Chapter 23  The Fattening Carbohydrate Disappears  

"It is incredible that in twentieth-century America a conscientous physician should have his hard-won professional reputation placed on the line for daring to suggest that an obesity victim might achieve some relief by cutting out sugars and starches." --Robert Atkins, testifying before Congress 1972 

In 1976 McGovern hearing, the first witness was Assistant Secretary of Health Theodore Cooper, who repeatedly emphasized the need for further research to establish reliable knowledge about the diet-disease connection. McGovern wanted something to tell the American public, asked if he could agree that overconsumption was a serious problem. 

"Particularly overconsumption of the wrong things... very often in the poor we see people who are plump who might be called obese, and people would then conclude that they do not have a deficiency because they look rotund, "healthy" in one sense of the word. But it is true that the consumption of high carbohydrate sources with the induction of obesity constitutes a very serious public health problem in the underprivileged and economically disadvanted" said Cooper. 

This response seems clear enough: the overconsumption of "high carbohydrate sources" - describing carb dense starches and refined carbs rather than leafy green vegetables and fruits - was associated with obesity in the poor, perhaps even the cause.  

Then McGovern asked Cooper to provide a "general rule of thumb" about eating habits that would help prevent disease. Cooper reluctantly agreed to do so. "I think what we need to consider doing is to reduce our total fat intake. Fat adds a caloric substance - almost twice as much - as compared to sugar. I think in order to have an effective reduction in weight and realighment of our composition we have to focus on reducing fat intake." 

With that answer, Cooper contradicted himself. and along with it the conventional wisdom on diet and health in America shifted. 

MANY such contradictions. 

Between 1973 and the mid-1980s, the notion of the fattening carbohydrate, which had persisted in clinical and popular literature for well over a century, was replaced with the belief that it is dietary fat, with its particularly dense calories, that is responsible for overweight and obesity.
What makes this shift all the more perplexing is that it occurred immediately after the science of fat metabolism evolved to explain why carbohydrates were uniquely fattening, and it followed a six-year period in which carbohydrate-restricted diets achieved unprecedented credibility among clinicians.
The shift in the nutritional wisdom was taking place, driven by the contagious effet of Ancel Keys's dietary-fat/heart-disease hypothesis on the closely related field of obesity. Any diet that lalowed liberal fat consumption was to be considered unhealthy. Clinical investigators working on the problem of human obesity concurred.
Meanwhile, these nutritionists would readily admit that they didn't know what caused obesity and that calorie restriction conspicuously failed to cure it. After nearly twenty years in the field, as Jean Mayer wrote in the introduction to his monograph Overweight, he was "as aware as any man of the gigantic gaps in our knowledge - and of the likelihood that many of our present concepts may be erroneous." He also noted, in his discussion of hormonal influences on obesity, that insulin "favors fat synthesis" and that someone who oversecretes insulin could "tend to become hungry as a result." But when a physician suggested publicly, as Atkins did, that carbohydrates raised insulin levels, that insulin favors fat synthesis, and that a diet lacking carbohydrates might reverse this process, these nutritionists would denounce it, as Mayer himself did in 1973, as "biochemical mumbo-jumbo."

In obesity research, particularly in the USA in the 1970s, the established wisdom was determined not by any testing of hypotheses or even establishing of consensus but by the judgment of fewer than a dozen men who dominated the field. They had all come out of the Northeastern academic corridor and they all knew each other. These individuals became the field's "leading authorities". They hosted the conferences, edited the textbooks, chaired the committees, and determined research priorities. By the end of the 1970s they had determined what clinicians and researchers in the field would believe, at least in the USA, and what they still believe overwhelmingly. When McGovern's committee held its post-facto hearings in February 1977, only members of this club testified on obesity, and they all embraced the committee's recommendation of a national diet richer in carbohydrates and poorer in fat.
NONE of these authorities actually specialized int he clinical treatment of obesity except Stunkard, who did so as a psychiatrist treating an eating disorder.

The dissociation of the science of fat metabolism from any discussions of the cause or treatment of obesity was particularly conspicuous throughout this era and could be considered its legacy. They had the concerted goal of discrediting any low carb theories.

In retrospect, the influential figures in the CLINICAL investigation of human obesity in the 1970s can be divided into two groups. There were those who believed carbohydrate-restricted diets were the only efficacious means of weight contro - and wrote books to that effect, or developed variations on these diets with which they could treat patients. These men invariably struggled to maintain credibility.
Then there were those who refused to accept that carbohydrate restriction offered anythign more than calorie restriction in disguise. These men rarely if ever treated obese patients themselves, and they repeatedly suggested that since no diet worked nothing was to be learned by studying diets. Meanwhile, their funding was from General Foods Corporation (the maker of the very carbohydrate-rich Post cereals Kool-Aid, and Tang breakfast drink) as well as Coca-Cola and the National Soft Drinks Association.

Because a generation of obesity authorities were determined to dismiss the practical significance of carbohydrate restricted diets, they dismissed the potential theoretical significance at the same time. Obesity researchers today say they still have no hypothesis of weight regulation that can explain obesity and leanness, let alone account for a century of paradoxical observations. They insist that obesity is inevitably caused by overeating and thus consuming more calories than we expend, but when asked what cuses someone to overeat, they have no answer. Yet the research on insulin and fat metabolism offers one, and it has for several decades.