Go anywhere that the public gathers — a mall, a sports event, an airport — and you’ll see the sobering evidence of what public health officials have known for more than a decade: We’re in the midst of an obesity-related health crisis. And unless we’re able to reverse current weight trends soon, it’s going to get worse. Much worse.
According to a new government report released Monday, more than 42 percent of American adults will be obese in 2030, up from today’s already gobsmacking figure of 36 percent. And the number of severely obese adults will more than double, from 4.9 percent to 11 percent. (You’re considered obese if you have a body mass index, or BMI, of 30 or more; you’re considered severely obese if your BMI is 40 or more.)
“If these forecasts prove accurate, this will further hinder efforts for healthcare cost containment,” the authors of the report conclude.
Indeed, they project that the increase in the obesity rate — just the increase alone — will add $550 billion to U.S. health-care costs by 2030.
The report, which is being published online in the American Journal of Preventive Medicine, was presented Monday at the Centers for Disease Control and Prevention’s second annual Weight of the Nation conference in Washington, D.C. The conference is also airing a four-part documentary with the same name, which will be broadcast on HBO next week as part of a new nationwide anti-obesity campaign.
The wrong approach?
Obviously, something needs to be done about the obesity epidemic. But what? That’s the billion-dollar question. The new campaign is centered on the eat-fewer-calories-and-exercise-more concept that’s been touted for decades as the answer to maintaining a healthy weight. Not everyone is convinced of this approach, though. A growing number of scientists and other experts believe that not only is the calorie-balance concept ineffective, it may be contributing to the obesity epidemic.
One of the most visible critics of the “energy balance” approach is science writer Gary Taubes. He’s written on this topic extensively over the past decade, including in two heavily researched books, “Good Calories, Bad Calories” and “Why We Get Fat: And What to Do About It.” On Monday, he wrote yet again on the topic for Newsweek magazine. Although the new anti-obesity campaign is needed, he says, it is doomed to fail.
“The problem is, the solutions this multi-level campaign promotes are the same ones that have been used to fight obesity for a century — and they just haven’t worked,” Taubes writes.
“The conventional wisdom these days — promoted by government, obesity researchers, physicians, and probably your personal trainer as well — is that we get fat because we have too much to eat and not enough reasons to be physically active,” he adds. “But then why were the PC- and Big Mac-deprived Depression-era kids fat? How can we blame the obesity epidemic on gluttony and sloth if we easily find epidemics of obesity throughout the past century in populations that barely had food to survive and had to work hard to earn it?
An alternative theory
As Taubes points out, an alternative theory — one mostly ignored by the medical establishment — has been around for decades:
This theory implicates specific foods — refined sugars and grains — because of their effect on the hormone insulin, which regulates fat accumulation. If this hormonal-defect hypothesis is true, not all calories are created equal, as the conventional wisdom holds. And if it is true, the problem is not only controlling our impulses, but also changing the entire American food economy and rewriting our beliefs about what constitutes a healthy diet.
Oddly, this nutrient-hormone-fat interaction is not particularly controversial. You can find it in medical textbooks as the explanation for why our fat cells get fat. But the anti-obesity establishment doesn’t take the next step: that fat fat cells lead to fat humans. In their eyes, yes, insulin regulates how much fat gets trapped in your fat cells, and the kinds of carbohydrates we eat today pretty much drive up your insulin levels. But, they conclude, while individual cells get fat that way, the reason an entire human gets fat has nothing to do with it. We’re just eating too much.
I’ve been arguing otherwise. And one reason I like this hormonal hypothesis of obesity is that it explains the fat kids in Depression-era New York. As the extreme situation of exceedingly poor populations shows, the problem could not have been that they ate too much, because they didn’t have enough food available. The problem then — as now, across America — was the prevalence of sugars, refined flour, and starches in their diets. These are the cheapest calories, and they can be plenty tasty without a lot of preparation and preservation. And the biology suggests that they are literally fattening — they make us fat, while other foods (fats, proteins, and green leafy vegetables) don’t.