There is no single cause of (or treatment for) obesity

scales

One of the most hotly debated subjects over the past few years has been the cause of the obesity epidemic, and along with that, the best strategy for weight loss.

Some folks (Atkins, Taubes, Eades, etc.) believe that carbohydrates are to blame. Others (Ornish, Campbell, Esselstyn, Fuhrman, etc.) believe that fat is the problem. More recently, researchers like Seth Roberts and Stephan Guyenet and clinicians like Dr. Sharma have raised awareness of another hypothesis, called the food reward theory, which holds that the consumption of highly palatable foods leads to overeating and weight gain. And Paul Jaminet and others have argued that micronutrient deficiencies, toxins and infections may play a significant role in the obesity epidemic.

Here’s what I think: the most accurate answer to “why do people get fat?” and “what’s the most effective weight loss strategy?” is: “it depends.”

Separating cause from mechanism and effect

One of the biggest mistakes often made in this debate is the confounding of cause, mechanism and effect. A classic example is the assumption that if reducing carbohydrate or fat intake leads to weight loss, then the original weight gain must have been caused by excess carbohydrate or fat consumption.

While it’s tempting to make such an assumption, the logic is faulty. It’s kind of like saying “Advil cures headaches. Therefore, headaches must be caused by Advil deficiency.”

Let’s look at some definitions.

Cause: something that brings about an effect or a result

Mechanism: the fundamental processes involved in or responsible for an action, reaction, or other natural phenomenon

Effect: an outward sign

Obesity is an effect. Insulin resistance, leptin resistance, lipotoxicity, disruption of the mesolimbic dopamine reward pathway and inflammation of the hypothalamus are presumed mechanisms. Excess consumption of carbohydrates, fat, highly palatable food and food toxins (wheat, seed oils, liquid fructose, etc.), exposure to environmental toxins (chemicals), stress, infections, etc. are presumed causes.

Say we do a study on obese people and we observe that they eat a lot of carbohydrates and are insulin and leptin resistance. It’s easy to assume that the chain of causality worked like this: normal weight person eats high-carbohydrate diet, becomes insulin and leptin resistant, and then becomes obese.

But again, this is faulty logic. There’s no proof that A (high carbohydrate intake) was what led to B (insulin and leptin resistance) was what led to C (obesity).

In fact, we could disprove that theory simply by observing another individual or group that eats a very high carbohydrate diet, but does not develop insulin or leptin resistance and obesity. Guess what? Such individuals and groups most certainly exist. There goes that theory.

Likewise, we could also disprove this theory by observing people that are insulin and leptin resistant, but don’t become obese. Such people do exist, and I’ve written about them in my series on diabesity here.

A more rigorous approach

How have we developed our theories on obesity and weight regulation? It seems to me they come from a blend of personal experience, belief and facts. And I think it’s time to become more rigorous about keeping them separate. Here’s an example of what I mean:

Personal experience: I lose weight on an low-carb diet, therefore low-carb diets must be best for weight loss.

Belief: carbohydrates are responsible for the obesity epidemic, via their effects on insulin.

Fact: many cultures around the world eat high-carbohydrate diets and are exceptionally lean.

Those who’ve lost a lot of weight on a low-carb diet have a tendency to become convinced that their wife, friends, family, plumber and everyone else will also lose weight following the same diet.

From this personal experience, a belief is formed. And once we believe in something, we have a remarkable ability to filter out any evidence that might contradict that belief.

This is especially true if our reputation or financial livelihood is tied to said belief. As Upton Sinclair famously said:

It’s difficult to get a man to understand something when his salary is dependent upon him not understanding it.

When a belief like “carbs cause obesity” is shared between enough individuals, it becomes a meme. Once that happens, it is accepted by most as fact – regardless of whether it has any scientific basis. Hence we had the idea for decades that eating fat makes you fat, and now the more recent idea that eating carbs makes you fat.

There’s no single cause (or treatment) of obesity

Perhaps one of the reasons it’s so easy to confuse cause, mechanism and effect and personal experience, belief and fact is that obesity is an incredibly complex disease. Just how complex is it?

Click on the Obesity Systems Influence Diagram below to find out.

Click image for larger version

Wow. That should give you a rough idea of how many variables are potentially involved in weight regulation. Now you know why it has been such a challenge to come up with a single, unified theory of obesity.

That said, of all of the hypotheses advanced to explain the mechanisms behind obesity, I think the food reward theory is the most inclusive.

However, as even its proponents would agree, it doesn’t tell the whole story because there are people and groups that eat large amounts of highly palatable foods that do not become obese.

My opinion is that the modern lifestyle (i.e. food and environmental toxins, stress, poor gut health, infections, micronutrient deficiencies, sleep deprivation, etc.) interfere with hypothalamic hormonal regulation, dopamine signaling, leptin and insulin sensitivity at the cellular level, glucose metabolism and a range of other mechanisms that lead to obesity.

This is consistent with the observation that obesity is extremely rare or nonexistent in traditional cultures that do not consume modern foods and do not live a “modern” lifestyle.

But even this theory is incomplete, because there are people fully exposed to the modern lifestyle that do not become overweight or obese. This suggests that genetics, and perhaps other undiscovered factors, also play a role.

We’re not robots

Humans are not robots. We’re living, breathing, dynamic organisms influenced by varying genetics and environmental conditions.

Anthropological evidence combined with modern research has helped us to reveal the basic template of a species-appropriate diet. However, it has also shown us that humans can thrive on a wide variety of macronutrient ratios and foods within that basic template.

This is not a belief. It’s a fact, supported by the evidence as a whole. Ignoring the evidence doesn’t make it go away. Believing passionately in something doesn’t make it true. Experiencing something personally doesn’t make it fact for everybody else.

19th century philosopher Charles Peirce said:

The state of belief is a calm and satisfactory state which we do not wish to avoid, or to change to a belief in anything else.

And Tolstoy said:

I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.

Recognizing this basic human trait, philosopher of science Karl Popper advised every researcher to earnestly try to discredit their own hypotheses.

That is no easy task, and it asks a lot of us. Yet intellectual rigor, emotional maturity and personal integrity are characterized by the capacity to question our own beliefs, no matter how deeply cherished they are or how much is at stake.

I sometimes wonder why we’re all so sure of ourselves. It helps me to remember that at every point in history scientists (and the general public) were convinced they had the right answers. At one time the world was flat, the earth was the center of the solar system and disease was caused by foul humors and could be cured by bloodletting.

Nowadays we look back on those fallacies with a smirk. But are we so arrogant to assume that our great-grandchildren won’t do the same?

The truth is, there’s far more we don’t know than we do know.

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Categories

Weight Loss

Comments Join the Conversation

  1. jason says

    Chris,

    This is a great article and long overdue concept. However, I have one question and would appreciate your opinion.

    Are there any cultures that become obese without a large intake in added sugars and/or wheat?

    It seems to me that sugar and flour are the required “ingredients” no matter what the underlying cause is.

    Thanks.

    Jason

    • Chris Kresser says

      Jason: that’s a good question. I can’t think of a culture that became come obese without processed sugar and flour. I’ll ask Stephan, and if anyone else has an example please chime in. But even if we can say they are pre-requisites (as I argued when I said the “modern lifestyle” is a pre-requisite to any of the prevailing theories like food-reward), it’s obviously not the whole story because there are plenty of people that eat sugar and wheat that don’t get fat.

      • garfinkel says

        It makes me think of allergies. Dogs don’t cause allergies, but the presence of a dog triggers allergic reactions in some people.

      • Ben says

        True, but if there has never been a culture that has gotten fat without sugar and flour, wouldn’t we know how to avoid getting fat? We might not know the whole picture, but we know a necessary component. You can say to someone, “you might not get fat if you eat flour and sugar, but you will definitely not get fat if you don’t eat them.”

        • says

          This is where genes and epigenetic mechanisms come to play. Take a band of hunter gatherers or traditional horticulturalist foragers (e.g., Pima, Inuit, Pacific Islanders). The band is made up of individuals with allelic variation that contributes to variation to obesity (or any given disease phenotype). On their ancestral diet this variation is not expressed; that is, it is latent. But put on a Western diet, especially industrially derived with refined sugar and flour, and those individuals with the “fat” variant (for lack of a more precise term) are the ones who get fat on this diet. The underlying genetic variation that was latent on the ancestral diet is now expressed on the industrial diet. This framework applies to many modern diseases that occur in a probabilistic manner within a population.

      • says

        Obesity per se is probably the wrong focus, i.e. there are people who eat wheat and sugar and don’t get fat, but at least some of those people develop other aspects of metabolic syndrome. Focusing on fat probably draws us away from the deeper issue. In the big picture (and depending on how you define it), obesity is “caused” by some failure in metabolic regulation. Perhaps the relevant question is the cause of metabolic dysfunction, whether it makes you fat or not.

        • Alex says

          Agreed! Cause > Mechanism > Effect (the change wrought via the ‘mechanism’ initiated by the ’cause’) > Symptom (any one of the visible/measurable manifestations of the ‘effect’)!

          As Charles Washington (of Zeroing In On Health) often says: “only the lucky ones get fat”!

    • Angelyne says

      They are some interesting cases of of native population where obesity is prized. They do manage to get fat(ter) without bread, through the consumption of massive quantities of calories. The process appears to be difficult, unpleasant and the results don’t last. I’m not aware of any non-modern population where gaining weight is accidental, unwelcome and difficult to reverse.

  2. ivy says

    Any idea where steroid weight gain fits? I was not overweight before steroids, and haven’t gained any weight since. Eight years later, I still can’t lose the 30 lbs I gained while taking them.

      • ivy says

        If that’s the case, is there a ‘fix’ and if so what is it? Everyone I know who gained weight on steroids is still carrying it around.

        • Bryan says

          I was a skinny child and diagnosed with asthma around 3-4 years old. My pediatrician put me on Prednisone every time I had an attack. By the time I started kindergarden I was chubby and I’ve been fat ever since. This continued until I was 12 years old and found out that most other children taking Prednisone had weight trouble also. I refused to take it after that. I’ve always been fat, never been able to kick the weight and keep it off.

          • says

            @Bryan
            Prednisone causes salt sensitivity and consequent fluid retention. Most of the excess weight you gained is water weight. You lose much of this excess water by seriously reducing your intake of salt and salty food. You will lose weight fast, easily and safely. But you will need to remain on a low salt regimen permanently.

            Eating plenty of potassium-rich foods like vegetables and fruit will accelerate the loss of the excess fluid because potassium displaces some of the sodium from your body.

            Salt sensitivity tends to deplete the body of calcium, and calcium insufficiency leads to some fat retention that would not otherwise occur. – Increasing your calcium intake, preferably from healthy dairy like yogurt – results in extra fat excretion via the faeces so this too helps with the weight loss you seek.

          • says

            @Bryan
            Prednisone is one of the many prescription drugs that cause sodium and water retention and lead to salt sensitivity. If you seriously reduce your intake of salt and salty food you will easily shed much of this excess fluid by way of urine. So you will lose weight fast, easily and safely. But you will need to make low salt eating a permanent feature of your life.

            Potassium displaces sodium in the body so if you eat plenty of vegetables (unsalted) and fruit this will speed up the weight loss.

            Salt sensitivity depletes the body of calcium and this leads to some fat retention, because with insufficient calcium the body cannot excrete fat properly. If you eat good dairy yogurt to increase your calcium intake you will then excrete more fat in the faeces. – See http://www.bbc.co.uk/sn/humanbody/truthaboutfood/slim/calcium.shtml

            Good luck!

    • gregory barton says

      A nice piece of epistemology. Perhaps the “Healthy Skeptic” rubric should not be abandoned.

      Russ Farris, The Potbelly Syndrome, has a few interesting concepts: weight and appetite setpoints.

      • gregory barton says

        Hmmm, I meant to put that comment at the end, as a general observation.

        In reply to Ivy, take a look at Russ Farris’s book, cited above. He claims that excess cortisol is a common cause of potbellies (Chapter 11).

        • ivy says

          When I was taking the steroids, my weight gain was in the typical steroid pattern. Over the years it has rearranged itself, but stayed with me. My cortisol levels were very low for a while, but now are within ‘normal’ range, albeit low-normal.

          I will look into that book. Thanks.

    • says

      @ivy

      Like you, I gained a great deal of weight as a result of taking prescribed steroids. Years into the problem I stumbled onto the explanation and also the best ways to reduce that drug-induced weight gain. The drugs you and I took caused sodium and water retention, and this fluid retention is the main constituent of the excess weight. If you seriously reduce your intake of salt and salty food you will lose weight easily, safely, fast and effectively, but you will need to make low salt intake a permanent feature of your life.

      Salt sensitivity also causes the body to become depleted of calcium and this in turn causes some fat retention and this too contributes to the weight gain. If you increase your intake of dairy calcium this results in more fat being excreted in the faeces and so helps with the losing of some of the excess weight. (See http://www.bbc.co.uk/sn/humanbody/truthaboutfood/slim/calcium.shtml)

      Furthermore, if you eat plenty of unsalted vegetables and fruit your weight loss will be speeded up because these foods are rich in potassium, and potassium tends to displace sodium from the body.

      My website contains much more detail about obesity and the salt connection, and does not sell or advertise anything. I hope you will visit it and benefit from the information there.

  3. toearly says

    The thing is, it isn’t just American people that are getting fat: draw a chart of their car size , home size, military budget size, size of wall-street profits, total US borrowing…
    to imagine that these are not all interconnected would be a real mistake

    • Jill says

      The chart you mention will of course show all of the numbers going up, but what about personal energy expenditure? i.e. exercise. Most of us sit at a computer all day, to earn the money to buy the food which appears magically on the shelves of the supermarket. We don’t even get out of the recliner chair to change the channel on the TV any more.

      • Chris Kresser says

        Jill,

        That’s a reasonable assumption, and certainly physical activity plays a role, but there are traditional cultures that aren’t particularly active and still are not obese as we are. Also, exercise has repeatedly been shown to be ineffective for weight loss.

        • Jill says

          Are there studies that prove that exercise has repeatedly been shown to be ineffective for weight loss? From personal exeperience, I would agree. I exercise regularly, but remain overweight but that seems to fly in the face of popular belief. There are definitely a lot of benefits and few negatives to physical activity but I find it hard to believe that it’s ineffective for weight loss.

          BTW, this is posted in the spirit of trying to understand, rather than a criticism.

          • selena says

            @jill
            the idea that exercise alone often doesn’t do much to help you lose weight (and can even make you heavier, by making you more hungry after rigorous training sessions) seems to have more or less become the accepted medical doctrine nowadays.
            which is indeed a change from the past, when exercise was often touted as *the* way to shed weight, which than in turn would reduce risk of several diseases.

            btw: i should point out that even if exercise does not make you lose weight it is still general consensus that it will make you more healthy (less risk of heart-attacks and such).
            medical theory seems to be moving to a point where not keeping fit is the main source of risk, rather than fatness as such (with fatness just being an indication that you might not be very active)

  4. says

    I prefer to think of the revival of LC, the beginning of the undoing of the institutional demonization of SFAs by Atkins, and the demolishing of the diet-heart hypothesis by Taubes to be steps in a process, like Copernicus’, and Newton’s to our current understanding of physics and astronomy. Were they 100% correct? No. But they were continuing steps on a road that will be traveled as long as humanity exists.

    I don’t think the intellectual rigor problem has anything to do with Karl Popper who was a raging pompous hypocrite in this regard. What can I say, I’m not a Popper fan. I think it has to do more with a science being disassociated from reality by things like politicized institutional funding bias and a deeply flawed peer review system. Richard Feynman, who actually accomplished a hell of a lot in the advancement of science had more interesting thoughts on this subject.

    I’m deeply skeptical of the food reward hypothesis, but then I’m deeply skeptical in general. The problem I have is that it is simply too malleable and generic. Great hypotheses make testable predictions, that is the ultimate test of intellectual rigor.

    • Chris Kresser says

      Sean: I’m no Popper fan-boy, and I agree he went off the rails. I do appreciate the idea of researchers trying to poke holes in their own theories.

      I’m also in full agreement with the idea that politics, economics and groupthink are as much or more to blame than a lack of intellectual rigor. They’re not mutually exclusive; political and economic motivations, as well as fear of being ostracized from the in-group, can often cause a lack of intellectual rigor.

  5. says

    Hi Chris, I agree with the content of your article. It’s not only one cause, but nutricionally speaking with have now many clues to discern what is and what is not helpful to loose weight.

    This said, I lost weight, when I began to adress the emotional issue. I didn’t eat much, far less than now, mostly salads, with some protein, some fruit, no fat. Sometimes I skipped meals, not because I wanted to loose wait, but because I forgot. But was really overweight, still I have weight to loose. But it was when I stopped and took time to apply my own coaching techniques, to my weight problem when I began to loose weight, naturally, eating actually more.

    After that I discovered the low-fat diet, and I follow it and enjoy its benefits. Thank you for this always interesting information, and ¡congratulations!

  6. masha says

    This is a great article and do I appreciate all you do. However, I really wish you had resisted the cliche of the photo of the headless morbidly obese woman. Obese people have heads and no particular reason to be ashamed of them! Also, the average obese person is quite a bit smaller than this individual.

    • Chris Kresser says

      I understand where you’re coming from. In almost every other article I’ve written on obesity, I’ve used a picture of a man in sensitivity to that stereotype. Unfortunately, most pictures on stock photography people of obese people follow this convention.

      • says

        I really enjoyed this article and agree that obesity is extremely complex. It’s foolish to think we have all the answers. However, I was glad to see Masha’s comment. I was definitely annoyed by that picture. It has little to do with whether it’s a man or a woman. Fat people are people, and depicting them in such a dehumanizing way is pretty offensive. It’s a small thing but emblematic of the problem many of us (“the obese”) face: we constantly are confronted with information about how the solve the problem by people who do not share the stigma. I love your site and didn’t expect it here. Just something to think about!

    • Lesie says

      Chris, as an overweight double amputee with no feet, I find your new photo very insensitive and inappropriate. Please change it to something else.

  7. says

    Chris –

    Nice post. A few things:

    First, no one says a high carb diet is the issue – Taubes, Eades, etc. all state that it is a diet high in refined carbs. No one thinks a diet high in leafy, cruciferous veggies and seasonal fruits will make you fat. No one who knows what they are talking about anyway.

    And just because you can observe lean people who eat lots of carbs does NOT mean that it is not the carbs that fattens some people. You will also NEVER observe an obese person who has lived his life eating only fatty meats, vegetables and some fruit.

    Sometimes we DO have the right answers. And when we have them, we should use them.

    Here is my question to you – if you had an obese patient/client, how would you have them eat? I’ll bet you’d suggest them to remove all refined foods to keep carbs to a minimum. You certainly would not suggest they eat most of their calories from carbohydrates, right?

    A low carb real food diet takes care of the insulin issue. It takes care of the leptin issue as well almost always. In fact, it takes care of systemic inflammation, obesity, toxicity and a host of other ills caused by a high refined carb, western type diet. As you know better than I do a diet that provides an adequate amount of fat and protein is by default a low carb diet.

    • gregory barton says

      “And just because you can observe lean people who eat lots of carbs does NOT mean that it is not the carbs that fattens some people. You will also NEVER observe an obese person who has lived his life eating only fatty meats, vegetables and some fruit.”

      Deserves a comment.

    • says

      Of course if you’ve been eating an industrial diet your whole life you may not be able to deal with the amount of carbs that would be ‘normal’ and well tolerated in people raised in a different environment. I tell people I’m not on a low carb diet, I’m making up for all the boxes of Capt. Crunch I ate as a kid. My averages still aren’t that low.

    • Alms says

      Conversely you will not see an obese person who eats an ultra low fat, high carb diet (mcdougall, ornish etc). This diet also solves diabetes and insulin issues believe it or not and has also been shown in clinical trials to reverse atherosclerosis. It is when I discovered this that I realised just how complex obesity actually is. Obesity and disease seems to lie in the high refined carb plus high fat area which is why in isolation, carbs and fats in isolation have nothing to do with obesity.

  8. Amy says

    It’s hard to see every bubble on the chart, but I did notice “female employement.” I’m assuming that you mean outside the home?

    This should be changed to mention the lack of involvement on the part of fathers in food prep when mothers work full time. If it’s on there, please correct me.

  9. says

    Initially – awesome post. I love dietary ideologies that defy dogma.

    In regards to Jason’s Inquiry “Are there any cultures that become obese without a large intake in added sugars and/or wheat?”

    Well, can’t address the degree of wheat consumption, but a look at ancient goddess imagery shows that what we’d now term “obese” isn’t solely the result of refined sugars/carbs. An example:

    http://en.wikipedia.org/wiki/Venus_of_Willendorf

    “The Venus of Willendorf, also known as the Woman of Willendorf, is an 11 cm (4.3 in) high statuette of a female figure estimated to have been made between 24,000 and 22,000 BCE. It was discovered in 1908 by archaeologist Josef Szombathy at a paleolithic site near Willendorf, a village in Lower Austria near the city of Krems.[1] It is carved from an oolitic limestone that is not local to the area, and tinted with red ochre.”

    • Wendy says

      The Venus of Willendorf was a symbol of fertility and meant to portray a very fertile and pregnant women. Not obese.

      • bonita says

        perhaps. though i’m not sure we can read the mind of the artist so many years later. frankly, too me she looks obese, not pregnant. that being said even if they weren’t eating wheat, sugar, and other process foods, that doesn’t mean some of our ancestors might not have been obese. metabolic derangements are not necessarily dependent on poor diet, just more likely, no?

      • selena says

        i never realized the internet was so loaded with ‘fertility-symbols’ than ;p

        i agree with bonita that we will probably never know the artist’s intent for sure.
        but the idea of these things as fertility-symbols seems to have had more to do with feminist ideas and political correctness than with rigorous scientific research. and now that feminist extremism is going out of fashion scientists finally dare to come up with alternative explanation in the vein of ‘maybe they just thought she looked totes hot’

        but regardless of it’s interpretation, it’s one of those things that flies directly in the face of everyone claiming obesity is a purely modern occurrence, a symptom of how far we have strayed from our cavemen roots.
        the woman depicted is clearly what we would now consider to be ‘overweight’ (she has fat legs and an enormous butt, so it’s not just pregnancy), and it stands to reason to assume the figure was based on women the artist would have seen around him.

  10. Chris Kresser says

    Fred:

    Taubes does say that carbs are the problem in his book, although he acknowledges that refined carbs are worse. I do think refined carbs contribute to obesity, but as Stephan asked in his latest point, the key question is “why”? Taubes et al say it’s because carbs raise insulin and increased insulin causes excess fat storage. Stephan’s latest post clearly proves those hypotheses are false. (http://wholehealthsource.blogspot.com/2011/08/carbohydrate-hypothesis-of-obesity.html)

    The fact that you will never observe an obese person who has lived his life eating only fatty meats, veggies and some fruits has nothing to do with the fact that they’ve avoided carbs, and everything to do with the fact that in eating only those foods they’ve avoided the processed foods and “neolithic agents of disease” that disrupt homeostatic and hedonic regulation of energy balance.

    While it’s true that I might put an obese patient on an LC diet, that does not mean carbs were the cause of obesity as I pointed out in the article. This is an important distinction, because one thing that has happened in the Paleo community is that even metabolically healthy people have put themselves on LC diets in an effort to prevent weight gain. I have many patients come to me on LC Paleo diets with a range of complaints that resolve when I have them start eating more CHO.

    It’s also true that a VLC diet does not work for all obese people, or its effect is short-term in others. That’s another reason why it’s necessary to be rigorous in our language and approach.

    There is no “insulin” issue as described by Taubes and Eades. Stephan’s recent article demonstrated that quite clearly. There is a leptin issue, but it’s caused by food and environmental toxins, LPS/intestinal permeability, stress and micronutrient deficiencies – not excess CHO intake.

    • ansgarr says

      Guyenet didn’t prove Taubes’ hypotheses are false. He just presented counterarguments and contrary opinions largely held by mainstream scientific community. While I do think Stephan raised some valid points, I still believe we need to give Taubes a chance to respond before we jump to definite conclusions. It’s not like Taubes made it all up and never backed his theory with scientific evidence. As a matter of fact he came up with two highly praised books, which takes a lot of research and thinking, much more than writing a blog post or two.

      In my view “the food reward theory” is just another way of saying we get fat because we overeat. How innovative is it? Many problems have been raised about the food reward theory: how do we design and conduct a controlled study to prove it or disprove it? Is the “reward value of food” an utterly intrinsic property of a given food or is it subjective, that is it differs from person to person depending on who is consuming it? Would it be possible to measure how rewarding a food is before we eat it? Also how do we tell the cause from effect: are we eating rewarding foods and thus gaining weight or are we gaining weight and consequently opting for more rewarding foods? Finally is “the food reward theory” even a falsifiable one?

      Noone claims , at least as far as I know, that obesity has simple roots and mechanisms. Of course it is multifactorial. However, scientists should be looking to identify and explain even potential causes rather than escape into mutlifactorial speculations and increasingly complex mechanisms that tell us nothing about why we get fat in real life. In my view “The Multifactorial Theory of Obesity”, FRT being part of it, is more and more popular, because it allows to reconcile different, even conflicting views of obesity under a single umbrella, and we want to be in agreement rather than at odds with each other. It helps to explain everything as it explains nothing. Let’s not cling to it, let’s not take that easy street, unless we wanna give up on our search for meaningful answers.

      That said, I really appreciate your work Chris. Many thanx!

      • M. says

        Ansgarr said: “It’s not like Taubes made it all up and never backed his theory with scientific evidence. As a matter of fact he came up with two highly praised books, which takes a lot of research and thinking, much more than writing a blog post or two.”

        His books have actually received a lot more scientific criticism than The China Project.

        If mainstream science and the vast majority of the scientific bloggers (Guyenet, Harris, Masterjohn, Jaminet, etc…) in the paleo-sphere believe the Carbohydrate Hypothesis is wrong, why become so attached to it? A “book with a lot of footnotes” is the The China Project all over again. “I don’t like {meat|carbs}, and this book with a lot of footnotes makes me happy that science agrees with me.”

        This is a particular issue within the Ancestral Health movement. How can the movement be tenable in the long run when a big chunk of the movement prefers “a book with a lot of footnotes” over the criticism of the scientific heavyweights in the movement? What is the movement without the scientific heavyweights?

        • ansgarr says

          I guess I didn’t make meself clear enough, I’m not saying that Taubes is right because he wrote two heavily footnoted books. I’m saying that he offered a testable hypothesis that can be proven or disproven. To me, so far it hasn’t been disproven. Opinions, and interpretation of science by bloggers (Harris, Masterhojn, Guyenet et.al) is not enough to disprove a 150-hundred-year-old hypothesis that “carbohadrates make you fat”. This has also been the experience of so many physicians in their everyday practice over the course of tme. Of course not everybody gets fat eating carbohydrate, as is shown by the Kitavans, for instance. But no theory explains everything. If insulin theory theory should be viewed as worthless, then we must admit the food reward theory is even more so, which is not what I think.

          As for criticism Taubes’ books recieve I believe this is very little wonder is it? We have been led to believe by scientific establishment that all that matters is calories, and thus only fat can make you fat. Please bear in mind that this has also been backed up by science.

          This is not about any movement or who leads it. If it was, then it would no longer be a scientific issue but rather a socialogical or even political one. In this case one might say that Harris or Guyenet are using science only to replace Taubes as new gurus and leaders of the movement. Hope this is just about science.

          • M. says

            Ansgarr ,

            What would it take in your mind to disprove the Carbohydrate Hypothesis? I believe quite a few people have reported fat gain on ZC or VLC. Quite a high percentage of the world’s population eating pre-industrial diets (1 billion or so Chinese, for example), not just the Kitavans, ate diets high in starch.

            Taubes theory of “carbs -> insulin -> obesity” is just not supported by the evidence, let alone the biochemistry. Taubes’ theory is much more than “carbohydrates make us fat;” he spelled out the biochemistry of why he believes this to be. The biochemists say he is wrong, and the evidence says he is wrong. Fructose doesn’t even cause “insulin spikes”.

            If a culture eats a “fast carb” like white rice without any problem, then switches to an industrial diet and then does see obesity and diseases of civilization, I believe it makes a whole lot more sense to look at what is it about industrial diets causing this instead of worrying about demonizing entire classes of macronutrients. The Carbohydrate Hypothesis just doesn’t work for this.

            Just because physicians use low-carb diets for weight-loss does not mean that carbs caused the weight gain to begin. Low fat diets are usually just as successful at weight loss.

            All this talk about low-carb diets being best for weight loss or best for people with “broken metabolisms” or best for whatever does not mean that “carbs” made you fat. The fact that refined wheat and sugar are bad does not mean that “carbs” are bad. But many within the guru’s influence will say “See, carbs are bad! Look at all this evidence. Taubes must be right.”

            It has nothing to do with replacing one guru with another; it is about guruism vs science. With all that is arrayed against it, there is just really no reason other than guruism to defend Taubes’ Carbohydrate Hypothesis.

            • ansgarr says

              “What would it take in your mind to disprove the Carbohydrate Hypothesis?”

              Well to me it’s quite simple.

              Let me start by saying that giving observations of healthy high-carb populations is not enough to refute a low-carb hypothesis. Why? Because correlation is not causation. As dr. Eades pointed out, the Japanese smoke much more than Americans and yet they have a much longer life expenctancy. Does it mean that we should all start smoking to live longer lives? Plus we do not know what would be, if the high-carb healthy people lived a low carb life. Maybe they would be even healthier? Or not. We simply do not know that.

              What we need is a prolonged controlled clinical trial comparing LC vs. HC (all other fatcors being controlled) showing that low carb causes more weight gain and disease than HC (even when composed of healthy unprocessed carbs). Not so sure such a study can ever be conducted for obvious reasons.

              • M. says

                Ansgarr,

                It is more than just “healthy high-carb populations” and correlations. It is that “healthy high-carb populations” are fine until the introduction of an industrial diet. Industrial diet is clearly the problem. The “healthy high-carb populations” simply show that “carbs” are not the problem with industrial diets.

                • gregory barton says

                  I don’t think it follows that healthy high carb populations show that ‘carbs’ are not the problem in industrial populations. One population might be adapted to high carbs, the latter might not.

                  Similarly, different age groups could respond differently to carbs. Michael Rose claims that people from populations with a long history of grain cultivation, such as those in the middle east and India, can metabolize grains well up to the age of about 30. After that their health deteriorates if they eat grain and dairy. The basis for the idea is that there are 10,000 years of selective pressure on people of breeding age to adapt to grains and dairy, whereas at the post breeding age there is no such adaption. The claim is interesting. Indians do not have an industrial diet. However potbellies are rife in middle age and diabetes is rampant.

                • ansgarr says

                  “It is that “healthy high-carb populations” are fine until the introduction of an industrial diet.”

                  If my memory serves me correctly, Taubes has described populations on a non-industrial high carb diet that are obese and sick. So we have healthy “high unprocessed carb” populations, unheatlhy “high unprocessed carb” populations, we also have “healthy high-fat unprocessed-food” populations but do we have unhealthy “low-carb high-fat unprocessed-food” populations? Then again these are just observations, good for hypothesizing, not much more.

                • M. says

                  Gregory,

                  The issue is though that if you have a culture that is apparently “adapted” to carbs, THEN experience problems AFTER the introduction an industrial diet, it would seem to point at the industrial diet being the problem, especially when the industrial diet seems to be the common meme in most cultures, “carb-adapted” or not.

                  Ansgarr,

                  Other people have noted how some of Taubes’ own example populations actually dispute his own claims – the Pima Indians for example (http://huntgatherlove.com/content/pima).

                  It appears that the majority of populations and people experience problems after the introduction of industrial diets, even the ones that are “carb-adapted”. You are correct that this doesn’t strictly disprove the Carbohydrate Hypothesis, but it is kind of a body-blow to its viability.

                  The common sense reaction might be to work on different hypotheses that don’t already have so much weight against it, especially when the claimed biochemical mechanisms are so strongly disputed as well. It just appears that the demonization of an entire class of macronutrients is not the way forward.

  11. Brian White says

    A first-rate article!
    The one thing that many people miss is that processes aren’t necessarily reversible, so even if X causes obesity, removal of X may not reverse it. Asbestos causes cancer, but removing it won’t cure it. Most people are justifiably interested more in the possibility of reversal rather than in understanding the cause. The question is, “what’s the “Y” that can cause a reversal?”.

  12. says

    Chris – Smoking causes lung cancer. But I can show you many people who smoke and don’t have lung cancer. However, smoking does indeed directly cause lung cancer. Lots of people eat huge loads of carbs and are not insulin/leptin resistant – yet. and if these same people are endurance nuts they can, by and large, get away with it.

    • Chris Kresser says

      Fred,

      That doesn’t hold water. The cultures I referred to often had relatively low levels of physical activity. They weren’t “endurance nuts” by any stretch of the imagination.

      Where is your proof that excess carbohydrates cause obesity, without some other contributing factor? So far, no one has come forward with that proof, and we have myriad examples that disprove that hypothesis. Therefore it is an indefensible hypothesis.

      • Mike says

        I thought Taubes addressed that in his book “Why We Get Fat” he goes through a litany of ‘primative’ cultures that developed obesity after introduction to flour.

        • Chris Kresser says

          Yes, but he was arguing that it was the dense carbohydrate content of the flour that made them obese, whereas I’m arguing that it’s more likely something else (i.e. toxins in the wheat, etc.).

          • Mike says

            If you follow the logic of WAPF or the Paleo/Primal community it would be the Phytic acid and other ‘anti’ nutrients that were never intended for human consumption. My limited understanding of it is that cereal grains have protective elements that prohibit digestion for the purpose of procreation. Once we process the grains so that they’re digestable we absorb elements that we were never meant to absorb.

            According to WAPF this is why traditional cultures would soak/sprout their grains before consuming them.

            • Mike says

              Perhaps insulin resistance is due to the fact that your body is trying to limit its exposure to these elements.

      • says

        You two are talking past each other. Somebody define “excess carbohydrates”. Is it quantity? Total amount absorbed in the blood? Rate at which it is absorbed in the blood? Effect on total insulin secretion? Rate of insulin secretion? Etc.

        • gregory barton says

          Quantity would be a starting point. Jimmy Moore said that at the peak of his obesity he was probably eating 1,000 grams of carbs per day. That sounds excessive.

  13. EF says

    ” it’s obviously not the whole story because there are plenty of people that eat sugar and wheat that don’t get fat.”

    I don’t see why this rules out excess sugar/wheat as the primary cause of obesity.

    Taubes often cites to a smoking analogy here. Nearly all lung cancer patients smoked, but not all smokers get lung cancer. This does not detract from the reality that smoking is the primary cause of lung cancer.

    Similarly, why can’t it be that obese people got obese from the excess sugar/wheat but not everyone who eats the excess sugar/wheat gets fat?

    Your thoughts are appreciated. Thanks!

    • Chris Kresser says

      There’s no doubt that sugar and wheat are primary contributing factors to the obesity epidemic, but not for the reason that Taubes, Eades and other LC proponents put forward (i.e. the insulin/fat storage hypothesis). You may think this is splitting hairs, and from the perspective of what to eat it may be, but it’s an important distinction in the discussion of what the causes and mechanisms of obesity are.

      The smoking analogy would only be relevant if we saw entire cultures that smoked heavily and had a zero or near zero incidence of lung cancer. Because there are several traditional cultures that eat very high amounts of CHO and have 0% obesity. That would be highly unlikely, to say the least, if high CHO intake alone caused obesity.

      • says

        Don’t the Kitavans smoke a lot and have very low rate of lung cancer? I think both the CHO hypothesis (and counter-arguments) and smoking hypothesis are neglecting the bigger picture, which is that biological organisms necessarily utilize a variety of mechanisms to be robust against variable environmental condition.

        Suppose Seyfried is right, and that cancer is the result of mitochondrial stress. There are multiple environmental factors that can lead to mitochondrial stress. If you eliminate most of them and still smoke, your risk of lung cancer may be greatly reduced (essentially delayed, assuming mitochondrial damage accumulates).

        One other point: there doesn’t really seem to be a downside to eating “low carbohydrate”, assuming that you’re including some low glycemic fruits and veggies (and some might even argue the necessity of plants at all). So I’m not really sure what the fuss is about. It’s an interesting academic discussion, but as another commenter pointed out, does it make much difference from a practical standpoint? Assuming that we’re going to eliminate refined carbohydrates (including grains) and possibly legumes, what does that really leave to argue about? Potatoes? Snore.

    • Jennifer says

      … Some smokers don’t get lung cancer…YET.

      Most Smokers who don’t have lung cancer die from something else before they have a lung cancer diagnosis. Example: my husband’s grandfather quit smoking at age 51. At 94, he was diagnosed with end-stage lung cancer. He died 17 days later.

  14. carol says

    No offense Chris… but I think this article misses the point entirely. There will never be “one” grand unified theory for obesity… but just because there will never been one unified theory does not invalidate the other theories.

    There is no mystery about the cause of the majority of obesity in the US or the developed world… refined carbohydrates and sugar and the associated cravings they cause. Just because some people CAN handle a high load of carbohydrates and sugar without gaining weight, does not invalidate the fact that other people CAN NOT handle the same amount of carbs and sugar and become overweight.

    The difference is in the individual’s genetics. And there are also a very complicated set of hormonal interactions combined with genetics that predispose some people to gain weight on a diet of high carbohydrates/sugar.

    The scientific evidence (see Phinney and Volek’s recent book citing their studies as well as others) is mounting that a removing sugar and refined carbs from one’s diet decreases inflammation, increases good lipids, decreases insulin resistance, etc etc…. Wheat is also turning out to be implicated in brain malfunctioning…

    I think you are looking for the wrong problem…. rather than looking for one “accurate” theory of obesity, I think it would be better to look for what causes “some” people to gain weight, which again science strongly supports the refined carb/sugar theory for many overweight people in the US… just look at sugar/carb consumption graphs over the last 50 years in correlation with weight gain in the US… and, again, just because someone else does NOT gain weight eating the same way (eg different genetics and epigenetics) does not invalidate the theory for the people that became overweight on the same diet.

    Also, as Fred as pointed out, it is doubtful that anyone has become overweight by eating too many good fats, proteins and vegetables… you lose your appetite with that way of eating.

    As you point out, some people do not lose on a VLC diet… even tho inflammation is decreased and their lipid profiles improve… and that is attributable to hormonal imbalances such as hypothyroidsim (greatly undiagnosed in America), adrenal fatigue and off-balance levels of sex hormones. Check out http://www.holtorfmedgroup.com for excellent pdf files explaining their intricate biochemistry in relation to weight loss.

    I love your website and your writings… I just think the logic is a bit faulty here. Just my opinion!

    • Chris Kresser says

      Carol,

      I’m not looking for an “accurate” theory or unified cause. In fact, the whole point of the article is that there isn’t one. I absolutely agree with you that the modern lifestyle (including diet) is at the root of the obesity epidemic, and that genetics predispose some to be more vulnerable than others. Toxins, stress, poor gut health and micronutrient also play a role in differing individual responses to modern food. I acknowledged this in the article, and I wrote about it in my series on diabesity.

      However, that does not mean that someone who is already obese will lose weight simply by eating a low-carb, real foods diet. That’s an important distinction, because I see patients in my practice all the time who are in this predicament. So yes, it’s important to me to determine how I can best help these people, and what I’ve seen is that a low-carb and/or Paleo diet does the trick in some cases, but not in others. Regardless of what the ultimate cause was (which you and I agree on: modern lifestyle + genetics), we still need to find a way of treating it and I’m arguing that a LC, whole-foods diet isn’t always successful.

      • says

        Chris,

        You address one thing that I have been trying to find, for people that low-carb doesn’t work, what does work?
        If you have covered this previously I apologize.

        Thanks,
        Justin

        • Rachel says

          Hi Chris and Justin,
          I have been curious about this as well. After eight months of eating Primal and LC, I have managed to gain about seven pounds, feel like crap, and now I have heart palpitations, which I am hoping are not related, but at this point I definitely wonder.

          I feel like going back to a full CW diet is clearly not the best choice, but yet although everything I read about Primal/VLC etc., makes sense, it is definitely not working for me.

          So I second Justin’s question: what does work?

          • Jeff says

            What it means is to include lots of healthy starches in your diet: yams, sweet potatoes, potatoes, other tropical root veggies and white rice along with all the other wonderful ancestral foods you already eat. I’ve heard that even some types of corn grit may be safe, but I’m not sure that holds water with the whole anti toxin argument.

            As obviously stated here avoid processed flour, sugar and all omega 6 heavy foods (especially processed seed and nut oils). Minimize all fructose containing foods that aren’t whole (intuition would say that the nutrients in fruit do something to offset its fructose content, maybe its potassium and vitamin c content for instance).

            So you don’t have to throw out the baby with the bath water, just give your body lots of healthy starches to go along with your healthy fats, veggies, fruits, fish and meat. That isn’t too complex, is it?

          • gregory barton says

            Read Russ Farris, Potbelly Syndrome, and Paul Jaminet’s latest post:

            http://perfecthealthdiet.com/?p=4268

            Both mention infection and toxins as possible causes for obesity.

            Farris suggests the mechanism that infection raises cortisol which leads to obesity. He also writes about the futility of dieting. See his website:

            http://www.potbellysyndrome.com/

            There is a nice flow chart on his website about “Dysphoria and Obesity”.

            Here is his yahoo group:

            http://health.groups.yahoo.com/group/infection-cortisol/

            His book is well worth reading. It’s well written, sensitive and provocative.

          • Alms says

            I feel your pain. I was in a similar position seeing no weight loss eating LC and I also noticed my fasting blood sugar which has always been completely normal begin to creep up on the diet(up to 5.7 at one point!) which also went completely against the LC wisdom. I am not even diabetic but just check my blood sugars regularly. My solution was to reduce fat drastically and increase carbs. I stayed at the same weight but fasting sugars went back to 3.9-4.2 which is normal. All this told me is that my body has a certain set point, for some reason it wants to hold on to its fat. It makes the food reward theory very attractive in my book.

  15. tess says

    to your question, “i sometimes wonder why we’re all so sure of ourselves…,” i can also reply with a quote. “Thinking’s a dizzy business, a matter of catching as many of those foggy glimpses as you can and fitting them together the best you can. That’s why people hang on so tight to their beliefs and opinions; because, compared to the haphazard way in which they’re arrived at, even the goofiest opinion seems wonderfully clear, sane, and self-evident.” :-) not that i think this applies to your blog (or Stephan’s, or Chris M’s…).

    tess (a big fan of Dashiell Hammett)

  16. Anthony says

    In reading Stephan’s post, I in no way see this as a R.I.P. for Taubes or Eades. In fact, Stephan is taken to task quite well by on of his readers (ItsTheWooo2.)

    I think before jumping on the Guyenet bandwagon, we should take into consideration that a diet free of processed carbohydrates could do wonders for our nation’s obesity problem.

    • Chris Kresser says

      Really?

      There isn’t a single person in the entire healthy nutrition blogosphere that would disagree with that statement, including Guyenet, Taubes, Ornish, Campbell and even the AHA. What’s your point?

      Stephan has never argued that eating processed carbs doesn’t contribute to the obesity epidemic. He’s just saying it isn’t for the reason that Taubes and others claim. And I completely disagree with you that ItsTheWoo2 has “taken Stephan to task”. He distorts and misrepresents Stephan’s argument, and Stephan’s original article already addressed most of the points he made.

      • Jack Kronk says

        ItsTheWoo2 knows a lot of stuff, but her approach and tone is completely repelling. She has some interesting thoughts and ideas, but much of what she lays down as “fact” is, in fact, not factual.

        Stephan has been extraordinarily patient with her, while she continues to clutter the comments section on dozens of his articles with endless long winded and whiny examples of how her particular situation could not possibly fit into his food reward theory, and so therefore his entire angle is bunk. It’s ridiculous.

        Simply put, most of his readers are sorta tired of scrolling through her comments. I think if she were to just ease up, and come at it with a less overblown approach and discuss things in a mature and reasonable manner, she might get somewhere with what she brings to the discussion.

        • gregory barton says

          I too found ItsTheWoo2′s tone is a bit over the top. But I also found Stephan’s tone a bit churlish and his writing style tortuous, disjoint and rambling. After reading the article (twice) I would say that isn’t apparent that he has proved that the insulin-fat storage theory is false. He has just added another layer of doubt into a complex problem. Perhaps there’s more we don’t know about fat storage than we do know.

        • STG says

          I think that it is inappropriate for anyone to be taking ItsThe Woo2 ‘s inventory. Other people who have commented on Stephan’s blog have also used insults, profanity, sarcassim and questionable arguments. Let’s not get into personal attacks and dismissive comments.

  17. Daniel Weber says

    Chris
    An interesting study by Bakker et al (2010) in which he demonstrates that chronic inflammation, as measured by hs C-RP was involved in obesity. In one aspect of the study, the reduction in inflammation paralleled an in increase in prolaction in the brain, which will, of course act as an antidepressant. The study goes on to suggest “An intervention with selected dietary products (antiinflammatory dietary mix / AIDM) affected inflammatory processes, oxidative stress, and metabolism in humans, as shown by large-scale profiling of genes, proteins, and metabolites in plasma, urine, and adipose tissue” (Bakke GCM, J van Erk MJ, Pellis L, et al. Am J Clin Nutr 2010;91:1044–59). I also see these increases in chronic inflammation being activated by ongoing stimulation of the HPA Axis, which is itself caused by unresolved stress. And as to Karl Popper, he and John Eccles in “The Self and its Brain” presents a fine and refined view of thinking in science.

  18. Mark says

    [quote]Chris wrote, “One of the biggest mistakes often made in this debate is the confounding of cause, mechanism and effect. A classic example is the assumption that if reducing carbohydrate or fat intake leads to weight loss, then the original weight gain must have been caused by excess carbohydrate or fat consumption.

    While it’s tempting to make such an assumption, the logic is faulty. It’s kind of like saying “Advil cures headaches. Therefore, headaches must be caused by Advil deficiency.”
    [/quote]

    From my perspective, it is not that the logic is faulty, but simply that the CAUSE (Advil) was wrong. Taubes says that carbs drives insulin which makes fat. If the cause, carbs, is removed, and the person loses fat, then the logic works.

    Chris wrote, “My opinion is that the modern lifestyle (i.e. that food and environmental toxins, stress, poor gut health, infections, micronutrient deficiencies, sleep deprivation.”

    This reminds me when I read something talking about some drugs that AIDS patients take, some of which makes them fat, so I agree that these things can contribute; however, obesity has exploded since the 1980s and it is striking that this jump seems to correspond with HCFS (high fructose corn syrup).

    Chris wrote, “Personal experience: I lose weight on an low-carb diet, therefore low-carb diets must be best for weight loss.
    Belief: carbohydrates are responsible for the obesity epidemic, via their effects on insulin.
    Fact: many cultures around the world eat high-carbohydrate diets and are exceptionally lean.”

    Taubes addresses this. What he says is that he believes is that while these cultures eat high carb diets, they tend NOT to eat much sugar. Sugar seems to be the “tipping point” (or catalyst) that creates the insulin resistance problem.

    I have a couple thoughts of my own about this: first, I believe that other cultures simply eat smaller portions, hence less carb intake. Second, the term “carbohydrate” is too general, as it can include everything from spinach to Pop Tarts. So, just to say that some cultures eat high carb diets, without addressing the “quality” of the carb is inappropriate.

    One final concern I have with using stress, lack of sleep, etc., as causes of obesity is that it is viewed as cause, instead of a correlation.

  19. Grampa Ken says

    I have been dealing with a weight problem for over 20 years. Having had over 15 mercury fillings ( I think all are now gone, having been extracted one or two at a time over that time period ) , I knew from my research that my body, including fat cells , was probably loaded with that highly toxic heavy metal and that losing weight rapidly could be the worst thing I could do, because I would probably end up in an Alzheimer unit, or get MS, etc.( a simple at – home test verfied my concern, I was loaded with heavy metal toxicity ) I finnaly found what I felt was a safe effective detox program ( bentonite clay ) and now feel it is safe to start losing weight gradually. However, I have also discovered that I am a ” congenital snacker ” which of course will DESTROY any weight loss program. It wasnt until I read and UNDERSTOOD that my snacking was actually caused by the fact that I did not receive the necessary love and hugs that all children need when young, and so I learned very early in life to SUBSTITUTE FOOD FOR LOVE. I have mentioned this little story to point out and validate the arguments given here just how complex the subject of weight loss / gain can be. However, I would also like to point out that once you make the crucial decision to be responsible for YOUR HEALTH and WELLBEING, it can become an exciting jouney of discovery filled with hope and optimism, as it has for me after being on the SAD diet for over 50 years. There are remarkable discoveries being made ( and/or being REDISCOVERED ) in the Holistic health field. And once you start to understand how your body functions at the CELLULAR LEVEL, you can make remarkable progress. I learned long ago, not to put all my eggs in the basket of just one health guru, and so I monitor the E – MAIL newsletters of 5 or 6. And yes, that takes an hour or two a day, but the info is freely shared, ( just like this site ) and just learning one new piece of info can turn your life around. One of my new favorites is DR Mark Sircus who has been pointing out how crucial Magnesium is since it affects over 300 body / cell functions
    Sugestion — dont get hung up on one single aspect of a health problem, try and look at as large a picture as possible, ( which I think our host does a great job of ) As an artist who paints watercolor landscapes, I learned to do that long ago, and it has SERVED ME WELL.

  20. vizeet says

    My thinking is that being obese is not bad for health if cause is food reward from non toxic sources (Or micro-nutrient deficiency or infection). Reason is whatever influences a person to become obese most of them hasn’t evolved in humans. This is something that has been there for very long time and every animal follow same and there are animals which are fat like hippo, bear and wild boar but they don’t die of heart attack or diabetes.

  21. garfinkel says

    According to the USDA…

    http://www.usda.gov/factbook/chapter2.pdf

    If you look at 1950 – 2000, the consumption of (in pounds/person):

    • wheat had not increased that drastically (126 to 147)
    • corn and rice saw a bump (15 to 28; 5 to 20)
    • fruits have had modest changes (99 to 127)
    • vegetables (95 to 154)
    • potatoes down (53 to 47)
    • red meat had a minor increase (107 to 114)
    • chicken tripled (16 to 53)
    • cheese tripled (8 to 30)
    • whole milk down (33 to 8)
    • lower fat milk up (3 to 15)
    • butter declined (9 to 5)
    • salad and cooking oil went up (10 to 35)
    • cane and beet sugar went down (97 to 66)
    • glucose (7 to 18)

    and no surprise…

    HFCS went from 0 to 64 pounds/person a year — by far, during those 50 years, the most dramatic change in the American diet.

    Stephen Guyenet has blogged on this in the past, but referred to a different USDA source that dates 1970-2005. It also has HFCS at slightly lower levels of 59 in 2005, than in 2000 — somewhat hard to believe. This study also shows the increase of wheat from 137 in 1970 to 192 in 2005. (Numbers are off between the two studies. Is there something I am missing?)

    http://www.ers.usda.gov/Publications/EIB33/EIB33.pdf

    Looking at the 55 years of data, the increase of wheat had been 66 pounds a year. Break that down per day, and it seems fairly insignificant. Even at 192 pounds a year total, that is only around 8 ounces a day. While I don’t believe wheat is healthy, is it a major contributor?

    While HFCS per pound, per year is even less, I find that it went from ZERO to around 60 pounds more interesting.

    • Ruby says

      This data also doesn’t account for GMO and the increase of actual gluten in our wheat over the past 50 years.

    • says

      Garfinkel, interesting info. To me the important factors identified in this data set are the big increase in salad and cooking oils with big decrease in dairy fats and the big increase in sugars from 104 to 148 lb/yr. What is missing are the big increases in non-nutritive sweeteners, like aspartame and sucralose, and flavor enhancers like MSG, both of which I believe are important factors along with the PUFA, trans-fat, and sugar increases and dairy fat decreases.

  22. Robert says

    Great article. How I would like someone to discover the simple, magical formula to shed (or never put on n the first place) the extra pounds. But “it depends” seems to be as good as it gets. Thanks for this reality check.

  23. Martine says

    Very interesting. HFCS does sound like the smoking gun, doesn’t? Still it’s only one fact among many. We need to take into consideration the well established fact that the health of whole populations deteriorates as soon as they are introduced to modern food, even before the advent of HFCS. It could be that people of European descent (among others) were partially adapted to eating a diet flour and sugar. This would explain why modern diseases were not as prevalent as today, before 1950. Could it be that HFCS is the factor that made everything tip over? Or could it be that something in our grandparents diet was protective ? Could it be the combination of HFCS, modern wheat, and PUFA?

    There has been so many changes over the past 50 years. Soil depletion, the green revolution, a massive move from the country to the city, an explosion in manufacturing, in the use of plastics, to name but a few; hundreds and hundred of factors. Our modern lifestyle is so radically different from that of let’s say, the Kitavans. We are so focused on nutritional changes, it might be that there is something that we have not even considered yet.

    • garfinkel says

      Great points. Certainly agree that there is more to it than just HFCS.

      Purely anecdotal, but I myself managed to pack on 40 extra pounds from ages 30 to 40 while doing a good job of avoiding HFCS and not overeating, most likely because of too much alcohol, lack of quality sleep, possible dysbiosis, and stress.

    • garfinkel says

      Another interesting thing to look at, assuming the data is correct.

      http://www.cdc.gov/obesity/data/trends.html

      In 1990, not state had an obesity rate over 15% (though 6 state had no data)
      In 1996, no state had an obesity rate over 19%.
      In 2000, no state had an obesity rate over 24%

      Obesity has more than doubled in just 20 years in the U.S.

      “In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more.”

      I am curious what the differences (lifestyle, diet, environ, economics, etc.) are between the 13 lowest states (20% obese), and the 12 most obese states (+30%).

  24. sdehne says

    My theory from personal experience and extensive reading over the past 30 years: stress is the underlying culprit for all dis-ease – including obesity. I posit that smokers who don’t get lung disease are people who are calmed greatly by their smoking, and don’t have a lot of other stress in their lives. The best way to deal with stress? Intense physical activity OR intense physical inactivity/meditation OR intense laughter – I love Chris’s idea about making FUN a part of your everyday life – lose the fun, lose your life, I think?

    I gained 30 pounds in 3 months 25 years ago, despite all thyroid tests being within “normal” limits and no change to my diet (except for perhaps eating LESS!). In the 6 mos. prior, my husband lost his job, we moved ourselves & 3 kids 3x (including cross-country), sold & purchased a home, one child had to have hernia surgery, and we moved in with my parents (and a father who was abusive.) The other key thing that went missing from my life during this time was regular exercise AND laughter……

    If you just look at the mobility in the US since 1970′s (moving is stressful, ask a military family!) and the technology that has allowed us to become a nation of watchers, as opposed to doers (we have to be entertained!), coupled with the addition of highly processed “fast” food (when I was a kid the only fast food was making your own peanut butter & jelly sandwich to take with you when you went outside to play after school) and you have a great recipe for diabesity.

    At 55, and morbidly obese, I am re-learning how to play from my toddler grandkids – avoiding gluten, sugar/processed foods & most fruits, and trying to figure out how to parent an adult child who is mentally ill/neuro-atypical who lives with me – a non-ending “stress piece” of my life. It is probably too late for me to regain the physical vitality of my youth given my weight status – but I am SO appreciative to have found the Healthy Skeptic (via Kathleen DesMaisons – “Potatoes not Prozac”) and scientifically-based blogs, opinions, insights! Keep up the great dialogue, Chris, and congrats on your new parenthood – the best education you get will be from her!

    ps – still love the “Healthy Skeptic” title – hate to see it go………

  25. Daniel Weber says

    Here is an interesting abstract on the issue of gluten
    Hansen AK, Ling F, Kaas A, Funda DP, Farlov H, Buschard K. Diabetes preventive gluten-free diet decreases the number of caecal bacteria in non-obese diabetic mice. Diabetes Metab Res Rev. 2006 May-Jun;22(3):220-5.

  26. carol says

    I propose that we change the acronym for HFCS per Barry Groves’ suggestion (from a Sept 2010 post on his blog http://www.barrygroves.blogspot.com):

    “The Corn Refiners Association (CRA) has been trying for years to make high fructose corn syrup (HFCS), which I prefer to call the ‘Corn Refiners Association Product’ (CRAP), as acceptable as all other forms of sugar.” and he goes on to talk about their re-branding efforts to begin calling it corn sugar… but I much prefer CRAP!

  27. says

    I love the tone of his article! It seems that obesity is a product of our modern diet, but that the cure for people who have it may not be so simple. I love that you challenge your readers to question our hypotheses and stop being so arrogant about our beliefs.

  28. Daniel Weber says

    The ongoing issue of specific foods may be missing the point, it’s how the body deals with the foods. Research on stress and inflammation demonstrate this may be the key issue, not the food we eat. For example: Circulating IL-6 stimulates the hypothalamic–pituitary–adrenal (HPA) axis, activation of which is associated with central obesity, hypertension and insulin resistance (Yudkin et al, 2000).
    Environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abdominal obesity with its associated co-morbidities. The activation of the HPA axis and the sympathetic nervous system have been utilised as objective measurements of stress reactions and elevated cortisol, particularly when combined with secondary inhibition of sex steroids and growth hormone secretions, which causes accumulation of fat in visceral adipose tissues as well as metabolic abnormalities (Björntorp , 2001).
    Also, low HPA axis (burnout) and locus ceruleus–norepinephrine (LC/NE) activity, fatigue, depressive symptomatology, hyperalgesia and increased immune/inflammatory responses to stimuli are pathophysiologic effects of the dysregulation of the stress response, which may result in vulnerability to several disease entities, such as anxiety or depression and chronic inflammatory processes including GI function (Tsigos & Chrousos 2002). Certain exteroceptive stressful life events have been associated with the onset or symptom exacerbation in some of the most common chronic disorders of the digestive system, including functional gastrointestinal disorders (FGD), inflammatory bowel disease (IBD), gastro-oesophageal reflux disease (GORD), and peptic ulcer disease (PUD) (Mayer,2000).

    Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut 2000;47:861-869 doi:10.1136/gut.47.6.861
    Tsigos C & Chrousos GP. Hypothalamic–pituitary–adrenal axis, neuroendocrine factors and stress. J Psychosomatic Research. Volume 53, Issue 4, Pages 865-871 (October 2002)
    Yudkin JS, Kumari M, Humphries SE & Mohamed-Ali V. Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link? Atherosclerosis. Volume 148, Issue 2, 1 February 2000, Pp 209-14 doi:10.1016/S0021-9150(99)00463-3
    Björntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obesity Reviews. Volume 2, Issue 2, pages 73–86, May 2001. DOI: 10.1046/j.1467-789x.2001.00027.

  29. carol says

    I’ve been doing a lot of internet research on hypothyroidism and various treatments. In the process I came across Dr. Derry, a former brilliant Canadian researcher who later became a brilliant GP… and learned much from his patients. He did a lot of research on iodine deficiencies and modern diseases, especially cancer… and in fact wrote a book after he retired called Breast Cancer and Iodine…. and described patients he had treated with iodine (Lugol’s) and their subsequent remissions.

    I have found his work fascinating and in doing some further research tonight came across an article of his (in response to a reader question on Mary Shomon’s thyroid.about.com site) where he lays out an hypothesis for the fact that Japanese are heavy smokers yet have a very low lung cancer rate, which several people commented on upthread.

    Here’s the link, see what you think… it sounds highly plausible to me:
    http://thyroid.about.com/library/derry/bl10.htm

  30. carol says

    ps…. the link I just posted also addresses a link between asthma and hypothyroidism… and that he treated asthma patients with dessicated thyroid with good results…

  31. Ron says

    Chris: this blog post reminded me of something I read in “The Web that has No Weaver”, a book about Chinese medicine. Patients that were diagnosed with angina by Western doctors were sent for examination and treatment by traditional Chinese medicine doctors. The TCM doctors found five different distinct patterns among the patients, with different herbs prescribed for each pattern (BTW: the subjective improvement was 91%). This shows that though the symptoms were the same, the underlying mechanisms were completely different. Great blog.

  32. says

    Thank you for an helpful article and great discussion in the comments section. It is indeed complex. I will throw one more element into the mix, primarily based on my own experience, and that is the danger of extreme diets causing the body to go into ‘starvation mode’ and ultimately making it worse. I’d gone down to one small meal a day (I know, none of you would ever recommend or do such a thing! But I was young and ignorant and it was 1974) and I still couldn’t lose the last 15 pounds. A change in roommates brought about a change in diet (being a bit of an eating chameleon) so I was easily eating two or three times the amount – and I started losing the weight. I learned I need to feed my body early in the day to reassure it “we’re getting food today!” Almost as if I have to trick it into burning calories…. My point: avoid starvation mode because at least some of us were designed to survive the long famine.

  33. says

    This is fascinating stuff! I think the point that everyone is missing but which is hinted at nicely in the article is the principle of individuality. Everyone is different. What works for one person will not necessarily hold true for another (“one man’s food is another man’s poison”).

    Whilst high protein / fat and low carb works well for many people, there is no, ‘one size fits all’ prescription for health and optimal body composition. Some people just thrive on carbs and can’t tolerate high protein and fat diets. Eating like this won’t make them obese. This individual variation is the basic principle of metabolic typing.

    Another thing is that people don’t distinguish between ‘good’ carbs and ‘bad’ carbs ie. natural, vegetable based carbs vs. refined carbs. This is an important point. So, the problem never was carbohydrates (the blanket term) per se.

    Olly

  34. Kirill says

    I’ve yet to see the “whole foods diet and resistance exercise” fail in this respect. In our 20th century world where carbs come from wheat and fructose along with fats derived from seed oils and corn or soy fed animals, it’s no wonder entire macronutrient groups became demonized. Of course there’s no single treatment for obesity. That’s because there’s no single cause for it either.

  35. Stephen says

    Good post, much like Chris Masterjohn’s today. So…..this all seems to be bring us back to…where was that again?

    Anyway, I’ve decided to follow my grandmothers advice (which sounds a lot like Michael Pollan’s): Eat when you’re hungry, don’t eat seconds, don’t snack, don’t eat too many deserts. Tempered by eat real food, mostly plants.

  36. trina says

    I read the Shangrila Diet and it had a really interesting take on food palatability, the complexity of which seems to be totally lost in the “eat bland food” recommendations. In fact, experimenting and trying out new foods was a recommended part of the plan, as the body doesn’t trust new flavours in the same way that it likes and remembers and craves comfort food. This is kind of the French Women don’t Get Fat concept. And interestingly, the author was in france when he came up with the idea.

    Also, bland food eaten to promote weight loss, had to be completely tasteless and kept free from all flavour for an hour on either side to avoid associations with it, as these associatons are learned and change over time.
    And another thing, “palatable” and “delicious” don’t mean exactly the same thing. (Remember the macdonald’s burgers with dijon and how they had to sell them as “adult” because their audience can’t stand any kind of flavour). All of the bland but high calorie food at macdonalds gets associated with specific strong flavours such as the coke and ketchup, but in general the food is generic and tasteless. It’s more about the texture and how it chews easy and goes down easy. They spend fortunes figuring out how to make all of the food form a bolus quickly so it’s swallowed quickly. It’s like baby food. It’s not gourmet food with complex flavours and texture. And it’s exactly the same everytime, so it’s extra easy to swallow. I recently ordered a bunch of unknown dishes at a japanese restaurant, and there’s nothing like that to realize how slowly one can eat when the food is new to you, compared to how quickly a familiar fast food goes down.
    Anyway, I am butchering the book and the concepts, but reading that eating chicken breast and rice with no flavourings is the way to lose weight is so …. lame! specially as you will probably learn to associate even that amount of flavour with calories, and then what do you do? there isn’t anything blander!
    I personally think that palatbility is an interesting concept but I think malnutrition in spite of high calorie intake has to be part of it too, and triggering any kind of starvation response, even with a low carb paleo, is disastrous. I recently was on the gaps protocol and was doing good and then had a couple of days where I under ate and wham! I was waking up with anxiety and my heart going crazy, and starving and gaining weight no matter what I ate. I dealt with it by just eating a lot of good food, as much as I could but kept it all paleo, until everything calmed down. About a week of eating 4 meals a day and then suddenly one day it all felt like too much food. Gained a couple of pounds, but now settling back down into weight loss.

  37. NicL says

    After having been a collegiate level athlete and graduating college eating the same amount and combination of food with little to no exercise, I gained 70 pounds. I realized my mistake and took my food intake down and my exercise up. I have successfully lost the 70 pounds plus more. I eat mostly healthy foods with the occasional pizza or burger, and try to make fresh foods for meals rather than using packaged. All that said, this is what worked for me specifically, true, but I think your sole focus on food intake is not correct. Our culture slowly throughout the 20th century became a culture of instant or very fast gratification, with processed foods but mostly in the way we live our lives by means of working our bodies. We drive cars, sit at desks, stare at television screens, and we forget that our grandparents or their grandparents did not have this kind of lifestyle. Yes we should look at food, but we should also ask ourselves if we are exercising our bodies enough to warrant the amount of food we consume. Moderation is key.

  38. Wang says

    Perhaps it is chronic high-carb intake that is a culprit? According to T.S. Wiley (author of Lights Outs: Sleep, Sugar, Survival) when we’re eating high-carb throughout the year, that tells our body we are in perpetual summer, which ages us 4x faster. Wiley even says that the reason Atkins doesn’t work long term is because it’s chronic low-carb (apparently the two were friends and Atkins asked her why his diet stopped working). Chronic anything might be bad for us.

    Our ancestors had to eat what was in season. Summer allows for more carbs, winter allows for mostly animal food.

  39. Janknitz says

    In regards to Jason’s Inquiry “Are there any cultures that become obese without a large intake in added sugars and/or wheat?”

    How about native Hawaiians before Europeans came to the islands? They wanted their royalty to be extremely fat, but they managed to be very fat without grains or refined sugars. Diets were primarily pig, seafood and fish,fiberous vegetables, starches (taro, breadfruit, etc), coconut and fruit. How did the alii get so fat????

  40. says

    EXCELLENT article, Chris. I just saw this now. It is very true that the unknowns about obesity are far greater than the knowns.

    One of the knowns is that the genetic component of obesity is almost equal to that of height ( and possibly equalling it) , as Dr. Jeffrey Friedman has demonstrated. he is one of the foremost experts on obesity in the world- a true genius.

    The good scientists always admit there are many things that we do not understand about our body’s weight regulation systems that make long term weight loss exceddingly difficult. Dr. Linda Bacon and Dr. Jeffey Friedman are great.

    Here is a VERY extensive review of the literature on weight management, none of which supports the popular media view :

    http://www.nutritionj.com/content/9/1/30

    Thanks for adressing obesity.

    Take care,
    Raz

  41. selena says

    excellent article.
    i think that obesity is really one of those things were lots of people (including scientists) are so convinced they ‘have it figured out’ that they will go very far to block out any data that does not fit with their own conclusions.
    i always felt that the notion of obesity as ‘your own fault’ plays a very large role in this: people like looking down on other people (‘he is a lazy slob who should just eat less/healthier/a particular kind of food’) and hate being looked down upon themselves (‘my weight is not caused by me being a lazy slob’)

  42. Kennen Neil says

    Respectfully, I think you’re using a lot of faulty logic here. First, it doesn’t matter that some people can consume high levels of carbohydrates and not get fat when discussing the causes of fat gain. However, this group can be helpful in understanding the causal mechanisms. Yes, people are different and therefore their bodies will react differently under different scenarios. However, while not everyone who consumes excessive carbohydrates (>100g/day) has a high body fat percentage, EVERYBODY with a high body fat percentage got that way while consuming excessive carbohydrates. Bottom line: You’re confusing “cause” and “causal mechanisms”.

    Second, you assume that the reverse logic of the hypothesis (consuming excessive carbs increases body fat %) must be true. In other words, you insinuate that carb restriction must result in fat loss in order for the hypothesis to be true. However, this logic doesn’t account for the possibility that consuming excessive carbohydrates might cause irreversible damage to a body’s ideal state. Such damage (thyroid issues for example) can make losing body fat near impossible. However, that doesn’t negate the hypothesis.

    Bottom line: EVERY person with high body fat percentage got that way while consuming in excess of 100 grams of carbohydrates per day.

    • Shulamit says

      Kennen,

      Well-stated logic.

      However, please cite your final assertion.

      It seems to me that fats are a major issue, but are not carbs, and glycemic index (GI) of food has a lot to do with modern obesity, maybe even more than carbs in general. Given those two issues, saying EVERY, strikes me as hyperbole. It seems to me, that someone who eats lots of fatty meats and lots of salads drowned in high-fat salad dressings (even if they are sugar free), and consumes fewer than 100 grams of carbs, but the ones consumed are high GI (like drinking some Gatorade) could still get a high body fat percentage.

      Yes, that kind of diet would be odd, but it is a modern oddity, brought on by the fear of carbs.

      My point is, without citation of the word EVERY, it seems conceivable that there could be exceptions to your assertion. But if your assertion can be cited, I would be highly motivated to read the citation(s).

  43. Michael says

    You know, while I agree in general with the message, I don’t actually agree with the title- Because there is a simple way for anyone without a legitimate medical condition to lose weight.

    Eat less and work out.

    The problem isn’t that we don’t know how to get into better shape and better health- It’s that a lot of the people who suffer from obesity find it too difficult to put the work in to change their lifestyles and become more active and healthy.

    There’s also a lot of coddling around the subject- “It’s fine if you’re fat, so long as you’re happy,” “You’re beautiful -because- of your corpulence,” etc. This is blantantly untrue- Being fat is not healthy or attractive- but we still tell people it’s fine because we’d rather let them kill themselves through complacency and consumption than make them feel bad.

    This isn’t a popular opinion- But I’d rather hurt someone’s feelings than let them kill themselves slowly. Perhaps that’s just me.

  44. says

    If there were a thunderous applause icon I’d be using it right now! You echoed my sentiments exactly, especially in the last paragraph! Thank-you, thank-you, thank-you!

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