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This past Monday, Dr. B and I attended Endocrine Grand Rounds at Boston University School of Medicine where the guest speaker was diet wisdom iconoclast Gary Taubes. His talk was entitled: "Why We Get Fat: Adiposity 101." We don't believe the presentation was recorded, but similar presentations given at UC Berkeley, Dartmouth Medical School and elsewhere are readily available online and are well-worth watching (we'll provide recommended links at the end of today's post).

The audience at the BU Grand Rounds, which consisted of both endocrinologists and nutritionists, was polite until the post-presentation Q&A when a "food fight" erupted over heated exchanges with the guest speaker during which two questioners stormed out of the room.

We were familiar with Mr. Taube's work, having read his book "Good Calories, Bad Calories" (GCBC) published in 2007. Tellingly, the U.K. edition was entitled "The Diet Delusion" which is an allusion to a certain cognitive dissonance in diet and nutrition thinking which Taubes believes has had catastrophic effects on the health of Americans since the onset of the obesity and diabetes epidemics in the 1970s. We have also read a draft of his new book, "Why We Get Fat and What To Do About It," (WWGF) which is due for release in late December (just in time to inform your New Years' resolutions).

Mr. Taubes' 2007 book is a 600-page tome (including 114 pages of footnotes and references) that painstakingly describes the history and development of the conventional wisdom on diet, weight control and disease that Taubes believes resulted in a tragic degradation of American health because that conventional wisdom derived from incomplete or faulty science that was prematurely enshrined as government policy in the U.S. and other other countries beginning in the 1960s. Specifically, that conventional wisdom is the "energy balance paradigm" otherwise known as "calories-in-calories-out." There are many official versions of the paradigm, from various U.S. Government agencies, the World Health Organization, the U.K. Medical Research Council and INSERM in France, but they are all equivalent to the CDC's formulation:


Mr. Taubes, in his BU lecture and his books, reviews all of the evidence behind this belief and concludes that, despite seeming so unassailably true, it is actually false and dangerously misleading.

Purveyors of the conventional wisdom almost always argue that the "calories-in-calories-out" paradigm must be true because if it wasn't this would violate the First Law of Thermodynamics. Mr. Taubes, who is a physicist by training, argues that this is a misinterpretation of the First Law for two reasons: The equation implies no arrow of causality and E_in and E_out are not independent variables.



Taubes' arguments are not confined to physics; he has also marshalled a mountain of facts and observations from biochemistry, metabolism, physiology, endocrinology, epidemiology, and clinical research to support his "alternative hypothesis"  to the energy balance paradigm which, simply stated, is this:

• Obesity is a disorder of excess fat accumulation and not the result of energy imbalance, overeating or sedentary behavior.
• Overeating and inactivity are compensatory effects; they are not causes of obesity.
• We don't get fat because we overeat, we overeat because our adipose tissue is accumulating excess fat.

Taubes does not claim that he is the originator of this alternative hypothesis. Indeed, based on extensive review of the historical literature, he points out that the alternative hypothesis was actually the prevailing paradigm prior to World War II.

As described in Chapter 21 of Good Calories, Bad Calories this lipophilia hypothesis and its relationship to insulin and carbohydrate metabolism had been widely discussed and accepted since the 1920s but largely confined to the German and Austrian research communities which evaporated with the rise of Hitler and World War II. Anti-German sentiments for everything (except rocket science) in the post-war period may have contributed to the pre-war German literature being actively ignored by leading U.S. dietary researchers.

Of course, there's a lot more to the story than this involving science, politics and professional turf wars in the 1950s, 1960s, and 1970s which are all extensively documented in Mr. Taubes' books.

In summary, Gary Taubes makes a compelling case that much of what we think we know about dieting and weight management is wrong. Given the epidemic of diabetes and obesity in the United States, the healthcare costs associated with these diseases, and new public policies emphasizing wellness and preventive care, patients, practitioners and politicians all need to learn and think about what Taubes has to say.

Links to video presentations of "Why We Get Fat"

• Taubes at . June 5, 2009
• Taubes at . November 7, 2007
• Taubes debates Dr. Dean Ornish on (guest moderator: Dr. Mehmet Oz). July 26, 2002

Gary Taubes' new book is available for pre-order from Amazon; his earlier book is also still available:

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