Shouldn't Where We Get Fat (and When) Tell Us Something About Why?
More observations from the history of a very bad idea.
For those who want an exceedingly short history of obesity science, here it is in three quotes:
From 1893:
Excess food beyond decomposition leads to fat accumulation, and with prolonged maintenance of the same ratio, it leads to obesity. From this logically follows: Obesity can occur a) with increased food intake but normal cellular decomposition energy; b) with normal intake but decreased decomposition energy, i.e., slowing of metabolism.
Carl von Noorden, Handbook of Biochemistry of Humans and Animals
From 1931:
All obesity is “simple obesity.” The increase in weight merely represents an inflow of energy greater than the outflow. Failure of the primitive instinct to adjust the inflow of energy to the bodily needs is always the immediate cause.
Louis Newburgh, The Journal of the American Medical Association
Today:
What causes overweight and obesity? Overweight and obesity can develop over time when you consume more calories than you use. This is also described as an energy imbalance: when your energy in (calories) does not equal your energy out (calories your body uses for things such as breathing, digesting food, and being physically active)….An energy imbalance causes your body to store more fat than can be used now or in the future.
The National Institutes of Health, NHLBI website
This idea that we store fat in excess because we consume more energy (calories) than we expend can be considered the central dogma of obesity science; it is to obesity science what DNA→RNA→protein is to molecular biology, or E = mc2 is to relativity.
Per the quotes above, the German internist Carl von Noorden proposes the hypothesis in 1893; Louis Newburgh of the University of Michigan asserts dogmatically in 1930-31 that it’s not only true, but that he’s proven it experimentally. And then Newburgh’s dogmatism carries the day, such that energy imbalance as the cause of obesity becomes the conventional wisdom, what the NIH now tells us, and virtually all authorities in obesity—physicians, as well as researchers—implicitly believe.
But this is where we can get in trouble if we know the history of the science, which the obesity research community does not. That history has never been told. And knowledge, as the cliché goes, can be a dangerous thing.
This transition of energy balance thinking from hypothesis to dogmatic assertion to conventional wisdom happens despite the fact that by the 1930s, when step 2 in the progression was taking hold, von Noorden’s colleagues in the European medical establishment had come to discard his energy balance thinking as a failed hypothesis—“the dead end of the energetic view” as a prominent Hungarian internist would describe it in 1936.
This is why Newburgh’s assertion needed a unique set of circumstances to carry the day, and World War 2 served that purpose (as I’ve described in my books). The lingua franca of medical science shifts from German to English; the European physicians and scientists are otherwise engaged; young American doctors enter the field post-War and write the textbooks, and they base their thinking almost solely on Newburgh’s perspective. Only his survives the war years.
In the years that follow, obesity becomes an eating disorder; the leading theories of obesity (the glucostat and lipostat theories) are theories of food intake regulation, attempts to explain why fat people eat too much, not why they accumulate too much fat, which (regrettably) are two very different questions. And when the hormone leptin is discovered in 1994, it transforms obesity research into a sub-discipline of molecular biology (hence, a serious science as modern medical researchers would think of it), and the action of leptin is interpreted solely through this lens of energy balance thinking (as I wrote about here), as is essentially all obesity-related research from then on.
I’ve addressed the numerous logical problems with energy-balance thinking in my books (the first half, for instance, of my 2011 book Why We Get Fat), as I have on this Substack.1
Here, I want to approach it from a different perspective: the lessons of the history of obesity science. On June 12th, I’m giving a presentation at the National Institutes of Health on precisely this subject—the second lecture in the NIH’s new Scientific Freedom Lecture Series—and I want to use this post to lay out my thinking.
When I said above that the European medical research community came to dismiss von Noorden’s thinking as a failed paradigm (i.e., about as useful to scientific progress as the notion that the Earth is the center of the solar system), the obvious question is why? What were they seeing that post-WW2 generations of reasonably smart and dedicated researchers were not? And because I’m literally asking what they were seeing, I’m going to show you, which means some graphic images of excess fat storage—localized and global obesity, as they thought of it—from the late 19th and early 20th century medical literature.
If these kinds of images disturb your sensibility or make you queasy (as they do me, although I think they’re necessary), you might want to stop reading here. I’ll put the paywall here, as well, to make that easier.
