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Fat Chance: Do Dietary Guidelines Actually Contribute to Obesity?
In this episode, Albert Einstein College of Medicine public health researcher Paul Marantz questions whether dietary guidelines are counterproductive and talks about the philosophy of recommendations based on population studies. We'll hear a Valentine's Day poem. Plus we'll test your knowledge of some recent science in the news. Websites mentioned on this episode include sciammind.com, sciamdigital.com, snipurl.com/sing-sciam, snipurl.com/paul-sciam, snipurl.com/paul2-sciam, snipurl.com/paul3-sciam
Welcome to Science Talk, the weekly podcast of Scientific American for the seven days starting February 13th, 2008. I'm Steve Mirsky. This week: a chat with epidemiologist, Paul Marantz, about how studies on lots of people's lifestyles lead to health recommendations and medical interventions. We'll have a Valentine's Day poem from a listener, plus we'll test your knowledge about some recent science in the news. Paul Marantz is professor of Clinical Epidemiology and Population Health at the Albert Einstein College of Medicine in New York City. He and colleagues recently published a controversial paper in the American Journal of Preventive Medicine. On Monday morning, February 11th, we talked in his Einstein office about the article and about the philosophy behind recommendations based on studies.

Steve: Dr. Marantz, good to talk to you today.

Marantz: Hi, Steve.

Steve: Very interesting paper you have here, "A Call for Higher Standards of Evidence for Dietary Guidelines." Let's cut right to the quick and then we'll back up a bit; but your basic thesis is?

Marantz: Our basic thesis is that the standards that had been applied to determining and promulgating dietary guidelines for all Americans have been insufficient to protect against the possibility of harm and in fact our analysis suggest that there indeed may be harm that can be an outcome of these guidelines. And once that's considered, the issue of standards of evidence becomes much more pressing.

Steve: And specifically, you're talking about the dietary guidelines about fat, as an example.

Marantz: That's the example we focus on. I think, the general concept of dietary guidelines is one that we explore, because we were curious as to why we then are in this business? Or why [is] the government is in this business? So by analyzing and focusing on the dietary fat guidelines, which we are not the first to do, others Gary Taubes and others have made that point in the lay press, and it has been in their professional literature as well, but we provided another data analysis consistent with the notion that focusing on fat led Americans to eat more calories overall, [and] has contributed to our obesity epidemic. And in light of that evidence, we really should be extremely cautious and careful when issuing guidelines.

Steve: Right. So the specific point that's controversial is that the dietary guidelines that were put into effect by the government in an effort to get people to cut down on their fat intake actually contributed to the obesity epidemic, and you point out this [out], you know, its very simple math-people did cut down on their fat calories as a percentage of total calories by increasing their total calories.

Marantz: That's it. Yeah, you can change the percentage or the proportion in two ways. You can reduce the numerator-how much fat people eat in total-which was clearly the goal of these guidelines; or you can also get the same effect proportionately by increasing the denominator-how much total calories you eat, I mean the total calories you eat.

Steve: Right. So now you have people [saying], "Well, I have cut my fat percentage down to below the 30 percent that the government recommended," but they are eating 3,000 calories a day, instead of 2,500.

Marantz: We can all remember, and in fact we still do, wolf down these low fat snacks that seem to us to be healthful or safe because we were really all taught that if the food was low fat it was healthful-that was the inference that we were led to make. By the way, this is not ancient history, the first official published dietary guidelines for all Americans were published in 1980, and it is now a legal mandate that they have to be reissued every five years. You know, reevaluate the evidence as it's done and reassure the guidelines. Then the focus was on cardiovascular disease, so a single-minded focus or at least a primary focus on dietary fat made sense with a cholesterol hypothesis. And of course we weren't focusing on total calories, we were focusing on dietary fat. The irony is, now that we have the obesity epidemic, suddenly calories have become the issue.

Steve: Go back a little bit to the idea of dietary guidelines. You point out in the paper, [the] government first issued nutritional guidelines in 1894, but these dietary guidelines as you say are kind of new. The original guidelines-well why don't you explain the difference?

Marantz: Well, they made great sense in the turn of the century when public health professionals were trying to meet the mission of public health, which is defined as assuring conditions in which the public can be healthy-that's how public health is defined. And in a time when malnutrition was a problem and, the emergence of nutritional science was helping public health professionals understand what needed to be in the diet in order for people to be healthy, to avoid deficiencies. It made good sense to issue information about the way in which vitamin C can prevent scurvy and that sort of stuff and that's where I guess, the minimum daily requirements came from. Over the 20th century, we did see our nutritional concerns move from issues of deficiency to issues of excess; and in that shift we saw a focus instead on the sorts of problems that excess leads: to coronary artery disease, diabetes, obesity, those sorts of concerns.

Steve: In your paper, you discuss something that doesn't get really talked about too much among lay people and that's one of the key, kind of, philosophical foundations of epidemiological studies and policy recommendations and that's this idea of small changes in risk for individuals winding up making large changes in outcomes in populations. That's something that really informs a lot of the decision making. So let's talk about, you know, what we see it in a cutback on your salt if you have hypertension and in the dietary guidelines, too, with cholesterol levels and diet. So let's talk about that a little bit, this idea of little changes for people making big changes in populations. One small step for a man, one giant leap for mankind!

Eat Like Me: My after work-out lunch

" by Cristin Dillon, Eat Like Me, SELF Magazine, 23 hours ago
With my walk, my housework and my lunch out of the way it's time to buckle down and do some work. Bruce will be sleeping for the rest of the afternoon after our trip this morning so there are no distractions except the beautiful weather that has stretched into the afternoon here. I'll just prop the windows open and enjoy it from inside though because there is no need to turn a nice balanced work-week into a hectic mess by skipping a whole day of tasks. Since I was out in the car (I walked with my girlfriend and her baby -- trying to get Bruce used to walking with a stroller beside him) I stopped and bought a Sebastian's salad for lunch. I am definitely filling up more easily these days then getting hungry sooner so I just ate half of the salad and saved the rest to have with my dinner. I'll work some sort of snack in for a pick-me up later this afternoon. Today's salad contained: mixed greens, onions, carrots, cucumbers, red peppers, beets, kidney beans, black beans, raisins and walnuts. I put some balsamic vinaigrette on myself and had a piece of pita bread they offered me with it. I also had an iced tea lemonade from Starbucks with my girlfriend after our walk since it was quite hot out. I usually ask for iced tea with a splash of lemonade but I forgot (since it's been a while) so I got a very sweet drink with lots of lemonade -- having just a splash still tastes good and definitely cuts down on the sugar content (discretionary calories).



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