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Tag: Body fat

  • The Hidden Costs of Bariatric Surgery | NutritionFacts.org

    Weight regain after bariatric surgery can have devastating psychological effects.

    How Sustainable Is the Weight Loss After Bariatric Surgery? I explore that issue in my video of the same name. Most gastric bypass patients end up regaining some of the fat they lose by the third year after surgery, but after seven years, 75% of patients followed at 10 U.S. hospitals maintained at least a 20% weight loss.

    The typical trajectory for someone who starts out obese at 285 pounds, for example, would be to drop to an overweight 178 pounds two years after bariatric surgery, but then regain weight up to an obese 207 pounds. This has been chalked up to “grazing” behavior, where compulsive eaters may shift from bingeing (which becomes more difficult post-surgery) to eating smaller amounts constantly throughout the day. In a group of women followed for eight years after gastric bypass surgery, about half continued to describe episodes of disordered eating. As one pediatric obesity specialist described, “I have seen many patients who put chocolate bars into a blender with some cream, just to pass technically installed obstacles [e.g., a gastric band].”

    Bariatric surgery advertising is filled with “happily-ever-after” fairytale narratives of cherry-picked outcomes offering, as one ad analysis put it, “the full Cinderella-romance happy ending.” This may contribute to the finding that patients often overestimate the amount of weight they’ll lose with the procedure and underestimate the difficulty of the recovery process. Surgery forces profound changes in eating habits, requiring slow, small bites that have been thoroughly chewed. Your stomach goes from the volume of two softballs down to the size of half a tennis ball in stomach stapling and half a ping-pong ball in the case of gastric bypass or banding.

    As you can imagine, “weight regain after bariatric surgery can have a devastating effect psychologically as patients feel that they have failed their last option”—their last resort. This may explain why bariatric surgery patients face a high risk of depression. They also have an increased risk of suicide.

    Severe obesity alone may increase the risk of suicidal depression, but even at the same weight, those going through surgery appear to be at a higher risk. At the same BMI (body mass index), age, and gender, bariatric surgery patients have nearly four times the odds of self-harm or attempted suicide compared with those who did not undergo the procedure. Most convincingly, so-called “mirror-image analysis” comparing patients’ pre- and post-surgery events showed the odds of serious self-harm increased after surgery.

    About 1 in 50 bariatric surgery patients end up killing themselves or being hospitalized for self-harm or attempted suicide. And this only includes confirmed suicides, excluding masked attempts such as overdoses classified as having “undetermined intention.” Bariatric surgery patients may also have an elevated risk of accidental death, though some of this could be due to changes in alcohol metabolism. When individuals who have had a gastric bypass were given two shots of vodka, their blood alcohol level surpassed the legal driving limit within minutes due to their altered anatomy. It’s unclear whether this plays a role in the 25% increase in prevalence of alcohol problems noted during the second postoperative year.

    Even those who successfully lose their excess weight and keep it off appear to have a hard time coping. Ten years out, though physical health-related quality of life may improve, general mental health can significantly deteriorate compared to pre-surgical levels, even among those who lost the most weight. Ironically, there’s a common notion that bariatric surgery is for “cheaters” who take the easy way out by choosing the “low-effort” method of weight loss.

    Shedding the weight may not shed the stigma of prior obesity. Studies suggest that “in the eyes of others, knowing that an individual was at one time fat will lead him/her to always be treated like a fat person.” And there can be a strong anti-surgery bias on top of that—those who chose the scalpel to lose weight over diet or exercise were rated more negatively (for example, being considered less physically attractive). One can imagine how remaining a target of prejudice even after joining the “in-group” could potentially undercut psychological well-being.

    There can also be unexpected physical consequences of massive weight loss, like large hanging flaps of excess skin. Beyond being heavy and uncomfortable and interfering with movement, the skin flaps can result in itching, irritation, dermatitis, and skin infections. Getting a panniculectomy (removing the abdominal “apron” of hanging skin) can be expensive, and its complication rate can exceed 50%, with dehiscence (rupturing of the surgical wound) one of the most common complications.

    “Even if surgery proves sustainably effective,” wrote the founding director of Yale University’s Prevention Research Center, “the need to rely on the rearrangement of natural gastrointestinal anatomy as an alternative to better use of feet and forks [exercise and diet] seems a societal travesty.”

    In the Middle Ages, starving peasants dreamed of gastronomic utopias where food just rained down from the sky. The English called it the Kingdom of Cockaigne. Little could medieval fabulists predict that many of their descendants would not only take permanent residence there but also cut out parts of their stomachs and intestines to combat the abundance. Critics have pointed out the irony of surgically altering healthy organs to make them dysfunctional—malabsorptive—on purpose, especially when it comes to operating on children. Bariatric surgery for kids and teens has become widespread and is being performed on children as young as five years old. Surgeons defend the practice by arguing that growing up fat can leave “‘emotional scars’ and lifelong social retardation.”

    Promoters of preventive medicine may argue that bariatric surgery is the proverbial “ambulance at the bottom of the cliff.” In response, proponents of pediatric bariatric surgery have written: “It is often pointed out that we should focus on prevention. Of course, I agree. However, if someone is drowning, I don’t tell them, ‘You should learn how to swim’; no, I rescue them.”

    A strong case can be made that the benefits of bariatric surgery far outweigh the risks if the alternative is remaining morbidly obese, which is estimated to shave up to a dozen or more years off one’s life. Although there haven’t been any data from randomized trials yet to back it up, compared to non-operated obese individuals, those getting bariatric surgery would be expected to live significantly longer on average. No wonder surgeons have consistently framed the elective surgery as a life-or-death necessity. This is a false dichotomy, though. The benefits only outweigh the risks if there are no other alternatives. Might there be a way to lose weight healthfully without resorting to the operating table? That’s what my book How Not to Diet is all about.

    Doctor’s Note

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

    This is the final segment in a four-part series on bariatric surgery, which includes:

    This blog contains information regarding suicide. If you or anyone you know is exhibiting suicide warning signs, please get help. Go to https://988lifeline.org for more information.

    Michael Greger M.D. FACLM

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  • Is Surgery Necessary to Reverse Diabetes? | NutritionFacts.org

    Losing weight without rearranging your gastrointestinal anatomy carries advantages beyond just the lack of surgical risk.

    The surgical community objects to the characterization of bariatric surgery as internal jaw wiring and cutting into healthy organs just to discipline people’s behavior. They’ve even renamed it “metabolic surgery,” suggesting the anatomical rearrangements cause changes in digestive hormones that offer unique physiological benefits. As evidence, they point to the remarkable remission rates for type 2 diabetes.

    After bariatric surgery, about 50% of obese people with diabetes and 75% of “super-obese” diabetics go into remission, meaning they have normal blood sugar levels on a regular diet without any diabetes medication. The normalization of blood sugar can happen within days after the surgery. And 15 years after the surgery, 30% remained free from their diabetes, compared to a 7% remission rate in a nonsurgical control group. Are we sure it was the surgery, though?

    One of the most challenging parts of bariatric surgery is lifting the liver. Since obese individuals tend to have such large, fatty livers, there is a risk of liver injury and bleeding. An enlarged liver is one of the most common reasons a less invasive laparoscopic surgery can turn into a fully invasive open surgery, leaving the patient with a large belly scar, along with an increased risk of wound infections, complications, and recovery time. But lose even just 5% of your body weight, and your fatty liver may shrink by 10%. That’s why those awaiting bariatric surgery are put on a diet. After surgery, patients are typically placed on an extremely low-calorie liquid diet for weeks. Could their improvement in blood sugar levels just be from the caloric restriction, rather than some sort of surgical metabolic magic? Researchers decided to put it to the test.

    At a bariatric surgery clinic at the University of Texas, patients with type 2 diabetes scheduled for a gastric bypass volunteered to stay in the hospital for 10 days to follow the same extremely low-calorie diet—less than 500 calories a day—that they would be placed on before and after surgery, but without undergoing the procedure itself. After a few months, once they had regained the weight, the same patients then had the actual surgery and repeated their diet, matched day to day. This allowed researchers to compare the effects of caloric restriction with and without the surgical procedure—the same patients, the same diet, just with or without the surgery. If there were some sort of metabolic benefit to the anatomical rearrangement, the patients would have done better after the surgery, but, in some ways, they actually did worse.

    The caloric restriction alone resulted in similar improvements in blood sugar levels, pancreatic function, and insulin sensitivity, but several measures of diabetic control improved significantly more without the surgery. The surgery seemed to put them at a metabolic disadvantage.

    Caloric restriction works by first mobilizing fat out of the liver. Type 2 diabetes is thought to be caused by fat building up in the liver and spilling over into the pancreas. Everyone may have a “personal fat threshold” for the safe storage of excess fat. When that limit is exceeded, fat gets deposited in the liver, where it can cause insulin resistance. The liver may then offload some of the fat (in the form of a fat transport molecule called VLDL), which can then accumulate in the pancreas and kill off the cells that produce insulin. By the time diabetes is diagnosed, half of our insulin-producing cells may have been destroyed, as seen below and at 3:36 in my video Bariatric Surgery vs. Diet to Reverse Diabetes. Put people on a low-calorie diet, though, and this entire process can be reversed.

    A large enough calorie deficit can cause a profound drop in liver fat sufficient to resurrect liver insulin sensitivity within seven days. Keep it up, and the calorie deficit can decrease liver fat enough to help normalize pancreatic fat levels and function within just eight weeks. Once you drop below your personal fat threshold, you should then be able to resume normal caloric intake and still keep your diabetes at bay, as seen below and at 4:05 in my video. 

    The bottom line: Type 2 diabetes is reversible with weight loss, if you catch it early enough.

    Lose more than 30 pounds (13.6 kilograms), and nearly 90% of those who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels (suggesting diabetes remission), whereas it may only be reversible in 50% of those who’ve lived with the disease for eight or more years. That’s by losing weight with diet alone, though. For people with diabetes, losing more than twice as much weight with bariatric surgery, diabetes remission may only be around 75% of those who’ve had the disease for up to six years and only about 40% for those who’ve had diabetes longer, as seen below and at 4:41 in my video.

    Losing weight without surgery may offer other benefits as well. Individuals with diabetes who lose weight with diet alone can significantly improve markers of systemic inflammation, such as tumor necrosis factor, whereas levels significantly worsened when about the same amount of weight was lost from a gastric bypass.

    What about diabetic complications? One reason to avoid diabetes is to avoid its associated conditions, like blindness or kidney failure requiring dialysis. Reversing diabetes with bariatric surgery can improve kidney function, but, surprisingly, it may not prevent the occurrence or progression of diabetic vision loss—perhaps because bariatric surgery affects quantity but not necessarily quality when it comes to diet. This reminds me of a famous study published in The New England Journal of Medicine that randomized thousands of people with diabetes to an intensive lifestyle program focused on weight loss. Ten years in, the study was stopped prematurely because the participants weren’t living any longer or having any fewer heart attacks. This may be because they remained on the same heart-clogging diet but just in smaller portions.

    Doctor’s Note

    This is the third blog in a four-part series on bariatric surgery. If you missed the first two, check out The Mortality Rate of Bariatric Weight-Loss Surgery and The Complications of Bariatric Weight-Loss Surgery.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

    Michael Greger M.D. FACLM

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  • Bariatric Surgery: Risks in the OR and Beyond | NutritionFacts.org

    The extent of risk from bariatric weight-loss surgery may depend on the skill of the surgeon.

    After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure, as you can see below and at 0:16 in my video The Complications of Bariatric Weight-Loss Surgery.

    Up to 25% of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery. Reoperations are even riskier, with up to 10 times the mortality rate, and there is “no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

    The extent of risk may depend on the skill of the surgeon. In a study published in The New England Journal of Medicine, bariatric surgeons voluntarily submitted videos of themselves performing surgery to a panel of their peers for evaluation. Technical proficiency varied widely and was related to the rates of complications, hospital readmissions, reoperations, and death. Patients operated on by less competent surgeons suffered nearly three times the complications and five times the rate of death.

    “As with musicians or athletes, some surgeons may simply be more talented than others”—but practice may help make them perfect. Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Risk for complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who had performed more than 600 bypasses. The odds of not making it out alive may be double under the knife of those who had performed less than 75 compared to more than 450, as seen below and at 1:47 in my video.

    So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

    It’s not always the surgeon’s fault, though. In a report entitled “The Dangers of Broccoli,” a surgeon described a case in which a woman went to an all-you-can-eat buffet three months after a gastric bypass operation. She chose really healthy foods—good for her!—but evidently forgot to chew. Her staples ruptured, and she ended up in the emergency room, then the operating room. They opened her up and found “full chunks of broccoli, whole lima beans, and other green leafy vegetables” inside her abdominal cavity. A cautionary tale to be sure, but perhaps one that’s less about chewing food better after surgery than about chewing better foods before surgery—to keep all your internal organs intact in the first place.

    Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. We’re talking about more than anemia, osteoporosis, or hair loss. Such deficits can cause full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage that can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in reported cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

    The malabsorption of nutrients is intentional for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories—at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Vomiting is reported by up to 60% of patients after bariatric surgery due to “inappropriate eating behaviors.” (In other words, trying to eat normally.) The vomiting helps with weight loss, similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

    “Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods, as they bypass your stomach and dump straight into your intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.

    Doctor’s Note

    This is the second in a four-part series on bariatric surgery. If you missed the first one, see The Mortality Rate of Bariatric Weight-Loss Surgery.

    Up next: Bariatric Surgery vs. Diet to Reverse Diabetes and How Sustainable Is the Weight Loss After Bariatric Surgery?.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

    Michael Greger M.D. FACLM

    Source link

  • Bariatric Weight-Loss Surgery and Mortality | NutritionFacts.org

    Today, death rates after weight-loss surgery are considered to be “very low,” occurring in perhaps 1 in 300 to 1 in 500 patients on average.

    The treatment of obesity has long been stained by the snake-oil swindling of profiteers, hustlers, and quacks. Even the modern field of bariatric medicine (derived from the Greek word baros, meaning “weight”) is pervaded by an “insidious image of sleaze.” Beguiled by advertising for fairy tale magic bullets of rapid, effortless weight loss, people blame themselves for failing to manifest the miracle or imagine themselves metabolically broken. On the other end of the spectrum are overly pessimistic practitioners of the opinion that “people who are fat are born fat, and nothing much can be done about it.” The truth lies somewhere in between.

    The difficulty of curing obesity has been compared to learning a foreign language. It’s an achievement virtually anyone can attain with a sufficient investment of energies, “but it always takes a considerable amount of time and trouble.” And, of those who do stick with it, most will regain much of the weight lost. To me, this speaks to the difficulty, rather than the futility. It may take smokers an average of 30 attempts to finally kick the habit. Like quitting smoking, curing obesity is just something that has to be done. As the chair of the Association for the Study of Obesity put it, it doesn’t take “will power” to do essential tasks like getting up at night to feed a baby; it’s just something that has to be done.

    Our collective response doesn’t seem to match the rhetoric or reality. If obesity is such a “national crisis” reaching alarming proportions, dubbed by the post-9/11 Surgeon General as “every bit as devastating as terrorism,” why has our reaction been so tepid? For example, governments meekly suggest the food industry take “voluntary initiatives to restrict the marketing of less healthy food options to children….” Have we just given up and ceded control?

    Our timid response to the obesity epidemic is encapsulated by a national initiative promulgated by a Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council: the “small-changes approach.” Since “small changes are more feasible to achieve,” suggestions include “using mustard instead of mayonnaise” and “eating 1 rather than 2 doughnuts in the morning.” Seems a bit like bringing a butter knife to a gunfight. Proponents of the small-changes approach lament that, unlike other addictions—for example, alcohol, cocaine, gambling, or tobacco—we can’t counsel our obese patients to give up the addictive element completely, as “[n]o one can give up eating.” But just because we have to breathe, doesn’t mean it has to be through the end of a cigarette. And just because we have to eat doesn’t mean we have to eat junk.

    What about bringing a scalpel to the gunfight instead? The use of bariatric surgery has exploded from about 40,000 procedures noted in the first international survey in 1998 to hundreds of thousands performed now every year in the United States alone. The first technique that was developed, the intestinal bypass, involved carving out about 19 feet of intestines. More than 30,000 intestinal bypass operations were performed before we recognized “catastrophic” and “disastrous outcomes” resulted from these procedures. This included protein deficiency-induced liver disease, “which often progressed to liver failure and death.” This inauspicious start is remembered as “one of the dark blots in the history of surgery,” as I discuss in my video The Mortality Rate of Bariatric Weight-Loss Surgery.

    Today, death rates after bariatric surgery are considered “very low,” occurring on average in perhaps 1 in 300 to impacting 1 in 500 patients. The most common procedure is stomach stapling, also known as sleeve gastrectomy, in which most of the stomach is permanently removed. Only a narrow tube of the stomach is left so as to restrict how much food people can eat at any one time. It’s ironic that many patients choose bariatric surgery convinced that, “for them, ‘diets do not work,’” when, in reality, that’s all the surgery may be—an enforced diet. Bariatric surgery can be thought of as a form of internal jaw wiring.

    Gastric bypass, known as Roux-en-Y gastric bypass, is the second most common bariatric surgery. It combines restriction—stapling the stomach into a pouch smaller than a golf ball—with malabsorption by rearranging one’s anatomy to bypass the first part of the small intestine. It appears to be more effective than just cutting out most of the stomach, resulting in a loss of about 63% of excess weight compared to 53% with a gastric sleeve. But gastric bypass carries a greater risk of serious complications. Many are surprised to learn that new “surgical procedures…do not require premarket testing and approval by the Food and Drug Administration (FDA)” and are largely exempt from rigorous regulatory scrutiny.

    Doctor’s Note

    I didn’t know there wasn’t some kind of approval process for new surgical procedures!

    This is the first video in a four-part series on bariatric surgery. Coming up are:

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local public library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

     

    Michael Greger M.D. FACLM

    Source link

  • The best smart scales for 2025

    A smart scale does more than show your weight. It tracks metrics like body fat, muscle mass and water percentage, then syncs that data to your phone so you can see changes over time. If you want to take control of your health, the best smart scale gives you clear insights and helps you stay consistent with your goals.

    Some models focus on accuracy, while others support multiple user profiles or connect with apps you already use. With so many options available, choosing the best smart scale comes down to the features that matter most for your routine. This guide highlights our top picks to make that decision easier.

    Table of contents

    Smart scale safety

    There are valid reasons to weigh yourself but your self-worth shouldn’t be defined by what number shows up between your feet. If you’re looking to alter your body shape, that figure could go up as your waistline goes down since muscle weighs more than fat.

    Some scales go further by providing additional metrics like visceral fat levels, giving you a more comprehensive picture of your health. Dr. Anne Swift, Director of Public Health teaching at the University of Cambridge, said “weighing yourself too often can result in [you] becoming fixated on small fluctuations day-to-day rather than the overall trend over time.” Swift added “it’s sometimes better to focus on how clothes fit, or how you feel, rather than your weight.”

    A meta-analysis from 2016 found there may be some negative psychological impact from self weighing. A 2018 study, however, said there may be a positive correlation between regular weigh-ins and accelerated weight loss. It can be a minefield and I’d urge you to take real care of yourself and remember success won’t happen overnight.

    Best smart scales for 2025

    Fitbit

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes | Length: 11.8 inches | Width: 11.8 inches | Number of profiles: Multiple

    There are plenty of good budget scales out there, with Xiaomi and Fitbit offering very different products for very little money. Fitbit’s scale has far fewer features but has better build quality and is faster and more reliable than its even-cheaper rival. Crucially, it also leverages the Fitbit app, which is refined and easy-to-use, offering clean and easy to understand visualizations of your weight measurements.

    Xiaomi, meanwhile, offers your weight and body composition data,but much of that is only seen inside the app. From a data perspective, Xiaomi has the edge but its companion app is terrible. The lag time for each weigh-in, too, leaves a lot to be desired with the Xiaomi, even if I had no qualms about its accuracy.

    One of my nan’s favorite sayings was “you can either have a first class walk or a third class ride.” Fitbit’s scale is the very definition of a first class walk, polished, snappy with a great app but otherwise pretty limited. Xiaomi, meanwhile, charges less and offers more for your money but both the hardware and software lack any sort of polish. It’s up to you, but this is one of those rare occasions where I’d prefer the first class walk to the third class ride.

    Pros

    • Good build quality
    • Easy to use
    • Convenient integration with Fitbit app
    Cons

    • Fewer features than competitors

    $50 at Amazon

    Image for the large product module

    eufy

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes, syncs with Apple Health, Google Fit, or Fitbit | Length: 12.8 inches | Width: 12.8 inches | Number of profiles: Unlimited

    This slot was previously occupied by Eufy’s last smart scale, the P2 Pro, so it’s little surprise its successor replaces it here. The company’s strategy remains the same: Throw as many features into the P3 smart scale as possible to ensure competitors are beaten on specs alone. It’s easy enough to use, and offers a whole host of data to better help you understand your body composition.

    The P3 will measure your weight, body fat, muscle mass, heart rate, water, bone mass and your protein levels. It promises to calculate your basal metabolic rate, the number of calories you need to maintain a constant weight. There’s a gorgeous and clear-to-read color screen that lays out all your stats after you’ve weighed in, including trend graphs annotated with emojis.

    A downside of this all-but-the-kitchen-sink approach is the lack of polish, cohesion and user friendliness. For instance, if multiple people in your home have similar weights, then you may need to tap the right quadrant of the scale to switch profile. That’s quite easy, or would be, if the selection window didn’t zoom by faster than the time it takes to lift your toes up and down.

    It’s also a little unforgiving, nagging you at every weigh in with an orange angry emoji if you gain weight, even if the overall trend is positive. The inverse is also true — during testing, my kids somehow managed to get their joint weight registered under my name. But despite losing half of my body weight overnight, it did nothing but make my 3D avatar look gaunt.

    If you’re prepared to accept the lack of polish to get ahold of the raw features, then Eufy’s latest scale is a solid option. You’re not likely to find anything that’s as similarly affordable and useful in this price range, especially given Eufy’s propensity for deep discounts.

    Pros

    • Easy to use
    • A lot of data
    • Very affordable
    Cons

    • Lackluster app
    • Lack of polish and joined-up thinking

    $100 at Amazon

    Image for the large product module

    Garmin

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes | Length: 12.6 inches | Width: 12.2 inches | Number of profiles: 16

    I’m partial to Garmin’s Index S2, but it’s the sort of scale that needs to be used by people who know what they’re doing. Everything about the hardware is spot-on, and the only fly in its ointment is the low refresh rate on its color screen. I can’t say how upsetting it is to see the screen refresh in such a laggy, unpolished manner, especially when you’re spending this much money. But that is my only complaint, with accurate and detailed readings, including your body water percentage. If you’re looking to set goals to alter your body shape, this isn’t the scale for you — it’s the scale you buy once you calculate your BMR on a daily basis.

    Pros

    • Good build quality
    • Good integration with Garmin mobile app
    • Provides a lot of data

    $200 at Amazon

    Image for the large product module

    Withings

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes, syncs with Apple Health and Google Fit | Length: 12.7 inches | Width: 12.7 inches | Number of profiles: 8

    If you’re looking for a machine catering to your every whim, then Withings’ Body Comp is the way forward. It’s a luxury scale in every sense of the word, and you should appreciate the level of polish and technology on show here. Withings health app remains best in class, and I love how effortless the whole thing is to use on a daily basis. It’s a lot more expensive than the rest since it does so much more, like checking your nerve and arterial health. The retail price is a bit steep, but it’s one of those moments where you get exactly what you pay for.

    Pros

    • Good build quality
    • Excellent software support with Withings app
    • In-depth health tracking, including data on nerve and artery heatlh
    Cons

    • Runs on disposable batteries

    $230 at Target

    What to look for in a smart scale

    Weight

    A scale that measures weight is probably the top requirement, right? Whether you’re after a basic weight scale or a full-featured body fat scale, bear in mind, with all these measurements, the readings won’t be as accurate as a calibrated clinical scale. It’s better to focus on the overall trend, up or down over time, rather than a single measurement in isolation. Scales offering high-precision measurements can help, especially if you’re looking at the data to inform a specific health or fitness goal.

    Connectivity

    Before you buy your scale, work out how you’re planning on weighing yourself and when, as it is an issue. Some lower-end smart bathroom scales connect via Bluetooth and have no internal storage, so if you don’t have your phone to hand, it won’t record your weight. If your scale has Wi-Fi, then your scale can post the data to a server, letting you access them from any compatible device. Also, you should be mindful that some smart scales aren’t built with security in mind, so there’s a small risk to your privacy should your scale be compromised.

    Bone density

    The stronger your bones are, the less risk you have of breaks and osteoporosis — common concerns as you get older. Clinical bone density tests use low-power x-rays and some scales can offer you an at-home approximation. These bone mass tests pass a small electrical current through your feet, measuring the resistance as it completes its journey. The resistance offered by bones, fat and muscle are all different, letting your scale identify the difference. A body composition monitor often includes this feature, too, providing a detailed breakdown of bone density, fat and muscle mass.

    Body fat percentage and muscle mass

    Fat and muscle are necessary parts of our makeup, but too much of either can be problematic. Much like bone density, a body composition measurement feature can monitor your body fat and muscle mass percentages using Bioelectrical Impedance Analysis (BIA). This measurement tests how well your body resists an electrical signal passing through your body. (It’s a rough rule of thumb you should have a 30/70 percent split between fat and muscle, but please consult a medical professional for figures specific to your own body and medical needs.) For those with specific athletic goals, smart scales offer an athlete mode to better tailor readings for accuracy. If body fat monitoring is a priority, look for a model marketed as a body fat scale.

    BMI

    A lot of scales offer a BMI calculation, and it’s easy to do since you just plot height and weight on a set graph line. Body Mass Index is, however, a problematic measurement that its critics say is both overly simplistic and often greatly misleading. Unfortunately, it’s also one of the most common clinical body metrics and medical professionals will use it to make judgements about your care.

    Pulse Wave Velocity

    French health-tech company Withings has offered Pulse Wave Velocity (PWV) on its flagship scale for some time, although regulatory concerns meant it was withdrawn for a period. It’s a measurement of arterial stiffness, which acts as a marker both of cardiovascular risk and other health conditions. For those looking for an even deeper understanding of their health, some scales now offer a body scan, which provides more advanced metrics such as segmental body composition and vascular health insights.

    Wearables and integration

    Pairing your smart scale with wearables like fitness trackers or smartwatches can further enhance your health-tracking ecosystem. Many smart scales sync directly with platforms like Fitbit or Apple Health, making it easier to track trends and analyze your data in one place.

    Display

    Less a specification and more a note: Smart bathroom scales have displays ranging from pre-printed LCDs or digital dot matrix layouts through to color display screens. On the high end, your scale display can show you trending charts for your weight and other vital statistics, and can even tell you the day’s weather. If you are short-sighted, and plan on weighing yourself first thing in the morning, before you’ve found your glasses or contacts, opt for a big, clear, high-contrast display.

    App and subscriptions

    You’ll spend most of your time looking at your health data through its companion scales app, and it’s vital you get a good one. This includes a clear, clean layout with powerful tools to visualize your progress and analyze your data to look for places you can improve. Given that you often don’t need to buy anything before trying the app, it’s worth testing one or two to see if you vibe with it. It’s also important you check app compatibility before making your purchase. Some health apps will only work with iOS or Android — not both. Apple Watch connectivity can also be a bonus for tracking workouts and health metrics seamlessly. Several companies also offer premium subscriptions, unlocking other features – including insights and coaching – to go along with your hardware.

    Data portability

    Using the same scale or app platform for years at a time means you’ll build up a massive trove of personal data. And it is (or should be), your right to take that data to another provider if you choose to move platforms in the future. Data portability is, however, a minefield, with different platforms offering wildly different options, making it easy (or hard) to go elsewhere.

    All of the devices in this round-up will allow you to export your data to a .CSV file, which you can then do with as you wish. Importing this information is trickier, with Withings and Garmin allowing it, and Omron, Xiaomi, Eufy and Fitbit not making it that easy. (Apps that engage with Apple Health, meanwhile, can output all of your health data in a .XML file.)

    Power

    It’s not a huge issue but one worth bearing in mind that each scale will either run disposable batteries (most commonly 4xAAA) or with its own, built-in battery pack. Either choice adds an environmental and financial cost to your scale’s life — either with regular purchases of fresh cells or the potential for the whole unit to become waste when the battery pack fails.

    How we tested and which smart scales we tested

    For this guide, I tested six scales from major manufacturers:

    Mi (Xiaomi) Body Composition Scale 2

    Our cheapest model, Xiaomi / Mi’s Body Composition Scale 2 is as bare-bones as you can get, and it shows. It often takes a long while to lock on to get your body weight, and when it does you’ll have to delve into the Zepp Life-branded scales app in order to look at your extra data. But you can’t fault it for the basics, offering limited (but accurate) weight measurements and body composition for less than the price of a McDonald’s for four.

    Fitbit Aira Air

    Fitbit, now part of Google, is the household name for fitness trackers and smartwatches in the US, right? If not, then it must be at least halfway synonymous with it. The Aria Air is the company’s stripped-to-the-bare bones scale, offering your weight and a few other health metrics, but you can trust that Fitbit got the basics right. Not to mention that most of the reason for buying a Fitbit product is to leverage its fitness app anyway.

    Anker Eufy Smart Scale P2 Pro

    Eufy’s Smart Scale P2 Pro has plenty of things to commend it – the price, the overall look and feel (it’s a snazzy piece of kit) and what it offers. It offers a whole host of in-depth functionality, including Body Fat, Muscle Mass, Water Weight, Body Fat Mass and Bone Mass measurements, as well as calculating things like your Heart Rate and Basal Metabolic Rate (the amount of calories you need to eat a day to not change weight at all) all from inside its app. In fact, buried beneath the friendly graphic, the scale offers a big pile of stats and data that should, I think, give you more than a little coaching on how to improve your overall health.

    It’s worth noting that Anker – Eufy’s parent company – was identified as having misled users, and the media, about the security of its products a few years back. Its Eufy-branded security cameras, which the company says does not broadcast video outside of your local network, was found to be allowing third parties to access streams online. Consequently, while we have praised the Eufy Smart Scale for its own features, we cannot recommend it without a big caveat.

    Omron BCM-500 Body Composition and Scale with Bluetooth

    Given its role in making actual medical devices, you know what you’re getting with an Omron product. A solid, reliable, sturdy, strong (checks the dictionary for more synonyms) dependable piece of kit. There’s no romance or excitement on show, but you can trust that however joyless it may be, it’ll do the job in question and will be user-friendly. The hardware is limited, the app is limited, but it certainly (checks synonyms again) is steady.

    Joking aside, Omron’s Connect app is as bare-bones as you can get, since it acts as an interface for so many of its products. Scroll over to the Weight page, and you’ll get your weight and BMI reading, and if you’ve set a fitness goal, you can see how far you’ve got to go to reach it. You can also switch to seeing a trend graph which, again, offers the most basic visualization of your workouts and progress.

    Garmin Index S2

    Garmin’s got a pretty massive fitness ecosystem of its own, so if you’re already part of that world, its smart scale is a no-brainer. On one hand, the scale is one of the easiest to use, and most luxurious of the bunch, with its color screen and sleek design. I’m also a big fan of the wealth of data and different metrics the scale throws at you – you can see a full color graph charting your weight measurements and goal progress, and the various metrics it tracks in good detail. If there’s a downside, it’s that Garmin’s setup won’t hold your hand, since it’s for serious fitness people, not newbies.

    Withings Body Comp

    At the highest end, Withings’ flagship Body Comp is luxurious, and luxuriously priced, a figure I’d consider to be “too much” to spend on a bathroom scale. For your money, however, you’ll get a fairly comprehensive rundown of body composition metrics including your weight, body fat percentage, vascular age, pulse wave velocity and electrodermal activity. Its monochrome dot matrix display may not be as swish as the Garmin’s, but it refreshes pretty quickly and feels very in-keeping with the hardware’s overall sleek look.

    Withings Body Scan

    If you want to flaunt your cash, you don’t buy a car, you buy a supercar, or a hypercar if you’re flush enough. What then, do we call Withings’ $400 Body Scan if not a super-smart scale, or a hyper-smart scale? As well as doing everything the Body Comp does, plus running a six-lead ECG, segmented body composition, and will even check for neuropathy in your feet. It is the best scale I’ve ever used, it is also the most expensive, and I suspect it’s too much device for almost everyone who’d consider buying one.

    Smart scales FAQs

    What’s the difference between a smart scale and a regular scale?

    A regular scale is pretty straightforward — it tells you how much you weigh, and that’s usually it. A smart scale, on the other hand, does much more. Not only does it give you your weight measurements, but it can also track things like your body fat percentage, muscle mass, and even your BMI. Some smart scales even monitor more advanced metrics like bone density, depending on the model.

    What’s even better is that smart scales sync with scales apps on your phone using Wi-Fi or Bluetooth, so you can see all your health data in one place. This lets you monitor trends over time, like if your muscle mass is increasing or your body fat percentage decreasing.

    How do smart scales work with more than one person using it?

    When more than one person in a household uses the smart scale, it usually recognizes each person by their weight range and other body measurements (like body fat percentage). Most smart scales allow you to set up individual profiles in the companion app, and once your profile is linked, the scale can automatically figure out who’s standing on it.

    Let’s say you and a family member have fairly different weights — the scale will easily know who’s who based on that. But if you and someone else have similar weights, it might ask you to confirm the profile on your phone after the weigh-in. Some scales even let you assign a profile manually in the scales app if it’s not sure.

    Daniel Cooper

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  • Taking Advantage of Sensory-Specific Satiety  | NutritionFacts.org

    How can we use sensory-specific satiety to our advantage?

    When we eat the same foods over and over, we become habituated to them and end up liking them less. That’s why the “10th bite of chocolate, for example, is desired less than the first bite.” We have a built-in biological drive to keep changing up our foods so we’ll be more likely to hit all our nutritional requirements. The drive is so powerful that even “imagined consumption reduces actual consumption.” When study participants imagined again and again that they were eating cheese and were then given actual cheese, they ate less of it than those who repeatedly imagined eating that food fewer times, imagined eating a different food (such as candy), or did not imagine eating the food at all.

    Ironically, habituation may be one of the reasons fad “mono diets,” like the cabbage soup diet, the oatmeal diet, or meal replacement shakes, can actually result in better adherence and lower hunger ratings compared to less restrictive diets.

    In the landmark study “A Satiety Index of Common Foods,” in which dozens of foods were put to the test, boiled potatoes were found to be the most satiating food. Two hundred and forty calories of boiled potatoes were found to be more satisfying in terms of quelling hunger than the same number of calories of any other food tested. In fact, no other food even came close, as you can see below and at 1:14 in my video Exploiting Sensory-Specific Satiety for Weight Loss.

    No doubt the low calorie density of potatoes plays a role. In order to consume 240 calories, nearly one pound of potatoes must be eaten, compared to just a few cookies, and even more apples, grapes, and oranges must be consumed. Each fruit was about 40 percent less satiating than potatoes, though, as shown here and at 1:45 in my video. So, an all-potato diet would probably take the gold—the Yukon gold—for the most bland, monotonous, and satiating diet.

    A mono diet, where only one food is eaten, is the poster child for unsustainability—and thank goodness for that. Over time, they can lead to serious nutrient deficiencies, such as blindness from vitamin A deficiency in the case of white potatoes.

    The satiating power of potatoes can still be brought to bear, though. Boiled potatoes beat out rice and pasta in terms of a satiating side dish, cutting as many as about 200 calories of intake off a meal. Compared to boiled and mashed potatoes, fried french fries or even baked fries do not appear to have the same satiating impact.

    To exploit habituation for weight loss while maintaining nutrient abundance, we could limit the variety of unhealthy foods we eat while expanding the variety of healthy foods. In that way, we can simultaneously take advantage of the appetite-suppressing effects of monotony while diversifying our fruit and vegetable portfolio. Studies have shown that a greater variety of calorie-dense foods, like sweets and snacks, is associated with excess body fat, but a greater variety of vegetables appears protective. When presented with a greater variety of fruit, offered a greater variety of vegetables, or given a greater variety of vegetable seasonings, people may consume a greater quantity, crowding out less healthy options.

    The first 20 years of the official Dietary Guidelines for Americans recommended generally eating “a variety of foods.” In the new millennium, they started getting more precise, specifying a diversity of healthier foods, as seen below and at 3:30 in my video. 

    A pair of Harvard and New York University dietitians concluded in their paper “Dietary Variety: An Overlooked Strategy for Obesity and Chronic Disease Control”: “Choose and prepare a greater variety of plant-based foods,” recognizing that a greater variety of less healthy options could be counterproductive.

    So, how can we respond to industry attempts to lure us into temptation by turning our natural biological drives against us? Should we never eat really delicious food? No, but it may help to recognize the effects hyperpalatable foods can have on hijacking our appetites and undermining our body’s better judgment. We can also use some of those same primitive impulses to our advantage by minimizing our choices of the bad and diversifying our choices of the good. In How Not to Diet, I call this “Meatball Monotony and Veggie Variety.” Try picking out a new fruit or vegetable every time you shop.

    In my own family’s home, we always have a wide array of healthy snacks on hand to entice the finickiest of tastes. The contrasting collage of colors and shapes in fruit baskets and vegetable platters beat out boring bowls of a single fruit because they make you want to mix it up and try a little of each. And with different healthy dipping sauces, the possibilities are endless.

    Michael Greger M.D. FACLM

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  • Dietary Diversity and Overeating  | NutritionFacts.org

    Big Food uses our hard-wired drive for dietary diversity against us.

    How did we evolve to solve the daunting task of selecting a diet that supplies all the essential nutrients? Dietary diversity. By eating a variety of foods, we increase our chances of hitting all the bases. If we only ate for pleasure, we might just stick with our favorite food to the exclusion of all others, but we have an innate tendency to switch things up.

    Researchers found that study participants ended up eating more calories when provided with three different yogurt flavors than just one, even if that one is the chosen favorite. So, variation can trump sensation. They don’t call it the spice of life for nothing.

    It appears to be something we’re born with. Studies on newly weaned infants dating back nearly a century show that babies naturally choose a variety of foods even over their preferred food. This tendency seems to be driven by a phenomenon known as sensory-specific satiety.

    Researchers found that, “within 2 minutes after eating the test meal, the pleasantness of the taste, smell, texture, and appearance of the eaten food decreased significantly more than for the uneaten foods.” Think about how the first bite of chocolate tastes better than the last bite. Our body tires of the same sensations and seeks out novelty by rekindling our appetite every time we’re presented with new foods. This helps explain the “dessert effect,” where we can be stuffed to the gills but gain a second wind when dessert arrives. What was adaptive for our ancient ancestors to maintain nutritional adequacy may be maladaptive in the age of obesity.

    When study participants ate a “varied four-course meal,” they consumed 60 percent more calories than those given the same food for each course. It’s not only that we get bored; our body has a different physiological reaction.

    As you can see below and at 2:13 in my video How Variation Can Trump Sensation and Lead to Overeating, researchers gave people a squirt of lemon juice, and their salivary glands responded with a squirt of saliva. But when they were given lemon juice ten times in a row, they salivated less and less each time. When they got the same amount of lime juice, though, their salivation jumped right back up. We’re hard-wired to respond differently to new foods. 
    Whether foods are on the same plate, are at the same meal, or are even eaten on subsequent days, the greater the variety, the more we tend to eat. When kids had the same mac and cheese dinner five days in a row, they ended up eating hundreds fewer calories by the fifth day, compared to kids who got a variety of different meals, as you can see below and at 2:35 in my video.

    Even just switching the shape of food can lead to overeating. When kids had a second bowl of mac and cheese, they ate significantly more when the noodles were changed from elbow macaroni to spirals. People allegedly eat up to 77 percent more M&Ms if they’re presented with ten different colors instead of seven, even though all the colors taste the same. “Thus, it is clear that the greater the differences between foods, the greater the enhancement of intake,” the greater the effect. Alternating between sweet and savory foods can have a particularly appetite-stimulating effect. Do you see how, in this way, adding a diet soda, for instance, to a fast-food meal can lead to overconsumption?

    The staggering array of modern food choices may be one of the factors conspiring to undermine our appetite control. There are now tens of thousands of different foods being sold.

    The so-called supermarket diet is one of the most successful ways to make rats fat. Researchers tried high-calorie food pellets, but the rats just ate less to compensate. So, they “therefore used a more extreme diet…[and] fed rats an assortment of palatable foods purchased at a nearby supermarket,” including such fare as cookies, candy, bacon, and cheese, and the animals ballooned. The human equivalent to maximize experimental weight gain has been dubbed the cafeteria diet.

    It’s kind of the opposite of the original food dispensing device I’ve talked about before. Instead of all-you-can-eat bland liquid, researchers offered free all-you-can-eat access to elaborate vending machines stocked with 40 trays with a dizzying array of foods, like pastries and French fries. Participants found it impossible to maintain energy balance, consistently consuming more than 120 percent of their calorie requirements.

    Our understanding of sensory-specific satiety can be used to help people gain weight, but how can we use it to our advantage? For example, would limiting the variety of unhealthy snacks help people lose weight? Two randomized controlled trials made the attempt and failed to show significantly more weight loss in the reduced variety diet, but they also failed to get people to make much of a dent in their diets. Just cutting down on one or two snack types seems insufficient to make much of a difference, as seen below and at 4:44 in my video. A more drastic change may be needed, which we’ll cover next.

    Michael Greger M.D. FACLM

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  • Hijacking Our Appetites  | NutritionFacts.org

    I debunk the myth of protein as the most satiating macronutrient.

    The importance of satiety is underscored by a rare genetic condition known as Prader-Willi syndrome. Children with the disorder are born with impaired signaling between their digestive system and their brain, so they don’t know when they’re full. “Because no sensation of satiety tells them to stop eating or alerts their body to throw up, they can accidentally consume enough in a single binge to fatally rupture their stomach.” Without satiety, food can be “a death sentence.”

    Protein is often described as the most satiating macronutrient. People tend to report feeling fuller after eating a protein-rich meal, compared to a carbohydrate- or fat-rich one. The question is: Does that feeling of fullness last? From a weight-loss standpoint, satiety ratings only matter if they end up cutting down on subsequent calorie intake, and even a review funded by the meat, dairy, and egg industries acknowledges that this does not seem to be the case for protein. Hours later, protein consumed earlier doesn’t tend to end up cutting calories later on.

    Fiber-rich foods, on the other hand, can suppress appetite and reduce subsequent meal intake more than ten hours after consumption—even the next day—because their site of action is 20 feet down in the lower intestine. Remember the ileal brake from my Evidence-Based Weight Loss lecture? When researchers secretly infused nutrients into the end of the small intestine, study participants spontaneously ate as many as hundreds fewer calories at a meal. Our brain gets the signal that we are full, from head to tail.

    We were built for gluttony. “It is a wonderful instinct, developed over millions of years, for times of scarcity.” Stumbling across a rare bounty, those who could fill themselves the most to build up the greatest reserves would be more likely to pass along their genes. So, we are hard-wired not just to eat until our stomach is full, but until our entire digestive tract is occupied. Only when our brain senses food all the way down at the end does our appetite fully dial down.

    Fiber-depleted foods get rapidly absorbed early on, though, so much of it never makes it down to the lower gut. As such, if our diet is low in fiber, no wonder we’re constantly hungry and overeating; our brain keeps waiting for the food that never arrives. That’s why people who even undergo stomach-stapling surgeries that leave them with a tiny two-tablespoon-sized stomach pouch can still eat enough to regain most of the weight they initially lost. Without sufficient fiber, transporting nutrients down our digestive tract, we may never be fully satiated. But, as I described in my last video, one of the most successful experimental weight-loss interventions ever reported in the medical literature involved no fiber at all, as you can see here and at 2:47 in my video Foods Designed to Hijack Our Appetites.

    At first glance, it might seem obvious that removing the pleasurable aspects of eating would cause people to eat less, but remember, that’s not what happened. The lean participants continued to eat the same amount, taking in thousands of calories a day of the bland goop. Only those who were obese went from eating thousands of calories a day down to hundreds, as shown below and at 3:22 in my video. And, again, this happened inadvertently without them apparently even feeling a difference. Only after eating was disconnected from the reward was the body able to start rapidly reining in the weight.

    We appear to have two separate appetite control systems: “the homeostatic and hedonic pathways.” The homeostatic pathway maintains our calorie balance by making us hungry when energy reserves are low and abolishes our appetite when energy reserves are high. “In contrast, hedonic or reward-based regulation can override the homeostatic pathway” in the face of highly palatable foods. This makes total sense from an evolutionary standpoint. In the rare situations in our ancestral history when we’d stumble across some calorie-dense food, like a cache of unguarded honey, it would make sense for our hedonic drive to jump into the driver’s seat to consume the scarce commodity. Even if we didn’t need the extra calories at the time, our body wouldn’t want us to pass up that rare opportunity. Such opportunities aren’t so rare anymore, though. With sugary, fatty foods around every corner, our hedonic drive may end up in perpetual control, overwhelming the intuitive wisdom of our bodies.

    So, what’s the answer? Never eat really tasty food? No, but it may help to recognize the effects hyperpalatable foods can have on hijacking our appetites and undermining our body’s better judgment.

    Ironically, some researchers have suggested a counterbalancing evolutionary strategy for combating the lure of artificially concentrated calories. Just as pleasure can overrule our appetite regulation, so can pain. “Conditioned food aversions” are when we avoid foods that made us sick in the past. That may just seem like common sense, but it is actually a deep-seated evolutionary drive that can defy rationality. Even if we know for a fact a particular food was not the cause of an episode of nausea and vomiting, our body can inextricably tie the two together. This happens, for example, with cancer patients undergoing chemotherapy. Consoling themselves with a favorite treat before treatment can lead to an aversion to their favorite food if their body tries to connect the dots. That’s why oncologists may advise the “scapegoat strategy” of only eating foods before treatment that you are okay with, never wanting to eat again.

    Researchers have experimented with inducing food aversions by having people taste something before spinning them in a rotating chair to cause motion sickness. Eureka! A group of psychologists suggested: “A possible strategy for encouraging people to eat less unhealthy food is to make them sick of the food, by making them sick from the food.” What about using disgust to promote eating more healthfully? Children as young as two-and-a-half years old will throw out a piece of previously preferred candy scooped out of the bottom of a clean toilet.

    Thankfully, there’s a way to exploit our instinctual drives without resorting to revulsion, aversion, or bland food, which we’ll explore next.

    Michael Greger M.D. FACLM

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  • Lose 200 Lbs Without Feeling Hungry  | NutritionFacts.org

    I dive into one of the most fascinating series of studies I’ve ever come across.

    Anyone can lose weight by eating less food. Anyone can be starved thin. Starvation diets are rarely sustainable, though, since hunger pangs drive us to eat. We feel unsatisfied and unsatiated on low-calorie diets. We do have some level of voluntary control, of course, but our deep-seated instinctual drives may win out in the end.

    For example, we can consciously hold our breath. Try it right now. How long can you go before your body’s self-preservation mechanisms take over and overwhelm your deliberate intent not to breathe? Our body has our best interests at heart and is too smart to allow us to suffocate ourselves—or starve ourselves, for that matter. If our body were really that smart, though, how could it let us become obese? Why doesn’t our body realize when we’re too heavy and allow us the leeway to slim down? Maybe our body is very aware and actively trying to help, but we’re somehow undermining those efforts. How could we test this theory to see if that’s true?

    So many variables go into choosing what we eat and how much. “The eating process involves an intricate mixture of physiologic, psychologic, cultural, and esthetic considerations.” To strip all that away and stick just to the physiologic variable, Columbia University researchers designed a series of famous experiments using a “food dispensing device.” The term “food” is used very loosely here. As you can see at 2:02 in my video 200-Pound Weight Loss Without Hunger, the researchers’ feeding machine was a tube hooked up to a pump that delivered a mouthful of bland liquid formula every time a button was pushed. Research participants were instructed to eat as much or as little as they wanted at any time. In this way, eating was reduced to just the rudimentary hunger drive. Without the usual trappings of “sociability,” meal ceremony, and the pleasures of the palate, how much would people be driven to eat? 
    Put a normal-weight person in this scenario, and something remarkable happens. Day after day, week after week, with nothing more than their hunger to guide them, they eat exactly as much as they need, perfectly maintaining their weight, as shown below and at 2:36 in my video.

    They needed about 3,000 calories a day, and that’s just how much they unknowingly gave themselves. Their body just intuitively seemed to know how many times to press that button, as seen here and at 2:48 in my video.

    Put a person with obesity in that same scenario, and something even more remarkable happens. Driven by hunger alone, with the enjoyment of eating stripped away, they wildly undershoot, giving themselves a mere 275 calories a day, total. They could eat as much as they wanted, but they just weren’t hungry. It’s as if their body knew how massively overweight they were, so it dialed down their natural hunger drive to almost nothing. One participant started the study at 400 pounds and steadily lost weight. After 252 days of sipping the bland liquid, he lost 200 pounds, as you can see here and at 3:35 in my video.

    This groundbreaking discovery was initially interpreted to mean that obesity is not caused by some sort of metabolic disturbance that drives people to overeat. In fact, the study suggested quite the opposite. Instead, overeating appeared to be a function of the meaning people attached to food, “aside from its use as fuel,” whether as a source of pleasure or perhaps as relief from boredom or stress. In this way, obesity seemed more psychological than physical. Subsequent experiments with the feeding machine, though, flipped such conceptions on their head once again.

    When researchers covertly doubled the calorie concentration of the formula given to lean study participants, they unconsciously cut their consumption in half to continue to perfectly maintain their weight, as seen here and at 4:24 in my video. Their body somehow detected the change in calorie load and sent signals to the brain to press the button half as often to compensate. Amazing!

    When the same was done with people with obesity, though, nothing changed. They continued to drastically undereat just as much as before. Their body seems incapable of detecting or reacting to the change in calorie load, suggesting a physiological inability to regulate intake, as shown below and at 4:40 in my video. 
    Might the brains of persons with obesity somehow be insensitive to internal satiety signals? We don’t know if it’s cause or effect. Maybe that’s why they’re obese in the first place, or maybe the body knows how obese it is and shuts down its hunger drive regardless of the calorie concentration. Indeed, the participants with obesity continued to steadily lose weight eating out of the machine, regardless of the calorie concentration and the food being dispensed, as you can see here and at 5:19 in my video. 
    It would be interesting to see if they regained the ability to respond to changing calorie intake once they reached their ideal weight. Regardless, what can we apply from these remarkable studies to facilitate weight loss out in the real world? We’ll explore just that question next.

    Michael Greger M.D. FACLM

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  • Dietary Components That May Cause Cancer to Metastasize  | NutritionFacts.org

    Palmitic acid, a saturated fat concentrated in meat and dairy, can boost the metastatic potential of cancer cells through the fat receptor CD36.

    The leading cause of death in cancer patients is metastasis formation. That’s how most people die of cancer—not from the primary tumor, but the cancer spreading through the body. “It is estimated that metastasis is responsible for ~90% of cancer deaths,” and little progress has been made in stopping the spread, despite our modern medical armamentarium. In fact, we can sometimes make matters worse. In an editorial entitled “Therapy-Induced Metastasis,” its authors “provide evidence that all the common therapies, including radiotherapy, chemotherapy, fine needle biopsies, surgical procedures and anaesthesia, have the potential to contribute to tumour progression.” You can imagine how cutting around a tumor and severing blood vessels might lead to the “migration of residual tumour cells,” but why chemotherapy? How might chemo exacerbate metastases? “Despite reducing the size of primary tumors, chemotherapy changes the tumor microenvironment”—its surrounding tissues—“resulting in an increased escape of cancer cells into the blood stream.” Sometimes, chemo, surgery, and radiation are entirely justified, but, again, other times, these treatments can make matters worse. If only we had a way to treat the cause of the cancer’s spreading.

    The development of antimetastatic therapies has been hampered by the fact that the cells that initiate metastasis remain unidentified. Then, a landmark study was published: “Targeting Metastasis-Initiating Cells Through the Fatty Acid Receptor CD36.” Researchers found a subpopulation of human cancer cells “unique in their ability to initiate metastasis”; they all express high levels of a fat receptor known as CD36, dubbed “the fat controller.” It turns out that palmitic acid or a high-fat diet specifically boosts the metastatic potential of these cancer cells. Where is palmitic acid found? Although it was originally discovered in palm oil, palmitic acid is most concentrated in meat and dairy. “Emerging evidence shows that palmitic acid (PA), a common fatty acid in the human diet, serves as a signaling molecule regulating the progression and development of many diseases at the molecular level.” It is the saturated fat that is recognized by CD36 receptors on cancer cells, and we know it is to blame, because if the CD36 receptor is blocked, so are metastases.

    The study was of a human cancer, but it was a human cancer implanted into mice. However, clinically (meaning in cancer patients themselves), the presence of these CD36-studded metastasis-initiating cells does indeed correlate with a poor prognosis. CD36 appears to drive the progression of brain tumors, for example. As seen in the survival curves shown below and at 3:21 in my video What Causes Cancer to Metastasize?, those with tumors with less CD36 expression lived significantly longer. It is the same with breast cancer mortality: “In this study, we correlated the mortality of breast cancer patients to tumor CD36 expression levels.” That isn’t a surprise, since “CD36 plays a critical role in proliferation, migration and…growth of…breast cancer cells.” If we inhibit CD36, we can inhibit “the migration and invasion of the breast cancer cells.” 

    Below and at 3:46 in my video, you can see breast cancer cell migration and invasion, before and after CD36 inhibition. (The top lines with circles are before CD36 inhibition, and the bottom lines with squares are after.)

    This isn’t only in “human melanoma- and breast cancer–derived tumours” either. Now we suspect that “CD36 expression drives ovarian cancer progression and metastasis,” too, since we can inhibit ovarian cancer cell invasion and migration, as well as block both lymph node and blood-borne metastasis, by blocking CD36. We also see the same kind of effect with prostate cancer; suppress the uptake of fat by prostate cancer cells and suppress the tumor. This was all studied with receptor-blocking drugs and antibodies in a laboratory setting, though. If these “metastasis-initiating cancer cells particularly rely on dietary lipids [fat] to promote metastasis,” the spread of cancer, why not just block the dietary fat in the first place?

    “Lipid metabolism fuels cancer’s spread.” Cancer cells love fat and cholesterol. The reason is that so much energy is stored in fat. “Hence, CD36+ metastatic cells might take advantage of this feature to obtain the high amount of energy that is likely to be required for them to anchor and survive at sites distant from the primary tumour”—to set up shop throughout the body.

    “The time when glucose [sugar] was considered as the major, if not only, fuel to support cancer cell proliferation is over.” There appears to be “a fatter way to metastasize.” No wonder high-fat diets (HFD) may “play a crucial role in increasing the risk of different cancer types, and a number of clinical studies have linked HFD with several advanced cancers.”

    If dietary fat may be “greasing the wheels of the cancer machine,” might there be “specific dietary regimens” we could use to starve cancers of dietary fat? You don’t know until you put it to the test, which we’ll look at next.

    Michael Greger M.D. FACLM

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  • Does Drinking Water Affect Our Adrenal Hormones?  | NutritionFacts.org

    Does Drinking Water Affect Our Adrenal Hormones?  | NutritionFacts.org

    Drinking water can be a safe, simple, and effective way to prevent yourself from fainting.

    Within three minutes of drinking a few cups of water (12 mL/kg of body weight), the level of the adrenal gland hormone noradrenaline in our bloodstream can shoot up by 60 percent, as you can see in the graph below and at 0:19 in my video The Effect of Drinking Water on Adrenal Hormones. 

    When researchers had people drink two cups (500 mL) of water with electrodes on their legs, about a 40 percent increase in bursts of fight-or-flight nerve activity within 20 minutes was documented, as shown in the graph below and at 0:25 in my video. 

    If you drink two or three cups (11 mL/kg of body weight) of water, blood flow squeezes down in your arms and calves, clamping down nearly in half, as the arteries to your limbs and skin constrict to divert blood to your core, as you can see in the graph below and at 0:42 in my video. That’s why drinking water can be such a safe, simple, and effective way to prevent yourself from fainting, which is known medically as syncope. 

    Fainting is “the sudden brief loss of consciousness caused by diminished cerebral blood flow,” that is, to the brain. About one in five people experience this at least once, and about one in ten may have repeated episodes. It’s the cause of millions of emergency room visits and hospitalizations every year. Though fainting can be caused by heart problems, it is most often triggered by prolonged standing (because blood pools in our legs) or strong emotions, which can cause our blood pressure to bottom out. 

    About 1 in 25 people has what’s called blood-injury-injection phobia, where getting a needle stick, for example, can cause you to faint. More than 150,000 people experience fainting or near-fainting spells each year when they donate blood. To help prevent yourself from getting woozy, try drinking two cups of water (500 mL) five minutes before getting stuck with the needle. The secret isn’t in bolstering your overall blood volume. If you drink two cups of water or even a whole quart (500 to 1,000 mL), your blood volume doesn’t change by more than 1 or 2 percent. Rather, it’s due to the shift in the distribution of blood toward your center, caused by the noradrenaline-induced peripheral artery constriction, as you can see in the graph below and at 1:56 in my video. 

    Drinking water stimulates as much noradrenaline release as drinking a couple cups of coffee or smoking a couple unfiltered cigarettes. If the simple act of drinking water causes such a profound fight-or-flight reaction, why doesn’t it cause our heart to pound and shoot our blood pressure through the roof? It’s like the diving reflex I talked about in my previous video. When we drink water, our body simultaneously sends signals to our heart to slow it down, to “still your beating heart.” You can try it at home: Measure your heart rate before and after drinking two cups (500 mL) of water. Within ten minutes, your heart rate should slow by about four beats per minute. By 15 minutes, you should be down by six or seven beats, as you can see in the graph below and at 2:42 in my video. 

    One of the ways scientists figured this out was by studying heart transplant patients. When you move a heart from one person to another, you have to sever all the attached nerves. Amazingly, some of the nerves grow back. But still, if you give healed heart transplant patients two glasses of water, their blood pressure goes up as much as 29 points. The body is unable to sufficiently quell the effect of that burst of noradrenaline. Some people have a condition known as autonomic failure, in which blood pressure regulation nerves don’t work properly and their pressures can skyrocket dangerously by more than 100 points after drinking about two cups (480 mL) of water. That’s how powerful an effect the simple act of drinking water can be. The only reason that doesn’t happen to all of us is that we have an even more powerful counter-response to keep our hearts in check. (This reminds me of the woman who had a stroke after taking the ice bucket challenge due to an insufficient diving reflex to tamp down all that extra noradrenaline release.)

    This remarkable water effect can be useful for people suffering from milder forms of autonomic failure, such as orthostatic hypotension, which is when people get dizzy after standing up suddenly. Drinking some water before getting out of bed in the morning can be a big help. What about that metabolic boost, though? With so much noradrenaline being released and your adrenal gland hormones in overdrive, might drinking a few glasses of water cause you to burn more body fat? Could tap water be a safe form of ephedra, giving us all the weight loss but with a nice slowing of our heart rate instead? Researchers decided to put it to the test, which we’ll explore next.

    If you missed the previous video, check out How to Get the Weight Loss Benefits of Ephedra Without the Risks.

    Stay tuned for What Is the Safest Metabolism Booster? and Friday Favorites: Optimizing Water Intake to Lose Weight.

    What kind of water is better? Find out in Is it Best to Drink Tap, Filtered, or Bottled Water?.

    Michael Greger M.D. FACLM

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  • Obesity and a Toxic Food Environment  | NutritionFacts.org

    Obesity and a Toxic Food Environment  | NutritionFacts.org

    Implausible explanations for the obesity epidemic serve the needs of food manufacturers and marketers more than public health and an interest in truth. 

    When it comes to uncovering the root causes of the obesity epidemic, there appears to be manufactured confusion, “with major studies reasserting that the causes of obesity are ‘extremely complex’ and ‘fiendishly hard to untangle,’” but having just reviewed the literature, it doesn’t seem like much of a mystery to me.

    It’s the food.

    Attempts at obfuscation—rolling out hosts of “implausible explanations,” like sedentary lifestyles or lack of self-discipline—cater to food manufacturers and marketers more than the public’s health and our interest in the truth. “When asked about the role of restaurants in contributing to the obesity problem, Steven Anderson, president of the National Restaurant Association stated, “Just because we have electricity doesn’t mean you have to electrocute yourself.” Yes, but Big Food is effectively attaching electrodes to shock and awe the reward centers in our brains to undermine our self-control.

    It is hard to eat healthfully against the headwind of such strong evolutionary forces. No matter what our level of nutrition knowledge, in the face of pepperoni pizza, “our genes scream, ‘Eat it now!’” Anyone who doubts the power of basic biological drives should see how long they can go without blinking or breathing. Any conscious decision to hold your breath is soon overcome by the compulsion to breathe. In medicine, shortness of breath is sometimes even referred to as “air hunger.” The battle of the bulge is a battle against biology, so obesity is not some moral failing. It’s not gluttony or sloth. It is a natural, “normal response, by normal people, to an abnormal situation”—the unnatural ubiquity of calorie-dense, sugary, and fatty foods.

    The sea of excess calories we are now floating in (and some of us are drowning in) has been referred to as a “toxic food environment.” This helps direct focus away from the individual and towards the societal forces at work, such as the fact that the average child is blasted with 10,000 commercials for food a year. Or maybe I should say ads for pseudo food, as 95 percent are for “candy, fast food, soft drinks [aka liquid candy], and sugared cereals [aka breakfast candy].”

    Wait a second, though. If weight gain is just a natural reaction to the easy availability of mountains of cheap, yummy calories, then why isn’t everyone fat? As you can see below and at 2:41 in my video The Role of the Toxic Food Environment in the Obesity Epidemic, in a certain sense, most everyone is. It’s been estimated that more than 90 percent of American adults are “overfat,” defined as having “excess body fat sufficient to impair health.” This can occur even “in those who are normal-weight and non-obese, often due to excess abdominal fat.

    However, even if you look just at the numbers on the scale, being overweight is the norm. If you look at the bell curve and input the latest data, more than 70 percent of us are overweight. A little less than one-third of us is normal weight, on one side of the curve, and more than a third is on the other side, so overweight that we’re obese. You can see in the graph below and at 3:20 in my video.

    If the food is to blame, though, why doesn’t everyone get fat? That’s like asking if cigarettes are really to blame, why don’t all smokers get lung cancer? This is where genetic predispositions and other exposures can weigh in to tip the scales. Different people are born with a different susceptibility to cancer, but that doesn’t mean smoking doesn’t play a critical role in exploding whatever inherent risk you have. It’s the same with obesity and our toxic food environment. It’s like the firearm analogy: Genes may load the gun, but diet pulls the trigger. We can try to switch the safety back on with smoking cessation and a healthier diet.

    What happened when two dozen study participants were given the same number of excess calories? They all gained weight, but some gained more than others. Overfeeding the same 1,000 calories a day, 6 days a week for 100 days, caused weight gains ranging from about 9 pounds up to 29 pounds. The same 84,000 extra calories caused different amounts of weight gain. Some people are just more genetically susceptible. The reason we suspect genetics is that the 24 people in the study were 12 sets of identical twins, and the variation in weight gain between each of them was about a third less. As you can see in the graph below and at 4:41 in my video, a similar study with weight loss from exercise found a similar result. So, yes, genetics play a role, but that just means some people have to work harder than others. Ideally, inheriting a predisposition for extra weight gain shouldn’t give a reason for resignation, but rather motivation to put in the extra effort to unseal your fate. 

    Advances in processing and packaging, combined with government policies and food subsidy handouts that fostered cheap inputs for the “food industrial complex,” led to a glut of ready-to-eat, ready-to-heat, ready-to-drink hyperpalatable, hyperprofitable products. To help assuage impatient investors, marketing became even more pervasive and persuasive. All these factors conspired to create unfettered access to copious, convenient, low-cost, high-calorie foods often willfully engineered with chemical additives to make them hyperstimulatingly sweet or savory, yet only weakly satiating. 

    As we all sink deeper into a quicksand of calories, more and more mental energy is required to swim upstream against the constant “bombardment of advertising” and 24/7 panopticons of tempting treats. There’s so much food flooding the market now that much of it ends up in the trash. Food waste has progressively increased by about 50 percent since the 1970s. Perhaps better in the landfills, though, than filling up our stomachs. Too many of these cheap, fattening foods prioritize shelf life over human life.

    But dead people don’t eat. Don’t food companies have a vested interest in keeping their consumers healthy? Such naiveté reveals a fundamental misunderstanding of the system. A public company’s primary responsibility is to reap returns for its investors. “How else could we have tobacco companies, who are consummate marketers, continuing to produce products that kill one in two of their most loyal customers?” It’s not about customer satisfaction, but shareholder satisfaction. The customer always comes second.

    Just as weight gain may be a perfectly natural reaction to an obesogenic food environment, governments and businesses are simply responding normally to the political and economic realities of our system. Can you think of a single major industry that would benefit from people eating more healthfully? “Certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries,” wrote emeritus professor Marion Nestle in a Science editorial when she was chair of nutrition at New York University. “All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.”

    If part of the problem is cheap tasty convenience, is hard-to-find food that’s gross and expensive the solution? Or might there be a way to get the best of all worlds—easy, healthy, delicious, satisfying meals that help you lose weight? That’s the central question of my book How Not to Diet. Check it out for free at your local library.

    This is it—the final video in this 11-part series. If you missed any of the others, see the related posts below. 

    Michael Greger M.D. FACLM

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  • Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

    Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

    Like the tobacco industry adding extra nicotine to cigarettes, the food industry employs taste engineers to accomplish a similar goal of maximizing the irresistibility of its products. 

    The plague of tobacco deaths wasn’t due just to the mass manufacturing and marketing of cheap cigarettes. Tobacco companies actively sought to make their products even more crave-able by spraying sheets of tobacco with nicotine and additives like ammonia to provide “a bigger nicotine ‘kick.’” Similarly, taste engineers are hired by the food industry to maximize product irresistibility.

    Taste is the leading factor in food choice. “Sugar, fat, and salt have been called the three points of the compass” to produce “superstimulating” and “hyper palatability” to tempt people into impulsive buys and compulsive consumption. Foods are intentionally designed to hook into our evolutionary triggers and breach whatever biological barriers help “keep consumption within reasonable limits.”

    Big Food is big business. The processed food industry alone brings in more than $2 trillion a year. That affords them the economic might to manipulate not only taste profiles, but public policy and scientific inquiry, too. The food, alcohol, and tobacco industries have all used similar unsavory tactics: blocking health regulations, co-opting professional organizations, creating front groups, and distorting the science. The common “corporate playbook” shouldn’t be surprising, given the common corporate threads. At one time, for example, tobacco giant Philip Morris owned both Kraft and Miller Brewing.

    As you can see below and at 1:45 in my video The Role of Corporate Influence in the Obesity Epidemic, in a single year, the food industry spent more than $50 million to hire hundreds of lobbyists to influence legislation. Most of these lobbyists were “revolvers,” former federal employees in the revolving door between industry and its regulators, who could push corporate interests from the inside, only to be rewarded with cushy lobbying jobs after their “public service.” In the following year, the industry acquired a new weapon—a stick to go along with all those carrots. On January 21, 2010, the Supreme Court’s five-to-four Citizen’s United ruling permitted corporations to spend unlimited amounts of money on campaign ads to trash anyone who dared stand against them. No wonder our elected officials have so thoroughly shrunk from the fight, leaving us largely with a government of Big Food, by Big Food, and for Big Food. 

    Globally, a similar dynamic exists. Weak tea calls from the public health community for voluntary standards are met not only with vicious fights against meaningful change but also massive transnational trade and foreign investment deals that “cement the protection of their [food industry] profits” into the laws of the lands.

    The corrupting commercial influence extends to medical associations. Reminiscent of the “just what the doctor ordered” cigarette ads of yesteryear, as you can see below and at 3:05 in my video, the American Academy of Family Physicians accepted millions from The Coca-Cola Company to “develop consumer education content on beverages and sweeteners.” 

    On the front line, fake grassroots “Astroturf” groups are used to mask the corporate message. RJ Reynolds created Get Government Off Our Back (memorably acronymed GGOOB), “a front group created by the tobacco industry to fight regulation,” for instance. Americans Against Food Taxes may as just as well be called “Food Industry Against Food Taxes.” The power of front group formation is enough to bind bitter corporate rivals; the Sugar Association and the Corn Refiners Association linked arms with the National Confectioners Association to partner with Americans for Food and Beverage Choice.

    Using another tried-and-true tobacco tactic, research front groups can be used to subvert the scientific process by shaping or suppressing the science that deviates from the corporate agenda. Take the trans fat story. Food manufacturers have not only “long denied that trans fats were associated with disease,” but actively “worked to limit research on trans fats” and “discredit potentially damaging findings.”

    At what cost? The global death toll from foods high in trans fat, saturated fat, salt, and sugar is at 14 million lost lives every year. The inability of countries around the world to turn the tide on obesity “is not a failure of individual will-power. This is a failure of political will to take on big business,” said the Director-General of the World Health Organization. “It is a failure of political will to take on the powerful food and soda industries.” She ended her keynote address before the National Academy of Medicine entitled “Obesity and Diabetes: The Slow-Motion Disaster” with these words: “The interests of the public must be prioritized over those of corporations.”

    Are you mad yet? To sum up my answer to the question underlying my What Triggered the Obesity Epidemic? webinar, it’s the food. I close next with my wrap-up video: The Role of the Toxic Food Environment in the Obesity Epidemic. 

    This was part of an 11-part series. See the related posts below.

    If the political angle interests you, check out: 

    Michael Greger M.D. FACLM

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  • Should We Take Any Responsibility for the Obesity Epidemic?  | NutritionFacts.org

    Should We Take Any Responsibility for the Obesity Epidemic?  | NutritionFacts.org

    The power of the “eat more” food environment can overcome our conscious controls.

    Food and beverage companies frame body weight as “a matter of personal choice.” Even when we aren’t distracted, the power of the “eat more” food environment may sometimes overcome our conscious controls of overeating. One look around the room at a dietician convention can tell you that even nutrition professionals are vulnerable to the aggressively marketed ubiquity of tasty, cheap, convenient calories. This suggests there are aspects of our eating behaviors “that defy personal insight or are below individual awareness,” flying below the radar of conscious awareness. Appetite physiologists call the result of these subconscious actions “passive overconsumption.”

    Remember that brain scan study where the thought of a milkshake lit up the same reward pathways in the brain as substance abuse? That was triggered just by a picture of a milkshake. Dopamine gets released, cravings get activated, and we’re motivated to eat. Intellectually, we know it’s just an image, but our lizard brain sees survival. It’s just a reflexive response over which we have little control, which is why marketers ensure there are pictures of milkshakes and their equivalents everywhere.

    As I discuss in my video The Role of Personal Responsibility in the Obesity Epidemic, maintaining a balance between calories in and calories out feels like a series of voluntary acts under conscious control, but it may be more akin to bodily functions, such as blinking, breathing, coughing, swallowing, or sleeping. You can try to will yourself power over any of these, but by and large, they just happen automatically, driven by ancient scripts.

    Not only are food ads ubiquitous, but so is the food. The types of establishments selling food products expanded dramatically in the 1970s and 1980s. Now, you can find candy and snacks at the checkout counters of “gasoline stations, building material outlets, auto parts stores, drug stores, and home furnishing stores” and more. The largest food retailer in the United States is Wal-Mart. You can get that jolt of “dopamine and the associated artificially induced feelings of hunger in modern society” around every turn. Every day, we run the gauntlet.

    It’s also become “socially acceptable to eat food at any time of day and anywhere—in cars, in your hand, on the street—places where eating had never been acceptable.” We’ve become a snacking society. Vending machines are everywhere. Daily eating episodes seem to have gone up by about a quarter since the late 1970s, increasing from about four to five occasions a day, potentially accounting for twice the calorie increase attributed to increasing portion sizes. Snacks and beverages alone could account for the bulk of the calorie surplus implicated in the obesity epidemic.

    And think of the children. Here we are trying to do the best for our kids, role-modeling healthy habits and feeding them healthy foods, but then they venture out into a veritable tornado of junky food and manipulative messages. A commentary in The New England Journal of Medicine asked: “But why should Mr. and Ms. G.’s efforts to protect their children from life-threatening illness be undermined by massive marketing campaigns from the manufacturers of junk food?” Pediatricians are now encouraged to have the “French Fry Discussion” with parents at the 12-month well-child visit instead of waiting until their kids are two—though even that may be too late. As you can see below and at 3:35 in my video, two-thirds of infants are being fed junk food by their first birthday. 

    Dr. David Katz may have said it best in the Harvard Health Policy Review: “Those who contend that parental or personal responsibility should carry the day despite these environmental temptations might consider the implications of generalizing the principle. Perhaps children should be encouraged, but not required, to attend school and tempted each morning by alternatives, such as buses to the circus, zoo, or beach.” 

    It may be helpful to take a step back and think of what’s at stake here. We aren’t just talking about being manipulated into buying a different brand of toothpaste. The obesity pandemic has resulted in millions of deaths and untold suffering. If you aren’t mad yet, brace yourself for my next video: The Role of Corporate Influence in the Obesity Epidemic.

    This is the ninth video in my 11-part series. If you missed any of the previous ones, see the related posts below.

    Michael Greger M.D. FACLM

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  • Are Food Ads Making Us Obese?  | NutritionFacts.org

    Are Food Ads Making Us Obese?  | NutritionFacts.org

    We all like to think we make important life decisions, like what to eat, consciously and rationally, but if that were the case, we wouldn’t be in the midst of an obesity epidemic.

    The opening words of the Institute of Medicine’s report on the potential threat posed by food ads were: “Marketing works.” Certainly, there is a “large number of well-conducted randomized experiments” I could go through with you that “have shown that exposure to marketing—especially, but not only, advertising—changes people’s eating behavior. Marketing causes people to choose to eat more.” But, what do you need to know beyond the fact that the industry spends tens of billions of dollars a year on it? To get people to drink its brown sugar water, do you think Coca-Cola would spend a penny more than it thought it had to? It’s like when my medical colleagues accept “drug lunches” from pharmaceutical representatives and take offense that I would suggest it might affect their prescribing practices. Do they really think drug companies are in the business of giving away free money for nothing? They wouldn’t do it if it didn’t work. 

    To give you a sense of marketing’s insidious nature, let me share an interesting piece of research published in the world’s leading scientific journal: “In-Store Music Affects Product Choice” documented an experiment in which French accordion music or German Bierkeller music was played on alternate days in the wine section of a grocery store. As you can see below and at 1:27 in my video The Role of Food Advertisements in the Obesity Epidemic, on the days the French music played in the background, people were three times more likely to buy French wine, and on German music days, shoppers were about three times more likely to buy German wine. And it wasn’t a difference of just a few percent; it was a complete three-fold reversal. Despite the dramatic effect, when shoppers were approached afterward, the vast majority of them denied the music had influence on their choice. 

    Most of our day-to-day behavior does not appear to be dictated by careful, considered deliberations, even if we’d like to think that were the case. Rather, we tend to make more automatic, impulsive decisions triggered by unconscious cues or habitual patterns, especially when we are “under stress, tired, or preoccupied. This unconscious part of our brain is estimated to function and guide our behaviors at least 95% of the time.” This is the arena where marketing manipulations do most of their dirty work. 

    The part of our brain that governs conscious awareness may only be able to process about 50 bits of information per second, which is roughly equivalent to a short tweet. Our entire cognitive capacity, on the other hand, is estimated to process more than 10 million bits per second. Because we’re only able to purposefully process a limited amount of information at a time, if we’re distracted or otherwise unable to concentrate, our decisions can become even more impulsive. An elegant illustration of this “cognitive overload” effect was provided from an experiment involving fruit salad and chocolate cake.

    Before calls could be made at the touch of a button or the sound of our voice, the seven-digit span of phone numbers in the United States was based in part on the longest sequence most people can recall on the fly. We only seem to be able to hold about seven chunks of information (plus or minus two) in our immediate short-term memory. The study’s setup: Randomize people to memorize either a seven-digit number or a two-digit number to be recalled in another room down the hall. On the way, offer them the choice of a fruit salad or a piece of chocolate cake. Memorizing a two-digit number is easy and presumably takes few cognitive resources. As you can see in the graph below and at 3:52 in my video, under the two-digit condition, most study participants chose fruit salad. Faced with the same decision, most of those trying to keep seven digits in their heads just went for the cake. 

    This can play out in the real world by potentiating the effect of advertising. Have people watch a TV show with commercials for unhealthy snacks, and, no surprise, they eat more unhealthy snacks compared to those exposed to non-food ads. Or maybe that is a surprise. We all like to think we’re in control and not so easily manipulated. The kicker, though, is that we may be even more susceptible the less we pay attention. Randomize people to the same two-digit or seven-digit memorization task during the TV show, and the snack-attack effect was magnified among those who were more preoccupied. How many of us have the TV on in the background or multi-task during commercial breaks? Research suggests that may make us even more impressionable to the subversion of our better judgment. 

    There’s an irony in all of this. Calls for restrictions on marketing are often resisted by invoking the banner of freedom. What does that even mean in this context, when research shows how easily our free choices can be influenced without our conscious control? A senior policy researcher at the RAND Corporation even went as far as to suggest that, given the dire health consequences of our unhealthy eating habits, “the marketing techniques of which we are unaware should be considered in the same light as the invisible carcinogens and toxins in the air and water that can poison us without our awareness.”

    Given the role marketing can play even when we least suspect it, what is the role of personal responsibility in the obesity epidemic? That’s the subject of my next video.

    We are winding down this series on obesity, with three videos remaining: 

     If you missed any of the previous videos, see the related posts below. 

    Michael Greger M.D. FACLM

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  • Marketing Takes Off and Obesity Soars  | NutritionFacts.org

    Marketing Takes Off and Obesity Soars  | NutritionFacts.org

    The unprecedented rise in the power, scope, and sophistication of food marketing starting around 1980 aligns well with the blastoff slope of the obesity epidemic.

    In the 1970s, the U.S. government went from just subsidizing some of the worst foods to paying companies to make more of them: “Congress passed laws reversing long-standing farm policies aimed at protecting prices by limiting production” and started giving payouts in proportion to output. Extra calories started pouring into the food supply.

    Then Jack Welch gave a speech. In 1981, the CEO of General Electric effectively launched the “shareholder value movement,” reorienting the primary goal of corporations towards maximizing short-term returns for investors. This placed extraordinary pressure from Wall Street on food companies to post increasing profit growth every quarter to boost their share price. There was already a glut of calories on the market and now they had to sell even more.

    This placed food and beverage CEOs in an impossible bind. It’s not like they’re rubbing their sticky hands together at the thought of luring more Hansels and Gretels to their doom in their houses of candy. Food giants couldn’t do the right thing even if they wanted. They are beholden to investors. If they stopped marketing to kids or tried to sell healthier food or did anything else that could jeopardize their quarterly profit growth, Wall Street would demand a change in management. Healthy eating is bad for business. It’s not some grand conspiracy; it’s not even anyone’s fault. It’s just how the system works.

    As I discuss in my video The Role of Marketing in the Obesity Epidemic, given the constant demands for corporate growth and rapid returns in an already oversaturated marketplace, the food industry needed to get people to eat more. Like the tobacco industry before them, it turned to the ad makers. The food industry spends about $10 billion a year on advertising and around another $20 billion on other forms of marketing, such as trade shows, consumer promotions, incentives, and supermarket “slotting fees.” Food and beverage companies purchase shelf space from supermarkets to prominently display their most profitable products. They pay supermarkets. The practice is also known as “cliffing,” because companies “force suppliers to bid against each other for shelf space with the loser pushed ‘over the cliff.’” With slotting fees costing up to $20,000 per item, per retailer, and per city, you can imagine what types of foods get the special treatment. Hint: It ain’t broccoli.

    To get a sense of what kind of products merit prime shelf real estate, look no further than the checkout aisle. “Merchandising the power categories on every lane is critical,” reads a trade publication on the “best practices for superior checkout merchandising.” It was referring to candy bars and beverages. Just a 1 percent power category boost in sales could earn a store an extra $15,000 a year. It’s not that publicly traded companies don’t care about their customers’ health. They might, but like most of the leading grocery store chains, their “primary fiduciary responsibility is to increase profits” above other considerations.

    For instance, tens of millions of dollars are spent annually advertising a single brand of candy bar. McDonald’s alone may spend billions a year. Now, “the food industry is the biggest spender on advertising of any major sector of the economy.”

    “Reagan-era deregulatory policies removed limits on television marketing of food products to children.” Now, the average child may see more than 10,000 TV food ads a year, and that’s on top of “the marketing content online, in print, at school, at the movies, in video games, or at school,” or even on their phones. “Nearly all food marketing to children worldwide promotes products that can adversely affect their health.”

    Besides the massive early exposure and ubiquity, food marketing has become “highly sophisticated. With the help of child psychologists, companies began to understand the factors that unconsciously influenced sales. They found out, for example, how to influence children and get them to manipulate their parents.” Packaging was designed to best attract a child’s attention, and then those products are placed at their eye level in the store. You know those mirrored bubbles in the ceilings of supermarkets? They aren’t just for shoplifters. Closed-circuit cameras and GPS-like devices on shopping carts are used to strategize how best to guide shoppers toward the market’s most profitable products. Behavioral psychology is widely applied to increase impulse buying, and eye movement tracking technologies are utilized.

    The “unprecedented expansion in the scope, power, and ubiquity of food marketing…coincided with an unprecedented expansion in food consumption in predictable ways.” Some techniques have “skyrocket[ed] from essentially zero to multi-billion-dollar industries” since the 1980s, including “product placement, in-school advertising, event sponsorships.” This led one noted economist to conclude that “the most compelling single interpretation of the admittedly incomplete data we have is that the large increase in obesity is due to marketing.” Yes, innovations in manufacturing and political maneuvering led to a food supply bursting at the seams with close to 4,000 calories a day for us all, but it’s the advances in marketing manipulations that try to peddle that surplus into our mouths. 

    I think the natural reaction to the suggestion of the power of marketing is: I’m too smart to fall for that. Marketing works on other people, but I can see through it. But that’s what everyone thinks! For a splash of cold water to shake us all out of this delusion, I next bring you some data: The Role of Food Advertisements in the Obesity Epidemic. 

    Also, for both the role of marketing and food advertisements, check out Friday Favorites: The Role of Marketing and Food Advertisements in the Obesity Epidemic.

    This is the seventh in an 11-video series. If you missed any of the first six, check out the related posts below. 

    Michael Greger M.D. FACLM

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  • Do Taxpayer Subsidies Play a Role in the Obesity Epidemic?  | NutritionFacts.org

    Do Taxpayer Subsidies Play a Role in the Obesity Epidemic?  | NutritionFacts.org

    Why are U.S. taxpayers giving billions of dollars to support the likes of the sugar and meat industries?

    The rise in calorie surplus sufficient to explain the obesity epidemic was less a change in food quantity than in food quality. Access to cheap, high-calorie, low-quality convenience foods exploded, and the federal government very much played a role in making this happen. U.S. taxpayers give billions of dollars in subsidies to prop up the likes of the sugar industry, the corn industry and its high-fructose syrup, and the production of soybeans, about half of which is processed into vegetable oil and the other half is used as cheap feed to help make dollar-menu meat. You can see a table of subsidy recipients below and at 0:49 in my video The Role of Taxpayer Subsidies in the Obesity Epidemic. Why do taxpayers give nearly a quarter of a billion dollars a year to the sorghum industry? When was the last time you sat down to some sorghum? It’s almost all fed to cattle and other livestock. “We have created a food price structure that favors relatively animal source foods, sweets, and fats”—animal products, sugars, and oils.

    The Farm Bill started out as an emergency measure during the Great Depression of the 1930s to protect small farmers but was weaponized by Big Ag into a cash cow with pork barrel politics—including said producers of beef and pork. From 1970 to 1994, global beef prices dropped by more than 60 percent. And, if it weren’t for taxpayers “sweetening the pot” with billions of dollars a year, high-fructose corn syrup would cost the soda industry about 12 percent more. Then we hand Big Soda billions more through the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamps Program, to give sugary drinks to low-income individuals. Why is chicken so cheap? After one Farm Bill, corn and soy were subsidized below the cost of production for cheap animal fodder. We effectively handed the poultry and pork industries about $10 billion each. That’s not chicken feed—or rather, it is! 

    This is changing what we eat. 

    As you can see below and at 2:03 in my video, thanks in part to subsidies, dairy, meats, sweets, eggs, oils, and soda were all getting relatively cheaper compared to the overall consumer food price index as the obesity epidemic took off, whereas the relative cost of fresh fruits and vegetables doubled. This may help explain why, during about the same period, the percentage of Americans getting five servings of fruits and vegetables a day dropped from 42 percent to 26 percent. Why not just subsidize produce instead? Because that’s not where the money is. 

    “To understand what is shaping our foodscape today, it is important to understand the significance of differential profit.” Whole foods or minimally processed foods, such as canned beans or tomato paste, are what the food business refers to as “commodities.” They have such slim profit margins that “some are typically sold at or below cost, as ‘loss leaders,’ to attract customers to the store” in the hopes that they’ll also buy the “value-added” products. Some of the most profitable products for producers and vendors alike are the ultra-processed, fatty, sugary, and salty concoctions of artificially flavored, artificially colored, and artificially cheap ingredients—thanks to taxpayer subsidies. 

    Different foods reap different returns. Measured in “profit per square foot of selling space” in the supermarket, confectionaries like candy bars consistently rank among the most lucrative. The markups are the only healthy thing about them. Fried snacks like potato chips and corn chips are also highly profitable. PepsiCo’s subsidiary Frito-Lay brags that while its products represented only about 1 percent of total supermarket sales, they may account for more than 10 percent of operating profits for supermarkets and 40 percent of profit growth. 

    It’s no surprise, then, that the entire system is geared towards garbage. The rise in the calorie supply wasn’t just more food but a different kind of food. There’s a dumb dichotomy about the drivers of the obesity epidemic: Is it the sugar or the fat? They’re both highly subsidized, and they both took off. As you can see below and at 4:29 and 4:35 in my video, along with a significant rise in refined grain products that is difficult to quantify, the rise in obesity was accompanied by about a 20 percent increase in per capita pounds of added sugars and a 38 percent increase in added fats. 

     

    More than half of all calories consumed by most adults in the United States were found to originate from these subsidized foods, and they appear to be worse off for it. Those eating the most had significantly higher levels of chronic disease risk factors, including elevated cholesterol, inflammation, and body weight. 

    If it really were a government of, by, and for the people, we’d be subsidizing healthy foods, if anything, to make fruits and vegetables cheap or even free. Instead, our tax dollars are shoveled to the likes of the sugar industry or to livestock feed to make cheap, fast-food meat. 

    Speaking of sorghum, I had never had it before and it’s delicious! In fact, I wish I had discovered it before How Not to Diet was published. I now add sorghum and finger millet to my BROL bowl which used to just include purple barley groats, rye groats, oat groats, and black lentils, so the acronym has become an unpronounceable BROLMS. Anyway, sorghum is a great rice substitute for those who saw my rice and arsenic video series and were as convinced as I am that we need to diversify our grains. 

    We now turn to marketing. After all of the taxpayer-subsidized glut of calories in the market, the food industry had to find a way to get it into people’s mouths. So, next: The Role of Marketing in the Obesity Epidemic. 

    We’re about halfway through this series on the obesity epidemic. If you missed any so far, check out the related videos below.

    Michael Greger M.D. FACLM

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  • Processed Foods and Obesity  | NutritionFacts.org

    Processed Foods and Obesity  | NutritionFacts.org

    The rise in the U.S. calorie supply responsible for the obesity epidemic wasn’t just about more food, but a different kind of food.

    The rise in the number of calories provided by the food supply since the 1970s “is more than sufficient to explain the US epidemic of obesity.” Similar spikes in calorie surplus were noted in developed countries around the world in parallel with and presumed to be primarily responsible for, the expanding waistlines of their populations. After taking exports into account, by the year 2000, the United States was producing 3,900 calories for every man, woman, and child—nearly twice as much as many people need. 

    It wasn’t always this way. The number of calories in the food supply actually declined over the first half of the twentieth century and only started its upward climb to unprecedented heights in the 1970s. The drop in the first half of the century was attributed to the reduction in hard manual labor. The population had decreased energy needs, so they ate decreased energy diets. They didn’t need all the extra calories. But then the “energy balance flipping point” occurred, when the “move less, stay lean phase” that existed throughout most of the century turned into the “eat more, gain weight phase” that plagues us to this day. So, what changed?

    As I discuss in my video The Role of Processed Foods in the Obesity Epidemic, what happened in the 1970s was a revolution in the food industry. In the 1960s, most food was prepared and cooked in the home. The typical “married female, not working” spent hours a day cooking and cleaning up after meals. (The “married male, non-working spouse” averaged nine minutes, as you can see below and at 1:34 in my video.) But then a mixed-blessing transformation took place. Technological advances in food preservation and packaging enabled manufacturers to mass prepare and distribute food for ready consumption. The metamorphosis has been compared to what happened a century before with the mass production and supply of manufactured goods during the Industrial Revolution. But this time, they were just mass-producing food. Using new preservatives, artificial flavors, and techniques, such as deep freezing and vacuum packaging, food corporations could take advantage of economies of scale to mass produce “very durable, palatable, and ready-to-consume” edibles that offer “an enormous commercial advantage over fresh and perishable whole or minimally processed foods.” 

    Think ye of the Twinkie. With enough time and effort, “ambitious cooks” could create a cream-filled cake, but now they are available around every corner for less than a dollar. If every time someone wanted a Twinkie, they had to bake it themselves, they’d probably eat a lot fewer Twinkies. The packaged food sector is now a multitrillion-dollar industry.

    Consider the humble potato. We’ve long been a nation of potato eaters, but we usually baked or boiled them. Anyone who’s made fries from scratch knows what a pain it is, with all the peeling, cutting, and splattering of oil. But with sophisticated machinations of mechanization, production became centralized and fries could be shipped at -40°F to any fast-food deep-fat fryer or frozen food section in the country to become “America’s favorite vegetable.” Nearly all the increase in potato consumption in recent decades has been in the form of french fries and potato chips. 

    Cigarette production offers a compelling parallel. Up until automated rolling machines were invented, cigarettes had to be rolled by hand. It took 50 workers to produce the same number of cigarettes a machine could make in a minute. The price plunged and production leapt into the billions. Cigarette smoking went from being “relatively uncommon” to being almost everywhere. In the 20th century, the average per capita cigarette consumption rose from 54 cigarettes a year to 4,345 cigarettes “just before the first landmark Surgeon General’s Report” in 1964. The average American went from smoking about one cigarette a week to half a pack a day.

    Tobacco itself was just as addictive before and after mass marketing. What changed was cheap, easy access. French fries have always been tasty, but they went from being rare, even in restaurants, to being accessible around each and every corner (likely next to the gas station where you can get your Twinkies and cigarettes).

    The first Twinkie dates back to 1930, though, and Ore-Ida started selling frozen french fries in the 1950s. There has to be more to the story than just technological innovation, and we’ll explore that next.

    This explosion of processed junk was aided and abetted by Big Government at the behest of Big Food, which I explore in my video The Role of Taxpayer Subsidies in the Obesity Epidemic.

    This is the fifth video in an 11-part series. Here are the first four: 

    Videos still to come are listed in the related videos below.

    Michael Greger M.D. FACLM

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  • Cutting the Calorie-Rich-And-Processed Foods  | NutritionFacts.org

    Cutting the Calorie-Rich-And-Processed Foods  | NutritionFacts.org

    We have an uncanny ability to pick out the subtle distinctions in calorie density of foods, but only within the natural range.

    The traditional medical view on obesity, as summed up nearly a century ago: “All obese persons are, alike in one fundamental respect,—they literally overeat.” While this may be true in a technical sense, it is in reference to overeating calories, not food. Our primitive urge to overindulge is selective. People don’t tend to lust for lettuce. We have a natural inborn preference for sweet, starchy, or fatty foods because that’s where the calories are concentrated.

    Think about hunting and gathering efficiency. We used to have to work hard for our food. Prehistorically, it didn’t make sense to spend all day collecting types of food that on average don’t provide at least a day’s worth of calories. You would have been better off staying back at the cave. So, we evolved to crave foods with the biggest caloric bang for their buck.

    If you were able to steadily forage a pound of food an hour and it had 250 calories per pound, it might take you ten hours just to break even on your calories for the day. But if you were gathering something with 500 calories a pound, you could be done in five hours and spend the next five working on your cave paintings. So, the greater the energy density—that is, the more calories per pound—the more efficient the foraging. We developed an acute ability to discriminate foods based on calorie density and to instinctively desire the densest.

    If you study the fruit and vegetable preferences of four-year-old children, what they like correlates with calorie density. As you can see in the graph below and at 1:52 in my video Friday Favorites: Cut the Calorie-Rich-And-Processed Foods, they prefer bananas over berries and carrots over cucumbers. Isn’t that just a preference for sweetness? No, they also prefer potatoes over peaches and green beans over melon, just like monkeys prefer avocados over bananas. We appear to have an inborn drive to maximize calories per mouthful. 

    All the foods the researchers tested in the study with four-year-old kids naturally had less than 500 calories per pound. (Bananas topped the chart at about 400.) Something funny happens when you start going above that: We lose our ability to differentiate. Over the natural range of calorie densities, we have an uncanny aptitude to pick out the subtle distinctions. However, once you start heading towards bacon, cheese, and chocolate territory, which can reach thousands of calories per pound, our perceptions become relatively numb to the differences. It’s no wonder since these foods were unknown to our prehistoric brains. It’s like the dodo bird failing to evolve a fear response because they had no natural predators—and we all know how that turned out—or sea turtle hatchlings crawling in the wrong direction towards artificial light rather than the moon. It is aberrant behavior explained by an “evolutionary mismatch.”

    The food industry exploits our innate biological vulnerabilities by stripping crops down into almost pure calories—straight sugar, oil (which is pretty much pure fat), and white flour (which is mostly refined starch). It also removes the fiber, because that effectively has zero calories. Run brown rice through a mill to make white rice, and you lose about two-thirds of the fiber. Turn whole-wheat flour into white flour, and lose 75 percent. Or you can run crops through animals (to make meat, dairy, and eggs) and remove 100 percent of the fiber. What you’re left with is CRAP—an acronym used by one of my favorite dieticians, Jeff Novick, for Calorie-Rich And Processed food.

    Calories are condensed in the same way plants are turned into addictive drugs like opiates and cocaine: “distillation, crystallization, concentration, and extraction.” They even appear to activate the same reward pathways in the brain. Put people with “food addiction” in an MRI scanner and show them a picture of a chocolate milkshake, and the areas that light up in their brains (as you can see below and at 4:15 in my video) are the same as when cocaine addicts are shown a video of crack smoking. (See those images below and at 4:18 in my video.) 

    “Food addiction” is a misnomer. People don’t suffer out-of-control eating behaviors to food in general. We don’t tend to compulsively crave carrots. Milkshakes are packed with sugar and fat, two of the signals to our brain of calorie density. When people are asked to rate different foods in terms of cravings and loss of control, most incriminated was a load of CRAP—highly processed foods like donuts, along with cheese and meat. Those least related to problematic eating behaviors? Fruits and vegetables. Calorie density may be the reason people don’t get up in the middle of the night and binge on broccoli.

    Animals don’t tend to get fat when they are eating the foods they were designed to eat. There is a confirmed report of free-living primates becoming obese, but that was a troop of baboons who stumbled across the garbage dump at a tourist lodge. The garbage-feeding animals weighed 50 percent more than their wild-feeding counterparts. Sadly, we can suffer the same mismatched fate and become obese by eating garbage, too. For millions of years, before we learned how to hunt, our biology evolved largely on “leaves, roots, fruits, and nuts.” Maybe it would help if we went back to our roots and cut out the CRAP. 

    A key insight I want to emphasize here is the concept of animal products as the ultimate processed food. Basically, all nutrition grows from the ground: seeds, sunlight, and soil. That’s where all our vitamins come from, all our minerals, all the protein, all the essential amino acids. The only reason there are essential amino acids in a steak is because the cow ate them all from plants. Those amino acids are essential—no animals can make them, including us. We have to eat plants to get them. But we can cut out the middlemoo and get nutrition directly from the Earth, and, in doing so, get all the phytonutrients and fiber that are lost when plants are processed through animals. Even ultraprocessed junk foods may have a tiny bit of fiber remaining, but all is lost when plants are ultra-ultraprocessed through animals.

    Having said that, there was also a big jump in what one would traditionally think of as processed foods, and that’s the video we turn to next: The Role of Processed Foods in the Obesity Epidemic.

    We’re making our way through a series on the cause of the obesity epidemic. So far, we’ve looked at exercise (The Role of Diet vs. Exercise in the Obesity Epidemic) and genes (The Role of Genes in the Obesity Epidemic and The Thrifty Gene Theory: Survival of the Fattest), but, really, it’s the food.

    If you’re familiar with my work, you know that I recommend eating a variety of whole plant foods, as close as possible to the way nature intended. I capture this in my Daily Dozen, which you can download for free here or get the free app (iTunes and Android). On the app, you’ll see that there’s also an option for those looking to lose weight: my 21 Tweaks. But before you go checking them off, be sure to read about the science behind the checklist in my book How Not to Diet. Get it for free at your local public library. If you choose to buy a copy, note that all proceeds from all of my books go to charity. 

    Michael Greger M.D. FACLM

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  • Are We Polar Bears in a Jungle?  | NutritionFacts.org

    Are We Polar Bears in a Jungle?  | NutritionFacts.org

    Rather than being some kind of disorder or a failure of willpower, weight gain is largely a normal response by normal people to an abnormal situation.

    It’s been said that “Nothing in biology makes sense except in the light of evolution.” The known genetic contribution to obesity may be small, but, in a certain sense, you could argue that it’s all in our genes. The excess consumption of available calories may be hardwired into our DNA. We were born to eat.

    Throughout human history and beyond, we existed in survival mode—in unpredictable scarcity. We’ve been programmed with a powerful drive to eat as much as we can while we can and just store the rest for later. Food availability could never be taken for granted, so those who ate more at the moment and were best able to store more fat for the future might better survive subsequent shortages to pass along their genes. So, generation after generation, millennia after millennia, those with lesser appetites may have died out, while those who gorged may have selectively lived long enough to pass along their genetic predisposition to eat and store more calories. That may be how we evolved into such voracious calorie-conserving machines. Now that we’re no longer living in such lean times, though, we’re no longer so lean ourselves.

    What I just described is the “thrifty gene” concept proposed in 1962. As I discuss in my video The Thrifty Gene Theory: Survival of the Fattest, it suggests that obesity is the result of a “‘mismatch’ between the environment in which humans evolved and our modern environment”—like being a polar bear in a jungle. All that fur and fat may have given polar bears an edge in the Arctic but would be decidedly disadvantageous in the Congo. Similarly, a propensity to pack on the pounds may have been a plus in prehistoric times but can turn into a liability when our scarcity-sculpted biology is plopped down into the land of plenty. So, it’s not gluttony or sloth. Obesity may simply be “a normal response to an abnormal environment.”

    Much of our physiology is finely tuned to stay within a narrow range of upper and lower limits. If we get too hot, we sweat; if we get too cold, we shiver. Our body has mechanisms to keep us in balance. In contrast, our bodies have had little reason to develop an upper limit to the accumulation of body fat. In the beginning, there may have been evolutionary pressures to keep lithe and nimble in the face of predation, but thanks to things like weapons and fire, we haven’t had to outrun as many saber-toothed tigers for about two million years or so. This may have left our genes with the one-sided selection pressures to binge on every morsel in sight and stockpile as many calories as possible in our bodies.

    What was once adaptive is now a problem—or at least so says the thrifty gene hypothesis that originated more than half a century ago. It “provides a simple and elegant explanation for the modern obesity epidemic and was quickly embraced by scientists and lay people alike.” Although the researcher, James Neel, later distanced himself from the original proposal, the basic premise, despite remaining mostly theoretical, is still “largely accepted” by the scientific community, and the implications are profound.

    In 2013, the American Medical Association voted to classify obesity as a disease (going against the advice of its own Council on Science and Public Health). Not that it necessarily matters what we call it, but disease implies dysfunction. Bariatric drugs and surgery are not correcting an anomaly in human physiology. Our bodies are just doing what they were designed to do in the face of excess calories. Rather than being some sort of disorder, weight gain is largely “a normal response by normal people to an abnormal environment.” As you can see below and at 4:12 in my video, more than 70 percent of Americans are now overweight. It’s normal. 

    “A body gaining weight when excess calories are available for consumption is behaving normally. Efforts to curtail such weight gain with drugs [or surgery] are not efforts to correct an anomaly in human physiology, but rather to deconstruct and reconstruct its normal operations at the core.”

    If weight gain is largely a normal response by normal people to an abnormal situation, what exactly is that abnormal situation? Calorie-Rich-And-Processed Foods. (I’ll let you work out the acronym.) That’s the topic we’ll turn to next.

    This is the third in an 11-video series on the history of the obesity epidemic. If you missed the first two, see The Role of Diet vs. Exercise in the Obesity Epidemic and The Role of Genes in the Obesity Epidemic.

    There are eight more coming up. See the related posts below.

    Michael Greger M.D. FACLM

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