The Truth About Fat

Why Obesity is Not that Simple

Anthony Warner

• Publisher: Oneworld Publications
• Year: 2019
• ISBN:
  9781786075147
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Most people try out diets just to see if they work. One friend cuts out sugar, a second cuts out fat. Another mumbles something about gut microbes. Even scientists still seem to be arguing about what causes obesity, so what hope is there for the rest of us?Anthony Warner, author of The Angry Chef, has decided to get to the bottom of it once and for all. Is obesity really an epidemic? Can you be addicted to food? Can't you just exercise your way to freedom? And what the heck is a food desert?You want the truth? The science, without the prejudice? You can handle it.

PART I

THE MODERN EPIDEMIC

1

WHY DO WE GET FAT? PART I

I have had a half-decent career as a chef. As a slightly geeky science graduate with an interest in food, I entered the terrifying cauldron of a professional hotel kitchen in late 1994. Most of the other chefs thought that I would last a week or two, but through a combination of talent, bloody minded determination and the ability to out-drink most of my peers, I quickly rose through the ranks. Within twelve months, I was a sous chef in the patisserie section of the hotel. Within two years I was running the kitchen of a busy restaurant. Within five years I was in charge of twenty chefs. Within ten, I was the head development chef of one of the UK’s largest food manufacturers, developing products eaten in millions of homes. My cooking career cost me injuries, stress, pain, and, at least twice, a genuine fear for my life.

In the past few years, I have somehow managed to develop a parallel career. I started a blog in 2016, and within a few months had an agent, a book deal, and was writing for a number of well-known publications in the UK and abroad. My first book sold well around the world, and was translated into fifteen languages. I now spend as much time writing as I do cooking, and it has transformed me in a wide range of positive ways. But writing my first book also meant that I did not have a day off for over six months, putting in sixteen-hour days in a cold, cramped, junk-filled spare room, distancing myself from my responsibilities as a husband and father.

Although many people have achieved far more significant things than I ever will, my career in the kitchen and my subsequent success as a writer are the most interesting things about me. I worked as hard as I could, and I am proud of what I have achieved. But apparently, there is something else about me far more worthy of note. I am frequently praised for it, especially by people I have just met. This week I received two random emails asking me about it, one from a follower in Thailand, and one from a new reader in the USA. It is literally being noticed around the world, and yet it is something that I have achieved with little to no conscious effort. I do not think it took a single moment of denial or sacrifice. No burns, no cuts, no stress or sleepless nights. Not even a cool scar to show for it.

What is this miraculous achievement, this secret that people are so desperate to know? ‘How do you stay so thin?’ People seem obsessed with the fact that even though I am a middle-aged chef who clearly loves food, vocally hates diets, embraces calorie laden ‘junk foods’ and occasionally eats breakfast at McDonald’s, I somehow remain thin.

I say ‘thin’ because that is the language used by others when I am praised, but obviously this is fairly subjective. You are unlikely to find me stripped to the waist on the cover of Men’s Health anytime soon, unless they have a dramatic change of editorial direction. If visible abs are the measure of worth that Instagram seems to think they are, I have a way to go. I own a pale, pallid torso, the muscle definition of a marshmallow, and a physique that the Daily Mail will never describe as ‘enviable’. But I am not, technically speaking, overweight.

The last time I was measured, I was 75 kilograms (165 pounds). At a height of 1.82 metres, that sets my Body Mass Index (BMI) at 22.6kg/m², which is considered to be nicely within the normal range. Although BMI is a crude and often misleading term, something that we shall look at in detail later on, it is widely accepted, and when it comes to analysing my body, reasonably accurate. I have never been called fat in any serious way, and do not consider myself to be so. Out of shape, perhaps. Fat, no.

THE MIRACLE OF CONSTANCY

I am forty-five years old and weigh roughly the same as I did when I was twenty-five. Although as a young man I was probably a little underweight, I never owned a set of scales, so cannot say for sure. I probably put on a few kilograms in my early twenties, but from twenty-five onwards my weight has been fairly constant. Despite this being beyond my conscious control, it is the thing for which I receive the most praise. The act of not getting fat. A great achievement and something of which I should be immensely proud.

And maybe I should be. After all, in the past twenty years I have probably burned around twenty million calories, and so, given that I have not gained any weight in that time, I must have absorbed twenty million calories from the food I have eaten. That sort of calorie intake required me to eat around 18 metric tonnes of food and drink, without any excess being laid down as bodily fat. This balancing act over such a sustained period is pretty remarkable. I am not sure whether or not I burned those calories according to how much I was eating, or if I managed to eat in relation to my energy needs, but either way it sounds like an impressive feat of calculation and control.

This is all the more remarkable because by any standards I have led a chaotic and poorly planned life when it comes to food. Some days, especially when working in kitchens, I skipped several meals in a row, staving off hunger by picking at various calorie-rich items throughout the day. I once went nearly a week consuming nothing but chicken skin, roast potatoes and Coca-Cola. Happy days.

There were many occasions when I had a huge takeaway, blowing out on pork ribs, pizza, curly fries or lamb jalfrezi, all washed down with family-sized bottles of cola. Often, I would eat until I felt I was going to burst, then somehow find room for ice cream or cake. But there were also times when I was ill, and had little to no appetite. I have had afternoons when I have run a half marathon. But I have also spent weekends on the couch watching the football, with potato waffles, cheese and cheap wine.

I have been drunk a number of times, consuming hundreds of calories in alcohol, before finishing the evening with a massive kebab. The next day I would nurse my hangover with a Big Mac, large fries and several energy drinks. Once or twice, lunch has been a twelve-course dinner at a fine dining restaurant. Other times, a family-sized pack of Maltesers eaten out of desperation while stuck in traffic.

And yet in all those years, I have somehow managed to maintain a constant weight, eating exactly the same number of calories as I have burned. Well done me. I’m a living, breathing miracle. My judgement of how much energy all those foodstuffs contain, all with different calorie densities, nutrient profiles and palatability, must be exquisite, especially given most calorie labels on foods are only around 90 per cent accurate. I must be capable of the most complex nutrient analysis imaginable, balancing this against subtle variations in my energy expenditure. And I have maintained this careful balancing act extraordinarily well over the long term.

THE IMAGINARY WORLD OF ANGRY CHEF

Imagine for a moment that my judgement was slightly out. Let us say that the day after my twenty-fifth birthday, I accidentally ate twenty calories more than I burned off. Just twenty calories, about the same amount that you might find in four olives. My body would not mind since it could easily store those twenty calories as fat. Now imagine that this slight miscalculation occurred on a regular basis every single day, for the entire twenty-year period up to now. Using the common estimate that 3500 calories is equivalent to around 500 grams of fat, over the first year, that excess energy would add up to around a single kilogram of weight gain. Not so bad. But if this continued, by the time I reached my forty-fifth birthday, instead of weighing in at 75 kilograms, I would be 115 kilograms (254 pounds) with a BMI of just under 35. I would be classified as obese, and it is highly likely that my life experiences would have been vastly different. My career prospects would have changed, the way people react to me would be completely altered, and the comfort with which I navigate the world would be greatly impaired. Katie Hopkins and Milo Yiannopoulos would think that I was disgusting, and never consider sleeping with me (every cloud). And all because of a single extra olive at each meal. And one before bedtime.

Now imagine that the difference was fifty calories a day, again a fairly insignificant amount of food. This is equivalent to less than half a tablespoon of olive oil, or a fifth of a single Dairy Milk chocolate bar. Over the three meals I eat most days, that amount of food would be unnoticeable for anyone living outside of a nutrition laboratory. Yet over twenty years, it would account for me gaining an additional 104 kilograms, meaning that I would be weighing in at 179 kilograms (395 pounds) with a BMI of 54. My life chances would be dramatically altered. Children would point and laugh at me in the street. The prime minister would make speeches about how people like me were ruining the country. Channel Five would offer me my own reality series. Too Fat to Cook – The 30 Stone Chef on Benefits.

One of the key things to understand about weight gain is that it rarely happens quickly. Most body fat is gained over years, not months, and for people to gain weight over that sort of timescale, it does not require a huge increase in calorie intake or drop in expenditure. The differences are likely to be unnoticeable to anyone not carefully weighing and measuring everything they consume. Yet our society and our media observe obese people and assume that their weight has a direct connection to food binges. And when people look at a middle-aged chef who is thin but does not diet, they assume he has some magical secret to share with the world.

Study after study has shown that, under normal circumstances, the majority of weight gain occurs slowly. The daily difference between calories consumed and expended, the famous ‘energy in – energy out’ equation, is generally very small. Even my four olives might be an overestimate of the average, with observed annual weight increases in populations likely to be accounted for by a difference of around nine calories per person per day. That’s the difference between choosing to stand or walk on an escalator.¹

I have controlled my weight over the years, but this has not been through any degree of self-control. I am often ill-disciplined, and frequently give in to desires and cravings. Although I enjoy exercise at times, I can be extremely lazy. The only reason I can offer for my thinness is pure luck. I have led a privileged life with a beneficial combination of good genes and a helpful environment, and this has resulted in me not getting fat. And in a world where thinness is seen as a proxy for moral superiority, it has handed me many life advantages.

The fact that my eating habits do not hide some hidden weight loss secret should not be too surprising. To understand the reasons why I am thin, it makes little sense to look in detail at my diet. And yet in order to understand why people are fat, the focus always falls upon what they eat. But what if the reasons had less to do with food intake than we think? What if large numbers of people get fat, even though they eat all the ‘right’ things? And what if others stay thin while eating all the wrong ones? Doesn’t that make it illogical to blame one and praise the other?

In fact, the diets of most overweight and obese people, especially children, seem to differ little from those of supposedly normal weight.^{2 3 4} Perhaps even more remarkably, despite the ubiquitous belief that people are fat because of what they eat, in 150 years of nutrition research no one has managed to establish a strong link between overeating, diet composition and obesity.⁵ In the UK, as rates of obesity have increased, dietary surveys have actually shown decreases in consumption of sugar, fat, carbohydrates and total calories.⁶ In fact, the only thing we are eating more of seems to be fruit and vegetables.

As we shall discover later on in the book, diet is an extremely weak predictor of weight gain, especially when compared against many other more powerful factors with an influence over bodily fat. Gareth Leng is a professor of endocrinology at the University of Edinburgh who has little time for anyone claiming that obesity is caused by a lack of willpower. On the link between diet and obesity, he told me:

There is lots of attention on diet, I guess because it makes folk sense, but there is plenty of other stuff that has changed. It might be partly true that changes in diet have had an effect, but it’s dangerous to mistake a plausible explanation for a valid one. There is very little evidence to show that the diets of obese people are different to people of normal weight, and diet generally is a very weak predictor of whether someone will become obese, far less than some other factors. Certainly, around the world there is a link between the level of food production and obesity rates, but if you compare developed countries, the correlation becomes very weak. Obesity is not a lifestyle choice. It is a multifactorial disease that is often a dysfunction in the hypothalamus.

This inconvenient fact is widely ignored not only within the media and the diet industry, but among many academics and public health professionals, all convinced that controlling and changing people’s dietary behaviours is the key to helping them achieve sustained weight loss. Whether they claim that this should be achieved by shame, stigma, education, cookery lessons or a restructuring of the environment, the assumption is the same: poor food choices made you fat, and better ones will make you thin. Sorry, but it’s not that simple.

WHY DON’T WE ALL GET FAT?

It is easy to postulate that evolutionary pressures and a competition for resources might keep wild creatures lean and hungry, and this could easily have kept a check on body weight throughout our evolutionary history. Nature is a cruel mistress, and likes to keep her charges in a state of near starvation, so the general leanness of wild populations is only natural. But when the majority of these pressures are removed, as they have been for those of us fortunate enough to live in developed economies, we are suddenly allowed free, almost unfettered access to food. And as we get richer, our agricultural systems and food supply chains become more efficient and robust, leading food to become a smaller and smaller proportion of our monetary expenditure. At this point, almost all of us have the freedom to eat well beyond our bodily requirements, with the tendency to lay down any excess calories as fat.

In this world of plenty, the fact that many of us manage to control our size with such extraordinary accuracy is unlikely to be accounted for by conscious effort alone. It seems incredibly unlikely that those who are not overweight are engaged in some superhuman feat of self-denial. It seems equally unlikely that our collective willpower has been gradually running out for the last forty years as obesity has grown into a so-called epidemic. Or do we think that people have stopped caring about their health over this time, which seems strange given how many have stopped smoking over the same period?

The most curious thing about body weight is not that some people have been getting fatter over the past few years. It is that, with the free access to food that our modern society enjoys, anybody manages to control their weight at all.

WHAT’S THE POINT OF FAT?

Our depictions of fat, and our general feeling about it as a substance, are in some ways indicative of the problems surrounding it. We see fat as a useless, inert jelly and create insults around it that imply sloth, inaction and ugliness. Yet fat is far from useless, and although lean creatures dominate the natural world that we regularly see, in many others, especially marine mammals, adipose tissue represents an essential requirement for life. Fat can insulate and protect us, and the development of subcutaneous* fat in humans is unique among large apes. Some think that it is what enabled early humans to lose their body hair, and perhaps even facilitated them walking upright and developing many other uniquely human characteristics.⁷ Fat, and the ability it gave us to store large amounts of energy, made us highly adaptable to variable conditions of food availability, temperature and seasonality, helping us colonise such a large proportion of the earth’s surface in a relatively short time.

As we learn more abou...

Table of contents

• Cover
• Title
• Contents
• A word on language
• Introduction
• Part I – The Modern Epidemic
• Part II – Why Are We So Fat?
• Part III – What Should We Do?
• Epilogue: What to do if you are fat
• Acknowledgements
• Notes
• Index
• Copyright