Archive for the “Low-Fat Nonsense” Category

If you’re around my age, you may remember when almost every commercial for cereal ended with the tagline: Part of this nutritious breakfast! Or, Part of this balanced breakfast! The “balanced” breakfast shown was always a bowl of cereal, two pieces of toast (because the cereal alone didn’t provide enough processed grain), a glass of milk and a glass of juice – usually orange juice.

Here are a couple of collections of old cereal ads I found on YouTube. The first is from the 1970s, the second from the 1980s:

Boy, cereal had some great flavors back in the day: chocolate, sugar, honey, cinnamon toast, more sugar, marshmallows, rocky road ice cream, even more sugar, and chocolate chip cookies. Trust me, Kellogg’s and General Mills had no problem convincing us to eat those “balanced” breakfasts. I think we may be looking at part of the reason rates of obesity began to take off around 1980.

Just for grins, I took clips from the videos above and stitched them into a little summary of my own:

Let’s look at the nutrition breakdown of that “balanced” breakfast the cereal manufacturers were promoting back then. Officially, a serving of cereal is cup or a half-cup, depending on the brand, but if you look at the commercials, those cereal bowls hold more like two cups – and I didn’t know any kids who ate just one cup of cereal for breakfast. They were called cereal bowls for a reason.

So I’ll go with two cups of Frosted Flakes, 2% milk (which is what we drank when I was an adolescent), Parkay Margarine (which was mostly trans fat back then) and Minute Maid orange juice from concentrate, the kind your mom mixed with water. Here’s what we get:

Frosted Flakes (2 cups)
Calories: 320
Protein: 2.7 g
Carbs: 75 g
Sugar: 32 g
Fat: 2 g

2% Milk (2 cups)
Calories: 244
Protein: 16 g
Carbs: 23 g
Sugar 23 g
Fat: 10 g

Toast (2 slices)
Calories: 140
Protein: 4 g
Carbs: 28 g
Sugar: 4 g
Fat: 2 g

Parkay Margarine (2 tbs)
Calories: 120
Fat: 14 g

Minute Maid Orange Juice (8 oz)
Calories: 110
Carbs: 27 g
Sugar: 24 g

Okay, let’s add up that nutritious breakfast:

Calories: 934
Protein: 22.7 g
Carbs: 153 g
Sugar: 83 g
Fat: 28 g

As a percent of calories, it works out to about 65% carbohydrate, 10% protein and 25% fat. Hey, I’ll be darned if those aren’t the proportions recommended by the USDA! No wonder people in my generation are so remarkably lean and free of diabetes.

I believe (or hope, anyway) that most parents these days know that cereals full of chocolate and marshmallows aren’t health food. But I’d bet many of them still believe a glass of orange juice is part of a nutritious breakfast.

Take a look at the sugar content in that glass of orange juice listed above. It’s a Coke with a bit of vitamin C. Now take a look at part of the abstract from a study in which investigators included orange juice with breakfast for one of the study groups, but not the other.

On 2 separate days, healthy normal-weight adolescents (n = 7) and adults (n = 10) consumed the same breakfast with either orange juice or drinking water and sat at rest for 3 h after breakfast. The meal paired with orange juice was 882 kJ (210 kcal) higher than the meal paired with drinking water. Both meals contained the same amount of fat (12 g). For both age groups, both meals resulted in a net positive energy balance 150 min after breakfast. Resting fat oxidation 150 min after breakfast was significantly lower after breakfast with orange juice, however. The results suggest that, independent of a state of energy excess, when individuals have a caloric beverage instead of drinking water with a meal, they are less likely to oxidize the amount of fat consumed in the meal before their next meal.

If you’re not oxidizing fat, you’re storing it. That’s why we never include orange juice (or apple juice, or grape juice, or any other fruit juice) in the nutritious breakfasts we serve at home – much less cereal and toast.

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While looking for something else on the USDA’s official My Plate site last week, I came across a list of daily meal plans.  I presume the meal plans are intended for people who are too stupid to simply look at the new and improved, colorful, easy-to-understand My Plate example and fill their plates accordingly.  I don’t think people are that stupid, but the USDA clearly does.  After all, when the Food Pyramid came along and people got fatter instead of thinner, the USDA took that result as evidence that the Food Pyramid was too confusing.  Couldn’t possibly be that the advice was wrong.

Anyway, here are some screen shots of the sample menus for a 2,000 calorie diet:

Although it was a bit tedious, I looked up nutrition information for everything on the Day 1 menu and added it up.  We’re looking at 2039 calories, 94 grams of protein, 82 grams of fat, and 254 carbohydrates.  That’s not a huge carbohydrate load (although far more than I would consume), but look at some of the major carb sources:  raisins, brown sugar, orange juice, lasagna noodles and a wheat roll.  Fructose and wheat.

Go through the rest of the week online, and it’s more of the same.  Sure, there are recommendations to eat vegetables, but there are also plenty of juices, English muffins, rolls, bread slices, crackers, cereals … heck, fat-free chocolate milk is even on the menu for Day 5.  Every single cut of meat is specified as lean and every single dairy product is specified as low-fat or fat-free.  Recipes call for margarine and corn or canola oil, but of course never butter.  There’s almost no quality fat on the menu to make you feel full and nourished.

I would shrug it off and say most people will ignore these menus – which they will – but of course every public school, military installation, prison, government cafeteria, etc., etc. is required to serve meals like these.

The My Plate site is full of nonsense about how eating this way can help people lose weight.  Riiiight.  The only people who will lose weight because of these menus are the prisoners – and only because they can’t go out and stuff themselves with snacks after their USDA-approved meals leave them feeling hungry.

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In my last post, I compared the organizations that have been promoting artercloggingsaturatedfat! hysteria for the past 40 years to prosecutors who refuse to believe they put an innocent man in prison — even when new evidence says that’s exactly what happened.  Never mind that pesky new DNA test, they insist. You have to look at the totality of the evidence. Someone who either works for or believes in the American Heart Association even left a comment to that effect (along with a couple of links):

You don’t take fringe studies from 50 years ago that contradict the vast majority of lipid research over the last half century and make a conclusion. You look at the body of evidence.

Well, the Sydney Diet Heart Study wasn’t exactly a “fringe” study.  It was a controlled clinical trial that ran for seven years and included 458 subjects.  Unless human biology has changed in the past 50 years, the results are still relevant.

I’ll examine that “vast majority of lipid research” the commenter linked to in a moment.  First I’d like to deal with the argument that we must consider the totality of the evidence.

No, we don’t.  Good scientists don’t consider a hypothesis to be validated unless the evidence supporting it is consistent and repeatable.  As the science philosopher Karl Popper explained, if your hypothesis is that all swans are white, as soon as I start finding black swans, your hypothesis is wrong.  It’s been falsified.  If you find 100 white swans and I only find three black ones, you might insist that the “totality of the evidence” is in your favor, and it is – but your hypothesis is still wrong.

Another reason I don’t buy the “totality of the evidence” argument is that selection bias and publication bias are both rampant in nutrition science.  I’ve read papers where the conclusions simply weren’t supported by the actual data.  Studies that don’t produce the results the investigators wanted are often buried.   If your academic paper supports conventional wisdom, it’s far more likely to be published.  As Dr. Uffe Ravnskov can tell you from personal experience, papers that challenge conventional wisdom are often rejected over and over, with little or no explanation … unless you consider “this just has to be wrong” an explanation.  So when researchers decide to do a meta-analysis of published studies, there’s a good chance they’re analyzing a stacked deck.

With that in mind, let’s start by looking at some of the “totality of the evidence” offered by the arterycloggingsaturatedfat! crowd, then move on to a few black swans.

The first link from our “body of evidence” commenter was to this study, a meta-analysis of eight studies.  And how were those studies selected?  Did the investigators go out and examine the entire body of evidence?  Hardly.  Here’s a quote from the study:

Of 346 identified articles, 290 were excluded based upon review of the title and abstract. Full texts of the remaining 54 manuscripts were independently assessed in duplicate by two investigators to determine inclusion/exclusion. Forty-six studies were excluded because they did not meet inclusion and exclusion criteria.

Most of the “body of evidence” was excluded merely by reading titles and abstracts.  I’m not claiming the investigators rejected studies that didn’t support conventional wisdom, but the potential for cherry-picking is certainly there.  Out of 346 studies they identified, they ran their analysis on just eight.

To their credit, the researchers discussed the weaknesses of the eight studies they selected:

Many of the identified randomized trials in our meta-analysis had important design limitations.  For example, some trials provided all or most meals, increasing compliance but perhaps limiting generalizability to effects of dietary recommendations alone; whereas other trials relied only on dietary advice, increasing generalizability to dietary recommendations but likely underestimating efficacy due to noncompliance. Several of these trials were not double-blind, raising the possibility of differential classification of endpoints by the investigators that could overestimate benefits of the intervention. One trial used a cluster-randomization cross-over design that intervened on sites rather than individuals; and two trials used open enrollment that allowed participants to both drop-in and drop-out during the trial. The methods for estimating and reporting PUFA and SFA consumption in each trial varied, which could cause errors in our estimation of the quantitative benefit per %E replacement. One of the trials also provided, in addition to the main advice to consume soybean oil, sardines to the intervention group, so that observed benefits may be at least partly related to marine omega-3 PUFA rather than total PUFA consumption.

Enough said about that one.

The commenter also left a link to this study, another meta-analysis published by our pals at the American Heart Association.   Here’s pretty much all you need to read to realize we’re not exactly looking at overwhelming evidence:

Several randomized trials have evaluated the effects of replacing saturated fatty acids with PUFAs on CHD events.  Intakes of PUFA (almost entirely omega-6 PUFA) ranged from 11% to 21%. In addition to the inability to double-blind these studies, many had design limitations such as small sample size (n=54), the provision of only ≈50% of meals, outcomes composed largely of “soft” ECG end points, randomization of sites rather than individuals with open enrollment and high turnover of subjects, use of vegetable oils that also contained the plant omega-3 fatty acid α-linolenic acid, and simultaneous recommendations to increase fish and cod liver oil use.

Think we have enough confounding variables there?  The “totality of the evidence” doesn’t appear to be very convincing.  I believe an intelligent jury would have to conclude there’s more than a little reasonable doubt.  So let’s move on to some black swans.

The American Heart Association’s advice is based on the belief that saturated fat raises cholesterol, and high cholesterol causes heart disease.   Replace those arterycloggingsaturatedfats with polyunsaturated or monounsaturated fats, and you’ll lower your cholesterol, thus preventing a heart attack.

Does eating saturated fat raise your cholesterol?  Perhaps, but not necessarily.  Look what happened in this study:

Multiple food allergies required a group of seven patients with elevated serum cholesterol levels to follow a diet in which most of the calories came from beef fat. Their diets contained no sucrose, milk, or grains. They were given nutritional supplements. This is the only group of people in recent times to follow such a diet. During the study, the patients’ triglyceride levels decreased from an average of 113 mg/dl to an average of 74 mg/dl; at the same time, their serum cholesterol levels fell from an average of 263 mg/dl to an average of 189 mg/dl. At the beginning of the study, six of the patients had an average high-density lipoprotein percentage of 21%. At the end of the study, the average had risen to 32%. These findings raise an interesting question: are elevated serum cholesterol levels caused in part not by eating animal fat (an extremely “old food”), but by some factor in grains, sucrose, or milk (“new foods”) that interferes with cholesterol metabolism?

When I cut the carbohydrates and increased my animal-fat intake, my total cholesterol dropped, my LDL dropped, my triglycerides dropped, and my HDL went up.  That’s what happened with the patients in this study as well.  So perhaps saturated fat, if it’s harmful at all, is only harmful in the context of diet that includes sugars and grains – exactly the point Dr. Richard Feinman has made over and over.

Switching to vegetable oils can indeed lower cholesterol levels, but that does translate to fewer heart attacks?  That’s what the American Heart Association tells us.  But once again, I see black swans in the sky.  In the Sydney Diet Heart Study that started this debate, the men who switched to safflower oil lowered their cholesterol by an average of 13%.  That means a subject whose total cholesterol was 230 (deemed unsafe by the AHA) would, on average, end up with total cholesterol of 200 – the recommended level.  And yet the men whose cholesterol was lowered by substituting polyunsaturated fats for animal fats ended up with a higher mortality rate, including higher mortality from heart disease.  I’d call that a rather dramatic black swan.

In this study, the researchers were able to lower cholesterol levels by having a control group of men switch to soybean oil.  Here are the results:

The test diet lowered the serum-cholesterol from a mean initial figure of 272 to 213 mg. per 100 ml. at six months (22% fall); the level in the controls fell from 273 to 259 mg. per 100 ml. (6% fall). Suspected relapses were assessed at regular intervals by a review committee unaware of the patient’s diet group. 62 men on the test diet suffered at least one relapse during the period of observation compared with 74 of the controls.  40 of the first relapses in the test group were major (i.e., definite reinfarctions or deaths from coronary heart-disease) compared with 39 major first relapses in the controls. The total number of men who had a major relapse at any time in the trial was 45 in the test group and 51 in the controls; of these major relapses 25 in each group were fatal. None of the differences found is significant. Relapses were not related to initial cholesterol level, to change in cholesterol level during the trial, nor, in any consistent way, to observance of the dietary regimen.

Once again, we see a dramatic fall in cholesterol levels, but no difference in heart-attack deaths.  That looks like another black swan to me.

Here’s still another clinical study in which polyunsaturated fats replaced saturated fats:

Four hundred fifty-eight men with coronary heart disease participated in a trial of secondary prevention for 2 to 7 years. Overall five year survival was 81%. For those with first heart attacks it was 86%.

From infarct to entry into the trial the majority of men had already made changes in their diet and smoking habit and has lost weight. They were allocated randomly to two dietary groups. In one group the diet consumed derived 9.8% of calories from saturated fatty acids and 15.1% from polyunsaturates. In the second group saturated fatty acids contributed 13.5% and polyunsaturated fatty acids 8.9% of total calories. Survival was slightly better in the second group. Multivariate analysis showed that none of the dietary factors were significantly related to survival.

No significant difference, and what difference there was favored the group that consumed more saturated fat.

I saved my favorite for last.  In this study, men with existing heart disease were divided into three groups:  the control group maintained their normal diet, a second group was instructed to cut back on animal fats and consume polyunsaturated corn oil, and the third group was instructed to cut back on animal fats and consume monounsaturated olive oil.  You know, olive oil – the stuff that’s supposed to prevent heart attacks.  Here’s a quote from the full text of the study:

Patients in both oil groups were instructed to avoid fried foods, fatty meat, sausages, pastry, ice-cream, cheese, cakes (except plain sponge), etc. Milk, eggs, and butter were restricted. An oil supplement of 80 g./day was prescribed, to be taken in three equal doses at meal-times. The general nature and purpose of treatment were explained, together with the fact that different patients were receiving different kinds of oil. No advice on dietary fat was give to control patients.

The men in the two invention groups were monitored and counseled every month at first, then every two months.  Investigators then tracked cardiac deaths and cardiac events for two years.  The control group, by the way, was the oldest on average:  58.8 years vs. 55 years for the olive-oil group and 52.6 years for the corn-oil group.  Considering that heart-disease rates increase dramatically as people move through their fifties, I think that’s significant.  Nonetheless, here are the results from the study:

At two years the proportion of patients remaining free of major cardiac events is greater for the control group (75%) than for the two oil groups (olive oil 57%, corn oil 52%). The likelihood that the difference between the control and corn-oil groups was due to chance is 0.05-0.1 (S.E. of difference, + 13 %). Among those patients who were followed for a third year no new trend emerged.

Strangely, the researchers concluded that corn oil isn’t a good treatment for heart disease, but said nothing about olive oil.

That study was published in 1965.  Here’s a bit of text from the American Heart Association’s current guidelines online:

Eat foods with monounsaturated fats and/or polyunsaturated fats instead of foods with high levels of saturated fats or trans fats.  Check out our Fats and Sodium Explorer tool to get your personal daily calories and fat and sodium limits.

Choose:  Vegetable oils and margarines with liquid vegetable oil as the first listed ingredient.  Examples are canola, corn, olive, peanut, safflower, sesame, soybean and sunflower oils.

Corn oil and safflower oil — two oils that produced higher cardiovascular mortality rates in clinical studies.

I rest my case.

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If you’re a sympathetic sort, you could almost feel sorry for people who work for the American Heart Association, the British Heart Foundation, the Australian Heart Foundation, etc.   They’ve been promoting anti-fat hysteria for more than 40 years now, people have dutifully cut back on their saturated fat intake and consumed more “heart-healthy” grains, and yet our societies are witnessing record rates of obesity and diabetes. Even if these organization believe their advice is correct, I don’t see how they could feel successful in their missions.

But of course, their advice isn’t correct.

I’m not a big fan of observational studies, but since the American Heart Association likes to cite them as evidence, here’s a conclusion several observational studies have reached:  when people replace saturated fats with refined carbohydrates, their rate of heart disease goes up, not down.  Clinical studies show that refined carbohydrates raise triglycerides, and high triglycerides at at least associated with heart disease, if not an actual cause.  And yet for decades now, the AHA has been putting its stamp of approval on products like the ones shown below.


Let’s look at the (ahem) nutrition in some of these heart-protecting foods.  In a serving size that provides just 118 calories (boy, that’ll get you through the morning, won’t it?), Honey Nut Cheerios contain 23 grams of refined carbohydrates.  Almost 10 of those grams are pure sugar.   A cup of West Soy vanilla soy milk contains 21 grams of carbohydrates, including 10 grams of sugar.  The instant oatmeal contains 31 carbohydrates including 12 grams of sugar, and the V-8 fusion juice may as well be a Coca-Cola:  25 grams of sugar in one cup.

So well-meaning people filling their grocery carts with products bearing the American Heart Association’s seal of approval could easily end up on a diet high in refined starches and sugars and think they’re doing their hearts a favor.  I’m sure many have.

Meanwhile, more and more studies are suggesting that the whole arterycloggingsaturatedfat! theory was wrong.  I just posted on one of those last week.

So image you’re a dedicated member of the American Heart Association.  Evidence is piling up that the advice your organization has been handing out since the 1960s not only didn’t help, it probably caused actual harm.  What can you do?

Well, you could call a press conference or take out ads in national newspapers and announce that you’ve been wrong all along, but that would likely spell the end of your organization.  It would also mean looking yourself in the mirror and saying, “Oh my god … have I been promoting foods that turned people into fat diabetics?  Have kids been diagnosed with ADHD and sent to special-ed classes because I told their parents Honey Nut Cheerios are a heart-healthy food?  Have I told people to eat foods that sent their triglycerides through the roof and caused their bodies to produce small LDL particles? Has my advice killed people?”

Nope.  You won’t do that.  You probably can’t do that.

I’ve mentioned the excellent book Mistake Were Made (but not by me) several times.  It covers a range of ideas, but here are three of the most important points:

  • Once we’ve taken a public position, it’s very difficult to admit we were wrong.
  • Psychologically, most of us need to believe we’re both good people and good decision-makers.
  • We are quite capable of fooling ourselves into believing things that simply aren’t true, even if that means ignoring clear evidence.

The book provides interesting (and unfortunately common) examples of those points in action.  What happens when, say, a woman marries a guy who turns out to be an abusive creep?  She runs out and gets a divorce, right?

Nope.  Odds are she’ll spend years with the guy before dumping him, if she dumps him at all.  Think about the three points above.  When you get married, you’ve made a dramatic public statement:  this is the one. It would be embarrassing to admit to your family and friends a year later that your marriage was a huge mistake – telling them, in effect, that in making perhaps the most important decision of your life, you chose badly.  (I broke off an engagement in my early 30s, so I know all about that one.)

So the abused wife can, against all evidence, convince herself that her husband is actually a decent guy.   Sure, he’s abusive, but it’s not really his fault.  He’s just under a lot of stress, you see.  It’s because other people treat him badly.  It may even be her fault for aggravating him.  And he’s nice to her once or twice per month, and that’s the real him, you see.  He just needs more time and few breaks, and he’ll be nice all the time.

Another example the book gives is police and prosecutors who arrest an innocent man and send him to prison, only to see him exonerated years later by DNA evidence.  You’d expect the prosecutors to say to themselves, “Wow, that’s horrible.  We put an innocent guy away.”  You’d also be wrong.  Despite the large number of people who have been exonerated by new evidence, it’s exceedingly rare for a prosecutor to admit he or she put the wrong man in prison.  As the authors recount, most prosecutors are still convinced – despite the evidence – that the guy they put away was guilty.

Once again, we’re talking about people who took a very public position (ladies and gentlemen, this is guy who committed the crime) and who need to think of themselves as good people (I’m the good guy because I put away bad guys.)  To protect themselves psychologically, they can explain away the evidence that they were wrong.  The alternative is to look in the mirror and admit they ruined an innocent person’s life, not to mention his family’s life.

As the authors note, people who insist they were right all along even when the evidence says they’re wrong aren’t usually lying.  To lie, you have to know what you’re saying isn’t true.  These people truly believe they’re right.   That pesky new DNA evidence was probably planted, you see.  The lab made a mistake.  The guy committed the murder, but the DNA that doesn’t match his was left behind by an accomplice we didn’t know about.  The guy we put in prison is guilty, damnit.  Never mind the fact that the DNA left behind on the victim doesn’t match.  You have to look at the totality of the evidence.

The American Heart Association and its sister organizations have been spreading arterycloggingsaturatedfat! hysteria for decades – in effect, prosecuting the innocent.  They’ve recommended processed vegetables oils instead of animal fats.  They’ve taken very public positions warning people away from high-fat foods and promoting breads, cereals, pastas, juices, and other foods low in fat but high in carbohydrates.  And of course, they think of themselves as the good guys.

So no, they’re not going to admit they were wrong.  They’re not going admit their advice may have killed people.  They’re incapable of believing that.  They’re going to show up in media articles and TV shows and blogs and insist they were right all along.  Never mind that latest study, they’ll insist.  You have to look at the totality of the evidence.

Actually, no, we don’t have to look at the totality of the evidence.  We just need to examine some key evidence that falsifies their theories.  I’ll cover that in my next post.

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A new report from the USDA says Americans are eating less fat than we did 30 years ago.  Here’s the opening from an online article about the report:

On average, Americans are eating 10g less fat per day today than they were in the late 1970s, according to new research.  In a report comparing food consumption patterns in 1977-78 versus 2005-2008, Biing-Hwan Lin and Joanne Guthrie from USDA’s Economic Research Service found that on average, Americans consumed 75.2g of fat in 2005-08 compared with 85.6g in 1977-78.

Meanwhile, the percentage of total calories derived from fat also declined substantially from 39.7% to 33.4% between 1977 and 2008, said the authors.

Hallelujah!  Now that USDA itself is admitting we’re eating less fat, surely they’ll finally also admit that the rise we’ve seen in obesity and metabolic syndrome in the past 30 years can’t be blamed on fat.  I can just hear the press conference where they announce they’re allowing whole milk back in schools …

However, with more Americans eating out than ever before, a growing proportion of the fat that they do consume is the unhealthy, saturated, variety, said the authors, noting that almost a third (31.6%) of calories were from foods consumed outside the home in 2005-8 compared with just 17.7% in the late 1970s.

“Food consumed away from home is higher in saturated fat than foods consumed at home [in the 2005-8 data set].  The higher percent of calories from saturated fat in fast-foods was especially noteworthy at 13.5%, compared with 11.9% in restaurant foods, 12.3% in school foods, and 10.7% in foods consumed at home.”

Similarly, foods consumed away from home in 2005-8 contained significantly more sodium (1,820mg of sodium per 1,000 calories), than foods consumed at home (1,369mg sodium per 1,000 calories); with foods from restaurants and fast-food outlets particularly sodium-dense at 2,151mg and 1,864mg of sodium per 1,000 calories, respectively.

Head.  Bang.  On.  Desk.

Faced with their own evidence that fat didn’t commit the crime, the USDA researchers nonetheless rounded up the usual suspects:  Saturated Fat and his evil sidekick Sodium.  I wondered if perhaps the news story missed the point of the USDA report, so I looked it up online.

Nope, the report is full of hand-wringing about how much more often Americans these days eat in restaurants, where (egads!) the meals are higher in saturated fat.  Here are some pieces of the report:

Food prepared away from home (FAFH)—whether from table-service restaurants, fast-food establishments and other locations, or from a take-out or delivery meal eaten at home—is now a routine part of the diets of most Americans. Previous Economic Research Service (ERS) research found that FAFH tends to be lower in nutritional quality than food prepared at home (FAH), increases caloric intake, and reduces diet quality among adults and children. This study updates previous research by examining dietary guidance and the nutritional quality of FAH versus FAFH in 2005-08, compared with 1977-78.

Poor diets contribute to obesity, heart disease, stroke, cancer, diabetes, osteoarthritis, and other health conditions that impose substantial economic burden on Americans (USDA/USDHHS, 2011; USDHHS, 2010). The medical costs associated with overweight and obesity have been estimated as high as $147 billion, or 10 percent of all medical costs in 2008 (Finkelstein et al., 2009; O’Grady and Capretta, 2012; Tsai et al., 2011). These enormous costs are one reason that USDA and other public and private entities place a high priority on improving Americans’ diets.

Well, we’re all grateful beyond belief that the USDA is dedicated to improving our diets and putting the country on sound financial footing as a result.  So what’s the “poor diet” that’s contributing to all those problems?

As the share of food expenditures spent on FAFH has risen over the past 30 years, so has the share of calories and nutrients consumed from such food. Previous ERS research found that FAFH in the 1990s contained less of the food components Americans underconsume, such as calcium and dietary fiber, and more of those overconsumed, such as fat, compared with FAH.

So there’s the problem:  we eat out more than we did 30 years ago, and restaurant food is higher in saturated fat (and sodium, as the researchers note several times in the report).  Case closed.

Except we somehow manage to consume less fat than we did 30 years ago, despite a higher calorie intake.  Are we actually eating a lot more saturated fat than our grandparents did, despite eating less fat overall?  How can that be?

If you suspect the USDA decided to toss around some accusatory percentages in order to frame their favorite suspect, you’d be right. I can almost imagine the conversation in the hallowed halls of USDA research:

“Did you finish crunching the numbers, Jenkins?”

“Yes, sir.  Good news:  people are eating less fat than they did in 1978.”

“Whew!  For a minute there, I thought you were going to say people are eating less fat.”

“I did say that, sir.  But rates of obesity and diabetes are clearly–”

“Great.  There you have it, then.  We should continue telling people to cut back on fat.”

“But sir, they have cut back on fat, almost to the level we’ve been recommending.”

@#$%!! Okay, here’s what you do, Jenkins.  Figure out how much more saturated fat is in restaurant food.  Then let’s roll those figures together with the data on how much more often people eat in restaurants these days.  Use percentages, because that makes the numbers look bigger.”

“One step ahead of you, sir.  I already crunched those numbers, and in terms of total saturated fat intake, the difference is only—”

“Jenkins, I don’t think you understand what I’m saying, so let me explain it this way:  shut up.”

The report mentions using surveys for collecting data, so the numbers are suspect.  But the USDA based a study on the data and reached conclusions about what’s causing our health issues, so let’s go along for the ride.

According to the report, we consumed an average of 1,875 calories per day in 1978 and 2,002 calories per day in 2008.  I thought those figures sounded ridiculously low until I realized the data is for Americans ages 2 and up.  I don’t know how many calories my daughters consume in a day, but it’s nowhere close to 2,000.  Kids obviously bring down the averages.

Now, let’s suppose we heed the USDA’s warnings about the higher saturated-fat content in restaurant meals and decide we shouldn’t be consuming 31.6% of our total calories in restaurants.  Let’s go back to consuming just 17.7% percent of our calories in restaurants, like in the good ol’ days of 1978.  (You may dig out your leisure suit and pull up KC and the Sunshine Band in iTunes if it helps you get in the mood.)

The report tells us that meals at home average 10.7% saturated fat by calories, restaurant meals average 11.9% saturated fat by calories, and fast-food meals average 13.5% saturated fat by calories.  Well, heck, just to tip the scales in favor of the USDA’s argument, I’m going to assume all restaurant meals are fast-food meals.  So using the 2008 average of 2,002 calories per day, here’s how our saturated-fat intake is affected by consuming 31.6% of our calories in restaurants instead of 17.7%  — I’ll listen to Sara’s math teacher and show my work:

31.6% calories consumed in restaurants:

Restaurant: (2,002 calories) x (13.5% sat-fat) x (31.6%) = 85.4
Home: (2,002 calories) x (10.7% sat-fat) x (68.4%) = 146.5

Add our home and restaurant meals together, and we’re averaging 231.9 calories per day from saturated fat.  I’ll do the USDA a favor and round up to 232 calories.  Now let’s heed the USDA’s advice.

17.7% calories consumed in restaurants:

Restaurant: (2,002 calories) x (13.5% sat-fat) x (17.7%) = 47.8
Home: (2,002 calories) x (10.7% sat-fat) x (82.3%) = 176.3

Add them together, we get an average of 224.1 calories per day from saturated fat.  I’ll do the USDA a favor and round down to 224 calories.

So here’s what we’re looking at if we do the math the USDA either didn’t do or chose not to share, opting instead for big, scary-sounding percentages so they could continue placing the blame on saturated fat:

Based on their own data, the difference between consuming 31.6% vs. 17.7% of our meals in fast-food joints works out to (hold your breath!) … 8 calories of saturated fat per day. Or you could calculate it as 25.8 grams per day vs.  24.9 grams per day.

Since I’m feeling generous, I’ll forget that we consume less fat now than in 1978 and run the numbers assuming we reduced both our total calorie intake and the percentage of calories consumed in restaurants to 1978 levels:

Restaurant: (1,875 calories) x (13.5% sat-fat) x (17.7%) = 44.8
Home: (1,875 calories) x (10.7% sat-fat) x (82.3%) = 165.1

The combined daily average is 209.9 calories from saturated fat.  Let’s call it 210.  So if we reduced our calorie consumption and percent of calories consumed in restaurants to 1978 levels, we’d be talking about 23.3 grams per day of saturated fat instead of 25.8 — a difference of 2.5 grams per day.  And to repeat, I ran those numbers assuming all restaurant meals are fast-food meals — which they aren’t.

Yup, I’d say the USDA has found the cause of all of our health problems.  We eat out more often, and we’re clearly loading up saturated fat as a result.

By the way, the term saturated fat appeared in the report 19 times.  The word sugar appeared once.  Thank goodness they’re focusing their efforts on the real culprit.

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Here’s one of the studies I’d saved and forgotten until I got organized over the holidays.  The researchers took a survey among doctors to determine their attitudes towards the obese.  Let’s look at the results:

Six hundred twenty physicians responded. They rated physical inactivity as significantly more important than any other cause of obesity. Two other behavioral factors — overeating and a high-fat diet — received the next highest mean ratings. More than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant.

So there’s the consensus medical opinion for you:  obese people are obese because they don’t move around enough and eat too much fat.  If you need more evidence that the average doctor doesn’t don’t know diddly about weight loss, there it is.

In his book Fat Politics, Professor Eric Oliver (who appeared in Fat Head) wrote that obese people often avoid doctors – thus allowing treatable conditions to go untreated – because they’re afraid they’ll be criticized for their size.  Given the results of this survey, I’d say that’s a reasonable fear.

“Why aren’t you sticking to the low-fat diet and exercise program I prescribed?!”

“I am, Doctor.”

“No, you’re clearly not.  Just look at you.  You’re awkward, unattractive, ugly and noncompliant.  Now, when should we schedule you for a follow-up visit?”

Unfortunately, much if not most of the general public shares the same belief:  obesity is the result of laziness.  I was reminded of that in two emails I received this week from readers.  Here’s part of the first one:

Having watched Super Size Me I was, as I assume many others were, led to believe what the film intended: the vast majority of Americans are fat, lazy and (for lack of a better term) stupid — a belief I’ve pretty much held my entire life. Being athletic and “skinny,” I have done nothing but look down on those who didn’t match what I saw in the mirror.

I thought all you had to do to be like me is get your ass off the couch and do something. Burn more calories, lose weight, easy enough … or so I thought.  Having grown older and somewhat wiser, I’ve started realizing the faults of that mentality.

Put an M.D. after his name and take away the wisdom that came with maturity, and you’d have your average doctor looking at an obese patient.  Thank goodness he saw the light (and Fat Head.)

Here’s another email from a guy who also believed losing weight was all about being more active – until he gained weight himself:

I was always skinny as a child. I wrestled in high school at a lower weight (130), at 5’9″. The coach was a popular guy, so we often got graduates coming back to practice with the team a few times on their college winter break. Invariably, the graduates would be well over their old weights, leading to joking around about how “fat” they’d become. The coach would always tell us that, in time, we’d all develop paunches and be “fat old men.” We just accepted it, while we downed rice cakes and diet cola at lunch during the season to keep us in our weight class –by senior year, this was already difficult for me, despite the grueling practices.

Years passed (I’ve always wanted to write that)….

When I hit 30, I looked at my weight. Despite never being “fat”, I’d gone up to 170-175lbs (depending on whether I’d pigged out or not the last few days), which is overweight on the BMI scale.

I immediately started working out again like I did on the old squad, and pretty soon had a 2-3 times per week routine of distance running and weight training. I clocked a 7 minute mile in 6 months, and was lifting a substantial amount. Yet, despite all this hard work, I was still tipping the scales at 170lbs!

My diet was “extra healthy”: a glass of orange juice for breakfast, with perhaps some oatmeal; a meal of rice, beans, and cheese for lunch (easy on that fatty cheese, pile on the rice and beans!); and spaghetti for dinner, with 2-3 pieces of wheat bread to mop up the sauce. For a snack, an English muffin, or else three “reduced fat” Oreos. Yet, after months of this “healthy eating,” I still was at 170lbs on my best day! Who’d have thunk it, right?

And then the injuries started up. Plantar fascitis was a huge one—I’d wake up in the morning and feel a ton of pain just standing up. The podiatrist I saw gave me some painkillers and told me I’d need some inserts for my shoes, probably for most of my life. My back and neck ached too.

At first I just thought I was getting old. So I continued to work out. I hit 10 pullups, 100 situps, and 50 pushups, with my running at a 7 minute mile clip and lifting weights. But … more pain, no weight loss!

The reader saw Fat Head and decided to try a low-carb diet based on meats, eggs and vegetables with some full-dairy.  He hoped to lose 3-4 pounds in the first month.  He lost 10 instead.  He continues:

I nearly flipped out! As one person wrote on another website, low-carb dieting was like playing a video game with a God-mode-cheat-code. So easy! I didn’t count calories, never skimped on a meal, was always full and happy. And I hadn’t seen 160 since…well, I don’t know when I passed it to begin with, but certainly not since I passed 30.

Full, happy, no counting calories … that’s my life now.  I didn’t make a New Year’s resolution to lose weight this year and haven’t in three years. I don’t even own a scale.  My only diet resolution this year was to return to what I know works after indulging a bit over the holidays.

The “fluffy” picture (as one reader kindly put it) I posted earlier in the week was of me on a low-fat diet – and I was a regular jogger in those days.  (I once found a videotape of me jogging, looking quite fat in my jogging outfit.)  I also worked out at a Nautilus club two or three times per week.  An athletic, naturally-lean buddy of mine (who also believed people are fat because they eat too much and don’t move around enough) once joined me for a workout and admitted later he was surprised by how much I could out-lift him.

Despite the low-fat diet and all that physical effort (doctor approved!), I was fat.  I wasn’t morbidly obese, but I do remember a doctor pointedly telling me I should focus on losing some weight.  He likely thought I was lazy and sat around all the time.  Hardly.  I probably could have beaten him in either an arm-wrestling match or a 5k race.

It’s January, so millions of fat Americans are hitting the gyms and health clubs, hoping to sweat their way into leaner physiques.  Their doctors would approve.

Around April or so, many of them will become frustrated and give up — at least that’s the annual pattern Chareva and I have noticed at the rec center where we work out.  Their doctors will disapprove, labeling them as lazy and non-compliant.

Their doctors don’t know squat.

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