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. When Bray, Van Itallie, Cahill, and Hirsch gave review talks at these conferences, as they did throughout this period, they would raise the issue of carbohydrate-restricted diets only to refute the claims that such diets offered a metabolic advantage over low-calorie diets. They would omit any mention of research that might explain the reported efficacy of the diets, even when that research was discussed at the same conferences and by investigators they knew personally. In 1977, for instance, Donald Novin, director of the Brain Research Institute at UCLA, discussed what he called the “carbohydrate hypothesis of ingestive behavior” at Bray’s Second International Congress on Obesity. Novin suggested that the “widespread popularity of the low carbohydrate diets” could be explained by the effect of carbohydrates on insulin, and then of insulin on fat deposition and thus hunger. Bray, who had worked closely with Novin at UCLA, gave the summary talk at the conference on obesity therapies and omitted mention of Novin’s hypothesis.*128 When M. R. C. Greenwood discussed the effect of insulin on the enzyme lipoprotein lipase, LPL, the “gatekeeper” for fat accumulation in cells, at the Fourth International Congress on Obesity, Hirsch ignored the implications in his review of dietary therapy, even though Greenwood had received her doctoral degree with Hirsch.

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 control—Denis Craddock, Robert Kemp, John Yudkin, Alan Howard, and Ian McLean Baird in England, and Bruce Bistrian and George Blackburn in the U.S.—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 anything more than calorie restriction in disguise—Bray, Van Itallie, Cahill, Hirsch, and their fellow club members. 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.