Hazards of the ‘Low-fat’ Dogma

According to the World Health Organisation (WHO), obesity worldwide has more than doubled since 1980. In 2014, over 1.9 billion adults (18 years and older) were overweight – 600 million of them were obese.

That means 39% of adults aged 18 years and over were overweight in 2014, and 13% were obese. Furthermore, 42 million children under the age of 5 were overweight or obese in 2013.

Those figures and statistics are extremely worrisome. They take the obesity issue to a whole new level: obesity is an epidemic. As such, it should be considered a global emergency for many reasons, including:

1. Most of the world’s population lives in countries where being overweight or obese is a substantial killer.

2. The cost of these illnesses will be “astronomical”, as stated by Marion Nestle, who chairs the Department of Nutrition and Food Studies at New York University.

But, as is elegantly put in the summary of the fact sheet on the WHO website, ‘obesity is preventable’. The WHO goes on to explain the fundamental cause of obesity. Far from being unexpected, the assumption is that there is an energy imbalance between calories consumed and calories expended. Globally, there has been:

• an increased intake of energy-dense foods that are high in fat; and
• an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation and increasing urbanisation.

Unfortunately, the answer to this global public health issue is not even close to helping patients. The WHO’s answer as to what causes the obesity epidemic is part of the reason why we inefficiently try to deal with it.

To me, it is very clear by now that the energy imbalance between calories consumed and calories expended is to blame. However, the concept of calories is most likely wrong and cannot explain obesity alone.

In this, the work of Dr Robert H Lustig (Professor of Paediatrics in the Division of Endocrinology; and Director of the Weight Assessment for Teen and Child Health Programme at the University of California, San Francisco) is more than noteworthy.

But more importantly, WHO’s answer pointing towards fat as the main issue (‘increased intake of energy-dense foods that are high in fat’) needs to be reassessed. Evidence clearly shows that such foods are not solely responsible for the obesity epidemic. Fat alone cannot explain obesity.