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Here’s the problem: I hate diet books. Furthermore, I hate diet books that purport to hate diet books yet relish in all the same absurdities. This book is for those who want facts, not filler, fantasy, or fluff.
You don’t need anecdotes when you have evidence. A Harvard sociologist of science calls those arguments by anecdotes in diet books “a deliberate attempt at credibility engineering.”4 When you don’t have the science to back you up, all you have are “success” stories.
What I am interested in is the science. When it comes to making life-and-death decisions that concern something as important as your own health and that of your family, as far as I’m concerned, there’s only one question: What does the best available balance of evidence say right now?
My goal was to create the oxymoron: an evidence-based diet book.
There are more than half a million scientific papers on the subject of obesity, with a hundred new ones published every day. Even researchers in the field might only be able to keep track of what’s going on in their narrow, subspecialized domains. But that’s precisely what we do at NutritionFacts.org. We comb through tens of thousands of studies a year so you don’t have to.
Even “simple” questions on weight loss, like whether you should eat breakfast or skip it, or whether it’s better to exercise before or after meals, turned into major, thousand-article research projects. If our nose-to-the-grindstone research team had trouble sifting through the stacks, a practicing physician would have no chance and the public would be totally lost.
Whether you’re morbidly obese, just overweight like the average American, or at your ideal weight and wanting to keep it that way, our goal was to give you every possible tweak and technique we could find to build the optimal weight-control solution from the ground up.
I discovered all sorts of exciting new tools and tricks along the way. We did indeed uncover a treasure trove of buried data, like simple spices proven in randomized, double-blind, placebo-controlled studies to accelerate weight loss for pennies a day. With so little profit potential, it’s no wonder those studies never saw the light of day.
In How Not to Diet, I cover everything from cultivating a healthy microbiome in your gut to manipulating your metabolism through chronobiology, matching meal timing to your circadian rhythms. Every section could have been a book in its own right.
It was important to me to include all the details so you can make as informed a decision about your health as possible, but you can always skip down to the summaries at the end of each section for my take-home suggestions. I wanted to be sure to clearly articulate how I arrived at each recommendation, because I don’t want to be anyone’s diet guru. I don’t want you to take anything on faith but rather on evidence.
“Science by itself cannot advocate courses of human action, but it can certainly illuminate the possible consequences of alternative courses of action.”9
Before we dive in, what does it really mean to be overweight? Obese? In simple terms, being overweight means you have too much body fat, whereas being obese means you have way too much body fat. In technical terms, obesity is operationally defined as a body mass index (BMI) of 30 or more, while being overweight means you have a BMI of 25 to 29.9. A BMI between 18.5 and 24.9 is considered “ideal weight.”
In the medical profession, we used to call a BMI under 25 “normal weight.” Sadly, that’s no longer normal. Being overweight became the norm by the late 1980s in the United States10 and appears to have steadily worsened ever since.11
Even if you eat and absorb the same number of calories, a calorie may still not be a calorie. As you’ll learn, the same number of calories eaten at a different time of the day, in a different meal distribution, or after different amounts of sleep can translate into different amounts of body fat.
It’s not only what we eat but how and when.
I have to explain that I feel as though my entire life is a holiday. I feel so blessed to be able to dedicate my time to helping people while doing what I love: learning and sharing. I can’t imagine doing anything else.
You’ve likely heard of greenwashing, where companies deceptively pretend to be environmentally friendly.
Leanwashing is the term used to describe companies that try to position themselves as helping to solve the obesity crisis when, instead, they’re directly contributing to it.
When it comes to obesity, the power of your genes is nothing compared to the power of your fork.
No matter our level of nutrition knowledge, in the face of pepperoni pizza, the ancestral heritage baked into our genes screams, Eat it now!106
The rise in calorie surplus sufficient to explain the obesity epidemic was less a change in food quantity than in food quality, with an explosion in cheap, high-calorie, low-quality convenience foods. The federal government very much played a role in making this happen. U.S. taxpayers unwittingly give billions in subsidies to prop up the likes of the sugar industry, the corn industry and its high-fructose syrup, and the soybean industry, which processes about half of its crop into vegetable oil and the other half into cheap animal feed to help make Dollar Menu meat.
The first farm bill started out as an emergency measure during the Great Depression of the 1930s to protect small farmers, but subsequent ones were weaponized by Big Ag into cash cows with pork barrel politics.145 Agricultural policies in the United States and Europe have been deliberately designed to lower the costs of basic cash crops like sugar and staples like meat, wheat, dairy, and eggs.
There is a lot of money at stake—and in steak. From 1970 to 1994, for example, global beef prices dropped by more than 60 percent.147 If it weren’t for taxpayers sweetening the pot with billions of dollars a year,148 high-fructose corn syrup would cost the soda industry about 10 percent more.149
This is changing what we eat. Thanks in part to subsidies, meats, sweets, eggs, oils, dairy, and soda were all getting relatively cheaper as the obesity epidemic took off (compared to the overall consumer food price index), whereas the relative cost of fresh fruits and vegetables doubled.
Whole foods, or minimally processed foods such as canned beans or tomato paste, are what’s referred to in the food business as commodities. They have such slim profit margins that they’re sometimes even sold at or below cost as “loss leaders” to attract customers in the hopes they’ll also buy the “value-added” products,153 the most profitable of which (for producers and vendors alike) are the ultraprocessed, fatty, sugary, and salty concoctions of artificially flavored, artificially colored, and artificially cheap ingredients, thanks to taxpayer subsidies.
This led at least one noted economist to conclude that “the most compelling single interpretation of the admittedly incomplete data we have is that the large increase in obesity is due to marketing.”
The opening words of the National Academy of Medicine’s report on the threat posed by food ads: “Marketing works.”177 Yes, there’s a large number of well-conducted randomized studies I could share with you to show how advertising exposure and other marketing methods can change your eating behavior and get you to eat more,178 but what do you need to know beyond the fact that the industry spends tens of billions of dollars on it?179
Just to give you a sense of marketing’s insidious nature, let me share an interesting piece of research published in Nature, the world’s leading180 scientific journal. The article titled “In-Store Music Affects Product Choice” documented an experiment in which either French accordion or German Bierkeller music was played on alternate days in the wine section of a grocery store.181 On the days the French music played in the background, people were three times more likely to buy French wine, and on German music day, shoppers were about three times more likely to buy German wine. Despite the
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We all like to think we make important life decisions, such as what to eat, consciously and rationally. If that were the case, though, we wouldn’t be in the midst of an obesity epidemic.
As I explore in the Habit Formation section, most of our day-to-day behavior does not appear to be dictated by careful, considered deliberations. Rather, we tend to make more automatic, impulsive decisions triggered by unconscious cues or habitual patterns, especially when we’re tired, stressed, or preoccupied. The unconscious parts of our brains are thought to guide human behaviors as much as 95 percent of the time,189 and this is the arena where marketing manipulations do most of their dirty work.
Because we’re only able to purposefully process a limited amount of information at a time, our decisions can become even more impulsive if we’re distracted or otherwise unable to concentrate.
We all like to feel as if we’re in control and not so easily manipulated. The kicker is we may be even more susceptible the less we’re paying attention.
There’s an irony in all of this. Calls for restrictions on marketing are often resisted by invoking the banner of freedom. What does that even mean in this context, when research shows how easily our free choices can be influenced without our conscious awareness?
A senior policy researcher at the RAND Corporation even went as far as to suggest that given the dire health consequences of our unhealthy eating habits, insidious marketing manipulations “should be considered in the same light as the invisible carcinogens and toxins in the air and water that can poison us without our awareness.”195
Food and beverage companies frame body weight as a matter of personal choice. But even when we’re not distracted, the power of the “eat more” food environment may sometimes overcome our conscious controls over eating.
Researchers concluded that losing around twenty pounds of fat “might be regarded as an alternative to knee replacement.”
Rarely discussed is the fact that nearly one in two hundred knee replacement patients dies within ninety days of surgery. Given the extreme popularity of the operation—about seven hundred thousand are performed each year in the United States—an orthopedics journal editor suggested that “people considering this operation are inadequately attuned to the possibility that it may kill them.”273 A surgeon responded by questioning whether patients should be told about what is arguably the “single most-salient fact”:274
To me, the real question is whether this knowledge will help the patient. Will it add to the anxiety of the already-anxious patient, perhaps to the point of denying that patient a helpful operation? Or will this knowledge motivate a less-handicapped patient to stick to a diet and physical activity regime? Ultimately, then, the question boils down to the surgeon’s judgment.
Weight loss, on the other hand, may offer a nonsurgical alternative that instead treats the cause and offers only beneficial side effects.
excess body fat raises the risk of most cancers, including esophageal, stomach, colorectal, liver, gallbladder, pancreatic, breast, uterine, ovarian, kidney, brain, thyroid, and bone marrow (multiple myeloma) cancers.290 Why? It could be due to the chronic inflammation that comes with obesity 291 or the high insulin levels due to insulin resistance.292 (Besides controlling blood sugars, insulin is a potent growth factor that can promote tumor growth.293) In women, it could also be the excess estrogen.294
is why obese women have up to nearly twice the estrogen levels circulating in their bloodstreams,295 which is associated with increased risk of developing—and dying from—breast cancer.296 A twenty-pound weight loss can reduce estrogen levels within the breast by 24 percent.
Of the four million deaths attributed to excess body weight every year around the world, nearly 70 percent are due to cardiovascular disease.338
In 1850, life expectancy in the United States was less than forty years,366 but it has steadily increased over the last two centuries,367 gaining about two years per decade—until recently, that is.
In the coming decades, some predict we may lose two to five years—or more—of life expectancy in the United States. To put that into perspective, a miracle cure for all forms of cancer would only add three and a half years to the average American life span.370 In other words, reversing the obesity epidemic might save more lives than curing cancer.
I’m all for fighting size stigma and discrimination, but the adverse health consequences of obesity are an established scientific fact. In a study of more than six hundred centenarians, those one hundred years old and older, fewer than 2 percent of the women and not a single one of the men were obese.404
The size-acceptance movement is definitely right about one thing, though: the extraordinary scourge of weight stigma. Described as the last “acceptable” form of bias,412 weight stigma is the rampant discrimination and stereotyping of overweight individuals.
This weight stigma starts surprisingly early. Children as young as three years old label overweight peers as “mean,” “stupid,” “lazy,” and “ugly.”
What about doctors? One representative national survey found that more than half of physicians viewed obese patients as “awkward, unattractive, ugly, and noncompliant.”422 About a quarter of nurses agreed or strongly agreed with the statement “Caring for an obese patient usually repulses me.”423 This antagonism can have serious health consequences for those who may need care the most.
“If shaming reduced obesity, there would be no fat people.”456
How Much Weight Does It Take?
