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Why We Get Fat -- Review

As mentioned on Twitter a while back, I recently got this book to review, and thought it might be of interest to some of my friends here.

Why We Get Fat, and What To do About It

I have been waiting for a book written from this angle for years. The "standard" theory of weight management is so simplistic it isn't of much help. Sure, people gain weight because they eat more than they burn, duh. Why does this imbalance exist? Why does it happen to some people and not others? Why is obesity on the rise? Why is it so hard to fix?

Saying that people are more slothful and gluttonous nowadays, while common, does not seem to be a reasonable answer, not when the weight gain is happening so fast, is so widespread, and occurring even to infants.

Gary Taubes has been pursuing the answers to these questions for a while. First, he presents evidence that the calories-in/calories-out model is fundamentally flawed. In animals, including humans, it appears that bodies set an internal standard for how much fat should be maintained and where it goes. Attempts to influence this value through changing caloric intake or activity might be temporarily successful, but they won't last. Gary presents ample evidence from history, scientific research, and population studies to prove his point.

So what's the cause of obesity, then? In some people it may just be genetic. Overall, though it looks like carbohydrates and sugar are the culprits. The author explains the effect that carbohydrate intake has on blood insulin levels, and the effect insulin has on fat stores. None of this biochemistry is debated at all, but there seems to be a glaring disconnect between the science of hormone signaling and theories of diet and weight loss.

To further prove his point, Gary next analyzes various diets and how successful they have been. In the end, it seems that a low carbohydrate diet is the best choice for weight loss, diabetes/insulin resistance, and overall health, *but* he warns, it hasn't been exhaustively tested long term yet. Initial tests are very promising though, showing improved blood lipids, and the most significant weight loss. A quick sample diet is provided in the appendix.

This is not a diet or weight loss book. This is an inquiry into why people get fat, starting without preconceived notions. As such, I think it's extremely valuable. This is a crucial subject, and the current set of theories and advice do not seem to be helping people much.

Which is not to say that I agreed 100% with the author. He has his theory and he pursues it fully, with the best evidence he can find. That's fine, but I noticed a few gaps. For one, just because the body has an idea how big its ideal fat stores should be, doesn't mean that people can't essentially force-feed themselves by eating beyond what hunger would dictate. Restaurant portions and addictive snacks are likely culprits in obesity too. See The End of Overeating: Taking Control of the Insatiable American Appetite for information on that.

Exercise, too, is dismissed as useless for weight loss. I agree that it's not effective for mere calorie burning. Appetite will counteract any deficit achieved. But exercise, especially long or high-intensity aerobic exercise uses up carbohydrates. And thus, by his theory regular aerobic exercise should have a similar effect to eating a low-carbohydrate diet. (I have read studies where this appears to be the case.)

Still, I think this is a fabulous book despite the occasional blind spot. If you are interested in the biology behind weight regulation, this is a must read.

[Originally posted to Amazon.com]



( 25 comments — Leave a comment )
Dec. 7th, 2010 11:22 pm (UTC)
I really wonder though. I mean, the traditional Chinese diet is SO carb heavy and SO low protein, it's ridiculous, and Chinese people traditionally are very thin. They're eating much more protein and fat now than they were before, and guess what, obesity is increasing...

I don't know where the answer is. There's a lot of confounding information.

I really think that it's probable that there is no real one-size-fits all recipe for healthy weight. I mean, when you consider just how different people are in terms of allergies, lactose intolerance, the Asian Flush reaction to alcohol, etc, there is soooo much about body chemistry that varies between individuals.

Looking around, I know there are people who get results via low fat, and people who do it via low carb, and people who have a more moderate balance.

My dream is that we'd be able to have a test that would go through our body chemsitry etc and come up with the perfect diet and exercise plan for our system.
Dec. 7th, 2010 11:29 pm (UTC)
I share your dream! A personalized diet would be great.

The biggest culprit in promoting obesity might actually sugar not just carbohydrates, which Chinese diets do much better at. This is mentioned in the book, but no one has done large scale tests on any of this yet, so it's hard to say. And there is indeed a huge genetic component to whether eating a lot of carbs affects someone or not. The book is more aimed at explaining population-wide trends, and perhaps people who have tried the traditional advice low-cal+exercise and found it didn't work.
Dec. 7th, 2010 11:52 pm (UTC)
Sugar would make more sense to me. I also suspect that there is something particular in refined sugars, especially corn syrup, when compared to similar amounts of sugar from, say, cherries.

I just get suspicious of viewing plain white rice as as much of an inherent diet enemy as twinkies.

For one thing, it seems to me that there is a self-correcting aspect to fruit, because if you overindulge on fruits, you tend to have a digestive reaction that discourages that in the future, lol! But you can eat that much sugar in a box of cookies and not have the same problem, or at least not to the same degree. Just something I've observed.

Slightly off-topic, the traditional Chinese recommendation to the obese would be to avoid raw fruits and vegetables. Salads are bad for you! So say the TCM doctors. LOL. (They're not bad for everyone, natch... if you're suffering from excessive heat in your constitution, then it's a good thing to eat.)
Dec. 8th, 2010 12:39 am (UTC)
Ha! So much for my present caesar-salad-based existence!! (I exaggerate... but not by much.) But I am kind of a genetic freak, so I'm not sure anyone's system works for me. :( It's an ongoing experiment.

You're right about the fruit. Not only is it self limiting, if it's having that *ahem* effect, it's because the fructose isn't being absorbed anyway.
(Deleted comment)
Dec. 8th, 2010 03:04 am (UTC)
Yeah. I always kind of wonder about people with serious food allergies who also choose to be vegetarian. That's really making things tough. Plain meat is the least allergenic food around.
Dec. 8th, 2010 01:54 am (UTC)
I think we're still missing a lot of information. I agree that complex carbs can't really be equivalent to simple carbs metabolically. There are all of those polysaccharide bonds to break. Also, the obesity epidemic started in the 70's, and we've been eating high carb diets for centuries.

I don't think Taubes has all of the answers. I don't think low carb is the answer. But he asks some very good questions. I think most of what we believe about food and weight loss/gain is wrong.
Dec. 8th, 2010 03:10 am (UTC)
Yeah, and add in the fact that we don't really process fructose right... though no one seems to have a straight answer on what the resulting effect is. I gather it's okay (goes to liver glycogen stores) if you're really active or calorie negative, but straight-to-fat with added toxins and metabolic consequences if you're not.

Complete aside: the book included a picture of a Zucker rat, which is genetically prone to obesity. Pudgy rat was totally adorable.
Dec. 8th, 2010 01:50 am (UTC)
*MY* dream is that we'd get nanites that simply absorb and dispose of excess and keep us thin so "diet and exercise plan" becomes a forgotten phrase.
Dec. 7th, 2010 11:33 pm (UTC)
A while back I read a book targeted either toward people with Poly-cystic Ovarian Syndrome (which both my sister and I have been diagnosed with) or Insulin Resistance (which some people believe is related). It was not a weight-loss book, but it did include a diet meant to help stabilize/normalize insulin levels in the blood.

The book went into great detail about the biochemical processes of hormones in the body, and how they link to each other in ways that many people, including doctors, do not spend time considering. If you have too many cysts on your ovaries, they produce too many hormones, which in turn trigger compensatory responses from other body systems, like the adrenal gland, for instance, which in turn causes responses from other body systems, and so forth. The details are lost to me now, but I found it fascinating.

The book contained a diet, which I stuck to for a while. It wasn't intended for weight loss, only to stabilize spiking insulin levels. Basically I was allowed to eat anything I wanted, as much as I wanted, as long as I ate a maximum of 30 grams of carbs and a minimum of 8 grams of protein per 3 hour window, while awake. Err, and I was supposed to eat at least 15 or 20 grams of carbs per window too, I think. The idea was to manually control blood sugar levels. This is an oversimplification of what was suggested. I wish I still had the book, but I loaned it to my sister.

In any case, even though it wasn't a weight-loss book/diet, I did lose weight and felt better. Unfortunately, it's difficult to live a busy lifestyle and so strictly regiment a diet, eating every 3 hours, constantly counting carbs and protein. If you're interested in knowing the title of the book, I'll ask my sister next time I talk to her.
Dec. 7th, 2010 11:37 pm (UTC)
Oh! I had a point: One of the theories was that sugar was a trigger that kicked off a variety of responses that resulted in cyst covered ovaries (clearly this doesn't explain similar weight gain issues in men though) which then turned into a sort of self-sustaining hormone imbalance. Or something. Hah. It's been years. I should borrow that book back from my sister and reread it.
Dec. 8th, 2010 12:18 am (UTC)
That totally makes sense. Sugar seems to be a big problem for a lot of people, and it's in so much food nowadays! Even without insulin resistance issues, I think it can trigger a lot of problems.

Just a sample of one, but for me, I can only maintain an acceptable weight if I either run a heck of a lot, or eliminate most carbohydrates. If I'm not doing either of those, my weight will creep up. If I try to reduce calories in response, I get cranky, lethargic, constantly sick, and my body temperature drops. My stupid fat will NOT come out of storage. And I'm not remotely insulin resistant! It's crazy.

Dec. 8th, 2010 02:42 am (UTC)
On the ubiquity of sugar: A friend of mine has developed a severe sugar reaction. It's very bad. There's sugar in frozen macaroni and cheese! WTF? Why is there sugar in frozen mac & cheese?! (Yes, frozen food bad, &c., but this is why it's bad!)

(Also, I now see my first comment added pretty much nothing new to the conversation. Sorry 'bout that!)
Dec. 8th, 2010 03:01 am (UTC)
Hee, no, your first comment was great!

Oh, your poor friend though. That's hard.
Dec. 8th, 2010 01:58 am (UTC)
That sounds kind of like Diana Schwarzbein's books, although I don't recall the eating every three hours thing from them.
Dec. 8th, 2010 12:23 am (UTC)
Wow, yeah, that would be a difficult diet to follow. I wonder what aspect was actually the most helpful to you? It probably isn't as complicated as all the timing and ratios and whatnot combined, whatever it was.

The book sounds interesting. I'd like to know the title if you get the chance.

Dec. 8th, 2010 01:48 am (UTC)
My answers for why *I* get fat are:

Pumpkin pie, cheesecake, spekulaas cookies, ginger granola chocolate chip cookies, pork ribs, turkey and stuffing, homemade bread slathered with butter, bacon-green bean salad... should I go on?

"Tis the season to get FATTER!"
Dec. 8th, 2010 03:00 am (UTC)
Shush, you!

I am so mourning the nearby cupcake shop that just opened. *weep*

Maybe a tapeworm is the answer. :P
Dec. 8th, 2010 02:25 am (UTC)
Someone might look at why hormone replacement therapy makes some women gain weight. I had BMI at borderine underweight all my life. Tried HRT at age 66 -- and gained 40 pounds. Stopped HRT two months ago and weight leveled off. Tending down a little now I hope.
Dec. 8th, 2010 02:42 am (UTC)
Wow. (And ouch, 40 lbs!!)

That's pretty strong proof of the book's point, though, isn't it? It's not simply calories-in/calories-out. I mean, I suppose you had a technical energy imbalance, but it's not like you suddenly lived in a different, more-fattening culture or adopted a bunch of radically different behaviors.

Hormones are powerful stuff.
Dec. 8th, 2010 02:56 am (UTC)
I don't think weight gain is a typical response to HRT, but it does cause breast cancer, so I won't be using it.
Dec. 8th, 2010 09:39 am (UTC)
WebMD.com shows weight gain as a side effect of FemHRT Low Dose Oral, which is what I took for about nine months. Granted most of the hits for 'hrt weight gain' are -- strongly dismissing the belief.
Dec. 8th, 2010 12:57 pm (UTC)
Forty pounds in short order would not be typical. The drug label is probably talking about something on the order of five or ten pounds. One of the touted benefits of HRT is weight maintenance. Some people do have idiosyncratic reactions to medications, and it sounds like you and HRT are one of those cases.
Dec. 8th, 2010 02:36 am (UTC)
I just can't get on board with the vilification of carbs in the obesity "epidemic". As has been pointed out, there are cultures that are very carb heavy (and ours historically) where people are not overweight.

I just can't buy that explanation when it didn't have that effect historically while, at the same time, the western food industry has changed so radically in the last ~65 years--right around the same time that overweight and obesity have become an issue.

Yeah, correlation isn't causation, but I'm not going to accept finger-pointing at something that hasn't been a problem for the entire history of humanity over something that's revolutionised in my mother's lifetime. Y'know?
Dec. 8th, 2010 02:58 am (UTC)
I hear ya. It is not a simple issue. That other book I linked to "The End of Overeating" is very convincing and well documented in laying the blame squarely on the modern western food industry.

OTOH, the most compelling and disturbing part of "Why We Get Fat" was numerous historical reports of very impoverished, relatively modern-era populations. Like 1800s and later. War-torn countries, refugee camps, reservations -- places where people were subsisting on utterly crappy food, like flour and sugar or other cheap, surplus non-perishables. In these places commonly the women (30%-50% of them) got huge and obese, despite simultaneously being malnourished. These people did labor-intensive chores, too, so no question of being sedentary. In people genetically vulnerable to it, it seems like getting too much sugar, and/or too many carbs can really set their bodies off on a fat-storage spree.

Signs point to it taking two or three generations of sugar/high-carb before the weight-gain effect takes off. Like, a pregnant woman eats a lot of sugar and her child develops with a tendency to react to it. It gets exacerbated further the next generation. That would be why it's only showing up recently. Dunno... it's interesting. I'm glad people are looking into it, at least.
Dec. 8th, 2010 12:48 pm (UTC)
I didn't know about those historical examples. That's quite interesting. It does sound like a genetic and generational thing. I agree that lots of refined sugar and white flour is Not Good. I guess what I want in the carb debate is a discussion of the differing qualities of carbs.

Variety and moderation are two excellent values in nutrition, and I find that both of those are lost in the low-carb diets. On the other hand, variety and moderation are in kinda short supply in our corn-dominated super-sized food landscape overall. *sigh*
( 25 comments — Leave a comment )