The alternative is that excess weight and obesity, like all diseases of civilization, are caused by the singular hormonal effects of a diet rich in refined and easily digestible carbohydrates. The fattening of our adult years, after all, is not just associated with chronic diseases of civilization, it is a disease of civilization, and so it, too, may be a symptom of an underlying disorder. In this hypothesis, it is the quality of the calories consumed that regulates weight, and the quantity—more calories consumed than expended—is a secondary phenomenon. Whatever causes weight gain is at the heart of this tangled web, and that is the question we must now address.

Part Three

Part Three

OBESITY AND THE REGULATION OF WEIGHT

How may the medical profession regain its proper role in the treatment of obesity? We can begin by looking at the situation as it exists and not as we would like it to be…If we do not feel obliged to excuse our failures we may be able to investigate them.

ALBERT STUNKARD AND MAVIS MCCLAREN-HUME, in “The results of treatment for Obesity: A Review of the Literature and Report of a Series,” 1959

To cultivate the faculty of observation must then be the first duty of those who would excel in any scientific pursuit, and to none is this study more necessary than to the student of medicine. Without the habit of correct observation, no one can ever excel or be successful in his profession. Observation does not consist in the mere habitual sight of objects—in a kind of vague looking-on, so to speak—but in the power of comparing the known with the unknown, of contrasting the similar and dissimilar, in justly appreciating the connection between cause and effect, the sequence of events and in estimating at their correct value established facts.

THOMAS HAWKES TANNER, A Manual of Clinical Medicine and Physical Diagnosis, 1869

Chapter 14

Chapter Fourteen

THE MYTHOLOGY OF OBESITY

A colleague once defined an academic discipline as a group of scholars who had agreed not to ask certain embarrassing questions about key assumptions.

MARK NATHAN COHEN, Health and the Rise of Civilization, 1989

CRITICAL TO THE SUCCESS OF any scientific enterprise is the ability to make accurate and unbiased observations. “To have our first idea of things, we must see those things,” is how Claude Bernard explained this in 1865; “to have an idea about a natural phenomenon, we must, first of all, observe it…. All human knowledge is limited to working back from observed effects to their cause.” But if the initial observations are incorrect or incomplete, then we will distort what it is we’re trying to explain. If we make the observations with preconceived notions of what the truth is, if we believe we know the cause before we observe the effect, we will almost assuredly see what we want to see, which is not the same as seeing things clearly.