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Tag: How Not to Diet

  • Can Onions Help with Weight Loss, Cholesterol, and PCOS? | NutritionFacts.org

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    Let’s talk about treating weight loss, cholesterol, and PCOS with diet. What can an eighth of a teaspoon a day of onion powder do for body fat, and what can raw red onion do for cholesterol?

    In one of my previous videos about onions, I talked about the data supporting—or not supporting—the role of onions in boosting testosterone in men, protecting bone health, controlling allergies, and dealing with the side effects of chemotherapy. What about weight loss? Enter the “Effect of Steamed Onion (ONIRO) Consumption on Body Fat and Metabolic Profiles in Overweight Subjects.” Researchers used steamed onions, which aren’t as spicy and have a weaker smell, so they could better disguise them as a placebo. They dried them into onion powder and gave people a minuscule amount—about an eighth of a teaspoon (300 mg) a day. Surely, a little daily dusting of onion powder wouldn’t affect people’s weight. But check out the results reported in the abstract: Measurements using a DEXA scan showed a significant reduction in body fat mass, and a CT scan revealed a significant decrease in whole, visceral, and subcutaneous fat areas.

    Hold on. If a little onion powder is so effective for weight loss, why wasn’t it featured in my book How Not to Diet? Because, as so often happens in studies, the spin in the abstract doesn’t accurately represent the actual data. The DEXA scan results measured no significant change of fat in the group that got the placebo capsules. They only appeared to lose about a spoonful (7 g) of fat, whereas the group unknowingly taking an eighth of a teaspoon of onion powder stuffed into capsules lost nearly one and a half pounds (0.64 kg) of body fat—a significant drop from baseline, but not a statistically significant drop compared to the placebo group, meaning the loss could have just been due to chance. Same thing with the CT scan results: 5 times more loss of overall fat and over 30 times more loss of the dangerous visceral fat, but the results did not reach statistical significance compared to placebo.

    A more recent study tried four teaspoons (9 g) of onion powder a day and similarly failed to accelerate the loss of visceral, total, or subcutaneous fat compared to placebo—but the placebo was also four teaspoons (9 g) of onion powder a day. They used yellow onions versus white onions, and it seems they both may have caused a loss of abdominal body fat, without a significant difference between them. Either way, you might look at these two studies and think, sure, but what are the downsides? It’s only an eighth of a teaspoon of onion powder a day, so why not give it a try? It can’t hurt, but we just don’t have enough evidence to be confident it will actually help.

    Let’s talk about polycystic ovary syndrome, also known as PCOS. It’s one of the most common hormone disorders, affecting 5% to 10% of reproductive-aged women. In addition to causing symptoms like irregular periods, “PCOS is a pre-diabetic state, with decreased insulin sensitivity.” PCOS treatment is challenging due to medication side effects. So, are there dietary options? How about a randomized controlled clinical trial of raw red onion intake?

    Why onions? Well, onion extracts can evidently improve blood sugar and insulin sensitivity in rats with diabetes and, more importantly, were found to reduce blood sugar levels in humans with diabetes, but evidently not in non-diabetic humans. People with PCOS are kind of pre-diabetic, so would it work for them? First, let’s look at those other two studies. To study the “Metabolic Effects of Onion and Green Beans,” people with diabetes spent a week eating either a small onion (60 g) each day or the same diet with about six cups (600 g) of green beans instead—and both approaches worked. The onion lowered people’s blood sugar levels by about 10% compared to a non-onion control diet, while the green beans lowered them by roughly 15% compared to the control.

    Here’s the study that supposedly shows no blood sugar benefits for people without diabetes. It’s true—onions don’t seem to lower normal blood sugar levels, which is a good thing, but check out what happens when you feed people sugar. Have people consume about two and a half tablespoons (50 g) of corn syrup, and their blood sugar levels shoot up over the next two hours before their body can tamp it back down. But give people the exact same amount of sugar along with more and more onion extract, and the blood sugar spike is significantly dampened, almost as much as if you had instead given them an antidiabetic drug, as you can see below and at 4:00 in my video Onions Put to the Test for Weight Loss, Cholesterol, and PCOS Treatment.

    We see the same blunting effect on blood sugar when people get a shot of adrenaline and eat onion extract, compared to receiving adrenaline without the onion extract, as you can see below and at 4:11 in my video.

    So, are there blood sugar benefits for both people with and without diabetes? No difference was found in blood sugar levels or other markers of insulin resistance between the high-onion and low-onion groups of PCOS patients, nor were there any differences in a marker of inflammation between the two groups. But women with PCOS aren’t just at higher risk for diabetes and inflammation—they are also at higher risk for high cholesterol.

    Women with PCOS are over seven times more likely to have a heart attack and develop heart disease, the number one killer of women. But consuming raw red onion appears to be effective in lowering cholesterol, though the group that ate more onions only dropped their LDL cholesterol about 5 points (5 mg/dL), which was not significantly different than the group that ate fewer onions.

    I did find this study from 50 years ago where researchers fed people nearly an entire stick (100 g) of butter, and their cholesterol shot up about 30 points within hours of consumption but by only 9 points or 3 points when combined with about a third of a cup (50 g) of raw or boiled onion. The moral of the story: Don’t eat a stick of butter.

    Doctor’s Note

    Check out the previous video I mentioned: Friday Favorites: Are Onions Beneficial for Testosterone, Osteoporosis, Allergies, and Cancer?.

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    Michael Greger M.D. FACLM

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  • The Hidden Costs of Bariatric Surgery | NutritionFacts.org

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    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.

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    Michael Greger M.D. FACLM

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  • Lose Weight with Cumin and Saffron?  | NutritionFacts.org

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    The spice cumin can work as well as orlistat, the “anal leakage” obesity drug.

    In my video Friday Favorites: Benefits of Black Cumin for Weight Loss, I discussed how a total of 17 randomized controlled trials showed that the simple spice could reduce cholesterol and triglyceride levels. And its side effects? A weight-loss effect.

    Saffron is another spice found to be effective for treating a major cause of suffering—depression, in this study, with a side effect of decreased appetite. Indeed, when put to the test in a randomized, double-blind, placebo-controlled trial, saffron was found to lead to significant weight loss, five pounds more than placebo, and an extra inch off the waist in eight weeks. The dose of saffron used in the study was the equivalent of drinking a cup of tea made from a large pinch of saffron threads.

    Suspecting the active ingredient might be crocin, the pigment in saffron that accounts for its crimson color, as shown here and at 0:59 in my video Friday Favorites: Benefits of Cumin and Saffron for Weight Loss, researchers also tried giving people just the purified pigment.

    That also led to weight loss, but it didn’t do as well as the full saffron extract and only beat the placebo by two pounds and half an inch off the waist. The mechanism appeared to be appetite suppression, as the crocin group ended up averaging about 80 fewer calories a day, whereas the full saffron group consumed an average of 170 fewer daily calories, as you can see below and at 1:21 in my video.

    A similar study looked specifically at snacking frequency. The researchers thought that the mood-boosting effects of saffron might cut down on stress-related eating. Indeed, eight weeks of a saffron extract halved snack intake, compared to a placebo. There was also a slight but statistically significant weight loss of about two pounds, as you can see here and at 1:41 in my video, which is pretty remarkable, given that tiny doses were utilized—about 100 milligrams, which is equivalent to about an eighth of a teaspoon of the spice.

    The problem is that saffron is the most expensive spice in the world. It’s composed of delicate threads sticking out of the saffron crocus flower. Each flower produces only a few threads, so about 50,000 flowers are needed to make a single pound of spice. That’s enough flowers to cover a football field. So, that pinch of saffron could cost a dollar a day.

    That’s why, in my 21 Tweaks to accelerate weight loss in How Not to Diet, I include black cumin, instead of saffron, as you can see here and at 2:30 in my video. And, at a quarter teaspoon a day, the daily dose of black cumin would only cost three cents.

    What about just regular cumin? Used in cuisines around the world from Tex-Mex to South Asian, cumin is the second most popular spice on Earth after black pepper. It is one of the oldest cultivated plants with a range of purported medicinal uses, but only recently has it been put to the test for weight loss. Those randomized to a half teaspoon at both lunch and dinner over three months lost about four more pounds and an extra inch off their waist. The spice was found to be comparable to the obesity drug known as orlistat.

    If you remember, orlistat is the “anal leakage” drug sold under the brand names Alli and Xenical. The drug company apparently prefers the term “faecal spotting” to describe the rectal discharge it causes, though. The drug company’s website offered some helpful tips, including: “It’s probably a smart idea to wear dark pants, and bring a change of clothes with you to work.” You know, just in case their drug causes you to poop in your pants at the office.

    I think I’ll stick with the cumin, thank you very much.

    Doctor’s Note

    The video on black cumin that I mentioned is Friday Favorites: Benefits of Black Cumin Seed (Nigella Sativa) for Weight Loss.

    My other videos on saffron are in the related posts below.

    For an in-depth dive into weight loss, see my book How Not to Diet. 

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    Michael Greger M.D. FACLM

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

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    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.

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    Michael Greger M.D. FACLM

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  • Drinking Water, Losing Weight  | NutritionFacts.org

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    A few times a day, drink two cups of cold water on an empty stomach for weight loss.

    After drinking two cups (half a liter) of water, you can get a surge of the adrenal hormone noradrenaline in your bloodstream, as if you had just smoked a few cigarettes or had a few cups of coffee, boosting your metabolic rate up to 30 percent within an hour, as shown below and at 0:22 in my video Optimizing Water Intake to Lose Weight. When put to the test in randomized controlled trials, that appeared to accelerate weight loss by 44 percent, making drinking water the safest, simplest, and cheapest way to boost your metabolism. 

    Now, this entire strategy may fail if you’re on a beta-blocker drug. (Beta blockers are typically prescribed for heart conditions or high blood pressure and tend to end with the letters lol, such as atenolol, nadolol, or propranolol, sold as Tenormin, Corgard, or Inderal, respectively.) So, for example, as you can see below and at 0:59 in my video, if you give people the beta-blocker drug metoprolol (sold as Lopressor) before they drink their two cups (480 mL) of water, the metabolic boost is effectively prevented. This makes sense since the “beta” being blocked by beta blockers are the beta receptors triggered by noradrenaline. Otherwise, drinking water should work. But what’s the best dose, type, temperature, and timing?

    Just a single cup (240 mL) of water may be sufficient to rev up the noradrenaline nerves, but additional benefit is seen with drinking two or more cups (480 mL). A note of caution: One should never drink more than about three cups (710 mL) in an hour, since that starts to exceed the amount of fluid your kidneys can handle. If you have heart or kidney failure, your physician may not want you to drink extra water at all, but even with healthy kidneys, any more than three cups of water an hour can start to critically dilute the electrolytes in your brain with potentially critical consequences. (In How Not to Diet, I talk about a devastating, harrowing experience I had in the hospital as an intern. A patient drank himself to death—with water. He suffered from a neurological condition that causes pathological thirst. I knew enough to order his liquids to be restricted and have his sink shut off, but I didn’t think to turn off his toilet.)

    Getting back to it. What kind of water are we talking about? Does it have to be plain, regular water? It shouldn’t matter, right? Isn’t water just water whether it’s flavored or sweetened in a diet drink? Actually, it does matter. When trying to prevent fainting before blood donation, drinking something like juice doesn’t work as well as plain water. When trying to keep people from getting dizzy when they stand up, water works, but the same amount of water with salt added doesn’t, as seen below and at 2:40 in my video. What’s going on? 

    We used to think the trigger was stomach distention. When we eat, our body shifts blood flow to our digestive tract, in part by releasing noradrenaline to pull in blood from our limbs. This has been called the gastrovascular reflex. So, drinking water was thought to be a zero-calorie way of stretching our stomachs. But, instead, if we drink two cups (480 mL) of saline (basically salt water), the metabolic boost vanishes, so stomach expansion can’t explain the water effect.

    We now realize our body appears to detect osmolarity, the concentration of stuff within a liquid. When liquids of different concentrations were covertly slipped into people’s stomachs via feeding tubes, detection of plain water versus another liquid was demonstrated by monitoring sweat production, which is a proxy for noradrenaline release. It may be a spinal reflex, as it’s preserved in people who are quadriplegic, or picked up by the liver, as we see less noradrenaline release in liver transplant patients (who’ve had their liver nerves severed). Whichever the pathway, our body can tell. Thought we only had five senses? The current count is upwards of 33.

    In my Daily Dozen recommendation, I rank certain teas as among the healthiest beverages. After all, they have all the water of water with an antioxidant bonus. But, from a weight-loss perspective, plain water may have an edge. That may explain the studies that found that overweight and obese individuals randomized to replace diet beverages with water lost significantly more weight. This was chalked up to getting rid of all those artificial sweeteners, but, instead, it may be that the diet drinks were too concentrated to offer the same water-induced metabolic boost. As you can see below and at 4:29 in my video, diet soda, like tea, has about ten times the concentration of dissolved substances compared to tap water. So, plain water on an empty stomach may be the best. 

    Does the temperature of the water matter? In a journal published by the American Society of Mechanical Engineers, an engineering professor proposed that the “secret” of a raw food diet for weight loss was the temperature at which the food was served. “Raw food, by its very nature, is consumed at room temperature or lower.” To bring two cups (480 mL) of room-temperature water up to body temperature, he calculated the body would have to dip into its fat stores and use up 6,000 calories. Just do the math, he says: A calorie is defined as the amount of energy required to raise one gram of water one degree Celsius. So, since two cups of water are about 500 grams and the difference between room temp and body temp is about a dozen degrees Celsius, it’s about 500 x 12 = 6,000 calories needed. 

    Do you see the mistake? In nutrition, a “calorie” is actually a kilocalorie, a thousand times bigger than the same word used in the rest of the sciences. Confusing, right? Still, I’m shocked that the paper was even published.

    So, drinking two cups of room-temperature water actually takes only 6 calories to warm up, not 6,000. Now, if you were a hummingbird drinking four times your body weight in chilly nectar, you could burn up to 2 percent of your energy reserves warming it up, but it doesn’t make as much of a difference for us.

    What about really cold water, though? A letter called “The Ice Diet” published in the Annals of Internal Medicine estimated that eating about a quart (1 L) of ice—like a gigantic snow cone without any syrup—could rob our body of more than 150 calories, which is the “same amount of energy as the calorie expenditure in running 1 mile.” It’s not like you directly burn fat to warm up the water, though. Your body just corrals more of the waste heat you normally give off by constricting blood flow to your skin. How does it do that? Noradrenaline.

    If you compare drinking body-temperature water, room-temperature water, and cold water, there’s only a significant constriction in blood flow to the skin after the room-temperature water and the cold water, as seen below and at 6:39 in my video. 

    What’s more, as you can see here and at 6:45 in the video, neither the warm nor tepid water could boost metabolic rate as much as cold (fridge temperature) water. Our body does end up burning off more calories when we drink our water cold (at least indirectly). 

    So, two cups of cold water on an empty stomach a few times a day. Does it matter when? Yes, watch my Evidence-Based Weight Loss lecture to see how you can add the benefit of negative-calorie preloading by drinking that water right before your meals.

    Too good to be true? No. Check out my other three videos on water and weight loss in the related posts below.

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    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

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    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. 

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    Michael Greger M.D. FACLM

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