WE WEREN’T ALWAYS so obsessed with calories. Throughout most of human history, obesity has been rare. Individuals in traditional societies eating traditional diets seldom became obese, even in times of abundant food. As civilizations developed, obesity followed. All foods can be divided into three different macronutrient groups: fat, protein and carbohydrates. The “macro” in “macronutrients” refers to the fact that the bulk of the food we eat is made up of these three groups. Micronutrients, which make up a very small proportion of the food, include vitamins and minerals such as vitamins A, B, C, D, E and K, as well as minerals such as iron and calcium. Starchy foods and sugars are all carbohydrates.
IT IS FAIRLY obvious that obesity runs in families.1 Obese children often have obese siblings. Obese children become obese adults.2 Obese adults go on to have obese children. Childhood obesity is associated with a 200 percent to 400 percent increased risk of adult obesity. This is an undeniable fact. The controversy revolves around whether this trend is a genetic or an environmental problem—the classic nature versus nurture debate. Families share genetic characteristics that may lead to obesity. However, obesity has become rampant only since the 1970s. Our genes could not have changed within such a short time. Genetics can explain much of the inter-individual risk of obesity, but not why entire populations become obese.
Nonetheless, families live in the same environment, eat similar foods at similar times and have similar attitudes. Families often share cars, live in the same physical space and will be exposed to the same chemicals that may cause obesity—so-called chemical obesogens. For these reasons, many consider the current environment the major cause of obesity. Any or all of these factors may contribute to the obesogenic environment. Therefore, most modern theories of obesity discount the importance of genetic factors, believing instead that consumption of excess calories leads to obesity. Eating and moving are voluntary behaviours, after all, with little genetic input.
The Thrifty Gene
In Palaeolithic times, food was scarce and difficult to obtain. Hunger is one of the most powerful and basic of human instincts. The thrifty gene compels us to eat as much as possible, and this genetic predisposition to gain weight had a survival advantage. Increasing the body’s food stores (fat) permitted longer survival during times of scarce or no food. Those who tended to burn the calories instead of storing them were selectively wiped out. However, the thrifty gene is ill adapted to the modern all-you-can-eat world, as it causes weight gain and obesity. But we are simply following our genetic urge to gain fat.
Misconception About Calories
TRADITIONALLY, OBESITY HAS been seen as a result of how people process calories, that is, that a person’s weight could be predicted by a simple equation: Calories In – Calories Out = Body Fat. This key equation perpetrates the calorie deception. It is dangerous precisely because it appears so simple and intuitive. But what you need to understand is that many false assumptions are built in.
Assumption 1: Calories In and Calories Out are independent of each other
THIS ASSUMPTION IS a crucial mistake. Experiments and experience have proven this assumption false. Caloric intake and expenditure are intimately dependent variables. Decreasing Calories In triggers a decrease in Calories Out. A 30 percent reduction in caloric intake results in a 30 percent decrease in caloric expenditure. The end result is minimal weight loss.
Assumption 2: Basal metabolic rate is stable
WE OBSESS ABOUT caloric intake with barely a thought for caloric expenditure, except for exercise. Measuring caloric intake is simple, but measuring the body’s total energy expenditure is complicated. Therefore, the simple but completely erroneous assumption is made that energy expenditure remains constant except for exercise. Total energy expenditure is the sum of basal metabolic rate, thermionic effect of food, non exercise activity thermogenesis, excess post-exercise oxygen consumption and exercise. The total energy expenditure can go up or down by as much as 50 percent depending upon the caloric intake as well as other factors.
Assumption 3: We exert conscious control over Calories In
EATING IS A deliberate act, so we assume that eating is a conscious decision and that hunger plays only a minor role in it. But numerous overlapping hormonal systems influence the decision of when to eat and when to stop. We consciously decide to eat in response to hunger signals that are largely hormonally mediated. We consciously stop eating when the body sends signals of satiety (fullness) that are largely hormonally mediated. For example, the smell of frying food makes you hungry at lunchtime. However, if you have just finished a large buffet, those same smells may make you slightly queasy. The smells are the same. The decision to eat or not is principally hormonal. Our bodies possess an intricate system guiding us to eat or not. Body-fat regulation is under automatic control, like breathing. We do not consciously remind ourselves to breathe, nor do we remind our hearts to beat. The only way to achieve such control is to have homeostatic mechanisms. Since hormones control both Calories In and Calories Out, obesity is a hormonal, not a caloric, disorder.
Assumption 4: Fat stores are essentially unregulated
EVERY SINGLE SYSTEM in the body is regulated. Growth in height is regulated by growth hormone. Blood sugars are regulated by the hormones insulin and glucagon, among others. Sexual maturation is regulated by testosterone and oestrogen. Body temperature is regulated by a thyroid-stimulating hormone and free thyroxine. The list is endless. We are asked to believe, however, that growth of fat cells is essentially unregulated. The simple act of eating, without any interference from any hormones, will result in fat growth. Extra calories are dumped into fat cells like doorknobs into a sack. This assumption has already been proven false. New hormonal pathways in the regulation of fat growth are being discovered all the time. Leptin is the best-known hormone regulating fat growth, but adiponectin, hormone-sensitive lipase, lipoprotein lipase and adipose triglyceride lipase may all play important roles. If hormones regulate fat growth, then obesity is a hormonal, not a caloric disorder.
Assumption 5: A calorie is a calorie
THIS ASSUMPTION IS the most dangerous of all. It’s obviously true. Just like a dog is a dog or a desk is a desk. There are many different kinds of dogs and desks, but the simple statement that a dog is a dog is true. However, the real issue is this: Are all calories equally likely to cause fat gain? “A calorie is a calorie” implies that the only important variable in weight gain is the total caloric intake, and thus, all foods can be reduced to their caloric energy. But does a calorie of olive oil cause the same metabolic response as a calorie of sugar? The answer is, obviously, no. These two foods have many easily measurable differences. Sugar will increase the blood glucose level and provoke an insulin response from the pancreas. Olive oil will not. When olive oil is absorbed by the small intestine and transported to the liver, there is no significant increase in blood glucose or insulin. The two different foods evoke vastly different metabolic and hormonal responses. These five assumptions—the key assumptions in the caloric reduction theory of weight loss—have all been proved false. All calories are not equally likely to cause weight gain. The entire caloric obsession was a fifty-year dead end. So we must begin again. What causes weight gain?
Unheard Truth About Exercise And Weight Loss
The fact that exercise always produces less weight loss than expected has been well documented in medical research. Studies lasting more then twenty-five weeks found that the actual weight loss was only 30 percent of what was expected. In one recent controlled study, participants increased exercise to five times per week, burning 600 calories per session. Over ten months, those who exercised lost an extra ten pounds (4.5 kilograms). However, the expected weight loss had been 35 pounds (16 kilograms). Many other longer-term randomized studies have shown that exercise has minimal or no effect on weight loss. A randomized 2007 study of participants who did aerobics for six days per week over one year found that women reduced their weight, on average, by 3 pounds (approximately 1.4 kilograms); men, by 4 (1.8 kilograms). A Danish research team trained a previously sedentary group to run a marathon. MEN averaged a loss of 5 pounds (about 2.3 kilograms) of body fat. The average weight loss for women was... zero. When it comes to weight loss, exercise is just not that effective. In these cases, it was also noted that body-fat percentage was not much changed. The Women’s Health Study, the most ambitious, expensive and comprehensive diet study ever done, also looked at exercise.14 The 39,876 women were divided into three groups representing high (more than one hour per day), medium and low levels of weekly exercise. Over the next ten years, the intense exercise group lost no extra weight. Furthermore, the study noted, “no change in body composition was observed,” meaning that muscle was not replacing fat.
Breakfast: The Most Important Meal To Skip?
THE MAJORITY OF Americans identify breakfast as the most important meal of the day. Eating a hearty breakfast is considered a cornerstone of a healthy diet. Skipping it, we are told, will make us ravenously hungry and prone to overeat for the rest of the day.
Although we think it’s a universal truth, it’s really only a North American custom. Many people in France (a famously skinny nation) drink coffee in the morning and skip breakfast. The French term for breakfast, petit déjeuner (little lunch) implicitly acknowledges that this meal should be kept small.
It is simply not necessary to eat the minute we wake up. We imagine the need to “fuel up” for the day ahead. However, our body has already done that automatically. Every morning, just before we wake up, a natural circadian rhythm jolts our bodies with a heady mix of growth hormone, cortisol, epinephrine and norepinephrine (adrenalin). This cocktail stimulates the liver to make new glucose, essentially giving us a shot of the good stuff to wake us up. This effect is called the dawn phenomenon, and it has been well described for decades.
Many people are not hungry in the morning. The natural cortisol and adrenalin released stimulates a mild flight-or-fight response, which activates the sympathetic nervous system. Our bodies are gearing up for action in the morning, not for eating. All these hormones release glucose into the blood for quick energy. We’re already gassed up and ready to go. There is simply no need to refuel with sugary cereals and bagels. Morning hunger is often a behaviour learned over decades, starting in childhood.
The word breakfast literally means the meal that breaks our fast, which is the period when we are sleeping and therefore not eating. If we eat our first meal at 12 noon, then grilled salmon salad will be our “break fast” meal—and there’s nothing wrong with that.
A large breakfast is thought to reduce food intake throughout the rest of the day. However, such does not always seem to be the case. Studies show that lunch and dinner portions tend to stay constant, regardless of the amount of calories taken at breakfast. The more one eats at breakfast, the higher the total caloric intake over the entire day. Worse, taking breakfast increases the number of eating opportunities in a day. Breakfast eaters therefore tend to eat more and eat more often—a deadly combination.
Furthermore, many people confess that they are not hungry first thing in the morning and force themselves to eat only because they feel that doing so is the healthy choice. As ridiculous as it sounds, many people force themselves to eat more in an effort to lose weight. In 2014, a sixteen-week randomized controlled trial of breakfast eating found that “contrary to widely espoused views this had no discernible effect on weight loss.” We are often told that skipping breakfast will shut down our metabolism. The Bath Breakfast Project, a randomized controlled trial, found that “contrary to popular belief, there was no metabolic adaptation to breakfast.” Total energy expenditure was the same whether one ate breakfast or not. Breakfast eaters averaged 539 extra calories per day compared to those that skipped breakfast—a finding consistent with other trials. The main problem in the morning is that we are always in a rush. Therefore, we want the convenience, affordability and shelf life of processed foods. Sugary cereals are the kings of the breakfast table, with children as the primary target. The vast majority (73 percent) of children regularly eat sugary cereals. By contrast, only 12 percent regularly eat eggs at breakfast. Other easy-to-prepare foods like toast, bread, sugary yogurts, Danishes, pancakes, donuts, muffins, instant oatmeal and fruit juice are also popular. Clearly, the cheap refined carbohydrate reigns supreme here. Breakfast is the most important meal of the day—for Big Food. Sensing the perfect opportunity to sell more highly profitable, highly processed “breakfast” foods, Big Food circled the easy money like sharks on wounded prey. “Eat breakfast!” they thundered. “It’s the most important meal of the day!” they bellowed. Even better, here was an opportunity to “educate” the doctors, dieticians and other medical professionals. Those people had a respectability Big Food could never achieve. So the money flowed. There are some common-sense you can ask yourself about breakfast. Are you hungry at breakfast? If not, listen to your body and don’t eat. Does breakfast make you hungry? If you eat a slice of toast and drink a glass of orange juice in the morning—are you hungry an hour later? If so, then don’t eat breakfast. If you are hungry and want to eat breakfast, then do so. But avoid sugars and refined carbohydrates. Skipping breakfast doesn’t give you the freedom to eat a Krispy Kreme donut as a mid-morning snack either.
ALARMED BY THE stunning rise of obesity and type 2 diabetes in school-aged children, hundreds of millions of dollars were deployed to counterattack. The first choice in our arsenal was the beloved Eat Less, Move More approach, which sported a perfect record unblemished by success. Nevertheless, as nutritional authorities scrambled to do battle, only one diet plan got the call. The U.S. National Institutes of Health funded the HEALTHY study, a large three-year effort involving forty-two schools in grades six to eight. Half of the schools would receive a multicomponent intervention, while the other half continued their usual routines. The study encouraged certain nutritional and exercise goals, including: lowering average fat content of food, providing at least two servings of fruit and vegetables per student, providing at least two servings of grain-based food and/or legumes, limiting dessert and snack foods to less than 200 calories per item, limiting beverages to water, low-fat milk and 100 percent fruit juice and encouraging more than 225 minutes of moderate to vigorous physical activity per week. Our old friend—Eat Less, Move More. Not too bright, but as familiar as an old blanket. There were classroom-based programs, newsletters for parents, social marketing (branding, posters, in-school announcements), student events and incentives (T-shirts, water bottles). Both groups began with roughly 50 percent of the students considered overweight or obese. By the end of three years, the Eat Less Move More group brought that down to 45 percent. Success! The group that followed their usual habits finished at... 45 percent. There was no measurable benefit for the diet and exercise group. This weight-loss strategy was virtually useless. But who hasn’t tried the Eat Less, Move More approach and failed? The HEALTHY study was only the latest in an unbroken string of failures.
The Solution: What to Eat
THERE ARE TWO prominent findings from all the dietary studies done over the years. First: all diets work. Second: all diets fail. Weight loss follows the same basic curve so familiar to dieters. Whether it is the Mediterranean, the Atkins or even the old fashioned low-fat, low-calorie, all diets in the short term seem to produce weight loss. Sure, they differ by amount lost—some a little more, some a little less. But they all seem to work. Obesity is a hormonal disorder of fat regulation. Insulin is the major hormone that drives weight gain, so the rational therapy is to lower insulin levels. There are multiple ways to achieve this, and we should take advantage of each one. Let’s outline a step-by-step approach to accomplish this goal.
STEP 1: REDUCE YOUR CONSUMPTION OF ADDED SUGARS
SUGAR STIMULATES INSULIN secretion, but it is far more sinister than that. Sugar is particularly fattening because it increases insulin both immediately and over the long term. Sugar is comprised of equal amounts of glucose and fructose, and fructose contributes directly to insulin resistance in the liver. Over time, insulin resistance leads to higher insulin levels. Therefore, sucrose and high fructose corn syrup are exceptionally fattening, far in excess of other foods. Sugar is uniquely fattening because it directly produces insulin resistance. With no redeeming nutritional qualities, added sugars are usually one of the first foods to be eliminated in any diet. Many natural, unprocessed whole foods contain sugar. For example, fruit contains fructose, and milk contains lactose. Naturally occurring and added sugars are distinct from one another. The two key differences between them are amount and concentration.
Obviously, first you should remove your sugar bowl from your table. There is no reason to add sugar to any food or beverage. But sugars are often hidden in the preparation of food, which means that avoiding sugar is often difficult and you can ingest a surprisingly large amount without knowing it. Sugars are often added to foods during processing or cooking, which presents dieters with several potential pitfalls. First, sugars may be added in unlimited amounts. Second, sugar may be present in processed food in much higher concentrations than in natural foods. Some processed foods are virtually 100 percent sugar. This condition almost does not exist in natural foods, with honey possibly being the exception. Candy is often little more than flavoured sugar. Third, sugar may be ingested by itself, which may cause people to overeat sugary treats, as there is nothing else within the food to make you “full.” There is often no dietary fibre to help offset the harmful effects. For these reasons, we direct most of our efforts toward reducing added, rather than natural sugars in our diet.
STEP 2: REDUCE YOUR CONSUMPTION OF REFINED GRAINS
REFINED GRAINS SUCH as white flour stimulate insulin to a greater degree than virtually any other food. If you reduce your consumption of flour and refined grains, you will substantially improve your weight-loss potential. White flour, being nutritionally bankrupt, can be safely reduced or even eliminated from your diet. Enriched white flours have had all their nutrients stripped out during processing and later added back to retain a veneer of healthiness. Whole wheat and whole grains are an improvement over white flour, containing more vitamins and fibre. The bran fibre helps protect against the insulin spikes. However, whole-grain flour is still highly processed in a modern flourmill. Traditional stone-mill grinding is preferable. The ultrafine particles produced by modern milling techniques ensure rapid absorption of flour, even whole-wheat flour, by the intestine, which tends to increase the insulin effect. Avoid processed bakery foods that are mostly flour and other starches: bread, bagels, English muffins, roti, naan breads, dinner rolls, bread sticks, Melba toasts, crackers, tea biscuits, scones, tortillas, wraps, muffins, cookies, cakes, cupcakes and donuts. Pasta and noodles of all varieties are also concentrated sources of refined carbohydrates; reduce these to a minimum. The whole-grain pastas that are now widely available are a better choice, though far from ideal. Carbohydrates should be enjoyed in their natural, whole, unprocessed form. Many traditional diets built around carbohydrates cause neither poor health nor obesity.
Remember: the toxicity in much Western food lies in the processing, rather than in the food itself. The carbohydrates in Western diets are heavily skewed toward refined grains, and are thus highly obesogenic. Eggplant, kale, spinach, carrots, broccoli, peas, Brussels sprouts, tomatoes, asparagus, bell peppers, zucchini, cauliflower, avocados, lettuce, beets, cucumbers, watercress, cabbage, among others, are all extremely healthy carbohydrate-containing foods. Quinoa, technically a seed but often used as a grain, is one of the so-called ancient grains. Grown originally in the Inca empire of South America, it was referred to as the “mother of all grains.” It comes in three varieties: red, white and black. Quinoa is very high in fibre, protein and vitamins. In addition, quinoa has a low glycaemic index and contains plenty of antioxidants, such as quercetin and kaempferol, which are believed to be anti-inflammatory. Chia seeds are native to South and Central America and have been dated to the Aztec and Mayans. The word chia is derived from the ancient Mayan word for strength. Chia seeds are high in fibre, vitamins, minerals, omega 3, proteins and antioxidants. They are usually soaked in fluid, as they absorb ten times their weight in water, forming an edible gel. Beans are a versatile, fibre-rich carbohydrate staple of many traditional diets. They are an extremely good source of protein, particularly for vegetarian diets. Edamame beans, popular in Japanese cuisine, provide 9 grams of fibre and 11 grams of protein per serving.
STEP 3: MODERATE YOUR PROTEIN CONSUMPTION
IN CONTRAST TO refined grains, protein cannot and should not be eliminated from your diet. Instead, moderate the amount of protein in your diet to fall within 20 percent to 30 percent of your total calories. Excessively high-protein diets are not advisable and are quite difficult to follow, since protein is rarely eaten in isolation. Protein-containing foods such as dairy or meat often contain significant amounts of fat. Vegetable proteins, such as legumes, often contain significant amounts of carbohydrate. Thus, extremely high-protein diets are usually quite unpalatable. They tend to rely on egg whites and very lean meats. Needless to say, it’s difficult to comply with such very limited diets. Some dieters turn to meal replacement shakes, bars or protein powders, which are really just highly processed “fake foods.” Optifast, Slim-Fast, Ensure and Boost are only some examples in a crowded marketplace of nutritional thieves. These products don’t produce lasting weight loss and they’re designed to keep you hooked on their processed concoctions.
STEP 4: INCREASE YOUR CONSUMPTION OF NATURAL FATS
OF THE THREE major macronutrients (carbohydrates, proteins and fats), dietary fat is the least likely to stimulate insulin. Thus, dietary fat is not inherently fattening, but potentially protective. In choosing fats, strive for a higher proportion of natural fats. Natural, unprocessed fats include olive oil, butter, coconut oil, beef tallow and leaf lard. The highly processed vegetable oils, high in inflammatory omega 6 fatty acids, may have some detrimental health effects.
Widely acknowledged as healthy, the Mediterranean diet is high in oleic acid, the monounsaturated fats contained in olive oil. Olives are native to the Mediterranean region, and olive oil was being produced as early as 4500 BC. Ripe olive fruit is crushed into a paste and the oil is extracted using a press. The term “virgin” refers to oil that is extracted using these mechanical means only and is certainly the best choice. Other grades of oil rely on chemical methods and should be avoided. “Refined” oils use chemicals and high heat to extract the oil and neutralize bad tastes, allowing producers to use second-rate olives. Be aware that the term “pure olive oil” often denotes refined oils. Extra-virgin olive oil is unrefined, contains fruity undertones, and it meets certain quality standards. The health benefits of olive oil have long been recognized. Olive oil contains large amounts of antioxidants including polyphenols and oleocanthal, which has anti-inflammatory properties. Among its purported benefits are reduced inflammation, lowered cholesterol, decreased blood clotting and reduced blood pressure. Together, these potential properties may reduce the overall risk of cardiovascular disease, including heart attacks and strokes. Heat and light cause oxidation, so olive oil must be stored in a cool dark spot. Dark-green glass containers reduce incoming light to help preserve the oil. Light olive oils undergo a fine filtration to remove most of the flavour, aroma and colour. This process makes it more suitable for baking, where the fruity aroma is not desirable.
Nuts are also prominent in the Mediterranean diet. Long shunned for their high fat content, they have since been recognized to have significant health benefits. In addition to healthy fats, nuts are naturally high in fibre and low in carbohydrates. Walnuts in particular are high in the omega 3 fatty acids. Full-fat dairy is delicious and can be enjoyed without concern of fattening effects. A review of twenty-nine randomized control trials showed neither a fat-gaining nor reducing effect. Full-fat dairy is associated with a 62 percent lower risk of type 2 diabetes. Avocados have been recently recognized as a very healthy and delicious addition to any diet. Although not sweet, they are the fruit of the avocado tree. High in vitamins and particularly high in potassium, the avocado is unique among fruits for being very low in carbohydrates and high in the monounsaturated fat oleic acid. Furthermore, it is very high in both soluble and insoluble fibre.
STEP 5: INCREASE YOUR CONSUMPTION OF PROTECTIVE FACTORS
FIBER CAN REDUCE the insulin-stimulating effects of carbohydrates, making it one of the main protective factors against obesity, but the average North American diet falls far short of recommended daily intakes. Numerous studies and observations have confirmed the weight-lowering effects of dietary fibre. Natural whole foods contain plenty of fibre, which is often removed during processing. Fruits, berries, vegetables, whole grains, flax seeds, chia seeds, beans, popcorn, nuts, oatmeal and pumpkin seeds provide ample fibre. Glucomannan is a soluble, fermentable and highly viscous dietary fibre that comes from the root of the elephant yam, also known as konjac, native to Asia. Glucomannan can absorb up to fifty times its weight in water, making it one of the most viscous dietary fibres known. The konjac tuber has been used for centuries as a herbal remedy and to make traditional foods such as konjac jelly, tofu and noodles. Vinegar is also a protective factor. Used in many traditional foods, it may help reduce insulin spikes. Italians often eat bread dipped in oil and vinegar—a prime example of eating a high-carb food with protective factors. Vinegar is added to sushi rice, which reduces its glycaemic index by 20 percent to 40 percent. Fish and chips are often eaten with malt vinegar. Apple cider vinegar may be taken diluted in some water.
THE LAST PIECE OF THE PUZZLE
When it comes to the question of what to eat, you pretty much already knew the answer. Most diets very conspicuously resemble each other. There is far more agreement than discord. Eliminate sugars and refined grains. Eat more fibre. Eat vegetables. Eat organic. Eat more home-cooked meals. Avoid fast food. Eat whole unprocessed foods. Avoid artificial colours and flavours. Avoid processed or microwavable foods. Whether you follow the low carb, low calorie, South Beach, Atkins or some other mainstream diet, the advice is very similar. Sure, there are particular nuances to each diet, particularly with respect to dietary fats, but they tend to agree more than they disagree. So, why all the controversy?
Agreement does not sell books or magazine. We always need to “discover” the latest and greatest “superfood.” Acai berries. Quinoa. Or we need to “discover” the latest and greatest dietary villain. Sugar. Wheat. Fat. Carbohydrates. Calories. Vogue magazine does not carry headlines such as “Diet advice you already knew!”
All diets work in the short term. But we’ve been ignoring the long-term problem of insulin resistance. There is one more piece of the puzzle—a solution found many centuries ago. A practice that has been enshrined in the nutritional lore of virtually every population on earth. A tradition rapidly becoming extinct.
The simple truth is that weight loss comes down to understanding the hormonal roots of obesity. Insulin is the main driver. Obesity is a hormonal, not a caloric imbalance. In considering the first question, there are some simple guidelines to follow. Reduce intake of refined grains and sugars, moderate protein consumption and increase natural fats. Maximize protective factors such as fibre and vinegar. Choose only natural, unprocessed foods. In considering the second question, balance insulin-dominant periods with insulin-deficient periods: balance your feeding and fasting. Eating continuously is a recipe for weight gain. Intermittent fasting is a very effective way to deal with when to eat. In the end, the question is this: If you don’t eat, will you lose weight? Yes, of course. So there is no real doubt about its efficacy. It will work. There are other factors that affect insulin and weight loss such as sleep deprivation and stress (cortisol effect). If these are the major pathways of obesity, they must be directly addressed, not with diet, but with techniques such as proper sleep hygiene, meditation, prayer or massage therapy. For each of us, there will be some factors that are more important than others. For some, sugars may be the main pathway to obesity. For others, it will be chronic sleep deprivation. For yet others, it will be excessive refined grains. For still others, it will be meal timing. Lowering sugar intake will not be so effective if the underlying problem is chronic sleep disturbances. Similarly, better sleep habits will not help if the problem is excessive sugar intake. What we have tried to develop here is a framework for understanding the complexity of human obesity. A deep and thorough understanding of the causes of obesity leads to rational and successful treatment. A new hope arises. We can begin to dream again—of a world where type 2 diabetes is eradicated, where metabolic syndrome is abolished. A dream of a thinner, healthier tomorrow.
That world. That vision. That dream. It starts today.