Why We Get Fat - Gary Taubes at Ohio State Medical Center

my husband suffered for over 25 years with type 2 diabetes and about nine years ago was on 80 pounds overweight was on 43 units of insulin and had neuropathy so bad in both of his feet that he could not walk more than 75 feet before he had to sit down our lives were in shambles and I can't even imagine where we would be today if it were not for the work of mr. Taubes and a man by the name of dr. Richard Bernstein I read Gary Taubes as the New York Times article what if it's all been a big fat lie loved that and then read dr. Bernstein's book and found that we should try low-carb and I will never forget the first breakfast we had with bacon and eggs I looked at my husband and said god I hope they're right so we feel very privileged yeah I must tell you that in this last eight years the first nine months my husband lost the 80 pounds he came off of the insulin hasn't been an insulin for over eight years seven eight years something like that it's been in - 5k races and my children say that out of our 13 grandchildren the second set of grandchildren knew a whole different grandfather than the first set did so thank you mr. Taubes we really appreciate your work you're a good calories bad calories as I told you I've given that book to so many people because it is a such a foundation in such wonderful research and then when why we get fat came out I was like yes so we really appreciate you very much thank you so it's hard to follow that presentation but I wanted to to tell you just for a second about what Gary has done in his career and and the impact that he might be able to make for you for your family and eventually I think from his stance on health and nutrition perhaps for the world so as the director of the Center for personalized health care it is it is my pleasure to welcome Gary Taubes who is an esteemed writer as a scientist and as somebody who critically can evaluate information my first contact with Gary was a interview he called me I believe to interview about personalized medicine he asked me one question two hours later he said I have to go my kids are are busy and I said well I just have one more question to ask you about nutrition so so in fact I interviewed him that day and and that led to to his very generous acceptance of our offer to come here and speak to you today our goal at the Center for personalized health care is to improve people's lives through through personalized medicine we have strong support and leadership from four all the way from dr. Gordon ghee to dr. Steve Gabi's Steve please stand up and be recognized as the CEO of our Medical Center - - mr. Larry Llewellyn I don't know if Larry is here or not but Larry moved from the University campus as a head of human resources to help us with our program and wellness and care coordination particularly around your plan for health and our goal is to understand the interaction between the behavioral environmental and genetic basis of health and disease and certainly there can't be anything more important than what we eat and what we want to do is focus on changing medicine from disease based care to health and well based care using principles of p4 medicine predictive preventive personalized and participatory medicine and in fact I think Gary has incredibly important data to share with us today so Gary Taubes the studied applied physics at Harvard and certainly this is a bit of a cry from physics but but I think the scientific acumen and and critical thinking has been well served and then also studied aerospace engineering at Stanford University two of the most outstanding universities besides Ohio State of course in our country aft after receiving a master's degree in journalism at Columbia University Gary joined Discover Magazine as a staff reporter in 1982 Gary is one the science and society journalism award of the National Association of science writers three times and has been awarded in MIT Knight science journalism fellowship in the past he has a Robert Wood Johnson Foundation independent investigator and health policy Gary's books have dealt with scientific controversies and in knowing him somewhat I don't see him as a guy that backs away from a controversy he has authored Nobel dreams in 1987 bad science the short life and weird times of cold fusion in 1993 and good calories bad calories in 2007 and now recently his book why we get fat and what to do about it release this year gary has has the cover of the New York Times Magazine I understand coming up Sunday a article about the role perhaps of sugars and causing human disease like cancer and as a person who is a again a critical thinker and someone who came into this field without a preconceived idea and has has accumulated and reviewed the scientific literature and presents a very compelling argument about perhaps how we should eat and what might be able to help us healthy and happy so I don't want to keep talking to keep you from hearing from our our guest lecture please join me in welcoming mr. Gary Talbot Thank You dr. Marsh thank you for having me here today um thank you Mary um I had just a little bit of background I was a you know I am a science background and I was kind of a hardcore investigative science reporter and for the first ten years of my career I basically I looked at studied controversial science basically scientists who screwed up in physics and nuclear engineering and molecular biology and in the early 1990s some of my friends in the physics community I just finished this book on cold fusion and they said if you think the science and cold fusion is bad you should look at some of this stuff in public health and excuse me mm-hmm I moved into public health and have been there ever since I in 2002 I wrote this sort of infamous store cover story for the New York Times magazine that doesn't sound very healthy wrong diet um anyway 2002 article called out what if it's all been a big fat lie that got me a large book advance and has allowed me to spend the next five years Wilde allow me to spend the next four years of my life doing the research that led to this book good calories bad calories I I spent five years which is the way these things go and this book is a kind of revisionist history in science of nutrition and chronic disease and I wrote it tried to make it appear to be for the lay public but it was basically written for the authorities and medical researchers to show that if you actually have the time to read all the literature going back to the nineteenth century you might learn things that people have forgotten and have since passed over and might be best to remember and my miscalculation was that that people don't have time to read a 500-page book that suggested everything they thought they knew was wrong so then I wrote done why we get fat in part also because I got emails from people saying you know I read your book it changed my life now could you write one that might you know my husband would read and my father would read or my doctor would read or my patients would read so this book is sort of you could think of it as the airplane reading version um and the book that you know you can give to other people and the it is based on this lecture so just to start right off you know we have an obesity epidemic in the works I'm not going to get into details but 50 odd years ago about 13% of the American public was overweight and you know in the early by the mid-2000s that that number had almost tripled there's a diabetes epidemic in the works from 1980 to 2006 diabetes diagnoses in the u.s. tripled and you know basically what we're dealing with with obesity is that it increases the risk of you know all a whole host of chronic diseases insulin resistance type 2 diabetes fatty liver disease atherosclerosis hypertension stroke cancer asthma osteoarthritis neuro degeneration including Alzheimer's disease so the way our public health conventional wisdom has it basically you start to get fat and over where and that in turn goes along with becoming insulin resistant and then that something about the the state of being obese and overweight causes all these associated diseases and what I'm going to suggest also that there's another causality involved which is whatever makes us fat also makes us sick so what I'm going to talk about today is what makes us fat because that's the simplest thing to discuss but from extent into that you can also argue that whatever that is that's triggering this excess accumulation of fat on our on our bodies that's also what causes heart disease diabetes some cancers so here's a question why do we get fat and here's the obvious answer the NIH tells us obesity occurs when a person consumes more calories from food than he or she burns the Surgeon General says over weights the result of caloric imbalance you know this is it the conventional wisdom energy in is greater than energy out we all hear that sometimes it gets short the calories in calories out another way to phrase it is we overeat on you know the biblical terms - gluttony and sloth um how many people in this room buy this just that this okay just want to know okay good because I'm going to try and convince you not only that it's wrong but that it's nonsensical literally nonsense does not make sense so while I do it I will probably come off a little bit glib on occasions I've been accused of being an intellectual bully on more than once I apologize for all that in advance but I'm literally going to try and convince you that your fundamental beliefs about why we get fat are wrong as mine were up until five years ago okay so here's our theory basically in general um by the way the beginning of this slide show was actually redone for me by a Swedish doctor who said that my slides were boring so it starts off amusing and funny and then it kind of digresses back into my but we have to explain one of the things we do in science that the fundamental asked what science is is explaining the observations okay so we have these observations not only do we individually get fat but we have an obesity epidemic and diabetes epidemic and we want to be able to explain that as well so our calories in calories out overeating hypothesis how does that explain why we've been getting fatter for the past 30 40 years and the explanation basically is marion Nestle an NYU nutritionist author of food pollicis paulo food politics she said it's improved prosperity they say and this is how she described that the food and entertainment industries turned people with expendable income into consumers of aggressively marketed foods that are high in energy but low in nutritional value and of cars television sets and computers that promise sedentary behavior gaining weight is good for business and another way this is wrapped up is in the concept of the toxic environment which was a term coined by the the Yale psychologist Kelly Brownell and the way kelly described the toxic environment it's one that encourages overeating and physical and activity we also hear the phrase on occasion now there's this new word an obesogenic environment which says the same thing and kelly in about five years ago described this he said cheeseburgers and french fries driving windows and super sizes soft drinks and candy potato chips and cheese curls once unusual are as much our background as trees grass and clouds few children walk or bike to school there's little physical education computers video games and television keep children inside and inactive and parents are reluctant to let children roam free to play so basically there's too much tasty energy dense food available and as we get richer there's more and more of its available and there's not enough reason to be physically active and as we get richer we have less and less reason so this kind of increased prosperity leads to a toxic environment and you end up with the obesity epidemic so there you have it increased prosperity overeating energy and greater than energy out and we have obesity in the obesity epidemic and the question we want to ask is is this true let's just make sense I mean we all believe it everyone will you know it's like there McDonald's and Burger Kings and everywhere you know we're all less active than we want to be surely this is the reason why we're fat and one way you can test the hypothesis is to look at other observations and see if it fits other groups other than the ones we have today so one of the things I did for my research I went back and I look populations prior to the 1970s 1980s it had high levels of obesity and the first ones you find curiously enough for the Pima Indians then the Native American tribe called the Pima that live in a reservation Arizona south of Phoenix and this young lady here was known as fat Luiza okay this photo was taken in 1902 and one little known fact about the the Pima is they used to be the most affluent Native American tribe in the United States they were hunters and gatherers and agriculturalists so they hunted in the nearby mountains they fished in the Gila River they make lamps from the Gila River they raised corn and oats and ate uh I should have a list here but fish and clams from the Gila River they raised corn bean wheats melons and figs on fields irrigated with Gila River water they raised cattle and chicken as well and in 1846 when an army of the the US Army battalion went through the Pima Territory on what would become the Santa Fe Trail the the army battalion the army surgeon described them as sprightly and in fine health said they have the greatest abundance of food and take care of it well that warehouse is full of food this population and when gold was discovered in California in 18-49 and 49ers started heading west between 1850s and the 1880s from 20 to 60 thousand 49ers went west on the Santa Fe Trail through the Pima Territory the US government asked the payment to feed them and make sure they were safe from the the hostile tribes further west and the Pima did and the problem is in the 1860s 1870s anglo-america de Mexican started moving into the Pima territory they diverted the Gila River water to irrigate their own fields they over hunted the nearby mountains and by the 1870s a Pima were starving they went through 20 to 30 years of famine the years of famine they called it and by 1902 when this Harvard anthropologist named Frank Russell came to live with them and took this photo of fat louisa they were living on and on a reservation their land had been turned into a reservation they were struggling to make enough to farm enough to survive and they were living living on government rations and Russell took this photo of Frank Louise and as he put it many old persons exhibit a degree of obesity that is in striking contrast with the tall and sinewy Indian conventionalized in popular thought so the interesting thing with this tribe is they went from being prosperous in 1846 to being poor almost beyond our imagination in 1902 and yet here they were leading healthy this drawing was actually made in 1918 51 to having a high level of obesity in 1902 so this is the opposite of what our Theory tells us our Theory says when you become prosperous you become rich not not when you become poor so if the Pima were the only population in which this happened it wouldn't be that interesting but you could find obesity in other non toxic environments environments that don't have computers and video games don't keep kids home from school that don't have cheese curls and you know fast-food joints this photo was taken in 1972 it's of Nigerian fish women Nigerian women in the market and you could see that there's an obesity problem there too so let's go through some of these populations the first that I found was the Sioux on the South Dakota Crow Creek reservation this was a study done by two University of Chicago economists in 1928 and the living conditions on this reservation again I mean these people could be used to describe what we mean if you have the definition of dirt poor and the dictionary they lived in one to two room shacks that were quote unfit for occupancy four to eight people per room forty percent of the children lived in homes without toilets water drinking water had to be drawn from the river fifteen families on the reservation with 32 children among them were living chiefly on bread and coffee and yet the obesity rates aren't that dissimilar to what we have in the United States today 40% of the women 25% of the men and 10% of the children were distinctly fat and 20% of the women and the court of the men and children were extremely thin and there was a serious malnutrition problem The Economist pointed out there were signs of malnutrition throughout this some population and this combination of obesity coexisting with malnutrition or undernutrition is a critically important observation and we'll get back to it shortly so african-americans in Charleston South Carolina 18 percent of the men and 30% of the women who are obese on total family incomes of nine to fifty three dollars a week it's about three hundred and fifty dollars a week in today's money Zulu's in Durban South Africa 40% of the women Roby's women in their 40s averaged 175 pounds I think it's 100 the average weight of women in America today is 165 pounds Trinidad 1961 early 60s there was a malnutrition problem in Trinidad the US government sends a team of nutritionists down to deal with it and they come back reporting that obesity is a quote potentially serious medical problem in women that a third of the women over 25 or obese and the next year an MIT nutritionist goes down to study the diet that these people are eating and she reports that the per capita daily diet of the obese women was less than 2,000 calories per day 21 percent fat fewer calories and were recommended at the time by the UN's Food and Agricultural Organization for required for a healthy diet 1964-65 banned to pensioners in South Africa these are the poorest of a disenfranchised black South African population the mean weight of the women over 60 was 165 pounds and 30% of the women were severely overweight I'm Raritan in the South Pacific 25% of the women were quote grossly obese unquote factory workers in Chile in 1974 30 percent were obese nearly 50% of the women over 54 were obese 10 percent suffer undernourishment so there's that combination again between obesity and malnutrition or under nutrition and most are engaged in heavy labor again these are factory workers so they're not you know going for one hour of fast walks every day they're not training for marathons they probably didn't have gym memberships but we could be pretty confident that they're more physically active than we are and yet they had these very high levels of obesity here's the last study I'll show you mexican-americans in scar at Stark County Texas 1981 this was a study that was done by UT Southwestern Medical Center cardiologist who wanted to study heart disease in star counties about right on the Mexican border about 200 miles due south of San Antonio and he came back he reported that 50% of the women and their 50s are obese and 40% of the men in their 40s and most inhabitants as he put our employed and agricultural laborer and/or work in the fields in the oil country so you can imagine that these people lived lives that were incredibly fitted physically active and rigorous and yet they had these high levels of obesity and there was one restaurant in Stark County Texas in 1981 a Mexican restaurant so no McDonald's no Burger Kings no supersizing no KFC's and yet these very high levels of obesity and the question you want to ask is why were these populations fat because now we have simpler populations to study there was less going on then there are in our present population you can just make the assumption Occam's razor the simplest possible hypothesis whatever made them fat probably makes us fat and we can guess that it wasn't sedentary behavior because we had a couple of populations in there that were extremely physically active and we can guess that it wasn't having too much food available right because some of these populations the kids are starving so here's how this question was phrased in 1973 Ralph Richards was a diabetes specialist trained in the United Kingdom who moved to Jamaica in the early 60s and started a diabetes clinic at the University of the West Indies and in 1973 he reported that 10% of the out of men in Kingston were obese and two-thirds of the adult women and this is what he said he said it's difficult to explain the high frequency of obesity seen in a relatively impecunious society such as exists in the West Indies when compared to the standard of living enjoyed in the more developed countries impecunious of course means poor so he's basically saying the same thing I think that rich people should be fat so how do I explain the fact that these very poor people are so fat malnutrition and sub nutrition are common disorders in the first two years of life in these areas in account for most 25% of all admissions to pediatric wards in Jamaica sub nutrition meaning children aren't getting enough food continues in early childhood to the early teens obesity begins to manifest itself in the female population from the 25th year of life and reaches enormous proportions from 30 onwards that's a discussion of this problem without any preconceptions without a paradigm or a belief system influencing how this person was thinking about it now I'm going to give you the same question and the same thanks same question asked 30 years later with our calories in calories out belief system attached to it ok this is from Benjamin caballero who's the director of the center for human nutrition at Johns Hopkins an article in the New England Journal called a nutrition paradox under weight and obesity in developing countries and he says a few years ago he's 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 that many of the mothers holding those undernourished infants were themselves overweight the coexistence of underweight and overweight poses a challenge to public health programs since the aims of programs to reduce under nutrition right make more food available are obviously in conflict with those for obesity prevention make less food available and I was when I put poses a challenge to public health programs in bold italics because the coexistence of underweight and overweight doesn't pose a challenge to your public health programs it poses a challenge to your paradigm ok if you believe that the mothers in these populations got fat because they took in more calories and they expended because they ate in effect superfluous calories they didn't need to create their excess fat mass and you believe that they are willing to eat excess calories that they could give to their children their starving children to keep them alive ok in effect you think that the mothers in these populations are going to go outside at night and sneak a Snickers bar that they could give to their kids who are starving and undernourished and that tells us that the mothers are willing to sacrifice their children's lives for their own obesity and goes against everything we know maternal behavior okay so we're either challenging our a paradigm of maternal behavior or we challenge our paradigm of what makes people fat by the way how many mothers are in the audience how many of you would starve your kids to death so you could get fat how many of you would allow them to starve to death so you could eat that Snickers bar yeah see my mother wouldn't either so I'm going to throw out I'm going to keep the maternal paradigm intact my mother would have killed me if I did anything else let's look at some other inconvenient observations if eating too much makes us fat and eating less should make us thinner okay and it doesn't work weirdly enough and the thing is it's not like you're just a hundred pounds overweight you get on a diet and therefore it doesn't cure you but as we get fat there are stages of which are only 10 or 20 pounds overweight or 30 pounds any place along the way we could choose to eat less and it doesn't work and if you look at clinical trials and I like to use the Cochrane Collaboration to do this because this was a organization founded to do unbiased reviews of the data and as they put a weight loss achievement calorie restricted diets is so quote so small to be clinically insignificant and it just doesn't work making trying to get people to eat less doesn't work and in fact it's so you know because of this fact you end up with these bizarre inconsistencies in the literature that should show people that there are something seriously wrong with their paradigms and I'll give you an example the handbook of obesity which was published in 1998 it was edited by three of the leading figures in the field and when you look up dietary therapy says dietary therapy remains a cornerstone of treatment and the reduction of energy intake continues to be the basis of successful weight reduction programs and then a couple paragraphs later it's as the results of dietary therapy quote are known to be poor not long last night so if they're known to be poor not long-lasting how can they be the cornerstone of treatment and anyone who wrote that should have thought to themselves what am I missing here and then you should ask you could ask the question should this come as a surprise that eating less doesn't work and Hilde Brock who she was a leading authority Deonne pediatric obesity in the mid 20th century in 1957 she put it this way she said more than any other illness the physician treating the obese patient is called upon to do a special trick to make the patient do something stop eating after it has already been proved that he cannot do it you know there was another german authority on obesity say we could describe obese individuals as those peoples for whom eating less doesn't work we know it doesn't work because we all know we're supposed to eat less for obese anyway then it's not a cure now here's another unfortunate effect exercising more also doesn't work ok nowadays it's interesting a lot of these diseases actually I was just reading an article today friends send me about atherosclerosis being identified in mummies and from ancient Egypt and the researcher doing the studies I don't understand they're eating low-fat diets they're exercising they still got atherosclerosis they weren't Center we now believe all those diseases associated with obesity are caused by sedentary behavior because we think that obesity is caused by sedentary behavior but if it is and exercising more should help cure and it doesn't and I could quite quote meta analyses but I find this more more persuasive in 2007 the American Heart Association the American College of Sports Medicine co-authored Physical Activity Guidelines and what's interesting these are people who believe that physical activity is inherent part of a healthy lifestyle as do i and so they would argue tend to argue you know spin the evidence to make it more likely that you should be physical active but this is what they said about exercising weight they said it's reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time compared with those who have low energy expenditures another way to phrase that is it's reasonable to assume that if you're a couch potato now you'll be less likely to gain weight over time than if you become a marathon runner no if you become a marathon runner you'll be less likely to gain weight than if you're a couch potato and then they say so far data to support this hypothesis are not particularly compelling and the key thing is this hypothesis is at least 130 years old you could say it's 150 years old it certainly dates as soon as metabolism researchers in Germany showed in the late 19th century that the laws of thermodynamics hold for animate objects just like they do for inanimate somebody came along and said well if that's the case people should exercise more in they'll lose weight if a hypothesis is 100 years old or 150 years old and the best you could say about is that the data to support it are not particularly compelling a very strong possibility is that your hypothesis is wrong okay doesn't mean it is but it's quite likely that it is and maybe the energy you expend actually has no effect whatsoever on how much weight you burn off how much fat you gain or lose now here's another problem practicing energy balance is impossible okay now we are this is a new phrase that's kind of started noticing in the past couple years a lot of industry groups are now supporting foundations the goal of which is to teach us to practice energy balance to match our energy into our energy out so that we do not gain weight um let's look at what that entails a typical Americans food intakes about 2700 calories a day okay that's average men and women so that's the equivalent of about a million calories a year 10 million calories in a decade it's about 10 tons of food in a decade ok now if you ask the question like right now you're leaning in your 20s is about seven people like that in this audience in the 20s part anyway and you don't want to gain 10 pounds a decade 20 pounds a decade so that by the time you're in your 40s you've gained 40 pounds and are obese so you could ask the question how accurately do I have to count calories do I have to practice energy balance so that I do not gain 20 pounds a decade so I don't go from being lean in my 20s to obese in my 40s and the answer is I have to match my calories into my calories out to better than 20 calories a day okay that's one bite of food if I overshoot by one bite of food that goes into my fat tissue and doesn't get burned I will gain 20 pounds in a decade 40 pounds in two decades here's a calculation it's pretty simple 20 calories a day times 365 days a year times 10 years a decade divided by 3,500 calories which is the amount of calories in a pound of fat and you end up with 21 pounds per decade so if I overshoot by Mowatt more than 20 calories 21 pounds now the implication by the way is if this is only 10 calories I'm still going to gain 10 pounds in a decade so if I actually don't want to gain weight I actually basically have to be perfect but even 20 pounds per day 20 calories per day is like point 8 percent accuracy matching calories into calories out and I would say that even if there's a Guinness world record holder for calorie counting he or she can't do that because you still have no idea how many calories you're expending you're only guessing there and the point of this observation it's not that I mean it's crazy obviously nobody can do this nobody can match the calories into the calories out to 20 so that the way we get around this is we say well you know when you say just walk away from the plate hungry or put you know half a portion or you know eat 10 bites less a day I don't know pick anything you want the idea is maybe I'll undershirt religiously so I won't get fat because I'm always going to understood and if you do that you can ask a question why don't we all end up looking emaciated right because the mathematics should go both ways another possibility is that I start gaining weight I put on 10 pounds I realize it so now I've been overshooting by like 20 calories a day and now I understood for a couple years and I take the weight off so I all ate around energy balance and that's possible but then you ask the question how to animals do it these animals aren't looking in the mirror to see that they're getting fatter and they're not trying to isolate so how do they maintain their body weight and if I first saw this calculation from a 1937 metabolism textbook written by Eugene Dubois who is the sort of father of nutrition and metabolism research in the United States pre-world War two and abroad did this calculation and he said there's no strain phenomenon and the maintenance of a constant body weight under marked variation in bodily activity and food consumption okay the question isn't why are some of us fat the question is if this is what we have to do to remain lean why aren't all of us fat or like half of us are fat and other half are emaciated because nobody can do it it's impossible okay now here's another inconvenient observation by the way this is unsweetened iced tea just in case anyone is curious and now I'm going to show some photos from pre World War two European nutrition of metabolism textbooks on obesity textbooks I'm going to apologize I'm showing photos of human beings you do not see photos of human beings in modern obesity textbooks okay you occasionally see photos of fat rats but prior to World War two the European researchers actually thought you could learn a lot about obesity and leanness and excessive leanness by looking at how people got fat not just whether or not they are fat and what I'm doing most of what I'm doing now is going to be channeling the way pre-world War two researchers thought about this in Europe because they had a different hypothesis that wasn't about calories and calories out so here's a lean pair of identical twins and here's an obese pair of identical twins and the point is our calories in calories out hypothesis might explain why this pair is fatter than this pair these pair ate too much sedentary and this pair balanced calories in calories out to like three calories a day on average perfectly great job ladies but what it doesn't say is why this pair has the exact same body in this pair had the exact same body so when you ask the question one of the genes we know that obesity has a large genetic determine that was first established in the 1920s in Europe what are the genes determining how many calories they ate and how much they exercise how much they lied on the couch and read books or took naps and how much these ladies wanted to go for runs or was there something else going on that those genes determined that maybe had nothing to do with how much they ate or exercise and an easier way to see this problem is to look at animal husbandry you know we've been reading animals for hundreds of years to be more or less fatty depending on the tastes at the time and so here's a this alein breed of cat or jersey cattle it's a dairy cow you can see the utters are Sutter is swollen and you can see the ribs here that's how lean it is and this is an obese fat breed of a meat cow Aberdeen Angus you can see the fatty meat here it's a very stocky fatty animal and you can ask the question we know since they're different breeds that genetics control it what's determining what makes this animal fatness animal lean one of the genes determine okay I'm determine how many calories they take per bite of graze so this one takes gets like 73 calories per biting this one only gets 59 or do they determine how long they graze like this one goes 12 hours a day and this one only goes 9 or you know whether or not they want to exercise or not like this cow you know maybe goes for jog and night like that far side cartoon and you know this one goes inside to the barn and watches television I mean it's obviously absurd with this you know I mean whatever these genes are doing it's not determining how much they eat and exercise what they might be doing is determining how they use the calories the technical term is partition the calories they take in so here's a dairy cow but basically you could think of it as a machine that takes in fuel here and converts it to milk and we want it to be a very efficient machine so we don't want it to waste fuel stocking fat here and there we just want it to be converted directly into milk so nothing else is going on here so it partitions you know the calories to its mammary glands and the result is me and this one you want fatten meat so maybe this one partitions the calories so it's how they use the fuel they take in what they do with that fuel not how much they take in and how much they expend here's another example sexual variations you know men fat and above the waist and women tend to fatten below the waist this is a beer belly if you fat enough here you've doubled your risk of heart disease if you fatten down here on you haven't which is an interesting question right there because you could say both these women people would have had to take in more calories than they expend it to get fat but what does that have to do with the fact that here it doubles the risk of heart disease in there a dozen obviously there are other factors determining where the fat goes then may be more important than how many calories they take in puberty is another good example boys and girls going through puberty if they start puberty with roughly the same amount of body fat okay boys go through puberty they lose fat and gain muscle girls go through puberty and they put on fat especially in the hips and the breasts so by the time puberty is done the women have about 50% more fat than the boys do both groups have to take in more calories than they expend both sexes right because they're both getting bigger and yet this the boys lose fat and gain muscle and the girls gain fat in very specific places so the fact that they both have to take in more calories and they expend to get bigger is irrelevant right what we're interested in is why they gain fat and they gain muscle and that's obviously controlled by sex hormones because there's a sexual difference so testosterone and growth hormone drive growth and determine you know mus and the female sex hormones determine the fat accumulation the point is the fact that they took in more calories and they expended and that one group actually put on fat while they did it is irrelevant now here's where it gets tripping tricky trippy and tricky um lipid dystrophies these are disorders of fat accumulation in this particular one is known as progressive lipid dystrophy again this comes straight from the 1933 German textbook progressive lipid history by the 1950s there about 200 cases on record most of about 80 percent when women they start losing fat subcutaneous fat in the forehead and it moves downward with time and that's why it's called progressive and over a period of time one British researcher measured in his patient he said she lost it went down at about one inch per year and eventually they end up with virtually no subcutaneous fat above the body and then a few years later they start gaining weight below the body and you get what's called lower body obesity a so the way these Germans and Europeans that is they said are we going to blame the top half on undereating and the bottom half on overeating and that's obviously absurd right this is what you would call Gedanken experiment a thought expand if that's absurd if this woman had ten pounds more fat on her upper body her BMI it was five for I think 185 or 205 pounds so BMI is over 30 anyway this isn't but because she has no fat an upper body we can say it's a lipid dystrophy give her ten pounds of fat and suddenly she goes into the doctor it smooths out the curves you know makes it look thus a stark and it goes into the doctrine she's diagnosed as obese and sent home being called eat less and exercise more but you can see that it can't be young if this localized obesity can't be explained by overeating then why this generalized obesity why does overeating become the conventional wisdom so by the way one way to look at this is um that nutrition paradox in the same human being okay malnutrition over nutrition in the same individual okay so why do we believe the calories and calories out stuff anyway we all do I mean I did up until five years ago seven years ago a little physics okay this is a physics problem we believe it because of the laws of thermodynamics in fact anyone who argues that it's not about calories and ventually gets accused of not believing in the laws of thermodynamics about three years ago after good calories bad calories came out I was on the Larry King show and Jillian Michaels the trainer from The Biggest Loser came on the air from California and gave me a lecture on the laws of thermodynamics on national television I do have a physics degree from Harvard I was not a good student as like a b-minus student which is the lowest grade they'll give you know because lower than that the grad students can lose their scholarship so but still you know it was a high point of my life I mean I was speechless I literally didn't know what to say it's like how do I respond to this yeah let me explain thermodynamics do you end to jillion if she's listening mm um here's a first law of thermodynamics energy conservation the change in mass or energy of a system is equal to energy that goes into the system minus the energy that comes out of a system basically by energy conservation means you can I've you've heard this you cannot create or destroy energy ok so energy just moves around in different forms and the reason we believe it says something about obesity is because people say Delta II like the energy in the system could be the fat mass and if that energy goes up then the energy into the system has to be greater than the energy out of the system if the fat mass gets smaller then more energy has to be expended than goes in because we can't you know just make energy vanish and the idea is if you increase en so if somebody starts eating more and they keep you out the same energy out doesn't change who en minus e out gets bigger then Delta gets bigger the person has to get fatter so if you take in more calories and you expend for the most part you have to get fatter and if you expend more than you take in you have to get thinner and so we believe that this means that obesity is caused by taking in more energy than we expend makes perfect sense except there's no arrow of causality here there's no causality whatsoever in the sentence by that I mean all this law says is if if someone gets fatter they have to take in more calories and they expand and if someone gets leaner they have to expend more there is no it says nothing about why that person gets fatter or why they take in more calories than they expend there's zero causal information in that so we take a law of physics that has to be true the laws of thermodynamics are always true but all they do is tell us this is how the universe works and then we say that it somehow has something to say about a chronic human disease and we could have picked any law of physics you know Heisenberg's uncertainty principle the laws of relativity they all have to be true they all say nothing about the cause of the disease and let me give you the good example for this let's say somebody wants to know somebody's outside they want to know why is this auditorium so crowded like when you're asking why someone got fat you're saying want to have so much energy and they're stored in their fat tissue and if you're asking why this auditorium is crowded you're asking why is there so much energy in the form of people in this auditorium so you ask me why the auditorium get crowd and I say well because more people came in then left okay absolutely true okay how can you deny it it's his absolutely nothing meaningful about why you guys are in here and then you say okay Gary I get you you're being silly why did it get crowded come on give me the real reason I go look if more people come in then leave it has to get crowded and so now I've clarified things okay I am saying the exact same thing as you're saying when you say or somebody is saying to you when you say you got fat because you took in more energy than you expended it's the exact same logic if you got fat you had to take in more energy than you expend just if you came in if the auditorium was crowded it had to take in more people than it let out but that tells you nothing about why nothing and the answer to why is well maybe it's you know there's a bomb outside you know ran in here or maybe there's a compelling speaker you want to hear maybe there's a study hall going on the conditions inside or outside that could determine why suddenly there's a lot of people in here but the fact that more people came in and left tells you nothing even though it's always true the other problem with this theory is this idea that if somebody can tell you that you know what is okay you're overweight we're going to tell you exercise more okay don't eat any more because then we know you can't eat less so we're going to tell you to exercise more so the idea is if Ian stays the same and you increase you out delta-e has to go down that's what this equation tells you so if you don't if you keep your intake the same and you up your exercise you have to lose weight okay and that assumes that these are en any outer what mathematicians would call our independent variables by then I mean you change energy out an energy n will stay the same okay or you could change energy and like you could eat less and continue to expend just as much energy as you always did it's like saying I'm going to try and use a metaphor that Jim gave me this morning just before you know imagine like you can suddenly decide that you're only going to charge you're like this a takes two hours to charge the battery of your computer and you're going to charge it for one hour so you're going to take in less energy and you assumed you could run it just as long as you ever did by only charging it half as long it's similar logic so the problem with this it's easier to explain with the energy out thing let's say we're going to increase expenditure and you're not going to change he in okay remember the concept of working up an appetite how many of you remember that concept okay used to be that when you were told to exercise or you did exercise you worked up an appetite okay you go for a hike you play two sets of tennis 18 holes of golf for those of you still in your 20s and lean you you know play with your boyfriend or girlfriend all night long you work up an appetite that's what you did you expend the energy and then your body wants to replete the energy so you get hungry um that's how your body should work okay yout determines II and the more energy you expend the more energy you want to take in and the less energy you take in the more energy you're going to the less energy you're going to want to expend um it was shown as early as 1917 that when people are semi starved in experiments their metabolism slows down and their body temperature gets lower they expend less energy because they're taking in less energy and in 2007 the way Jeff Flyer Jeff is a Dean of Harvard Medical School Terry Murray toast Flyers his wife and research colleague they both study obesity in a 2007 article in Scientific American they said an animal whose food is suddenly restricted so you got a lower e in here you can't just tell an animal to eat less because it'll ignore you tends to reduce its energy expenditure outcomes down both by being less active and by slowing energy use in sales its metabolism actually slows down thereby limiting weight loss and then of course it also experiences increased hunger so the animal is actually trying to keep Delta e the same the fat mass is trying to be the same and it's doing that by if you decrease the in it decreases e al if you increase the in it will increase yeah these are dependent variables how much we and how much we X expend are intimately linked and you can't just tell someone to eat less or exercise more without fidelity less they're going to have compensatory effects on how much they expand and if you tell them to expend more they can have compensatory effects on how much they take in so let's look at the alternative hypothesis I've now talked about the problems on with why we believe this calories and calories out stuff here I actually have a solution often as a journalist I don't have a solution um one of the things I learned during my research is there was actually an alternative hypothesis prior to the Second World War all serious medical research was done in Europe mostly a lot of it by Germans and Austrians who sort of pioneered all the fields of research that are relevant to human obesity you know genetics endocrinology the science of hormones metabolism nutrition and they had a different theory of obesity and the problem is it didn't survive the war and after the war nobody cared what the Germans and Austrians had to say about anything except in physics because we had to build atomic bombs and hydrogen bombs and we had a cold war to fight so the physics community embraced these European scientists and the leading physicists in the 1950s 60s 70s and into the 80s or all these European emigrate because they knew how to do real science but in medicine and public health we did not embrace them in to a large extent we even shunned them and you could actually see this in the textbooks the last textbook published in am actually the first and last textbook published in america in the first half of the 20th century was called obesity and leanness was written by University of Northwestern University endocrinologist a Hungarian emigres who had come over in the 1920s and and talking about the chapters on obesity had some 520 odd references of which 200 were in German for in either the German or Austrian medical literature and the next textbook first textbook written after the war in 1947 by two Mayo Clinic doctors had 500 references of which twelve were in German from the German or Austrian literature we simply didn't care and it would be the equivalent in physics of saying oh we didn't care what the Heisenberg guy had to say or that Einstein guy or that Bohr guy or you know any of those might make a day were Europeans and they spoke with accents and we're not interested because they also caused this horrible calamity and with that a whole world of research was forgotten so this is how they thought about obesity they started from first principles they said obesity is a disorder of excess fat accumulation okay so today what you see is obesity sort of energy balance it's a classic line I bet if I ask some people probably written that in this audience but they said obesity sort of excess fat accumulation simplest possible hypothesis you could say having too much fat is a disorder of having too much fat but as soon as you do that you get attention away from how much the person's eating and how much they're exercising and looking at what regulates their fat tissue okay and then overeating an inactivity we're assumed to be compensatory effects or not cause and by that I mean anything that increases the accumulation of fat in your fat tissue will cause either energy out to go down or energy in to go up because of this laws of thermodynamics if you increase Delta e we have a drug that I give you that makes you fatter your body you will compensate by the getting hungrier or getting sedentary or both so overeating and inactivity or compensatory effects and one way to put it is we don't get fat because we overeat we overeat because our fat tissue is accumulating excess fat the causality is fundamentally flipped so what we're interested in is what's happening at the fat tissue because whatever happens there will determine how hungry you are and how much you have to go through your life so here's an analogy that the Europeans used although the photos are some particularly cute kid who now lives in Berkeley California a growing child okay here's this young child when he was one-year-old he weighed 20 pounds I never seen anybody so cute here's the same photo three years later he weighs 45 pounds okay he's gained 25 pounds in three years right took in more calories and he expended he overate he was in positive energy balance but he didn't grow because he was in positive energy balance he was in positive energy balance because he was growing and the reason he was growing is because he was secreting growth hormone and if we gave him more growth hormone to stimulate that growth that would increase the positive energy balance and he'd grow fast don't he'd be hungrier and you know but it wouldn't still the positive energy balance isn't why he's growing he's growing and that's causing the positive enter his body needs fuel both to do all the building of new tissues to supply the energy for that as well as to supply the natural way the resources necessary to build new bone new fat new connective tissue new organ tissue and that's why is in positive energy balance is a more gruesome analogy cancer okay here's a tumor you could see it growing okay this tumor is in positive energy balance it's taking in more calories and it expends we know that because it's getting bigger but it's not getting bigger because it's taking in more calories and expense it's getting bigger because their various hormones and signaling molecules that are triggering it to grow and sending signals to it to grow and as it grows it takes in more calories okay both the tumor and the child can be starved and their growth can be stunted just like you can starve an obese person and reduce the size of their fat mass but that doesn't mean that the growth was caused by taking in more calories than they expend it just means that if we starve the and the the child the tumor the fat person we could affect the course of that growth temporarily this theory was known as lip ophelia that was a theory the German Austrian hypothesis to proponents for Gustav von Bergman who was the leading expert on internal medicine in Germany in the first half of the 20th century the leading other the most prestigious award given today by the German society of internal medicine is the Gustav von Bergman award and then Julius Bauer and Austrian a professor of genetics and endocrinology at the University of Vienna Bauer is still remembered today if you happen to know any Austrian biologists ask him if they remember Julius Bauer and they'll say sure and the point is these people were not quacks they were highly respected physicians and researchers and the theory was more or less fully accepted in Europe by 1940 okay and by the theory the way they thought about it is they said look you know they went through all these things I showed you about the you know sexual dimorphism and obesity I had weight gain and and most an obviously fat tissue is regulated in the human body and we know that and it's regulated by hormones and enzymes and central nervous system and so something becomes dysregulated when somebody comes obese and one of the examples they had that von Bergman first used was a young girl who had a bad burn on the back of her hand and they took a graph from her stomach and put it on her hand then she grew up to be obese she had this huge puff of skin puff of fat on the back of her hand they said yeah this interesting because we get fat in some places not others in the back of our hands is not typically someplace we get fat so something about the tissue itself was lipophilic I'd loved to accumulate fat and all we had to do is move it from one place to another and it did what it did so they said maybe getting fat is like growing hair like we grow hair in some places but not others and we get fat in some places but not others some people are hairier than others and some people are fatter than others and what we want to know is what is it that bestows this characteristic of being lipophilic loving to accumulate fat because if we identify that we'll know what obesity is so this is how bauer put it in 1929 said like a malignant tumor like the fetus uterus of the breast of a pregnant woman the abnormal lipophilic tissue seizes on foodstuffs even in the case of undernutrition it maintains its stock and may increase it independent of the requirements of the organism a sort of Anarchy exists the adipose tissue lives for itself and does not fit into the precisely recommended regulated management of the whole organism and even here it can increase its stock even in the case of undernutrition we're beginning to think of obesity in a way what we could explain you know obese mothers and starving children because maybe the fact that their kids are undernourished doesn't have any effect on whether or not their can get fatter and you can look at animal models of obesity I'm not going to go through this but one of the things I did for my book is they basically track down every animal model of obesity I could find and there are you know now there are hundreds of them but you could remove the ovaries from a rad you can they're trans you can make genetic defects hibernators get you know hugely fat every fall though they technically don't get obese you could lesion the ventromedial hypothalamus of an animal you can ask yourself when I do this do I make the animal just to eat more and exercise less or do I change the regulation of the fat tissue do I somehow make its fat tissue lipophilic and what you find is in every case I found that one of two things that rose either the researcher never thought to do the proper experiment to find out why the animals were getting fat or what the surgery did or the genetic defect or the even the hibernating is it actually changed the regulation the fat tissue and by that I mean you could even starve these animals you could semi's starve them you could calorie restrict them from birth okay there are a particular strain of genetic my seed studies were done the 1980s where when they're born the researcher took some of them and put them on calorie restricted diets actually from the moment they get weaned from the mother at about three weeks and the animals actually got fatter if they were calorie restricted from childhood than they did if they were allowed to eat as much as they wanted to and when they got fatter they didn't weigh more than the animals at a more but they had more fat mass in their brains and organs were smaller they in effect cannibalize their organs to accumulate fat in their fat tissue and you could starve some of these animals to death and they will die with their fat tissue intact so they'll eat their muscles and their heart in effect before they're eat their fat tissue whatever you're doing you're changing the regulation of the fat tissue and an extreme example of this was um I'm not going to get into it because we're running out of time this is how John my ear put it in 1968 very famous nutritionist who got some things right most things wrong but he was studying a strain of obese mice not this one but I like this photo so these mice will make fat out of their food under the most unlikely circumstances even when half starved for the point is the animals don't get fat because they overeat they get fat if you let them eat at all okay their bodies are programmed to accumulate fat and what you want to know is why so here's some obvious questions okay why and when we look at vertical growth we know that overeating is the effect and hormones are the cause why isn't that true for horizontal growth in animals overeating is always the effect and growth is the cause but why not man and then just this question if obesity is the sort of excess fat accumulation what regulates fat accumulation the human body and one of the things that is a researchers a journalist that pissed me off doing this research one of the danger I love science that's why I'm in this business I'm a huge fan of science I'm fascinated by it particularly fascinated by how hard it is some wonderful research was done from the 1920s to the 1960s or even 1980s on the regulation of fat tissue in the human body and in animals and when you say that obesity is caused by overeating or sedentary behavior you're ignoring all of it okay you don't care what regulates the fat tissue human body couldn't care less you just think somehow if you throw enough garbage into the system the fat tissue is going to accept it and that's all there is and it's reading this research I mean really smart good scientists and it just gets ignore and I actually document in good calories bad calories why it got ignored and we'll get to that shortly so here it is this is what you have to know about fat accumulation can be about five slides here it's very simple um what's relatively simple adiposity 101 okay fad this is a triglyceride right here these are fatty acids these long chains and they're bound together by this glycerol molecule so tri means the three for the fatty acids glycerol and we store fat as triglycerides okay and we burn the fatty acids individually for fuel and fat enters and exits the cells as fatty acids and inside the fat cells fatty acids continually site go into triglycerides and back out again okay so the reason we store fat is triglycerides and burn it as fatty acids is actually pretty simple fatty acids are small enough to pass through the cell membranes of the fat cell and the muscle cells so they do once you put them together as triglycerides the triglyceride molecule is too big to get out of the fat cell so the triglyceride is the form in which fat is stored because it's so big and anything that breaks down the fat into its component fatty acids works to get fat mobilized fatty acids from the fat cells so they can be burned for fuel and anything that works to what's called esterified fatty acids into triglycerides works to store fat so when we what we're concerned about now the energy and energy out concept actually holds here you'll get fat or if more fatty acids go into your fat cells then go out so that simple okay and you'll get leaner if more fatty acids go out and go in literally this is a fat cell so what you want to know is what factors determine the flow of fatty acids across the fat cell into the fat stored and then the breakdown of triglycerides into fatty acids so they can get out this is there's some other factors like you want to know what happens whether they'll be burnt the fatty acids will be burned or not so excuse me the UM somewhat complicated slide here what determines whether or not fat goes into your fat cell and stays there as triglycerides ta G is triglyceride is insulin okay two things are required to figure out how we regulate fat in the human body we needed a technology to measure fatty acids in the bloodstream which was discovered in 1956 technology to merit measure hormones in the bloodstream which was published in 1960 by Rosalyn Yalow and Solomon Burson yellow later won the Nobel Prize person had passed away by then within two years of their discovery of this radio immunoassay to measure hormones it was clear that insulin is the primary regulator of fat metabolism so here's basically white fat then we have fat storage and mobilization this is from a 2010 metabolic regulation textbook and you can see insulin increases the breakdown of triglycerides into fatty acids it increases the uptake of glucose to be used to create the glyceride molecule it increases the formation of fatty acids from glycerol basically it does all these things to increase fat storage and then it suppresses immobilization of fat here and then there are these three other hormones that might also increase the mobilization of fat so the only form own that works to put fat in your fat tissue is insulin okay and here's when you look at the suppression of fat mobilization suppressing fat from getting out of your fat tissue again it's insulin insulin and insulin and as the Alan bersin put it in 1965 release of fatty acids from fat cells requires only the negative stimulus of insulin deficiency so if you want to get fat out of your fat cells you litter you have to lower insulin levels it's a fundamental thing that has to be done and the point is this science has worked out by the early 1960s okay and the reasons I use a 2010 throw is it hasn't changed there's nothing controversial about this okay it's very clear that insulin is a fattening hormone that what it does is to create fat accumulation and here's a good example from 2001 a particularly graphic example of insulin and fat storage and this is a young woman the patient developed type 1 diabetes in 1941 she was 17 and then she gave herself insulin shots for 40 odd years in the same two spots of her thighs and as they put it the overall action of insulin on the adipocyte the fat cells to stimulate that storage and inhibit mobilization to put fat into the tissue and not let it out and the remarkable effects of locally injected insulin on the accumulation of fat into fat cells are graphically illustrated here so you just give in so nothing to do with overeating or under exercising it's just put enough insulin and you accumulate fat that's what happens so if you just look at the science of fat metabolism okay which again was worked out by the mid 1960s this is what you come to when insulin is secreted or chronically elevated fat accumulates in the fat tissue when insulin levels drop fat escapes from the fat tissue in the fat Depot's shrink you burn that fat for fuel and then we secrete insulin primarily in response to the carbohydrates in our diet okay in 1965 the American Physiological society put together a 500 page handbook of adipose tissue metabolism because they wanted to take this science that had been worked out by biochemist and physiologists that was published in those disciplines journals and make it available for the rest of the medical research community so they can understand fat metabolism and I read that five I skimmed to be serious five hundred page document there's eight hundred pages is like fifty chapters and I got to the end and I called up George Cahill who was the Harvard diabetes specialist professor at Harvard went on to be the science director for the Howard Hughes Medical Institute and I said George I read this I've had a post tissue metabolism handbook that you co-edited 40 years ago and it seems to me that everything about it basically said that insulin puts fat in fat tissue and you want to get fat out and then the way George put and we secrete insulin in response to carbohydrates and George said yeah carbohydrate is driving insulin is driving fat that was his synopsis of what this 40 years of research had come to and the interesting thing is if you take out these words is driving insulin you have carbohydrate is driving fat okay and the problem is you know it's now been I've been talking for about an hour I'm way over schedule I'm sorry I apologize but I this is the Atkins diet okay and when I talk to doctors at you know hospitals their eyes often glaze soon as I get to this carbohydrate thing they go monk out it's the Atkins diet it's like this was interesting until now now we're dealing with quackery okay now I got to just shut down assume he's a quack hope that they're serving you know that there's wine and cheese outside problem is what's interesting until the 1960s the conventional wisdom was that carbohydrates make us fat okay this is what my mother grew up believing okay this sentence British Journal of nutrition 1963 first sentence an article by one of the two leading British dietitians every women knows that carbohydrates are fattening this is a piece of common knowledge which few nutritionists would dispute this dr. Spock's baby in childcare was first published in 1946 had the same sentence for 50 60 years in a 50 million version six editions 50 million books the amount the plain starchy foods taken is what determines in the case of most people how much weight they gain or lose okay if you went into a hospital in the 1940s 1950s and they wanted to treat you for obesity and this was true at Cornell Medical School Harvard medical Stanford Medical School they would give you a diet almost identical to this this one's from the practice of endocrinology Raymond Greene was the foremost British endocrinologist in the 20th century the brother of Graham Greene and the diet was like this foods to be avoided bread and everything else made with flour cereals including breakfast cereals potatoes white root vegetables foods containing sugar all sweets you

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Keywords: Wexner Medical Center, Ohio State University Wexner Medical Center, Ohio State Wexner Medical Center, OSU Wexner Medical Center, OSU Medical Center, Ohio State Medical Center, Gary Taubes, Why We Get Fat, weight management, good calories bad calories, bad science: the short life and weird times of cold fusion, the case against sugar, public health

Id: bTUspjZG-wc

Length: 70min 43sec (4243 seconds)

Published: Wed May 04 2011