Review & Critique: The Skinny on Obesity ~ Intro and Part I

Staying true to one of the founding missions of the Asylum, there's a YouTube series entitled The Skinny on Obesity, from University of California, that deserves critical attention.   If you're going to put forth science to explain obesity and associated disease, especially in the affirmative sense ("fact", "we know", "is" rather than "possibly", "probably", "evidence supports"), it should be correct to the best of current knowledge.   I've made it through five of the episodes to date, and sad to say, this series falls far short of that mark.  

Thus far, there have been three contributors:  Dr. Robert Lustig, Elissa Epel, and Barbara Laraia.  Almost everyone is familiar with Lustig, the last two listed as affiliated with The Center for Obesity Assessment and Study at UC but we learn nothing about their backgrounds.   By far the major contributor to the science is Lustig and he gets some basic things so horribly wrong they must be called out.  Lustig became an instant star in LC circles with his viral fructophobic YouTube video.  YouTube fame is one thing, but this series, put out by University of California, and media appearances like on 60 Minutes (that I did not see) are evidence that this man IS mainstream, and his Nature article and recent public statements can leave no doubt he is highly agenda driven with draconian goals.  Therefore it is important to examine the evidence he puts forth.

In this regard, I think this series is probably best viewed after first reading Alan Aragon's Fructose Alarmism (Lustig's comments are enlightening there) and Retrospective posts, as well as David Despain's interview with Dr. John Sievenpiper.  Avid low carbers might do well to read Richard Feinman's Fructophobia post as bitter pills are generally easier to swallow from folks you otherwise revere.  

So without further ado, let's take a look at Episode 1: An Epidemic for Every Body

(Lustig unless E or B)

  • Obesity is part of the human condition that's been around since before McD's and Coke
  • Obesity has been selected for because those who can store energy are more likely to survive famine
  • But it's a pandemic, that's what the bubonic plague and influenza look like!
  • How to explain epidemic of 6 month olds who aren't gluttons and sloths
  • This goes beyond personal responsibility
  • E:  We have to question model of personal responsibility and look at societal changes
  • A calorie is a calorie is sacrosanct dogma
  • Obesity caused by eating too much and moving too little, but it doesn't work, it's dogma
  • E:  What is it?  It's not just one thing, but it's the food environment
  • Fast food is fast preparing and fast eating ... the industrial global diet has taken over the world because all of our labor saving devices have actually reduced our time to attend to life
  • E:  Changes in last 30 years how we interact with food supply, sleep, stress, how we treat our animals, nutrients in soil
  • The IGD is cheap, horrible, no depreciation (10 year old Twinkie), designed to taste really good to keep people eating.
  • Perfect storm:  changed food, restricted activity (e.g. no PE in schools) and chemicals we have no idea what they're doing to our body.
  • In the 70's there was a war over sugar v. fat and we were remanded to reduce our fat intake from 40% to 30%

  • "Guess what ... we did it ... we're there".  This is a direct quote while the array of diet books from the 70s are displayed.   But the total consumption of calories and specifically carbohydrates went up, and especially sugar has gone through the roof.  
  • It was that edict that started the obesity epidemic
  • E:  It's almost impossible to eat any of these processed foods without getting added sugars because they have to compensate for the removed fat.  "I'm suspicious of any product that says low fat" {paraphrase}
  • Snackwells!  2g fat down, 13g carb up, 4g sugar increase -- Same number of calories
  • "Fat's not the problem and sugar is.  You can see where we're going here."
  • B:  Those highly palatable comfort foods are available to be reached for 24 hrs a day to add extra calories.
  • Metabolic Syndrome:  Heart disease, lipid problems, hypertension, diabetes, PCOS, dementia, cancer 
  • Everyone thinks those downstream diseases is caused by obesity and that couldn't be further from the truth.  Obesity travels with MetSyn but it's only a marker.
  • 20% obese are MetSyn free, 40% of non-obese have MetSyn -- When you do the math that accounts for 60% of America?  
  • This adds up to 75% of all healthcare costs
  • These non-infectious diseases pose a more serious threat to developing nations than infectious ones, including HIV
  • This is mind-boggling!  Staggering!  Developing countries have a bigger problem with obesity and diabetes than they do with cholera.
  • "Something is going on here" (in ominous tone)

Teasing out Myths / Setting Facts Straight

Obesity has been selected for:  
This is the Thrifty Gene Hypothesis that, to be honest, I haven't looked much into.  Bernstein says it's true, Taubes says it's not, Lustig seems to be on Bernstein's side.  Wooo pointed out in comments here a "black swan" vis a vis the Pima.  If they were subjected periodically to famines, then there should have been historical manifestations of obesity in prosperous times.  Taubes reports the Pima were "sprightly" just 150 years or so before GCBC was published while tremendously prosperous.  Therefore I don't tend to subscribe to the TGH.  However, animals do tend to give up very little that they manage to consume and absorb, as well as possessing energy/metabolite conserving adaptive mechanisms during starvation.   In general, our bodies do seem to defend against the threat of too little body fat far more than they defend against excesses. 

Eating More and Moving Less doesn't work as an explanation for the obesity epidemic 

Let me first say that whenever I hear people defaulting to the whole "gluttony and sloth" mantra, I become immediately suspect.  Why?  Because this is an appeal to emotion and the normal human reaction against feeling judged.  Gluttony conjures up images we don't equate with our "normal" overconsumption, and Biblical verses and all that.  Same for sloth.    And yet later in the presentation, Lustig speaks specifically to the fact that we are eating more.  Further, he inadvertently  infers we move less as he rattles off a list of "labor saving" devices that have become more and more prevalent and accessible in the past 30 years.  Ironically (and I find this confusing and illogical) he makes the claim that somehow cars and lawn tractors and other devices that also save time, are somehow robbing us of the time we need to prepare foods at home and attend to our health and nutrition??!!  I would also note that the cutbacks in PE classes and such were mentioned as well (not by Lustig).
The fact (yes I feel quite confident in using that word) is that the obesity epidemic is perfectly well explained by the observation that we DO eat more and move less in general.  We can quibble over why that is and what to do about it, but the fact that ELMM "diet and exercise regimes" have a high failure rate is that we're not focusing enough on building good habits and changing bad ones.  I don't expect folks will go back to using manual push-mowers and it's damn near impossible to even operate my TV without the remote control anymore, but we're going to have to figure out some adaptive mechanisms to the modern lifestyle to counter it or we're doomed!  

The Government told us to cut fat but don't worry about sugar.
At right is a food pyramid from the USDA.  We can argue over the wisdom of the base of whole grains, etc., but right up there with Fats & Oils -- to USE SPARINGLY -- is Sweets!  What Lustig is suggesting now is that the government should have targeted sugar.  Then I suppose we Americans would have done what?  Gone on butter binges?

Americans actually listened to our government and adopted a low fat diet
Come on.  Enough of this already.  If we actually adopted the USDA pyramid in any sort of majority even, the McLean Deluxe would still be on the menu, Krispie Kremes wouldn't be in existence and on and on and on.  Because if the stuff weren't being bought and consumed these companies would all be out of business.  Further, the NHANES data clearly shows we did not as a nation decrease fat consumption, it stayed relatively flat while we upped carbs.  When current intake is carefully monitored and evaluated in controlled settings, (as opposed to any sort of self report) , there's no evidence whatsoever that the SAD is low fat or that we listened.
The really funny part of this video is that array of diet books displayed with the we listened and we're there now joke (that was facetious, right??).   All but one of those books is a low carb diet!  Pritikin being the exception to the rule, and we all know how many Americans have gotten fat following the Pritikin diet!  Atkins and Doctor's Quick Weight Loss are both low carb, and Scarsdale Diet is probably what one of the Kimkins plans was based on.  All but Atkins are probably unfamiliar to most younger than around 40.    And yet this is instructive, because you see, Americans have had the supposed right tools but despite Atkins being around forever (and tried by milllions) it hasn't stopped the obesity epidemic any better than low fat fad diets have.  
When looking at that disinfographic yesterday, I also was struck by some BK nutritional info I didn't include in the post.  They have these newer burgers called Stackers -- you can get a single (380 cals, 53% fat, 32g carb/7g sugar) on up to a quad (820 cals, 73% fat, 33g carb/8g sugar). A regular burger is 260 cals, 35% fat, 31g carb/7g sugar.   Fries are about 40% fat.  So the only way Americans are eating a "low fat" meal at BK is by adding a sugary beverage to lower the percent fat.  But if you're eating those stackers, you're in Atkins fat percent land even with the bun!  And how about all those low fat yogurt consumers?  Well, they must be eating something else as well!
Lustig does make the point for calories with the Snackwells, I'll give him that.  But it's more because people don't pay attention or think LF is healthy so it's OK to eat a whole box that's the problem.  Not that we replaced a 6 Oreo pack with a 6 Snackwell pack. 

 "Fat's not the problem and sugar is.  You can see where we're going here."
Building on the last segment, the above is quite absurd in the context of Burger King offerings.  (The video series seems to focus heavily on McDonalds).  I suppose Lustig might lament why a burger contains 7g sugar, but in going from an ordinary single burger to just a single Stacker, what is "the problem"?  Fat calories.  Lots and lots of fat calories.  And more and more fat calories as you add on fatty patty upon fatty patty.  To say that fat is not the problem is irresponsible Dr. Lustig.   Clearly it's not the whole problem, and it's not inherently a problem, but when we're talking the SAD-induced obesity epidemic?  It sure as heck is A problem.  There's one obese segment of the population for which it is the problem, however.   I don't think I need to spell that out for you ...

Obesity & Metabolic Diseases
Lustig contends that obesity is merely a marker for metabolic disease.  Clearly obesity is not the cause of all metabolic diseases, but where classic type II diabetes is concerned, in the vast majority (80%) obesity precedes diabetes by a decade or longer.  I'll leave his fuzzy math on how if 20% obese are not MetSyn and 40% non-obese are, this effects 60% of the population.

The Tell
Lustig collects practically every organic disease known to man, says they are all caused by one thing, then tallies up the cost.  So in his mind, sugar causes all non-communicable ills.  Create a crisis, scare people with the mind-boggling costs -- that will affect everyone whether or not Obamacare remains in force -- run the red flag culprit up the flagpole.  Wait for it people.   The low carb movement is too scientifically bereft to get just sugar taxes enacted.  They'll come for your butter and your beef, perhaps especially so for your grass-fed beef that requires more land mass to sustain.   Let's not let this happen in the name of "science".   

More:  Part II 


Unknown said…
Unknown said…

DD: Why do you think Lustig continues to argue that de novo lipogenesis makes fructose intake a metabolic danger?

JS: When you look at someone like Rob Lustig, who, again, I actually I have a lot of respect for because I think he's well-intentioned and he's sincere about his belief. But I think his passion and enthusiasm in this area are clouding his judgment a bit. You could say the same for Gary Taubes or anyone who has kind of taken a very extreme position on the data.

If you look at the data carefully, sort out the wheat from the chaff, and look for the well-controlled data to drill down on some of these mechanisms -- OK, let's look in humans and not animals; let's look under basic normal energy balance conditions, and let's use the best or most elegant tools we have, which are stable isotope tracers -- this is the answer you get: 50 percent glucose, 25 percent lactate, greater than 15 percent to glycogen. These may vary a bit just based on the rest of the background diet and activity level of the organism or human in this case. But in general, this is the fate of fructose.

It's not what Dr. Lustig and others would have you believe -- massive influx into de novo lipogenesis to hugely raise triglycerides, overweight, obesity, metabolic syndrome. You don't see it through this mechanism. We just don’t see the signal of increase in bodyweight or even for triglycerides; only the very high doses.
Unknown said…

Perhaps where Taubes goes wrong is in failing to realize the role of muscle in body metabolism. It wouldn't be the first time. As I've discussed before in a post about the work of another kinesiologist, Stuart Phillips, Ph.D., of McMaster University, skeletal muscle is often forgotten in discussions of obesity. However, as Phillips affirms, skeletal muscle is a highly metabolically active tissue, consuming a great deal of energy, as a primary site for glycogen storage and the largest site for fat burning. Skeletal muscle mass also helps determine metabolic rate.

Taubes, in this latest article, also fails to mention that carbohydrate is not the only macronutrient that stimulates insulin. Protein stimulates insulin too; in fact, it's the branched-chain amino acids (leucine, isoleucine, valine) that trigger the insulin release -- these same amino acids are also the key players in triggering protein synthesis, which is explained in part by their effects on insulin.
Sanjeev said…
> Why do you think Lustig continues to argue

Once his arguments have been validly debunked all else is irrelevant

SO ...

IMHO the question's invalid. It invites us to start down the same path the other side uses, and eventually it leads them to conspiracy theories and other unhelpful stuff.

this always reminds me of when Mike Wallace interviewed one of my heroes[0], Ed Teller ... whenever ET was asked on others' motivations and/or reasons ET refused to answer.

[0] I'm on the opposite end of the political spectrum but that interview raised my estimation & respect for ET even higher
Sanjeev said…
> Perhaps where Taubes goes wrong is in failing

no specific error, no single incidence of incorrectness is "where Taubes goes wrong".

IMHO Taubes is justifying and rationalizing hi pre-existing conclusion. His process is off kilter so his results will be correct only by accident.
Unknown said…

When properly evaluated, the theories and arguments of popular low carbohydrate diet books like the Zone rely on poorly controlled, non-peer-reviewed studies, anecdotes and non-science rhetoric. This review illustrates the complexity of nutrition misinformation perpetrated by some popular press diet books. A closer look at the science behind the claims made for the Zone Diet reveals nothing more than a modern twist on an antique food fad.
Unknown said…
Re ELMM yesterday at MDA the topic was "I hate to exercise," which is pretty funny given it's a "primal" site. Maybe this whole industry is geared towards people who are determinedly sedentary and who aren't about to MM. If you weigh 400 pounds and will never exercise then weighing 300 pounds is a huge improvement.

If you start with the proposition "We refuse to MM" then ELMM is pretty much out the window, isn't it?

Then the question becomes "For someone who absolutely refuses to MM, what produces the best results?"

So I would like to see a study with a group of obese people who refuse, under any circumstances, to MM. What diet produces the best result for them?
Richard J D'Souza said…
It will be some time before these obesity issues are sorted out. In the meantime it's guess work.