Why We Get Fat: And What to Do About It by Gary Taubes Read Free Book Online

that undereating failed to cure you of this particular affliction, even if it has some short-term success at treating the most conspicuous symptom—excess adiposity.
    The very first time anyone published a review of the efficacy of undereating as a treatment for obesity—the psychologist Albert Stunkard and his colleague Mavis McLaren-Hume, in 1959—this was their conclusion. Nothing much has changed since. Stunkard said their study was motivated by what he called the “paradox” between his own failure to treat obese patients successfully at his New York Hospital clinic by restricting how much they eat and “the widespread assumption that such treatment was easy and effective.”
    Stunkard and McLaren-Hume combed the medical literature and managed to find eight articles in which physicians reported on their success rates treating obese and overweight patients in their clinics. The results, said Stunkard, were “remarkably similar and remarkably poor.” Most of these clinics were prescribing diets that allowed only eight hundred or one thousand calories a day—maybe half what the WHI women said they were eating—and still only one in four patients ever lost as much as twenty pounds;only one in twenty patients managed to lose as much as forty pounds. Stunkard also reported on his own experience prescribing “balanced diets” of eight hundred to fifteen hundred calories a day to a hundred obese patients in his own clinic: only twelve lost as much as twenty pounds, and only one lost forty pounds. “Two years after the end of treatment,” Stunkard wrote, “only two patients had maintained their weight loss.” *
    The more recent assessments benefit from the use of computers and elaborate statistical analyses, but the results, as Stunkard might say, are still remarkably similar and remarkably poor. Prescribing low-calorie diets for obese and overweight patients, according to a 2007 review from Tufts University, leads, at best, to “modest weight losses” that are “transient”—that is, temporary. Typically, nine or ten pounds are lost in the first six months. After a year, much of what was lost has been regained.
    The Tufts review was an analysis of all the relevant diet trials in the medical journals since 1980. The single largest such trial ever done yields the very same answer. † The researchers were from Harvard and the Pennington Biomedical Research Center, which is in Baton Rouge, Louisiana, and is the most influential academic obesity-research institute in the United States. Together they enrolled more than eight hundred overweight and obese subjects and then randomly assigned them to eat one of four diets. These diets were marginally different in nutrient composition (proportions of protein, fat, and carbohydrates), but all were substantially the same in that the subjects were supposed to undereat by 750 calories a day, a significant amount. The subjects were also given “intensive behavioral counseling” to keep them on their diets, the kind of professional assistance that few of usever get when we try to lose weight. They were even given meal plans every two weeks to help them with the difficult chore of cooking tasty meals that were also sufficiently low in calories.
    The subjects began the study, on average, fifty pounds overweight. They lost, on average, only nine pounds. And, once again, just as the Tufts review would have predicted, most of the nine pounds came off in the first six months, and most of the participants were gaining weight back after a year. No wonder obesity is so rarely cured. Eating less—that is, undereating—simply doesn’t work for more than a few months, if that.
    This reality, however, hasn’t stopped the authorities from recommending the approach, which makes reading such recommendations an exercise in what psychologists call “cognitive dissonance,” the tension that results from trying to hold two incompatible beliefs simultaneously.
    Take, for instance,