Book Review: Fat Chance, Robert H. Lustig

This article was first published at Blogcritics

Over the years expanding waist lines have generated a plethora of books aimed at slimming them down. There is nothing like an evangelizing 'get off your couch and eat right to lose weight' manual, especially one that promises maximum results with minimum effort, to get overweight readers into action. Action, that is, at least for some initial weight loss, at least until that water weight is gone. Year after year there comes book after book making promise after promise, and they work for awhile, but they never seem to solve the problem.

From the layman's point of view, facing a variety of often conflicting claims all defended with supposedly scientific testing, it becomes nearly impossible to make a judgment about the validity of any of them. Even simply trying to eat healthily, let alone trying to do so and lose weight, becomes a problem when yesterday's scientific gospel, becomes today's mythology. Remember when all fats were taboo. Remember the food pyramid. Remember olestra. So when a new entry in the fight against obesity genre comes along, one can be forgiven for some skepticism. They all sound so sure of themselves.

Like all the others, Fat Chance, Robert H. Lustig's entry in the anti-obesity sweeps offers answers, and his answers are nothing if not persuasive. But still, while he goes out of his way to demonstrate just where the others have gone wrong and how his answers will solve the problem, one has to wonder. What he says makes sense, but is it practical? What he says about the problem is convincing, but are his solutions simply utopian dreams?  

Lustig is a pediatric endocrinologist. Professor of Pediatrics at the University of California, San Francisco, Director of the UCSF Weight Assessment for Teen and Child Health Program and member of the UCSF Institute for Health Policy Studies and the Obesity Task Force of both the Endocrine Society and the Pediatric Endocrine Society. He is not lacking in authority to speak on the subject. His video with the punning title Sugar: The Bitter Truth has 2,948,953 views at last count. If you have an hour and a half, you'll find that this is a man with both wit and knowledge, but perhaps most importantly a man with a mission. Lustig is at war with obesity, and Fat Chance is another volley in that war.

Obesity is the problem. Dieting and exercise as recommended by weight loss gurus in past years don't work because they fail to take into account basic human biochemistry, a process he explains in detail, perhaps more detail than the layman (at least this layman) can easily digest. His conclusions on the other hand are clear. All calories are not created equal. The body doesn't deal with them all in like manner. Sugars in all forms are a problem. Processed foods, all processed foods, are the villains. They overload us with sugar; they under load us with fiber. We don't get enough exercise. The solution to the obesity pandemic then is obvious. Don't feed yourself and your family any foods with added sugar (that is any processed food that comes in a package or container). Eat fresh fruit and vegetables for fiber. Make sure you and your children exercise.

The book ends with a discussion of the changes in public policies and personal values necessary to facilitate ideal solutions on a large scale. Drastic changes in eating habits will have effects beyond the individual. After all if we all stop eating processed foods what happens to all the workers and General Mills and Coca Cola? If we ban high fructose corn syrup, in his mind perhaps the worst of the offenders, what happens to the farmer? Are the politicians going to abandon all those mid-western votes? How will fresh fruits and vegetables be made available in poor neighborhoods where there may be no access to a super market, let alone a farmer's market? What reaction will libertarians have to the "nanny state" telling them what they should or should not eat? The kinds of changes his solutions demand may well be necessary, but they may also be a long time, if ever, coming.

If you buy into Lustig's arguments in Fat Chance not only will you be kissing Coke goodbye, but you'll be giving up orange juice as well. You won't ever go through a McDonald's drive thru or feast on a large fries. If you eat at a local restaurant, you'll tell the waiter to keep the bread off your table. You'll eat desert once a week at most, but you'll eat a hell of a lot of legumes. These are symbols of what will have to be major life style changes for most 21^st century Americans, at least those with the 34 inch waists . Whether those changes are any more likely to last over the long haul than those diets and exercise regimes most of us never manage to stick with after a month or two is the real question. Of course we'll never know if we don't try.