But if fatter mothers are more likely to make fatter babies, and fatter babies are more likely to make fatter mothers, which is also a well-documented observation, then this is another vicious cycle. It suggests that, once a generation of adolescents and adults start eating the highly refined carbohydrates and sugars now ubiquitous in our diets, even their children will feel the effect, and perhaps their children’s children as well. The extreme instance of this phenomenon today is the Pima Indians, whose incidence of diabetes is among the highest of any population in the world. In 2000, NIH investigators reported that Pima born to mothers who were diabetic have a two-to threefold increased risk themselves of becoming diabetic as adults, and so have a two-to threefold increased risk of passing diabetes on to their own children—of “perpetuating the cycle,” as the NIH investigators explained. The “vicious cycle” of the “diabetic intrauterine environment,” they wrote, can explain much of the post–World War II increase in Type 2 diabetes among the Pima, and may also “be a factor in the alarming rise of this disease nationally.”

The question we now face is whether the same vicious cycle may also be a factor in the alarming rise of obesity nationally, as well as internationally. There’s no reason to think that the hormonal and metabolic consequences of high blood sugar—from what James Neel in 1982 called the “excessive glucose pulses that result from the refined carbohydrates/ over-alimentation of many civilized diets”—do not pass from mother to child through the intrauterine environment, whether the mother is clinically diabetic or not. If so, the longer the obesity epidemic continues, and the longer we go without unambiguously identifying the causes of obesity, metabolic syndrome, and diabetes, the worse this vicious cycle is likely to get.

Chapter 23

Chapter Twenty-three

THE FATTENING CARBOHYDRATE DISAPPEARS

We need the help of the psychosocial scientists in finding better ways of communicating with our patients, in explaining to them that obesity is dangerous, that weight is lost slowly, that carbohydrates make fat and so on.

W.J.H. BUTTERFIELD, later vice-chancellor of the University of Cambridge, introductory remarks to the first Symposium of the Obesity Association of Great Britain, October 1968

It is incredible that in twentieth-century America a conscientious 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, author of Dr. Atkins’ Diet Revolution, testifying before Congress, April 12, 1973