Big Fat Liars

Since 1980, Americans have gotten progressively more lazy and gluttonous. As if this were not bad enough, apparently about 2/3 of the population—the fat 2/3 of the population—have also become unrepentant liars. Although we have no way to explain this precipitous decline in the moral fiber of Americans, we know it must be happening because Americans seem to be getting fatter and fatter even though many of these fat Americans report that they are not eating more calories than their normal-weight, honest, hard-working counterparts.

It seems that when we gave the USDA and HHS the responsibility for determining what food was healthy for each of as individuals, Government Approved Nutrition Experts also developed a magical ability (in Nutrition, we love magic!) to tell the difference between what was Truly True and what was a Big Fat Lie. Here’s a response I got to a food record assignment during an introductory Nutrition course:

Question: What are your barriers to meeting the MyPyramid recommendations? (In other words, what might prevent you from consuming the recommended amount of each food group?)
My answer (after describing the low-carb diet that I used to lose weight and improve my migraines):I have a history of glucose intolerance and overweight/obesity.  Past a certain point of consumption, carbohydrates make me gain weight, raise my blood     pressure, reduce my energy levels, give me migraines, make my blood sugar wonky, and leave me hungry and cranky.  I stick to fiber-rich, nutrient-dense, non-starchy vegetables for my carbohydrates, although I do eat fruit when it is in season locally.
Instructor’s response (I am not making this up):  It is actually the total calories that make you gain weight, not the carbohydrates.  The high fat intake would be more detrimental than the whole grains and fiber rich vegetables.  Refined carbohydrates would cause the symptoms you describe but using whole grains and high fiber fruits and vegetables should not do so.  You need carbohydrate for your brain to function.  It does not function on fat and protein calories.  In fact eating a low carbohydrate diet such as you describe would make you tired, give you migraines, make you hungry and cranky.

Silly me! Of course the Nutrition Expert knows what REALLY caused my weight gain and migraines. Obviously the lack of carbohydrate to my brain prevented me from realizing her innate superiority at understanding and interpreting my own personal experiences. Either that or I’m just a Big Fat Liar.

Let me introduce you to another Nutrition Expert with the magical ability to tell Truth from Fat People Fiction–Michael Pollan:

Consider: When the study began, the average participant weighed in at 170 pounds and claimed to be eating 1,800 calories a day. It would take an unusual metabolism to maintain that weight on so little food. And it would take an even freakier metabolism to drop only one or two pounds after getting down to a diet of 1,400 to 1,500 calories a day — as the women on the “low-fat” regimen claimed to have done. Sorry, ladies, but I just don’t buy it. (Pollan M. Unhappy Meals)

The women in the Women’s Health Initiative (to which Pollan refers) are: Female. Post-menopausal. Overweight. From my experience at the Duke Lifestyle Medicine Clinic (director, Dr. Eric Westman), just about any woman who met those three criteria exhibited this sort of “freaky metabolism.” Not only is it possible for a woman in that hormonal situation to maintain her weight on 1800 kcals/day, it may be absolutely impossible for her to lose weight on 1400-1500 kcals/day—if she’s eating foods that enhance fat storage and prevent fat utilization (carbs, I’m lookin’ at you). In fact, not only did I see many other women like this in clinic, I stopped losing weight myself (at 185 pounds) eating 1200-1500 calories a day—and I wasn’t even postmenopausal. But then, at that point, I wasn’t a Nutrition Expert either. Not like Michael Pollan.

I always wonder why Mr. Investigative Journalist/Nutrition Expert Pollan didn’t go out find a few real live overweight, post-menopausal women and ask them what their personal experiences were with weight loss instead of simply discounting the experiences—and calling into question the humanity and integrity—of the “ladies” in the study. Oh wait, if the ladies he interviews are overweight, they’d all just LIE to him!

Anyway, why ask a real person, when you have Science on your side? Here’s a nutrition textbook explaination just how it is that we KNOW fat people lie:

Another approach to check for underreporting is to compare reported usual energy intake with resting energy expenditure calculated using various equations . . . If a subject’s reported usual energy intake is <1.2 times his or her calculated REE, underreporting of energy, and therefore nutrient, intake is highly likely. (Lee & Nieman, 2007).

In other words, if fat people don’t eat as much as we think they should be eating according to calculations that are known to be notoriously inaccurate, they must be “underreporting” (this is a complicated Scientific Term that means “lying about”) how much they eat. In my current Obesity class at UNC, Dr. Andrew Swick has confirmed—through evaluations done in a metabolic chamber—that some overweight/obese women have energy requirements as low as 1200-1300 calories (hmm, “freaky metabolism” maybe?),  requirements that would be far below “calculated requirements” referred to above. Dr. Swick pointed out to us that some fat people don’t, in fact, eat that much food.

But we should never let reality stand in the way of Government Approved Nutrition Information (code name: GAIN). Our good buddies at the USDA and HHS prepared this helpful chart for the 2010 Dietary Guidelines Advisory Committee Report to show how many calories Americans are consuming compared to the recommended ranges:

The vertical lines are recommended calorie ranges; the pink triangles are the average calorie intake in each group. Caloric intake appears to be within the recommended range for all age levels; adult women in general seem to be consuming at the very low end of their caloric range, about as many calories as a preschool male. That’s right, women over the age of 50 eat, on average, about as much food as 2-5 year old boys.

This must be more of that “freaky metabolism” thing to which Mr. Pollan refers. Or—wait—maybe they are all just LYING (the old ladies, not the little boys): the 2010 Dietary Guidelines for Americans go on to say, “While these estimates do not appear to be excessive, the numbers are difficult to interpret because survey respondents, especially individuals who are overweight or obese, often underreport dietary intake.” And we know what “underreport” means, right?

According the USDA and HHS, Americans aren’t fat because they are told to eat foods they don’t need to eat, Americans are fat because they eat too much–and then lie about it.

So, let me sum this up for the folks at home:

Fat people say that they don’t eat more calories than their normal weight (and apparently morally superior) counterparts.  But we know they are lying because Nutrition Experts—like Michael Pollan—KNOW how much fat people eat should be eating (i.e. A LOT of food—otherwise, golly, they wouldn’t be so darn fat).  ).  He KNOWS this because he’s a Nutrition Expert and because we have scientists who have calculations that tell us how much fat people are supposed to eat (i.e. A LOT) so when fat people say they don’t each as much as scientists think they eat (i.e. A LOT), well then, the only possible explanation for that is that the fat people are LYING!  And if that’s not enough evidence for you (and really, it should be), you can absolutely believe that that fat people LIE about how much they eat because the Government says they do.

And the government never lies.

References:

Lee RD and Nieman DC. Nutritional Assessment, 4th ed. Boston: McGraw Hill, 2007.

Pollan M. Unhappy Meals. The New York Times Magazine, January 28, 2007

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. June 15, 2010.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm Accessed January 31, 2010.

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23 thoughts on “Big Fat Liars

  1. I’m late to this post for a comment but I had a couple things relevant to this topic I thought you might find interesting.

    The first, sadly I have no ref for — it’d take me a year to find it. I read Dr. Sharma’s ‘obesity notes’ blog and a long time ago (maybe Fall 2013 wild guess) he talked about this study where they used double-labeled water to evaluate the ‘real’ energy intake of the participants.

    Prior to reading this, I had been reading on how the actual calories that a human ingests/digests is so variable — for example, that even separate sources of the same food can vary a great deal, that even a food scale if using ounces is not too precise, that gut bacteria can have a very unique result on internationally generated calories (fats from fiber I guess), and so on. In short, that it would be almost impossible to get two people to eat the same thing and get the same result from it, but if they ate it separately (e.g. reported they ate 4oz of fried potatoes) there’d just be no way.

    Also prior to reading this, I had been reading a book by Jonny Bowden, and he said:
    “When I taught personal training at New York’s Equinox Fitness Clubs, we had an exercise physiology lab that contained an apparatus called a metabolic cart. You would get on a treadmill and put on a mask attached to a computer that would measure your oxygen intake and your carbon dioxide output at different levels of exercise intensity. Then the computer would calculate your caloric expenditure as you exercised. The individual variations were absolutely astonishing, and they would often vary enormously from what the standard equations would predict.”

    So, not only does the intake vary, and processing vary, but the outgoing varies too.

    So after having read on those two topics, I read one of Dr. Sharma’s blog posts where in this study, the overweight participants were determined to have:
    a) lied about their intake (underreporting, of course), but here’s the best part:
    b) they all ‘secretly’ lied about *the same number of calories.* Yes, these independently living subjects, with no known association with each other even, with unique bodies, all managed to magically “sneakily eat” EXACTLY the same amount.

    (Not that I recall, I can’t remember if it was an amount to reach the same number of calories, or just the same amount. Anyway.)

    There is something fundamentally flawed with our science, if they used a seemingly “proven” and “scientific” method to come to this conclusion. I don’t believe it. They could have just started talking about the fairies and dolphins or something for all the factual objectivity it seemed to have once I factored in the ingest/process/outgoing variables I’d just been reading about.

    A better way of thinking about it might be: could you actually MAKE two (let alone several) independently living and eating people with unique variables for intake, body processing, and outgoing energy, come to a caloric result exactly the same for a day let alone a week? On purpose? I doubt it. Yet what is unlikely to be possible even on purpose is claimed to be the explanation for what is happening, if what is happening is that “reality” keeps threatening the entrenched paradigm.

    2. Dr. Jeffrey Friedman (of Rockefeller U., head of molecular biology, the guy whose team discovered Leptin I think) gave an interview years ago to Ira Flatow where he was talking about obesity and gastric bypass and he said:

    “…there’s another feature of this surgery that people, I think, ignore, and it’s this: when you do this procedure you limit the intake of a person to about 700 calories a day. Just so you know, none of you could consume 700 calories a day for very long; it is a very small number of calories. Despite that fact, these people still end up being clinically obese at the other end of the procedure. They lose a lot of weight but they would still on average be definable as significantly obese on average after the procedure. Now think about it, they’re eating 700 calories a day and they’re still obese. I mean if that doesn’t say that there’s something metabolically different about the obese than the lean, I don’t know what does.”

    (He also said: “I think for the people who are really significantly overweight, it’s just who they are — to a very, very large extent. …It’d be much better to forget about the stigma and assume people weigh what they weigh, and then encourage people to do what they can to improve their health.”)

    Love you blog, thanks.
    PJ

    1. Thanks for the thoughtful comments & the kind words.

      “There is something fundamentally flawed with our science, if they used a seemingly “proven” and “scientific” method to come to this conclusion.” These are called evidence-based assumptions. They are very handy for proving a point you’ve already decided is true before you have proof.

      Yes, I’ve worked with a number of people in the past (and there are plenty of post-bariatric surgery studies that demonstrate this as well), and most do not achieve a “normal” weight. But some of them do develop disordered eating patterns and a host of other problems. It would be a lot easier to allow “people to weigh what they weigh” and focus on health (which is a fine idea), if there were not a multi-billion dollar scientific-academic-research industry built on obesity. And I’m not even talking about private for-profit weight loss interventions. Thanks to Walter Willet and company, we’ve decided that any BMI over 25 is a health hazard, and we’ve made that central to our public health messaging around nutrition. This means that if you have a research program that gets funded by the NIH, you MUST be weight-obsessed or you don’t get funding.

      And look how well that’s worked for us so far. Grrrrrr.

  2. Nothing like giving our kids a head start on a fat belly:
    http://www.sciencedirect.com/science/article/pii/S0308814611003712
    http://www.nutritionhorizon.com/news/UK-Study-Reveals-Jars-of-Baby-Food-Very-Low-in-Micro-Nutrients.html
    Has anything been published on the subject of an autonomous drive for full nutrition in humans? There is evidence of this in animals in piking, eating almost anything and everything when there is nutritional deficiency. In canines it appears to be quite sophisticated in that some canines are observed to seek out particular herbs in response to particular disease. Perhaps when started on severely deficient baby food the human piking instinct becomes primed for a lifelong unsuccessful quest for complete nutrition, obesity being an outcome..

    1. This is an excellent question. “First foods” have traditionally been (at least in 20th century US) iron-fortified cereals and fruits (vegetables too, but babies won’t touch pureed green beans once given applesauce–the preference for sweetness is clear). The foods are low-protein and low-fat, along with being low in micronutrients (unless fortified). Quite recently, there has been a shift towards offering pureed meats first instead (a fine source of iron without fortification). As the past 35 years of nutrition science has been dominated by the calories in-calories out paradigm, we don’t know very much about innate drivers of appetite. Stephen Simpson at Oxford has done the most interesting work on this so far. I’ll get around to posting on it one day.

      1. In the animal world the introduction of the young to food is often directly from the parent’s mouth or, taking canines as an example, partially digested from the gut. I understood this is true of primitive human tribes, the parent will pre-chew the food for the infant. This passes digestive juices and perhaps other essential material form the parent to the infant. This would have been the only source of baby food during evolution. Has anything been published regarding potential issues which might arise due to bypassing this process. By comparison we now know that avoiding natural birth via the birth canal through Cesarean Section is indeed accompanied by disadvantages to the child and to the adult in terms of lifetime health and mortality.

        1. Another excellent question. I haven’t seen anything on this topic. We have a hard enough time getting moms to breastfeed infants 🙂 But it makes all kinds of sense. Of course, health care seems to be moving in the opposite direction, with an increase in C-sections and veg*n diets approved for children.

  3. What are your thoughts on the so-called Happiness Diet and the way positive thinking may or may not affect weight gain and weight loss? We know that stress can be destructive to our health in so many ways, so it stands to reason that it may affect metabolism as well.

    1. I wasn’t familiar with this diet, but I looked it up and it looks like it is right on the money. I just finished a research assignment on brain-derived neurotrophic factor, which seems to regulate a number of cognitive, mood, appetite, and metabolic processes. Not surprisingly, high levels of glucose/insulin will lower BDNF, while low glucose/insulin raise it. The studies that demonstrate this relationship have been mainly done with calorie restriction (and I’m talking serious calorie restriction), but we also know that–in most cases–simply reducing carbohydrate load will reduce glucose/insulin effectively as well.
      The problem that I predict we will run into in pursuing this line of research is it is “okay” to prove this point by way of calorie restriction (why hunger is okay for fat Americans with big bellies and to be avoided for third-world children with big bellies when the problem is the same, lack of true nutrition in the face of adequate or excess calories, is a mystery to me). It is not okay to prove this point if it means reducing carbs and–gasping & knuckle-biting here–allowing, nay, even encouraging people to eat animals & animal products. Even if it will make them happy.

      1. Thanks for your reply Adele! I do think it’s hard to ignore the mind-body connection and looking at health and weight holistically — which is why it’s hard to make a diet stick without an entire lifestyle change.

        1. I teach yoga and I’m always a little amused by the notion that there *wouldn’t* be mind-body connection. Where else is your mind? In a shoebox? It has to be in your body and as such is subjected to all the regular chemical soup exposures of hormones and enzymes–or lack thereof. When you think of food as a way of conveying to the body information about the environment, it totally makes sense that the mind (through both instinctive and learned responses) then interprets that information in a certain way–like a dark sky at noon means find some shelter, or sweet means edible. What I’m beginning to think is that the mind interprets high insulin levels as “poor food availability” thus the increased food seeking, while the physiological response is increased fat storage. These end up as a double whammy in weight control.

  4. I can’t thank you enough for writing this! I’m one of those “trick metabolism” people; my caloric history is exactly the same numbers you mention. One of the worst things about being fat in this society is simply not being BELIEVED. It’s so insulting. The look on my doctor’s face at every checkup when he asks me how much I’m eating and “whether” I’m getting any exercise – I can’t think of any other medical condition where the patient’s personal experience is so doubted and discounted. How can he possibly provide me with adequate medical care when he doesn’t believe a thing I say?

    I almost started crying reading this post, just from the relief of someone else understanding, verifying my reality, because sometimes I feel like I must be insane when every expert and source of advice says that what I am observing isn’t really happening. It makes me understand that weird phenomenon when innocent people admit to a crime just because of everyone insisting that they did it – it’s hard to stand up against the pressure of a millions-to-one belief.

    1. Gingerzingi – You totally made my day (and it’s been sucking so far). You are why I’m here. After explaining to my doctor that I was eating 1200 calories/day and exercising at LEAST 1 hour a day & not losing weight, he said, “Maybe you should try eating less and exercising more.” Like some kind of sick joke. And we wonder why obesity, dieting, and eating disorders are so closely associated.
      My experience–and yours–was confirmed my experience in clinic. I found it hard to believe that hundreds of otherwise upright, lovely, law-abiding citizens, who were absolutely candid about everything else in their lives, would just look at me and start lying when it came to diet history. They too were eating “normal” (whatever that means) calorie levels, but were unable to lose weight. They too had run into other healthcare practitioners who assumed they were lying.
      There is so much about the Dietary Guidelines that is wrong, but I think the worst unintended effect has been that is has given scientists, healthcare professionals, and Nutrition Experts like Marion Nestle carte blanche to simply disregard the humanity of a portion of our population. I don’t think it is overstating the matter to say the “fat people lie about what they eat” concept is very similar to other stereotypes like “black people are lazy” (look how many of them are unemployed!) and “homosexuals are sex fiends” (look how many of them are not married!). If you look hard enough, you can find evidence to confirm your bias (Objective Scientific Evidence!). We had the same Objective Scientific Evidence to “prove” that white people are smarter than black people too. I’m sure there are some fat people who lie about how much they eat—and some normal weight people and some underweight people.
      What I know from my clinical experience is that once we had people focus on the QUALITY of the diet, rather than the number of calories, that whole part of the conversation could disappear. It’s much easier to think about the kinds of food you are eating rather than meaningless metrics like calories. And, quite contrary to people lying about what they ate, sometimes I felt like the “cookie confessor”—everyone reported every little dietary transgression that occurred! Bottom line: Changing the quality of the food allowed people to feel better, improve health markers, and control their own hunger and eating behaviors without a lot of self-restrictive measuring and counting—that’s where our focus as scientists should be. The fact that they lost weight too was just a bonus.

      1. Thanks so much Adele, and those are excellent points about the stereotypes and circular logic. Back when I used to track calories, I tracked celery sticks, Tums, and teaspoons of MUSTARD! *Every*thing. So it infuriates me when people assume that a fat person is lying, either to them or to themselves. The good news is that since going mostly paleo about a year ago, I did lose ten pounds essentially without trying, in a year that included too much work stress, too much drinking, and very little exercise or quality sleep. I’m not one of those people who have a “the pounds just dropped off!” story (that would be my husband), but that I lost ANY weight AT ALL is wonderful. That I was able to do it without starving myself is miraculous.

        1. I knew my relationship with food was getting insane when I began wondering if there were calories in toothpaste! It sounds like a joke now, but I’d internalized all those messages about “hidden” calories & there had to be some reason dieting wasn’t working.
          Y’know it’s nice to lose weight if that’s what you want to do. But when I’d gotten down to 175 (doing low carb) and still quite a bit shy of my “goal” weight, I realized that I felt great, I wasn’t hungry (which was a real change for me), and I had muscles for the first time ever in my life. I sort of stopped caring about my weight. When I started doing yoga, I noticed my pants got a little looser. Stress does have a lot to do with it–meds, age, hormones, genetics, epigenetics, etc. It’s not just the freakin calories.
          Mostly what I like now is that I eat normal meals, I don’t go hungry, I don’t worry about exercising (I like to move & be active, but “exercise” happens only sometimes), and my weight stays the same. This is what I remember about the grownups in my world when I was young; that’s how they lived. That’s all I want–to be able to live my life & not have health & weight be a constant battle. There’s other stuff I want to do–like harass the USDA : )

  5. Wow this makes me so angry. I hate how the instructor corrected YOUR experience. It’s one thing to spew misinformation, but another to discount another’s experience. And I had no idea that Michael Pollan had this absurd bias … I always knew he was misinformed about the dietary guidelines (he advocates a plant-based diet and kind of dismisses our need for quality protein), but I didn’t realize that he would be making these kinds of assumptions about overweight women. I thought he was on the people’s side … :-/ Thanks for a great post, as always!

    1. Pollan’s condescending attitude toward whom I guess is everyone in America who doesn’t read the NY Times is readily apparent throughout “Unhappy Meals.” Regarding the hardly-surprising revelation that a low-fat diet doesn’t seem to actually reduce health risks (the science on this has been weak and inconclusive for 40 years), he suggests that many newspaper readers would “no doubt” order a Quarter Pounder with Cheese to celebrate the news. No doubt. What they really might do and what they should be doing is wondering why they were ever given low-fat diet recommendations in the first place, why, in the face of such news, these recommendations persist, and why Pollan is willing to scrutinize some “nutritionist” ideology (as he does throughout Unhappy Meals, while embracing the ideology (eat plants blah blah blah) that suits him without any questions whatsoever.
      As for my instructor, it is truly remarkable how my identity as an actual human seems to vaporize in the face of nutrition expertise! Something to remember when I’m the “expert.”

  6. So how long before the Nutrition Nazis demand a Diet Gulag to avoid facing up to their failed ideas? and will the Soup Nazi find a job there?

    1. I have a post in the wings called “Calories In, Calories Out Would You Please Go Now!” It’s really time to give up on this notion. If Nutrition Nazis weren’t so obsessed with calorie counts, they wouldn’t be so obsessed with trying to prove that fat people lie about them.

    1. Something like that. I don’t know. It’s kind of like arguing with my mother. My mother can tell a long complicated story about me that NEVER ACTUALLY HAPPENED to me (she has 4 kids, she gets us confused). When I say, “But Mom, that didn’t happen to me,” she says, “Well, that’s what you told me!” How do you argue with that? I think it is the very definition of a catch-22 situation: We know fat people eat too much, but we can’t prove it because they lie about how much they eat. Therefore, you have to take our word for it that fat people are fat because they eat too much because fat people cannot be trusted to tell the truth about how much they eat. Sounds like another blog post in the making . . .

      1. Something I’ve noticed about true experts is you usually can’t tell from their attitude. True experts know a great deal and as many have observed once you know a great deal you become quite humble; the more we know the more clearly we see how much we need to learn. Flippant experts are typically airheads who rarely get beyond basics and attempt to cover up with what they mistake for style.

        1. There’s no doubt that the more I learn, the less sure I am about anything. When I hear any “expert” speak with absolute conviction about something, it makes me nervous & I start looking for the ulterior motives. I can usually find them right next to the dollar signs.

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