The Blackburn Award II
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George L. Blackburn, M.D.
A reader commented on yesterday’s post guessing that I was going after Dr. Blackburn for his advocacy of weight-loss surgery. I’m not. He gets the award named after him for much worse. Advocacy for weight-loss surgery is boneheaded to be sure, but Dr. Blackburn is a surgeon, so we can kind of forgive him his tendencies in that direction. Plus, there have been a number of papers published lately promoting bariatric surgery as a treatment for not just obesity but for diabetes as well, so he at least has some – misguided, in my view – rationale for his surgical advocacy.
No, what I am presenting here is his latest medical writing. He wrote a commentary piece for the debut of the new journal Obesity that is mind numbing in its insipidity. I have never read so many totally stupid statements in such a short (one page without references) paper in my life. It makes me wonder if there is an editorial staff for this journal, and if so, were they off the day this dreck came through.
You can read the piece in its entirety here. In fact, you can read this entire issue of the journal free. And lest you suspect that this is some throw-away journal that no one reads, let me assure you that it is not. This journal is published by the Nature Publishing Group, the same group that publishes Nature, probably the most respected scientific journal in the world. It is the replacement for the journal Obesity Research, which is the house organ of the Obesity Society, nee NAASO, the academic obesity group. So, as I say, it’s not a slouch journal.
Dr. Blackburn’s piece is short, so let’s go through it almost paragraph by paragraph just looking at the crass stupidity manifest there.
The premise of the article, title The Low-Fat Imperative, is that we (the august group of obesity ‘experts’ who read this journal) should encourage everyone to go on low-fat diets to defeat the obesity epidemic.
Oh, really? Let’s take a look.
Strangely, given how short this piece is, there is a fair amount of repetition. Dr. Blackburn starts out by mentioning two studies that he says support the idea that reduced fat consumption is a good thing. (He repeats this first sentence almost word for word three paragraphs later.) Then he comes up with his first insipid statement.
Diets with less fat (
20–25%) can reduce mean energy intake by 100 kcal/day—enough to stop the growing epidemic of overweight and obesity.
Do tell. And his second.
Our task is not to debate whether low-fat diets work, but to find ways to increase adherence to them.
In other words, we’re not interested in whether or not low-fat diets are the optimal diet, we simply want to promote them. He precedes this idiotic statement by referring to two studies contained in this issue of Obesity that he contends support the idea that low-fat diets are efficacious in treating obesity. You can read the two studies he references here and here, and although the second one minimally supports his premise, the first one doesn’t at all. In fact, it concludes
Energy intake, but not percentage of energy from fat, appears responsible for the observed weight gain.
Not particularly a resounding endorsement for the low-fat diet.
After the obligatory paragraph about the extent of the obesity epidemic, he goes on to write
Cutting dietary fat is the most efficient way to stop the obesity epidemic.
How he can write this with a straight face, I don’t know. Especially since virtually every study done comparing low-carb diets to low-fat diets has proclaimed low-carb diets the winner.
Here is a chart from another journal from the Nature group published a few months ago showing the superiority of the low-carb diet as compared to the low-fat one. Did Dr. Blackburn not see this article? Has he not kept up with all the studies emerging showing the low-carb diet to be the preferred diet for weight loss?
The forth paragraph is a virtual word for word repetition of the first with the added idiocy that low-fat diets can reduce energy intake by 100 kcal per day leading to a 10 pound weight loss over a year, which, in Blackburn’s mind, is
enough to stop the growing epidemic of overweight and obesity.
Pitiful. Dr. Blackburn has obviously never read the papers on adaptive thermogenesis.
Then he goes on to say that there is a question as to whether or not low-fat diets can be adhered to for the long haul. He references the Women’s Health Initiative (WHI) study as proof that they can. Instead of my going through the WHI myself, let me simply give you the pdf of the critique of it that came from JAMA, the journal in which it was published. I certainly wouldn’t use the WHI to prove that low-fat diets are effective for the long haul. whi-editorial.pdf
He drones on about a couple of other allegedly supportive studies then writes:
Unlike a diet high in carbohydrates and proteins, a high-fat diet works against the goals of healthy eating.
Since the goals of healthy eating have gotten us into the mess we’re in with the obesity epidemic, it would seem that working against those goals would be a good thing, not a bad thing.
He tells us that
The United States Department of Agriculture has been recommending moderate fat intake since it released its first set of nutritional guidelines in 1916.
And that
The American Dietetic Association, American Heart Association, National Heart, Lung, and Blood Institute, and the Institute of Medicine all recommend lifetime consumption of diets high in vegetables and moderately low in fat.
What he doesn’t tell us, however, is that since all these groups began recommending the low-fat diet, rates of obesity and diabetes have skyrocketed.
Then he really goes over the edge. He wades into the evolutionary aspects of diet, a place he should avoid in the future. He writes:
Evolution favors such a diet. For nearly 2 million years, our predecessors consumed lean meat, fish, vegetables, fruits, and nuts—low-fat diets high in fiber, proteins, and essential fatty acids. Retrospective models of Paleolithic diets estimate macronutrient content at
To support this ludicrous statement, he references Loren Cordain’s seminal paper on the plant/animal subsistence ratios of hunter/gatherers, which shows that most hunter/gatherers got 65 percent of their calories from foods of animal origin and 35 percent from plants. Who knows where Blackburn got his numbers? As Loren emailed me when I sent him this paper
Nowhere in that paper do we give the numbers he quoted. We provided these ranges of macronutrient estimations are being most likely (protein 19-35% energy, carb 22-40% energy, and fat (28-58% energy).
Finally he comes out with one of the stupidest statements I’ve ever read. (I swear it’s true; read the article to see for yourself.)
As all macronutrient-based diets produce similar long-term weight loss, it does not matter which one people choose…
All macronutrient-based diets?!?!?! What are macronutrients? Fat, protein and carbohydrate. That’s it. Those are the macronutrients. So, what are macronutrient-based diets? As far as I can tell, they are diets composed of fat, protein and carbohydrate. And these macronutrient-based diets all produce similar weight loss? Say what?
As I say, one of the stupidest, most nonsensical statements I’ve ever read. Where were the editors who should have saved Dr. Blackburn from himself?
Finally and mercifully he ends this garbage by repeating himself yet again. Almost word for word. Where were the editors?
Our task is not to debate whether low-fat diets work, but to find ways to increase adherence to them. We need to spread the message that moderate weight loss of 10% is an acceptable, healthy option for those who want to lose weight—an option easily achieved by cutting small amounts of fat out of each meal. This is a reasonable and realistic goal, one that can be achieved as well as sustained.
We’ve had several instances of misrepresenting others’ work, a couple of examples of failing to understand the data, a few misinterpretations of what’s going on, and an outright, no question about it, idiotic statement. All in one short article. Stupidity compressed.
So now you know the rationale for the Blackburn Award, which will go to the person who makes most feckless, stupid, dogmatic, insipid nutritional statement imaginable. And whoever makes such a statement will have to go a long, long way to top that made by the man after whom the award is named.
While not the title of Wolgang Lutz’s medical book, the German title that the US book was based on (co-authored by Christopher Allan) was Leben Ohne Brot meaning the same as the US title – Life without Bread. There are references to Lutz medical studies(?) in the back of the book in English with their German titles. Don’t read German so hard to say if one of them is the medical text.
I expect that by “macronutrient-based diet” he simply means eating advice based on some “ideal” range of percentage of calories from one or more of the macronutrient classes. Like a “low-fat diet” targets percentage of calories from fats, while a low-carb diet limits percentage of calories from carbs. Presumably this is in contrast to the universe of other diet ideas based on specific foods (e.g., the grapefruit diet) , meal timing (e.g., the 3-hour diet, or intermittent fasting), etc. The latter are based on ideas other than overall macronutrient composition, and it would be odd indeed to call them “macronutrient-based” diets.
The chart reproduced here summarizing a meta-analysis doesn’t refute Blackburn’s stated view of this: it shows a measly 1-kilogram mean advantage after 1 year for low-carb vs low-fat diets, and the 95% confidence interval ranges from a 3.5 kg advantage to a 1.5 kg disadvantage. IOW, Blackburn’s “similar” is spot-on with respect to this data — this specific meta-analysis didn’t find a clear winner after 1 year, although it suggests low-carb may enjoy a small advantage over low-fat after 1 year. It did show a low-carb advantage after 6 months, but Blackburn said “similar long-term weight loss”, and while I don’t know what “long-term” means to him, I’m charitable enough to grant he meant /something/ by it
I’m not arguing that Blackburn is right in all he says, but except for cheerleading purposes
it doesn’t really help to work at misconstruing him.
I don’t think I am misconstruing him. He clearly favors a low-fat diet, and the chart I posted showed that a low-fat diet came in second to a low-fat diet. With such a wide spread of results in the number of subjects in meta-analyses, small differences are actually pretty large if significantly different.
Dr. Eades, the question of significance is directly addressed in the chart, in the line
Overall (95% CI) -1.0 (-3.5 to 1.5)
IOW, with 95% confidence the authors believe their data shows that the advantage of a low-carb diet is somewhere in the range of -3.5 kg to +1.5 kg after a year, relative to a low-fat diet. This doesn’t show that low-carb diets are better, it shows that the data they analyzed isn’t strong enough to resolve the question with reasonable confidence. The data is even consistent with the possibility that the low-fat diets had a 1.5 kg advantage, although since that’s at the extreme end of the confidence interval, it’s unlikely to be true. Put that all together, and “similar results” is a fair assessment.
That said, I’m personally surprised that most studies don’t show stronger advantages for low-carb, high-protein diets. High-carb, low-fat eating never made sense to me, and never “worked” for me either, but it’s darned hard to do a randomized, placebo-controlled, double-blind study on myself
Keep up the great work!
That’s true at the 12 month mark. But two out of three studies showed a significant advantage to the low-carb diet at 12 months. If you read this entire article, you can see that it is not particularly predisposed to low-carb dieting, so the studies used were not selected to show an advantage to low-carb diets. It was the only chart I had available without having to make on myself. Good eye on catching the confidence interval crossing the zero line. We’re I not biased in favor of low-carb diets, I would have caught it myself.
Cheers–
MRE
Wasn’t there a study where they divided the people into metabolic syndrome and non-metabolic syndrome types and then put half of each group on low fat and half on low carb? Low carb showed a clear advantage among the metabolic syndrome types?
A number of such studies.
This is completely off-topic, so I’m sorry. I’m curious if you guys have heard about this theory:
“As carbon dioxide levels rise in the atmosphere, most plants accumulate more carbon in their tissues, Taub explained, which can reduce concentrations of other elements, such as nitrogen, a key component of proteins.
“Taub says that the decrease in nitrogen could be partially overcome by using fertilizers that contain nitrogen, but that these can have negative environmental consequences of their own, particularly for nearby waterways. Another option would be to breed strains of grains that have higher protein concentrations under elevated carbon dioxide levels, he said.”
http://www.livescience.com/environment/080122-co2-nutrition.html
Interesting overlap between Protein Power and global warming, eh?
Except when I asked him, the famous author of Protein Power said he is a agnostic on the idea of global warming. So where does that leave us?
Cheers
The January 25th issue of Science has a short blurb (p. 399) stating the results of separate surveys which show that the majority of people in the US and Europe think that physicians, not physicists, engineers, or even biologists, are in the “most scientific” field of study. Yipes!
No one would seriously doubt the well-established physical laws of energy conservation. Still it always amazes me how the proponents of the idea sometimes called “calories-in-calories-out” keep concentrating on calories-in while largely ignoring the calories-out half of the equation.
If you measure the changes over time in your fat stores (and of course, to a lesser extent, protein and glycogen stores), you can always count backwards: If you know your total calories-in, just add or subtract the calorie worth of the changes, and you get a good estimate of your total calories-out. And this may be the only realistic way of estimating calories-out…
The logical fault that non-physicists seem to love is to believe that it follows from the laws of energy conservation that, by modifying energy intake, you could control the fat stores. For instance, as Blackburn sugests, by lowering energy intake by 100 calories a day, you would force the body to burn an extra 100 calories’ worth of stored body fat.
It is not an inherently impossible idea – the storage of fat just might be unlike any other comparable processes in the body by lacking what is known as homeostasis – active regulation mechanisms (often hormone mediated) that keep for instance electrolyte balances closely regulated, or body temperature. Within limits of course – you could drink water and upset the balance lethally, and in sufficiently hot or cold environments, the temperature regulation can and will fail.
But is it a reasonable model of reality? Do calorie-counting dieters actually achieve the weight change predicted by the change in calorie intake? Or, by modifying the calories-out by exercising? Has anybody tried ? In a very short perspective, yes, but any data from the literature will show you it doesn’t work like that over any reasonable time.
A very different way of thinking would be considering obesity as a fat-storage disease, where the normal regulation of the fat stores fails for some reason. Like body temperature – one person might keep the body temperature within bounds, while another might fail and die of heat stroke – and a third, due to some infection, might have significantly elevated temperature in a perfectly normal environment.
So, if this model is of any use, why would the fat-store regulation ever fail? It might be overloaded by what’s in a “Western” diet – the ubiquitous Pima indians or the Pacific islanders seem to get universally obese when leaving their traditional eating for “imported” food habits. Is it insulin mediated? Often, I think, but other mechanisms (thyroid or adrenal hormones, etc) might be more important for some.
But why is extreme calorie reduction at least temporarily effective? For instance, there are low-calorie powder preparations (designed to supply protein to cover losses, and some carbs thrown in) that are low enough in carbs to be ketogenic, and lower insulin levels very strongly. It is, for all I’ve seen, taken for granted that the calorie reduction is what leads to the quick weight loss – instead, could it be the effect of it being a low-carb diet instead? And can the almost inevitable long-term failure be the consequence of the calorie deficiency?
Or take exercise. In some cases, but not all, it seems exercise aids fat weight loss – again, if so, is it by the increase in calories-out or the improvement in insulin resistance of the muscles?
Just wondering.
(Oh, I can indeed post here ! Good)
Blackburn sounds like a real scum bag. I’ve been re-reading Alicia Mundy’s “Dispensing With The Truth”, in which Blackburn is a notable character because of his Wyeth-sponsored promotion of Fen-Phen, that horrible off-label cocktail of diet drugs that caused so much death and disease.
A 2006 CBS News report stated “Dr. George Blackburn says the practice is untested, and patients who seek off-label drugs for weight loss are desperate and vulnerable. “They need therapy,” he said. “They need counseling, they do not need an off-label medication.”"
Ha ! What a change of heart he’s had ! I guess all of those Fen-Phen lawsuits have made an honest man out of him after all. But I do wonder … if he thinks that patients who seek off-label drugs for weight loss are desperate and vulnerable, I wonder what he thinks of physicians who advise people to use off-label drug combos for weight loss ? Perhaps desperate and greedy ? I wonder how much he made from promoting Fen-Phen ? I wonder if he’ll start pushing Lorcaserin when it’s approved by the FDA ?