Thursday, July 18, 2019

Retrospective #152: Set Point Theory

My current interest in Set Point Theory was spurred by my own (n=1) experience. I’ve been working on losing weight (as always) and recently reached another weight loss “plateau.” I eat a Very Low Carb Ketogenic Diet, and for the last two weeks my weight hasn’t changed. It goes up or down a pound or two (of water weight) daily, but the scale has not gone lower from week to week. We’ve all been frustrated by this experience and wonder “why?”
Many people are acquainted with the scientific concept that, as we attempt to eat a restricted-calorie, balanced diet, as recommended by mainstream medicine, our metabolism “adjusts” (slows down).  Our body senses that we are in “semi-starvation mode,” and hormonal changes beyond our conscious control initiate this change. Our body decides, independently of our intention, to conserve (use less) energy as a survival mechanism. That is why it is so hard to lose weight. Our body fights us “tooth and nail” to maintain our weight. And our body wins every time.
Until recently, my own experience has been that this “slowing down mechanism” doesn’t apply to me.  I find that my energy level is elevated when I diet. The reason is that all of my weight loss (170 pounds during my initial loss) was attributable to Very Low Carb (VLC) eating in which low serum insulin, a consequence of eating Very Low Carb, allowed my body to access body fat for energy. The body got the “low insulin” signal from the absence of carbs in my diet for energy. On that signal, it mobilized the breakdown of body fat to maintain my energy balance.
And since I had plenty of fat in “storage,” and my survival was not threatened, my metabolism didn’t slow down!
My body was not being starved because it got all the nutrients it needed from the reduced level of protein and fat that I ate plus the body fat it needed to supplement my energy needs – so long as I ate Very Low Carb.
I also try to avoid all grains and as much fructose and “vegetable” (seed and legume) oils as I can, to avoid harm. When I do, my body is “happy,” and I “feel great,” and I lose weight. So, why has my weight plateaued?
My wife related how she remembered this subject when she was low-carbing “before Atkins.” (I wonder if she realizes how much she is dating herself.) Her response over breakfast today was, “Be patient, it (weight loss) will start up again,” and “You may just need to ‘jump start’ it by fasting” to create a little “calorie confusion.” Hmmm…
That comment reminded me of a diet called “The 8-hour Diet,” in which you eat all your food in any day within an 8-hour “window.” The theory is that gives your body a chance to get into “fasting” mode for 16 hours a day, when it will burn body fat for energy. I like this idea but how it relates here is that the author suggests doing it only 3 times a week. That would certainly create a state of “calorie confusion,” wouldn’t it?
That idea led me to a New Year’s Resolution idea from a few years ago from the now deceased blogger David Mendoza. His suggested “weight loss tip” was that whenever your weight drifts above “target,” you skip dinner that day. That’s not as hard as it sounds because you’re not hungry on a VLCKD. In fact, I did it recently two days in a row. I actually ate only breakfast for two days and my weight dropped like a stone.
So, the common thread of all these ramblings and ruminations is: Fasting, so long as you are in fat burning mode (in ketosis) to begin with, and thus not experiencing hunger or any mysterious drives or cravings, is an effective way to jump start weight loss again.
The inescapable conclusion, however, is that set-points can even set in when you are ketogenic. Your body gets “happy.” Homeostasis (energy balance) has many under-understood aspects.
Perhaps J. Stanton at said it best: "It's tempting to talk about ‘set point’ and leave the discussion there — but as I've said before, ‘A set point is just a homeostasis we don't understand.’” The trillions of cells in our bodies each have metabolic requirements for macro- and micro-nutrients, as well as a functional hormonal environment -- in the words of the great mid-19th century French physiologist Clause Bernard, the “milieu intérieur.” So, to answer the “why” of those pesky set points stalls, try “calorie confusion,” using a mix of intermittent fasting protocols.

Wednesday, July 17, 2019

Retrospective #151: Homage to Vilhjalmur Stefansson by his wife Evelyn

This entire column, with thanks to my editor, is an excerpt from the blog Empirica, by L. Amber Wilcox O’Hearn.
“I recently came across an edition of Richard Mackarness's book, Eat Fat and Grow Slim. It includes a preface written by Stefansson's wife, Evelyn…. I reproduce it here because it is an interesting perspective from a wife and home-maker.
PREFACE: One morning at breakfast, the autumn of 1955, my explorer-anthropologist husband, Vilhjalmur Stefansson, asked me if he might return to the Stone Age Eskimo sort of all-meat diet he had thrived on during the most active part of his arctic work. Two years before, he had suffered a mild cerebral thrombosis, from which he had practically recovered. But he had not yet succeeded in losing the ten pounds of overweight his doctor wanted him to be rid of. By will power and near starvation, he had now and then lost a few of them; but the pounds always came back when his will power broke down. Doubtless partly through these failures, Stef had grown a bit unhappy, at times grouchy.
My first reaction to his Stone Age diet proposal was dismay. I have three jobs. I lecture, in and out of town, and enjoy the innumerable extracurricular activities of our New England college town of Hanover, New Hampshire. Forenoons I write books about the arctic, "for teen-agers and uninformed adults," to be able to afford the luxury of being librarian afternoons of the large polar library my husband and I acquired when we were freelance writers and government contractors, which library now belongs to Dartmouth College. I take part in a course called the Arctic Seminar, and last winter was director. I sing in madrigal groups and act in experimental theater plays. Only by a miserly budgeting of time do I manage these things. "In addition," I thought to myself, "I am now supposed to prepare two menus!"
But aloud I said: "Of course, dear." And we began to plan.
To my astonished delight, contrary to all my previous thinking, the Stone Age diet not only proved effective in getting rid of Stef's overweight, but was also cheaper, simpler, and easier to prepare than our regular mixed diet had been. Far from requiring more time, it took less. Instead of adding housekeeping burdens, it relieved them. Almost imperceptibly Stef's diet became my diet. Time was saved in not shopping for, not preparing, not cooking, and not washing up after unrequired dishes, among them vegetables, salads, and desserts.
Some of our friends say: "We would go on a meat diet too, but we couldn't possibly afford it." That started me investigating the actual cost of the diet. Unlike salads and desserts, which often do not keep, meat is as good several days later as the day it was cooked. There is no waste. I found our food bills were lower than they had been. But I attribute this to our fondness for mutton. Fortunately for us it is an unfashionable meat, which means it is cheap. We both like it, and thanks to our deep freeze, we buy fat old sheep at anything from twenty-two to thirty-three cents a pound and proceed to live on the fat of the land. We also buy beef, usually beef marrow. European cooks appreciate marrow, but most people in our country have never even tasted it, poor things.
When you eat as a primitive Eskimo does, you live on lean and fat meats. A typical Stefansson dinner is a rare or medium sirloin steak and coffee. The coffee is freshly ground. If there is enough fat on the steak, we take our coffee black, otherwise heavy cream is added. Sometimes we have a bottle of wine. We have no bread, no starchy vegetables, no desserts. Rather often we eat half a grapefruit. We eat eggs for breakfast, two for Stef, one for me, with lots of butter.
Startling improvements in health came to Stef after several weeks on the new diet. He began to lose his overweight almost at once, and lost steadily, eating as much as he pleased and feeling satisfied the while. He lost seventeen pounds, then his weight remained stationary, although the amount he ate was the same. From being slightly irritable and depressed, he became once more his old ebullient, optimistic self. By eating mutton, he became a lamb.
An unlooked-for and remarkable change was the disappearance of his arthritis, which had troubled him for years and which he thought of as a natural result of aging. One of his knees was so stiff he walked up and down stairs a step at a time, and he always sat on the aisle in a theater so he could extend his stiff leg comfortably.
Several times a night he would be awakened by pain in his hips and shoulder when he lay too long on one side; then he had to turn over and lie on the other side. Without noticing the change at first, Stef was one day startled to find himself walking up and down stairs, using both legs equally. He stopped in the middle of our stairs; then walked down again and up again. He could not remember which knee had been stiff!
CONCLUSION: The Stone Age all-meat diet is wholesome. It is an eat-all-you-want reducing diet that permits you to forget you are dieting--no hunger pangs remind you. It saves time and money. Best of all, it improves the temperament. It somehow makes one feel optimistic, mildly euphoric.
EPILOGUE: Stef used to love his role of being a thorn in the flesh of nutritionists. But in 1957 an article appeared in the …American Medical Association journal confirming what Stef had known for years from his anthropology and his own experience. The author of this book has also popularized Stef's diet in England, with the blessing of…British medical folk.
Was it with the faintest trace of disappointment in his voice that Stef turned to me, after a strenuous nutrition discussion, and said: "I have always been right. But now I am becoming orthodox! I shall have to find myself a new heresy."
Evelyn Stefansson
April 22, 1959

Tuesday, July 16, 2019

Retrospective #150: Another Milestone, Amid Ramblings and Ruminations

Seven and a half years ago, as this blog reached the 3k page-view mark, my hometown weekly newspaper advised me that they “had had done enuf on carbs and fat.” So, we both moved on. Since then I have published almost 500 more columns online and just passed the 365k page-view threshold. The newspaper has ceased operations.
In a parallel universe, Gary Taubes’s Alternative Hypothesis of eating Low-Carb High-Fat (LCHF) has also grown steadily. This is very gratifying. I see LCHF everywhere, on the radio, on TV, in print, and especially in the plethora of web-based resources…and of course in my readership. I am especially gladdened to see so many readers from overseas – from China, the Ukraine, Canada, Germany, the UK, Russia, France, Singapore, Australia, and Sweden.

One of the basic premises of The Nutrition Debate is that we as individuals are in charge of our own health because diet is a large part of health. The conditions that we have always associated with aging are increasingly being seen as instead being associated with diet. “Let food be thy medicine,” Hippocrates told us.  It should be no surprise then that we are interested in getting the best dietary advice. Unfortunately, the medical professions are not trained in nutrition. They are trained in diagnosing and treating disease, not in preventing it.

Equally unfortunate, the dietetics profession and the diabetes educators (CDE’s), while trained in nutrition, are, to be kind, misinformed. They (in general) are the last persons whose advice I would seek, and I do not see this changing soon. They hone to the AHA and the ADA conventional wisdom. And large organizations like them can be very slow to change. It is a shame, and so illogical, that these professions – medicine and dietetics – who should be interested in science and who should be open minded about unproven and disproven hypotheses like the diet/heart hypothesis, are ignoring the increasing body of irrefutable evidence that eating a low-fat, high-carb diet is what is making us sick. So, if you care about your health, you must seek your own dietary advice.
If you think this is a daunting prospect, just remind yourself that your doctor just monitors your health but is very results-oriented. He or she is interested in healthy outcomes: a good weigh-in and good lab tests. These are things that YOU can make happen. Will he care about how you did it?  Maybe. If he is surprised at your stellar results and asks you how you did it, don’t you be surprised if he’s supportive. But more likely he will be skeptical and offer another explanation for the turnaround. An open-minded doctor will be interested in and follow your progress.
You should be pleased if he just quietly accepts your explanation, even with a wry grin, an upturned corner of the mouth and a glint in his eye, as mine was. He was always glad to see me because he knew it was going to be a “happy” consultation, because with my treatment plan, I lost a lot of weight and put my diabetes in remission.
If your doctor is pleased with your health outcomes, but not favorably disposed towards how you did it, consider the fact that if he is stuck in his ways, that is not your problem. YOUR HEALTH IS YOUR PROBLEM. He’s gotta do what he’s gotta do. He needs to follow the Standards of Medical Care to protect his practice and get paid for his services from your insurance. And, there are other factors at play besides the “best interests” of the patient.
Big Pharma, Agribusiness and the Public Health Establishment are all engaged in this giant corrupt bargain. The “Alternative Hypothesis” movement is made up of serious health care researchers and clinicians who think otherwise, so we should all be grateful for the small but important changes we are seeing. The trend and the rate are accelerating. The only dragon we have left to slay is the saturated fat/dietary cholesterol demon, and that one is down on one knee. We just need to keep hammering out the mantra: “Dietary Cholesterol has nothing to do with Serum Cholesterol.” And we need to get more doctors to care more about how to get lower triglycerides and higher HDL by diet alone than care about lowering high Total Cholesterol and LDL-C with statin drugs.
Remember: The TG/HDL ratio, NOT the TC/HDL ratio, is the important metric for minimum cardiovascular risk. So is A1c. Heart attack risk falls by half as the A1c drops to 5.5% and below. You can set these targets as your goals and reach them with LCHF. And lose weight. And lower your blood pressure. And reduce inflammation…

Monday, July 15, 2019

Retrospective #149: Feral Cat Feeding Frenzy

We have had a small colony of feral cats for 11 years. When four adolescent siblings appeared on our terrace one fine day, we fed them. They were truly feral and were too old to be domesticated. To make a long story short, after a few litters were produced clandestinely, we eventually caught, spayed or altered them all, and the population stabilized at six adults. We set out food for them twice a day, though we still can’t touch or even get close to any of them.
And every year, as winter approaches in our temperate climate (upstate New York), I’ve observed that our small feral cat colony knows it’s time to fatten up for the long winter ahead. Their appetites seem insatiable. Ordinarily cats know not to overeat. If they are full, they leave food on the plate. But their appetites change when they sense they will need fat reserves to survive a long winter when they “think” they will have to depend on “the hunt.”
Gary Taubes describes this mammalian behavior in “Good Calories – Bad Calories” (pg. 294). It’s an example, he says, of hormonal control of feeding behavior, just as human growth hormones account for the appetites of children. On a good diet, children don’t normally get fat; they get plump briefly and then they grow. They get taller very quickly. And when cold weather is coming, cats eat voraciously to fatten up for winter. It’s a hormonal thing.
The temporary fat that cats put on provides insulation from the cold as well as body fat energy reserves. Of course, these cats don’t “know” why they have rapacious appetites as the days get shorter and colder. Their unconscious brains function autonomically regulating homeostasis on a daily and seasonal basis. Their hormones “tell” them to eat. It’s a survival behavior. When spring comes, and the fat reserves are depleted, their eating behavior will return to “normal.” They will need to be lean again to have the agility to hunt. “Fat cats” don’t get the “early bird.”
What can we learn from these observations? Well, we’re mammals too, and it’s only been 500 generations or so (10,000 years) since we learned to grow food as crops and then harvest and store them for winter. This was at the beginning of the Neolithic Age. The time before that is referred to as the Paleolithic Era, hence what is known today as Paleo dieting. But in today’s world, we live in an environment of abundance in the food supply. Our modern lifestyle allows us to shop at the local super market rather than “hunt and gather” or grow our own food.
The market is filled with a cornucopia of foods all year long, many of them “processed,” which means they have already been “partially digested”! White flour milled from whole grain is a perfect example, as are fruit juices and smoothies. Even fruits, which are primarily sucrose, fructose and glucose – all simple sugars, with a little fiber and pectin – have all been hybridized to make them even sweeter (and larger) than they ever were in ancestral times.
The result: When processed carbs dominate our diet, we eat every day like winter is about to descend at any minute. The same autonomic control system that tells the feral cat to prepare for winter, tells us to “overeat.” Not the same mechanism, but the same effect because, for us, there will be no seasonal change in our food supply.
The alternative to feast and famine is the way we were designed to eat. Our bodies were designed to be for a period in a condition of mild ketosis after a meal is digested. It is a natural state. Food wasn’t always abundant. The cycle then was: feed, digest and absorb, then fast, repeated maybe once or twice a day, if we were lucky.
The feral cat colony feeding frenzy is being driven by the onset of winter. Feeding of the human mammalian colony is now being driven by an over dependence on boxed, bagged, and “predigested” processed foods that we have come to overly rely on “for our convenience.” It is also with the blessing and encouragement of our government whose misguided advice is still being driven by 60 years of bad science, among other things.  The “corrupt bargain” of government funding, well-meaning but overreaching “big government” “fat cats” who want to tell us what we should eat, and the influence of Agribusiness and Big Pharma that profit from it.
As individuals in society we need to learn to think for ourselves and recognize what is really in our best interest. 

Sunday, July 14, 2019

Retrospective #148: Obesity, a Condition of Genetic Susceptibility

Obesity is, for most of us, a condition of genetic susceptibility. I say “most of us” because I want to address in particular NOT the very small number of people who have a rare genetic disorder (e.g.: Prader-Willi syndrome). I want to address the one-third to one-half of us who will gain weight eating the same foods in the same amounts that the rest of us do who do not gain weight. At one time we did eat the same foods and amounts without gaining weight, but then something changed, and that something is not simply behavioral, nor is it less physical activity.
My bias as a member of this cohort is also an advantage. I am amazed by several respected authors in the health and nutrition field who still just don’t get it. It’s too bad. Maybe you just have to be in our shoes to understand how the body responds to carbohydrates once your metabolism has become disregulated by Insulin Resistance, with the resulting hunger/cravings yet complete intolerance for carbohydrates as an energy source without weight gain.
Anyway, I do not seek sympathy. I just want wider understanding and acceptance of the science behind the cause of obesity. That might enable empathy and 1) an interest in advancing the science, and 2) an openness by the medical and public health establishments to accept the evidence presented by so many serious researchers.
Unfortunately, both the medical and public health establishments today are thoroughly corrupted by Agribusiness, Big Pharma and they by government funding for research. So, only independent researchers, most of them younger and unencumbered by conflicts of interest or conscience, can make a difference. I am but a speck in this firmament, but I power on, seeking and broadcasting the truth to a small following. Thank you for reading my blog.
My bias is generally informed by award-winning science writer Gary Taubes. His seminal tome, “Good Calories – Bad Calories,” is a foundational document. In Retrospective #5, “Gary Taubes and the Alternative Hypothesis,” I give his “10 certain conclusions” which lay down the basis for his understanding of the scientific cause of obesity.
In Retrospective #120, “Nutrigenomics,” I wrote: “It is hoped that by building up knowledge in this area, nutrigenomics will promote an increased understanding of how nutrition influences metabolic pathways and homeostatic control, which will then be used to prevent the development of chronic diet related diseases such as obesity and Type 2 diabetes.” Nutrigenomics clearly defines obesity as a condition of genetic susceptibility.
In an NPR piece some time ago, Dr. Lee Kaplan said, “There are thousands of genes in the body, and about 100 of them are involved in making some people more susceptible to weight gain.” “We’re all wired in slightly different ways,” and “those subtle differences are reflected in how the body deals with energy stores and fat.”
The head of the Obesity Clinical Program at the Joslin Diabetes Center said: “The reality is, if you have that genetic susceptibility to gain weight, you will gain weight easily, no matter what. Genetic susceptibility has to do with hormones and chemical systems in the body that direct appetite, metabolism and the absorption of nutrients. If you've always loved the sugary taste of ice cream, you may end up eating too much of it simply because an enzyme in your brain fails to halt the chemical that signals your brain to eat as much of the beloved food as you can.”
A 2009 study on the genetic susceptibility to weight gain found that when 12 pairs of identical twins were overfed 1,000 calories a day for three months, each set of twins gained a different amount of weight. Some only gained 8 pounds, while others gained thirty pounds. But within the pairs of twins themselves, the weight gain was the same.
A story in The Telegraph reported that Paul van der Velpen, the head of Amsterdam’s health service, said, “Just like alcohol and tobacco, sugar is actually a drug.” Van der Velpen claims that sugar, unlike fat or other foods, interferes with the body’s appetite creating an insatiable desire to carry on eating, an effect he accuses the food industry of using to increase consumption of their products. Whoever uses sugar wants more and more, even when they are no longer hungry. Give someone eggs and he’ll stop eating at any given time. Give him cookies, and he eats on…”
I can relate to that. I wonder if van der Velpen is fat too, or does he just “get it.” I wonder…

Type 2 Nutrition #494: My Food Rules

My food rules haven’t changed much since I began eating Very Low Carb in September 2002. The “program” I followed then, at the my doctor’s suggestion (to lose weight) was Atkins Induction: 20 grams of carbs a day. It worked in the way my doctor intended. I lost 60 pounds in 9 months. It also worked in another way that was unintended or at least not anticipated. In the 1st week I had to come off nearly all my diabetes meds I was on.
As best I remember, Atkins only  addressed carbohydrates at the time . That’s worth noting. It’s only – okay, well largelyonly carbs that matter. To lose weight (lots of it – I eventually lost 170+ pounds), you only need to restrict – severely, I’ll admit – carbohydrates.
So, if all you need to know is to severely limit the carbs you eat, the first thing you need to learn is: what foods contain carbs. Today, there are many ways to go about doing this: 1) You can “count carbs.” That’s what I did. From the start, I estimated portion sizes, used on-line sources for carb counts and recorded everything I ate in an Excel chart I created; or 2) You can use an on-line service to do the work for you, but be careful; many of these sources are way too lenient in their allowed foods. They think you “can’t” or won’t want to eat in a way that severely limits your carb intake. They’re way too friendly to the weak-willed or insufficiently motivated. Whichever way you choose, once you learn about carbs, remember: you just have to stick with Very Low Carb.
I learned what I needed to know, and then I ate (mostly) in compliance with my new knowledge. The foods I ate, were primarily protein and fat – saturated fat that is an inherent component of animal protein. If you aren’t prepared to do that, you will have a tough row to hoe. Vegetable oils are inherently unhealthy, and you must eat fat with protein. Protein has primarily cellular and hormonal functions. And you need healthy saturated fats to absorb the fat-soluble vitamins: A, D, E and K.
As I lost weight, I discovered I needed less food to feel full.  I wasn’t hungry most of the time. My body was slightly in ketosis, just ketotic enough to burn body fat as an energy source. Fat and carbs are the only two sources of energy.  I didn’t need to eat carbs for energy balance. My body fat provided the needed energy.
That’s when I started to ask myself: If I’m not hungry, why am I eating 3 meals a day. My body runs well on its own fat (and ketones), so why eat just because it’s a certain time of day. I started having just coffee with heavy cream for “breakfast,” and skipping lunch or just being sure it was only protein with some fat so I could stay mildly ketotic and not be hungry. At supper, just eating a small meal of animal protein (with saturated fat) and a portion of low-carb vegetables tossed in butter or roasted in olive oil, was always enough for me.
But I sometimes snacked. My snacking was always just before supper. When I was on anti-diabetes meds (sulfonylureas) that was always the time of day when my blood sugar was lowest. My snacking may be cultural as well. I have always enjoyed a glass of wine, or two. (I only have spirits in a restaurant or when we have guests for dinner.) And with wine I might have radishes with butter or celery with anchovy paste, or olives.
My cheats are 1) once in a while I’ll steal some of my wife’s ice cream from the freezer, or 2) in a restaurant, eat a roll or two with butter or olive oil. Rarely, I’ll share a dessert. These are indulgences. Simple pleasures, from a life almost forgotten. The best part of eating Very Low Carb almost all the time is how well I feel. I am often “pumped,” almost euphoric. The mood difference is palpable. It’s not just knowing I am no longer fat!

Oh, and did I mention...I have saved a lot of money on drugs and food. And my blood pressure is lower. And my HDL doubled and my triglycerides dropped by 2/3rds. And I don’t have to take a statin. And my chronic systemic inflammation is way lower. And I did it without exercise (and saved lots of time and gym costs). And all it requires is that I eat Very Low Carb most of the time. That’s Very Low Carb. It’s all you have to do.

Saturday, July 13, 2019

Retrospective #147:Obesity is a Disease (for billing purposes)

The New York Times article begins, “The American Medical Association has officially designated obesity as a disease…” This ties in nicely with my last two columns, #146, “Medicare to Pay for Obesity Counseling” and #145, “Gastric Bypass vs. Medical Therapy,” and the next, #148, “Obesity, a Condition of Genetic Susceptibility?”
The AMA call was a tough one for a variety of reasons, not least of which is that there is no general agreement in the scientific community on the definition of “disease.” The Times piece explains, “Those arguing against it [the designation of obesity as a disease] say that there are no specific symptoms associated with it, and that it is more of a risk factor for other conditions than a disease in its own right.” In making the designation, the AMA at their convention overrode a recommendation against doing so by a committee that had studied the matter for a year.
The committee said that “obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index (BMI), is simplistic and flawed.” The committee argued that “some people with a BMI above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity.” The committee wrote, “Given the existing limitations on BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes.”
According to an article in Forbes by Chris Conover, the AMA finessed the BMI business by “simply defining obesity as an excess of body fat sufficiently large to cause reduced health and longevity.” According to Conover, “they answered the question of ‘should we consider obesity a disease’ largely on utilitarian grounds – that the social benefits of doing so will outweigh the costs.” Conover then went on to brilliantly demolish that argument.
Conover said, “the AMA is (late) to the party.” The National Institutes of Health declared in 1985 that “obesity is a serious health condition that leads to increased morbidity and mortality.” And the National Heart, Lung and Blood Institute commented in 1995 that “obesity is a multifactorial chronic disease developing from multiple interactive influences of numerous factors.” And he cites the Surgeon General’s 2001 Call to Action to Prevent and Decrease Overweight and Obesity. And Michelle Obama’s 2009 Taskforce on Childhood Obesity. Even the IRS considered obesity to be a disease, and Medicaid jumped on the bandwagon in 2010. Medicare has too, for counseling and surgery, but not for reimbursement for weight loss drugs. Why then is the AMA defining obesity as a disease now?
If we needed one, The Times gives us a clue to a motive for the AMA action. One advocate commented, “I think you will probably see from this, physicians taking obesity more seriously, counseling their patients about it.” And it noted, “…it could help improve reimbursement for obesity drugs, surgery and counseling. Two new obesity drugs – Qsymia…and Belviq…have entered the market in the last year,” and “Qsymia has not sold well for a variety of reasons, including poor reimbursement…”
At the Huffington Post, self-described policy wonk and blogger Larry Cohen enthusiastically huffed, “After the AMA announcement, some members of Congress introduced a bill to expand Medicare reimbursements for weight-loss drugs and weight-reduction treatment.” The Washington lobbyists jumped in exaltation.
And then The Times piece cracks the door open just a bit with, “Some doctors say that people do not have full control over their weight,” and “that ‘medicalizing’ obesity by declaring it a disease would define one-third of American as being ill and could lead to more reliance on costly drugs and surgery rather than lifestyle changes. But, if the treatment is merely treating a symptom (obesity), rather than the underlying disease, doesn’t that solidify a wrong treatment modality for a non-existent disease? The AMA finessed that too by saying that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like type 2 diabetes and CVD.”
Neither The Times nor the AMA subscribes to Gary Taubes’s Alternative Hypothesis that INSULIN RESISTANCE, the metabolic disregulation that characterizes Type 2 diabetes, is what leads to fat accumulation. (obesity).