When We Get Fat, Do We Really Know What To Do About It?


Dr. Szarka:  “So Mrs. Smith, what are you doing for your weight management?”

Mrs. Smith: “I go to boot camp, 4-5 times per week”

Dr. Szarka: “How is your diet?”

Mrs. Smith: “I have a pretty healthy diet, lots of fruit and vegetables and whole grains”

Dr. Szarka: “Those are good choices. Any meat or other protein?”

Mrs. Smith: “I have a little chicken and some fish”

Dr. Szarka: “Are you getting enough to eat?”

Mrs. Smith: “Oh yes, I manage my calories exactly”

Dr. Szarka: “Really? Do you know how many calories you get in your diet?”

Mrs. Smith: “The trainer I work with told me I should not be eating more than 1500 calories a day, they figured out my BMI and in order for me to lose weight I shouldn’t be eating more than 1500 calories a day”

Dr. Szarka: “So how long have you been following this routine?”

Mrs. Smith: “About a year and a half”

Dr. Szarka: “How much weight have you lost?”

Mrs. Smith: “Initially I think I lost about 5 pounds, but now I have gained it all back plus another 15 pounds, and I can tell you it’s not muscle because my percentage of body fat has increased! Not only that but I have less energy now, and I am hungry all the time.”

I have used quotation marks in this discussion but it is really just a version of a very common discussion with both men and women I have seen that have become frustrated with their exercise and diet routines that are based, to a large degree, on these official statements:

“the fundamental cause (italics added) of obesity and overweight, is an energy imbalance between calories consumed on one hand, and calories expended on the other hand.”

- World Health Organization

“Weight management is all about balance – balancing the number of calories you consume with the number of calories your body uses or ‘burns off’.”

                                                                                                                - - U.S. Centers for Disease Control

 “Overweight is the result of caloric imbalance (too few calories expended for the amount of calories consumed) and is mediated by genetics and health.”

                                                                                                                                - U.S. Surgeon General, 2008

We hear this so often and by so many different, seemingly credible sources, that it has become accepted as common knowledge.  It seems so logical, eat more than you need you will gain weight.  Eat less, and burn it off with exercise, you lose weight. 

But what if it doesn’t happen?  What if you are one of those people like Mrs. Smith?

What if these statements are flat out wrong?

That is what Gary Taubes is trying to say in his most recent book which was released in the beginning of 2011, “Why We Get Fat, And What To Do About It”.  

Taubes is no ordinary author, but it may come as a surprise to some that he is also not a medical doctor, dietician, or any type of health care provider whatsoever.  He is a scientific journalist, with degrees from Harvard, Stanford and Columbia university.  He is a contributing author for Science magazine and the New York Times.  After reading his books, what you should conclude is that he is a well-educated questioner of conventional wisdom, especially that which defies good science.

The reason I am referring, or rather deferring to Mr. Taubes, is that I found that the information written is his book was extraordinarily compelling.  For me as a clinician, working with people to regain their health using diets, nutrition, and exercise, it has helped to provide much needed answers to those people who were struggling with their weight.  For those who have struggled with the “conventional wisdom” of eat less and exercising more.  It wasn’t working, and in fact, it was making them even less healthy than before they had started applying that wisdom.

The purpose of this article is not to review his book entirely, although I do advise my patients and anyone else who has an interest in this subject, to read his book.  Or better yet, to review much of his writing as I believe it will answer some much needed questions regarding diet, weight management and obesity.                       http://www.garytaubes.com/


The Case for Dr. Atkins

In 1972, Dr. Robert Atkins released his, now controversial, book, Dr. Atkins’ Diet Revolution.  Most people who have struggled with their weight, and have turned to scores of different diets trying to combat weight gain, are familiar with this low-carb or restricted carbohydrate philosophy.  And subsequent diets, such as the The South Beach Diet in 2003 are really just similar approaches to the same concept.

While Taubes does reference Atkins, and others who wrote or did research around this subject, one of the main points of his book was that, although Atkins’ book was written over 40 years ago, the bulk of the good science that supported a higher protein and fat diet with restricted carbohydrates had already been done several decades before Atkins book.


Back to the Case of Mrs. Smith

In the case of Mrs. Smith (and every other patient like her), it was very difficult to try and undo the conventional wisdom that had been drummed into her psyche.  But I was equally determined to help her.

My first obstacle was convincing her that she absolutely needed to eat more than 1500 calories a day.  She first looked at me as if I had sprouted horns and was becoming the Devil himself.  For someone who has struggled so long to lose every gram of fat, much less pound, I pardoned the look and offered the following:

Dr. Szarka: “Mrs. Smith, I can’t tell you how many calories your body needs per day, and neither can anyone else for that matter.  Your body knows how much it needs, but more importantly your body knows how much nutrition it needs per day.  Given the extent of your exercise routine and the degree to which you are asking your body to accomplish daily, I would suggest that you would need something more than 1500 calories.”

Mrs. Smith: “Well, how many calories should I eat?”

Dr. Szarka: “I can’t tell because I really don’t know.  What I do know is what you should be eating.  Your diet diary you filled out tells me that you are eating twice as much fruits as vegetables, and you are eating whole grain cereal and yogurt with fruit every morning for breakfast.  It also shows me that in a 21 meal per week diet, you are getting about 7 servings of proteins per week.  I would like you to try the opposite.  Unlimited amounts of vegetables a day, only one serving of fruit.  Have a serving of protein at every meal each day.  And by the way, eat some butter and throw away your “I Can’t Believe It’s Not Butter” stuff.  It isn’t butter, so it’s better if you do not eat it”.

Mrs. Smith: “I’m not sure I can eat that kind of diet.”

Dr. Szarka: “Let’s just try it for 3 weeks, what have you got to lose?”

Mrs. Smith: “You mean other than the 15 lbs of fat I’ve gained in the last year and a half!?”

Dr. Szarka: “Good one Mrs. Smith!”

Mrs. Smith lost 15 pounds in the 3 weeks of her new “diet”, her body fat percentage decreased by 4% when she had it retested, and on a follow up with her primary care doctor he told her that her triglycerides and LDL (“bad”) cholesterol markers had show a significant reduction, while her HDL (“good”) cholesterol had risen significantly.  Go figure.

Final note...Einstein’s definition of insanity; “doing the same thing over and over again and expecting a different result.”


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