Chapter 1: How Obesity Became an Epidemic

Jun 07, 2019

 

Click here to watch a replay of the Facebook LIVE discussion. 

You Will Learn 

  • Why "eat less, exercise more" is NOT the answer to lose weight.  
  • History on the low-fat era and how this has led to skyrocketing levels of obesity.  
  • Why we shouldn't let the government tell us what to eat.

 

About Dr. Fung, Author of The Obesity Code and The Diabetes Code

Dr. Jason Fung is a medical doctor, nephrologist by trade, who specializes in kidney disease, type 2 diabetes, and obesity. He acknowledged that traditional medicine wastes time and resources attempting to treat symptoms of disease, rather than the cause of disease.  

You can purchase The Obesity Code book HERE. Much of the information in this post is directly from this book.

 

Overview of the Book 

Here is the outline of the book. Today I’m covering Part 1 in Chapter 1: How Obesity Became an Epidemic.  

  • Part 1: “The Epidemic,” explores the timeline of the obesity epidemic and the contribution of the patient’s family history. It highlights the underlying causes of obesity. 
  • Part 2: “The Calorie Deception,” reviews the current caloric theory in depth and highlights the shortcomings of the current understanding of obesity. 
  • Part 3: “A New Model of Obesity,” describes how hormones are involved in the development of obesity. These chapters explain the central role of insulin in regulating body weight and describe the vitally important role of insulin resistance. 
  • Part 4: “The Social Phenomenon of Obesity,” dives into childhood obesity and why obesity is associated with poverty. 
  • Part 5: “What’s Wrong with Our Diet?,” explores the role of fat, protein, and carbohydrates, the three macronutrients, in weight gain. In addition, it examines one of the main culprits in weight gain - fructose - and the effects of artificial sweeteners. 
  • Part 6: “The Solution,” provides guidelines for lasting treatment of obesity by addressing the hormonal imbalance of high blood insulin through proper nutrition, sleep, and stress management.  

 

The Bold Question...

Dr. Fung asks a very bold question. Why are there doctors who are overweight? Doctors are smart, hard-working, self-disciplined, and have the knowledge and dedication to complete an undergraduate degree, medical school, residency, and fellowship.  

The standard prescription for weight loss is to “eat less, move more.” It is not plausible that overweight doctors simply lack the willpower to follow their own advice. Dr. Fung argues that this simple answer to a complex problem is simply wrong.  

When I was working in traditional PT, I interacted a lot with nurses and other healthcare providers who were not healthy themselves. Inevitably the lunch conversation involved the latest diet they were trying or gym they joined. Clearly, diets and exercise programs dominate everyday conversations. It evident that people are trying, but too often than not the standard advice of eat less and move more is just not working.  

If someone were to ask you what causes weight gain, I bet you would say something like calories in equals more than calories out. The advice to eat less (i.e. put less calories less in), exercise more (i.e burn off more calories) seems very plausible. We don’t stop to consider if this philosophy is even correct because it makes so much sense.  

The problem is that it is too simple, and not complete.  

 

Proximate Vs Ultimate Cause 

Dr. Fung goes into somewhat of a confusing but important section here. He discusses the difference between the proximate and ultimate cause of a problem.  

The proximate cause is the immediate, apparent, or superficial cause of a problem. Whereas the ultimate cause is what we find when we dig deeper. It is the start or root of the problem.  

Treatments are a lot more effective and meaningful when they focus on the ultimate, not the proximate cause of a problem.  

 

Why Eat Less, Move More Doesn’t Work 

Consider the question: What causes weight gain?  

If the proximate cause is consuming more calories than you burn, it seems logical that the ultimate cause is “personal choice”. We choose to eat chips instead of broccoli. We choose to watch TV instead of exercise. This is dangerous reasoning because it transforms obesity from a disease that needs to be investigated and understood into a personal failing, a character defect.

Instead of searching for the REAL, ultimate cause of obesity, we transform the problem into: 

  • Eating too much (gluttony)
  • Exercising too little (sloth)

Gluttony and sloth are two of the seven deadly sins! By saying that eating less and exercising more is the solution to obesity, we are essentially judging the person for making bad choices.  

Think about puberty. Before puberty, boys and girls have about the same amount of body fat. When puberty hits, girls start storing more body fat. Girls are not more lazy or gluttonous than boys, it is obviously a change in hormones that makes men and women different and leads to the change in body weight and fat.  

When a woman becomes pregnant, she gains weight and experiences changes in appetite (and sometimes mood) primarily because of hormones changing in her body. Again, it’s obvious that hormonal changes resulting from her pregnancy - NOT personal choice - encourages this weight gain.  

When a women goes through menopause, her body experiences even more changes, often including weight gain, due to hormones.  

On a side note….why do women have to go through all the changes!?  

We commonly attribute weight gain during puberty, pregnancy, and menopause to hormonal changes but fail to acknowledge the pivotal role hormones play for weight gain during other times of our lives, and in men.  

Eating less calories solves the proximate problem, not the ultimate problem. This philosophy is being pushed down our throats by major players like the United States Department of Agriculture, who stated in their Dietary Guidelines for Americans: “Control total calorie intake to manage body weight.” The advice from the National Institute of Health’s pamphlet “Aim for a Healthy Weight” is to “cut down on the number of calories...they get from food and beverages and to increase their physical activity.”  

Millions of dollars have gone to promoting this message of eat less, exercise more to America to lose weight. But it’s not working. Two out of every three adults in America are either overweight or obese. It’s not working because it’s not the right advice, it treats the proximate, rather than the ultimate cause of weight gain.  

In reality, the ultimate, or root cause of obesity is a complex hormonal imbalance with high blood insulin as its central feature.  

Therefore, in order to have meaningful, sustainable weight loss, we have to direct treatment to lowering blood insulin levels. 

 

Obesity Wasn’t Always a Problem 

We were not always so obsessed with calories. Throughout most of human history, obesity was not a problem. The more civilized the world became, the more obesity became a problem. Until about 1950, it was common knowledge and practice to avoid sugary and starchy foods to maintain a healthy weight.  

In the 1950s, a perceived epidemic of heart disease was becoming a public concern. In hindsight, there wasn’t really an epidemic, people were just living longer to develop heart disease because vaccines and antibiotics were treating conditions that were previously fatal like pneumonia and tuberculosis. Heart disease and cancer now caused more deaths so treatment efforts turned there.  

Dietary fat, which was thought to increase cholesterol and thus lead to heart disease, was targeted by the medical community with very little scientific evidence to back this claim up.  

Regardless, doctors began to prescribe low-fat diets. There are 3 macronutrients, or major food categories. Carbohydrates, proteins, and fats. When you reduce your food from one category, you have to compensate by eating more from another.  

Since carbohydrates are low in fat (and fat was presumed to be causing the heart disease epidemic), people started eating more of them. In the developed world, these carbohydrates tend to be highly refined, meaning processed with the fat and protein removed from the grain, leaving straight carbohydrate.  

This shift in thinking created a big disconnect. How could refined carbohydrates be good (because they are low in fat) and bad (because historically they are fattening)? I grew up in the 90's so had never even heard of the old adage "fattening carbohydrates" until I did my own research into the topic as an adult. I grew up on low-fat.  

Without evidence or historical precedent, it was arbitrarily decided that excess calories, not specific foods, caused weight gain.  

The calories in/calories out model dominated the long-accepted “fattening carbohydrates” model.  

Not every nutritionist bought into this new philosophy. British nutritionist John Yudkin found no relationship between dietary fat and heart disease. He believed the main culprit of both obesity and heart disease was sugar, even published a book called Pure, White, and Deadly: How Sugar is Killing Us.  

Since then, the scientific community has debated vigorously whether dietary fat or sugar is behind the epidemics we are seeing today. 

 

The Dietary Guidelines

The issue about dietary fat or sugar being the culprit for obesity was settled in 1977, not by the scientific community, but by a government committee who wrote The Dietary Goals for the United States, also known as the “McGovern Report” after the chairmen of the committee. The report encouraged Americans to eat less fat, cholesterol, and refined and processed sugars. Notice is says nothing about refined grains (which is just more sugar as I explain in THIS article).  

I don’t know what happened to the later part of that statement but the “less fat” part, really stuck. Now fat was responsible not only for heart disease but obesity because fat is higher in calories than carbohydrates and protein.  

As Dr. Fung points out “an entire nation, and soon the entire world, would now follow nutritional advice from a politician.”  

The Dietary Guidelines for Americans, now updated every 5 years, resulted in the creation of the food pyramid that was prominent in health classes and marketing for years. The based of the pyramid - the foods that we should eat most of every single day - were breads, pasta, potatoes, and cereal. These were precisely the foods just a couple of decades previously were considered “fattening carbohydrates.”  

These foods, according to the American Heart Association, were encouraged because they were low in fat and cholesterol. What the AHA failed to determine was what happens with these foods once they are in our bodies. They are actually turned into bad cholesterol!  

In 1977 when that report was released, the damage was done. Food companies started to create low-fat versions of nearly every food. To compensate for the lack of flavor they added sugar. While it was a recommendation of the McGovern Report to decrease refined sugar, that message was trumped by “eat low-fat” which inevitably was higher in sugar.  

Americans did pay attention to those guidelines. Consumption of low-fat, low cholesterol foods like sugar and grains went up, consumption of meat, butter, and eggs went down.  

Unfortunately, rates of heart disease did not go down. What happened instead was that rates of obesity dramatically increased as shown in the chart below, starting almost exactly at the same time as the new Dietary Recommendations for Americans/McGovern Report was released.  

 

As I’ve discussed before, there is not just one cause of obesity. We can’t ONLY blame sugar, refined carbs, and hormones.  

It is fairly obvious that excess weight runs in the family. I’m going to talk about Chapter 2 in Part 1 of the Obesity Code, called “Inheriting Obesity.” We will review just how much your genes can influence your tendency to gain weight. This will put into perspective how much personal “choice” really comes into play.  

 

References 

1. Chapter 1. (2016). In J. Fung, The Obesity Code: Unlocking the Secrets of Weight Loss. Vancouver: Greystone Books. 

2. Picture: From the Video The Evolution of American Food Policy. https://www.realclearpolitics.com/topic/in_the_news/politics_of_the_plate/.  

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