I am still plodding through Taubes’s Why We Get Fat. It’s slow going, because his language remains alienating. He insults me with his word choice and tenor, and by asking me to throw out my narrow assumptions and replace them with his narrow assumptions.
First, his language. He repeatedly refers to “the overweight and obese.” Hasn’t he been in this field long enough to know how dehumanizing it is to define people this way: to say you don’t have adiposity, you are your adiposity. In this book, he’s writing for the lay audience, not the medical and scientific community whose brains are presumably immune to the influence of such short hand. Because of this broad audience, it would simply be polite (I won’t marginalize it with the phrase “politically correct”) to talk about people, not conditions or characteristics who happen to walk, breathe, think, eat and poop.
His language is tinged with an anger that smacks of a martyr complex. Apparently, his ideas are not venerated to his satisfaction, so, he believes, everyone who disagrees with him either lacks imagination, is ignorant and not very well read, is biased to believe that fat people are gluttonous and slothful (and he may have a point there, but not enough to justify his intense outrage), or is stuck in a post-World War II mentality that will not permit the equal consideration of ideas from scientists of German origin. Huh? Get real.
Taubes obviously feels like he’s in a war of ideas. I wish I could say he’s unjustified in his feelings, but I think that attitude pervades this area of study. And how unhelpful! The losers of this war aren’t scientists who stand shamed amongst the ruins of their false theories. The losers, the victims, in this confusing war of words and judgment, are we, the dieters, the serial dieters, the failed dieters, even the “successful” dieters and the steadfast and stalwart non-dieters who have the misfortune of being fat in this war-on-obesity culture. Nobler people in this debate should rise above this war mentality, and call a truce, to everyone’s benefit. There is nothing to prevent Taubes’s ideas from existing peacefully with others.
It gets back to assumptions. I’ve said the NWCR needs to re-examine its assumptions but, in fact, everyone in this field needs to review their assumptions regularly. Here, enumerated, are a few of the many dangerous assumptions that clearly need to be re-evaluated, the first two most important:
Assumption 1. Obesity is a single condition: calorie imbalance or carb sensitivity (circle only one).
Revised assumption 1: Obesity may be several conditions. (The variety of body shapes that obesity creates and the range in human appetites suggests there are more than one or two.) Science can help society by defining these different conditions. Taubes insists it’s all about insulin, but then describes a system of fat metabolism in which insulin must interact precisely with dozens of other enzymes, proteins and natural chemicals. I’m not a scientist, but I see how disturbances in those interactions could manifest as a variety of complications, each suggesting different interventions (or none at all, other than acceptance). And he doesn’t even begin to address how modern environmental toxins may throw a wrench in the machinery.
Assumption 2: Obesity has a single cause. Circle it: bad or lazy character, toxic food environment, congenital endocrine imbalance, emotional imbalance, genetics, a virus, environmental poisoning from (pick only one): pesticides, hormones in drinking water, neuro-toxic food additives, livestock antibiotics or growth hormones, OR anything else we discussed when we played Roulette.
Revised assumption 2: Obesity may have several causes. Science can help by isolating them, and the type of obesity condition that they create (see revised assumption 1).
Assumption 3: All obesity over a certain BMI is “morbid” and, in as much as science undergirds medical practice, doctors should encourage people over that BMI to lose weight through diet or surgery.
Revised assumption 3: Some types of obesity are harmless (see revised assumption 1). All fat people should be evaluated as individuals. In no event should fat people be taken as fair game for dangerous scientific experimentation (and I’m thinking here about gastric mutilation).
Assumption 4: Even if an individual’s excess weight is not dangerous, and even though diets routinely fail long term, it doesn’t hurt to encourage people to keep trying to lose weight through dieting.
Revised assumption 4: Many people will attempt to lose weight in patently dangerous ways. Moreover, all yo-yo weight cycling, even when using “healthy tactics,” may endanger the immune system, gall bladder or heart. Finally, even if it is later proved to be harmless physically, yo-yo weight cycling is demoralizing. Maybe doctors should put a moratorium on prescribing weight-loss dieting until we know more about what the different types of obesity are and what causes them (return yet again to revised assumptions 1 and 2). We who insist on dieting are doing so despite evidence (and our own experience) of its significant failure rate. Many of us know that already. It would be affirming, not discouraging, if our doctors and the scientists who supply them information would acknowledge that reality. In lieu of weight-loss dieting, doctors should prescribe healthy behavior – exercise, increased vegetable consumption, etc. – which may also result, as a side effect and social bonus, in weight loss.
With his book title, Taubes asks two questions: why do we get fat and what should we do about it? I give him extra points for discrediting the assumption that we get fat or regain weight because we are lazy, stupid or emotionally imbalanced. On the other hand, his one-size-fits-all answer that we get fat eating carbs and should counter that by not eating carbs (but eating fat), strikes me as incomplete. Before we arrive at more answers and more broadly useful answers, scientists need to regularly examine and recraft their basic assumptions. And maybe we need to stop referring to “obesity” all together, and start talking about “obesities.”