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Obesity Crisis

I was reading an article on obesity and the misconceptions by experts in the field. I found this quite interesting and thought I would share some ideas that I currently have after doing the keto diet for 10 months.

I’ve wanted to assume that the experts I interview can be trusted to understand their subjects. Put simply, to get it right. But watching researchers in the field of obesity almost blindly follow a failed paradigm has led me to cross a line that few journalists ever do, to publicly embrace and promote a minority opinion that many in the obesity field think is quackery.

The term ‘expert’ simply means that somebody is knowledgable and generally accepted as being an authoritative voice in a field. It doesn’t mean that they are correct on everything - even everything in their own field. The Scientific method dictates that they must accept the possibility they are potentially wrong. It’s even dangerous for experts to claim that a field is completely known or even explored.

When it comes to obesity, or more generally biology and the human body, the verdict is very much still out. The human body is an exceptionally complex machine that has evolved over many millions of years and Science only really came about relatively recently. It stands to reason that nature still has a thing or two to teach us.

For nearly a century, obesity research has been predicated on the belief that the cause of the disorder “is an energy imbalance between calories consumed and calories expended,” to quote the World Health Organization. By this ubiquitous thinking, obesity is an energy balance disorder: People get fat because they take in more calories than they expend. They stay lean when they don’t.

The equation they propose is pretty simple (quoting a HackerNews comment by amelius):

$$ES = CI - CO$$

Where $ES$ is energy stored, $CI$ is calories in and $CO$ is calories out. The comment then goes on to point out that $CO$ is at least a little more complicated, being:

$$CO = {CO}_{P} + {CO}_{E}$$

Where ${CO}_{P}$ is physically burned calories out and ${CO}_{E}$ is excess burned calories out. Both ${CO}_{P}$ and ${CO}_{E}$ will be largely different from person to person, even varying based on time, age, stress, etc.

Another comment by AndrewDucker points out that $CI$ is not even the same for each person either. Your digestive system, health, micro biome, etc, all play a part in how you process those calories.

Instead of constants, we can think of these values as functions tailored to an individual, $i$. We can then rewrite the original equation as:

$$ES(i) = CI(i) - ({CO}_{P}(i) + {CO}_{E}(i))$$

But again, we are still making an assumption here - that all calories are the same. If ketosis has taught be one thing, it’s that this is entirely not true. Your body runs entirely on sugar, but your three main macro nutrients are protein, carbohydrates and fats. Proteins tend to be used for muscle growth/repair, unless you consume too much, in which it is converted to carbohydrates. Carbohydrates are essentially your sugars, they can be easily stored as fat if you have an excess.

Fats on the other hand can be burned as is - or is broken down, absorbed, recombined and then stored. Fats tend to be about double the calorific value per gram than carbohydrates, but the way in which the body processes them is entirely different. You must also consider that there are different types of fats (animal fats, trans fats, etc) - all of which are processed slightly differently and have different health benefits/negatives.

And don’t even get me started on Fructose! Not even all carbohydrates are burned the same!

This energy-in-energy-out conception of weight regulation, we argue, is fatally, tragically flawed: 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.

And there you have it. Obesity is at least in large part due to a large increase in carbohydrates, not calories. There is a fundamental misunderstanding of weight gain that has propagated all the way up to the WHO whom then disseminate it as fact.

In the U.S., 12% of Americans lived with obesity 60 years ago; more than 40% do today.

Exceptional. Looking around in New Zealand, an astonishing number of people are obese. I’m not a slim bean myself, but the ease at which I can find clothing is actually concerning, it used to be much harder to find anything 2XL and above.