6, “The Solution,” provides guidelines for lasting treatment of obesity by addressing the hormonal imbalance of high blood insulin. Dietary guidelines for reducing insulin levels include reducing added sugar and refined grains, keeping protein consumption moderate, and adding healthy fat and fiber. Intermittent fasting is an effective way to treat insulin resistance without incurring the negative effects of calorie reduction diets. Stress management and sleep improvement can reduce cortisol levels and control insulin.
The Obesity Code will set forth a framework for understanding the condition of human obesity. While obesity shares many important similarities and differences with type 2 diabetes, this is primarily a book about obesity.
The process of challenging current nutritional dogma is, at times, unsettling, but the health consequences are too important to ignore. What actually causes weight gain and what can we do about it? This question is the overall theme of this book. A fresh framework for the understanding and treatment of obesity represents a new hope for a healthier future.
JASON FUNG, MD
The Epidemic
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HOW OBESITY BECAME AN EPIDEMIC
Of all the parasites that affect humanity, I do not know of, nor can I imagine, any more distressing than that of Obesity.
WILLIAM BANTING
HERE’S THE QUESTION that has always bothered me: Why are there doctors who are fat? Accepted as authorities in human physiology, doctors should be true experts on the causes and treatments of obesity. Most doctors are also very hardworking and self-disciplined. Since nobody wants to be fat, doctors in particular should have both the knowledge and the dedication to stay thin and healthy.
So why are there fat doctors?
The standard prescription for weight loss is “Eat Less, Move More.” It sounds perfectly reasonable. But why doesn’t it work? Perhaps people wanting to lose weight are not following this advice. The mind is willing, but the flesh is weak. Yet consider the self-discipline and dedication needed to complete an undergraduate degree, medical school, internship, residency and fellowship. It is hardly conceivable that overweight doctors simply lack the willpower to follow their own advice.
This leaves the possibility that the conventional advice is simply wrong. And if it is, then our entire understanding of obesity is fundamentally flawed. Given the current epidemic of obesity, I suspect that such is the most likely scenario. So we need to start at the very beginning, with a thorough understanding of the disease that is human obesity.
We must start with the single most important question regarding obesity or any disease: “What causes it?” We spend no time considering this crucial question because we think we already know the answer. It seems so obvious: it’s a matter of Calories In versus Calories Out.
A calorie is a unit of food energy used by the body for various functions such as breathing, building new muscle and bone, pumping blood and other metabolic tasks. Some food energy is stored as fat. Calories In is the food energy that we eat. Calories Out is the energy expended for all of these various metabolic functions.
When the number of calories we take in exceeds the number of calories we burn, weight gain results, we say. Eating too much and exercising too little causes weight gain, we say. Eating too many calories causes weight gain, we say. These “truths” seem so self-evident that we do not question whether they are actually true. But are they?
PROXIMATE VERSUS ULTIMATE CAUSE
EXCESS CALORIES MAY certainly be the proximate cause of weight gain, but not its ultimate cause.
What’s the difference between proximate and ultimate? The proximate cause is immediately responsible, whereas the ultimate cause is what started the chain of events.
Consider alcoholism. What causes alcoholism? The proximate cause is “drinking too much alcohol”—which is undeniably true, but not particularly useful. The question and the cause here are one and the same, since alcoholism means “drinking too much alcohol.” Treatment advice directed against the proximate cause—“Stop drinking so much alcohol”—is not useful.
The crucial question, the one that we are really interested in, is: What is the ultimate cause of why alcoholism occurs. The ultimate cause includes
•the addictive nature of alcohol,
•any family history of alcoholism,
•excessive stress in the home situation and/or
•an addictive personality.
There we have the real disease, and treatment must be directed against the ultimate, rather than the proximate cause. Understanding the ultimate cause leads to effective treatments such as (in this case) rehabilitation and social support networks.
Let’s take another example. Why does a plane crash? The proximate cause is, “there was not enough lift to overcome gravity”—again, absolutely true, but not in any way useful. The ultimate cause might be
•human error,
•mechanical fault and/or
•inclement weather.
Understanding the ultimate cause leads to effective solutions such as better pilot training or tighter maintenance schedules. Advice to “generate more lift than gravity” (larger wings, more powerful engines) will not reduce plane crashes.
This understanding applies to everything. For instance, why is it so hot in this room?
PROXIMATE CAUSE: Heat energy coming in is greater than heat energy leaving.
SOLUTION: Turn on the fans to increase the amount of heat leaving.
ULTIMATE CAUSE: The thermostat is set too high.
SOLUTION: Turn down the thermostat.
Why is the boat sinking?
PROXIMATE CAUSE: Gravity is stronger than buoyancy.
SOLUTION: Reduce gravity by lightening the boat.
ULTIMATE CAUSE: The boat has a large hole in the hull.
SOLUTION: Patch the hole.
In each case, the solution to the proximate cause of the problem is neither lasting nor meaningful. By contrast, treatment of the ultimate cause is far more successful.
The same applies to obesity: What causes weight gain?
Proximate cause: Consuming more calories than you expend.
If more calories in than out is the proximate cause,
