The Kaleidoscope of obesity

Image taken from https://unsplash.com/photos/cixohzDpNIo

For years, we have tried to solve the looming obesity epidemic. This has been done in the most intuitive way: the scientific method. The problem, however, are the varying outcomes we have achieved whilst using the same scientific methodology: on one hand we claim that a positive energy balance (i.e. too many calories) is the issue. On the other hand, we state that the hormonal response is to blame, with there even being a hormonal weight set point theory. Somewhere in between, we leave a narrow space for the consideration of the effects of an obesogenic environment as well as the psychological experience of being obese in a social-media-centric, judgemental society.

So what is the truth?

WHY IS OBESITY AN EPIDEMIC?

In 2018, 70% of women and 39% of men were obese in South Africa. According to Teresa K. Woodruff, the 2020 obesity projections in America are to be worse than the threat of terrorism. As of 2018, the global obesity rate has tripled since 1975. From this, it is clear that the rates of obesity are increasing at an alarming rate. In countries such as South Africa, these increases occur against the backdrop of malnutrition and poverty, with these phenomena occurring in the same environment whilst being seemingly juxtaposed to each other.

The bigger looming threat, however, is not just the increasing rates of obesity, but the increasing number of individuals predisposed to lifestyle diseases such as insulin resistance, diabetes, and metabolic syndrome.

But this is precisely where the confusion begins: does obesity give rise to these conditions or do these conditions give rise to obesity?

WHAT IS THE WORLD EATING?

Much of what we consume is the result of our country’s nutrition guidelines. These control what is and what isn’t allowed in supermarkets, as well as what is recommended to us by our healthcare practitioners. But it is becoming more and more evident that the logic used to formulate these guidelines may be flawed.

Numerous individuals such as Professor Tim Noakes and Dr Zoe Haracombe have long lambasted the current nutritional guidelines employed by many countries. These guidelines closely mimic the classic ‘food pyramid’, encouraging various populations to consume more carbohydrates, and less fats. These guidelines, however, have spawned disastrous results, leading to the current obesity epidemic.

Image taken from https://www.waitaramedical.com/2018/01/18/healthy-diet/food_pyramid/

Take, for instance, the science behind insulin resistance: a cell becomes resistant to the effects of insulin. This is because it down-regulates it’s receptors for this hormone due to there being an excessive amount in circulation. The food-group responsible for the release of insulin are the same carbohydrates and grains recommended in abundance by the high-carb, low-fat dietary guidelines employed by numerous countries. This manner of thinking could induce insulin resistance in an otherwise healthy individual, thus leading to obesity, where the calorie-in-calorie-out (CICO) model of obesity fails to account for this hormonal occurrence.

Professor Tim Noakes highlights yet another disturbing possibility: pregnant mothers consuming these high-carb low-fat diets could be priming their children to be insulin resitant in future, due to the excess in-utero exposure to carbs. Some children are then weaned onto high carb diets consisting of staples such as Maize meal, further increasing one’s predisposition to insulin resistance and related metabolic issues. It’s worth noting that when Noakes made this point to several dieticians, the weaning of children onto high-carb foods was justified by indicating that that is what is more affordable. Is it moral to recommend a diet on the basis of its affordability and not on the basis of it’s nutritional qualities when affordable alternatives, such as eggs and liver, do exist?

In fact, in 2018, Tim Noakes was sued by advising a breastfeeding mother (via twitter) that weaning a baby onto a low-carb diet wouldn’t be dangerous. Whilst he won this court case, it illustrated yet another disturbing influence in our eating choices: the influence of food companies.

WHAT DO FOOD COMPANIES DO BEYOND ADVERTISING?

In the 1900’s, physician sponsored cigarettes were a thing. In the 2000’s, phycisian sponsored ‘bad foods’ are a thing.

It turns out that the dieticians and nutrionists leading the charge against Tim Noakes were sponsored by various cereal companies: those that were his indirect bulls-eye whenever he lambasted high-carb, high-sugar foods (such as numerous cereals currently on the market). Furthermore, an NIH study conducted by Jacques Roussouw, a scientist who was supposed to testify at the hearing, attempted to prove the benefits of a low-fat diet, but failed. Speaking on this, veteran journalist Marika Sboros writes:

He (Roussouw) also has what some scientists say is the dubious distinction of spending more than $700 million funding trying and failing to prove that low-fat diets reduce the risk of heart disease in post-menopausal women.

And so, beyond advertising, food companies use their financial leverage to brush various studies, as well as up-and-coming scientists, over.

WHAT DO SCIENTISTS HAVE TO DO WITH IT?

Enter the case of Ansel Keys.

Ancel Keys coined the diet-heart-hypothesis that we know today: excess fat leads to excess cholesterol in circulation, leading to the formation of various plaques, culminating in an atherosclerotic pathology. He’s also the same scientist that was put in charge of managing president Eisenhower’s diet after his first heart attack. It’s important to note that Eisenhower, under Ancel Keys’ management, suffered from constant hunger, fatigue, and later suffered congestive heart failure. To quote Gabe Mirkin:

Researcher Ansel Keys of the University of Minnesota claimed that a low-fat, high-carbohydrate diet could prevent heart attacks. He was wrong because most people replaced saturated fats in animal food (meat, chicken, eggs, dairy) with refined carbohydrates made from flour and sugar and that bad advice increased the rate of heart attacks rather than reducing it, as Keys expected (Clinical Pharmacist, Jul 14, 2017;9(8)). Now we know that dietary cholesterol (from foods such as eggs) does not cause heart attacks (Am J Clin Nutr, August 2015;102(2):276–294), and saturated fats in meat are not the factors that cause heart attacks (Ann Intern Med, March 18, 2014;160;398–406).

Whilst I am not certain as to whether Ancel Keys was sponsored by any food companies, it is well known that in establishing this diet heart hypothesis, Keys conducted biased studies (the seven countries study), culminating in many journalists and scientists alike doubting his scientific credibility. It is thus shocking that this diet heart hypothesis remains the central tenet in cardiology practices.

WHAT ABOUT THE HORMONES?

Apart from insulin and insulin resistance, another hormone’s effect, Ghrelin, has surfaced. It is termed ‘the hunger hormone’ as it is responsible for stimulating appetite, increasing food intake, and storing fat. Thus, level’s of Ghrelin are higher in those with higher weights.

What is becoming apparent, however, is that calorie-restrictive diets do not ‘reset’ the effects of Ghrelin. Those loosing weight on these diets only have Ghrelin levels associated with their new weights and body compositions many months later, with many often gaining weight back during this period due to the effects of this hormone (as it is still operating as if they were at their bigger weight).

So, whilst we commonly tell people that they are eating too much and moving too little (and thus not adhering to the CICO model), our calorie counting solutions still do not combat their obesity in the long term, making this a flawed model that is still recommended by many nutritionists and physicians alike.

Thus, avoiding processed food (which Tim Noakes argues would have you on a low-carb moderate/high-fat diet, albeit unintentionally) and losing weight gradually seem to be the sustainable answers. So why is this not the popularised version of things?

WHAT ARE WE SEEING IN THE AROUND US?

On instagram fitness pages, you will see arguments about whether ‘a calorie is a calorie’. You will find fitness influencers who, according to The Telegraph, actually make women feel worse about themselves, predisposing them to even worse health and fitness habits. On TV, you will find reality shows such as the biggest loser that put contestants on highly restrictive diets, shame them, over-work them in workouts, and make them loose unhealthy amounts of weight in short periods of time. You will also find body-positivity activists, such as Lizzo, being shamed by people such as Jilian Michaels, further complicating the difference between body-negativity and health consciousness.

Take it a step further, and you have ‘food deserts’: places where the nearest grocery store selling fresh produce is much further (sometimes even taking an hour, or more, to get to) than the nearest fast food shop. The phenomenon tends to be common in poorer areas, where residents are thus forced to either purchase fast foods or buy packaged/long lasting foods on their grocery store hauls: the same foods filled, sometimes, with dangerous preservatives.

All of this culminates not only to create an obsogenic environment, where healthy eating may be looked down upon, but creates an environment that makes weight loss either an unhealthy obsession, a painful endeavour, or an impossible task altogether.

SO WHY DID I WRITE ABOUT THIS?

When I was in sixth grade, I managed to lose 13kg by methods of extreme restriction. Nowadays, I don’t think I would survive on a handful of cranberries for lunch. Throughout the rest of my schooling career, I gained a whopping 28kg back. Yes- I gained all the weight back, and some. During this period, not only did I discover my genetic predisposition to diabetes (a father and his father are both affected), but I went through several yoyo diets, apple cider vinegar diets, all of them culminating in feelings of helplessness and abandoned calorie counts.

Now in my second year of varsity, I’ve managed to lose 23kg (we hope forever this time!), and although I’m not at my goal weight, I do feel more confident, and enjoy the feeling of taking my body to the next fitness challenge.

The second time round- I never counted calories. Admittedly, I tried it once during my first year, to see if my relationship with this unit of measurement had changed. It hadn’t.

But on this journey, I seem to have developed a new found appreciation for the blight that many obese patients face, having formely been one myelf. To say that a person eats too much and moves too little (CICO) doesn’t quite do it. I regularly went on 10km runs in my obese days. Placing the blame on a person, whilst they are responsible for their choices, ignores the misinformation and propaganda they have recieved for years.

TO WRAP IT UP

And so, just when we think we have it, the prism is tilted and the light bounces, blinding our senses in the midst of optical illusion. We are left with what seem to be conflicting reflections, contemplating whether this current epidemic is due to hormones, calories, or psychology. Whilst we continue to argue this out in the academic sphere, the global population’s health continues to worsen. Amidst this confusion, we even forget to ask the question if the Insulin Resistance that may be attributed to our nutritional guidelines is the cause of obesity, instead insisting that obesity is the cause of this metabolic phenomenon, evading the bigger question of which parties have the biggest stake of what we eat.

The end result is the complicated, poltical sphere on nutrition. Where so many corporate companies have a hand in determining what we eat, and legislation has failed to protect populations from diets that encourage metabolic issues, and thus effectively culminate in obesity, as a medical student, I wonder what the future looks like. Are we going to start changing these systematic issues, or continue to watch from afar, unscientifically insisting that the commonality of rising obesity rates across populations is instead due to individual gluttony?

Your neighbourhood physician-politician. 2nd year medicine. Instagram: @asandevilane

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Asande Vilane

Asande Vilane

Your neighbourhood physician-politician. 2nd year medicine. Instagram: @asandevilane

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