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The Revolution Will Be Kuhnian.

Involuntary Manslaughter By Health Reporting

The New York Times and Gina Kolata will be guilty of manslaughter when the article  In Struggle With Weight, Taft Followed Modern Diet inevitably causes a person's death.

The law of manslaughter

According to Section 125.15 of the New York State Penal Code:

§ 125.15 Manslaughter in the second degree.
    A person is guilty of manslaughter in the second degree when:
    1. He recklessly causes the death of another person; or...

Section 15.05 of the Penal Code elaborates: a person acts "recklessly" with respect to a result or circumstance when he or she is "aware of and consciously disregards a substantial and unjustifiable risk that such result will occur or that such circumstance exists."

An Anecdote about a fat President

Kolata tells us that before he was elected president, William Howard Taft was troubled greatly by his weight and so,

he went on a low-fat, low-calorie diet. He avoided snacks. He kept a careful diary of what he ate and weighed himself daily. 

As you may know from history: Taft stayed fat. 

The experts say that Taft's diet was the same that we would recommend today:

Doctors today would most likely offer Taft weight-loss surgery — which could have a big effect on weight — or drugs, which have a small effect at best. But the diet he was advised to follow would be largely unchanged, Dr. Allison said.

The Universe of diets contains only two possibilities: what people eat or the low fat diet they should eat.

The only kind of diet considered by the article, and, as far as we can tell, the "obesity experts" being quoted, is a low calorie, low fat diet. It is a binary world: people eat what they eat or they eat low fat. If that doesn't work, there are no other options

Obesity experts said Taft’s experience highlights how very difficult it is for many fat people to lose substantial amounts of weight and keep it off, and how little progress has been made in finding a combination of foods that lead to permanent weight loss. “Maybe we are looking for something that doesn’t exist,” said David B. Allison, the director of the Nutrition Obesity Research Center at the University of Alabama at Birmingham.

Here's the logic at work:

  1. Doctors have long believed that obese patients who follow a low-calorie, low-fat diet will lose weight.
  2. This did not work for William Howard Taft. 
  3. Recent studies demonstrate that low-fat diets do not work for anyone
  • Therefore: no diet leads to weight loss. Surgery is probably the only option.

What about low-carb? What's the evidence pro and con? THE EXISTENCE OF DIETS OTHER THAN LOW-FAT IS IGNORED BY THE ARTICLE!

But whose death will be caused by this article?

Gastric surgery means general anesthesia and general anesthesia will cause a known number of deaths. If you do something that you know will cause death, and you ignore that fact, that is: "gross disregard for human life." But this only follows if two things are true:

  1. There are other diets, short of surgery, that do lead to weight loss, or prevent obesity.
  2. Kolata should know this.

What should the journalist know? 

Lets generously hold Kolata only responsible for knowing information published in her own paper the NYT. Does she have any reason to question the conventional wisdom on diet? Yes, if she read this article, written by Gina Kolata: No Benefit Seen in Sharp Limits on Salt in Diet.

But the truly mystifying thing is why she ignored a piece in the NYT by Gary Taubes: What Really Makes Us Fat where we learn that the low-fat diet is supported by theory, not evidence. More importantly, as science actually tests the idea that the way to lose weight is a low-fat low-calorie diet, it is proving to be false.

Funny how you don't learn anything if you lecture people but don't conduct any actual experiments

The key to learning about this subject is moving away from the "simple math" of "calories in, exercise out" and looking at how the food we eat affects our behavior.  Gary Taubes highlights a study conducted by David Ludwig that focused on a problem known to anyone who has followed the low-cal, low-fat conventional wisdom: people who do manage to lose weight feel like they are starving to death and inevitably gain the weight back

Dr. Ludwig semi-starved obese subjects until they lost 15% of their weight. He then put them on one of three different diets, each with the exact same number of calories. 

  • Diet 1: "Healthy diet", includes whole grains-- Low fat, high carb.
  • Diet 2: "Real food diet", avoids all grains--Low glycemic, lower (but not low) carb.
  • Diet 3: "Atkins diet"--High fat, high protein, low carb. 

Every subject ate the same number of calories. Ludwig could have also controlled the subject's exercise. After tossing out the subjects that didn't stick to the regimen, the results would have proven, yet again, that no matter what kind of calorie you eat, it takes the same amount of exercise to burn it off.

Stop moralizing, this is science! 

But what happens if we get off the moral high horse ordering people to do what's good for them? What if we simply study how human beings actually behave?

Ludwig left his subjects to their own devices when it comes to exercise: 

The results were remarkable. Put most simply, the fewer carbohydrates consumed, the more energy these weight-reduced people expended. 

So doctors have a choice when faced with a patient who has lost weight and is trying to keep it off:

  1. Put the patient on a low fat diet and order him to exercise, knowing full well that patients are rarely able to keep this up, making sure to utter "tut, tut, tut" noises when he comes back in and steps on the scale, or
  2. Put the patient on a low carb diet and know that this will cause him to exercise even in the absence of moral opprobrium. 

Taubes notes that the study casts light on a subject that is almost impossible to study directly: the decades long process by which "pre-obese" people--those who are predisposed to get fat--slowly become obese. He notes that the "pre-obese" and the study subjects share a common feature: "They’re almost assuredly going to get fatter."

This leads to an important conclusion:

If we think of Dr. Ludwig’s subjects as pre-obese, then the study tells us that the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed. The fewer carbohydrates we eat, the more easily we remain lean. The more carbohydrates, the more difficult. In other words, carbohydrates are fattening, and obesity is a fat-storage defect. What matters, then, is the quantity and quality of carbohydrates we consume and their effect on insulin.

Judgment In The Case of Manslaughter

In other words, the experts are wrong: the choices facing obese people are not limited to gastric surgery. Ignoring all the low fat nonsense and getting on the Atkins diet could work wonders, and save a few lives that would be lost to surgery complications.

Verdict: Guilty

But It Gets Worse

Here's the thing that makes you really want to put someone in jail for the public health disaster created by the low fat conventional wisdom, from the Taubes piece: 

UNTIL the 1960s, carbohydrates were indeed considered a likely suspect in obesity: “Every woman knows that carbohydrate is fattening,” as two British dietitians began a 1963 British Journal of Nutrition article.


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