Obesity Mindset

There is a piece from The Atlantic about weight loss, The Weight I Carry. It’s written from a personal perspective. The author, Tommy Tomlinson, has been overweight his entire life. He describes what this has been like, specifically the struggle and failure in finding anything that worked. One has to give him credit for trying a wide range of diets.

It was sad to read for a number of reasons. But a point of interest was a comment he made about carbs: “I remember the first time carbohydrates were bad for you, back in the 1970s. The lunch counter at Woolworth’s in my hometown of Brunswick, Georgia, sold a diet plate of a hamburger patty on a lettuce leaf with a side of cottage cheese. My mom and I stared at the picture on the menu like it was a platypus at the zoo. We pretended to care about carbs for a while. Mama even bought a little carbohydrate guide she kept in her pocketbook. It said biscuits and cornbread were bad for us. It didn’t stay in her pocketbook long.”

That is what I’ve read about. Into the 1970s, it was still well known that carbs were the main problem for many health problems, specifically weight gain. This was part of mainstream medical knowledge going back to the 1800s. It was an insight that once was considered common sense, back when most people lived on and around farms. Everyone used to know that how cattle were fattened for the slaughter was with a high-carb diet and so the way to lose weight was to decrease carbs. There was nothing controversial about this old piece of wisdom, that is until the government decreed the opposite to be true in their 1980s dietary recommendations.

The sad part is how, even as this guy knew of this wisdom, the context of understanding its significance was lost. He lacks an explanatory framework that can sift through all the bullshit. He writes that, “I’ve done low-fat and low-carb and low-calorie, high-protein and high-fruit and high-fiber. I’ve tried the Mediterranean and taken my talents to South Beach. I’ve shunned processed foods and guzzled enough SlimFast to drown a rhino. I’ve eaten SnackWell’s cookies (low-fat, tons of sugar) and chugged Tab (no sugar, tons of chemicals, faint whiff of kerosene). I’ve been told, at different times, that eggs, bacon, toast, cereal, and milk are all bad for you. I’ve also been told that each one of those things is an essential part of a healthy diet. My brain is fogged enough at breakfast. Don’t fuck with me like this.”

His frustration is palpable and reasonable. But I notice all that gets left out from his complaints. A low-carb diet by itself very well might feel impossible. If you aren’t replacing carbs with healthy fats and nutrient-dense whole foods, you will be trying to swim upstream. Carbs is used by the body as a fuel. Take it away and you better give the body a different fuel. And after a lifetime of nutrient deficiency as is common in modern industrialization, you’d be wise to rebuilding your nutritional foundations.

That is the failure of the deprivation model of diets. They eliminate without offering any good advice about what to add back in. The advantage of traditional foods and paleo is that they are less diets in this sense. They are simply seeking scientific knowledge based on how humans live in traditional communities in the world today and how humans have lived going back to the ancient world and beyond. The point is finding what naturally works for the human body, not forcing restrictions based on ideological demands. If a diet feels like a constant struggle, then you are doing something wrong. For most of human existence, the vast majority of individuals maintained a healthy body weight with no effort whatsoever. The epidemic of obesity is extremely and bizarrely abnormal. Obesity indicates something is seriously out of balance, specifically with insulin sensitivity and the related hormonal hunger signals. Deprivation simply antagonizes this state of disease.

We already know that the ketogenic diet is the most effective diet for weight loss. Not only in the losing part but also in maintaining one’s optimal weight. No other diet decreases hunger and eliminates cravings to the same extent. More generally, a recent study showed that a low-carb diet beat a low-fat diet in burning fat, even when protein and calories were exactly the same in both groups. This possibly indicates that, as some have speculated, a diet low enough in carbs may increase metabolism in burning more calories than one is consuming. Then when you reach your preferred weight, you can add back in some calories to attain an equilibrium. This is apparently the one thing the author didn’t try. He did try the South Beach diet, but it is only moderately low-carb and unfortunately is also low-fat, a bad combination — this diet, for example, recommends low-fat milk which is not only eliminating the needed fats but also the fat-soluble vitamins, especially in the form of dairy from cows that are pastured/grass-fed.

The author is trapped in the dominant paradigm. He doesn’t need to “Eat less and exercise.” And he recognizes this is bad advice, even as he can’t see an alternative. But he should look a bit further outside the mainstream. On a ketogenic diet, many people can lose weight while eating high levels of calories and not exercising. It’s more of a matter of what you eat than how much, although in some cases where there are serious health problems as is typical with lifelong obesity more emphasis might need to be given to exercise and such. But the point is to find foods that are satisfying without overeating, which generally means healthy fats. Your body gets hungry for a reason and, if you don’t feed it what it needs, it will remain hungry. Calorie counting and portion control won’t likely help anyone with long term weight issues. It will just make them frustrated and hangry, and for good reason. But when the old patterns repeatedly fail, it is best to try something new. Sadly, the author’s conclusion is to more fully commit to the old way of thinking. His chances of success are next to zero, as long as he continues on this path.

It’s an obesity mindset. The individual blames himself, rather than blaming the bad advice. He just needs more self-control and less gluttony. This time, he tells himself, it will work. I doubt it. I hope he doesn’t spend the rest of his life on this endless treadmill of self-defeat and self-blame. Life doesn’t need to be so difficult. Rather than losing weight, he should focus on what it takes to be and feel healthy. But it is hard to convince someone of that when their entire identity has become entangled with obesity itself, with their appearance as judged by the same society that gave the bad advice.

* * *

The Weight I Carry
What it’s like to be too big in America

by Tommy Tomlinson

I remember the first time carbohydrates were bad for you, back in the 1970s. The lunch counter at Woolworth’s in my hometown of Brunswick, Georgia, sold a diet plate of a hamburger patty on a lettuce leaf with a side of cottage cheese. My mom and I stared at the picture on the menu like it was a platypus at the zoo. We pretended to care about carbs for a while. Mama even bought a little carbohydrate guide she kept in her pocketbook. It said biscuits and cornbread were bad for us. It didn’t stay in her pocketbook long.

I’ve done low-fat and low-carb and low-calorie, high-protein and high-fruit and high-fiber. I’ve tried the Mediterranean and taken my talents to South Beach. I’ve shunned processed foods and guzzled enough SlimFast to drown a rhino. I’ve eaten SnackWell’s cookies (low-fat, tons of sugar) and chugged Tab (no sugar, tons of chemicals, faint whiff of kerosene). I’ve been told, at different times, that eggs, bacon, toast, cereal, and milk are all bad for you. I’ve also been told that each one of those things is an essential part of a healthy diet. My brain is fogged enough at breakfast. Don’t fuck with me like this.

Here are the two things I have come to believe about diets:

1. Almost any diet works in the short term.
2. Almost no diets work in the long term.

The most depressing five-word Google search I can think of—and I can think of a lot of depressing five-word Google searches—is gained all the weight back. Losing weight is not the hard part. The hard part is living with your diet for years, maybe the rest of your life.

When we go on a diet—especially a crash diet—our own bodies turn against us. Nutritional studies have shown that hunger-suppressing hormones in our bodies dwindle when we lose weight. Other hormones—the ones that warn us we need to eat—tend to rise. Our bodies beg us to gorge at the first sign of deprivation. This makes sense when you think about the history of humankind. There were no Neanderthal foodies. They ate to survive. They went hungry for long stretches. Their bodies sent up alarms telling them they’d better find something to eat. Our DNA still harbors a fear that we’ll starve. But now most of us have access to food that is more abundant, cheaper, and more addictive than at any other time in human history. Our bodies haven’t caught up to the modern world. Our cells think we’re storing up fat for a hard winter when actually it’s just happy hour at Chili’s.

Even worse, when people succeed at losing a lot of weight, their bodies slam on the brakes of their metabolism. […] Other studies had already shown that the body’s metabolism slows down as people lose weight, which means they have to eat fewer and fewer calories to keep losing. But this study showed that, for the contestants who lost weight quickly, their metabolism kept slowing even when they started gaining weight again. Basically, however fat they had been, that’s what their bodies wanted them to be. […]

“Eat less and exercise.”

That’s what some of you are saying right now. That’s what some of you have said the whole time you’ve been reading. That’s what some of you say—maybe not out loud, but you say it—every time you see a fat person downing fried eggs in a diner, or overstuffing a bathing suit on the beach, or staring out from one of those good-lord-what-happened-to-her? stories in the gossip magazines.

“Eat less and exercise.”

What I want you to understand, more than anything else, is that telling a fat person “Eat less and exercise” is like telling a boxer “Don’t get hit.”

You act as if there’s not an opponent.

Losing weight is a fucking rock fight. The enemies come from all sides: The deluge of marketing telling us to eat worse and eat more. The culture that has turned food into one of the last acceptable vices. Our families and friends, who want us to share in their pleasure. Our own body chemistry, dragging us back to the table out of fear that we’ll starve.

On top of all that, some of us fight holes in our souls that a boxcar of donuts couldn’t fill.

My compulsion to eat comes from all those places. I’m almost never hungry in the physical sense. But I’m always craving an emotional high, the kind that comes from making love, or being in the crowd for great live music, or watching the sun come up over the ocean. And I’m always wanting something to counter the low, when I’m anxious about work or arguing with family or depressed for reasons I can’t understand.

There are radical options for people like me. There are boot camps where I could spend thousands of dollars to have trainers whip me into shape. There are crash diets and medications with dangerous side effects. And, of course, there is weight-loss surgery. Several people I know have done it. Some say it saved them. Others had life-threatening complications. A few are just as miserable as they were before. I don’t judge any people who try to find their own way. I speak only for myself here: For me, surgery feels like giving up. I know that the first step of 12-step programs is admitting that you’re powerless over your addiction. But I don’t feel powerless yet.

My plan is to lose weight in a simple, steady, sustainable way. I’ll count how many calories I eat and how many I burn. If I end up on the right side of the line at the end of the day, that’s a win. I’ll be like an air mattress with a slow leak, fooling my body into thinking I’m not on a diet at all. And one day, a few years down the road, I’ll wake up and look in the mirror and think: I got there.

Clearing Away the Rubbish

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue”
~Richard Horton, editor in chief of The Lancet

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor”
~Dr. Marcia Angell, former editor in chief of NEJM

Back in September, there was a scientific paper published in Clinical Cardiology, a peer reviewed medical journal that is “an official journal of the American Society for Preventive Cardiology” (Wikipedia). It got a ton of attention from news media, social media, and the blogosphere. The reason for all the attention is that, in the conclusion, the authors claimed that low-carb diets had proven the least healthy over a year period:

“One-year lowered-carbohydrate diet significantly increases cardiovascular risks, while a low-to-moderate-fat diet significantly reduces cardiovascular risk factors. Vegan diets were intermediate. Lowered-carbohydrate dieters were least inclined to continue dieting after conclusion of the study. Reductions in coronary blood flow reversed with appropriate dietary intervention. The major dietary effect on atherosclerotic coronary artery disease is inflammation and not weight loss.”

It has recently been retracted and it has come out that the lead author, Richard M. Fleming, has a long history of fraud going back to 2002 with two FBI convictions of fraud in 2009, following his self-confession. He has also since been debarred by the U.S. Food and Drug Administration. (But his closest brush with fame or infamy was his leaking the medical records of Dr. Robert Atkins, a leak that was behind a smear campaign.) As for his co-authors: “Three of the authors work at Fleming’s medical imaging company in California, one is a deceased psychologist from Iowa, another is a pediatric nutritionist from New York and one is a Kellogg’s employee from Illinois. How this group was able to run a 12-month diet trial in 120 subjects is something of a mystery” (George Henderson). Even before the retraction, many wondered how it ever passed peer-review considering the low quality of the study: “This study has so many methodological holes in it that it has no real value.” (Low Carb Studies BLOG).

But of course, none of that has been reported as widely as the paper originally was. So, most people who read about it still assume it is valid evidence. This is related to the replication crisis, as even researchers are often unaware of retractions, that is when journals will allow retractions to be published at all, something they are reluctant to do because it delegitimizes their authority. So, a lot of low quality or in some cases deceptive research goes unchallenged and unverified, neither confirmed nor disconfirmed. It’s rare when any study falls under the scrutiny of replication. If not for the lead author’s criminal background in the Fleming case, this probably would have been another paper that could have slipped past and been forgotten or else, without replication, repeatedly cited in future research. As such, bad research builds on bad research, creating the appearance of mounting evidence, but in reality it is a house of cards (consider the takedown of Ancel Keys and gang in the work by numerous authors: Gary Taubes’ Good Calories, Bad Calories; Nina Tiecholz’s The Big Fat Surprise; Sally Fallon Morrell’s Nourishing Diets; et cetera).

This is why the systemic problem and failure is referred to as a crisis. Fairly or unfairly, the legitimacy of entire fields of science are being questioned. Even scientists no longer are certain which research is valid or not. The few attempts at determining the seriousness of the situation by replicating studies has found a surprisingly low replication rate. And this problem is worse in the medical field than in many other fields, partly because of the kind of funding involved and more importantly because of how few doctors are educated in statistics or trained in research methodology. It is even worse with nutrition, as the average doctor gets about half the questions wrong when asked about this topic, and keep in mind that so much of the nutritional research is done by doctors. An example of problematic dietary study is that of Dr. Fleming himself. We’d be better off letting physicists and geologists do nutritional research.

There is more than a half century of research that conventional medical and dietary opinions are based upon. In some major cases, re-analysis of data has shown completely opposite conclusions. For example, the most famous study by Ancel Keys blamed saturated fat for heart disease, while recent reappraisal has shown the data actually shows a stronger link to sugar as the culprit. Meanwhile, no study has ever directly linked saturated fat to heart disease. The confusion has come because, in the Standard American Diet (SAD), saturated fat and sugar have been conflated in the population under study. Yet, even in cases like that of Keys when we now know what the data shows, Keys’ original misleading conclusions are still referenced as authoritative.

The only time this crisis comes to attention is when the researcher gets attention. If Keys wasn’t famous and Fleming wasn’t criminal, no one would have bothered with their research. Lots of research gets continually cited without much thought, as the authority of research accumulates over time by being cited which encourages further citation. It’s similar to how legal precedents can get set, even when the initial precedent was intentionally misinterpreted for that very purpose.

To dig through the original data, assuming it is available and one knows where to find it, is more work than most are willing to do. There is no glory or praise to be gained in doing it, nor will it promote one’s career or profit one’s bank account. If anything, there are plenty of disincentives in place, as academic careers in science are dependent on original research. Furthermore, private researchers working in corporations, for obvious reasons, tend to be even less open about their data and that makes scrutiny even more difficult. If a company found their own research didn’t replicate, they would be the last in line to announce it to the world and instead would likely bury it where it never would be found.

There is no system put into place to guard against the flaws of the system itself. And the news media is in an almost continual state of failure when it comes to scientific reporting. The crisis has been stewing for decades, occasionally being mentioned, but mostly suppressed, until now when it has gotten so bad as to be undeniable. The internet has created alternative flows of information and so much of the scrutiny, delayed for too long, is now coming from below. If this had happened at an earlier time, Fleming might have gotten away with it. But times have changed. And in crisis, there is opportunity or at very least there is hope for open debate. So bring on the debate, just as soon as we clear away some of the rubbish.

* * *

Retracted: Long‐term health effects of the three major diets under self‐management with advice, yields high adherence and equal weight loss, but very different long‐term cardiovascular health effects as measured by myocardial perfusion imaging and specific markers of inflammatory coronary artery disease

The above article, published online on 27 September 2018 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the journal Editor in Chief, A. John Camm and Wiley Periodicals, Inc. The article has been withdrawn due to concerns with data integrity and an undisclosed conflict of interest by the lead author.

A convicted felon writes a paper on hotly debated diets. What could go wrong?
by Ivan Oransky, Retraction Watch

Pro-tip for journals and publishers: When you decide to publish a paper about a subject — say, diets — that you know will draw a great deal of scrutiny from vocal proponents of alternatives, make sure it’s as close to airtight as possible.

And in the event that the paper turns out not to be so airtight, write a retraction notice that’s not vague and useless.

Oh, and make sure the lead author of said study isn’t a convicted felon who pleaded guilty to healthcare fraud.

“If only we were describing a hypothetical.

On second thought: A man of many talents — with a spotty scientific record
by Adam Marcus, Boston Globe

Richard M. Fleming may be a man of many talents, but his record as a scientist has been spotty. Fleming, who bills himself on Twitter as “PhD, MD, JD AND NOW Actor-Singer!!!”, was a co-author of short-lived paper in the journal Clinical Cardiology purporting to find health benefits from a diet with low or modest amounts of fat. The paper came out in late September — just a day before the Food and Drug Administration banned Fleming from participating in any drug studies. Why? Two prior convictions for fraud in 2009.

It didn’t take long for others to begin poking holes in the new article. One researcher found multiple errors in the data and noted that the study evidently had been completed in 2002. The journal ultimately retracted the article, citing “concerns with data integrity and an undisclosed conflict of interest by the lead author.” But Fleming, who objected to the retraction, persevered. On Nov. 5, he republished the study in another journal — proving that grit, determination, and a receptive publisher are more important than a spotless resume.