
The Obesity Era - mshafrir
http://www.aeonmagazine.com/being-human/david-berreby-obesity-era/
======
boneheadmed
As a practicing Endocrinologist I will go out on a limb and say excess
carbohydrates are the problem leading to obesity. Sugar (or sucrose) is a
particular problem as it will stimulate insulin release from the pancreas.
Insulin promotes storage of glucose and I am convinced, the growth of fat
cells. I have seen patients lose a tremendous amount of weight (34 lbs over 7
months) and lower blood glucose and their amount of diabetes medication simply
through cutting out sugar and flour. They also reduced their overall
carbohydrate intake. I presented the data at our annual Endocrinology
conference recently.
[https://endo.confex.com/endo/2013endo/webprogram/Paper9044.h...](https://endo.confex.com/endo/2013endo/webprogram/Paper9044.html)

~~~
eightpersimmons
This doesn't address what I think was one of the most interesting points in
the article - weight gain is present even in lab animals with strictly
monitored diets.

The implication being, of course, that this isn't the whole story, and we are
doing ourselves a disservice by chalking up everything to diet.

(I don't mean to say you are wrong about this fact by any means - I'm not any
kind of expert, and you sound very convincing.)

~~~
mixmastamyk
I was thinking about that myself and came up with the idea that perhaps their
diet _is_ changing.

I wouldn't be surprised if laboratory food was centralized around corporations
just like human food. Meaning, I bet cheaper ingredients (more wheat/corn)
have made their way into it over time. I can't imagine such peripheral
industries not being affected.

~~~
nwhitehead
This is an interesting hypothesis. It wouldn't even have to be changing
percentages of ingredients, it could simply be the result of increased
agricultural efficiency and yields. 100 calories worth of corn feed is quite
likely to be subtly different in composition today than decades ago.

~~~
mixmastamyk
Yes, pesticides and packaging are thought to be possible factors too.

------
mixmastamyk
Interesting. My anecdote comes from a slightly different angle. I've always
been in very good shape, lots of weightlifting and cardio my whole life, and
been a very healthy eater. But, the "spare-tire" was always there, even with
muscles bulging underneath.

Just for kicks I decided to try Steve Gibson's recommendation to remove sugar
and starch from the diet.
([https://www.grc.com/health/lowcarb.htm](https://www.grc.com/health/lowcarb.htm))

No knee-jerk here please, this isn't one of those butter-bacon-cheeseburger
things. Nope, I eat tons of fresh veggies, lean meats, all smothered in olive-
oil, nuts/flax, etc. I do actually allow myself some treats on the weekends
for sustainability.

Still, one month later, for the first time in 20 years I no longer have a
spare-tire. It makes perfect sense now that I think about it. As long as you
fill yourself with sugar/starch you prevent the body from being able to go
into fat-burning mode. Eat too much (as is common) and you go into fat-storage
mode.

Bread may have built civilization, but now it builds waistlines.

~~~
johnrob
Bread now builds waistlines only because we eat too much of it. I would be
surprised if a normal sized person gained weight eating mostly carbs but
staying below 1500 calories per day.

~~~
mixmastamyk
You're right on some level. But given that sugar and starch are packed into
all processed food, I think it makes that level of calories difficult to
sustain for most people. Note that the blood-sugar-rollercoaster that cheap
carbs give makes you ravenous at the trough. An additional factor in why we
eat too much of it.

Meanwhile after an example lunch of fish, veggies, and olive oil I feel full
and satisfied almost all day (with the same range of calories).

------
falcolas
Interesting read; I've encountered many of the problems signaled out here.

I'm overweight, and I've changed my life and my diet to try and fix it. When I
took note of where I was, I was drinking between 4 and 8 mountain dews a day.
I ate candy in prodigious amounts, and constantly ate until I was full.

Since then, I altered my diet and eating habits to where I drink no pop, and
rarely have any kind of sugary treat. I eat only until I'm satiated, and in
usually get out to exercise daily.

The end result? I'm the same weight as I was before. My weight has not changed
in over 9 years now.

I sure I could go on a starvation diet (< 1,000 calories a day) and exercise
for hours on end - it's worked to a limited degree in the past - but that's
not willpower, that's torturing myself. The last time I tried, I was
constantly tired and sickly, and after coming down with a nasty bout of the
flu and recovering from it, all of my progress had been lost.

I've come to terms with my weight. I'm eating healthy, I'm exercising
regularly, and I'm thinking of getting into a gym and working on my strength a
bit more. I have accepted that getting to a "normal" weight again is not
within my reach, unless something outside of my control changes.

[EDIT] Before critiquing my story with the usual tropes of "you're still
eating too much and exercising too little", please read the entire article and
realize that it may not be the perfect answer you think it is.

~~~
eightpersimmons
This is one of the most frustrating things about how we, as a society, talk
about obesity - we act like you can know something meaningful about a person's
lifestyle and health from a single glance. Not to mention the related
assumption that a thin body is inherently desirable and worth striving for.

A measurement like BMI, which is a great way of looking at a population, is a
terrible way of understanding an individual, and the use of weight and BMI as
a stand-in for health is infuriatingly wrongheaded.

~~~
joelrunyon
I'd argue that most people - other than knowing they're overweight - know
little about their lifestyle as well (or at least they don't know it as well
as they'd like to think).

The prevalence of quantified self & self-tracking is starting to change this &
when you're able to measure & track inputs better, you're better able to
correlate the results with them as well.

------
foxylad
My friends, I have discovered a miracle cure for weight gain. It's simple,
painless, and you don't have to cut out whole food groups. Best of all, I'll
tell you what it is - here and now - at no charge! Here it is...

A SMALL PLATE.

That simple. Go out and buy a really individual side-plate, and make that what
you always eat off. If you need seconds, OK - but after a few days you'll find
that you can actually get by quite happily with one helping.

I'm sure we do eat too much sugar (way too much), but we eat too much
_everything_. I started putting on weight when I was 40, and this is the thing
that stopped it. It would be fascinating to measure our grandparent's plates,
and what size meals they consumed. Despite a more active lifestyle, I bet they
ate far less.

~~~
Dewie
> I started putting on weight when I was 40,

A late bloomer, huh... did you stay active your whole youth and then stopped
for some reason? Or did you have an I-can-eat-anything-I-want metabolism in
your youth which then petered out a little? I do wonder...

~~~
foxylad
A little of both, I think. It coincided with a more sedentary job, but I've
noticed a lot of small aging-related changes in my body (nostril hair going
crazy, fingernails getting rougher, that sort of thing) at about the same
time, and I don't think they are related to the job.

------
gummify
I saw on the news today that 70% of the US is a size 14 or larger now.
Shocking. In addition to the need for sugar and starch reduction, a lot of
grocery foods are not as natural as we think they are. Having lived in
European and Asian countries I can say that the people there are less calorie
conscious and sometimes eat more than Americans do but their food options and
ingredients seem more wholesome and less processed than in North America. Is
it worthwhile to investigate who controls the health standards in
manufacturing of food?

~~~
nsxwolf
What is a size 14? That's the size of a woman's dress in the United States,
but certainly not anything for man (maybe very large shoes). What standard are
you going by?

Also, sizes in the US are pretty much all over the map. Pants sizes in the US
are measured in inches, and they can easily be 4 inches different than what a
tailor will measure with a tape measure.

~~~
gummify
I was going by a woman's US dress size. This would equate to a woman's Large
and approx. 32" waist. For men, the average suit size is now a US 44.

------
asteli
The article points to by-products of industrialization (namely industrial
chemicals and artificial lighting) as potential culprits in the case of rising
obesity, but the distribution of obesity doesn't match level of
industrialization across countries. Obesity is seemingly focused in North
America plus other anglophone countries, while mostly absent in other highly
industrialized countries like Japan and Norway. Red herring, perhaps?

~~~
snogglethorpe
Hmm, well one thing I've noticed is that people in Tokyo walk/bicycle _a lot_
more than most people in any American city I've lived in. Not intentionally,
really, but simply as a side-effect of the non-car-oriented transportation
system and urban design that results in highly walkable environments.
Anecdotally, co-workers who had temporary assignments to other locations where
they drove everywhere complained of gaining 5-10kg over the year or so they
were there.

I regularly see things in Japan like dressed-up women in high-heels, elderly
people, and other non-particularly-athletic-looking types, sprinting up long
staircases to make the train. In the U.S. I would be quite surprised to see
_anyone_ sprinting in public...

Portions also often seem to be smaller. While of course it's easy enough to
order large portions in Japan ("oomori kudasai!"), there's far less of the
feeling of hard-to-avoid excessively large portions I often seem to get in the
U.S. In Japan, "small" always seems to be on the menu, and is often the
default; in the U.S., not so much...

I think it's important that such things are not unusual and "intentional"
actions that you have to remember to do (and can easily shirk), but rather are
a side-effect of the environment, and so happen all the time, even when you're
tired, even when you're busy, even when you're out with friends to play, etc.

------
null_ptr
People that lack analytical thinking are doomed. They are preyed on from every
angle by unscrupulous companies peddling their processed garbage. No sandwich
without mayo, no salad without dressing, no food marketed to children without
loads of sugar and artificial ingredients. Entire aisles of frozen fatty
foods, entire aisles of soda and chips. Shelves and shelves of sugar-laced
yogurt. The key lies in the individual's hands, but governments must step in
and put an end to the criminal businesses that peddle their poison to a
largely ignorant population.

~~~
nsxwolf
Who in their right mind would eat a sandwich without mayo, or a salad without
dressing? Come on. Mayo and salad dressing predate big evil corporations, you
know.

------
enraged_camel
The mechanics of weight gain and loss are fascinating. Every time I read an
article like this it makes me appreciate the complexity of the human body even
more.

That said, the issue as a whole is not rocket science, and should not be
treated as such. While it is very interesting to examine and discuss how the
human body treats various types of calories, at the end of the day the closed
system that is the human body is still governed by calories in minus calories
out. It is _impossible_ for someone to continue to gain weight if they are
eating less calories than they are consuming. Literally. Impossible.

The problem is one of human psychology, both at the calorie consumption side
and calorie burning side.

On the consumption side, there are two main causes. First, for overweight and
obese people, the act of putting food in their mouths and drinking high-
calorie drinks has become so second nature that their minds simply stop
registering it after a while. This is why in scientific studies and surveys
that examine the topic, overweight and obese participants massively under-
report what they ate throughout the study while those who have trouble putting
on weight (the so-called "hardgainers") over-report it. The mind underplays
the importance of events and situations it is familiar with (such as eating)
and vice versa.

The second reason is that even when people do pay attention to how much they
are eating and count the calories _at that moment_ , they are terrible at
estimating their daily or weekly intake. They try to do "mental accounting,"
the most common example being "I ate a salad at lunch today, so it's OK for me
to order some fries at dinner." For obvious reasons, this approach fails hard.

There's also the calorie burning side. Just like most people are terrible at
estimating how much they are eating, they are also terrible at estimating how
much they are burning. For example, walking counts as exercise for a
surprisingly large number of people, yet walking for an hour straight at
moderate pace burns only about as many calories as in a slice of bread. And
yet the mental accounting comes into play afterward during dinner and they
justify their bad habits by telling themselves they exercised that day.

There are other issues, such as the way food companies manufacture their
products in very specific ways so as to maximize their consumption, or the way
they market to children. But in my opinion these are at the periphery.
Ultimately the matter is about the individual. It's about how much they
individual eats. Not what they _say_ they eat, but what they actually eat.

~~~
nsxwolf
There's also skinny people who burn calories for no apparent reason, like in
the Vermont Prison Overfeeding Study.

I do not lose weight on low calorie diets, period. I get hungry and sick and
cold for weeks on end, and my weight does not budge. My most successful
periods of weight loss have been on high fat, zero carb, very high calorie
diets. I know what I was eating - I measured everything correctly, regardless
of all the patronizing "fat people are unaware of how much they really eat"
talk.

~~~
enraged_camel
The Vermont Prison Overfeeding Study actually perfectly explains what you
experience on low calorie diets.

[http://idealbodyweights.blogspot.com/2009/08/vermont-
prison-...](http://idealbodyweights.blogspot.com/2009/08/vermont-prison-
overfeeding-study.html)

"The rapid weight loss these prisoners experienced is the mirror image of what
happens when overweight people try to lose weight. If your set point is too
high and you try to lose weight quickly, your body will fight to defend that
weight and slow down your metabolism. But if your set point is within a normal
range, your metabolism will speed up when you gain weight quickly."

In other words, if you have been fat for a while, then drastically reducing
calories will cause your body to fight the changes, which will make you feel
sick and cold for a while. That said, adjustment is inevitable.

Low carb and zero carb diets are great for losing weight reliably though,
because without carbs the pancreas does not secrete insulin, which means your
body cannot store the excess calories in adipose tissue. So it either has to
burn it or excrete it.

~~~
jacques_chester
You are wrong. The body can and does assimilate dietary fat into adipose
tissue.

Low-carb diets work by reducing total dietary calories; a secondary
contributing cause is satiety from an increase in protein.

~~~
enraged_camel
How does it do that without insulin?

~~~
magnusson
Acylation Stimulating Protein

~~~
enraged_camel
ASP stores fat in adipose tissue, but it's nowhere as effective as insulin.
ASP secretion is controlled by chylomicrons, which are very short lived, and
that makes it so that only a very limited amount of dietary fat can be stored
as body fat.

~~~
magnusson
>a very limited amount of dietary fat can be stored as body fat

In the complete absence of insulin, maybe, which is almost never the case in
normal dietary conditions, since both protein and carbohydrate stimulate
insulin secretion. But dietary fat is nonetheless the primary source of body
fat; direct conversion of dietary carbohydrate to body fat is not a
quantitatively significant process in humans except for in extreme conditions.
See De novo lipogenesis in humans: metabolic and regulatory aspects.
[http://www.ncbi.nlm.nih.gov/pubmed/10365981](http://www.ncbi.nlm.nih.gov/pubmed/10365981)

"Only when CHO energy intake exceeds TEE does DNL in liver or adipose tissue
contribute significantly to the whole-body energy economy."

------
jacques_chester
The preponderance of evidence is that net caloric balance predicts weight.

[http://examine.com/faq/what-should-i-eat-for-weight-
loss.htm...](http://examine.com/faq/what-should-i-eat-for-weight-loss.html)

Given the choice between "astonishing phenomenon never before detected in
history" and "record-keeping errors", I know which horse Occam is telling me
to bet on. And it's not that HFCS has more Higgs bosons.

~~~
mietek
Have you actually looked at the studies cited, and checked the
fat—protein—carbohydrate ratios used?

For example, this 2009 study used the following ratios to conclude "low-carb"
diets aren't better than regular reduced-calorie diets:

20%—15%—65%

20%—25%—55%

40%—15%—45%

40%—25%—35%

[http://www.ncbi.nlm.nih.gov/pubmed/19246357](http://www.ncbi.nlm.nih.gov/pubmed/19246357)

None of these are actually low-carb. The recommended ketogenic ratio is:

60%—35%—5%

Try Peter Attia's Eating Academy for some highly informative reading:

[http://eatingacademy.com](http://eatingacademy.com)

~~~
jacques_chester
You've missed the point, which is that body mass is directly predicted by
total calories and is not statistically distinguished regardless of
macronutrient composition. There are multiple studies listed, you just picked
one.

Review articles come to the same conclusion:

[http://www.ncbi.nlm.nih.gov/pubmed/15351198](http://www.ncbi.nlm.nih.gov/pubmed/15351198)

~~~
mietek
>
> [http://www.ncbi.nlm.nih.gov/pubmed/15351198](http://www.ncbi.nlm.nih.gov/pubmed/15351198)

I don't think this citation supports your point of view.

~~~
jacques_chester
> _A systematic review of low-carbohydrate diets found that the weight loss
> achieved is associated with the duration of the diet and restriction of
> energy intake, but not with restriction of carbohydrates._

Put another way: ketogenesis isn't a magic escape hatch from physics. If you
eat foods rich in protein, you are satieted sooner and total calories consumed
falls.

 _Total calories consumed falls._

That's what causes the weight loss. Not a particular hormonal-metabolic
configuration.

~~~
mietek
So, you're saying that it's actually easier to lose weight with a low-carb
diet? Well, then, glad we agree.

As for the "calorie is a calorie" point of view, I recommend reading the
following:

[http://eatingacademy.com/nutrition/do-calories-
matter](http://eatingacademy.com/nutrition/do-calories-matter)

~~~
jacques_chester
We're arguing about different things. Some people do genuinely believe that
ketogenesis is on a per-calorie basis somehow better at losing weight due to
the distinct hormonal configuration. But the effect is totally predicted by
net calorie balance, whether or not that balance is within observability (I
can't, for example, control for my own particular thermic reaction to protein
vs carbs, can't control for variation in food density blah blah blah it's on
the average).

Myself personally, I like to eat substantial food and I train hard, so high
protein, high carbohydrates suits me to a T.

------
pasquinelli
"Dear obese PhD applicants: if you don’t have the willpower to stop eating
carbs, you won’t have the willpower to do a dissertation. #truth."

ha, what a jerk.

