In diet studies, big question goes unexplored

Fifteen years ago, I gained the dreaded “freshman 15” — times two. I packed on 30 pounds in what felt like a blink of an eye. Sophomore year, things were going to change. I adopted a Spartan regime: limiting my calories and fat intake, emulating Greg LeMond on the stationary bike and Arnold Schwarzenegger in the weight room.

By my junior year, after a Herculean amount of effort and willpower, I had lost a grand total of 3 pounds.

The weight I effortlessly gained seemed impossible to shed.

It was time to explore the unthinkable: the Atkins diet. My friend had said he lost weight just as easily as I had gained it by eating copious amounts of meat, fish and fowl while eschewing carbohydrates — the very same sugar, starch, rice, pasta and flour that made up the bulk of my diet. So I tried it. I was determined to lose the beer belly, even if it meant eating voluminous handfuls of foods of the “artery-clogging” variety.

I lost almost all of the 30 excess pounds in less than six months and have stayed lean on this diet ever since. Meanwhile, in the past 30 years, America has done the opposite — tried to stick to diets rich in carbs and poor in calories and gotten fatter and fatter.

Throughout that time, our medical authorities have steadfastly ignored the possibility that those of us staying lean on this supposedly artery-clogging diet have any relevance to why we get fat as individuals or why we’ve gotten fatter as a nation.

In 2000, the Centers for Disease Control and Prevention set national goals to reduce obesity to 15% of the population. Today, not a single state meets the proposed aim. The latest CDC report, released Aug. 3, says in half the U.S. states, 1 of every 4 adults is obese. In nine states, 1 of 3 is obese.

Coincidentally, one day earlier, another report was published, this one in the Annals of Internal Medicine, that seemed to vindicate the Atkins diet as a way of losing weight and keeping it off.

Researchers (funded by the National Institutes of Health) randomized half their subjects to a diet that limited both calories and fat — women ate no more than 1,500 calories a day; men no more than 1,800. The other half were told to avoid carbohydrate-rich foods, as I’ve been doing for 15 years, but could eat all the protein and fat they wanted.

The study’s authors concluded both diets were equally effective for weight loss, and that is how the press reported it. But the low-carb diet also was associated with better heart health.

Let that sink in for a moment.

The people on the low-fat, low-calorie diet were enduring what nutritionists used to call “semi-starvation diets.” They were presumably being deprived of the pleasure of satiation and expected to go at least a little bit hungry every day. Yet the diet that allowed for gluttony was just as effective, and healthier, than the diet that implied temperance, moderation and self-restraint.

The study raises two important questions about our national problems with weight: First, why would a diet unrestricted in calories produce the same amount of weight loss as a diet that requires, in effect, a lifetime of semi-starvation and the one we’ve been told to live by throughout the obesity epidemic: eat fruits and vegetables and whole grains and low-fat dairy products, just eat significantly less of them?

And why didn’t the researchers see fit to discuss this question? How is it that the NIH can spend $4 million on a single study that ignores the single most important question it raises, one that any reasonably intelligent high school student would ask? If two diets result in the same weight loss, and one restricts calories and the other doesn’t, maybe it’s not the calories that are important but something else — the carbohydrates, perhaps?

Even if somebody had bothered to ask this question, the researchers couldn’t have answered it. Despite spending $4 million, they didn’t even gather the kind of data that might have done so.

Of the 307 participants enrolled in the study, not one had their food intake recorded or analyzed by investigators. The authors did not monitor, chronicle or report any of the subjects’ diets. No meals were administered by the authors; no meals were eaten in front of investigators. There were no self-reports, no questionnaires.

The lead authors, Gary Foster and James Hill, explained in separate e-mails that self-reported data are unreliable and therefore they didn’t collect or analyze any.

But what are we to make of a study that had no reporting of food intake, when the whole point of the study was to compare the results of different patterns of food intake?

Obesity is now the No. 1 preventable cause of death in America. The CDC estimates that 10% of healthcare costs — about $150 billion annually — are tied to the obesity epidemic. And yet the kinds of studies that speak directly to the question of not just how we lose weight but perhaps why we gain it, and what we may be doing wrong as individuals and as a nation, are mishandled so badly that they border on scientific ineptitude.

Until the press, funding agencies and researchers start asking the obvious questions, we will continually find ourselves in the same predicament.