

Why We Get Fat - simonreed
http://www.sciencebasedmedicine.org/index.php/why-we-get-fat/

======
jdminhbg
"So, why does it get warmer in the summer?"

"Because our hemisphere takes in more calories than it gives off, causing it
to get warmer."

"Well, I mean I suppose that's true in the strictest sense, but is there a
reason we can come up with tha--"

"What, you don't believe in thermodynamics? What a crackpot!"

~~~
derleth
> "What, you don't believe in thermodynamics? What a crackpot!"

Come back to me when you've heard a few people say that it is physically
impossible for them to lose weight regardless of what they do. They think they
could be eating nothing but celery and water and still maintain an upwards
trend.

Thermodynamics works. _That means it is always possible to lose weight, not
that it is always easy._

A weight-loss plan that works is an engineered calorie deficit. Calories in-
calories out is the basic outline, but you need to get the details right to
find a plan you'll stick to long enough to have a decent impact.

You can engineer a calorie deficit through diet only, exercise only, or a mix;
personally, I had very good results with something that was mostly due to a
major change in diet with no change in my exercise habits, which mainly
consist of walking for a few hours a day. Other people are actually capable of
exercising a huge amount more than they have been and making only a modest
dietary change. And there are people in between.

And then there are specific foods. Ultimately, no food is bad in itself, and
every diet has to meet _all_ your needs, including emotional needs. It can be
_easier_ to lose weight and keep it off by banning certain kinds of food, but
that is _not necessary_. Demonizing foods is psychologically unhealthy because
it leads to a sin-guilt-redemption cycle that inhibits a rational approach to
this engineering problem.

 _My point, again, is that once you get the details worked out, as long as you
actually are in a calorie deficit you will lose weight. There is nothing more
to it._ The fad diet pushers can fuck off.

~~~
Someone
I agree with your remark, but would like to make an addition: apart from diet
and exercise, there is a third variable that controls the calorie balance:
culture/customs. For example, the amount of clothing one wears and the
temperature at which one keeps ones living quarters in winter affects calories
'out', as does what one does while waiting for a cab/train/appointment
(standing still vs walking around). Those are areas where I think easy gains
can be made, even when forgetting about the elephant in the room 'get out of
your car', which, apparently, is very hard to do for many people.

And, as with all dieting related stuff, for most people, there is no need for
drastic action. Gaining 3 grams of body weight per day brings you 20 kg extra
body weight going from 20 years to 40 years of age; that is what happens to
most people. Your diet/exercise plan, similarly, is good enough if it leads to
3 grams of weight loss a day.

~~~
anthonyb
Except that it's not that easy. Your body will conserve energy if you're
hungry, making you feel colder and more lethargic. If you go without a
sweater, you'll burn more calories and end up eating more.

------
funkwyrm
The big mistake begins here:

"Simple physics requires that to lose weight, we must burn more calories than
we ingest"

THAT fallacy is how the author leads the reader in to HIS strawman argument,
that somehow Taubes is unaware of, or disregards, the laws of thermodynamics.

1) Ingesting calories is not relevant, digesting is.

2) We don't "burn" any calories whatsoever. We use various components of food
as raw materials for various biological processes. One conceptual example:
when you ingest some sort of protein, your body might break it down in to
amino acid chains and then repair a muscle fiber using those raw materials.

Talking about the human body as if it is a closed system that burns food is
just silly. We're accidentally taking our metaphors as literal. Yes, if we
literally burned all the calories we ingest, the thermodynamics argument would
be correct. However, that just a metaphor, don't mistake the map for the
territory.

~~~
jrs235
Was waiting to see someone to make the distinction between ingestion and
digestion.

Most people would consider me skinny... and I always eating and often things
that most would consider fattening or unhealthy. People will remark, "How do
you stay so skinny?! You're so lucky!"... Except, I would be willing to bet
that I have a digestive disorder. Which one? I don't know and I don't care to
find out. For the most part it hasn't/doesn't adversely affect me.

It seems that much of what I eat doesn't get digested and/or absorbed by my
body.

tl;dr; There's a difference between ingestion and digestion. I ingest a lot
but probably don't digest much of it.

Update: I have strong reasons to believe I have a digestive disorder since
they run in my family. Also, I wonder how many calories I burn from being a
"leg shaker".

~~~
robbiep
going to take this on a slightly weird angle here:

Does your faeces float or have oily discharge around it?

Malabsorption of fat is essentially defined by the clinical features that can
be easily determined.

Do you get bloated, have excessive flatulus, or discharge? All signs of
malabsorption as well.

It is relatively unlikely that people have digestive problems long term
without developing consequences as there are pretty much always side-effects
from having nutrients running around a 20m track inside your body loaded with
bacteria but not being taken into your body.

What you don't absorb, your bacteria will run riot on, with subsequent
symptoms;

And if you have a fat malabsorption problem you will rapidly develop symptoms
(see <http://en.wikipedia.org/wiki/Olestra> or
<http://en.wikipedia.org/wiki/Lipase_inhibitors> for induced fat
malabsorption)

------
hunvreus
Too many times have physicians, from my point of view, fall short of common
agreement with regards to my health, especially when it comes to nutrition. I
tend to be skeptical of their opinion on the matter, more even so since I
switched to a paleo diet and literally dropped the weight that I was supposed
to be "genetically" stuck with. So have several of my friends around me.

I doubt the answer is as easy as some would like it to be, but empirically it
seems low carb diets have tremendous benefits. I'd recommend reading the
Primal Blueprint (<http://primalblueprint.com/>) for a more thorough
explanation of the theory behind it, I'll stick with with my current diet as
all indicators (including regular doctor checks) show a drastic increase in my
health.

~~~
shortandsweaty
Doctor here. I agree with you about being skeptical of physicians' nutritional
advice; we generally aren't nutrition experts and internists, especially, are
jaded by the vast number of hospitalized patients we see who have simply
abused their bodies with food and drink for decades.

That said, you echo an argument that's as useless as me telling patients
"calories in < calories out": that you switched to X diet and dropped weight,
just like "several of your friends." That's doesn't provide utility to any
public health stance. Of course, I will freely admit that I don't have the
answer, either.

What I tell my fat patients who are starting out is this (and I use these
exact words): eat the same shit you're eating now, just cut it in half. For
educated, motivated people who aren't in denial (which I'm convinced
represents < 10% of my patients), we have a more in-depth discussion about
dieting ideas that might specifically work for them.

~~~
rickdale
I lost about 50lbs this year. If someone told me to cut the shit I was eating
in half, no way in the world a "diet plan" would have worked. Explain to your
fat patients that a diet isn't eating less, its eating differently. And three
words to end this: slow carb diet.

------
rb2k_
While this is highly non scientific and very subjective, my personal
experience is pretty much exactly mirroring the article. A high-fat, low-carb
diet makes it easy to lose weight and and fat at the same time. While
running/pullups/... help with muscle definition and make me feel healthy in
general, the weight loss for me seems to be 80% related to the food I eat.

Here are the graphs:

<http://i.imgur.com/y0CJJ.png>

I lost an additional 4-5 kilos before starting to use the withings scale that
generates these graphs.

~~~
lambda
I fell like there's an awful lot of confirmation bias in people's reports of
how well low-carb diets work, just like there was back when low-fat diets were
the big fad. In general, any deliberate change in your diet is likely to lead
to results, at least in the short term, as you're paying that much more
attention to what you're eating. This is similar to the strength of the
placebo effect in medical studies; one reason it's so strong is that even the
people getting the placebo in the study are getting a lot more medical
attention, and are paying more attention to their health.

Now, I suspect that low-carb diets do actually work better than low-fat,
merely because it's easier to keep the calories down on a low-carb diet.
"Carb-loading" is a popular way for athletes to give themselves plenty of
energy to perform for a reason; carbs are the easiest way to boost calorie
intake. So if you have an extreme low-fat diet, you wind up replacing the fat
with even more calories in carbs; I can't count how many low-fat foods I've
seen that just add a bunch of sugar to make it taste better.

But that doesn't mean that low-carb is a magic wand. In fact, it's fairly
dangerous in some ways. Low-carb means you wind up replacing the calories from
carbs with fats and proteins; a lot of people eat more meat as a result.
Eating a lot of meat can increase your chances of getting certain kinds of
cancer. I've seen studies that showed that in the long run, low-carb and low-
calorie diets had about the same effects for weight loss, but the low-carb
dieters were at a slightly higher risk for cancer due to the extra meat they
ate.

I actually think that a large amount of the value of low-carb comes from
cutting out the worst form of carbs, sugars. There is an awful lot of modern
food that is being loaded with more and more sugar, especially given how cheap
HFCS is. It's a very cheap and easy way to make mediocre food taste better; so
we wind up eating a lot more sugar than our bodies can handle. Avoiding foods
that have sugar added can help a lot.

There has also been a lot of diet fearmongering over something else that has
traditionally been used to make food taste better: salt. Lots of foods are
sold as "low-sodium" ever since people started blaming salt for heart disease.
The problem is, most of the reason for that was based on correlation, where
causation had never been shown; some groups of people at higher risk of heart
disease were eating more salt, but there was never any good evidence that the
salt was the reason for the risk. Reducing salt in food has meant replacing it
with other things to make the food taste better, like sugars and fats.

There have been an awful lot of diet fads over the years. Many of them lead to
more problems than they solve, as people take them to an extreme, and wind up
replacing what they're cutting out with something equally bad or worse. And
many of them have lots of adherents who proclaim their advantages, due to
confirmation bias, while dismissing anyone for whom the diet doesn't work as
not doing it properly (the "no true Scotsman" fallacy).

In the end, "eat less, exercise more" is the best way to lose weight. Yes,
exactly what you eat can make a difference, but eating less (fewer calories)
is a pretty good first step on the way to losing weight, rather than focusing
on one particular source and winding up eating more or eating worse by doing
so.

~~~
JPKab
"with fats and proteins; a lot of people eat more meat as a result. Eating a
lot of meat can increase your chances of getting certain kinds of cancer. I've
seen studies that showed that in the long run, low-carb and low-calorie diets
had about the same effects for weight loss, but the low-carb dieters were at a
slightly higher risk for cancer due to the extra meat they ate."

I have yet to see a true scientific study that attributes cancer to high meat
intake. The "studies" that I've seen which attribute high meat intake to
cancer are observational in nature, following tens of thousands of people over
30 years, and pretending that the people who ate lots of red meat in the 70's
and 80's have the same lifestyles as those who listened to doctors and ate
more salads and fish. The kind of person who ate lots of red meat in the 80's
was the same kind of person who probably ignored all sorts of medical advice.
This inability to control for other variables is why observational studies are
horrible. I'm a huge coffee drinker, but I'm not stupid enough to fall for the
observational studies which link coffee consumption to living longer. All too
often, the people who DON'T drink coffee DO drink soda, which is a simple
example of how these ridiculous observational studies can be misinterpreted.

~~~
hazov
"following tens of thousands of people over 30 years"

That's called a cohort, it's a well studied method in statistics and depending
on the size of the sample and the number of studies you can build correlations
out of these.

As your sample gets larger the population for the proportion of heavy meat
eaters and the rest of your sample tend to normalize in almost every
variable[1], that means the median of every other observable variable will be
close to the general population's value for both groups, and you can assume
that the quantity of meat is the sole variable worthy of analysis.

Mind you that the use of statistics in health and social sciences is because
these fields are not physics, we can't find general solutions based on the
present state of affairs putting some number on a equation. How many people
will get cancer or whatever.

I doubt this was the type of study that are used in this case because a cohort
study is really expensive to conduct, generally this type of study is
conducted more using the Case-control method which makes than more affordable.

The fact that if you conduct such a study and find that heavy meat eaters get
more cancer or heavy coffee drinkers live more doesn't mean that every coffee
drinker will live more or that there will be much more heavy meat eaters with
cancer than the rest of the population, it will only means that some
epidemiological indices are higher in a group than in the other.

If you really wish to test both hypothesis you must do the same study as many
times as you can and try to use the median of these indices obtained in the
same study for both populations, the median is a robust measure and see if
they are too distant numerically one from the other.

Of course, this can still proves nothing and only find that correlations are
in fact established. It can simply be that rich people live longer and get
more cancer than the rest and both drinking coffee and eating too much meat be
associated with income.

[1]: That's not exactly true you can have confounding variables in your data,
which sadly sometimes are not included in the data, when they are you could
read the methods of controlling this developed by Mantel and Haenszel.

------
miked
>> _Rather than jumping on the low-carb bandwagon before his ideas are
properly tested, the precautionary principle suggests that it might be more
reasonable to follow a moderate diet like the Mediterranean diet (or to follow
Michael Pollan‘s stunningly simple advice to “Eat food. Not too much. Mostly
plants.”), to limit “empty calories” from simple carbohydrates like sugar, to
eat a variety of vegetables and fruits, to choose low calorie density foods
that are more filling, to limit meat intake, to limit salt, and to keep
looking for behavioral and environmental ways to change our calories-
in/calories-out balance._

Ummm, why does the precautionary principle state that we should avoid Diet X
(Mediterranean Inuit, Vegetarian,...), rather than Diet Y?

Doesn't the precautionary principle really say that nothing should _ever_
change, since we can always gather more data to further remove risk? (Except,
of course, the things the speaker really wants to change, in which case the
principle won't be invoked.)

~~~
rcthompson
The Mediterranean, Inuit, and vegetarian diets (and presumably also the Pollan
diet) are empirically well tested, because many people already live by those
diets. This makes them conservative choices. There's no guarantee that they
will work, but there is a high probability based on empirical evidence.

------
super_mario
I challenge the author to load himself on steak and saturated fats and no
carbs and come race me 100 miles on a road bike.

I burn in excess of 4000 Calories on a 80 mile bike ride. That's a kilogram of
rice on a single ride. And honestly I find it incredibly hard to eat enough
just to satisfy the energy requirements of racing. Not eating carbs and
attempting an endurance race event is just suicidal and guaranteed way to
abandon and not finish at all let alone place well.

Eating large proportion of your energy from meat is also a good way to kill
racing performance, let alone if all your energy is from meat.

But even for sedentary lifestyle, no complex carbs at all is sure way to make
yourself feel completely miserable. On the other hand living on saturated fat
and protein is a sure way to give yourself a coronary disease.

~~~
nathos
Compared to the average person, you're a bit of an outlier. If you're not
racing 100 miles, why would you consume those carbs?

If you've read Taubes' writing, he doesn't say to eliminate all carbs. He
does, however, demonize "white" carbs that have become a staple of the modern
western diet.

Even Tim Ferriss' "slow-carb diet" features legumes heavily, but eliminates
sweets, bread, and other high-glycemic calorie sources.

~~~
super_mario
I was deliberately flippant in my answer. Of course I would need to challenge
one of my racing buddies who are on the same level as I am. But no need for
that, I have tried some low carb diets (described in Ferriss' four hour body
book) in the off season to try to lower my weight, and even though they work
short term (I can do it for a couple of weeks), the performance on the bike
started to suffer immensely. I just can't keep up my watts. But that is to be
expected.

I will agree that the modern western diet is a horrible thing. I have grown up
eating typical Mediterranean diet with mostly home grown organic ingredients,
and I find it incredibly hard to continue to eat like that living in Canada.

I think the biggest problem in North America at least is economical. The fact
that certain produce like corn are subsidized by the government to the point
that they are so cheap they make it into everything where you would never
expect. This means you have to exclude certain foods altogether unless you
have the time to make them yourself every time you want to eat them, which is
rather impractical.

------
paul_f
Weight equals calories in minus calories out. This ridiculously flawed concept
is why people get fat.

It seems plausible. It's how our bank account works. Sounds like science. But
is wrong. And easy to debunk:

Have you ever sat on a toilet?

~~~
monochromatic
"Calories out" includes what goes into the toilet.

------
papa_bear
As I understand it, one of the largest factors in low carb dieting is that
carbs are less satiating per calorie than fats and proteins. Also that
simple/highly processed carbs are even less satiating, largely because they
lack any fiber. So if you aren't counting calories, you're much more likely to
eat less on a low carb and high fiber diet.

Regardless of what you do, counting calories will probably be the most
effective method for losing weight. And even then, calorie estimations are
rough, change based on how the foods are prepared, and highly dependent on
biological factors unique to each person.

I'm working on Eat This Much (<http://www.eatthismuch.com/>) as a way to
automate my own diet. It still needs some work to get to the point where I'm
never thinking about what to eat, but I've been using it to gain weight very
successfully over the past few months. Gaining weight can be a lot simpler
than losing it, but it still helps to pay attention to what you eat to avoid
putting on fat as opposed to muscle.

</stealth plug>

------
dools
This is a relevant and very informative video about the impact of sugar on
humans:
[https://www.youtube.com/watch?v=dBnniua6-oM&feature=yout...](https://www.youtube.com/watch?v=dBnniua6-oM&feature=youtube_gdata_player)

I'd say that if you were to just dramatically reduce sugar you'll get results
pretty quickly.

------
kenjackson
This is the best article I've read on dieting:

[http://blogs.scientificamerican.com/guest-
blog/2012/08/27/th...](http://blogs.scientificamerican.com/guest-
blog/2012/08/27/the-hidden-truths-about-calories/)

IMO, if you eat fewer calories than you expend, you'll lose weight. BUT I do
think that you can eat more calories than you expend and still lose weight.
Likewise, the amount of weight one loses/gains eating the same number of
calories and expending the same number is variable based on the actual person
and food.

That is to say some people/diets are more calorie efficient (which in our day
and age is generally not a good thing). Additionally, some foods/behaviors are
probably more likely to make people want to eat more/less.

We can't cheat thermodynamics, but there are other some things we can do to
make us eat less and be less efficient.

~~~
quotemstr
> BUT I do think that you can eat more calories than you expend and still lose
> weight.

Then where does the energy go? The only way you can eat less than you expend
and still lose weight is to not adsorb some of what you eat, and doing that,
while possible with laxatives use, bulimia, and certain drugs, tends to have
messy consequences.

~~~
corysama
Laxatives really are not necessary to have inefficient digestion or energy
storage. There are plenty of skinny people who have a hard time putting on
weight even though they regularly eat like hogs.

------
munger
Gotta love any explanation and suggested resolution for being overweight and
wanting to lose it that doesn't mention exercise.

If you exercise enough, your diet doesn't have to be so strict, and you're way
more likely to actually lose weight and feel good. Some rough guidelines of
eating higher quality foods helps, but certainly exercise or lack of it is
much more the root cause of so many weight/health related issues.

Most of the time it's very simple. Basic healthy eating and exercise. The
problem has always been people don't want to exercise, and there are
consequences to that.

~~~
derleth
You don't need exercise if your diet is strict enough. Doing it all with diet
might be the hard way for you but it was the easy way for me; fundamentally,
it is calories in-calories out, but you do have to look at the details, and
pick a specific plan to accomplish that goal based on the details.

------
sown
Oh god, _let's have this discussion again_.

~~~
jacques_chester
I know how you feel.

------
polyfractal
Tangentially, I don't understand why so many articles/diets get written about
weight loss. At the end of the day, _everything_ boils down to "eat fewer
calories than you expend". Given enough time, this regimen will reduce your
weight. Period. End of story.

Why must people continually try to create new weight-loss fads all the time?

~~~
travisp
>At the end of the day, everything boils down to "eat fewer calories than you
expend".

Sure, if you stop eating you will lose some weight, but, you can die of
starvation while obese. In animal studies, that Taubes cites in one of his
books, it is possible to reduce calories and the animals won't lose weight and
it is also possible to add a lot of extra calories and not become obese.

Calories have something to do with it because they are one part of the
equation. Calories in does equal calories out. Calories In = Calories Stored +
Calories Expended. But, the mistake is in thinking that the law of
thermodynamics means that the type of calories in doesn't impact the ratio of
calories stored/expended -- the variables are not independent. The content of
the food you eat impacts: your hunger, your energy level, fat storage rates,
and your metabolic rate, all of which mean that attempting to cut or add
calories may not have the expected impact depending on what the food is.

~~~
spindritf
> Sure, if you stop eating you will lose some weight, but, you can die of
> starvation while obese.

This guy[1] went for over a year on vitamins and water. He didn't die, and he
did drop a lot of weight. Actually, "prolonged fasting in this patient had no
ill-effects." Though it's probably one of those things you really shouldn't
try at home.

[1] <http://pmj.bmj.com/content/49/569/203.abstract>

~~~
glenra
Taubes gives the example of rats bred or genetically modified to be fat - if
you starve them, the body eats the heart and the brain before it gives up on
the fat - the animal can starve to death while still fat. Getting fat changes
you - a person who was 400 lbs and diets down to 200 has a very different
metabolism than a person who has always been 200 lbs. It's possible that
something we've been doing is making fat more prone to stick around than it
was in times past.

The hypothesis that the problem is too many carbs is plausible but not proven
and the full truth is certainly going to be more complex.

Starvation guy is an interesting data point in any cace.

------
recursive
If you are doing exercise for which you need energy, the fact remains that
carbohydrates can give quicker access to energy than any other macronutrient.

------
dools
Isn't this just Atkins?

