ObesiTy epidemic
I GREW UP in Toronto, Canada, in the early 1970s. My younger self
would have been utterly shocked if someone had told me then that obe-
sity would be a rising, unstoppable global phenomenon within only a
couple of decades. Back then, there were serious Malthusian fears that
the nutritional needs of the world’s population would soon eclipse the
world’s capacity for food production and we would face mass starva-
tion. The major environmental concern was global cooling due to the
reflection of sunlight off dust particles in the air, which was expected to
trigger the dawn of a new Ice Age.
Instead, almost fifty years later, we find ourselves facing exactly the
opposite problems. Global cooling has long ceased to be a serious con-
cern, with global warming and melting polar ice caps now dominating
the news. Instead of global hunger and mass starvation, we face an obe-
sity epidemic that is unprecedented in human history.
There are two puzzling aspects to this obesity epidemic.
First, what caused it? The fact that it is both global and relatively
recent argues against an underlying genetic defect. Exercise as a leisure
( 10 )
THE OBESITY CODE COOKBOOK
activity was largely unheard of in the 1970s. People just didn’t sweat to
the oldies in that decade. The proliferation of gyms, running clubs, and
exercise studios was a 1980s phenomenon.
Second, why are we so powerless to stop it? Nobody wants to be fat.
For more than forty years, doctors have consistently advised that follow-
ing a low-fat, calorie-reduced diet is the way to stay lean. Yet the obesity
epidemic has accelerated relentlessly. From 1985 to 2011, the prevalence
of obesity in Canada tripled from 6 percent to 18 percent. All the avail-
able evidence shows that people were desperately trying to cut calories
and fat and exercise more often. But they weren’t losing weight. The
only logical answer is that we didn’t understand the problem. Eating too
much fat and too many calories wasn’t the problem, so cutting the fat
and calories was not the solution. So, what causes weight gain?
In the 1990s, I graduated from the University of Toronto and the Uni-
versity of California, Los Angeles, as a physician and kidney specialist. I
must confess that I did not have the slightest interest in the treatment
of obesity. Not during medical school, residency, or specialty training, or
even as I entered practice. But I wasn’t alone. The same was true for just
about every physician at that time who had trained in North America.
Medical school taught us virtually nothing about nutrition, and even
less about the treatment of obesity. There were hours and hours of lec-
tures dedicated to the proper drugs and surgery to prescribe to patients.
I was proficient in the use of hundreds of medications. I was proficient
in the use of dialysis. I knew all about surgical treatments and indica-
tions. But I knew nothing about how to help people lose weight—despite
the fact that the obesity epidemic was already well established and the
type 2 diabetes epidemic was following closely behind, with all its health
implications. Doctors just didn’t care about diet. That was what dieti-
tians were for.
But diet—and maintaining a healthy weight—is an integral part of
human health. It’s not just about looking good in a bikini for the sum-
mer swimming season. If only. The excess weight people were now
( 11 )
introduction
carrying was more than an aesthetic issue—it was largely responsible for
the development of type 2 diabetes and metabolic syndrome, dramat-
ically increasing the risk of heart attacks, stroke, cancer, kidney disease,
blindness, amputations, and nerve damage, among other problems. Obe-
sity was not some peripheral topic of medicine. I was realizing that it
was central to most of the diseases I was encountering as a physician—
and I knew almost nothing about it.
As a kidney specialist, what I did know was that the most common
cause of kidney failure, by far, was type 2 diabetes. And I treated patients
with diabetes exactly as I had been trained to—the only way I knew how—
with drugs like insulin and procedures like dialysis.
From experience, I knew that insulin would cause weight gain. Actu-
ally, everybody knew insulin caused weight gain. Patients were rightly
concerned. “Doctor,” they would say, “you’ve always told me to lose
weight. But the insulin you gave me makes me gain so much weight.
How is this helpful?” For a long time, I didn’t have a good answer for
them, because the truth was, it wasn’t helpful.
Under my care, my patients were just not getting healthier. I was sim-
ply holding their hands as they deteriorated. They were unable to lose
weight. Their type 2 diabetes progressed.
