The May 2008 issue of Obesity Reviews, the journal of the International Association for the Study of Obesity, contained a review written by George Bray, M.D. of Gary Taubes’ book Good Calories, Bad Calories (GCBC). Gary Taubes has written a rebuttal that will appear in this same journal. Before we get to Gary’s response, I would like to spend a little time on Bray’s review, which I found interesting and troubling on a number of fronts.
Most reviews of books in academic journals are of academic books and are, at most, a page and a half, maybe two pages, long. The Bray review of GCBC was 13 pages long, including two plus pages of citations. And this for what is basically a popular book written for a general audience, not an academic tome. In all the reading I do of the medical literature, I’ve never seen a book review come even close to this in terms of length and comprehensiveness. Obviously Taubes’ work struck a chord.
George Bray, M.D. is probably the most renowned figure in the field of obesity research today. He is the Boyd Professor at the Pennington Biomedical Research Center (and former executive director) in Baton Rouge, LA; he holds numerous other professorships at various academic institutions; he has held leadership positions in virtually every academic obesity organization in existence; he has authored or co-authored more than 500 scientific papers; he has written at least a dozen books and authored chapters in many more; and he figures prominently in the recent history of how the academic ideas of the causes and cures of obesity are what they are today. It speaks volumes that someone of Dr. Bray’s academic stature would be tapped to write a review (a review, in fact, that is longer than most scientific papers) of a popular book. GCBC has gotten the attention of the academic community.
I don’t think there is anyone out there who would be less likely to pooh pooh the idea that there is an obesity epidemic today than George Bray, yet he starts out his review with a couple of quotes from two centuries ago juxtaposed with a sentence from GCBC (see below) in an attempt right at the get go to belittle Gary’s arguments.
I believe no age did ever afford more instances of corpulency than our own. (Short, T. 1727)
If the increase of wealth and the refinement of modern times have tended to banish plague and pestilence from our cities, they have probably introduced to us the whole train of nervous disorders, and increased the frequency of corpulence. (Wadd, W. 1810)
Some factor of diet and/or lifestyle must be driving weight upward, because human biology and our underlying genetic code cannot change in such a short time. (Taubes, G. 2007)
Early on in the review after describing how GCBC is laid out, Dr. Bray writes the following:
As I read through Good Calories, Bad Calories, I found a number of errors of omission or commission that are important when relating diet to disease. There is no mention in the Diet-Heart section of low-density lipoprotein-cholesterol (‘bad cholesterol’) or of high-density lipoprotein-cholesterol (‘good cholesterol’).
I find this comment curious for a couple of reasons. First, anyone who has read GCBC knows that LDL- and HDL-cholesterol are covered in depth. Second, this review is published in an academic journal read by pretty much only academics (as compared to, say, the New England Journal of Medicine, which is also academic but has a much higher general and medical readership), so why the need to identify LDL-cholesterol as ‘bad cholesterol’ and HDL-cholesterol as ‘good cholesterol’? Surely the readers of this journal – academic obesity researchers – would know what LDL- and HDL-cholesterol are. Even JAMA and the New England Journal of Medicine wouldn’t identify these molecules this way. I suspect the intent was for this review to have wide circulation in the popular press and, consequently, was made more understandable for the lay reader.
Bray goes on to clarify his own position as to the cause of obesity:
Let me make my position very clear. Obesity is the result of a prolonged small positive energy surplus with fat storage as the result. An energy deficit produces weight loss and tips the balance in the opposite direction.
Again, I find the notion of Dr. Bray’s laying out his own view of the cause of obesity to be curious. Isn’t this supposed to be a review of GCBC? I would think that it would be more important to lay out the position of the author of the book being reviewed. Which Bray does by mischaracterizing Taubes’ position. Taubes’ ideas, according to Bray’s interpretation of them, run counter to the laws of thermodynamics, which interpretation is the refuge for all those who can’t or won’t understand what Gary is trying to say.
Bray is saying that obesity is a matter of creating a positive energy balance, i.e., consuming more calories than are being burned off. He implies that obesity is simply a matter of overeating and under exercising. If you consume more calories than you burn over time, you get fat. Gary’s perspective is that fundamentally obesity is a disorder of fat accumulation. And that this disorder drives people to overeat. Obesity, the disease, drives people to overeat and be lethargic. Bray believes that people overeat and are lethargic and, consequently, bring on the disease of obesity.
I’ve met George Bray, I’ve read many of his publications, and I’ve heard him lecture numerous times. And I can tell you that George Bray believes that obesity is a disease. And he believes that it should be regarded as a disease and treated with drugs. In an interview in 2005, he said
Obesity is multifactoral, develops over time, and manifest differently among individuals. I define it as a relapsing, chronic neurochemical disease. No specific dietary regimen can change that. We must accept the fact that we cannot cure obesity with diets.
Since we don’t fully understand the causes of obesity, we should take the patient’s responsibility out of it. Rather than focusing on the gluttony, sloth, and moral issues, it is far better to address the neurochemical imbalance and why it occurs. [In other words, let’s give them drugs.]
But in this review we have Dr. Bray telling us that obesity is “the result of a prolonged small positive energy surplus.” He has definitely taken on the mantle of George you’re-fat-because-you-overeat Bray. It does make one wonder.
Enough of my preamble. You can decide for yourself.
Here is the link for the full-text version of George Bray’s review: bray-review-of-gcbc
Take a look about two thirds of the way down the right-hand column of the third page. Bray takes off on a riff about thermodynamics while completely missing the point Gary makes in GCBC. Unfortunately, the academics who read this, most of whom know little or nothing about thermodynamics, will swallow it hook, line and sinker and think they’ve been enlightened.
And here is Gary’s response: taubes-response-to-bray-ob-reviews