Good Calories, Bad Calories

Van Itallie felt that Diet Revolution was full of what he called “gross inaccuracies,” and that there were far too many reasons to believe that the diet could be dangerous to disseminate it so widely. There may have been some personal enmity as well: Van Itallie had been chief of medicine at St. Luke’s Hospital in New York when Atkins had served under him as a cardiology resident in the late 1950s. Van Itallie said he didn’t work with Atkins closely enough to know him personally, but he did not find him “an appealing personality” nonetheless. Stunkard, talking about all his colleagues in the field, said, “We just despised [Atkins]. We thought he was a jerk, an idiot, who just wants to make money.”

The critique that Van Itallie drafted and White edited, which was then published as the official AMA declaration on carbohydrate-restricted diets, was not a balanced assessment of the science, nor was it absent its own gross inaccuracies. It was akin to the diatribes that had been aimed at Banting in the 1860s, Pennington in the 1950s, and Taller, by White himself, in the early 1960s. Atkins, like Banting, Pennington, and Taller, was censured for advocating a diet that was “neither new nor revolutionary.” The article accused Diet Revolution of lacking “scientific merit,” primarily by implying that here was a “way of circumventing the first law of thermodynamics.” The diet itself was denounced as “grossly unbalanced,” because it “interdicts the 45 percent of calories that is usually consumed as carbohydrates,” and so cannot “provide a practicable basis for long-term weight reduction or maintenance, i.e., a lifetime change in eating and exercise habits.” That this was the opinion of a nutritionist and a physician, neither of whom had worked clinically with obese patients, was lost in the publication of the critique under the auspices of the AMA itself. Mayer dedicated one of his syndicated newspaper columns to condemning Atkins, based on the AMA critique, which he cited repeatedly as though it were the considered opinion of the entire American Medical Association and not just his former collaborator, edited by his former student. “The American Medical Association,” wrote Mayer, has “taken the unusual step of warning the U.S. public against the latest do-it-yourself diet as propounded in ‘Dr. Atkins’s Diet Revolution.’” The AMA report, Mayer wrote, “explains why the ‘diet revolution’ cannot work.”

After Van Itallie drafted the AMA attack on Atkins, he spent the next decade as the principal arbitrator of the risks and benefits of weight-reduction diets. This coincided with his rise to prominence in the field, after receiving a 1974 NIH grant—“a few hundred thousand dollars,” he says, “which was a lot of money at the time”—to start the first federally funded clinical obesity center in the United States, now known as the Theodore Van Itallie Center for Weight Control at St. Luke’s Roosevelt Hospital Center. That same year, Van Itallie gave the review presentation on dietary approaches to obesity at the First International Congress on Obesity, although he had yet to do any research personally on the dietary treatment of obesity, or to treat obese patients. In 1975, Van Itallie cowrote (with Pi-Sunyer) the review chapter on obesity and diabetes in the textbook Diabetes Mellitus, having now been in the field, in a part-time capacity, for at most four years. He then wrote the chapters on dietary therapy for obesity in the 1978 symposium report Obesity: Basic Mechanisms and Treatment, edited by Stunkard; in the 1979 NIH report Obesity in America, edited by Bray; in Bray’s 1980 textbook, Obesity: Comparative Methods of Weight Control; and in Stunkard’s 1980 textbook, Obesity. In 1983, Van Itallie cochaired the Fourth International Congress on Obesity. In 1984, he coauthored the obesity chapter in the fifth edition of Present Knowledge in Nutrition, which had been a standard nutrition reference since its first edition was published thirty years earlier. Because Van Itallie was also engaged as chair of the medical department at Columbia University’s Presbyterian College of Physicians and Surgeons, he says, he had no time to do research himself, and relied almost entirely on his collaborators for the few studies he did publish.