Good Calories, Bad Calories

The funding of research projects, laboratories, and entire academic centers by the food and pharmaceutical industries is now a fact of life in modern medical research, which is why many journals require that their authors declare potential conflicts of interest. But it raises important questions, just the same. When Science dedicated special issues to obesity research in 1998 and again in 2003, James Hill from the University of Colorado was selected both times to write the review article on diet and lifestyle factors that influence weight gain. In those articles Hill argued that passive overeating and sedentary behavior were the causes of obesity, and he recommended reducing fat in the diet. Hill had long been a defender of the role of carbohydrates and particularly sugar in weight regulation. He even wrote an article, paid for by the Sugar Association, promoting the use of sugar in weight-loss diets, under the assumption that a high-carbohydrate diet, even if loaded with sugar, would “reduce the likelihood of overeating, rather than increasing it, as some popular diet theories purport.” (“The theory that dietary sugar equals high insulin levels equals excess fat deposits is unproven and makes little biological sense,” Hill wrote.) Over the years, as Hill has acknowledged in his conflict-of-interest statements, he has also received consulting fees from Coca-Cola, Kraft Foods, and Mars (makers of Snickers, M&M’s and Mars Bars), companies that would stand to suffer significant setbacks if the notion of the fattening carbohydrate was institutionalized as a fact of science. He has also received over $2 million in what are technically termed “gifts” to his laboratory from Procter & Gamble, the maker of the fat substitute olestra, which has been described in the press as potentially a “dieter’s dream.” Olestra’s only reason for existence is that it will allegedly help us manage our weight by replacing fat in the diet and making it easier for us to consume a low-fat, low-calorie diet. If carbohydrates are the fattening nutrients in human diets rather than fat or all calories, as Atkins suggested, then these diets have no role in weight loss or weight regulation, and olestra’s rationale vanishes.

If the study of weight regulation were a legal issue, rather than a medical and scientific one, the support from Procter & Gamble would have been considered reason enough for Hill to recuse himself from any discussions of the dietary treatment of obesity or participation in any dietary trials that might directly influence Procter & Gamble’s profitability, and thus perhaps Hill’s interests.

In 2002 and 2003, Hill also received over $300,000 a year from the NIH to do a clinical trial testing the Atkins diet against a low-calorie, low-fat diet and, by implication, the justification for olestra as a fat substitute in a weight-reduction diet. And Hill was one of three principal investigators in the follow-up trial of the Atkins diet, for which the NIH provided $5 million. The salient question is whether Hill and the other academics in this pursuit are any less open to having their interpretation of the evidence influenced by financial considerations than Atkins or Taller or any of the other diet-book authors.

“A resolution of the very controversial question of the efficacy of low carbohydrate diets has great practical and theoretical significance,” wrote Donald Novin of UCLA in 1978. Because a generation of obesity authorities were determined to dismiss the practical significance of carbohydrate-restricted diets, they dismissed the potential theoretical significance at the same time. Obesity researchers today say they still have no hypothesis of weight regulation that can explain obesity and leanness, let alone account for a century of paradoxical observations. They insist that obesity is inevitably caused by overeating and thus consuming more calories than we expend, but when asked what causes someone to overeat, they have no answer. Yet the research on insulin and fat metabolism offers one, and it has for several decades.

Chapter Twenty-four

THE CARBOHYDRATE HYPOTHESIS, III: HUNGER AND SATIETY

There is only one way to lose weight, and that is to grow accustomed to feeling hungry. This simple fact, known to most people in affluent countries, seems somehow lost on the authors of the diet, weight-loss, and exercise books that find their lucrative way through the drugstore book racks. Two questions, then: Why do they fail to mention it? And why is it so?

Emory University anthropologist Melvin Konner,

The Tangled Wing, 2003