The Obesity "Epidemic" and Nutrition

There has been a lot of talk and newsprint about the obesity "epidemic" that is occurring, but I feel that certain facts have been ignored, as well as certain principles of human behavior. Whenever patients tell me that doctors don't know much about human nutrition, I generally comment that neither does anybody else. There have been very few double-blinded studies about the effect of nutrition on human health and well-being, but that doesn't seem to stop people from being more certain about human nutrition than the facts will allow:

1) No one knows how many meals a human should eat each day: one, six, or whatever.

2) No one knows at what time of the day the largest meal should be eaten, (but if you eat within 2 hours of bedtime you increase your risk of reflux esophagitis).

3) If you eat only vegetables, you will die from pernicious anemia, aka vitamin B-12 deficiency, since vegetable cells contain NO vitamin B-12; vitamin B-12 is is needed for animal cell DNA synthesis, and not for vegetable DNA.

4) Nobody smiles in a vegetarian restaurant, but everyone looks ecstatic at a steak restaurant such as Peter Luger's.

5) The only vegetables that seem to benefit human health when added to the diet are alcohol (beer, wine or whiskey), dark chocolate, olive oil (the Mediterranean diet), and the bark of the willow (salicylic acid, which Bayer transformed into aspirin).

6) No one knows how much water/fluids a human should drink each day, but the general consensus is a minimum of 0.5 liters, since that is the urine volume required to excrete the products of oxidation in maximally concentrated urine.

7) In a hospital, the minimum IV should be D5/0.5NaCl with 20 meq of KCl at 125 cc/hr, and then adjust to the patient's condition.

8) Fat cells require cholesterol and preferentially absorb insulin, so if you are a diabetic or have a cholesterol problem, you should lose weight.

9) Cholesterol does not increase cholesterol, so egg yolks are OK, and, in fact, eggs have about the highest protein per gram of any food.

10) If you do not have high blood pressure and are not diabetic, then salt and sugar should cause you no problem.

11) Almost all my patients who on oral medicine for diabetes cannot/will not lose weight, even after I tell them that a 20m pound weight loss will probably (temporarily) cure their diabetes.

12) As you get older, your metabolism slows up, and your blood pressure, cholesterol and fasting blood sugar generally increase.

13) Most women find it impossible to lose the last 5 pounds necessary to get down to their pre-pregnancy weight.

14) Most men gain at least 10-15 pounds the first year they work or get married, in the first case from lack of exercise (8-10 hrs/day behind a desk), and in the second case from an increase in calories consumed at dinner.

15) Cigarette smoking increases your metabolism and decreases your appetite, so most men gain 10 pounds the first year they quit smoking and most women gain 15.

16) And this is key: The first pleasure all humans got was from being fed, either at their mother's breast or from a bottle. The first desire to be fulfilled was that created by hunger. Therefore, it feels good to eat, and it is difficult to deny yourself this fundamental pleasure and to feel hungry, which you must do in order to lose weight. The first time a woman's dress goes from size 6 to size 8, or a man's belt from 32" to 34", they rarely say "I must lose some weight". It has nothing to do with not knowing how many calories they are eating, or doctor-patient information, or lack of electronic medical records. Most patients don't care enough about how they look after gaining 10 pounds, or believe that there is enough increased health risk from added weight to lose the additional pounds. Men actually are less stressed by their appearance when overweight than are women: When a woman looks full face into a mirror, she sees the added weight that went to her hips, but when a man looks in a mirror the same way, he barely sees the added weight that went to his belly.Losing weight means being willing to suffer present pain for future gain, and the human brain is not geared to worry about the future, but rather to fasten the seatbelt 10 seconds before the car hits a brick wall. The same comment about future gain also holds true for exercise, but the average patient finds it much easier to exercise than to lose weight.

17) I also think the reason that almost all humans love ice cream is that it is rich in sugar and fat, just like mother's milk.

18) Don't you think that by the time he/she is 7 days old, a baby is addicted to sugar by Pavlovian conditioning: whenever he/she is hungry (or whatever is felt), this discomfort is assuaged by a warm sweet fluid, so that the baby associates warmth (chicken soup?) and sweets with a sense of comfort and well-being. It's difficult to see how an external message can easily overcome this dependence.

19) Final observation: based on my informal questioning of my patients, the majority of adults who loved chocolate ice cream as a child can curl their tongue (I can!), while the majority of patients who did not like chocolate ice cream cannot. I wonder what the genetic linkage is. I personally thought that my friends who preferred vanilla ice cream to chocolate could not have possibly tasted the same chocolate flavor that I did.