Thursday, May 24

The Pear-Shaped Secret of the Obesity Epidemic

I remember the shocking and memorable photograph that science writer Gary Taubes showed in his book "Good Calories, Bad Calories," to help make the point of obesity as "a disorder of excess fat accumulation" -- a concept and phrase I had never heard before his book. The picture showed a woman who was nearly emaciated on the top half of her body, and more than just plus-size on the bottom half, a drastic difference that left her looking like some old-style carnival attraction. Which half of that woman "ate too much and moved too little?"

I recall I had to take time out of my ranting to friends about what I was reading, to sit in stunned silence over some of the profound "reversal of paradigms" about health and obesity in that book. They were ideas I had never heard before. I credit him for educating me, but the writing was a tribute to the fact that a lot of things have been known for decades, even over a century -- but are carefully ignored, like that elephant in the living room on AA commercials, where everyone pretends the overwhelmingly obvious problem is not there.

Apparently the Germans were on the right track, 75 years ago, but the world was so yonked about the war, the USA just started much of obesity science all over again, this time in English -- and this time, from the armchair of emotional psychology, rather than from the science lab of biochemistry. Oh sure, that's what the world needs -- more Puritan-guilt about biblical sins such as gluttony and sloth, to displace any objective reasoning -- like how some animals have similar metabolisms  and results, even though they can't buy ice cream when upset and they get along very well with their mothers.

Until the Taubes book, my maternal family's experience with being obese, morbidly obese, and severely obese, was as much like the "official government and health agency" story of fat as my seriously dysfunctional, lower-middle-class family was like television's Brady Bunch. I watched that surreal sitcom as a child with the kind of fascinated awe normally reserved for ancient pyramids and alien-looking sea creatures. How bizarre! How does that happen? Is that real?? Tell me more!  It was a lot like the official version of dieting, where in inspired frenzy, desperately hopeful people can calculate precisely how many calories they will be not-eating, and allegedly burning-off, for that simple formula and a promised happy ending. Except you never get your money back with that guarantee.

There is only one body-theology in the church of whole-grains and calories amen. The government-ordained priests of health are now the High Interpretive Intercessors between the layman and science. Doctors in white coats shake their heads at how you cannot possibly be telling the truth or the magic would have happened, and when your 4.9 minutes of personal attention are up, you can get a prescription for statins that for most people won't much help (and for many, especially women, do actual harm) -- drugs that are, except in rare cases, ridiculously unnecessary since several nutrients you need anyway and an eating plan called "real food" will fix you. But the world is expected to abide by the mantra of "eat less and move more," and if that doesn't work out any better for you than it does for most of the rest of planet earth, the front desk can provide a new photocopy of a diet that'd make even perky Marcia Brady want to leap from a ledge.

Then, call it gut-instinct, but you know when it's coming: a nurse (often obese) will express astonishment when you say no, you are not planning to have someone slice open your guts and profoundly screw up your ability to digest nutrients in the name of your being less fat. (Not lean. Just less fat.) Not counting the majority of people you may know who tried it and who are now dead, miserable or as fat as they ever were, there's that little thing about months or years of ongoing nightmare 'complications' followed by doom. As the ultimate in black irony, all those eons of horror followed by death are used as 'success' stories by the "gosh we don't collect those statistics" business world... a surgical industry nearly to the point of drive-thru bypass, even for children. And we thought medieval medicine was appalling. I'll take some Eye of Newt over that, any day.

That doesn't even start on the bozos who want to re-define 'obesity' as compulsive eating -- troubled psychology, and wrong assumptions to boot -- not biology.


The official doctrine of nutrition is right there in college textbooks. Science that was out of date decades ago (and things that were never good science, and things that were never even pretending to be science) are in today's college nutrition textbooks, teaching the people who will be doctors and nutritionists (a single-word oxymoron of the times) later. Frustrated at the fight to educate those who should already know better today? Guess what, you'll still be doing it at least a decade from now. 

It's said that science advances one funeral at a time; that not until the 'old guard' of science paradigms die off does allowance of new findings truly come about, but we've improved on that model. Now education sits in textbook pedagogical gridlock, and "remains consistent" a few million funerals at a time, giving advice that was ignorant and dangerous in the 1970's and helped shift a whole culture into diabetes overdrive, but is still being taught in 2012. 

Don't believe me? Pick three major textbook publishers. Get a university-level nutrition textbook from each. Read 'em and weep. Probably that author was taught that decades ago. Probably their textbook author was taught it before then. The authors in 10-20 years are being taught by the books today. You gotta admit, it's impressive--even those sponsoring holy books have to work hard to maintain so much consistency over time.

Nutrition has become a state-sponsored religion. Authorities tell us what science says. I read the language of science, although with serious limits (and limits on journals I cannot begin to afford), and I read the blogs of scientists, doctors and specialists who know the subject and review such things, and I find it just fascinating how science so often doesn't say anything like what the abstract, or the title, or the press release, or the media, or the government, tells the public it says. Or even what the books say, as Denise Minger so eloquently outlined. (For sure, keep avoiding cholesterol and eating grains: somewhere, a cardiologist needs a new sportscar, and you can help each other out before long.)

The congregation of people who are ill or fat are expected to have "faith," even when the official advice doesn't work. Even when it's so far from working it's not even humor anymore. The experts who represent the divine ideal of science will tell us what we need to know and if they say it works, no amount of obvious results saying otherwise matter. It is sacrilege to question the government-approved, agency-represented, and conflict-of-interest funded experts: those whose advice has so spectactularly failed to treat an epidemic of overweight and obesity, that it's now a pandemic of an entire spectrum of nutritional-deficiency diseases, of which issues like obesity (and now even morbid- and super-obesity) are merely one part.

The public wants to believe, because they want a solution, who wouldn't? Follow the paint-by-number plan, the slogans and logos... follow the money. The magazines make it all seem fun. There are even diet dinners (with heavy carbs on the side) frozen for your convenience. If it works, you'll be thin! Awesome. 

  • Then strangers shopping won't look at you like you're more vile than an ax-murderer, despite your attempts to wear large loose dark shrouds of clothing that will not offend them with details. 
  • Then people who sublimate all their racism, sexism, nationalism and other -ism's into the one "allowed and encouraged" ism of fat-ism will target elsewhere, not knowing that once upon a time you were in that very crowd of untouchables. 
  • You won't be walking through a world where lean people get to sit down and rest, but fat people can't because all the chairs have arms and you don't fit. 
  • You won't pay for two plane tickets with seats that have hard, curved bottom and back edges, so with high weight pressing against your back and the middle of one buttock, the hours of tense spinal distortion in turbulence costs you a fortune and leaves you crippled.
  • All those planes and trains with bathrooms you can't even use because you're too wide will be a thing of the past. (You can "hold it" for three days, right? I once had to. Thanks, Amtrak.)

We're a culture-wide Stockholm Syndrome of fat. Even many of the victims of horrible nutritional advice and barbaric bariatic practices join in condescending identification with the very health agencies instructing us to eat a majority of carbohydrates for carbohydrate-spawned diseases like diabetes (rather like taking more arsenic to cure arsenic poisoning); the very researchers (and peer reviewers) whose approach to science is so bad my 8th grade chemistry teacher would have sent them to the hall; the very medical experts who guide us toward the most brain-opiate drug-addicting and digestive-destroying foods (it's no coincidence that the agency dedicated to supporting the USA grain industry is also the agency insisting on all those grains in the diet...); and let's not forget the official "latest nutrition standards" that fail on more points of real science than they've ever represented.

In war, in terrain combat, it has long been known that killing the enemy is just poor planning. The better goal is to disable an individual sufficiently that at least two or more other soldiers have to change their focus away from fighting, and toward keeping that soldier alive and reaching medical care. The same war-logic works for medicine: the goal is neither to cure nor to kill, both of which remove the consumer's financial usefulness, but to "treat" an ongoing (and ideally slowly degenerating, so it requires more drugs and more procedures for more issues over time) collection of maladies that ensure paying customers forever.

"There is no cure of course, but you'll die if you don't buy this prescription!" -- Best. Marketing. Slogan. Ever.


Here's a few little things I didn't learn from official sources.

The average weight gain of the 'obesity epidemic' hysteria is only about 7-10 pounds. As this is on a population bell curve, of course any increase even fairly small would mean a great increase in numbers. So when they say "the number of obese people has doubled!!" that is technically true, but it sure sounds much more extreme than "on average, the population has gained 7-10 pounds."

The obesity increase is not evenly distributed. It correlates with genetics, although more research is needed on this. Next time you read about someone who could not adopt a child because they were too overweight, or editorials on why fat kids should be removed from family, or teenagers surgically gutted "for their own good," or why insurance should cost more, jobs should be less available,  public transportation is fairly unavailable or unaffordable to fat people, consider that this is not evenly applied: some genetic lines are going to be in the cross-hairs of that focus, and others barely so. 

" turns out actually that these really obese kids are concentrated in particular ethnic groups and the gene pools are different in different ethnic groups," said Dr. Jeffrey Friedman,  head of the Laboratory of Molecular Genetics at Rockefeller University.   "...some of the most powerful evidence that this is a biological problem and not a "behavioral one" (in quotation marks) is genetics. And so there are a number of ways to assess the genetic contributions to a trait. It turns out if you look for obesity it is probably the second most heritable trait, second only to height, with which it is quite close. Based on estimates that can be done by analyzing twins, 80 percent of the variability in weight can be accounted for by genetic factors." Anybody in the real world knows that some people get huge quickly and with little effort while some eat everything in sight and are beanpoles, but it's nice to see someone like this guy recognize this also. "...So when you see a very obese person walking down the street there’s a very, very significant possibility that that individual just has a genetic alteration that makes them so."

If I mention that obesity is also correlated with poverty, I bet you can guess at least some of the races more prone to obesity (and morbid- and super- obesity) than others. Like the world needs institutionalized prejudice wrapped into everything else, right? 

"Calorie math" is humor when applied to much of the morbid- and super- obese population. Even after gastric bypass, even after weight loss, even in  a metabolic ward, very obese people can survive on less than 'starvation calories' and still not lose any further bodyfat. Really? Are we sure they aren't just lying about their food? Yes, we're sure. Friedman (the modern science rock star whose lab discovered the hormone Leptin), was talking about gastric bypass patients when he said: "...there’s another feature of this surgery that people, I think, ignore, and it’s this: when you do this procedure you limit the intake of a person to about 700 calories a day. Just so you know, none of you could consume 700 calories a day for very long; it is a very small number of calories. Despite that fact, these people still end up being clinically obese at the other end of the procedure. They lose a lot of weight but they would still on average be definable as significantly obese on average after the procedure." "...If they’re consuming 700 calories every day they’re going to be expending more than that. And so what you would find, you would expect to see is as long as they’re that imbalanced they’re going to keep losing and losing and losing and losing. That’s not what happens in these people; they plateau and they stop losing weight at what is definable as a significantly obese level. Now, if I had that procedure you probably wouldn’t see me in profile anymore because I would just get so thin. That’s not what happens to these people and it appears that in the face of reduced intake the body shuts down caloric expenditure and they can’t lose any more weight." "...Now think about it, they’re eating 700 calories a day and they’re still obese. I mean if that doesn’t say that there’s something metabolically different about the obese than the lean, I don’t know what does." 

The Taubes book recounted research where fat rats were starved until they died, and the autopsy showed they still had lots of fat: their body literally sacrificed vital organs to spare the fat. Apparently the "eat less and move more" philosophy didn't work for them either.


Here's something fairly new to me: there's an "incurable disease" called Lipoedema--it tends to occur in familes. Although it was named in the USA, it's profoundly under-diagnosed here. You'll never guess how this condition is described officially: "a disorder of excess fat accumulation." Wow, where have I heard that before?! Right: the Taubes book. It turns out this was already known in 1940, when researchers at the Mayo Clinic coined the term -- yet it's nearly unheard of 70 years later. I thought he'd just found a picture of something incredibly rare but telling. It's more than that, as it turns out.

This affects women. Fat accrues between the upper pelvis and ankles (and in ~30% of the cases, arms). The feet are oddly free of it, as if the 'fat suit' only goes to the ankles. The upper body can range from skeletal to morbidly obese, but is not directly involved in the condition, so the top-half of the woman is often vastly smaller than the bottom half. Looks pretty weird. I know because I have a mirror, and other family members who in varying degrees look the same.

It's official with the condition: Diet will not make this fat go away. Even anorexics will merely look exactly like that picture in the Taubes book: skeletal on top, still hugely fat on the bottom. Exercise does not make it go away. Even gastric bypass surgery and the following starvation from that does not make it go away: patients will simply lose weight on the top half of the body, and still be very fat on the bottom. Much like I lost lots of weight on low-carb: pretty much all on the top half of the body. Between loose skin and disproportional fat storage, 'losing weight' just makes one look more like a mutant.

On the bright side, the fat is as far from the vital organs as it can get. On the down side, the fat will keep accruing, especially if the person doesn't get diagnosed (so they are unaware of the situation), and especially if they simply keep dieting, in ever-more try-anything-desperation. Plenty of research backs the ways the body adjusts half a dozen biological parameters to arrange weight regain--which in this case, even if lost off the top half of the body, is likely to return on the bottom, and be trapped there forever.

Fat cells are not inert luggage: they put out hormones and enzymes and affect the entire body. No matter how otherwise seemingly-healthy the person is, guess what happens when they are eventually 100+ pounds overweight "in the hips to ankles?" Their whole body is affected, and additional serious obesity is likely. This condition is hormonal (starts around puberty, although not always apparent then, and kicks in more strongly after a major hormonal event(s)), and it's clearly a disorder of fat accumulation -- the body will not release that energy no matter what.

The human body normally stores energy in fat cells and gives it back to build the body or as motive energy. The weight of a human may naturally vary at least slightly with the seasons. But in this case, both of those things merely add to this fat-bottom-half condition. The fat can form big lumps that interfere with sitting and walking. The fat is often very sensitive, with painful bruising on minor pressure, not helped by growing weight and size from the fat itself as you might imagine. And eventually it can begin to crush the lymphatic system of the legs, leading to an even more dangerous and miserable secondary disease condition called Lymphadema.

I bet you're thinking, "Yeah, but stuff like that is rare." Think again. It's estimated at least 11% of adult women have this. Leaving out women under 15 or over 64 for a moment, we have an estimated 103 million women in the USA. The obesity percentage for adult women is "over 60 percent" so let's say 60% of that is nearly 62 million. (Which reminds me, if public transportation is funded in part by taxes, and the majority of the population is fat, how come fat people can't fit in the bathrooms on public transportation, or have to pay double to be crippled by the only option?) Let's say only 10% have this condition: that's over 10 million people. Odd this is so unknown, given those numbers.

Is anybody diagnosing this and informing women -- before cutting them open in dangerous-to-deadly weight-loss surgeries -- that it won't even affect their primary obesity? Is anybody diagnosing this before various other situations punish them for not being able to get thin? Is it considered before needed surgeries are refused "until they lose some weight?" It's not surprising that the casual world is full of people who will yell "Fat ass!" without concern for the cause of someone's fat, but how come the medical field is doing their equivalent of the same thing?

To put this in perspective by numbers, breast cancer affects just under 12% of women, so it's nearly the same number. 12 million Americans are estimated infected with Hepatitis B. AIDS in the USA has 'more than a million' cases. You hear a lot about those conditions, in part because vaccinations and "treatment drugs" can be sold for them. (Well, and because they are fatal.) There is no known cure for at least 10 million American women with the Lipoedema condition, who may gradually end up with horribly disabling and even fatal secondary results. There is not very much to sell so it's nearly a secret.

If it were better known, it might cause a lot of people to wonder if "dysregulation of fat accumulation" might be an important concept to focus on. They might wonder why that "eat less and move more" plan doesn't work as well as it should for most people. The bigger the person, the more this seems to be so. 

Looking for cause and solution for this condition (which would be unusual, given the current focus on 'eternally treating symptoms' instead) might give insight into obesity across the board. Do the funding parties really want to know?

Much of my overly pear-shaped maternal family has Lipoedema. Several key elements of our bottom-half fat that I always thought made my family uniquely weird, turn out to be case-study obvious instead. Reading how "it has no cure" was demoralizing. But then I realized, I had already stumbled on that realization myself anyway. At least, "so far." That's what they say about diabetes as well, and paleo/lowcarb have reversed that in more cases than we can count.

But think about this: pretty much every other pathological 'disease condition' that mankind has ever found a true cause and cure for, has ended up being a severe ongoing (and perhaps multi-generational) deficiency of some nutrient(s). (At the least, disease is certainly not caused by a deficiency of surgery or drugs.) So perhaps yet-more focus on very dense absorbed nutrition will help. Who knows?


What I do know is that the human body is not math, it is biochemistry. I know that the science of stuffing a rodent with soybean trans-fats does not justify saying the rodent's poor health is why humans shouldn't eat steak. I know that modern wheat is a mutant that will make you eat more, mess with your brain in a few ways including addiction, and destroy many peoples' digestive systems, causing anything from joint pain to asthma to reflux to brain fog or depression to syndromes like IBS, and chronic inflammation, which contributes to many diseases, including to being too fat. And I know that medicine is the new religion, where science has become like the old Latin, with 'agency spokespeople' and doctors like priests who 'translate' for us and whom we are not expected to question.

I know that the health agencies are becoming mostly public relations "fronts," with the stalker strong-arm of organized crime available to them via government power, for global mega-corporations. I know that there are many things the public usually doesn't realize, though it's info openly available, such as how in USA and Britain most medium to hard dairy cheese is actually made with GMO soy rennet. I know that there is a spectrum of disease, many conditions, all likely related to improper nutrition and toxins, many of which the medical industry is officially pretending does not exist for years now (such as Morgellon's, chronic Lyme, and many others). I know that any approach or substance which is truly curative and threatens big money is likely to end up squashed and its discoverer curing people with it in prison, if he doesn't die from a conveniently tragic accident instead.

I know that the surreal disconnect between nutrition propaganda and biological reality has created the most intriguing mass psychology experiment since the WWII era. I know that the entire obesity topic is as much a sociological phenomenon as medical: no amount of evidence is sufficient to make most the public question the party line that is so overtly not working... and the identification with the sources of that party line, and the social prejudice against obese people,  is endemic in our culture. In previous eras, the reasonings and groupings of propaganda and public acceptance were different, but the governing intent and public psychology seems eerily familiar. We may be doomed to repeat history for lack of understanding it, but we're doing so in creative new ways.

Gary Taubes released his first book on the review of the science for nutrition several years ago. After reading it, I figured it was a good thing it was long and dense, so you had to be a good reader for it: if the general public really absorbed the situation in the medical world, there might be riots at health agency doors. (His simpler book is "Why We Get Fat.") If you think the world banking situation is a racket, even that has little on the Machiavellian inverted-focus of illness-care... which is then used as a back door for ever-more frightening politics.

I thought the concept Taubes wrote about, the dysregulation of adipose tissue, was so novel. It explained so much -- finally, a model that fit the "reality" of experience for so many, including me. But it turns out that's been known to be an issue since 1940! So why was he the first person to really bring that to the public?

The number of people affected even by just this one condition (Lipoedema) is huge, literally over 1 in 10 adult women. Yet I still don't see any sign that the US or UK governments or their regulating agencies are even looking at this neon-obvious question of why, when the body stores energy as fat (which is normal), it then refuses to give back the energy in that fat (which is not normal, and means that energy stays stored as fat, accumulates, and the person has to eat more to get energy to keep functioning). So as Taubes put it, you don't get fat because you are eating more and moving less; you are eating more and moving less because you are getting fat. If the body wasn't refusing to release it from storage, neither of those other things would be happening.

Some things are known and help a lot, such as reducing insulin in the body, primarily by reducing carbohydrates, especially refined foods. Some other things, like how to "fix" the body if that alone doesn't do it, are unknown. Alas my "disease" won't make much money unless it stays uncured -- although the diet industry is doing unusually well.

When you see folks trying 'alternative' approaches they read on the internet (see the fascinating forum-websites and, consider that some people don't want to just sit around and get more miserable until they die. They actually want to feel better, imagine that. When the groups in our culture entrusted with guidance and science fail to serve those goals with any integrity, the public (or those with enough brains to question things, anyway) will look elsewhere.

The situation in illness-care in the USA and UK is nothing that religion hasn't shown us before. The answers are waiting for a little genuine investigation, some science ethics looking for solutions, not eternal drug dependencies. But like the Church and Galileo, current officials might get away with 300 more years of intentional ignorance, hidden by all that pontificating expertise. As long as they don't look through that scope, they will have "seen no evidence" of the reality so many of us live with every day.


P.S.: I have a number of 'experiments' with 'alternative nutrients and approaches' to various things that I'll be detailing here for friends over the next six months.


Roseanna Smith said...

Standing ovation. I love everything you write, but this post was just one brilliant gem after another.

KMG said...

Excellent points. I'm reminded of steatopygia, another kind of excess fat accumulation in the lower part of the female body. Island tribes in the Indian Ocean had women who tended to have the condition (which the men viewed as very attractive!). It shocked the hell out of European explorers, of course.

I echo what you said about Earth Clinic and Curezone. At some point when medical science cannot help you, your choices are to suffer for the rest of your life (silently, please!), or to look to alternative medicine and anecdotal evidence. Standard medicine is great for standard problems. But when your issues don't fall into standard categories, well, yeah, you have to look elsewhere. Usually on your own, usually at great expense, usually with lots of snake oil to detect and avoid. It's too much for some people, understandably--it takes so much energy and when you're already feeling sick, you get the distinct impression that society at large wishes you'd shut up and die already and stop reminding them that the world is not, in fact, all figured out.

CJ - Food Stories said...

I have been reading your blog and I just wanted to stop by and nominate you for my NEW Food Stories Award for Excellence in Storytelling. You can check out the details at my site ... ... Have a great foodie day!

mem said...

In my book, and experience, full of truth, heart wrenchingly delivered. I've read it three times now and twetted it. I feel like I could tweet it hourly and the mass of people who need to GET IT still wouldn't get it
From my heart, thank you for pressing on. Never doubt that the world needs your incisive, truth-seeking mind and voice.

Toni said...

PJ, I am always so pleased to see a new post from you pop up in my feed. I've "known" you for ages, from my low carb forum days.

Thank you, thank you for writing this. Thank you for laying it all out in such an understandable way.

PJ said...

Thanks you guys!

I've spent the last several weeks obsessively buried, in all my time off work, with reading and collecting everything I could that might point to some alternative approaches and solutions to health. I don't mean to being lean, I gave up on that, I just mean to being healthier in any way, even in small ways (silly things, like getting rid of skin tags, or trying to thicken hair).

A side effect, though, is that I've also by accident stumbled on a whole list of modern disease the officials want to say doesn't exist, so much that it's starting to seem like our whole world is sick to a really high %, and a seemingly endless list of dedicated scientists and doctors dating back 150 years who have been harassed to the point of imprisonment or death for daring to offer 'eat real food' advice to people, even people left for dead by the medical establishment.

It has created what amounts to a rather resentful paranoia about the official powers that be.

But it's also given me a lot of ideas, so I'll be doing some experiments that I'll blog about over the next six months, just to see what the heck happens. Some are health-wide, some are more specific, and even if none of the efforts work, I figure it's healthy to be an optimist and to keep working toward the good! :-)


Shahnaz AKA (Janglitz) said...

Fab post...Excellent and very informative xxx

I have tagged you in my post - Getting to know you

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