Gary Taubes [ 29 JUN 2012 | Obesity Epidemic | 1:10:40 ] Let me just give you a little bit of background before I start and why a journalist is here talking about weight — and why a journalist has anything to say about this.

Why We Get FatAs Michael explained, my obsession over the years has been controversial science. Good science and bad science, how easy it is to get the wrong answer in science and how hard it is to do it right.

After I had finished this book on the scientific fiasco cold fusion, some of my friends in the physics community said to me, “if you’re really interested in bad science you should look at some of the stuff in public health — it’s really terrible.”

So in the early 90s I moved into public health and I meandered around the field until the late 90s I was writing about nutrition issues. I did a series of exposes for the journal Science in which I spent a year on an entire twice I spent a year on an entire article

first about the idea that salt causes high blood pressure

and then about dietary fat and heart disease

and that led me to do what was a relatively famous cover story for the New York Times magazine called What if fat doesn’t make you fat? or what if it’s been a big fat lie? and I got a large book advance from that

One of the things with the large book advance is that it gives you a lot of time to do the do the research. so I spent five years on the book, the advance lasted four.

when I talked to doctors and researchers about this I say, “imagine if you took one of your reasonably smart postdocs who had a reasonably good understanding of science and said look we have this obesity epidemic, we have this diabetes epidemic, we think we understand this but the fact that obesity and diabetes have run wild during our lifetime suggests that maybe we don’t

could you just go back through the literature and see if we missed something

see if maybe there’s some other explanation that we just blanked on because we thought we understood it

one of the common pitfalls in Science is as soon as you think you understand something you ignore all other possible hypotheses

so that’s in effect what I did

and unfortunately I stumbled upon what I thought were some obvious mistakes that had been made over the past 60 years

and now as a journalist I’m in the position of trying to convince the medical research community and the scientists and the educators that they have to rethink what they’ve been doing

so that’s what I’m going to do tonight with you

the gist of it is . . .

I wrote this book good calories bad calories — five years of my life, it’s dense densely annotated, and after came out I got a lot of emails and letters from people saying look this book changed my life now would you please write one that my husband could read or my father could read or my children would read?

Pourquoi on GrossitI got letters from patients saying would you write one that my doctors could read?

and I got letters from doctors saying would you write one then when my patients could read

so I wrote why we get fat which is kind of the airplane weaning version of good calories bad calories

instead of providing the history and the perspective and the background, it’s more of an argument and it’s based on this lecture

and I’m going to argue that what I say is true

so as we know there’s an obesity epidemic out there

obesity levels have increased dramatically

this is the epidemic here

we know that just you know, as a mike said, living in Santa Cruz County you’ve got obesity and the obesity epidemic

it goes along with the diabetes epidemic

so diagnosis of type 2 diabetes have tripled since 1980 in the United States

The conventional wisdom, and I’m just going to give you this in background, obesity is associated with a whole cluster of metabolic diseases

and what we mean by associated means the fatter you are – the more obese you are – the greater your risk of getting these diseases

so they include type 2 diabetes, fatty liver disease, heart disease, hypertension, stroke, cancer, asthma, sleep apnea, neuro degeneration with Alzheimer’s disease is one of them

Just yesterday there was a report that came out in the journal Pediatrics that autism is associated with obesity and maternal obesity and maternal type two diabetes

The conventional wisdom is that as you get fatter, something about being fat then increases, maybe the inflammatory molecules that are released by your fat tissue, increases the risk of these diseases

the subtext of what I’m going to argue is that whatever makes us fat also causes all these diseases

so it’s not whatever makes us fat causes heart disease, causes type 2 diabetes, causes cancer, causes Alzheimers

and it’s kind of a radical position but I want you to take it seriously

at least as I explain to you why we get fat or hopefully sort of expand your beliefs about why we

open your mind a little bit about why we might get fat

so okay boom so

why do we get fat simple question

and the answer is pretty obvious also

as an NIH puts at obesity occurs when a person consumes more calories from food than they burn

okay it’s conventional wisdom

energy n is greater than energy out

okay we overeat

simple enough

this is the energy balance hypothesis of obesity

that’s how it’s known

we take in its calories in calories out — whenever you hear somebody say that a calorie is a calorie is a calorie — this is what they’re arguing

and any food will make you fat if you take in more but then you’re expending

so I just want to ask question how many of you believe this is true

just so I get a feel for . . .okay thirteen people

No um . . .

I’m going to argue that this is one hypothesis of obesity and there are alternatives

obvious as it seems what we want to do is look at the alternative and see because it’s the science maybe the alternatives explain the observations better than our energy in energy out hypothesis

so again this is kind of how it’s perceived today in the popular press

one of the things we want to do as a science is we want to explain not just obesity but the obesity epidemic

so science is about observing things and then figuring out what the causes are

and our explanation for the obesity epidemic is increased prosperity

this is a phrase that the NYU nutritionist Marion Nestle used in a science article ten years ago

and Marian is still arguing this today

so the idea is we get richer and as we get richer, food is more available and we have to exercise less

basically the food and entertainment industries conspire — not consciously but subconsciously — to feed us too much and give us too many opportunities to be sedentary watching TV, watching video games

our kids are playing video games or on the iPads every day

they’re not outside running

Kelly Brownell Yale psychologists use the phrase the toxic environment to describe this

A toxic environment is an environment that promotes sedentary behavior and overeating and by doing so makes cat more calories in more than calories out

as Kelly put it, cheese curls and french fries drive-in restaurants are more part of environment now than trees grass and clouds

yourchildren sit at home and watch television

they play video games

parents were afraid to let them walk or bike to school anymore so we drive them to school

so there’s all these opportunities to eat too much and expend too little and that’s the toxic environment that we live in today

and the question we could ask as a scientist is pretty simple

we have our hypothesis: increased prosperity leads to overeating (energy and greater than energy out)

the result is the obesity and the obesity epidemic.

what we want to do is say does this hypothesis make sense? does it explain the observations?

because that’s again what we want our hypothesis to do

we want it to explain things that we see

and it certainly seems to explain what we see today

but there are some less obvious observations out there

and this is what I did in the course of my research

I was able to go back in time and look for examples, for populations that had high levels of obesity, but none of the toxic environment that we see today around us

and the first is the Pima Indians, a Native American tribe that live in on a reservation today in Arizona south of Phoenix

and the Pima happened to be among the most affluent Native American tribes through the middle of the 19th century

so they were hunters and gatherers

they hunted in the nearby mountains

they fished in the Gila River

they farmed

they were an agrarian population as well so they raised wheat and beans

they raised pigs and cattle

and in eighteen late 1840s when army battalions started traveling through the Pima Territory they noted that the Pima were sprightly and in fine health

and they had this great abundance of food

warehouses full of food

so much so that after gold was discovered here in California, in 1849 and from the 1850s through 1880s, 20 to 60,000 49ers went west on the Santa Fe Trail that goes through the Pima Territory.

and the US government asks the Pima to feed them

which they did

so in 1846, they were very prosperous tribe and they were described as sprightly and fine health by several observers

this drawing was actually made in 1851

and then what happens is Anglo Americans and Mexican Americans start moving into the Pima Territory in Arizona and they over hunt the local mountains and they divert the Gila River water to irrigate their own streams

and by the 1870s the Pima are starving

and they go through 20 to 30 years of famine

and by 1902, a Harvard anthropologist named Frank Russell comes to live with the Pima and he describes the conditions on the reservation as poor beyond our imagination

they’re trying to make it a go with farming and barely doing it

and Russell takes this picture of this Pima Indian that he calls fat louisa

and he says there’s a degree of obesity on the tribe, particularly in the older people, completely at odds with the popular image even back then of the native american lean handsome native american of popularized thought

and actually shortly thereafter a physician, turned anthropologist named alex redliquor came to visit the Pima tribe

he was doing a series of explorations in the American Southwest and he also commented about how obese they were

and what’s interesting is our hypothesis says increased prosperity causes obesity but here we have an example where they were prosperous and affluent in the mid-century, they go through 20 to 30 years of famine, and then they have an obesity problem in 1902 when they were extremely poor

and 20 to 30 years of famine you could think of as 20 to 30 years on a low-calorie diet right

these people should be lean, if not emaciated

and yet there’s a obesity problem

so one of the things I did is I went through the research looking for examples like this

populations in which obesity levels were measured prior to the 1980s when it became a cottage industry and everyone blamed it on McDonald’s

one of the first ones you see is Sioux Indians on a South Dakota Crow Creek reservation 1928

this was a study done by University of Chicago economists

and they went to live on the reservation

and what’s interesting again, the living conditions were poor beyond our imagination

as a matter of fact, in 1927 there was a government report on living conditions on the Indian reservations and they said they were poor beyond the imagination of the the Anglo Americans living in in 1927

and here there were four to eight people living per room

15 families with 32 children among them on this population we’re living on bread and coffee

they had to go to the river to get water

the toilets were in outhouses and yet you have obesity levels and are not that dissimilar to what we have today

40% of the women, 25% of the men and 10% of the children were distinctly fat

and 20% of the women, 25 percent of the men and twenty five percent of the children were on extremely thin

and in fact they were on this combination of obesity and malnutrition or emaciation is is a very important observation

we’re going to come back to it

there was plenty of signs these economists reported of malnutrition, deficiency diseases on the population

certainly these people weren’t getting enough food and they weren’t getting enough protein

they weren’t getting enough minerals , enough vitamins

and yet they had this high level of obesity

poverty and obesity

african-americans in Charleston South Carolina in nineteen fifty nine

thirty percent of the women are obese, eighteen percent of the men and the family incomes are nine to fifty three dollars a week

that’s about three hundred and sixty dollars a week in today’s money

Zulu’s in Durban South Africa nineteen sixty

forty percent of the women are obese women in their 40s averaged one hundred and seventy-five pounds

women in America today average around 165 pounds

so you’ve got again this obesity epidemic in this population and we want to explain that to not just obesity today

Trinidad in the early 1960s

there’s a malnutrition crisis going on in Trinidad

Trinidadians are dying of deficiency diseases

the u.s. government sends a team of nutritionists down to help out and these nutritionists come back and they report that a third of women over 25 were obese

and obesity is a potentially serious medical problem in women

and the next year an MIT nutritionist goes down to Trinidad to quantify the diet that they’re eating and she reports that the the obese women are eating roughly 2,000 calories a day

it’s 21 percent fat

it’s a low-fat diet

less calories than were recommended time by the Food and Agriculture Organization for a healthy diet

and yet there is this explosive obesity in the population

Bantu pensioners in South Africa –mid 1960s –the poorest of a disenfranchised black South African population, and yet thirty percent of the women are severely overweight

Raratonga, in the South Pacific, in 1971

twenty five percent are grossly obese

factory workers in Chile. these people they’re working. they’re engaged in heavy labor. you’ve got 30 percent obesity. nearly 50% of the women over 50 and 10% suffer undernourishment

so there’s a combination again of obesity and not enough food existing in the same population of factory workers in Chile

and the key observation there again is they’re doing heavy labor like this mexican-american study that was done in 1981

Starr County Texas is about 200 miles south of San Antonio along the Mexican border

a University of Texas Southwestern cardiologist named William Mueller was down there studying diabetes in this population

and he measured obesity as well

and he reported that 50% of the women in their 50s are obese, 40% of the men in their 40s

And their living conditions– most inhabitants are employed in agricultural labor and/or work in the oil fields in the country

These are hard-working people

they may not be running marathons, or training for triathlons if you’ll excuse me they may not be doing CrossFit or belonging to gyms, but they’re working out in the oil fields, they’re working in the in the in the field, and they have high levels of obesity

and they’re poor

and there was actually one restaurant in Starr County Texas in 1981

a Mexican restaurant

so there’s no aspect of this toxic environment as we think of it today

no fast-food joints you know no televisions no video games they’re not keeping their children home from school

they’re not sedentary

they’re not white-collar workers

and yet they have high levels of obesity

so the question you want to ask is why are these populations fat

okay because if we can figure out why they’re fat, we can probably figure out why we’re fat

and our our explanation for what makes us fat should encompass these populations also

so our toxic environment theory, our increased prosperity theory, can’t explain poor hard-working populations with high levels of obesity

so this is how this was perceived in the 1970s — before this idea that obesity was a disorder of over-nutrition, of over-consumption of food set in like ice on a pond

and I’m gonna have to read it leaning over a little

“it’s difficult to explain the high frequency obesity scene in a relatively impecunious society such as exists in the West Indies

actually let me interrupt for a second

this is Ralph Richards

Ralph Richards was a British trained diabetes specialist who moved to Jamaica in the early 1960s and started a diabesity clinic at the University of the West Indies in Kingston Jamaica

and Richards pointed out, when he made this statement, he observed that two-thirds of the adult women in Jamaica were obese

Okay and he said

so when he says it’s difficult when the high frequency of obesity seeing a relatively impecunious society such as exists in the West Indies when compared to the standard of living and enjoying the more developed countries

he’s asking the same question I do

we expect the rich countries to have obesity problems right not the poor countries

malnutrition and some nutrition are common disorders in the first two years of life in these areas and account from was 25% of all admissions to pediatric wards in Jamaica

sub nutrition continues in early childhood to the early tween

sub nutrition the kids aren’t getting enough food

okay

obesity begins to manifest itself in the female population from the twenty fifth year of life and reaches enormous proportions from thirty onwards

okay

that was how this question was asked circa nineteen seventy three seventy four

now we could look at the same issue, the same observation 2005, after this belief that obesity is just a disease of sort of overconsumption sets in

okay

this is Benjamin Caballero

he runs the laboratory for human nutrition at Johns Hopkins University

which is a pretty good school

this was from an article in the New England Journal of Medicine called obesity and under nutrition, obesity and malnutrition and nutrition paradox

2005 he says a few years ago I was visiting a primary care clinic in the slums of South Paulo Brazil

the waiting room was full of mothers with thin stunted young children exhibiting the typical signs of chronic undernutrition

their appearance sadly would surprise few who visit poor urban areas in the developing world

what might come as a surprise is that many of the mothers holding those undernourished infants were themselves overweight

and then he says the coexistence of underweight and overweight poses a challenge to public health programs since the aim of programs to reduce under nutrition — which is make more food available — was in conflict with those for obesity prevention –which is make less food available

and I proposed a challenge to public health programs in bold print and italics because this coexistence of underweight and overweight in the same populations, in the same family doesn’t pose a challenge to public health programs

it poses a challenge to your paradigm

ok if you believe that the mothers got obese because they took in more calories than they expended

they in fact took in superfluous calories that they didn’t need, so that they could get fat, is a brutal way of saying it that they snuck outside to eat Snickers bars while their children are starving — then you believe these mothers were eating calories they didn’t need that they could keep from their children to keep their children from starving to death

ok

so we have a paradigm of maternal behavior that says mothers will starve themselves to death before they’ll see their children starve

ok

how many of you are mothers in here

probably a lot

how many of you would let your children starve so you could eat a Snickers bar

okay that’s what we’re talking about

so that’s our maternal behavior paradigm says mothers starves the children can live

and our obesity paradigm says the mothers are getting fat because they’re eating calories they don’t need

we have to throw out one of the two of them

and what makes this observation so interesting, is in physics the field I grew up in, physicists, scientists spend their whole lives waiting for what they call anomalous observations

and anomalous observation is something that your theory can’t explain

because if you find something your theory can’t explain you could then improve your theory or come up with a new theory that then can explain it which then makes progress

In physics,for instance, they’ve spent billions of dollars building one atom smasher outside of Geneva in this laboratory called CERN so they could create one reliable observation that their theory can’t explain

in obesity and nutrition research we’ve been sitting on one for arguably 80 to 100 years

and we don’t pay attention

all we care about is that it doesn’t kind of make sense if we want to solve the public health programs

and one of the issues I come back to over and over again in my book is that obesity nutrition researchers and the public health authorities have been so convinced they know the answer

this energy balance thing

this calories and calories out

that they’ve been blinded even to sort of glaringly obvious anomalies that their theories can’t explain

so let’s look at some other inconvenient observations here

for starters if eating more causes us to get fat, eating too much, we should be able to eat less and lose the weight

and it’s not that you know you can argue okay when somebody’s fifty or hundred pounds overweight, eating less doesn’t work, but you don’t you’re not born fifty or hundred pounds overweight

or at least most people aren’t

they get overweight in little bits and pieces

one day you notice you’re ten pounds heavier than you want to be

your pants don’t fit right or you look you know you’re turning to your husband and saying do I look fat in this outfit and your husband’s trying to lie to you um desperately

and at those points, when you’re a little bit overweight, you should be able to cut back on calories and lose weight

and the fact is it doesn’t work

and in fact in the mid nineteen fifty some of the leading experts on obesity said look we can define obesity disorder in which eating less doesn’t work

every one who’s obese or overweight knows are supposed to eat less or exercise more

some combination of both

everyone tries to do it their whole life

and if they’re still fat, it means it didn’t work

it’s that simple

so it means for third of the American population it didn’t work or for two-thirds of the American population

and you can actually quantify it in clinical trials

you can do experiments where you tell people to eat less and other people not to

and as the Cochrane Collaboration, which is a group that was founded to do unbiased reviews of the medical literature put it, weight loss achieved in trials of calories restricted diets are so small as to be clinically insignificant

one of the interesting things is Hilda Brooke was a leading obesity pediatric obesity researcher in the mid twentieth century wrote a great book on obesity in nineteen forty seven –fifty seven –and she talked about this and she said, “should it come as a surprise that eating less doesn’t work or that calorie restricted diets doesn’t work since the obese people again they spend their whole lives trying to eat less.

having a doctor tell you to do it or a researcher tell you to do it –if that suddenly did work, that would be shocking

now the other problem is that exercising more doesn’t work also

okay and by exercising more I’m going to quantify this because I always get in trouble

expending more energy

okay we we have this energy balance thing

so we either eat too much or we expend too little

so you could increase energy expenditure, and hope that you’ll lose weight, and I could quote meta-analyses on this but I find this more compelling

2007 the American Heart Association, the American College of Sports Medicine, published joint physical activity guidelines

these are people who want us to exercise

who like me believe that physical activity is an inherent part of a healthy diet, healthy lifestyle

and you would expect that they would bend the data to make exercise more attractive

and yet this is what they said their guidelines

They said it’s reason to assume that persons with relatively high energy expenditures would be less likely to gain weight over time compared with those who have low energy expenditures

that’s like saying it’s reasonable to assume that a marathon runner would be less likely to gain weight over time than a couch potato

or that if you are a couch potato you would be less likely to gain weight if you become a marathon runner than if you remain a couch potato

those are all logically equivalent

and then they say so far data to support this hypothesis are not particularly compelling

okay and

the interesting thing about this is this hypothesis is at least 100 years old

as early as 1907 there was a famous German researcher named Karl Bonn Norden, diabetes obesity specialist who said maybe a people get fat because they take in more calories than they expend that

if we just get him to expend more they won’t get fat

as early as 1860 there was a famous British Undertaker who went on a diet and wrote a book about it and said look when I was younger I told a doctor I just keep getting fatter and fatter and he told me to take up rowing and I took up rowing

I bought a boat

I took of rowing and I just got hungry and still fatter

and the idea

the point I’m making here is that if the best you could say about a hypothesis and notion that increasing energy expenditure should help you lose weight or prevent you from gaining it after a century is that the data are not particularly compelling –maybe your notion is incorrect

maybe your hypothesis is incorrect

doesn’t mean it is

maybe you never studied it right

maybe these people didn’t do enough exercise

we know from The Biggest Loser that if we get people to do 6 hours a day, and starve them, they’ll lose weight

but we don’t know what they’ll do as soon as the show ends

one of the ways to think about this was given to me by a British blogger

and he said and I wish I could remember his name so I could give him more credit than that

imagine that when I came to Santa Cruz tonight, I also came with the top 10 chefs from the bay area where I live, and they cooked a feast of monumental proportions

you know twelve courses of the best food that you will ever taste in your entire life

so when you heard about this lecture, you got an invitation saying come hear Gary Taubes lecture and please come to this feast we’re having with the best food you’ve ever had

there’s going to be a ton of it

bring your appetite

come hungry

what would you do to make sure that when you got here you could eat as much of that food as humanly possible

okay

so you might skip lunch that day

or eat less over the course of the day

that’s one obvious thing you’d do

and the other thing you might do is exercise more right

if you run three miles you run five or if you spend 40 minutes in the gym you spend six

if this was a day off you go to the gym anyway you might say look I only live five miles from the school I walk

so the two things that you would do to assure that you were hungry eat less and exercise more

the two things we tell obese people to do to lose weight

does that strike you as odd

and perhaps a sign of something that’s wrong here

okay

what about practicing energy balance

the CDC says when it comes to maintaining a healthy weight for lifetime, the bottom line is calories count, weight management is all about balance, balancing the number of calories you consume with the number of calories your body uses or burns off

okay

how many of you have tried to basically do calorie counting

okay

and how many thank you and

how many of you when you workout at the gym go to the aerobics machines and look at the calorie counter and say okay I got to like 300 calories I could stop now or 500

if you ever actually think about this

is one of the place where when I was doing my research I actually tend to get angry

because you never think about what this entails

and I was reading a 1937 metabolism textbook, written by the leading expert on metabolism, and he gave me the calculation I’m about to give you

with what it entails

so it’s just to ask yourself what does this mean to practice energy balance

how do we do it

so a typical American’s food intake average between men and women’s 2700 calories a day

it’s about a million calories a year

it’s about 10 million calories in a decade

it’s about 10 to 12 tons of food

so now you just ask the question how accurately do I have to balance calories in to calories out so I don’t gain any more than 20 pounds over the course of a decade

okay because if I gain 20 pounds in a decade –that’s 40 pounds in 20 years –I’ll go from being lean in my 20s as many of us were and many of us, are to being obese in my 40s as many of us are and many of us will be

and I don’t want that to happen

right

so I want to make sure that I don’t gain any more than 20 calories

just ask what do I have to do to do that

how many calories do I overeat for that to happen

and the answer is 20 calories a day

if I stick 20 calories a day in my fat tissue that I don’t burn on average I will gain 20 pounds in a decade

here’s a calculation

it’s very simple

20 calories a day times 365 days a year times 10 years divided by 3500 — which is a reasonable number for the calories in a pound of fat and you come out to 21 pounds in a decade

okay so that’s one bite of food, two sips of soda

if I eat 150 bites of food over the course of a day, and I only burn off 149 of them –and the one hundred and fiftieth ends up in my fat tissue — I am going to become obese.

When Jean Dubois, a leading expert on metabolism in the U.S. pre-world war II, wrote about this, he said this tells you that there’s something wrong here

obviously there’s something going on

regulating weight that has more to do with the our conscious balance of calories in, calories out because nobody can do this

this is point eight percent accuracy

so even if you were the world Guinness world record holder on calorie counting you still couldn’t do it

because you’d have no idea how much you were expending over the course a day

and that’s what Dubois said

he said there’s nothing stranger than the maintenance of a constant body weight under fluctuations of energy intake and energy expenditure

the question should be, not why are some of us fat

if this is what we have to do to remain lean why aren’t we all fat

Or why aren’t half of us fat and the other half look out anorexic because half of us overshoot in one direction the other half under shoot in the other

and you could argue you could say there ways to get around it

and the researchers do

you say well maybe what we do is we oscillate

so we start to eat too much we consume a bite of food too much every day and we start to get fatter and then as we get fatter we under eat and we undershoot

so we oscillate around perfect energy balance

which is possible

but the questions and how to animals do it

because they don’t know they’re getting fatter

right they don’t have mirror

they’re not looking in mirrors and not asking their husbands

their clothes aren’t not fitting

so if we do it by oscillating how do they do it

because the one thing we can bet they’re not doing is counting calories over the course of the day or consciously doing this 20 calories a day thing

so here’s another way to look at it

some more in inconvenient observations and now I’m going to show photos of naked human beings and I apologize I am going to be channeling the way pre-world War two European researchers thought about this because they had a different theory of obesity so I’m now going to tell you how they thought about the problem and I’m going to say by the way that pre-world War to all meaningful medical research was done in Europe the lingua franca of science was German and if you wanted to be a medical researcher or actually a physicists or chemist or any field you had to at least read German so you could read the German literature and you had to speak German ideally so you could move to Germany and Austria and train with these people as all the leading experts in nutrition and metabolism in the u.s. pre-world war ii did so this is how those excellent scientists thought about obesity and today you won’t see photos of naked human beings or in obesity textbooks you might see naked rats these Europeans thought you could learn a lot from looking at not just whether someone’s fat or not which is what we get from a BMI a body mass index but how they get fat where they get fat when they get fat all these things will tell us something about why they get fat so for starters we have genetics here’s a lean pair of identical twins and an obese pair of identical twins our calories in calories out notion might explain why these women are fat and these women are lean these ones took in more calories and they expended in these practice perfect energy balance but it says nothing about why they have the identical bodies and why they have the identical bodies we know obesity is a large genetic component we also know that obese you know sign uh identical twins don’t just look alike they have the same bodies body types run in families so what’s controlling that the amount of calories they took in and expended can’t be doing it’s something about their genes are making are giving them the same body even when they’re say 50 70 80 pounds overweight what’s doing that why do they have why does the fat go to the same places on these women and on these women too for that fact our calories theory says nothing about there something else must be regulating where the fat goes and how much the idea that the genes just regulate how much these women need and exercise is a little absurd here’s another way to look at it okay animal husbandry for hundreds of years we’ve been breeding farm animals to be more or less something so here’s a lean breed of cattle gee cow it’s a dairy cow you can see the swollen udder and here is a meat cow Aberdeen Angus it’s a stocky fatty muscular cow you could see the meat from this cow actually this is probably a bull and I should have switched the photos but would have been the same you can see the fat accumulation you can just ask we know because they’re different breeds what’s regulating this it’s genetics is controlling it what are the genes controlling why does this animal so stocky and this animal so lean and are the genes controlling how much they eat in exercise you know how much calories per byte per graze of grass this one takes in versus Alan or maybe this one the genes tell it to graze only 10 hours a day and this one 12 hours a day or maybe the genes promote this one too you know it gets dark it goes for run at night like that far side cartoon and this one it gets dark and it’s genetics make it going and watch television I mean it’s obviously absurd right and what the genes probably we can think of it this way um this is an animal that you know all ethical moral issues aside we can think of it as a machine that takes in fuel here and converts it to milk and we want that that’s a very energy expensive thing to do we want it to happen as efficiently as possible we don’t want it bulking up here we don’t our fuel being lost elsewhere in this animal we do want the fuel going to muscle and fat and protein it’s not a milk house oh maybe what the genes do is determine on how many calories the animal takes in our expense but how it uses them the technical term is fuel partitioning in this animal the fuel is partitioned to milk and in this animal it’s partitioned to protein and fat so what our genes determine is this how the animal partitions fuel or how the human partitions fuel here’s another problem sexual variations okay men and women fatten differently which has always been you know well known men get fat above the waist women get fat below the waist both of these people would have had to take in more calories and they expend to get fat but here this guy went here this woman and went below the waist this guy doubled his risk heart disease by getting fat up here this woman did not so what are the calories have to do with it that’s a question what determined where the fat went and why did the fat in one place double the risk of heart disease where the fat in the other place doesn’t you can look at this as a puberty boys and girls go through puberty they start off puberty with roughly the same amount of body fat about 7% and then as they go through puberty the boys lose fat and gain muscle and the girls excuse me gain fat in very specific places okay so by the time they’re done with puberty the girl is about 50% more fat than the boys do both of them got bigger both of them got heavier they both took in more calories and they expended but the boys lost fat and gain muscle and the girls gained fat in very specific places what do the calories have to do with it this positive energy balances calories and greater than calories out have to do with that and we know why they got you know they both grew because they were secreting growth hormone the boys gained lost fat and gain muscle because of testosterone the girls gained fat in specific places because of sex hormones the fact that they were in this positive energy balance taking in more calories than they expend addicted or said you know this beginnings looked like a freak show Gary I think we want to sell books we don’t want a circus sideshow Lippa dystrophies that’s a disorder of fat accumulation Lippo means fat dystrophy disorder this is a rare disorder called progressive lipid dystrophy by the 1950s there are about 200 of them on record the United States this photo again comes from a 1940 textbook progressive lipid history was called progressive because in this case most of the cases were women and they start losing fat in their forehead all subcutaneous fat and it progresses downward in one case a British physician actually measured it at moving downward at a rate of about an inch a year and then you get to the waist and often in these cases it would stop and you would get lower body obesity so the way these Europeans thought about it they use this an example and they said look are we going to blame the top half on undereating and the bottom half on overeating and if this woman had 10 more pounds of fat on her upper body five more pounds she actually had a BMI of around 34 anyway so she was technically obese but if she had just enough fat so that you couldn’t see the emaciation you couldn’t see the lipid dystrophy she’d go into the doctors and the doctor would say look eat less exercise more you know the point of this is that if overeating can’t explain localized obesity why can you use it to explain generalized obesity obviously there’s something else going on here and that’s what we want to find out so let me just answer the question why is it we believe in this energy balance thing to begin with and the answer is physics okay so the first law of thermodynamics and often when you give whenever somebody like me argues that it’s not about energy and energy out somebody accuses you of not believing in the laws of thermodynamics I actually was on the Larry King show and Jillian Michaels came on the air from Los Angeles and gave me a lecture on the laws of thermodynamics on national television and I was literally speechless I mean you can watch this clip on YouTube I I have a physics degree from Harvard okay I was a lousy student I was a b-minus student but I understand the laws of thermodynamics it may have been the high or a low point in my life depending on how you look at it okay why do we believe it the first law of thermodynamics energy conservation change in energy of a system that’s what we mean by Delta a is equal to the energy and minus energy out okay so this is based pretty simple means if a system gets more energy in it it’s got to take in more energy than expended the system gets less energy it’s got to let out more energy than it takes in that’s why it’s called the law of energy conservation the idea is we can’t create energy from nothing energy can only change its form it can’t be created destroyed its conserved so what we do is we say look here’s a fat mass Delta e and if energy and if the energy you eat goes up and you don’t compensate by increasing your expenditure then Delta e has to go up so you get fatter right and if Delta if the if you become sedentary if he out goes down and you don’t compensate by eating less Delta e goes up you get fatter therefore eating too much or exercising too letõs the cause of obesity and the point is there’s no arrow of causality here this is unlike an eighth grade physics mistake that we all made actually I guess in eighth grade you’re not even learning physics you’re just learning science so we all make it it’s been made in the United States since the 1950s it wasn’t made pre-world War to buy know we’re off gazali what this law says is if someone gets bigger if I get fatter I have to take in more energy than I expect but it says nothing about why there’s no causality or doesn’t say I got fat because I took in more energy than it expends it just says that if I get fatter this has to happen and if I actually am in negative energy balance if I’m expending more energy than I take in I have to get thinner but it doesn’t say that the way to get thinner is to do this there’s no causality in the slot just says if one thing happens the other thing has to happen because that’s the way the universe works period so let me give you example of how absurd this is that we take this and we put a law of causality on this imagine that instead of wanting to know why you get fat while your fat tissue fills up with such energy you want to know why is this room full of such energy instead of energy in the form of triglycerides and fats how we have energy in the form of people in this room and so you ask me you go Gary why is this room so crowded why is it so full of energy and I say because more people entered then left okay have I told you anything that you didn’t know anything at all meaningful this is what logicians would call vacuously obvious it’s true of course more people under than left that’s what do you say to me Gary of course more people under than left but why is the room so crowded and then I say to you and I’ve said the equivalent by the way if you get fat because you take in more energy than you expend so now you say but why is it so kind of what look if more people enter than leave it’s got to get crowded right which is the equivalent of saying if you take in more energy than you expend you have to get fatter but I still haven’t told you anything meaningful obviously more people enter the room than left that’s a given the question is why is the room crowded well maybe it was pouring outside and everybody ran in to get out of the rain maybe there was free food maybe there was free drinks maybe there’s a birthday party maybe I put large men in motorcycle jackets at the door and they grabbed everyone and walked in and threw them into the room and won let them leave there are a lot of explanations for why the room is crowded that have to do with the conditions outside the room the conditions inside the room and the conditions at the barrier but the fact that more people wonder than left is irrelevant it’s obvious and what I’m saying is if you tell someone that they got back as they took in more energy than they expended you’re just saying I believe in the laws of thermodynamics but you’re saying nothing meaningful and when our government says that you get fat because you took in more calories and you expend it they’re telling us nothing meaningful it’s completely irrelevant if you got fatter you had to take in more energy than you expended there’s no causal information in there and just making that mistake steak is why obesity researchers went off the rails and it’s one of the things when I was doing my research and I was reading the literature in the 1950s and I could see this happening after it was explained to me what the mistake was because I believed just like everyone else that obesity was all about energy balance I was stunned like how could we do this how could we actually think this equation says anything about why you can’t help out thermodynamics says anything about why we get fat it’s not physics it’s biology so let’s have an alternative hypothesis I hope I at least made you doubt the idea that this is about energy balance if there are any doctors in here I hope that you will never again use the phrase you got fat because you took in more calories and you expended okay here’s the alternative hypothesis obesity is a disorder of excess fat accumulation this is a way the Germans and Austrians looked at a pre-world War two so instead of saying obesity the sort of energy balance or overeating or sedentary behavior they started from first principles which is what you’re supposed to do in science it’s supposed to make a statement of the problem that has the least assumptions attached so obesity is sort of excess fat accumulation you could say obesity having too much fat is a disorder of having too much fat which sounds so simplistic is to be meaningless and yet if you just said that and you’re a doctor you might first question that might come to – wonder what regulates fat tissue because if you’re saying it’s about eating too much and exercising too little you don’t care what’s regulating fat tissue you only care about what’s making somebody eat too much ok in this hypothesis over eating an activity or compensatory effects they’re not causes so by that I mean that whatever makes you fat causes you to eat more or exercise less causes overeating or sedentary behavior it’s not the other way around and the way this was phrased to me by various researchers we don’t get fat because we overeat we overeat because our fat tissue is accumulating excess fat so to show that this isn’t a rhetorical argument I’m making an example used by the pre-world War two researchers were growing children I kind of got into this with the puberty thing but I’ll do it again here’s a extraordinarily cute young child in 2006 who weighed 20 pounds he was one year old okay three years later he weighs 45 he’s gained 25 pounds in three years he’s over eaten he’s taken in more calories and he expended right we know this Benz he’s grown children grow so the question is did he grow because he overate or did he overeat because he was growing and the fact is he was growing because it was was creating growth hormone which was stimulating something called insulin like growth factor which was making his body grow and he needed all this energy both for the act of growing and to create new structures and bigger structures so he grew he overate because he was growing he didn’t grow because he was overeating and what I’m arguing is in any example in biology here’s another one a tumour cell cancer this is a sort of gruesome photo get back here gruesome photograph of cancer cell growing here’s a tumor it’s getting bigger and bigger and bigger it’s taking in more calories and expends that’s what the first law of thermodynamics tells us but we don’t care because we know that the reason it’s growing it’s got various genes that are broken oncogenes that will stimulate growth and tumor suppressor genes that are supposed to break growth and because of that it’s being driven the unfettered growth and not stopped and it’s taking in more calories and expends because it’s growing in every biological system I can come found I’ve yet to find in a counter example growth is the cause and eating too much of you know positive energy balance is the effect it’s never the other way around except in human obesity where we put the cause on positive energy balance so this was theory was known as a lip ophelia theory prior to the First World War it was a German Austrian hypothesis okay the two leading proponents were Gustav von Bergman who was the leading German authority on internal medicine pre World War two and today one of the leading awards in the German society of internal medicine is the Gustav von Bergman award and Julius Bauer who was a University of Vienna endocrinologist and geneticist who was a very famous man and is still famous today in Austria so these people were in quacks they were very well respected scientists and was more or less fully accepted in Europe by 1940 and the problem is 1940 was a really bad um by that time Bauer had fled Austria in 1938 the Nazis invaded Austria the war breaks out this German school evaporates this German Austrian school evaporates and after the war we don’t pay no attention to this obesity and nutrition research the beliefs we grew up with were created by young American researchers post-world War two without any concern to what these Germans and Austrians had learned prior to the war because they didn’t like the Germans for good reason so the lingua franca of science went from Germany pre-war to English after the war in some fields like physics it didn’t have an effect because we know the Germans chased all the brilliant scientists out of Europe and we embrace them because we had atomic bombs and hydrogen bombs to build the Cold War to fight but in medicine in public health we wanted nothing to do with these people so this pre World War two theory the slip athelia theory was forgotten and we we created obesity is an eating disorder but let’s look what this theory was here’s Lippa feeling in a nutshell by Bauer’s is like a malignant tumor like the fetus the obesity the uterus of the breasts of a pregnant woman the abnormal lipophilic tissue seizes on food so flipo filip means love of fat and the idea is that some tissue will readily absorb fat just like an other tissue own this is what they call Whipple feeling the metaphor they use was hair growth so just as we grow hair in some places but not in others you know we grow hair on top of our head but not in our foreheads we grow fat in some places but not in others and we all know where we grow fat and we all know the places we don’t and they said just like some people are get are hairier than others some people are fatter than others and this is all regulated by hormones and enzymes and central nervous system things and we have to know what those are so the abnormal lipophilic issue seizes on foodstuffs even in the case of undernutrition it maintains its stock and may increase it independent of the requirements of the organism so see even in the case of undernutrition we can begin to explain these obese mothers with their starving children doesn’t matter if they’re getting starved the fat tissue like a tumor is doing what it wants a sort of anarchy exist the adipose tissue lives for itself and does not visit into the precisely regulated mechanism of the whole organism okay think of the fat tissue like a tumor suddenly something has stimulated it to grow more so on some than another some of us are lucky and it never happens and the question is what is that something so you can look at animal models of obesity and just ask the question there’s a hundred different ways you can make animals obese nowadays and you can ask the question when I make them obese do I make them eat too much and exercise a little or do I change the regulation of their fat tissue and showing my year famous the most influential nutrition at the United States in 1968 he studied a strain of obese mice and he said look these mice will make fat out of their food under the most unlikely circumstances even when half starved okay so it’s not that they get fat because they eat too much they get fat if they eat at all and in fact there are copious animal models obesity where you could starve the animals and they’ll die with their fat tissue intact okay so you can starve you can take littermates um actually there’s a type of rat called a Zucker rat and you could put this rat on a diet from birth this was actually done by a researcher at UC Santa Cruz in the early late 1970s so you wean them from the mothers and you put them on a diet and then you compare their weights to their litter mates I get to eat as much as they want and the ones on the diet actually get fatter than the ones who get to eat as much they want they don’t weigh as much but they have more fat tissue and as this research or MRC Greenwood said they cannibalize their brains and their muscle in their organs so they have smaller brains smaller muscles smaller organs in order to feed this drive to get fat what you do is you increase the sort of Lippo feeling of the fat tissue and then they do Drive calories into the fat tissue when the animal responds by eating less or exercising more so you just ask some questions in vertical growth we know that growth is a cause and positive energy balance is the effect and when we look at animals we know that growth is a cause and positive energy balance in the effect so why not man and if obesity is a sort of excess fat accumulation what regulates fat so this is your quick course I’m going to get a little bit technical okay but in five minutes you going to have to know everything you need to know about your fat tissue I’d like to say you’ll know more than what your doctors know but your doctors were actually taught this in medical school and they were taught it was irrelevant to obesity and you think about that we have a disorder of excess fat accumulation and we don’t care what regulates our fat tissue because we know it’s all about eating too much and exercising too little I’m going to tell you what regulates your fat tissue so lesson number one is fat circulates in the human body in two forms three forms with this two are interested in triglycerides and fatty acids okay here’s a fatty acid it’s a long chain of carbon and oxygen and it bounds together into a fatty acid so you get three fatty acids bound together with the glycerol molecule into a triglyceride okay so fat is stored as triglycerides this big thing but fatty acids are burned for fuel this long thin thing that enters and exits fat cells as fatty acids and inside the fats how fatty acids continually cycle into triglycerides and backs let me show you what this looks like here’s a fat cell here’s the fat cell membrane if fatty acids outside the membrane and the reason we store fat is triglycerides it’s because the triglycerides are too big to get through the membrane it’s like if you’ve ever bought a piece of furniture and you brought it home and found out it was too big to fit into the room through the door into the room that you bought it for so what you have to do is like take it apart and then rebuild it inside I had to do this with an Ikea bed once and I wanted to shoot myself um that’s what we do the fatty acids actually they start off in lipoproteins as triglycerides is an enzyme here called lipoprotein lipase that breaks them down into fatty acids the fatty acids are small enough to fit through the fat cell membrane that’s why they by the way we traffic the fatty acids across the cell and that’s why we burn fatty acids inside the cell they’re put together into triglycerides fixed here because this guy is too big to get out and then they’re broken down again into fatty acids there are enzymes in the cell that break them down into fatty acids and as fatty acids they could escape through the cell so here’s where our energy balance thing becomes meaningful if this is like insanely simple if more fatty acids go into the cell then leave it you get fatter Lisa fat cell does and if more fatty acids go out of the cell then go in you get leaner so anything that works to move fatty acids this way makes you fat or anything that works to move fatty acids that way makes you leaner what you want to know is what regulates this process because that’ll tell you whether your fat cells are getting fatter and if your fat cells are getting fatter you’re getting fatter and it’s kind of simple actually it was known by now remember the Germans vanish this German hypothesis vanishes in 1940 at that time they couldn’t they didn’t have the tools necessary to figure out what regulates fat tissue that was 1956 three groups of research discovered a mechanism to measure the fatty acid level in the breath blood and in 1959 Salah Rosalyn Yalow and Solomon Burson discovered what’s called the radio immunoassay to measure hormones in the blood stream yellow later got the Nobel Prize for this work Burson had passed away and as they pointed out by 1965 insulin is a principal regulator of fat metabolism the hormone insulin this is a diagram from 2010 just to show that this hasn’t gone away but the hormone insulin is the hormone that puts fat and fat tissue and you can see here is you know white fat tissue and here is insulin insulin insulin insulin putting fat in and here’s insulin suppressing the mobilization of fat and these other hormones play a little bit of role getting fat out of fat tissue but it’s the hormone insulin fundamentally that puts fat in and it’s Alan bersin said back in 65 release of fatty acids from fat cells requires only the negative stimulus of insulin deficiency okay so again here’s the suppression of fat mobilization from this 2010 buck and again it’s insulin insulin insulin insulin if you want to get fat out of your fat tissue and burn it for fuel you have to lower in some levels this was known back in 1965 it’s still true and the funny thing is insulin had always been known to be a fattening hormone now there were debates about how it worked and why okay but here’s a good example from a textbook you could get online at the library of Medicine the the endocrinology and integrated approach so here’s a young woman this is a photo of a young woman with age 17 was tied to diagnosis type 1 diabetic and for the next 47 years she injected herself with insulin and two spots on her thighs she ended up with these huge fat masses and this textbook said the overall action of insulin on the adipocyte that’s a technical word for fat cell it’s to stimulate fat storage and inhibit mobilization the remarkable effects of locally injected insulin on the accumulation of triglyceride fat and the fat cells are graphically illustrated here you know this woman also it took her forty years to build those fat masses she probably didn’t notice at first and you could argue that she was doing to her thighs where we’ve done to our guts and below our waist so here’s a lesson the bottom line of adiposity 101 when insulin is secreted or chronically elevated fat accumulates in the fat tissue that is conventional wisdom okay that’s in the endocrinology textbooks it’s in the biochemistry textbook when insulin levels drop that escapes in the fat tissue and the fat Depot’s shrink okay if you want to get fat out of fat tissue you’ve got a lower in some levels and we secrete insulin primarily in response to the carbohydrate content of our diet okay the way it was described to me by George Cahill a Harvard professor emeritus professor who did some of this research back in the 1960s is carbohydrate is driving in someone’s driving fat okay and if you remove these three words is driving insulin you have the logical equivalent carbohydrate is driving fat okay so insulin driving fat is conventional wisdom carbohydrate is driving insulin is conventional wisdom you put all three together remove these words carbohydrate is driving fat and now you’re in quackery okay when I lecture to medical schools I’ve given Grand Rounds at the Mayo Clinic and elsewhere and the doctors are with me and with me and soon as I mentioned the word carbohydrates oh my god it’s that Atkins crap he’s a quack you could see it happening on like half of them their faces he fooled us he sounded intelligent he sounded logical he’s making really fascinating points and then he said the word carbohydrates in Co are with the word fat and he became a quack and they leave the room completely unconvinced because they were unconvinced going in by the way not all carbohydrates drive obesity there break it into two into fat accumulation they’re high glycemic index carbs it’s like crackers pasta bread potatoes rice all the foods that my mother’s generation thought were fattening that happened to be the base of the food guide pyramid okay and then sugar sugar sucrose and high fructose corn syrup I gather you heard a lecture last year from Robert Lustig but there’s good evidence that these foods these nutrients which are half fructose and roughly half half glucose roughly half fructose cause a condition called insulin resistance okay so the sugars could be the fundamental problem and then make all those other carbohydrates fat night but the question you can then ask yourself is should this be surprising I’m now arguing that it’s and we don’t get facts we eat too much or exercise too little we get fat because II quant quality of the carbohydrates in our diet have changed and they’ve we’ve gone from eating carbs that were hard to digest had a lot of fiber and I’m too eating refined carbohydrates and sugar and enormous quantities and that’s causes condition called insulin resistance causes us to change the way we’ve partitioned fuels so that we now partition fuels into our fat tissue because insulin levels stay elevated so what’s interesting is from 1825 at least through the mid-1960s the conventional wisdom was that carbohydrates were fattening this British Journal of nutrition article 1963 was written by one of the two leading British dieticians this was the first sentence every woman knows that carbohydrates are fattening this is a piece of common knowledge which few nutritionists would dispute okay dr. Spock’s baby and child care how many of you use it dr. Spock to raise your kids six editions okay from the very first in 1946 to the last before Spock died 1992 had this sentence in the amount of plain starchy food cereal bread potatoes taken is with the terms in the case of most people how much weight they gain ok what’s interesting is if you went into a hospital and in late 1940s and 1950s and you were obese you would be put on a diet for obesity Harvard Medical School Stanford Medical School Cornell Medical School all published their diets in the literature and they were all effectively the same as this one which comes from a British textbook the practice of endocrinology in 1951 Raymond Green was the leading British endocrinologist its hormone specialist he was a brother of Graham Greene the novelist this was their diet for obesity foods to be avoided bread and everything else made with flour cereals potatoes foods containing much sugar all sweets you can eat as much as you like the following meat fish birds all green vegetables eggs cheese fruit except bananas or grapes ok he didn’t even know about insulin yet but when he knew was these foods you avoid because they’re literally fattening and these foods you can eat as much as you want them because they’re literally not okay it’s not about the quantity you’re taking and it’s about certain foods are literally fattening and those foods are the foods that have the ability to chronically elevate the hormone that regulates fat accumulation so if you just go conclusions biology again it’s biology it’s not a physics thing so obesity is sort of fat accumulation not energy balance not overeating and sedentary behavior that accumulation is recommended fundamentally by insulin and dietary carbohydrates carbohydrates driving into this driving fat and the only non-pharmaceutical remedy of which we have none is to remove the carbohydrates so it’s even odder than that this one makes it so hard to accept if you remove the carbs you want to replace those calories it’s not a caloric issue it’s not about how much you eat if you’re overweight or obese you have a lot of body mass to run you have a large caloric requirement so you want to replace those calories something don’t actually replace them with protein you replace them with fat actually even saturated fat arguably so a calorically restricted die carbohydrate restricted diet is a high-fat diet and this was a problem ok because if you ask where did the science go and I’m telling you it was a obesity was solved in the 1960s with 1960s era and the chronology and we ignored we literally threw it out in my book good calories bad calories I document how I show this happening and the obesity conference in the textbook how the leading authorities in the field were so threatened by this idea that carbohydrates and insulin caused obesity and that diet doctors like afghans and others jumped on it first that they threw it out they said it’s irrelevant we don’t care but you could see it happening as early as 1965 okay remember 1965 was when the Alan bersin were saying the way to get fat out of fat tissues is to lower insulin the New York Times is an article new diet decried by nutritionists dangers are seen in low carbohydrate intake so this is the first paragraph some of the nine nation’s top nutrition experts are concerned is a new popularity of the low carbohydrate reducing diet which one of them calls nonsense nonsense because you could tell B’s people they could eat as much as they want and when we know they got fat to begin with by eating too much right so it violates the laws of thermodynamics and another this was on my year the leading nutritionist of the day compares to mass murder mass murder because you’re putting them on a high fat high saturated fat diet when we had come to start believing in the 1960’s that fat and saturated fat caused heart disease in 1965 there was actually no experimental evidence to support our belief that fat and saturated fat caused heart disease and I would argue that today they’re still virtually none but the same year that the physiologists are saying insulin drives fat accumulation carbohydrates drive insulin so a reasonable hypothesis if you want to reduce fat accumulation reduce sense and reduce carbs the nutritionists are saying you’re going to kill people it’s equivalent to mass murder the other thing that happened is the calories in calories out idea so if you look at an endocrinology textbook today or a biochemistry textbook this is Landon Drew’s principles of biochemistry it’s a leading biochemistry textbook and you go to DIPA site and index which is fat tsch cell and then you see what page so you go to the age four fatso and you look at what makes fat tissue or fat cell fat this is what it says high blood glucose it’s high blood sugar which comes from eating a carb rich meal elicits a release of insulin which speeds the uptake of glucose by tissues and favors of storage of fuels as glycogen that’s a storage form of carbohydrates and triglycerol x’ fat while inhibiting fatty acid mobilization adipose tissue so what makes a fat cell fat dietary carbohydrates driving insulin and blood sugar what makes people fat to a first approximation of BC’s result of taking more calories in the diet that are expended by the body’s energy consuming activities it’s a different mechanism I actually had a conversation with the guy who wrote the textbook that I showed you those 2010 textbook that I showed you those diagrams from he just retired from Oxford where’s now an emeritus professor and we were talking on the phone I was interviewing about this insulin resistance stuff for an article in science and he spent 20 minutes explaining to me how insulin makes fat cells fat and then he started talking about overeating as a cause of obesity I said wait a minute wait wait wait wait wait wait he just spent 20 minutes explaining that fat cells get fat because of insulin and then when you got to humans it was this overeating thing you switched the mechanism on me why and he said I never thought of that and we are so programmed to believe this is true that it has to be true that even the people understand have spent their whole lives understanding what makes a fat cell fat and we are the integration of all our fat tissue kin to understand that the same thing that makes our fat cells fat is what makes us fat okay by the early 1990s with the food guide pyramid the same foods at my mother’s generation that every woman knows is fattening we’re institutionalized as the staple of a healthy diet carbohydrates went from being literally fattening to heart-healthy diet foods and I lived through this many of you the older people in this room lived through that transformation you know I lived in Paris in the mid-1980s and no self-respecting French woman over the age of 25 would eat any of these foods you know the baguette thing it’s always what about the baguettes it’s a twelve year old you see riding on their bicycles with the baguettes in the back or the 18 year olds not the thirty year olds or the forty year olds because they knew these foods are fattening we made these a staple of a healthy diet and in doing it we made sugars healthy okay because sugars are low fat there’s no fat and sugar so there all these foods the iconic example is low-fat yogurt okay you take the food that Michael Pollan would call a food full fat yogurt you remove a little bit of the fat that becomes low-fat yogurt and you replace it with fruit and high fructose corn syrup so you’ve replaced it with a bag you’ve taken away about 50 calories of fat man at about 90 calories of – sugar and now it’s a health food that we all we then we serve it to our kids for breakfast you know I going to go on for two more minutes my own stick what’s the difference between low-fat yogurt and dessert maybe the chocolate content I don’t know the butter content that’s it we started with this question what made those populations fat I quoted raw from Richard’s in 1973 said most third-world countries of high carbohydrate intake is or economic dependence is predominantly agricultural the heavy dependence on the reproduces it is conceivable that the ready availability of starch and preferenced animal protein contributing as it must the main caloric requirements of these populations needs to increase lipid Genesis that’s formed fat formation and the development of obesity I think the only thing you missed is you probably need sugar in that as well we solve the obesity problem in the 1960s before the obesity epidemic and we’ve been going backwards ever since and what I want hoping to get from a room like you folks is to get help bringing us back 50 years in time to when we actually understood this ok thank you very much you

Why We Get Fat
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