The obesity epidemic

Overweight and obese people silhouette illustration

I grew up in Toronto, Canada in the early 1970s. My younger self would have been utterly shocked that today, obesity has become a rising, unstoppable global phenomenon. At that time, there were serious Malthusian fears that the world’s population would soon eclipse the world’s food production and we would face mass starvation. The major environmental concern was global cooling due to the reflection of sunlight off dust particles in the air triggering the dawn of a new Ice Age. I wonder if Time Magazine thought one of the 51 things we should do is to become a penguin…

Time-ice-age-1977

Instead, some 50 years later, we find ourselves facing exactly the opposite problems. Global cooling has long ceased to be a serious concern, but global warming and melting polar ice caps dominate the news. Instead of global hunger and mass starvation, we face an obesity epidemic, unprecedented in human history.

There are many puzzling aspects to this obesity epidemic. First, what caused it? The fact that this epidemic is both global and relatively recent argues against an underlying genetic defect. Exercise as a leisure activity was largely unheard of in the 1970s. People just didn’t sweat with the oldies in that decade. The proliferation of gyms, running clubs, exercise studios and the like were a product of the 1980s. I would struggle with this question for many years. People ate white bread, ice cream and Oreo cookies in the 1970s. Whole wheat pasta and bread didn’t truly exist as foods real people ate. They were doing everything ‘wrong’ but yet there’s little obesity, as you can easily see if you were to look at old photographs from the 1970s.

Starch structure Second, why were we powerless to stop this epidemic? Nobody wanted to be fat. All the best scientists, doctors and dieticians of the era were giving dietary advice to stay lean. For more than thirty years, doctors have recommended a low-fat, calorie-reduced diet as the treatment of choice for obesity. Yet the obesity epidemic accelerated. From 1985 to 2011, the prevalence of obesity in Canada has tripled, from 6 percent to 18 percent. All the available evidence shows that people were trying to cut their calories, cut their fat and exercise more. But they weren’t losing weight. The only logical answer is that we didn’t understand the problem. Eating too much fat and too many calories wasn’t the problem, so cutting the fat and calories was not the solution. So, it all comes back to that first essential question. What causes weight gain?

The lack of interest in nutrition

In the 1990s, I graduated from the University of Toronto and the University of California, Los Angeles as a physician and kidney specialist. And I must confess that I did not have the slightest interest in the treatment of obesity. Not during medical school, residency, specialty training or even during practice. But it wasn’t just me. This was true for just about every physician trained in North America. Medical school taught us virtually nothing about nutrition, and even less about the treatment of obesity. There were hours and hours of lectures dedicated to the proper medications and surgery to prescribe. I was proficient in the use of hundreds of medications. I was proficient in the use of dialysis. I knew all about surgical treatments and indications. But I knew nothing about nutrition and even less about how to lose weight. This is despite the fact that the obesity epidemic was well established, and the epidemic of type 2 diabetes was following just behind, with all its health implications. Doctors just didn’t care about diet.

Weight loss was not a matter of looking good in a bikini for the summer swimming season. If only. The excess weight was largely responsible for development of type 2 diabetes and metabolic syndrome, dramatically increasing the risk of heart attacks, stroke, cancer, kidney disease, blindness, amputations, and nerve damage, among other problems. This was not some peripheral topic of medicine. Obesity was at the very heart of everything, and I knew just about nothing.

I entered practice as a kidney specialist in the early 2000s, and the most common cause of kidney failure, by far, was type 2 diabetes. I treated those patients exactly as I had been trained, the only way I knew how. With drugs like insulin and procedures like dialysis.

From experience, I knew that insulin would cause weight gain. Actually, everybody knew insulin caused weight gain. Patients were rightly concerned. “Doctor,” they say, “you’ve always told me to lose weight. But the insulin you gave me makes me gain so much weight. How is this helpful?” For a long time, I didn’t have a good answer for them, because the truth was it wasn’t helpful.

The problem was that my patients were just not getting healthier. I was simply holding their hand as they got worse and worse. I was doing everything I was taught, but it wasn’t doing any good. Gradually, it dawned on me what the problem was.

The root cause of the entire problem was the weight. Obesity caused metabolic syndrome and type 2 diabetes, which caused all the other problems. Yet everything I was taught, almost the entire system of modern medicine, with its pharmacopeia, with its nanotechnology, with all the genetic wizardry was focused myopically on the problems at the end.

OCC1

Nobody was treating the root cause. If you treat the kidney disease, patients are still left with obesity, type 2 diabetes and every other complication. This was the way that I, and virtually every other doctor was trained to practice medicine. But it was not working. We needed to treat obesity. We were trying to treat the problems caused by obesity rather than obesity itself.

When people lost weight their type 2 diabetes would also reverse course. Treating the root cause is the only logical solution. If your car is leaking oil, the solution is not to buy more oil and mops to clean the spilled oil. The logical solution is to find the leak and fix it. As a medical profession, we were guilty of blindly ignoring the leak.

If you could treat the obesity at the beginning, then type 2 diabetes and metabolic syndrome could not develop. You could develop diabetic kidney disease if you didn’t have diabetes. You couldn’t develop diabetic nerve damage if you didn’t’ have diabetes. It seems obvious in retrospect.

OCC2

How can obesity be treated?

The problem was that I didn’t know how to treat the obesity. Despite having worked more than twenty years in medicine, I found that my own nutritional knowledge was rudimentary, at best. This sparked a decade long odyssey and eventually led me to establish the Intensive Dietary Management (IDM) program and the Toronto Metabolic Clinic.

In thinking seriously about the treatment of obesity, there was one singularly important question to understand. What causes weight gain? What is the root cause? The reason we never think about this crucial question is that we already think we know the answer. We think that eating too many calories causes obesity. If this were true, then the solution to weight loss is simple. Eat fewer calories.

But we’ve done that already. Ad nauseam. For the last 50 years, the only weight loss ever given out was to cut your calories and exercise more. This is the highly ineffective strategy called ‘Eat Less, Move More’. We’ve added calorie counts to food labels. We have calorie counting books. We have calorie counting apps. We have calorie counters on our exercise machines. We’ve done everything humanly possible to count calories so that we could cut them. Did it work? Did those pounds melt like a snowman in July? No. It sure sounds like it should work. But the empiric evidence, plain as a mole on the tip of your nose, is that it does not work.

From a human physiology standpoint, the entire calorie story collapses like a house of cards. The body does not measure calories because it has no calorie sensors. The body does not respond to ‘calories’. There are no calorie receptors on cell surfaces. It has no ability to know how many calories you are or are not eating. If your body doesn’t count calories, why should you? Calories is purely a unit of energy borrowed from physics. The field of obesity medicine, desperate for some simple measure of food energy, completely ignored human physiology and turned to physics instead.

So, we got the saying ‘A calorie is a calorie’. But that’s not a question I can recall anybody ever asking. Instead, the question is ‘Are all calories of food energy equally fattening?’, to which the answer is an emphatic no. One hundred calories of kale salad is not as equally fattening as one hundred calories of candy. One hundred calories of beans is not equally as fattening as one hundred calories of white bread and jam. But for the last 50 years, we pretended they were equally fattening.

And so I started from the beginning. Unraveling the rotten tapestry of the Calories model to answer that all-important question of the underlying causes of weight gain was the reason I wrote The Obesity Code. Since then, in my Intensive Dietary Management program (www.IDMprogram.com) has treated thousands of patients over the last 5 years. I’ve wondered sometimes about why such a simple concept about using free dietary measures like fasting to treat dietary diseases runs into such obstacles. Here is the traditional medical system.

OCC3Money

Here is how the modern medical system fares if people could use diet to control their own health and destiny. Reversing type 2 diabetes, as I explored in The Diabetes Code, is really very simple, and does not involve using expensive medicines or surgeries.

OCC4Money


Dr. Jason Fung

Dr. Fung’s top posts

  1. Intermittent fasting for beginners
  2. My single best weight-loss tip
  3. How to renew your body: Fasting and autophagy

Weight loss

Keto

Intermittent fasting

 

More with Dr. Fung

All posts by Dr. Fung

Dr. Fung has his own blog at idmprogram.com. He is also active on Twitter.

The Obesity CodeThe Complete Guide to Fastingthe-diabetes-code (1)

Dr. Fung’s books The Obesity Code, The Complete Guide to Fasting and The Diabetes Code are available on Amazon.

7 comments

  1. Fatima
    ***You couldn’t*** develop diabetic kidney disease if you didn’t have diabetes. You couldn’t develop diabetic nerve damage if you didn’t’ have diabetes.
    -great post overall
  2. 1 comment removed
  3. Gillian
    I have lost weight through low car/IF, exercise etc., reversed my diabetes and off all meds after 22 years, great blood pressure results for nearly 2 years but my GFR continues to drop now 32 - and I’ve just been diagnosed with osteoporosis - what can I do to halt my kidney failure. Hoping Jason Fung will reply as my GP just shrugs his shoulders.
  4. Danny
    I had to start going to a kidney specialist 2 years ago when my GFR dropped below 60 (to 58). Was about 60 lbs overweight and had had moderately high blood pressure for years (only treated for past few years). Went on LCHF diet in early May. As of Sept 14 I am 45 lbs lighter with completely normal blood pressure (off medication). Had 6 month checkup with my kidney specialist last week and my GFR had risen to 66!! Was worried before going in, but in my case going off sugar/grain helped.
  5. David
    This is a good article as far as it goes, but it still doesn't answer the mystery of what caused the obesity epidemic. Was it soft drinks, which were around long before the obesity epidemic but may have recently been consumed in larger quantities? Was it the invention of high-fructose corn syrup which may have properties that cause more obesity than sugar? Is there some unknown chemical or virus that has affected the population as some have suggested? The answer to this scientific mystery is very important so we can truly solve the obesity epidemic for future generations, so I was disappointed that it was not actually addressed.
  6. Deb
    I agree with David above, this article never answered the question as to the root cause of the obesity epidemic....people used to eat carbs all the time and they were thin....so what is going on here?
    Reply: #8
  7. Tera
    Another great article, those industries have made billions off keeping us sick, unhealthy, and fat. I am hopeful that one day everyone will be told the truth (or stumble on it accidentally like I did) and are given the tools they need to truly get healthy from the inside out.
  8. Tera
    I believe it is due to the way our foods are processed these days - and the fact that we eat sooo much of them. I'm 45 so not that old, but I remember growing up that going out to eat was really only on rare occasions - we ate real food that we cooked at home; we rarely ate food from a box. And when we went out the portion sizes were what I would get at home. Today our foods are stripped of nutrients and pumped with tons of unrecognizable and unpronounceable ingredients. Everywhere you turn there is aisle upon aisle of crap from the grocery store to the gas station. The portion sizes are so huge that I could eat out and take some for lunch for 2 days in a row. And the amount of processed food is staggering! I only shop the perimeter of the store but that area is a 1/10 of the available "food" - 90% of it is highly processed carbs. Oh yeah, and also the fact that in most foods there is quadruple the amount of sugar then what was being put in previously. Sugar is more addictive than cocaine and more readily available in just about EVERYTHING.

    Yes, the article could have done more; but really our governments could too; but there is no money in healthy people - only in the fat and unhealthy. They won't ever tell the truth.

Leave a reply

Reply to comment #0 by

Older posts