Good Calories, Bad Calories

When these men came of age in their careers, in the 1950s and early 1960s, obesity research was a new and expanding field of science. It had been reinvented in the United States after World War II, and the National Institutes of Health was just beginning to provide money for research. These men filled the expanding vacuum. They all came out of the Northeastern academic corridor—Harvard, Yale, Columbia, Rockefeller, the University of Pennsylvania—and they all knew each other. Van Itallie befriended his classmate Stunkard on their first day of medical school at Columbia; he then went to work with Mayer at Harvard and enlisted Stunkard’s help to test Mayer’s theory of hunger, and so Stunkard got to know Mayer as well. Philip White received his doctorate with Mayer at Harvard and remained in Stare’s department until 1956, when he became secretary of the American Medical Association’s Councils on Foods and Nutrition and wrote an influential nutrition column for JAMA. Van Itallie then became a member of White’s council and initiated its 1973 public condemnation of Atkins and all similar carbohydrate-restricted diets. White edited the article. If you weren’t in the club, you had little influence. (“The Mississippi River is very deep, or at least it used to be,” is how the biochemist and diabetologist Gerald Grodsky of the University of California, San Francisco, described the inability of West Coast investigators to influence medical wisdom in the 1960s and 1970s.)

These individuals became the field’s “leading authorities,” as the newspapers would call them. They hosted the conferences, edited the textbooks, chaired the committees, and determined research priorities. By the end of the 1970s, they had determined what clinicians and researchers in the field would believe, at least in the United States, and what they still believe overwhelmingly. When McGovern’s committee held its post-facto hearings in February 1977 to address the Dietary Goals for Americans, only members of this club testified on obesity^*125 (Mayer had been the committee’s consultant), and they all embraced the committee’s recommendation of a national diet richer in carbohydrates and poorer in fat. Although Van Itallie also testified that he was unaware of any research to support their opinions: “Thus, what I am saying is an assumption rather than a statement of established fact,” he acknowledged.

None of these authorities actually specialized in the clinical treatment of obesity except Stunkard, who did so as a psychiatrist treating an eating disorder. Nor were they necessarily the best scientists in the field. Fred Stare and Philip White never studied obesity at all. Cahill’s research on fat metabolism and fuel partitioning was seminal, but he didn’t see why it should be relevant to human obesity. Stunkard’s primary contribution to obesity research through the 1970s was his observation that the obese rarely lose weight on diets, and if they do, they don’t keep it off. But he never noted, and as a result neither did anyone else, that the only dietary studies he addressed in his seminal analysis were of semi-starvation, so what he had confirmed was that semi-starvation failed, not that all diets did.

Van Itallie and Bray deserve a disproportionate share of the responsibility for effectively removing the concept of the fattening carbohydrate from the nutritional canon, and thus the carbohydrate-restricted diet as well. Virtually everything we believe about what constitutes an effective weight-loss diet can be traced back to the 1970s and the efforts of these two men.

Before Van Itallie decided to write what he called the AMA-sponsored “denunciation” of Atkins in 1973, his only substantive involvement in the science of obesity, as either a researcher or a clinician, was his work with Mayer twenty years earlier. In the intervening years, he had worked on intravenous feeding of hospital patients and dietary influences on cholesterol, among other subjects, but he returned to the subject of weight in 1971, only when one of his post-docs developed an interest in the subject. This led to what Van Itallie considered his primary contribution to obesity research, the development of a feeding machine to study food intake: “You could basically feed yourself by pushing a button,” Van Itallie explained. “The machine would deliver a measured quantity of formula diet into your mouth, and then keep a record of how much you took.”