Food is a Hot Potato

My recent post about weight loss myths generated more page views than anything else on my blog (9,394 and counting) and more comments, many arguing back and forth between them. A few were by board certified obesity experts who made the claim that fighting obesity is pretty much like rocket science – not something you should dabble in with just a regular MD degree.

Now, I’m just a Country Doctor (I imagine saying this with a slow drawl), but I have trouble understanding why this should be so.

I don’t think it’s rocket science to start with the premise that over the last few hundred years the human genome has not changed, but our habits and environment have. Sometimes those things have direct consequences and sometimes they change gene expression (epigenetics).

So if we look at what has changed parallel to the obesity, diabetes, cardiovascular and autoimmune epidemics, it is hard for me to accept the comment someone made that food has nothing to do with obesity.

We, as a culture, eat differently from one or two hundred years ago, and much has been written about the health benefits of eating a less processed, more natural diet. From Paleo to what the Functional Medicine movement calls “ancestral diet” these shouldn’t be shocking, radical or controversial ideas, yet they seem to be. I can understand that the food industry is fighting this movement vigorously, but I wonder why parts of the clinician community also are.

I live next to an Amish community, where children play in the dirt and with barn animals. They have fewer allergies than urban children in highly sanitized environments. The rate of obesity in the Amish is 4%, compared with 36% in the general population. The Amish typically walk 14,000 to 18,000 steps per day – far beyond the idealized 10,000 typical goal. They also do more manual labor beyond just walking. Their diet is not Paleo or ancestral, but quite high in meat, bread and root vegetables; you’d have to emulate more old fashioned habits than theirs to fit into those categories. But the differences between their statistics and ours are startling according to BMJ, the British Medical Journal:

Prevalence rates for diabetes, hypertension and hypercholesterolemia were 3.3%, 12.7%, and 26.2% in the Amish compared with 13.2%, 37.8% and 35.7% in NHANES (p<0.001 for all).

The Amish are a powerful illustration, with the caveat that they are a fairly homogenous genetic group, that a physically very active lifestyle (beyond the goals of many of the rest of us) is linked to low levels of obesity, and its related conditions. But if we don’t have that activity level, what impact does diet have on the prevalence of these diseases?

The Mayo Clinic states plainly:

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat.

Most Americans’ diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

So, if the Mayo Clinic says so, I’ll simply start with the premise that food matters. It may be fascinating to some clinicians exactly which endocrine mechanisms are involved in the causation of obesity, diabetes, heart disease and so on. Again, I’m just a Country Doctor and it’s enough for me to ask, first, are you planning your meals in advance and consciously choosing portion size and, second, are you eating a lot of things that weren’t invented a couple of hundred years ago?

That’s a good start, in my humble opinion. It often leads to a plan for reversal of these disease processes right then and there. Even if the details of exactly how that happens may require another board certification or even a PhD.

3 Responses to “Food is a Hot Potato”

  1. 1 John R. Dykers, Jr. MD May 24, 2021 at 2:12 pm

    Obesity Medicine looks to establish itself as a destination for those fat patients whose primary care physicians wish to refer them, or to whom fat patients may flee when they fail to lose weight on the simple advice of “the Country Doctor”. Diabetes drugs have come along that may cause weight loss by their mechanism of action; Semaglutide injection being recently tested well and now added to by iraglutide, et al. Bariatric surgery has a place; it works. Try “Pleasure Per Calorie” for a direct read and practical summary for physician and patient. Readily available on Amazon Kindle and paperback.

  2. 2 Tony Glaser May 25, 2021 at 8:44 am

    Agree entirely. In your description of the Amish’s steps per day and other physical activity you are of course acknowledging that exercise does play a role in obesity (or lack thereof) – I think your somewhat extreme position in your original post (that exercise really didn’t make much difference, or words to that effect) was the main thing that sparked a lot of controversy

    • 3 acountrydoctorwrites May 25, 2021 at 10:08 am

      Walking a few minutes every few days and being sedentary the rest of the time doesn’t compare with hard work and manual labor. I do favor radical eye opening statements to shake up conventional thinking, like in my post about starting with the big idea.

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