The science of obesity: what do we really know about what makes us fat? An essay by Gary Taubes

Nobody can get fat unless they eat more than they consume.

Today we (in western societes) eat far more than we need but most stay reasonably slim.

There is a growing (excuse the pun) number of fat people (obese).

Some are due to over eating but most can be considered an illness condition.

We put hormones into the agricultural system to speed up animal growth.

We GMO plants/animals to make them grow faster amongst other things.

We use more and more sugar replacements to fool our insulin system. eg aspartame

Antibiotics come in our food and even drinking water (eg fluorides (an antiseptic) and recycled drugs).

Any of the above and more are almost certain to be playing their part in the unacceptable number of obese persons and those with diabetes or pre-clinical signs.

Refined sugar has been around for hundreds of years and probably plays an unimportant role in this new illness condition.

France had virtually no obesity problem a few years ago.

Today with rampant and growing use of sugar substitutes or artificially made attempts to mimic honey together with forced direct or indirect ingestion of GMO foods from the Americas, France is fast becoming a mimic of the obesity and other maladies in USA.

This problem is extremely serious for those obese and a dire warning for the rest of us that not all is right and correct in our food and drink.

In 1974, Dr. Cottrell’s World Sugar Research Organization (then the International Sugar Research Foundation) hosted a conference to discuss the evidence linking sugar to obesity and diabetes. The organization then disseminated a memo in which its own scientist-consultant stated that a “well-designed research program” was necessary to elucidate sugar’s role in these disorders and “should be undertaken in a sufficiently comprehensive way as to produce results. A gesture rather than full support is unlikely to produce the sought-after answers. (1)” Since the Nutrition Science Initiative is trying to do just that with independent, unbiased researchers, I would hope that the WSRO would give its full support.

Dr. Cottrell cites a WRSO report claiming that world caloric sweetener consumption has been static for decades. These data are difficult to reconcile with International Sugar Organization reports that world sugar consumption rose between 2001 and 2011, for instance, by an average of 2.2 percent yearly, nearly twice the population growth rate (2).

Such trends can neither confirm nor refute the hormonal/regulatory defect hypothesis or sugar’s role in obesity. Dr. Cottrell assumes incorrectly that caloric sweetener consumption must increase to explain the obesity epidemic. If a threshold effect is at work, then prevalence can increase so long as sugar consumption is above that threshold. This is another argument for well-controlled experiments to establish causality.

Dr. Cottrell claims that insulin levels remain low in healthy individuals, but the study he cites reports a long-term deterioration of insulin sensitivity in this population (3). The accompanying editorial suggests that "this is doubtless the effect of progressive inactivity and middle-age spread.” It could just as likely be the effect of a dietary trigger of “progressive inactivity and middle-age spread (4).” Such observations can't differentiate.

Dr. Cottrell suggests that the hormonal/regulatory defect hypothesis is incorrect because de novo lipogenesis is low during carbohydrate overfeeding, a common misconception. As the reference Cottrell cites says, body fat stores can be increased “not by conversion of the carbohydrate to fat. Instead, the oxidation of dietary fat [is] suppressed and fat storage thereby increased. (5)"

Despite our disagreements, it’s critical to remember that this discussion is about real people, their health and quality of life. Based on what the last 50 years has shown us, we need new information and better science, because the conventional wisdom isn’t working. Our friends, family and neighbors are afflicted with a spectrum of metabolic disorders; it is incumbent upon us to challenge conventional thinking when it appears so clearly to be failing.

1. Taubes G, Couzens CK. Sweet Little Lies. Mother Jones 2012;November/December:34-40,68-9.

2. International Sugar Organization. Quarterly Market Outlook. International Sugar Organization 2011;November. www.sugaronline.com/Samples/ISO_QMO.pdf

3. Tabak AG, Jokela M, Akbaraly TN, et al. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet 2009;373:2215-2221.

4. Matthews DR, Levy JC. Impending type 2 diabetes. Lancet 2009;373:2178-9.

5. Hellerstein MK. No common energy currency: de novo lipogenesis as the road less travelled. American Journal of Clinical Nutrition 2001;74:707-8.

Readers of this article and some of the respondents might be interested in an article published in 2004 in the Int. Journal of Sport Nutrition and Exercise Metabolism 14:709-199 2004. It may not be applicable to all groups but is nonetheless interesting and pertinent to the discussion about energy balance, food type and obesity.
The study looked at the dietary intake of Kenyan long distance runners. The average height of these runners was 5'9" and the average weight was 129 lbs, quite lean by any standard. Carbohydrates contributed 76.5 percent of the daily energy intake, 13.4 percent was from fat. Of the carbohydrates, ugali, a corn based product, contributed 23 percent of the total calories. Simple sugar contributed 20 percent of all calories (534 calories a day) and rice contributed 14 percent. The athletes ate 5 times a day and quantities were unlimited. Meat was eaten 4 times a week in small quantities.

Of course, they also ran about 75 miles a week with about 1/3 of this at a very fast pace.

Dear Sir,

For most cases of obesity, why can’t we simply say that obesity is a manifest discrepancy between total energy intakes versus the energy output? Wouldn’t this simple statement be appropriate in about 90 to 95 percent of cases of obesity? Lifestyle factors, and excess energy intake, vis-à-vis reduced energy expenditure are at play here in this major chunk of nearly 90 to 95 percent. It is just a miniscule of percentage that some of the other causes for obesity can actually be traced, like genes, metabolic and hormonal causes, etc.

Let us start by relating the first author’s own personal inch and pound story. All the times that he was sent on postings to some real difficult areas, arctic climates, hot-spots so as to say, for months and years together, his weight remained well within the laid down parameters, like almost everyone who were with him along sides. Those were the times when he was away from his family, took all the entitled calories and then some more as well, never really counting the calories. Like all others out there posted with him, as he says, he too was missing his family and was slightly concerned for their welfare while they were separated from him owing to his posting to very difficult areas. But then, he did use to return to the base after two and a half to three years, and it did not take him more than six months to start getting counted in the overweight or obese category, although every other possible factor had remained quite unchanged. This cycle was repeated many a times with him, and we did raise this concern earlier on as well [1, 2]. Call it whatever you may, mental peace, tranquility, mood, familiar and congenial surroundings, being in the company of the family once again, etc.

These cycles of his postings to estranged and very difficult areas affected his wife and his children in almost a similar pattern; turning slim when he was away, and picking up weight as soon as he was back, although all that while they had kept staying at a far off secure places with other families, and there was daily cooking of delicious and savory food, with more than enough calories. We believe that this peculiar trend would have been observed by all veterans from around the world, and of any country, and that they would easily understand and acknowledge, notwithstanding the difference in beret, or whatever emblem or insignia they might have been sworn to.

We believe that mood, temperament, congenial and relaxed environment, cooking and eating habits, do have a strong role to play, besides physical inactivity, and other indulgences that have already been identified elsewhere. As per his own reasoning, the reasons for him catching on weight are not too many. It is just one perhaps, and that is that he turns lazy, from the very moment he used to get back home and rejoin the congenial environment of his family.

We do have some latest management techniques for obesity, like the anti-obesity pills, liposuction, bariatric surgery, etc. Recently, we have developed a fairly new technique to remove unwanted flab from the waist, thighs, arms, etc. This is a totally painless technique, non-invasive, and we are able to decrease waist by three inch in a matter of three days. We would want this technique be called “Dr. S. Arulrhaj’s non-invasive technique for flab and cellulite removal” [FIGURE 1], as he has always been a revered teacher and a mentor. This technique uses an interplay of various electro-medical appliances in varying combinations and proportions, depending on the problem, its extent, duration, and severity. We could do just this much at our own, with our own initiative, own accord, own resources, and without any help or encouragement from any non-governmental or governmental source, national or international. Alongside we have also been prescribing, empirically though, a short course of aspirin and anti-cholesterol agents in minimal doses for just about a week. We do feel that much more research needs to be done, to make this technique more viable, acceptable, more precise, with improved accuracy, safety, acceptability, and making it totally free from any untoward results or complications. We had presented this latest technique threadbare to the august gathering of doctors, along with many other new techniques, at the III International Congress of Family Medicine and the ICON 2012, that were held at Chennai, India, in September 2012. A gist was also presented at the Commonwealth Medical Association’s Annual Conference that was held at Chennai, India, on the same dates and at the same venue where the other conferences were held.

Best regards.

Dr (Lt Col) Rajesh Chauhan
Hon’ National Professor (IMA CGP), INDIA

Dr. Ajay Kumar Singh Parihar
Resident, Dept of Medicine, Index Medical College, Indore. INDIA.

Dr. Shruti Chauhan

REFERENCES:

1. Chauhan R, Chauhan S, Chauhan S, Chauhan SPS. Obesity: the new "raja" or just fetal origins? BMJ 14 June 2005. http://www.bmj.com/rapid-response/2011/10/31/obesity-new-raja-or-just-fe... (Accessed on 09 May 2013)

2. Chauhan R, Chauhan S, Chauhan S, Chauhan SPS, Chauhan A, Chauhan A. Obesity - an ongoing controversy. BMJ 12 Dec 2005. http://www.bmj.com/rapid-response/2011/10/31/obesity-ongoing-controversy (Accessed on 09 May 2013)