About eight years back, I attended the first high school play I’d seen in decades, and I was so confused. The directing, acting and sets were practically professional — much better than in 1980. And the actors — they didn’t look like high school kids. The boys were bulked up, and the girls had full thighs and round hips. Were they ringers from a community theater group? Maybe college kids?
Turns out, they were just high school kids, in the sizes that high school kids are now. In 1980, only 5 percent of teens were obese. By 2000, 14 percent of teenage girls were overweight. Three years later, it was 16 percent. Since then, the percentage has stabilized at 17 percent.
So what happened after 1980? Robert Lustig has been watching from his post as a pediatric endocrinologist at Children’s Hospital in San Francisco. In his 2012 book Fat Chance he argues that a calorie is not a calorie. What it’s made of is critical. Lustig’s idea is that tracing why Americans are fatter means looking at what kind of calories we’re eating.
Americans eat less fat (as a total percentage of calories) than they did prior to the 1980s. Protein consumption is stable. But carbohydrate consumption? Up from 40 percent of the average diet to 55 percent.
That extra intake — 15 percent more carbohydrates — adds 300 calories to a 2,000-calorie-a-day diet. And it’s disproportionately sugar, says Lustig. “Our consumption of fructose has doubled in the past 30 years and has increased sixfold in the last century,” he writes.
His book isn’t aimed at wagging a finger at overeaters. It’s the opposite. “Obesity is a biochemical alteration in the brain. … Gluttony and sloth are not the cause of the problem; they are the result of the problem.” Instead he accumulates a mass of data leading toward a central conclusion: A calorie of sugar makes us fatter than a calorie of fat or protein.
The result of eating more sugar, and other changes in our environments, is that “the majority of humans, regardless of weight, release double the insulin today that we did 30 years ago” per unit of glucose. The excess insulin and resulting fat lead to elevated triglycerides, reduced HDL, high blood pressure, central obesity (belly fat), insulin sensitivity, elevated fasting glucose. That cluster of symptoms is called metabolic syndrome, and it’s spreading like a pandemic.
Lustig deploys recent studies that offer lots of little “I didn’t know that” moments. Take beer. Most alcohol doesn’t contain glucose, but beer does. That’s why it’s implicated in metabolic syndrome, one aspect of which is “visceral” or belly fat. So the beer belly is a real thing.
Or starch: Glucose energy, the kind in starch, has energy that every cell in the body can use, but fructose turns straight into stored fat unless you burn it right away.
Or this valuable little nugget about fiber: Nonsoluble fiber (like celery strings) forms a mesh in the gut. Soluble fiber sticks to this mesh, and the combination slows the “rate of flux from the intestine to the bloodstream,” preventing starch or sugar from overwhelming the liver. But if the soluble-fiber food is pulverized (like blueberries in a smoothie) the fiber content is destroyed. So the second part of the latticework isn’t there, and any sugar in the meal hits the bloodstream quickly.
Or this: Exercise isn’t about burning calories to lose weight. Exercise is about improving your insulin sensitivity by improving leptin signaling. (Leptin is the hormone that makes you feel full.) And it’s about creating new mitochondria, which improve your resting energy expenditure.
Or this scary trait of fructose: “Consumption of fructose does not stimulate an insulin response, so leptin doesn’t rise and [you] keep eating (or drinking soda, as the case may be). “Ghrelin, a peptide produced by cells in the stomach, is the ‘hunger’ signal. … Fructose intake does not decrease ghrelin; therefore, caloric intake is not suppressed. Indeed, fructose consumption in the form of a Big Gulp does not reduce the volume of solid food needed to feel satiated. …”
Sugar goes to fat. We eat too much sugar. Not news, but the way it happens is so relentless, and the volume of sugar in our environment is so inescapable. Sugar is the food environment in the lives of many.
Janet Colson, a nutrition professor at MTSU, has a photo she shows to her child nutrition classes. It’s a child, eating a USDA-supplied school breakfast: a bowl of Froot Loops sits before her, and she’s pouring strawberry milk over it. “The USDA says we’re only supposed to have 120 ‘empty’ calories a day, and that’s 100 right there,” says Colson. “It’s mind-boggling that a child can go to school in the USDA lunch program and they can easily exceed their recommendation [for empty calories.”
She sends her nutrition students to watch a YouTube lecture called “Children of the Corn Syrup” by Dr. Stephen Ponder, another pediatric endocrinologist and an anti-sugar activist.
The amount of sugar Americans eat and drink is obviously part of the problem, but Colson cautions that nutrition is more nuanced. Fiber intake and exercise are other legs holding up the nutrition table. And the role of genetics is becoming clear and is bigger than we thought.
Still, it’s impossible not to be affected by the mortifying obesity case studies that open each chapter of Fat Chance. And the enormity of the scientific citations is undeniable: Some 321 footnotes cite papers with titles like “Fast Food Insulin Resistance and Obesity” and “Fructose Intake is a Predictor of LDL Particle Size in Overweight Schoolchildren.” It’s easy to find yourself running to the fridge to pour out the juice and throw the sugary breakfast bars in the trash.
And what happens next? Lustig’s advice is familiar. Eat only food that someone’s grandmother would recognize as food. And Michael Pollan’s famous advice: “Eat food. Not too much. Mostly plants.”
Stay far away from added-sugar beverages like soda, but also juice and smoothies. Limit dessert to once a week.
He recommends food labeling to distinguish added sugar from natural sugars (like lactose in yogurt). Labels should be even clearer on serving sizes with real-world phrases like “half this package.”
And he floats aggressive social and policy interventions to reduce supply and demand for sugar.
* Tax sugar-sweetened beverages.
* Enact age limits for purchasing sugar-sweetened beverages,.
* Ban advertising to children, as the EU has done.
* Use zoning to control fast food and convenience stores in neighborhoods with a high incidence of childhood obesity and metabolic syndrome.
* Re-engineer farming subsidies away from storable crops like corn and soybeans to fresh fruits and vegetables.
Who knows if the advice of Lustig, Ponder and others will “take” as well as the low-fat diet mania of the ’90s? And if it does, will it make a difference? Other approaches certainly seemed convincing in their time, though Lustig definitely wins on volume of science. Still, the devil’s in the details, and science uncovers more details all the time.
Maybe we’ll look back and laugh at the unsophisticated science of the Aughts and Teens. Maybe we’ll have found a better way to eat and be healthy.
Or maybe we’ll be sitting at our grandchildren’s high school plays, watching knobby-kneed, skinny-hipped kids we heard about before the 1980s.
The important thing about whole grains is that the bran on the outside is gradually digested, slowing the release of starch in the wheat. And also? It’s chewy and delicious.
2 tablespoons lemon juice
1 tablespoon balsamic vinegar
1/4 cup olive oil
1 teaspoon salt
1 teaspoon freshly ground black pepper
1 tablespoon chives, minced green onion
or minced shallot
2 tablespoons torn basil
2 tablespoons fresh dill (or 2 teaspoons dried)
1 cup farro or wheat berries
2 to 2 1/2 cups vegetable broth
1 cup shelled edamame
1/2 cup blue cheese or feta crumbles
Combine all the dressing ingredients in a jar with a tight-fitting lid. Shake to blend.
Cook the farro in 2 cups broth in a pressure cooker for 45 minutes, or in 2 1/2 cups broth in a covered pan for 2 hours. Let cool. Drain if needed.
Cook the edamame in boiling water according to package directions (a couple of minutes); drain. Combine the farro and edamame in a big bowl. Add the dressing while the mixture is warm. Let cool. Top with blue cheese when ready to serve. Makes 8 side dish servings, or 4 main dish servings.
This filling and flavorful salad recipe originated with Delia Smith, a stalwart of English cookbook authors. Halloumi cheese, which has the right texture to pan-fry or grill, is usually available at Middle Eastern markets and sometimes at supermarkets.
1 garlic clove, minced
1 small shallot, minced
Salt to taste (about 1 teaspoon)
1 teaspoon grainy mustard
Zest and juice of 1 lemon
1 tablespoon white wine vinegar
11/2 tablespoons capers
2 tablespoon chopped fresh parsley
2 to 4 tablespoons olive oil
8 to 10 ounces halloumi cheese
1/2 to 2/3 cups all-purpose flour
Salt and pepper to taste
2 tablespoons vegetable oil
4 to 5 cups chopped romaine lettuce or torn leaf lettuce
Combine the dressing ingredients in a jar with a tight-fitting lid and shake to blend.
Mix the flour with salt and pepper. Pat the cheese dry and cut into eight slices. Coat the sliced cheese with the flour mixture. Heat the oil in a large skillet and fry the cheese over medium-high heat for a few minutes until golden brown. Turn and fry the other side (add a little more oil to the pan if needed). Drain on paper towels if needed.
Arrange the greens in a salad bowl. Add about half of the dressing and toss to coat the leaves. Top with the halloumi slices, then drizzle them with about 1 teaspoon of dressing each. Makes 2 main dish salads or 4 side dish salads.