The war on fat

[EJRothman]

"What this country really needs is to appoint Harvard professor Walter Willet - one of the most pragmatic and learned nutrition experts currently around - to head the FDA."

He might make an inspired, if unconventional subject for an eGullet Q and A.

I would be thrilled if EGullet could get Willet to do a Q&A.

c'mon people speak up, join me here!

[Stone]

Re the above -- My bad. Go about your business.

[nerissa]

"What this country really needs is to appoint Harvard professor Walter Willet - one of the most pragmatic and learned nutrition experts currently around - to head the FDA."

He might make an inspired, if unconventional subject for an eGullet Q and A.

I would be thrilled if EGullet could get Willet to do a Q&A.

c'mon people speak up, join me here!

peep, peep, peep

(I would also be thrilled)

[pim]

Extremely interesting discussion. cGullet does get better and better everyday---mind you it's been like three days since I found you people. :-)

This whole issue of fat and diet is extremely interesting to me. I'm definitely on the thin side. I eat anything I want and have never dieted even once. Yes, I guess I am blessed with good genes. But is that all? I don't think so. As Fatguy said in a few posts back, only a small percentage of obese people actually have glandular issues that cause the weight---and I've seen a number of studies that have the same assertion. I think we're pretty safe to assume that the surge in the number of obese people is a result of lifestyle.

And I'm not saying that we should just all blame the stupid fat folks here. Lifestyle by no means imply deliberate choice. People don't choose the be fat. They are fat because they live in the kind of society in which it is difficult to stay thin.

You can think of it as something akin to Bordieu's term "Habitus". Yes, he used it to explain high minded stuff like society and the question of free will and such, but in a way it is completely applicable here. A Habitus is a general set of disposition common to a class. Fat people in the US, for example, though exercising their free will, are bounded by what is available and economically feasible for them to eat. Not to mention the cultural propensity toward less activities, and larger portion sizes.

Going into any restaurant or browsing in any supermarket, one has to concede that it is really difficult to eat "well" in this country. Yes there are lots and lots of Low-fat this, Non-fat that, but very little of these foods are in any way a balance meal. And I'm not talking of inherently good or bad food here, but food that are so proportionally high in fat, carbohydrate, sugar, salt, etc, as to throw any healthy body out of whack! And here I'm not speaking of us "gourmets". We, with our organic produce and artisanal cheese, are in no way a microcosm of the food world. Wonder bread and Hamburgur Helper is.

And of course there are people who, despite their intellect and the lack of Hamburger Helper in their lives, simply relish the joy of food, perhaps a bit much, and so end up on the wee bit heavier side of the scale. As they say in Seinfeld--not that there's anything wrong with it! I mean, joking aside, there's a huge difference between being clinically obese and just plump, isn't in. Being plump is not a problem, being so obese as to be diabetic, in danger of heart disease, etc, is!

This "Fat Habitus" carries into the ways in which we deal with food and with getting "fat". The culturally induced reaction to getting fat is getting on a diet--which or course is the worse thing ever to do to your body. When you suddenly deprive your body of food, our body goes into starvation mode--as in use as little fuel as possible, thanks to our evolutionary instinct to stay alive. And when a diet fails, as it inevitably will, your body is now inundated with excess calories, but it's still in starvation burn-as-little-as-I-can-get-away-with mode. And you know where this ends.

Edited June 27, 2003 by pim (log)

[Xanthippe]

"What this country really needs is to appoint Harvard professor Walter Willet - one of the most pragmatic and learned nutrition experts currently around - to head the FDA."

He might make an inspired, if unconventional subject for an eGullet Q and A.

I would be thrilled if EGullet could get Willet to do a Q&A.

c'mon people speak up, join me here!

peep, peep, peep

(I would also be thrilled)

As would I . . .

[KNorthrup]

Totally unscientific opinion.

I do think most people with poor (junk) eating habits do know they are eating the wrong things. Much like smokers. Like someone said several pages back (I just read the whole thing), the problem is knowing what to do instead. Which wasn't my opinion until I read their post. But I think it's like that GK Chesterton quote about the Christian ideal has not been tried and found wanting - it's been found difficult and left untried. Most people I know who live off of McDonald's (many coworkers) know they should eat better but really feel their only alternative is undressed salad and rice cakes. However illogical that is. And so it becomes to big a change to bother with.

I also think that activity should receive at least as much attention as consumption. I actually eat quite practically in terms of low calories, low fat, high fiber, well balanced meals, etc. But I'm still over 200 pounds because I spend my entire workday at my desk and -- more significantly -- all my waking hours at home on the couch. And I firmly believe that getting more exercise would have a much more significant impact on my weight -- and my health -- than eating less.

In terms of a-calorie-is-a-calorie, although that's apparently true biologically (not qualified to get involved there), I do think focussing on more-filling foods is better, because you end up consuming fewer calories and being less inclined to snack later etc etc. So long term you have fewer, even with the same initial number of 500 or what have you. Getting all your food groups and a wide variety of complex flavours should be helpful for the same reason. More satisfying and more enjoyable is somehow more filling. Bland you can eat all day. And frequently do without even noticing.

Going back to the activity bit, a different prior post inspired a thought on that. When someone referred to people eating junk for pyschological comfort. That may also be a reason people are so much more sedentary. Television. Escapism etc. Although I had to give up tv when I got a mortgage and I still don't move but still. Hopefully this is more coherent than it feels.

[corvus]

ignorance

Fat Guy argues that he is not ignorant but is still fat (though not getting fatter). this is beside the point. the proponents of intervention/education are not attempting to restrict freedom of choice but attempting to give people the chance to make a real choice by being in possession of as many objective facts as possible. this can make a huge difference. the best example of this is the Karelia project in Finland where, through education, heart disease mortality was reduced by 65%.

Welcome enthusiat. I'm pretty new here myself.

Is that the 1972 public heath campaign in North Karelia, Finland you are

talking about? If so, you might have missed the fact that:

"In Kuopio [Finland], where the inhabitants served as control

subjects, the number of heart attaks had decreased even more [than

North Karelia]." - Ravnskov, The Cholesterol Myths, p. 154

Ravnskov goes on to note that the decrease was seen in all of Finland, not

just in North Karelia. So I don't think we can rely on that study to

support the argument for public education. In this case, ignorance was

actually better for some people.

And if you get Willet in for a Q&A, please also try to get Dr. Uffe

Ravnskov also.

[enthusiast]

i haven't read Ravnskov but the comment sounds slightly dubious. The North Karelia project started in 1972. Five years later it was rolled out across the whole of finland because it was so successful. subsequently mortality from coronary heart disease tumbled across the country as well as in Karelia.

but my point was a slightly different one which is that it IS possible to change a population's habits - now what you change them too and whether that's the right thing to do is a differnt matter and there is no doubt that this is a massively complex subject with no easy answers.

# : ^ )

[Fat Guy]

The North Karelia project started in 1972. Five years later it was rolled out across the whole of finland because it was so successful.

During those five years, the control group fared better than the group for whom the test had allegedly been so successful.

"North Karelia, which had Finland's highest rates of heart disease, was compared with neighbouring Kuopio in The North Karelia Project. In North Karelia, risk factors were cut by seventeen percent over the period of the study. As Table III shows, in North Karelia there was a reduction in both CHD mortality and total mortality. Table III also shows, however, that in Kuopio, the control group, where there were no restrictions, there was an even bigger decline in both CHD and total mortality."

http://easydiagnosis.com/articles/cholesterol2.html

but my point was a slightly different one which is that it IS possible to change a population's habits

But is it possible, short of extreme rationing solutions, to change a population's habits such that the population loses weight?

[JasonCampbell]

But is it possible, short of extreme rationing solutions, to change a population's habits such that the population loses weight?

I would say it's not possible in a free market economy. I think it's right to be concerned about a nations eating habits, but it's unlikely that any 'quick fix' is available. The suggestion that we may one day have a pill that enables us to eat what we like without worrying about the consequences is an example of how unlikely it is a solution will be found.

The reality is that individuals have to take responsibility for what they eat. In the first world we can, but don't. In the third world they should but cant.

[enthusiast]

interestingly the main chapter in the official review of the Karelia Project on mortality changes insists on quoting improvements relative to the whole of Finland rather than Kuopio (tho' it does quote an analysis that "showed" there was a significantly greater delcine in Karleia than Kuopio - Salonen et al, 1983).

Incidentally there were some other surveys that purported to show that there was no sig nif difference in smoking between the two regions after 5 years but ten years on there was a sig nif greater reduction in smoking in Karelia.

which all goes to show that you can "prove" anything from these studies.

can you change a society's habits so as they lose wieght? i think we can try and if we start by better education/labelling and a rather more stringent control of advertising claims (eg "90% fat free"!!). then i think we have nothing to lose at very low cost.

my new ice cream machine on the other hand is a thing of beauty...

[Fat Guy]

i think we can try and if we start by better education/labelling

The efficacy of education depends first and foremost on having knowledge to convey. We do not possess that knowledge. Thus far, the primary piece of evidence about the efficacy of public nutrition education seems to be that, with the food pyramid, we taught it effectively and taught it wrong -- and people got fatter. So I'm not inclined to give a shred of support to any educational program until such time as governments are competent to educate their citizens in this area. To proceed with an education program in the absence of valid information is destructive, expensive, and wrong.

[Fat Guy]

The suggestion that we may one day have a pill that enables us to eat what we like without worrying about the consequences is an example of how unlikely it is a solution will be found.

What's so unlikely about that? Certainly, an effective psychoactive drug -- a nutritional Prozac -- that limits the propensity to overeat is easy to imagine. I'd be absolutely shocked if we didn't see a good one emerge within the next 5-10 years. As soon as it's proven safe, someone write me a prescription and I'll post a Weblog about how it's working. And is it so hard to imagine a gastrointestinally oriented drug that limits absorption? I see nothing fantastical about either, and I think the evidence is mounting that no other solution has a chance. Perhaps some individuals -- those with especially high degrees of self-control -- can take knowledge and restraint and combine them into an effective eating plan that reduces weight and maintains good blood chemistry. But what percentage of the population is really going to do that? Certainly less than 5% and probably more like 1%.

[JasonCampbell]

I think the fact that there's a back lash against Prozac (and that quit smoking drug, the name of which alludes me) is what's wrong with that. We've meddled with the idea of 'appetite suppressants' for 100 years, none have been successful. I can't share your faith that the next one will be.

I do agree that fat people are fat because they eat too much, and most often they eat to much of the same things.

[Marlene]

One major cause of obesity in this country is a profound ignorance towards the field of nutrition.

In order to substantiate that statement you'd have to show that, among similarly situated people, the ones with more knowledge of nutrition weigh less.

The only information I've seen on this point indicates that many people are obese despite the fact that they understand they're eating unhealthy food and too much of it.

And the jury is still very much out on trans-fats.

As an obese person who eats virtually no junk food and probably knows more about nutrition than 99% of the population and more about how food is produced and prepared than 99.99%, I find the notion that ignorance and disconnectedness from production are the root causes of obesity to be absurd. There is only one universal cause of obesity, and I stated it above. Beyond that, any attempt at a one-size-fits-all (so to speak) explanation is bound to be misguided and, if it forms the basis of policy, harmful to those who don't conform to averages (and in my life, I've met very few average people).

I haven't read all the way through this thread, so forgive me if I repeat anything.

First of all, I agree with FG, that apart from those with glandular problems and those requiring drugs to sustain life, that have side effects of retaining water etc, the basic problem is consuming more calories than the body burns.

With regards to nutrition, trans fat, high cholesteral foods etc, the circle goes around and around. A few years ago, we were told of the evils of red meat. Now, Atkins has more or less proved that red meat is not the evil it was made out to be. Eggs were maligned as the source of high cholesteral and were to be avoided. Margarine instead of butter. Etc. When each of those industries began to founder because people belived these "quick fix" solutions, all of a sudden, new research appeared, "disproving" all the evils that had been previously stated.

People discovered that not eating red meat, or using margarine instead of butter did not miraculously make them lose weight. Diets generally do not work, because they are short term solutions. Go off any diet, and return to your old eating habits, and volia, you put on the weight you lost, plus usually a few more pounds and thus the cycle begins again.

Fast food alone, is not the problem. I detest fast food and I still have to be very careful about what I eat, because I have a tendency to put on weight. The problem is, people want quick fixes and something easy and tangible to "blame" for their obesity.

We are a sedintary society. Lack of exercise, combined with portion control, tends to be the problem. You can eat anything you want, but you can't do it every day, and you can't have Hulk Hogan size portions.

All things in moderation. Exercise. Portion control. Water. These are the basic tenets of losing weight or maintaining a weight you want to be at. Taxing the fast food industry? Right. Will that stop people from deep frying at home, making rich creamy sauces, and calorie filled desserts? Not likely. And that is where a lot of the problem lies.

[Marlene]

This whole issue of fat and diet is extremely interesting to me.  I'm definitely on the thin side.  I eat anything I want and have never dieted even once. 

I think I hate you.

Seriously, I have to add something (ok, maybe a couple of things) to my previous comments.

First of all, the "obsession" to be thin. That is societial pressure. We've been inundated with magazine articles on how to lose weight. We see pictures of thin models every day. We see commercials that advertise "healthy" foods. I belong to a gym whose philosophy is "good enough is good enough". It is also the basic philosphy we will build our "egullet weight loss plan" on. I am never going to be thin. It just isn't going to happen. So, I've stopped beating myself up over the fact that I'm likely several pounds over with the BMI index says I should be for my height/weight. I'm at a weight that I can comfortably maintain, (although I do still have to think about the choices I make when eating), and I consider myself to be reasonably healthy. My blood pressure is great, my cholesteral is non existent, my dress size is satisfactory (10-12 depending on the cut) and I have reasonable muscle tone.

Forget the fast food restaurants. Go into any grocery store, and at the front of most of the aisles are the boxes of food that proclaim they are "healthy, low in fat, no cholesterol". Marketing people know people will buy these because they are "easy". After all, if the box says so, it must be ok - right?

I stand by my original premise that all things are right in moderation. What is needed is a little more education on how to make choices. Going out for that gourmet dinner? Great! Have a party, a pig out. Just know that the next day, choose to eat lighter, salads etc. Get some exercise.

One of the major factors attributed to obesity or being "plump" is overeating. No one ever mentions the undereating factor or starvation mode

When you suddenly deprive your body of food, our body goes into starvation mode--as in use as little fuel as possible, thanks to our evolutionary instinct to stay alive. And when a diet fails, as it inevitably will, your body is now inundated with excess calories, but it's still in starvation burn-as-little-as-I-can-get-away-with mode. And you know where this ends.

This is so true. And is the cause for much of "dieting" failure. One of my biggest problems was never eating breakfast or lunch. Thus, my metabolism never "woke up". Instinctively, it hoarded any calories I took in, not knowing when it would get more.

Deprivation of any kind is wrong. Dieting is wrong. Eat, enjoy, exercise, choose. In fact, just say

Choices -make them wisely

Hhappiness-be happy with yourself

E eat- what you want in moderation

E enjoy-what you eat - don't guilt yourself

S select- what works for you - don't try to be something you never will

E exercise- even if it's walking up the stairs instead of the elevator

Ok, so it's not the greatest acronym, but it more or less gets the point across

[mjc]

...the body deals with calories from fat different than with calories from proteins.  Small meaningless point.

And in absolute terms vis-a-vis weight loss/gain, completely untrue.

I thought about it, and I should have said that the source of calories matters. Actually, I think that the word Calorie -- a unit of heat to raise water one degree (or whatever), has little meaning in this debate. But if you intake 500 "calories" of bacon, compared with 500 "calories" of steamed broccoli, your body will process and store it differently. The bacon will have more of an "adverse" effect in terms of putting on weight.

So, I agree that 500 calories is 500 calories and if you burn 500 calories of one thing its the same as buring 500 calories of another. But there is indeed a difference in how quickly/efficienty the calories of one type of food and "burned off" compared to another type of food. Some foods energy will more quickly be used while other food enery is more likely to be stored as fat. This is what the atkin's diet is based on.

"Now, Atkins has more or less proved that red meat is not the evil it was made out to be."

I wouldn't say that at all, but perhaps his diet has shown that it doesn't necessarily may you fat.

And as for a Fat Tax, how about the alternative thin tax credit.

[slkinsey]

When you suddenly deprive your body of food, our body goes into starvation mode--as in use as little fuel as possible, thanks to our evolutionary instinct to stay alive.  And when a diet fails, as it inevitably will, your body is now inundated with excess calories, but it's still in starvation burn-as-little-as-I-can-get-away-with mode.  And you know where this ends.

It's not entirely clear to me that the whole "starvation mode" thing has ever been scientifically substantiated. It has always struck me as a hypothesis that some diet people came up with to explain why it is hard to lose weight and why rebound weight gain is so common after overly strict dieting. But I don't think there have ever been any studies showing that people on highly calorie-restricting diets somehow experience a profound metabolic change whereby their bodies burn fewer calories and absorb more.

This page here has the best and most sound explanation for rebound weight gain I have seen, and no mention is made of any such metabolic change.

[Fat Guy]

Some foods energy will more quickly be used while other food enery is more likely to be stored as fat.  This is what the atkin's diet is based on.

That's not my understanding of the basis of the Atkins diet. As I understand it, the Atkins diet is based on extreme restriction of carbohydrate intake in order to induce a state of ketosis.

[mjc]

Some foods energy will more quickly be used while other food enery is more likely to be stored as fat.  This is what the atkin's diet is based on.

That's not my understanding of the basis of the Atkins diet. As I understand it, the Atkins diet is based on extreme restriction of carbohydrate intake in order to induce a state of ketosis.

exactly so that you are burning calories from fat preferentially.

Edited June 30, 2003 by mjc (log)

[Fat Guy]

How is it preferential? People on Atkins aren't eating carbohydrates. There's nothing to prefer.

[mjc]

How is it preferential? People on Atkins aren't eating carbohydrates. There's nothing to prefer.

Ok, you have won me over with your logic.

Perhaps I can explain my thought in a different way. The reason that atkins diet excludes carbohydrates is to favor ketosis as you mentioned. When carbohydrates are present glucose is the bodies prefered source of energy and ketones are not favored and therefore their calories are not burned, but stored. So Atkin's knew that if he could eliminate the sources of glucose, the body would have to utilize ketones to make energy--in other words make the body burn the calories of fat. So therefore the atkin's diet is based on the principle that the body will handle the calories from different food in different ways.

how's that?

[nerissa]

The suggestion that we may one day have a pill that enables us to eat what we like without worrying about the consequences is an example of how unlikely it is a solution will be found.

What's so unlikely about that? Certainly, an effective psychoactive drug -- a nutritional Prozac -- that limits the propensity to overeat is easy to imagine. I'd be absolutely shocked if we didn't see a good one emerge within the next 5-10 years. As soon as it's proven safe, someone write me a prescription and I'll post a Weblog about how it's working. And is it so hard to imagine a gastrointestinally oriented drug that limits absorption? I see nothing fantastical about either, and I think the evidence is mounting that no other solution has a chance. Perhaps some individuals -- those with especially high degrees of self-control -- can take knowledge and restraint and combine them into an effective eating plan that reduces weight and maintains good blood chemistry. But what percentage of the population is really going to do that? Certainly less than 5% and probably more like 1%.

That's a pipe dream. I don't see how a pill, if possible, could solve anything. I also don't see an analogy between Prozac and a nutrional Prozac. Prozac and other SSRI's make it possible to function, and in an ideal situation, progress better in psychotherapy. A pill to prevent absorption? How to you program it choose which nutrients and foodstuffs should and should not be absorbed? I really need that extra protein--no wait, I meant to say fiber...A pill belittles any notion of personal responsibility that you have been advocating (and with which I agree).

[slkinsey]

Some foods energy will more quickly be used while other food enery is more likely to be stored as fat.  This is what the atkin's diet is based on.

That's not my understanding of the basis of the Atkins diet. As I understand it, the Atkins diet is based on extreme restriction of carbohydrate intake in order to induce a state of ketosis.

My understanding, based on conversations with several doctors in the extended family, of the way the Atkins diet really works is the same way every diet works: it gets you to eat less calories than you burn. Period.

The trick of the Atkins diet, and the way it accomplishes this calorie reduction, is to eliminate allmost all carbohydrates. As it turns out, carbohydrates taste good and we tend to eat a whole lot of them. The range of foods that are completely devoid of carbohydrates is very limited, and many otherwise palatable foods are not all that tasty in their carb-free form. One reaches a point where it just becomes boring to fill up on steaks with no potatoes and hamburger patties without the bun night after night after night. So, inevitably what ends up happening is that the dieter ends up taking less calories than they burn. The result of this is weight loss.

In case anyone missed it, the only proven diet for weight loss is... wait for it... to consume less calories than you burn. In other words, eat less and exercise more.

[JasonCampbell]

A pill belittles any notion of personal responsibility that you have been advocating (and with which I agree).

And it seems a fundamental madness to research such a pill when we haven't even solved the problem of world hunger. Fat people just aren't funny anymore, they are a reminder of the imbalance between the haves and have nots.