Fixing Epidemic Obesity? We Have Never Tried...

Similarly, I don't think we can say that historical advice about diet, health and weight control -- whatever the historical era, or advice -- is wrong because people subject to a diet of willfully addictive junk foods failed to follow it.
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This column isn't about guns or gun control. It's about food, and food for thought, entirely out of control. It's about epidemic obesity, and what passes for deep thinking on the topic. With that proviso out of the way, let's get back to guns.

Our gun control arguments must be wrong. Why? Because we are making them, and people are still getting shot. The prosecution rests, holstering its pistols.

Actually, let's take it a step further. To make our thinking on gun control roughly analogous to what passes for deep thinking on weight control calls for an exercise of the imagination; a fantasy, if you will. Alas, it is a rather macabre fantasy, so prepare accordingly.

Let's pretend we are addressing an audience in some large auditorium -- a metaphor for the world -- on the topic of gun control. Let's pretend we make a variety of what at least some among us would consider sound and sensible, clear and well-reasoned arguments on the topic. And then, we shoot everyone in the audience.

And then, waving a hand in the general direction of all those bloody and bullet-riddled carcasses we say, to anyone inclined to listen: see? I told you our gun control arguments must all be wrong!

Forgive me, but I don't think shooting people can be used to prove that advice about not shooting people is wrong.

Similarly, I don't think we can say that historical advice about diet, health and weight control -- whatever the historical era, or advice -- is wrong because people subject to a diet of willfully addictive junk foods failed to follow it.

And yet, we do exactly that -- over and over, and even in the guise of deep thinking.

I attended a lecture recently by someone with a prominent voice in the domain of diet, health, and weight control. For whatever it's worth, I respect this person's integrity and intentions, but have disagreed with him about salient messaging for many years.

On this particular occasion, his talk led to the conclusion that all of our weight control woes were due to insulin, and thus, sugar. We might quibble about some important deficits in that argument, such as: fructose does not evoke the release of insulin, while protein does. But there are better fish to fry here, as it were.

The emphasis on insulin was presented as an alternative to the hypothesis that we are fat because we eat too much. The evidence provided to indicate this 'hypothesis' is wrong is that we have been advising people to eat less, and it hasn't worked.

But that's where this loop of reasoning closes. We have no more reason to conclude that advice about eating less is flawed simply because people can't do it, than to conclude that gun control arguments are wrong if they fail to protect people we proceed to shoot.

The food supply is actively, willfully rigged to make overeating all but inevitable. Michael Moss has written brilliantly about this, both in essay and book form. But he is not the first. We received much the same memo nearly a decade earlier in a four-part series in the Chicago Tribune. We learned then that tobacco industry scientists, and food industry scientists, were sharing their fMRI machines to determine how best to stimulate the human appetite center. I won't belabor the details here, the story remains accessible to those so inclined.

We hear these days that we aren't fat because we overeat; we overeat because we are fat. Whatever the merits of this ambidextrous thinking, it begs the question: how, then, did we get fat in the first place?

We hear that we must eat more fat to be thin, since cutting fat so obviously failed us. Except for the fact that we never cut fat in the first place! Whether we look to the USDA's supply-side data on food consumption trends, or CDC's trend data from dietary intake assessments -- the answer is the same. We never decreased our intake of fat; we simply increased our intake of calories. If there is cause to be surprised that adding a dessert of Snackwells to a lunch of pepperoni pizza and Coca-Cola does not guarantee weight loss, I have yet to find it.

I have my own alternative hypothesis to the much-in-vogue alternative hypotheses about what's making us fat and sick. Namely: all these alternative hypotheses.

Yes, of course, excess sugar is a problem -- and for several reasons, only some related to insulin. Sugar stimulates appetite, and is routinely blended into foods that aren't even recognized as sweet as a crucial part of the "bliss point" engineering Michael Moss describes. But despite diverting noise about "sugar conspiracies," advice to limit sugar has not only been in the Dietary Guidelines for the past 40 years, it has been on the short list on page 1.

As for dietary fat, it's another argument full of sound and fury, signifying next to nothing. Some of the world's best, most healthful diets are high in fat; some are low. There are high fat foods, notably nuts, nut butters, seeds, and avocado that are highly nutritious and highly satiating, and might well contribute something to weight control. Perhaps the same is true of full-fat dairy.

But fat-free vegetables and fruits are long established to do the same on the basis of their high volume, among other virtues, as documented extensively by Dr. Barbara Rolls. The world's "best" diets, producing the world's best health outcomes, range from high-fat to low, but do not diverge from the theme that actually matters: wholesome foods, mostly plants, unprocessed or minimally processed, in some sensible, and generally time-honored arrangement.

The endless sequence of competing hypotheses is a decades-old boondoggle. We have been playing into the hands of diverse profiteers all along, and inviting Big Food to invent new varieties of junk food that pretend to address the nutrient worry du jour. Just as Ancel Keys never recommended Snackwells, Robert Atkins never recommended low-carb brownies. But that's just what we got. These days, we have foods swapping out high-fructose corn syrup for sucrose; replacing canola oil with coconut oil; or renouncing gluten. They all lead, as ever, with the lipstick, and hope we won't notice the pig. If history is any indication, we won't.

There is a pretty straightforward reason, no esoteric hypothesizing required, accounting for our failure to fix epidemic obesity. We have never tried to fix it.

I'll repeat that lest you think a typo was involved: we have never tried to fix epidemic obesity. The public has never cut fat, let alone calories. Advice to eat less has been accompanied by taunts of "bet you can't eat just one," and the requisite research to make that a very safe bet indeed. Advice to exercise more has been accompanied by the ever-accelerating proliferation of technology to replace the work of muscles, with invention now the mother, and necessity the offspring. We lament the fate of children prone to epidemic obesity, diabetes, and possibly a truncated life expectancy; yet tell them and their parents every day about multi-colored marshmallows as part of their complete breakfast.

And where a formidably vast and consistent trove of evidence, widespread global consensus, and confluence with the needs of a planet in peril might long since have rallied us to the theme of healthful eating, we instead practice fickle allegiance to the latest fad, current best-seller, or some headline enjoying its 15 minutes in the light.

If we treated swimming like eating, we would actively encourage people never taught to swim in the first place to enjoy the beach despite the rip tides and sharks, and then fret about the blood and the bodies.

If we treated gun control like diet, we would not only continue our deplorable want of meaningful response to the crisis, we would cite the very people we shoot as evidence that we need alternative gun control hypotheses.

Gun control is an extremely important topic. This just isn't about that.

Our failure to use what we know about diet and health is also, all too often, lethal.


Director, Yale University Prevention Research Center; Griffin Hospital