Historic Perspective on Obesity – Hormonal Obesity I

Since we know that calories are not the real problem, we can start to focus on what is really the cause of obesity (the aetiology of obesity).  You can review the calorie series here for an indepth discussion of why calories are not relevant.  The entire obsession with calories was a 50 year dead end.  We can only start to address the problem of weight loss and gain by understanding the real causes. So what is the real cause of obesity?  Let’s go back in time and see what people thought about obesity in the past.

William Banting 1796-1878 is considered to have written the first diet book.  He started off as a normal weight fellow in his teens and 20’s.  However, as he went through his 30’s, 40’s and 50’s he started to gain some weight.  Not much, but a few pounds per year.  Before long, he was age 62 and weighed 202 pounds.  Not bad by modern standards, but a real chunky monkey by the standards of that time. So, on the advice of his physicians, he tried to eat less.  But then, he felt tired, hungry and he wasn’t really losing any weight.  Then, he tried to exercise more.  He rowed the Thames and became quite physically fit.  However, he was still not able to keep the weight off. Finally, on the advice of a French surgeon, he started a new diet.  He would severely restrict not calories, but sugars and starches – what we now call refined carbohydrates.  He avoided all breads, milk, beer, sweets and potatoes.  Poor fellow loved his carbs, too. He lost so much weight and felt so well that he decided to publish his findings in “Letter on Corpulence Addressed to the Public“.  This pamphlet was really the first modern diet book.  Based on personal experience, Banting felt that it was not calories that caused weight gain, but refined carbohydrates.  Many of his ideas that sugars and starches caused obesity persisted through the next 100 years of so. Sir William Osler – the influential Canadian physician who wrote “The Principles and Practice of Medicine” – illustrates that most doctors of the early 1900’s considered that refined carbohydrates were the chief cause of obesity.  In his famous textbook, he described treatment of obesity with diets predominantly featuring meat and eggs and low in refined carbohydrates. In his 1882 monograph “Obesity and its Treatment” Dr. Osler felt that fatty foods were crucial to reducing obesity because they increased satiety (feeling of fullness). Contrast this to the modern demonization of dietary fats.  This coincides neatly with the obesity epidemic.  Maybe the good Dr. Osler was onto something after all. By the 1950’s it was fairly standard advice.  If you were to ask your grandparents ‘back in the day’ what caused obesity, they would not talk about calories.  Calories as a unit of energy was largely unknown at that time.  They would say instead, that sweets and starchy foods caused obesity. Dr. Spock’s Baby and Child Care – a bible of child rearing of the 1950s – describes the gaining or losing of weight as mostly dependent upon the amount of desserts and plain, starchy foods consumed.  Dr. Passmore in the British Journal of Nutrition in 1963 wrote the “Every woman know that carbohydrate is fattening”.  Every.  Woman.  Knows. This was no secret.  Everybody knew it. These ideas had withstood the test of time.  Common sense and empiric observation served to confirm the truth of the matter.  The ideas were “Anti-Fragile” as the great Nassim Taleb puts it.  And obesity wasn’t such a great problem back then.  This is what they thought:
Things started to change in the 1950s.  There was a perceived increase in the incidence of heart disease.  Whether this is actually true or not is debatable.  Gary Taubes argues that this was not true in his groundbreaking book  “Why We Get Fat“.  Nevertheless, people started to search for the reason behind this ‘great epidemic’ of heart disease.  Their gaze soon fell upon dietary fat. The “Diet-Heart Hypothesis” started to gain traction in the 1960s.  Ancel Keys, a very influential nutition ‘expert’ played an instumental role in popularizing these ideas.  With great enthusiasm and shaky science, the demonization of dietary fat  (a food that humans had been eating since, well, we became humans) started. There was a problem, though we didn’t see it at the time.  Dietary protein tends to remain fairly constant in human diets.  It is actually quite difficult to increase dietary protein to more than 20-30% of calories without resorting to protein bars/ shakes etc.  So, if one were to restrict dietary carbohydrates, then one must increase dietary fats and vice versa.  This is the result: Low Fat = High Carb and Low carb = High Fat Since dietary fat was now the villain of the hour, the ‘Heart Healthy’ recommended diet became a high carbohydrate one.  Since carbohydrates in the Western hemisphere tended to be refined, we ate more and more low fat bread and pasta.  After all, we weren’t giving up hamburgers for cauliflower and kale, but for bread and big plates of pasta. Through the 1950’s and 1960’s scientific debate (occasionally very acrimonious) raged back and forth.  Some believed that dietary fat was the villain where others, such as John Yudkin believed that refined carbohydrates were the problem.  His book, “Pure, White and Deadly – How Sugar is Killing Us” is eerily prescient, and should certainly win the award for Best Book Title – Ever. The vitriol sometimes reached extreme levels.  Jean Mayer, PhD of Harvard once likened the carbohydrate reduced diet “in a sense, equivalent to mass murder”.  Just a little extreme….The American Heart Association felt that these diets were also dangerous fads. Umm…dude….really?  A 200 year old fad?  Ideas that had withstood the test of time?  Dietary fats that humans had been eating for, like, a bazillion years?  That’s what was killing us?  Didn’t it occur these geniuses that if dietary fat was going to kill us, it would have already done so in the preceding, oh, 1 million years? The low-fat diet, of course, up until that point in time was completely untested in humans.  Nobody in history had ever decided to lower the fat content of their diet for health reasons.  We had no idea what effect it would have. Of course, this was around the time that we also believed that we could make a more nutritious substance for babies than breast milk.  That we were somehow smarter than 20 million years of evolution.  So, instead of eating natural fats such as cream, butter, and olive oil we turned to purely artificial oils like margarine.  Of
course, these turned out to kill us with trans-fats but that is a story for another time.  We moved away from fat and towards refined carbs. So who won?  You already know the answer, and we are all the worse off for it.

Continue to Hormonal Obesity II here.

Begin here with Calories I

Watch the entire lecture – The Aetiology of Obesity 1/6 – A New Hope

 

2018-05-26T11:55:36+00:0012 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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Sean Raymond
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Sean Raymond

This is a really fantastic series thus far, and does pull together some of the frequently unconsidered aspects of weight loss/weight gain i.e. the set point theory. However there is a glaring flaw which hasn’t been addressed and this particular post exposes it. See, you acknowledged that when people are over fed they gain weight – the studies you cite show this. Yet, despite the concomitant rise in TEE the weight of these individuals ONLY came down AFTER they reverted back to their original lower calorie diets. Therefore, we can conclude that IF these people had continued to over-eat their… Read more »

kfacwpup
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It is unknown if weight would reverse even if caloric excess is maintained. For ethical reasons, it is not possible to overfeed people for months/ years. In the reverse situation, it takes 6 months to one year for weight to regain despite lowered caloric intake. I suspect the opposite is true as well, but we’ll never know. I consider TEE ‘calories out’ a mostly unconscious decision, like breathing. Yes, you take consciously control breathing for a period of time, but it is mostly a function of the autonomic nervous system. Same for metabolism. It is very difficult to consciously increase… Read more »

Sean Raymond
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Sean Raymond

Sorry – I was meant to say that the change in TEE in response to weight gain or weight loss cannot be “infinite”.

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[…] That is the next topic we address in the upcoming series “Hormonal Obesity I“. […]

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[…] this question in substantial detail.  There was the 41 part series of posts entitled “Hormonal Obesity”.  You can review it here – starting with post 1.  You may also review our 11 part series entitled “Calories” to review why calories do […]

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[…] facts and conclusions, watching Dr Fung’s videos and reading his blog series on calories, hormonal obesity and fasting has turned out to be life changing for […]

Deb Griffith
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Deb Griffith

Sean, If I am understanding your post correctly, it seems that you are saying that calorie restriction and voluntary energy expenditure (eat less, move more) works. And I am living proof that it doesn’t, and I have lots of friends who also were in the same situation. I was following the Zone eating plan, and doing Zumba and step aerobics 4 times a week, for the past 5 or so years, as well as many times over the years (53 now). It wasn’t until I found fasting that I REALLY lost the weight and kept it off. I even kept… Read more »

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[…] פוסט זה מוגש כשירות לציבור. הזכויות על התוכן שייכות לכותב של הפוסט המקורי. את הפוסט המקורי ניתן למצוא בכתובת הזאת. […]

Ernani
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Ernani

The “calorie series” link at the start of the text is dead.

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[…] insulin should lead to weight loss. And guess what? It worked just as advertised. (See the Hormonal Obesity series for a full […]

Abe Ramat
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Abe Ramat

While I think we need a few more decades of research to begin to reasonably understand diet, further exploring genetics, environmental factors, and gut micro biome, to name a few, I agree that, based on what we know at present, it is likely that refined carbohydrates are the chief cause of diabetes and obesity. How do we reconcile this, however, with the fact that many, if not most hunter-gatherer societies and early civilizations depended starches as staple foods, yet, as far as we know, were not fat? For example, manioc throughout the Amazon region, potatoes (different of course from today’s… Read more »

Robert Conroy
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Robert Conroy

Refined carbihydrates are not the problem unless you consider cooked grains, cooked potatoes, and dried fruit as highly refined. These are all higher glycemic index and glycemuc load than sucrose – table sugar. I like all these nutritional experts who know NOTHING about food nutrition.