become fat. If we get fatter than more energy enters our body then we use up. But when in that explanation tells us why we get fat. The problem is not how we got, but it is how do we get unfat. Since the law of thermodynamics does not address that, maybe we should come up with a theory that does explain it. Spoiler: we will be addressing the in the next part of the book review, but that is next week. Now let’s move on to the last chapter I will be talking about today.

  1. Thermodynamics for Dummies, Part 2

In the first part, we learned about the thermodynamics, in this chapter we learn that the “eat less, move more” is neither the problem nor the cure for obesity. This is because it is an incorrect assumption.

In actuality, the energy we consume and the energy we expend have little influence on one another. For example, if we limit our intake of calories over a long period of time, your body will start to burn less to compensate for the calorie deficit. So, it should be, if we eat less we will burn less. To see this in action let’s look and a study Taubes quotes, “Terry Maratos-Flier, published an article in Scientific American called ‘What Fuels Fat.’ In it, they described the intimate link between appetite and energy expenditure, making clear that they are not simply variables that an individual can consciously decide to change with the only effect being that his or her fat tissue will get smaller or larger to compensate.”

Again and again, thermodynamics does not apply to humans. The law of thermodynamics was found to be true in a closed system. It is in a closed system that energy is neither created nor destroyed, it either changes form or it is transferred into another object. As this transfer happens thermal energy is released. This is why the calories-in/calories-out hypothesis does not work for humans since a closed system, we lose energy through heat, and restroom breaks. Which is why Gary Taubes and others like him have started think less about calories and more about the hormonal effects of the foods we eat. In part two we will learn about the hormonal signaling that causes us to utilize our fat stores for energy instead of consuming more food. Which means, we are able to eat less and burn more, irrespective of us moving more. That is how you lose weight, it isn’t caloric, it’s hormonal.

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