September 13th, 2012
A Manhattan Project to End the Obesity Epidemic
Larry Husten, PHD
A newly launched nonprofit organization, the Nutrition Science Initiative, will try to find an answer to the question, “What should we eat to be healthy?” Called NuSI (pronounced “new see”) for short, the organization is nothing if not ambitious: its goal is to seek “the end of fad diets and high obesity rates.”
NuSI’s founders are Gary Taubes and Peter Attia. Taubes is the science journalist who helped launch the low-carb diet resurgence with his controversial New York Times magazine articles and subsequent books, Good Calories, Bad Calories and Why We Get Fat. Attia, who is the President of NuSI, trained in surgery at Johns Hopkins and the NIH before working as a consultant at McKinsey & Company.
Taubes explains the premise of NuSI:
NuSI was founded on the premise that the reason we are beset today by epidemics of obesity and type 2 diabetes, and the reason physicians and researchers think these diseases are so recalcitrant to dietary therapies, is because of our flawed understanding of their causes. We believe that with a concerted effort and the best possible science, this problem can be fixed.
NuSI originally started as a more modest endeavor, but has now received a significant commitment of financial support from a foundation started by billionaire hedge fund manager John Arnold. The aim of the organization, as the following NuSI publicity slide states, is to “create a Manhattan Project-like effort to solve” the problem of obesity in the U.S.:
The NuSI scientific advisory board is composed of Alan Sniderman, a lipid researcher at McGill University; David Harlan, the former head of the Diabetes, Endocrinology, & Metabolic Diseases branch of the NIDDK and now at the University of Massachusetts; Mitchel Lazar, of the University of Pennsylvania; and Kevin Schulman, of Duke University.
On his Weighty Matters blog, obesity clinician and writer Yoni Freedhoff offers a perspective both critical and supportive of the NuSI agenda.
10 Responses to “A Manhattan Project to End the Obesity Epidemic”
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A sufficiently powered randomized trial with a) hard cardiovascular end points b) over a long period of time (many years, not months) c) objective methods of assessing dietary adherence other than surveys, supplying free foods, and self-reporting (eg as on “metabolic wards” where no food can be brought, discarded, or swapped by participants) is needed to answer the question of cardiovascular safety of low carb diets long-term.
Most certainly, an undertaking of such unprecedented proportions is required to reverse the obesity epidemic. There are many pitfalls and obstacles that beset former initiatives. Let us hope that this new Manhattan obesity project avoids the less rigorous approaches of the past, for they have generally raised more questions than they answered.
The dual epidemics of obesity and diabetes are at the top of the list of global public health problems. This alliance is to be commended and admired for their energy. I wish them luck… they will need it against this multi-headed hydra.
Richard Kones MD
I submit that the obesity epidemic of today has almost nothing to do with food choices or eating patterns.
I believe that the current level of life stress is a major contributor. The availability of food associated with stress is a factor but without the stress obesity would not be a major issue.
Reduction in exercise as a result of our motorized mobility as well as electronic entertainment must play a significant role independent of dietary choices.
Additional factors such as hormones used to increase milk production and meat production in modern forming techniques may be the culprit.
Perhaps flavor enhancers induce obesity independently from them causing an increased consumption of food.
If these factors are operative rather than choice of starches vs protein vs fat, then the “Manhattan Project” of obesity research could be an obese waste of resources. Obesity may have almost nothing to do with what we eat.
My grandmother told me to “eat to live.Do not live to eat”.A lot of us need to gain some common sense and to appraise our lifestyles.This approach does not require grant money.It is the only approach that will work.
As was pointed out by many busy mothers/grandmothers to kids who arrived home from school and who said they were hungry, the reply was, “eat an apple”. If the kid said he didn’t want an apple, s/he was told, “then you aren’t really hungry” and can wait for dinner.
A lot of people eat and drink stuff even when they are not really hungry.
It adds up.
Mark Perlroth MD.
Stanford CA
No conflicts.
As was pointed out by many busy mothers/grandmothers to kids who arrived home from school and who said they were hungry, the reply was, “eat an apple”. If the kid said he didn’t want an apple, s/he was told, “then you aren’t really hungry” and can wait for dinner.
A lot of people eat and drink stuff even when they are not really hungry.
It adds up.
Mark Perlroth MD.
Stanford CA
.
Opinions, editorials, interpretations, repetitions, and endless testimonials and commentary have been used to “substantiate” the use of fad diets, with bits and pieces carefully chosen and crafted to support an argument, since hard evidence is sorely lacking. Many diet studies have serious limitations, yet the very qualified “results” are widely quoted according to the agenda of the writer.
Obesity is not a single “disease”, and the obese phenotype is so heterogeneous that only impeccably-designed, large-scale, randomized trials with strict controls of all variables may offer actionable information.
In this context, armchair critics and their debates tend to resemble a cat chasing its own tale, with no evidence-based conclusion possible, nonetheless ending with a robust declaration of the author’s opinion.
Calories count, physical activity counts. It is a common observation through millennia that an unfed animal loses weight, whereas an overfed animal gets fat. All other variables–stress, intestinal flora, hypothalamic inflammation, complex signaling disturbances, thrifty gene adjustments, etc, all ultimately influence weight through a change in energy balance. This is not to say any pertinent variable is unimportant, or should not be further studied or addressed, but some carry far more weight than others.
Further discussion regarding the basis of NuSI is at http://wholehealthsource.blogspot.com/2011/08/carbohydrate-hypothesis-of-obesity.html
http://boingboing.net/2011/08/13/stephan-guyenets-critical-examination-of-gary-taubes-anti-carb-book-good-calories-bad-calories.html
http://wholehealthsource.blogspot.com/2012/09/more-thoughts-on-macronutrient-trends.html?m=1
Richard Kones MD
“Eating less is bad for business”. This is what’s clear. And this is the message that no one wants to hear. Not a food industry, not restaurants, not sports clubs, nutritionists, doctors, hospitals, nursing homes, health care equipment manufacturers, pharma, etc, etc.
Let’s be honest – for each one of us – it will be undesirable – from business stand point – if people will start eating less/losing weight.
Thus – acknowledged or not – we all have conflict of interests – this much needs to be admitted. Except for those who treats anorexics exclusively, perhaps.
As big tobacco diversified into food industry they brought exactly the same modus operandi into our food as they had done it with smoking.
Advertising to minors, attractive packaging, manipulating sugar/caffeine content, hiring celebrities to market products, hiring “experts” for the blogs to attack anyone who is dangerous (to industry profits), producing “scientific literature” of their own, emphasizing “consumer choice”, starting “public” campaigns for unrestricted choice to harm oneself – these are all textbook moves of the industry to squeeze more money out of public – and pass the bill for the adverse effects/sickness created by consumption of their products back to the public.
Tobacco companies did it.
Banks did it.
Now food industry is doing it. Privatizing the profit and socializing the adverse consequences.
As long as huge profits are to be made on making people obese – there is no one to stop them.
Bon Appetite!
PS: eating less may be bad for our political system too. Obese people do not start revolutions. I do not have a study to quote – it is self evident however -just look at the photos of OWS protesters – high BMIs are grossly underrepresented there – unlike in the confronting them police force…
To start a long-term controlled low-carb trial with clinical events as end points, as suggested by Richard Kone, may be difficult, at least if a major part of the participants are type 2 diabetics. My colleague Jørgen Vesti Nielsen has tried. Sixteen patients with type 2 diabetes followed a low-carb, high-fat diet (20 cal%) and 15 a high-carb,low-fat one, but after six months 11 of those in the high-carb group switched by themselves to a low-carb diet because they saw the striking health improvements in the low-carb group.
The question is also, if it is necessary, because a recent meta-analysis of 23 low-carb trials (Obes Rev 2012, doi: 10.1111/j.1467-789X.2012.01021.x) found that this diet resulted in a highly significant decrease of body weight, systolic and diastolic blood pressure, HbA1C, triglycerides, fasting plasma glucose, plasma insulin and plasma CRP, as well as an increase in HDL without any changes of LDL cholesterol. It is highly unlikely that a diet with these beneficial effects on the major risk factors should have negative effects on cardiovascular endpoints. In Sweden thousands of type 2 diabetics have regained their health and have been able to stop their anti-diabetic medication by following this diet. In the 44 week follow-up study of the participants in Nielsen et al.´s trial (Nutr Metab 2008;5:14-9) a cardiovascular event occurred in four of the six patients who continued with the high-carb diet, but only in two of the 23 patients who followed the low-carb diet.
That the obesity epidemic has nothing to do with food choices or eating patterns, as claimed by William Blanchet, is highly unlikely. According to official US statistics (Public Health 2008;122:739-46) the consumption of carbohydrates started to increase one year after the introduction of the high-carb diet in 1984; the obesity and the diabetes epidemics followed a few years later, and both of them have continued since then. During the same time the consumption of fat has remained unchanged because the increased consumption of vegetable oils has been balanced by a decreased consumption of animal fat
The reason why a low-carb, high-fat diet is superior as an aim to lose weight is that the large fluctuations of the blood glucose levels after a high-carb meal make you hungry again already after a few hours, whereas you feel satiated most of the day after a fat meal. Try yourself!
There is ample evidence that inceasing exercise and reducing caloric intake will reduce weight. There was no obesity among the British troops in the “Bridge of the river Kwai area or story.They were given 800 calories a day by records after WWII.
Earlier a Harvard research effort paid a willing Italian man with no othere job opportunity to starve under supervision. He burned less and less calories until he reached 800 and seemed to plaeau.
Thee are many rationalizations about the inability to loose weight. Stress may be a component, but even without stress, calories count.
Adherencve to drugs, diet and exercise is less than 50% There is where the effort should be spent.
David T Nash
No conflict of interests
1) Reduce carbohydrate intake, especially simple and refined carbohydrates (the “whites”) – sugar, starch from rice, potatoes, bread, pasta, sweets & treats, pastries.
2) Make sure each meal contains sufficient fat and protein to make you feel full until the next meal. No snacking between meals, as a corollary.
3) Get a good night’s sleep every night, if possible (realizing this does not apply to night shift workers).
4) Any carbohydrates that you eat should be in the form of fibre-dense, low GI carbs – e.g. legumes, non-tuberous vegetables, soy products.
5) Most importantly, breakfast must be a large and satisfying meal. By the same token, never eat on the “run” if you can avoid it. Avoid putting anything, even coffee, in your mouth between meals (except for water), as the resulting insulin release will stimulate appetite by decreasing blood glucose.
6) Exercise in moderation every day. Weigh yourself 2x per week. Do not be discouraged by fluctuations in weight by up to +/- 4 lbs.
7) When you eat, don’t do anything else at the moment – no TV, no blackberry, no newspaper. Pure mindful attention to what you are putting in your mouth. Do not race through your meal. Use a small spoon instead of a large spoon to slow you down.