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

the
Handbook of Obesity
, a 1998 textbook edited by three of the most prominent authorities in the field—George Bray, Claude Bouchard, and W. P. T. James. “Dietary therapy remains the cornerstone of treatment and the reduction of energy intake continues to be the basis of successful weight reduction programs,” the book says. But it then states, a few paragraphs later, that the results of such energy-reduced restricted diets “are known to be poor and not long-lasting.” So why is such an ineffective therapy the cornerstone of treatment? The
Handbook of Obesity
neglects to say.
    The latest edition (2005) of
Joslin’s Diabetes Mellitus
, a highly respected textbook for physicians and researchers, is a more recent example of this cognitive dissonance. The chapter on obesity was written by Jeffrey Flier, an obesity researcher who is now dean of Harvard Medical School, and his wife and research colleague, Terry Maratos-Flier. The Fliers also describe “reduction of caloric intake” as “the cornerstone of any therapy for obesity.” But then they enumerate all the ways in which this cornerstonefails. After examining approaches from the most subtle reductions in calories (eating, say, one hundred calories less each day with the hope of losing a pound every five weeks) to low-calorie diets of eight hundred to one thousand calories a day to very low-calorie diets (two hundred to six hundred calories) and even total starvation, they conclude that “none of these approaches has any proven merit.” Alas.
    Until the 1970s, low-calorie diets were referred to in medical literature as “semi-starvation” diets. After all, what’s expected on these diets is that we eat half or even less of what we’d typically prefer to eat. But we can’t be expected to semi-starve ourselves for more than a few months, let alone indefinitely, which is what such diets implicitly require if we are to maintain whatever weight loss we may initially experience. Very low-calorie diets are known as “fasts” because they allow barely any food at all. Again, it’s hard to imagine fasting for more than a few weeks, maybe a month or two at best, and certainly we cannot keep it up forever once our excess fat is lost.
    The two researchers who may have had the best track record in the world treating obesity in an academic setting were George Blackburn and Bruce Bistrian of Harvard Medical School. In the 1970s, they began treating obese patients with a six-hundred-calorie-a-day diet of only lean meat, fish, and fowl. They treated thousands of patients, said Bistrian. Half of them lost more than forty pounds. “This is an extraordinarily effective and safe way to get large amounts of weight loss,” Bistrian said. But then Bistrian and Blackburn gave up on the therapy, because they didn’t know what to tell their patients to do after the weight was lost. The patients couldn’t be expected to live on six hundred calories a day forever, and if they returned to eating normally, they’d gain the weight right back. The only medically acceptable alternative, said Bistrian, was to give the patients drugs to kill their appetites, and they weren’t willing to do that.
    So, even if you lose most of your excess fat on one of these diets, you’re then stuck with the what-happens-now problem. If you lose weight eating only six hundred calories a day, or even twelve hundred, should it come as a surprise that you get fat again when you return to eating two thousand calories a day or more? This is why the experts say a diet has to be something we can follow for life—a lifestyle program. But how is it possible to semi-starve ourselves or fast for more than a short time? As Bistrian said when I interviewed him a few years ago, echoing Bruch half a century earlier, undereating isn’t a treatment or cure for obesity; it’s a way of temporarily reducing the most obvious symptom. And if undereating isn’t a treatment or a cure, this certainly suggests that