Intended for healthcare professionals

Rapid response to:

Clinical Review

Management of overweight and obese adults

BMJ 2002; 325 doi: (Published 05 October 2002) Cite this as: BMJ 2002;325:757

Rapid Response:

Cause of and best prevention strategy for obesity is already known

Professor David Crawford asks: ‘What . . . are the causes of the
obesity epidemic, and what can be done to prevent it?’(1)

We know the answers to both questions already. The major cause of the
dramatic rise in obesity we see today is the ‘healthy’ carbohydrate-based,
low-fat diet. The remedy is a low-carbohydrate, high-fat diet.

After being overweight and in considerable discomfort for over thirty
years, in 1893, William Banting wrote of a miraculous diet which cured all
his ailments completely.(2) This was the first low-carbohydrate diet book.

That the ‘Banting diet’ works has been attested to by 140 years of
epidemiological studies and clinical trials. I will mention just four:

In 1932, a clinical study carried out at the Royal Infirmary,
Edinburgh studied the effects of low- and high-calorie diets, ranging from
800 to 2,700 kcals.(3)

Average daily losses on 1,000 kcal isocaloric diets were:

· high carb/low fat diet - 49g

· high carb/low protein - 122g

· low carb/high protein - 183g

· low carbohydrate/high fat - 205g

The authors note: ‘The most striking feature of the table is that the
losses appear to be inversely proportionate to the carbohydrate content of
the food. Where the carbohydrate intake is low the rate of loss in weight
is greater and conversely.’

In 1955 Dr Albert Pennington also found that: ‘weight loss appeared
to be inversely related to the amount of glycogenic materials in the diet.
Carbohydrate is 100 per cent, protein 58 per cent and fat 10 per cent
glycogenic’. He concluded: ‘The recommended diet is a calorically
unrestricted one, very low in carbohydrate, high in fat and moderate in
protein. Neither fat nor protein is restricted, however.’ (4)

Professor Alan Kekwick and Dr Gaston Pawan had similar results in
1956.(5) In a trial at the Middlesex Hospital, London, overweight

· lost the least weight on a high-carbohydrate, low-fat diet

· lost the most weight on a high-fat, low-carbohydrate diet

· Lost weight even at 2,600 kilocalories a day – but only on a high-
fat diet.

For those worried about the effects of a high-fat diet on CHD risk, a
recent trial in which 61% of calories were derived from fat improved the
lipid disorders characteristic of atherogenic dyslipidaemia. Subjects’
fasting serum triacylglycerol fell by 33%, postprandial lipaemia declined
29%, postprandial insulin fell 34%, and HDL-C rose 11.5% with total
cholesterol unchanged. (6)

In their review (7) Hitchcock Noël and Pugh say that trials comparing
high- and low-fat diets are underway. Why? The evidence is already
overwhelming. We should remember the words of Cicero: ‘If we do not learn
from history, we remain in the infancy of knowledge.’

Barry A Groves, PhD

Independent research

Author: Eat Fat, Get Thin!


1. Crawford D. Population strategies to prevent obesity. BMJ 2002;
325: 728-729

2. William Banting. Letter on Corpulence Addressed to the Public.
London, 1863.

3. Lyon DM, Dunlop DM. The treatment of obesity: a comparison of the
effects of diet and of thyroid extract. Quarterly Journal of Medicine
1932; 1: 331-52.

4. Pennington AW. Pyruvic acid metabolism in obesity. American
Journal of Digestive Diseases 1955; 22: 33-7.

5. Kekwick A, Pawan GLS. Calorie intake in relation to body-weight
changes in the obese. Lancet 1956; ii: 155-160.

6. Sharman MJ, Kraemer WJ, Love DM, et al. A ketogenic diet favorably
affects serum biomarkers for cardiovascular disease in normal-weight men.
J. Nutr 2002; 132:1879-1885

7. Hitchcock Noël P, Pugh, JA. Management of overweight and obese
adults. BMJ 2002; 325: 757-761.

Competing interests: No competing interests

07 October 2002
Barry A Groves
Independent research