Why the Campaign to Stop America's Obesity Crisis Keeps Failing (Gary Taubes)
Monday May 7th, 2012
The nation's most powerful anti-obesity groups are teaming up for a new HBO documentary--but it pushes the same tired advice. Gary Taubes on the research they're ignoring.
Most of my favorite factoids about obesity are historical ones, and they don't make it into the new, four-part HBO documentary on the subject, The Weight of the Nation. Absent, for instance, is the fact that the very first childhood-obesity clinic in the United States was founded in the late 1930s at Columbia University by a young German physician, Hilde Bruch. As Bruch later told it, her inspiration was simple: she arrived in New York in 1934 and was "startled" by the number of fat kids she saw--"really fat ones, not only in clinics, but on the streets and subways, and in schools."
What makes Bruch's story relevant to the obesity problem today is that this was New York in the worst year of the Great Depression, an era of bread lines and soup kitchens, when 6 in 10 Americans were living in poverty. The conventional wisdom these days--promoted by government, obesity researchers, physicians, and probably your personal trainer as well--is that we get fat because we have too much to eat and not enough reasons to be physically active. But then why were the PC- and Big Mac---deprived Depression-era kids fat? How can we blame the obesity epidemic on gluttony and sloth if we easily find epidemics of obesity throughout the past century in populations that barely had food to survive and had to work hard to earn it?
These seem like obvious questions to ask, but you won't get the answers from the anti-obesity establishment, which this month has come together to unfold a major anti-fat effort, including The Weight of the Nation, which begins airing May 14 and "a nationwide community-based outreach campaign." The project was created by a coalition among HBO and three key public-health institutions: the nonprofit Institute of Medicine, and two federal agencies, the Centers for Disease Control and Prevention and the National Institutes of Health. Indeed, it is unprecedented to have the IOM, CDC, and NIH all supporting a single television documentary, says producer John Hoffmann. The idea is to "sound the alarm" and motivate the nation to act.
At its heart is a simple "energy balance" idea: we get fat because we consume too many calories and expend too few. If we could just control our impulses--or at least control our environment, thereby removing temptation--and push ourselves to exercise, we'd be fine. This logic is everywhere you look in the official guidelines, commentary, and advice. "The same amount of energy IN and energy OUT over time = weight stays the same," the NIH website counsels Americans, while the CDC site tells us, "Overweight and obesity result from an energy imbalance."
The problem is, the solutions this multi-level campaign promotes are the same ones that have been used to fight obesity for a century--and they just haven't worked. "We are struggling to figure this out," NIH Director Francis Collins conceded to Newsweek last week. When I interviewed CDC obesity expert William Dietz back in 2001, he told me that his primary accomplishment had been getting childhood obesity "on the map." "It's now widely recognized as a major health problem in the United States," he said then--and that was 10 years and a few million obese children ago.
There is an alternative theory, one that has also been around for decades but that the establishment has largely ignored. This theory implicates specific foods--refined sugars and grains--because of their effect on the hormone insulin, which regulates fat accumulation. If this hormonal-defect hypothesis is true, not all calories are created equal, as the conventional wisdom holds. And if it is true, the problem is not only controlling our impulses, but also changing the entire American food economy and rewriting our beliefs about what constitutes a healthy diet.
Oddly, this nutrient-hormone-fat interaction is not particularly controversial. You can find it in medical textbooks as the explanation for why our fat cells get fat. But the anti-obesity establishment doesn’t take the next step: that fat fat cells lead to fat humans. In their eyes, yes, insulin regulates how much fat gets trapped in your fat cells, and the kinds of carbohydrates we eat today pretty much drive up your insulin levels. But, they conclude, while individual cells get fat that way, the reason an entire human gets fat has nothing to do with it. We’re just eating too much.
I’ve been arguing otherwise. And one reason I like this hormonal hypothesis of obesity is that it explains the fat kids in Depression-era New York. As the extreme situation of exceedingly poor populations shows, the problem could not have been that they ate too much, because they didn’t have enough food available. The problem then—as now, across America—was the prevalence of sugars, refined flour, and starches in their diets. These are the cheapest calories, and they can be plenty tasty without a lot of preparation and preservation. And the biology suggests that they are literally fattening—they make us fat, while other foods (fats, proteins, and green leafy vegetables) don’t.