How a ‘fatally, tragically flawed’ paradigm has derailed the science of obesity
Obesity has been growing as an epidemic of sorts across the world, especially in the rich world (12% of the population sixty years ago to more than 40% today in the US) and its tendency to spawn off other health disorders makes it even more dangerous. The long-held belief as the most common reason for obesity has been that of an energy imbalance i.e, if we consumer more calories than we burn, we accumulate fat leading to obesity over time. However, Gary Taubes, a science journalist has been arguing for years that we need to debunk this as the fundamental truth if we were to have a real shot at tackling obesity. Over the years, he had posited that it is simply not the energy imbalance but the quality of calories i.e, you could consume a lot of calories but in the form of protein and fat as opposed to carbohydrates being the main source of energy and you could avoid obesity (many popular diets such as the Atkins and keto are built on this). However, in this piece, he presents his findings from a research project with other academics in the field, which goes further by suggesting that obesity is more due to a hormonal imbalance which in turn can be triggered by excess intake of sugar or carbs among many other factors. So if you have been getting your calorie deficit right as well as eating the right kind of calories and avoiding sugar of all kinds but nothing to show for fat loss, you might be better off visiting an endocrinologist.
“Obesity is not an energy balance disorder, but a hormonal or constitutional disorder, a dysregulation of fat storage and metabolism, a disorder of fuel-partitioning. Because these hormonal responses are dominated by the insulin signaling system, which in turn responds primarily (although not entirely) to the carbohydrate content of the diet, this thinking is now known as the carbohydrate-insulin model.
Its implications are simple and profound: People don’t get fat because they eat too much, consuming more calories than they expend, but because the carbohydrates in their diets — both the quantity of carbohydrates and their quality — establish a hormonal milieu that fosters the accumulation of excess fat.”
Gary claims that very little obesity research focused on this process of fat metabolism or the lack of which led to fat accumulation although medical science in general had already developed its understanding of the same:
“Medical textbooks discuss the physiological mechanisms central to fat storage and metabolism — fat synthesis (lipogenesis), mobilization of fat from fat cells (lipolysis), fat storage, and burning fat for energy (oxidation) — implying that subtle disruptions in these processes could easily cause individuals to accumulate excess fat, but such explanations appear only in metabolism and endocrinology chapters. Discussions of obesity itself start and end with energy balance and, with no exceptions that I have found, omit the science of fat metabolism almost entirely. Textbooks dedicated to obesity will describe the causes of the disorder as “multifactorial” and “complex,” but the seemingly countless factors deemed relevant are all assumed to influence fat accumulation only indirectly through how much we eat and exercise.”
Through the rest of the piece, Gary scathingly criticises obesity researchers for having been dogmatic about the energy imbalance paradigm and ignored several findings in history that point towards the hormonal imbalance paradigm.
“In the case of obesity, the hormonal/constitutional hypothesis also encountered dogmatic resistance in response to its single most direct practical implication: Diets that can successfully resolve obesity are not those that induce us to eat less, per energy-balance thinking, but those that reduce circulating levels of insulin, accomplished most effectively by replacing dietary carbohydrates — sugars, starchy vegetables and grains, and the like — with fat.”