Book & Cinematic Reviews
Questioning the Obesity Paradigm by Deborah Donlon, MD
CURRENT BOOKS, Sonoma Medicine: Spring 2012
Why We Get Fat: And What to Do About It, by Gary Taubes, 272 pages, Knopf.
As physicians, we think we know what causes obesity. Eating too much. Exercising too little. Sedentary jobs and leisure activities. Soda, chips, channel surfing and junk-food advertising. We counsel our patients to eat less and move more. I confess I am skeptical when an obese patient tells me she “eats tiny portions” and “exercises all the time.” Based on what I learned in medical school about calories consumed versus calories expended, this just can’t be true.
Or can it? In his book, Why We Get Fat: And What to Do About It, Gary Taubes argues against the prevailing wisdom about what causes people to gain weight. Over 10 years ago, bestselling author Taubes found that he continued to gain weight despite exercising regularly and restricting both caloric intake and fat consumption. As a self-identified carnivore, he started himself on an Atkins-like diet consisting of animal protein, healthy fats and vegetables--and lost 20 pounds in six weeks. He has maintained his weight loss by staying on the diet, and has spent the past decade researching the connection between specific foods we eat and their effect on our weight. (He is also the author of Good Calories, Bad Calories, a highly technical tome less accessible to the lay public than his current book.)
In Why We Get Fat, Taubes challenges widely held beliefs. For example, we tend to think that obesity is caused by affluence and abundance, or having “too much of a good thing.” We think that wealth, including the ability to buy machines to do work for us and transport us, is what is making us fat. Taubes turns this belief around by highlighting the historical connection between obesity and poverty. The Pima Indians became increasingly obese during a period of economic decline and famine. The poorest Americans during the Great Depression were those most likely to be obese. Today, people who live in poverty and are employed in physically demanding jobs have a high rate of obesity, as well as malnutrition. Under Taubes’ examination, the paradigm connecting obesity to too much food and too little activity begins to weaken.
Taubes follows his history lessons with two fairly discouraging chapters titled “The elusive benefits of undereating” and “The elusive benefits of exercise.” Prior to the 1970s, he observes, low-calorie diets were referred to as “semi-starvation diets,” the idea being that people would have great difficulty following such a regimen for a couple of months, let alone permanently. Well-controlled studies, according to Taubes, have failed to show a connection between calorie restriction and sustained weight loss. And vigorous exercise, while having numerous health benefits, leads to hunger and increased caloric intake. This fact limits the utility of exercise as a weight-loss strategy. Nonetheless, despite the lack of evidence for calorie restriction and exercise, the multibillion-dollar diet industry continues to promote these behavior changes for weight loss—and profits from our failures.
For Taubes, “why we get fat” turns out to be a complex interplay between genetics, diet and lipid metabolism. Those looking for a crash course in thermodynamics will be pleased to find one in his book. Basically, the more fat cells we have in our bodies, the more those fat cells drive us to eat, and the more energy they rob from other cellular functions in the body. “What to do about it” requires identifying a villain that we should avoid in our diets. Taubes’ villain is the carbohydrate, which drives insulin secretion, which drives energy storage in fat cells. According to Taubes, the more carbohydrates we consume, the more we crave, and the fatter we become. The same carbohydrates zap our energy and leave us unmotivated to exercise. So, our fat cells from excess carbohydrate intake turn us into couch potatoes, rather than the other way around. The last chapter of Taubes’ book offers a nutritional program in which carbohydrates are essentially eliminated in favor of animal protein, vegetables and fats.
In the arena of weight-loss research, every argument has a counter-argument. One of those taking a contrary view to Taubes is local physician Dr. John McDougall, whose new book The Starch Solution will be published in May. According to McDougall, animal products are what should be limited in the American diet. He recommends a low-fat, vegan diet that includes liberal quantities of starches such as rice, beans and potatoes.
Let’s return to our obese patients . . . Read the entire review at Sonoma Medicine . . .
Dr. Donlon, a Santa Rosa family physician, chairs the SCMA Editorial Board.
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