Opening Speaker: This talk is part of the Authors@Google of the Health@Google series. We’ll have a lot of time at the end for questions and there’s a mic here.
So, I’m very pleased to welcome today, Gary Taubes, who is a contributing correspondent for Science Magazine. His work has appeared in the New York Times, the Atlantic, the Esquire. His work has also been included in The Best of The Best American Science Writing and also has received three Science in the Society Journalism awards from the National Association of Science Writers.
He’s the author also of Good Calories, Bad Calories that I’m sure many of you know about. And currently, he is the Robert Wood Johnson Foundation investigator in health policy research at the University of Berkeley.
So, with this, we’ll have Gary Taubes talk about his latest book.
Gary Taubes
Thank you very much. This book is basically — Good Calories, Bad Calories took me about five years to write and was 500 pages long.
This is the screen I used to use for this talk and I had written that book hoping to get both the lay readers and to the public health authorities around the country and the medical research community. Because the goal of these books are to convince people that–I mean, it’s almost a cliché–but that our fundamental understanding of why we get fat, of obesity, is completely incorrect and that a new paradigm is in order.
And that Google should change the foods that they’re serving at their wonderful, healthy, low-fat cafes. So, after Good Calories, Bad Calories came out, I wrote Why We Get Fat, in effect, to make it the kind of airplane-reading version of Good Calories, Bad Calories for people who don’t have the time.
I got a lot of emails from people, from doctors, who asked me if I could write a book that their patients could read, from patients who asked me if I could write a book that their doctors would read. So, in this lecture, Why We Get Fat is actually based on the lecture. So, once you’ve seen this, you don’t actually have to read the book. Let me see if this works a little. That’s better.
Obesity epidemic in the works
This is just background. You know there’s an obesity epidemic in the works. I’m not going to go over it because, as usual, I’m probably going to run a little long on this talk. The obesity epidemic goes along with the diabetes epidemic. Diabetes diagnoses have tripled in the past 30 years in the United States.
And let’s see if this — Diabetes, obesity are associated with a host of chronic diseases that are known as metabolic diseases, which include fatty liver disease, atherosclerosis, hypertension, stroke, cancer, asthma, sleep apnea, osteoarthritis, neural degeneration.
Actually, Alzheimer’s disease is a disease that’s now associated with what’s called insulin resistance in obesity. And one of the subtexts of the talk I’m going to give today is that the conventional wisdom is that as we get fatter, that increases the risk of all these diseases and the fundamental problem is us getting fatter.
And I’m going to suggest that the same foods, the same thing that makes us fat, also causes these diseases. So, it’s a fundamentally different causality.
So the question we want is why do we get fat? Obvious question. And the official answers are, “Obesity occurs when a person consumes more calories from food than he or she burns.”
“Overweight is the result of a caloric imbalance and is mediated by genetics and health.” That’s what the old Surgeon General and the NIH tells us.
So how many people in this room actually believe this and think it’s meaningful? That’s not bad.
You know, I gave this talk at Tufts a couple weeks ago to the nutrition department. And the Tufts people have been behind every dietary guidelines for the past 20 years. And I asked how many people believe this and nobody–literally, nobody–raised their hand. And then I said, “Are you kidding? Because if you don’t, I can leave.” And then everybody raised their hand.
And then after the talk, they said, “Well, we don’t really believe it.” So here’s a conventional wisdom: “Energy in is greater than energy out.” And that’s why we get fat. We take in more energy than we consume. We overeat and the excess calories go to our fat tissue. You hear about this in a lot of different ways.
In the medical literature, they’ll refer to “over nutrition”. “Positive energy balance” is another way to phrase it. And often, virtually every article you read on obesity, they’ll say, “Obesity is a disorder of energy balance.”
And when they say that, what they mean is we take in more calories than we consume and that’s why we get fat.
So here’s the general image of what’s going on here. And what you want to do when we talk about this, one of the key things you want to do in any science is explain the observations.
So we have this observation of an obesity epidemic and we want to explain it by our hypothesis, which is that we take in more calories than we expend.
And the way it’s been done over the years is that the idea is “increased prosperity.” This is what Marion Nestle, a New York University nutritionist, wrote in ‘Science’, “As we get richer, more food becomes available. We have less reason to become physically active.”
That food’s on every street corner. You don’t have to work to get it.
And so we get fatter and fatter. Kelly Brownell, a Yale University psychologist, used, coined the term “toxic environment,” which is an environment that promotes overeating and sedentary behavior. And so physical activity, and as Kelly put it, he said, “Cheese curls and French fries, fast food joints are as much a part of our environment as trees and clouds. Mothers keep their kids home from school. We sit in front of computer screens all day long and video games and television.”
So a lot of reasons to eat too much, not enough reason to burn it off. And the question we want to know — here’s the hypothesis: increased prosperity leads to overeating–energy in is greater than energy out– and that leads to obesity and the obesity epidemic. And what we want to know is, is this true? Because this is a science and in science, this is a hypothesis.
So you just ask a question. Is this true? Does it explain the observations?
When I’m lecturing to nutrition departments and obesity research departments, I often want to piss them off in the beginning. It’s part of my nature. And I’ll say, “Let’s pretend this is a science for a second and see if this can actually explain the observations.”
There are a lot of observations out there, but they’re less than obvious. They’re not — right now, we know we’ve got McDonalds on every street corner. We know a lot of people watch television. And we know a lot of people are getting heavier. So we put them all together, these associations, and we say. “That’s the cause”. But we could find populations that didn’t have all these, this toxic environment as we define it, and we could look to see if the obesity existed there.
And one of the underlying contexts here, one of my underlying hypothesis, and also of any science, the underlying principles is Occam’s Razor. So we should find the simplest possible hypothesis.
So we’re going to work from the hypothesis of whatever makes any population fat is what makes our population fat, until we have to change it.
So, here we have a photo. This young woman, or middle-aged woman, was known as ‘Fat Louisa’. This photo was taken in 1902. And Fat Louisa was a Pima Indian. And the Pima live on the Gila River reservation. Now, it’s the Gila River reservation, south of Phoenix, Arizona.
What’s little-known about the Pima is today, they are the poster children for obesity and diabetes in the United States because they have conceivably the highest risk of any population.
In the 17th, 18th, 19th Century, they were the most affluent Native American tribe. They were hunters and gatherers. They hunted in the nearby mountains. They fished in the Gila River. They raised sheep–not sheep–cattle, pigs. They had warehouses full of food available in the 1840s.
When the first US Army Battalion moved to the Pima territory on the San Jose Trail, they reported that the Pima had this incredible amount of food available. And they were all lean and sprightly. And by 1849, gold was discovered in California.
And over the next 20 years, 20,000 to 60,000 49ers went west to the Pima territory and the US government asked the Pima to feed them, which they did, and protect them from the hostile tribes farther West. And then by the 1870s, 1880s, Mexican Americans and Anglo Americans started moving into the Pima territory and they overhunted the nearby mountains.
They diverted the Gila River water to irrigate their own fields, and the Pima went into what they called the Years of Famine, which lasted for 20 or 30 years.
And by 1902, when Frank Russell, a Harvard anthropologist came to live with the Pima and wrote the Seminole text on the Pima Indians, they were living on a reservation. They were struggling as farmers to survive, and it was Russell who took the photo of Fat Louisa on the right. And he said many old people in the tribe, unlike the classical image of the strong, buff Native American, many old people in the tribe were actually obese and overweight.
And this was an observation that was seconded a few years later by Alex Hrdlicka, who was the physician-anthropologist who went on to become the curator of the Smithsonian, Department of Physical Anthropology. So, the point about the Pima was that they went from being affluent in the 1840s — that drawing was actually made in 1851 — to poor in 1902. And they went through 30 years of famine in the middle. And 30 years of famine, you could think of as 30 years of being on a diet. And they should have been leaner, right? Because our hypothesis says if poverty leading to prosperity causes obesity, not prosperity leading to poverty. And yet, in the early 19th Century, we have a high level of obesity observed by two separate anthropologists living with the tribe. If this was the only example, we could probably toss it and assume something else was going on. But there are a lot of examples of obesity in what we would call “non-toxic environments.”
And one of the things that sort of pissed me off doing my research for Good Calories, Bad Calories, which took five years, is you only had to go to look for them to find them. And yet, the obesity research community hadn’t bothered because they had settled on their hypothesis. It’s all about overeating. It’s all about taking in too many calories. It’s all about fast food joints. And so they never looked. If you go look, you’ll find a lot of different populations.
The Sioux on the South Dakota Crow Creek Reservation, in 1928 — this was a study done by two University of Chicago economists. And this, this population was so poor that you could use it. You could put it in the dictionary next to the definition of “dirt poor.” They lived four to eight people per room. Something like 15 families with 32 children on the reservation were living only on bread and coffee. There were no bathrooms. There’s no plumbing. They had to get water from the river. And yet, 40% of the women, 25% of the men, and 10% of the children were distinctly fat. And 20% of the women, 25% of the men, and 25% of the children were distinctly thin. And there were definite signs of malnutrition.
The economists documented all kinds of deficiency diseases among these Native Americans. And this combination of obesity and malnutrition, or under nutrition, existing in the same population is an observation I’m going to come back to shortly — many times, in fact.
Okay, African Americans in Charleston, South Carolina in 1959. Thirty percent of the women are obese and 18 percent of the men. Family incomes are nine to 53 dollars a week. That’s less than 400 dollars a week in 2011 dollars.
Zulus in Durban, South Africa in 1960. Forty percent of the women are obese. Women in their 40s averaged 175 pounds. Today in the United States, the average weight for adult women is around 165 pounds. Trinidad, early 60s, Trinidad’s having a malnutrition, a famine crisis. The US government sends a team of nutritionists down to help out and they come back reporting that a third of women over 25 are obese. They report obesity as a “potentially serious medical problem in women.”
The per capita data
The next year, an MIT nutritionist goes down to Trinidad to figure out what’s going on. She studies the diet of the obese women, compares it to the diets of the lean women in Trinidad and concludes that the per capita daily diet was less than 2000 calories a day, 21 percent fat. Fewer calories than were recommended at the time by the Food and Agricultural Organization for a healthy diet.
Bantu “pensioners” in South Africa in the mid-60s. These are the poorest of a disenfranchised population. 30 percent of the women are severely overweight and the mean weight of women over 60 is 165 pounds. Raratonga in the South Pacific. Forty percent of the women are obese, 25 percent are greatly obese, grossly obese. That’s in 1971.
And then, factory workers in Chile in 1974. Thirty percent are obese. Nearly 50 percent of the women over 54 are obese. Ten percent suffer undernourishment. Okay, so here’s that combination again of obesity and malnutrition in the same population and most are engaged in heavy labor.