THE PERFECTLY KNOWN CAUSES OF OBESITY: The Unknown

In this series, we will look at the basics of metabolism and discuss the very well-known science around obesity. Many of the diseases that bedevil humanity flow from obesity, including cancer and Type 2 diabetes, and so understanding metabolism and the causes of obesity is ground zero in the fight for a long life and good health.

In the fantastic book by Robert Whitaker, Anatomy of an Epidemic, Whitaker notes that psychotropic drugs became very popular with psychiatrists because it allows the physicians of the mind to have what the physicians of the body had: pills. The mind doctors only had talk therapy previously and much of it was Freudian, with a strong emphasis on symbols and analogous methods of describing the mind. So, if you talked to your primary care physicians about an infection, he gave you some pills and a few days later, you were healed. If you want to your psychiatrist about anxiety, he wanted you to come every week and discuss abstractions like your id, or your superego, and he might also wish to plumb your dreams. While you were engaged in this painful self-examination, your anxiety or depression might get even worse!

And so the field of psychiatry was all abuzz when the first round of drugs focused on mental states came into being in the 1950s. These compounds included Thorizine and Lithium and later, Valium, and finally, Prozac. The field of psychiatry had declined as faith in talk therapy declined and then suddenly, the mind doctors had what the body doctors had previously, which was pills. Pills for the mind, which were said to address ‘chemical imbalances’ in the brain.

This brings us to the wildly controversial research around food. Pills have a general methodology of testing. The gold standard of proof that a pill works is the placebo-controlled double-blind study. The wiki definition reads as such:

Placebo-controlled studies are a way of testing a medical therapy in which, in addition to a group of subjects that receives the treatment to be evaluated, a separate control group receives a sham “placebo” treatment which is specifically designed to have no real effect. Placebos are most commonly used in blinded trials, where subjects do not know whether they are receiving real or placebo treatment. Often, there is also a further “natural history” group that does not receive any treatment at all.

‘Double-blind’ simply means that the doctors or administrators of the test don’t know either which of the test subjects are getting the drug or which are getting the placebo. This protects against the doctors or test administrators treating the test subjects differently.

This leads us right to the reason food research is so terribly confused, confusing, and uncertain; there can be no real testing. There is no way to test a human diet on a placebo-controlled double-blinded method without resorting to some sort of deeply unethical testing manner. People know what they are eating, so there goes the blinded part of the protocol, and there is no such thing as placebo food.

Because food research can’t be done the way pills are researched, there is only the antidotal studies, or self-reported food diaries, which are notoriously unreliable. There have been many hundreds of food studies on prisoners, and mental institute patients, but they have the same problems; not blinded, not consistently applied, not that long, plus a few others. Food and diet research is simply a fraught field full of information that is mostly noise and made even more difficult by the core fact that human biology has real variations by gender, geography, and individual.

Humans are just very complicated. We aren’t going to get a really good story out of the medical establishment around food, and if the psychiatric experience with psychotropic drugs is any indicator, this is the good news. Perfectly formulated ‘food pills’ would likely be subject to warped rules around their efficacy and the outcomes might be even worse than what we have.

Given that there is a lot we can’t know, the anecdotal reports from people from William Banting to the latest research in athletics is what we have to go on. There are ample reports that ketogenic diets work, and plenty of other evidence that shows that calorie restriction works but only in the short term. This might be as good as it gets from the dietary sciences regarding ‘real’ evidence in the field of nutritional advice.   Human biology is hard. Going to the moon or Mars might be an easier lift that just coming to consensus on what we should be eating.


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