Fat Chance

Copyright

First published in Great Britain by

Fourth Estate

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1 London Bridge Street

London SE1 9GF

www.4thestate.co.uk

First published by Hudson Street Press, a member of the Penguin Group (USA) Inc.

Copyright © Robert H. Lustig 2012

The right of Robert H. Lustig to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988

A catalogue record for this book is available from the British Library

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Ebook Edition © December 2012 ISBN: 9780007514137

Version: 2018-08-03

Dedication

This book is dedicated to all the obese patients worldwide who suffer daily, and the family members who suffer with them. The children who will not know a normal childhood, who will endure an inhuman existence, and will die a slow and early death. The parents who are engulfed by guilt. The unborn children, who are already imprisoned by changes in their brains and their bodies. But most of all, I dedicate this book to those of you who are or have been my patients; for it is you who taught me the science of your affliction. You also taught me more than medical school ever did or could; and that each life is valuable, precious, and worth saving. You maintained your dignity in the face of the most adverse circumstances imaginable. You shared with me your misery, and your joy in small victories. We cried and we laughed together. I hope I was of some service and comfort.

This book is my way of returning the favor.

This book is written only for those of you who eat food.

The rest of you are off the hook.

INTRODUCTION: Time to Think Outside the Box

“We just eat too damn much.”

Indeed we do. That’s it, thanks for buying this book, you’ve been a great audience, I’m outta here.

Well, that’s what the U.S. government would have you believe. All the major U.S. governmental health agencies, the Centers for Disease Control (CDC), the U.S. Department of Agriculture (USDA), the Institute of Medicine (IOM), the National Institutes of Health (NIH), and the U.S. Surgeon General, say that obesity results from an energy imbalance: eating too many calories and not getting enough physical activity. And they are right – to a point. Are we eating more? Of course. Are we exercising less? No doubt. Despite knowing this, it hasn’t made any difference in the rates of obesity or associated diseases. More to the point, how did this epidemic happen and in such a short interval of just thirty years? People say, “The food is there,” and it is. But it was there before. People say, “The TV is there,” and it is. But it was there before, and we didn’t have this caloric catastrophe. There’s more to this story, way more, and it’s not pretty.

Everyone blames everyone else for what has happened. No way is it their fault. Big Food says it’s a lack of activity due to computers and video games. The TV industry says it’s our junk food diet. The Atkins people say it’s too many carbohydrates; the Ornish people say it’s too much fat. The juice people say it’s the soda; the soda people say it’s the juice. The schools say it’s the parents; the parents say it’s the schools. And since nothing is for sure, nothing is done. How do we reconcile all these opinions into a cohesive whole that actually makes sense and creates changes for the better for each individual and for all society? That’s what this book is about.

Food is not tobacco, alcohol, or street drugs. Food is sustenance. Food is survival. Most important, food is pleasure. There are only two things that are more important than food: air and water. Shelter’s a distant fourth. Food matters. Unfortunately, food now matters even more than it should. Food is beyond a necessity; it’s also a commodity, and it has been reformulated to be an addictive substance.

This has many effects on our world: economically, politically, socially, and medically. There is a price to pay, and we’re paying it now. We pay with our taxes, our insurance premiums, and our airline fares – nearly every bill we receive in the mail has an obesity surcharge that we underwrite. We pay in misery, worsening school scores, social devolution, and we pay in death. We pay for all of it, one way or another, because the current food environment we have created does not match our biochemistry, and this mismatch is at the heart of our medical, social, and financial crisis. Worse yet, there is no medicine for this. There is no edict, ordinance, legislation, tax, or law that can solve this alone. There is no quick fix, but the problem is resolvable if we know what’s really going on – and if we really want to resolve it.

In his 2004 book Food Fight, Kelly Brownell of Yale University talks about obesity and the “toxic environment” we now live in, a euphemism for our collective bad behaviors. I am going a step further. I’m interested in whether there is something actually toxic, I mean poisonous, going on here. Even laboratory animal colonies have been getting fatter over the past twenty years!

Every good story needs a villain. While I am loath to reveal it this early in the book, I won’t keep you in suspense. It’s sugar – the Professor Moriarty of this story, a substance that now permeates nearly all food and drink worldwide. It’s killing us…slowly, and I’ll prove it. Every statement throughout this book is based on scientific study, historical fact, or recent statistics.

I’m a physician. We take an oath: primum non nocere (first do no harm). But there’s a paradox in this statement: when you know the final disposition – that the outcome is going to be bad – then doing nothing is causing harm.

I certainly did not start out as an advocate. I wasn’t looking for a fight. I didn’t come to this controversy with a preconceived agenda. Indeed, I was fifteen years into my medical career before I stepped up to deal with obesity as an issue. Until 1995, like my medical colleagues, I did my best to avoid seeing obese patients. I had nothing to tell them except “it’s your fault” and “eat less and exercise more.” At that time, seeing an obese child with type 2 diabetes was an anomaly. Now it is an almost everyday occurrence. The problem of obesity is now inescapable in medical practice. You can’t avoid it any more.

The concepts elaborated here didn’t just wake me from sleep one day in a divine revelation. This book is the culmination of sixteen years of medical research, medical meetings, academic discourse with colleagues, journal clubs, policy analysis, and a whole lot of patient care. I have no conflict of interest in espousing the information here; I am not a pawn of the food industry or a mouthpiece for any organization. Unlike many authors addressing the devastation of obesity, I don’t have a product line designed to enrich my bank account. I came by these views honestly and through rigorous data analysis. And the data are out there for everyone to examine. I’m just putting them together somewhat differently.

As a scientist, I have personally contributed to the understanding of the regulation of energy balance. As a pediatrician, I get to watch the interaction between genetics and environment that causes obesity play out in my examining room every day. And now, as a fledgling policy wonk, I have seen how the changes in our society have sprouted this global pandemic. It is this panoramic view that allows me to connect the dots for you, and they don’t connect in the way you’ve been told.

To blame obesity on the obese is the easy answer, but it is the wrong answer. The current formulation of gluttony and sloth, diet and exercise, while accepted by virtually everyone, is based on faulty premises and myths that have taken hold in the world’s consciousness. Obesity is not a behavioral aberration, a character flaw, or an error of commission. When we think about the ravages of obesity, our minds often go first to adults. But what about kids? One quarter of U.S children are now obese; even infants are tipping the scales! Children don’t choose to be obese. They are victims, not perpetrators. Once you understand the science, you realize what applies to children also applies to grown-ups. I know what you’re thinking: adults are responsible for their own choices and for the food they give their children. But are they?

An esteemed colleague involved in the obesity wars once said to me, “I don’t care what’s causing the obesity epidemic. I just want to know what to do about it.” I respectfully disagree. In order to pull ourselves out of this ditch, we have to understand how we drove into it. Indeed, our current thinking is based on correlation, supposition, and conjecture. I wrote this book to persuade you, the reader, to take up this cause, for your own health and for our country’s. However, you can’t truly advocate for a cause unless you know what is going on. And you can’t disagree with me until you know all the facts. And that means the science. After you’ve read this book, if you think it’s a crock or that I’m a crank, tell me. I want to know. In fact, I’ll make a promise to you right now: there is not one statement made in this entire book that can’t be backed up by hard science. My reputation in the field is built on the science. It’s also my protection against those who would try to discredit me, including the food industry and, as you will see, the federal government. Indeed, it’s the only reason I haven’t been discredited yet. And I won’t be, because I stick to the science. Now and forever.

However, in four places in the book, I let my imagination run wild. I will try to explain how obesity fits within the process of evolution, how our evolutionary biochemistry works to keep us alive, and finally how our food environment has altered that biochemistry to promote this global catastrophe. These fits of speculation will carry the section heading “Deconstructing Darwin.”

This book is targeted at the patients who suffer, the doctors who suffer along with them, the U.S. electorate who pays for this debacle, the politicians who must take up arms to dig us out of the mess that has been created out of our economy and our health, and the rest of the world, so they don’t make the same mistakes (although they already have).

In Part 1 of this book, I will challenge some of the theories you’re used to hearing in the media, and indeed from the medical profession. Parts 2 and 3 will focus on the science of obesity, and how the body deals with energy burning versus storage. No, you don’t need to be a biology or medical expert to understand the science. I’ve worked hard to reduce it down to its essence, and to keep it interesting, light, and accessible. In Part 2, I’ll also explain how your brain has developed, evolutionarily and in utero, to thwart your attempts at dieting. You truly are hormonal when it comes to the foods you crave, just not in the ways you think. Part 3 will elaborate on the science of fat tissue, and when and how it can make you sick. In Part 4, I will prove that our current environment is indeed “toxic.” I will show how the “American diet,” which is now the “industrial global diet,” is killing us…slowly. I will identify the poison and the antidotes, why those antidotes work, and why they’ve been added to or removed from our diet for the food industry’s purposes. Part 5 elaborates what you, as an individual, can do to protect yourself and your family by changing your “personal environment.” Finally, in Part 6, I argue that governments around the world have been co-opted by the food industry, and I will outline how they must instead partner with the populace and exert influence over the food industry to stop the obesity pandemic before we all reach the medical and financial Armageddon now within sight.

PART I

The Greatest Story Ever Sold