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- How Phone Taps and Swipes Train Us to Be Better Consumers
- WHY ARE WE FAT?
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One Big Fat Truth | badufyjuhi.cf
Meanwhile, newer science has undermined the consensus that fat is all that bad for you. A recent meta-analysis published in the Annals of Internal Medicine found no clear evidence that eating saturated fat contributes to cardiovascular disease. Mehmet Oz, who had previously preached against high-fat diets. Taubes and Attia are firmly in the sugar-bad, saturated-fat-good camp. Indeed, Taubes has written a number of the articles and books—including the best-selling Good Calories, Bad Calories —on which that thinking is based.
But even they acknowledge they can't be certain. That's because, as Taubes eloquently argues, most of the existing knowledge gathered in the past five decades of research comes from studies marred by inadequate controls, faulty cause-and-effect reasoning, and animal studies that are not applicable to humans. For instance, much of what we think we know about nutrition is based on observational studies, a mainstay of major research initiatives like the Nurses' Health Study, which followed more than , women across the US for three decades.
Such studies look for associations between the foods that subjects claim to eat and the diseases they later develop. The problem, as Taubes sees it, is that observational studies may show a link between a food or nutrient and a disease but tell us nothing about whether the food or nutrient is actually causing the disease. It's a classic blunder of confusing correlation with causation—and failing to test conclusions with controlled experiments. You get it checked out. NuSI's starting assumption, in other words, is that bad science got us into the state of confusion and ignorance we're in.
Now Taubes and Attia want to see if good science can get us out. Gary Taubes Peter Yang. Perhaps it's no surprise that Taubes, 58, founded a project as daring and ambitious as NuSI. He has a well-deserved reputation for being tough-minded and combative. His detractors in nutrition science have long accused him of hubris. He majored in applied physics at Harvard, where he also played on the football team's defensive line. John Tuke, one of his teammates, recalls that Taubes stood out for his intensity. After Harvard, Taubes headed to Stanford for a master's in engineering with visions of becoming an astronaut.
He caught a break in , when a profile of particle physicist Carlo Rubbia led to a deal for his first book, Nobel Dreams. Taubes thought he would be documenting a breakthrough in physics. Instead, the book chronicled Rubbia's errors and the machinations he used to outmaneuver his fellow physicists. Taubes was struck that science could be so subjective at the highest levels—that it's not just the big mistakes that scientists have to worry about but the numerous small ones that accumulate to support their misconceptions. That lesson stuck with him when, almost by accident, he turned his attention to nutrition science in By then a freelancer and running low on rent money, he called his editor at Science and asked if there were any assignments he could turn around quickly.
The editor mentioned a paper in The New England Journal of Medicine that detailed a dietary approach to reducing blood pressure without restricting salt. Maybe he could write about that? Taubes knew almost nothing about the topic. He would end up spending the next nine months interviewing 80 researchers, clinicians, and administrators.
The belief that too much salt was the cause of hypertension wasn't based on careful experiments, Taubes wrote, but primarily on observations of the diets of populations with less hypertension.
The scientists and health professionals railing against salt didn't seem to notice or care that the diets of those populations might differ in a dozen ways from the diets of populations with more hypertension. Taubes began to wonder if his critique applied beyond salt, to the rest of nutrition science.
After all, one of the researchers Taubes interviewed had taken credit not only for getting Americans to eat less salt but also for getting them to eat less fat and eggs. He kicked off a multiyear research project that culminated in , when he published a New York Times Magazine cover story on fat that would vault him into prominence and onto the path to NuSI.
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He argued that carbohydrates, not fat, were more likely to be the cause of the obesity epidemic. The piece was a sensation. In doing so, he found himself drawn to an even more radical theory, the so-called alternative hypothesis, which holds that we get fat not because we eat too many calories but because specific kinds of calories trigger hormones that regulate how our fat cells behave. In particular, eating refined carbohydrates, and especially sugar, on a sustained basis leads to chronically elevated insulin levels. Among its many other crucial functions in the body, insulin tells fat cells to take up glucose, which is converted into fat, and then keeps fat from all sources locked inside.
Therefore: Consume a bunch of sugar every day, as most Americans do, and you'll get fat. Of course, Taubes could only present the hypothesis. He couldn't prove any of it. The right experiments had never been done. By the time Peter Attia read Good Calories, Bad Calories, he already sensed that something was off about nutrition science. He didn't have to look much farther than his own waistline. Attia had taken up endurance swimming in his thirties.
In , at age 34, he became the first person to swim from Maui to Lanai and back. Between and , the real cost of fats and oils declined by sixteen per cent. During the same period, the real cost of soft drinks dropped by more than twenty per cent. Kessler, a former commissioner of the Food and Drug Administration, takes a somewhat darker view of the situation. The principles of Food Rehab owe a lot to those of drug rehab, except that it is not, as Kessler acknowledges, advisable to swear off eating altogether.
In the early nineteen-sixties, a man named David Wallerstein was running a chain of movie theatres in the Midwest and wondering how to boost popcorn sales. Once Wallerstein introduced the bigger boxes, popcorn sales at his theatres soared, and so did those of another high-margin item, soda. Customers were purchasing a burger and perhaps a soft drink or a bag of fries, and then leaving.
How could they be persuaded to buy more? Kroc pointed out that if people wanted more fries they could always order a second bag. These have convinced him that people are—to put it politely—rather dim.
How Phone Taps and Swipes Train Us to Be Better Consumers
Instead, they rely on external cues, like portion size, to tell them when to stop. The result is that as French-fry bags get bigger, so, too, do French-fry eaters. Some years ago, Wansink and his graduate students handed out buckets of popcorn to Saturday-afternoon filmgoers in Chicago. The popcorn had been prepared almost a week earlier, and then allowed to become hopelessly, squeakily stale.
Some patrons got medium-sized buckets of stale popcorn and some got large ones. A few, forgetting that the snack had been free, demanded their money back. After the film, Wansink weighed the remaining kernels. In another experiment, Wansink invited participants to cook dinner for themselves with ingredients that he provided. One group got big boxes of pasta and big bottles of sauce, a second smaller boxes and smaller bottles. The first group prepared twenty-three per cent more, and downed it all.
WHY ARE WE FAT?
In yet another experiment, Wansink rigged up bowls that could be refilled, via a hidden tube. Today, a small order of fries has two hundred and thirty calories, and a large order five hundred. Add fifteen calories for each package of ketchup. Today, a small soda is sixteen ounces a hundred and fifty calories , and a large soda is thirty-two ounces three hundred calories. Perhaps owing to the influence of fast-food culture, up-sizing has by now spread to all sorts of other venues.
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In a study, Marion Nestle, a nutrition professor at New York University, and Lisa Young, an adjunct there, examined the offerings, past and present, at American supermarkets. They found that during the nineteen-eighties the amount of food that was counted as a single serving increased rapidly. According to the federally supported National Heart, Lung, and Blood Institute, the bagels that Americans eat have in the past twenty years swelled from a hundred and forty to three hundred and fifty calories each. If, as Wansink argues, people are relying on external cues to determine their consumption, then the new, bigger bagel is sneaking in an additional two hundred and ten calories.
For someone who is in the habit of eating a bagel a day, these extra calories translate into a weight gain of more than a pound a month. Among the founding principles of the discipline is that weight is not a dietary issue but a political one. Fat people are widely represented in popular culture and in interpersonal interactions as revolting—they are agents of abhorrence and disgust. Overall prevalence of obesity among adults is With respect to social class it increases from In the case of women, it increases threefold from 6.
Differences also expressed regionally. The highest prevalence is for children between 5 to 9 years old Parents' professional background is related to prevalence, increasing from 4. It is a metabolic rule that when we consistently overeat we put on weight: it therefore follows that dietary intake and physical activity matters [ 24 ].
However, changes in diet and levels of physical activity always occur in historical and social context, a fact which is often ignored [ 25 ]. The result is that behavioural and biomedical discourses emphasise proximate causation and individual responsibility [ 26 ], which, in turn, limits the possibilities of public health action [ 27 ]. Proximate causes include dietary patterns, levels of physical activity, and genetic factors.
Specialists stress the consequences of reductions that have occurred in everyday activity, such as walking, the time spent in sedentary pursuits and patterns of body weight in parent and child. Advice from experts therefore centres on changing 'disordered' lifestyles and consumption patterns in order to promote healthy habits, guided by general practitioners, pharmacists and others, increasing the responsibility of individuals through taming their appetites and encouraging the self-regulation of appetite.
It follows that explanations of obesity found in the media, and refracted into political discourse, focus on a person's choices and lifestyle in their immediate environment behavioural frame , although lately there is an increasing recognition of the importance of the environmental factors which simultaneously constrain mobility and stimulate the intake of high fat, high energy foods systemic frame [ 27 ]. As a consequence, policies focus on the individual and highlight the role of individual choice in diet or participation in physical activity as the key to health improvement.
The principal recommended mechanism of change is educational, including family recognition that the problem actually exists, and encouragement towards healthy lifestyles, along with some environmental improvements, such as food labelling [ 28 ]. Given that there is little evidence that the favoured social marketing approach, in any of its different formats, has halted overall obesity trends [ 29 , 30 ], the question might be as to why the focus on educating individuals remains dominant to prevention efforts.
The answer may be that alternative explanations, which by implication require a much broader range of policies and actions, are too economically and politically challenging. In more market-oriented societies, it has been suggested that social and health problems take on a more common character [ 31 ]. In the case of obesity there are numerous commercial opportunities. For instance, functional foods, dietary advice and diet book publishing have risen rapidly. While large investments have been made by pharmaceutical companies in the field of anti-obesity drugs, market growth does not follow the growth of obesity prevalence but rather the scope of reimbursement for pharmacological management, which in many countries remains limited [ 33 ].
To the dietary recommendations launched by health professionals and public authorities to promote health, the numerous and often contradictory messages distributed through market channels must be added [ 34 ].
Why are we fat? Discussions on the socioeconomic dimensions and responses to obesity
Advice in favour of the optimum diet and normal body weight has been adopted by the health and 'body care' market. Advertising and marketing campaigns offer clues for understanding the role of the food industry, aided by scientific and technological innovations. The marketing industry is the creator, par excellence, of the rhetoric of "well-being" and the commercialization of the term "health", an umbrella concept that subsumes a broad range of other concepts: pleasure, beauty, convenience and mental health [ 35 ].
Products are advertised as "light" or "free" - as in cholesterol-free, sugar-free, and fat-free. In the same way, products "with" - fibre, lactic acid bacteria, minerals, fatty acids -represent a new generation of products designed to cater to our perception of well-being and health [ 36 ]. For all these reasons, it is difficult to separate interests related to health and interests related to commerce in biomedical discourse [ 37 ]. Thus, at the same time that the medical establishment warns against overweight as a threat to health, the consumer and medical economy is inundated with food products of doubtful nutritional quality, diet plans, weight loss drugs and weight loss surgery.
Is consumer choice driving global or national trends in population weight gain, and underlying the independent consumption decisions of millions of people, or are there other, less visible, but nevertheless real, explanatory factors at work? While individual consumer choice provides the enduring narrative circulated in policy circles and the media, attention to structural causes and thus structural solutions linked to the economic and cultural identity of society is given less prominence.
Structural types of explanation for obesity focus on long-term economic and social policy trends - some of which take a global form [ 31 ] and the changing context of consumer choices. One approach for explanation begins by analysing changes within the food supply chain and the reshaping of the way in which food is produced, formulated, priced, marketed and consumed. Following the lead of the USA, farming legislation has resulted in ever-cheaper basic ingredients available to food manufacturers and retailers, boosting portion sizes as well as consumption of high fat, energy dense foods [ 38 ].
Since the s the European Common Agricultural Policy, has balanced subsidies to primary producers with economic liberalisation in markets, particularly in food manufacturing, food services and food retailing. Whereas the former boosted production levels, the latter introduced new capital into the food manufacturing and retail segments, profoundly altering food provisioning systems [ 39 ]. The impact has been dramatic. Traditional diets, in particular 'Mediterranean Diet' of Spain, Italy, Greece and Malta - previously much praised by nutritionists - has given way to new dietary regimes containing much higher levels of saturated fats, salt and sugars.
Such trends extend well beyond Europe and may be resulting in a global culture of food [ 40 ]. Even so, apparently homogenizing forces produce outcomes which vary according to national or cultural context [ 41 ]. A second type of policy analysis aims at encompassing these economic and business realities, public policy and cultural factors, implying the need for scientific collaboration across different research disciplines as well as co-ordination and collection of different types of knowledge together with detailed understanding of the interplay of local, regional, national and global factors [ 42 - 44 ].
A third focus points to the imbalance of power between the public good and corporate freedom [ 45 ] and raises questions over current understandings of health and the nature of the economical interventions needed to support health [ 46 ]. If these perspectives add to our knowledge of structural factors, there remains open the need to construct an integrated and holistic perspective which can draw upon not only the biological and physiological aspects of obesity and its social, economic and environmental determinants, but which also examines the feedback between the conditions which are shown to influence health to those which affect the natural environment.
In part, the formulation of this new approach has already begun. An ecological perspective has already been established within the prestigious US Institute of Medicine [ 47 ], while a specifically ecological model was formulated to examine obesity [ 48 ]. An ecological approach is also present within the British government's Foresight Study of obesity [ 49 ]. It has been suggested that tackling obesity and tackling climate change can both be characterised as 'ecological' in form and share a number of similar underlying drivers and characteristics [ 29 , 50 ].
Both have been years in the making, both involve the interplay between similar factors - overuse of energy derived from fossil fuels and underutilisation of human energy, overproduction and waste, and lack of sustainability- and both, in public policy terms, are insufficiently recognised and require long term framework of action, implying a thorough redirection of society. It is agreed that steps towards low-carbon living including changes in consumption patterns or green-designed cities have health benefits that will improve quality of life by challenging diseases arising from affluent high-carbon societies, such as obesity [ 50 ].
A full response requires a holistic global approach, but this fact should not be a reason to delay changes that are beneficial to human health and can be implemented immediately [ 50 ]. Obesity has been dramatised as one of the leading public health challenges of our age, but it is equally a conceptual and public policy challenge as well.
What emerged from the ESOF scientific table is that solutions presented at the level of the individual, whether they be health education or medical interventions, are unlikely to be successful while newer ecological approaches have yet to capture the attention of policy makers. As the societal consequences of obesity fully emerge, pressure will be placed upon supply chains, economic actors and upon public and private behaviour to make wholesale changes. GR has written the summarised ideas of his contribution to the ESOF conference and helped in the writing of the paper bringing all the ideas together.
MGRF organised the conference and led the writing of the paper. All authors have read and approved the final manuscript. Socioeconomic dimensions of obesity" at the ESOF and the publication of this article, respectively. National Center for Biotechnology Information , U. Journal List Global Health v.