So, I am verrrrry curious to read Gary Taubes’s new book, Good Calories, Bad Calories, after reading his recent articles in The New York Times Magazine (on the limitations of epidemiological studies — notably, our old friend Walter Willett’s Harvard Nurses Study) and New York Magazine (on why exercise won’t make you thin). Both are long and dense but well worth the read.
From the former (in which Taubes uses the conflicting beliefs about Hormone Replacement Therapy as his primary example), with my own emphasis:
The catch with observational studies like the Nurses’ Health Study, no matter how well designed and how many tens of thousands of subjects they might include, is that they have a fundamental limitation. They can distinguish associations between two events — that women who take H.R.T. have less heart disease, for instance, than women who don’t. But they cannot inherently determine causation — the conclusion that one event causes the other; that H.R.T. protects against heart disease. As a result, observational studies can only provide what researchers call hypothesis-generating evidence — what a defense attorney would call circumstantial evidence.
This just in: correlation does not equal causation! Kudos to Taubes for exploring that point in great depth, and kudos to the Times for publishing it, even if they’ve also been rather irritating this week.
Then, from the NY Magazine article (thanks to reader Kris for the link), we have this:
Just last month, the American Heart Association and the American College of Sports Medicine published joint guidelines for physical activity and health. They suggested that 30 minutes of moderate physical activity five days a week is necessary to “promote and maintain health.” What they didn’t say, though, was that more physical activity will lead us to lose weight. Indeed, the best they could say about the relationship between fat and exercise was this: “It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling.” In other words, despite half a century of efforts to prove otherwise, scientists still can’t say that exercise will help keep off the pounds.
Ahhhhhh. Refreshing, ain’t it?
So I’m a big fan of Gary Taubes. So far.
Here are the things that make me worry. First, from the NYT article, we also have this, again with my emphasis:
One reason researchers believe that heart disease and many cancers can be prevented is because of observational evidence that the incidence of these diseases differ greatly in different populations and in the same populations over time. Breast cancer is not the scourge among Japanese women that it is among American women, but it takes only two generations in the United States before Japanese-Americans have the same breast cancer rates as any other ethnic group. This tells us that something about the American lifestyle or diet is a cause of breast cancer. Over the last 20 years, some two dozen large studies, the Nurses’ Health Study included, have so far failed to identify what that factor is. They may be inherently incapable of doing so. Nonetheless, we know that such a carcinogenic factor of diet or lifestyle exists, waiting to be identified.
We all know I’m no scientist, or even a science journalist, but what that tells me is that something about the American lifestyle, diet, or environment is a cause of breast cancer. And that such a carcinogenic factor, period, exists. Are as many Japanese women as Americans on the pill? Do Japanese women who move to the U.S. have babies later in life, or are they more likely to choose not to have children? Are they moving from the country to big cities? Are they exposed to more pollution? Does culture shock and/or the American work environment cause more stress? Do they drink more alcohol here? Some of these questions fall under the rubric of “lifestyle,” sure, but “lifestyle and diet” in contexts such as these always seems to come down to what you eat and how much you exercise — not how stressed out you are or how old you were when you had kids or where your house is located or how educated and monied your friends are or are not.
Which brings me to the second thing that makes me wary of Taubes: as you can guess by the title of his book, he’s got a problem with what we eat. Specifically, he’s arguing (according to the Amazon page) that refined carbs fuck up our health and make us fat, while saturated fat is not a problem. Not having read the book, I can’t comment on his argument yet — which might be compelling — but I also can’t help noticing how much that thumbnail description sounds like Atkins or South Beach. And since the Amazon page indicates that there’s a “Thus, the key to permanent weight loss is…” argument in there somewhere, I’m as leery of the book as I am intrigued by it. If he’s seriously arguing (and again, I don’t know that he is) that a high-protein, low-carb diet will lead to permanent weight loss and improved health, he really needs to read about the study Gina Kolata follows in Rethinking Thin. Or, you know, talk to anyone who started on Atkins or South Beach more than 5 years ago.
Nevertheless, based on the above-linked articles, I really admire Taubes’s skepticism and thoroughness, and I look forward to reading what he has to say about obesity research. I should also admit my own bias here (other than the screamingly obvious one): as a rule, I don’t dig books that say “Americans aren’t to blame for making themselves so fucking fat — Big Food is!” It’s why I lost interest in Fat Politics halfway through, why Fast Food Nation makes me cringe as much as it makes me want to never touch a french fry again, and why I’d really like to kick Morgan Spurlock in the shins. I’m most certainly no fan of Big Food, and like any good liberal, I am definitely inclined to believe that massive corporations would rather go ahead and poison us all within the bounds of the law than make any changes that threaten their profits. But A) I think we must be just as skeptical of studies that suggest that as those that suggest weighing 250 lbs. is the end of the world, even if the former appeal more to our sensibilities — after all, Cheez Whiz is arguably nature’s perfect food — and B) when the argument comes down to “THIS is what really makes people fat!” then it just reinforces the idea that being fat is intrinsically a terrible thing, and that the “obesity crisis” remains a real problem in need of a solution, not a load of fucking horseshit. “Being fat isn’t as bad as we’ve been led to believe — BUT ZOMG, HIGH FRUCTOSE CORN SYRUP IS WHAT’S MAKING US FAT!” isn’t an argument that’s going to advance the cause of fat acceptance a whole lot; it’s just going to move the goal posts and give fat people a different set of rules for eating that they must follow to please the gods of Good Health — and, of course, get less fat.
That doesn’t mean I think the people pumping us all full of HFCS shouldn’t be taken to task, or that there’s no chance that refined carbs in processed foods have contributed to the relatively modest increase in Americans’ weight over the last few decades or that foods loaded with them are less nutritious than meat and whole grains (or whatever the hell food is gonna be our salvation this week). Hell, I’d like to see HFCS go the way of the dodo just because real sugar tastes so much fucking better to me (but then, I’m not much of a sweet person). And since insulin resistance is about the only health problem that appears as if it might have a genuine relationship to fat — not just a coincidental one — and Taubes seems to be arguing that refined carbs cause both insulin resistance and fat, I’m even open to accepting his whole argument. But I remain wary of it. Seriously wary of it.
Having said that, I’ll go ahead and also say that I’m excited to see Gary Taubes getting attention either way. He may not be a true ally to fat acceptance activists, but at this point, I’ll cheerfully take a new frenemy in the public eye. I mean, as delighted as I was to see Paul Campos trounce Kelly Brownell in the L.A. Times last week (the whole series is a must-read if you haven’t gotten to it yet), as obesity researchers go, I’ll take a Kelly Brownell over a Walter Willett any damn day. Someone who meets us halfway, or a third of the way, is a whole lot better than someone who just wants to howl about how we’re making excuses and killing ourselves by eating too much and not exercising enough. I can’t wait to read Taubes’s book and see where he really falls on that continuum.