Why We Get Fat--and What To Do About It.
Article Type: Book review
Subject: Books (Book reviews)
Author: Arnett, Jerome C., Jr.
Pub Date: 06/22/2011
Publication: Name: Journal of American Physicians and Surgeons Publisher: Association of American Physicians and Surgeons, Inc. Audience: Academic Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2011 Association of American Physicians and Surgeons, Inc. ISSN: 1543-4826
Issue: Date: Summer, 2011 Source Volume: 16 Source Issue: 2
Topic: NamedWork: Why We Get Fat--and What To Do About It (Nonfiction work)
Persons: Reviewee: Taubes, Gary
Accession Number: 267810805
Full Text: Why We Get Fat--and What To Do About It, by Gary Taubes, hardback, 257pp, $24.95, ISBN 978-0-307-27270-6, New York, N.Y., Alfred A. Knopf, 2011.

"... The diet we have to eat to lose weight--the one restricted in fattening carbohydrates--is also the diet that will best prevent heart disease."

--Gary Taubes

"Why are we fat?"

"Why are our children fat?"

"What can we do about it?"

These are the questions science writer and best-selling author Gary Taubes answers in How We Get Fat. He states that obesity is not a disorder of overeating, or of energy balance, or of "calories in/calories out," although this dangerous idea has survived virtually unchallenged for the last 50 years. Instead, he concludes, we get fat because of the carbohydrates we eat.

Two hundred years ago we ate less than a fifth of the sugar we eat today. Fifty years ago one in every nine Americans was considered obese, whereas today it is one in three. And today more than a quarter of our adult population suffers from metabolic syndrome, which includes diabetes and obesity.

Taubes says we have been getting fat and diabetic because we have been getting the wrong advice. The vast majority of today's physicians and public health officials have a flawed "energy balance" paradigm that stipulates that the reason we get fat is as clear and incontrovertible as is the cure--that obesity is simply a problem of eating more than the body needs, and that under-eating will correct it.

A competing theory, the notion of the fattening carbohydrate, has been around for most of the last 200 years. Until the 1960s it was conventional wisdom, and it led to a string of best-selling diet books such as Eat Fat and Grow Slim (1958), Calories Don't Count (1960), Dr. Atkins' Diet Revolution (1972), The Carbohydrate Addict's Diet (1993), Protein Power (1996), and Sugar Busters (1998).

Taubes notes that since the end of World War II, the question of what makes us fat often has seemed like a religious rather than a scientific issue. By the 1960s obesity had come to be thought of as an eating disorder, so the science of fat regulation wasn't considered relevant, and this is still largely true today. In addition, health officials had become convinced that dietary fat caused heart disease.

In 1965, for example, Jean Mayer, prominent Harvard nutritionist, warned that to prescribe carbohydrate-restricted diets for the public would be "the equivalent of mass murder." By the 1970s dietary fat had become the official dietary villain; by the early 1980s Jane Brody of The New York Times, the most influential journalist on the subject of nutrition for the last 40 years, was telling us to eat more starches and bread as diet foods, stating, "We need to eat more carbohydrates."

In 1984 the National Heart, Lung, and Blood Institute launched its $115 million decade-long campaign to convince Americans that low-fat diets protected us against coronary heart disease. Since then we've been getting fatter instead of leaner, and the incidence of heart disease has not diminished. Even in 1995 the American Heart Association advised we could eat anything--even candy and sugar--as long as it was low in fat.

By the mid-1990s the Centers for Disease Control and Prevention and the World Health Organization declared that we were in the midst of an epidemic of obesity that they blamed on too much money and too much food. But obesity is associated with poverty, not with prosperity, as studies of the Native American Pimas of Arizona and the Sioux of South Dakota, and studies in more than a dozen other locations all over the world have shown. And under-eating doesn't correct it.

Nor does exercise correct it--despite the advice of the U.S. Department of Agriculture, the International Association for the Study of Obesity, the International Obesity Task-Force, and Jean Mayer, the most influential nutritionist in the U.S. He has been recommending exercise as a means of weight control since the 1950s. But many people exercise to work up an appetite. One researcher in 1942 calculated that one would need to climb 20 flights of stairs to use up the energy contained in one slice of bread.

In fact, the human body is perfectly able to function normally without any carbohydrates in the diet. As Taubes points out, meat contains all the amino acids, all of the essential fats, and 12 of the 13 vitamins essential for life. Only vitamin C is lacking.

It turns out that the low-carbohydrate diet we must eat to lose weight is the same diet that will best prevent disease, Taubes states. He explains that if you eat a high-carbohydrate Western diet, you expose yourself to the Western diseases. These include obesity, diabetes, heart and artery disease, hypertension and stroke, Alzheimer's and other dementias, cavities and periodontal disease, appendicitis, ulcers, diverticulitis, gallstones, hemorrhoids, varicose veins, and constipation.

Studies have shown that only a change in the regulation of the fat tissue will make us lean or obese. Fat is continually flowing in and out of the fat cells in the form of fatty acids, which the body uses for fuel. But when carbohydrate is available, insulin is secreted and the carbohydrate is used as fuel, while the fatty acids are stored in fat cells, which makes us fatter. When insulin levels fall we liberate fat from the fat tissues and burn it as fuel.

Our insulin levels are determined by the carbohydrates we eat; the more carbohydrates we eat, the more insulin we will secrete, and the more fat we will store in our fat cells. Carbohydrate drives the insulin, which drives the storage of fat. So, if you are predisposed to get fat and want to be as lean as you can be and still remain healthy, you must restrict carbohydrates and thus keep your blood sugar and insulin levels low, Taubes states.

The refined carbohydrates, such as flour and cereal grains, starchy vegetables such as potatoes, and sugars are especially liable to make us fat, increase our appetite, and make us sedentary, he argues. Even worse, these sweets are addictive--in the same way that drugs are and for much the same biochemical reasons. They trigger a response in the same "reward center" of the brain that is targeted by cocaine, alcohol, and nicotine. So the foods that make us fat (the carbohydrates) make us crave these same foods that make us fat.

Taubes has documented an alarming defect in current dietary practice. That patients must educate their physicians and public health officials about dietary science is a sad commentary on the politicization of nutritional research and much other science. Arguably, this in no small part is because of the massive increase in government funding of research that followed creation of the National Science Foundation in 1950.

Why We Get Fat should be required reading for all who want to promote better health--especially our physicians and medical students, and our public health and government officials.

Jerome C. Arnett, Jr., M.D.

Helvetia, W.V.
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