Good Calories, Bad Calories

hypotheses or even establishing of consensus but by the judgment of fewer than a dozen men who dominated the field: Jean Mayer, Fred Stare, Jules Hirsch, George Bray, Theodore Van Itallie, Albert Stunkard, George Cahill, Philip White, and perhaps a few others. (And when these men began to retire from the scene in the 1980s, their younger colleagues—Johanna Dwyer, who received her Ph.D. with Mayer; Francis Xavier Pi-Sunyer, who collaborated with Van Itallie; Kelly Brownell, who worked and studied with Stunkard—assumed the leadership and perpetuated their beliefs.)

When these men came of age in their careers, in the 1950s and early 1960s, obesity research was a new and expanding field of science. It had been reinvented in the United States after World War II, and the National Institutes of Health was just beginning to provide money for research. These men filled the expanding vacuum. They all came out of the Northeastern academic corridor—Harvard, Yale, Columbia, Rockefeller, the University of Pennsylvania—and they all knew each other. Van Itallie befriended his classmate Stunkard on their first day of medical school at Columbia; he then went to work with Mayer at Harvard and enlisted Stunkard’s help to test Mayer’s theory of hunger, and so Stunkard got to know Mayer as well. Philip White received his doctorate with Mayer at Harvard and remained in Stare’s department until 1956, when he became secretary of the American Medical Association’s Councils on Foods and Nutrition and wrote an influential nutrition column for JAMA. Van Itallie then became a member of White’s council and initiated its 1973 public condemnation of Atkins and all similar carbohydrate-restricted diets. White edited the article. If you weren’t in the club, you had little influence. (“The Mississippi River is very deep, or at least it used to be,” is how the biochemist and diabetologist Gerald Grodsky of the University of California, San Francisco, described the inability of West Coast investigators to influence medical wisdom in the 1960s and 1970s.)

These individuals became the field’s “leading authorities,” as the newspapers would call them. They hosted the conferences, edited the textbooks, chaired the committees, and determined research priorities. By the end of the 1970s, they had determined what clinicians and researchers in the field would believe, at least in the United States, and what they still believe overwhelmingly. When McGovern’s committee held its post-facto hearings in February 1977 to address the Dietary Goals for Americans, only members of this club testified on obesity^*125 (Mayer had been the committee’s consultant), and they all embraced the committee’s recommendation of a national diet richer in carbohydrates and poorer in fat. Although Van Itallie also testified that he was unaware of any research to support their opinions: “Thus, what I am saying is an assumption rather than a statement of established fact,” he acknowledged.

None of these authorities actually specialized in the clinical treatment of obesity except Stunkard, who did so as a psychiatrist treating an eating disorder. Nor were they necessarily the best scientists in the field. Fred Stare and Philip White never studied obesity at all. Cahill’s research on fat metabolism and fuel partitioning was seminal, but he didn’t see why it should be relevant to human obesity. Stunkard’s primary contribution to obesity research through the 1970s was his observation that the obese rarely lose weight on diets, and if they do, they don’t keep it off. But he never noted, and as a result neither did anyone else, that the only dietary studies he addressed in his seminal analysis were of semi-starvation, so what he had confirmed was that semi-starvation failed, not that all diets did.

Van Itallie and Bray deserve a disproportionate share of the responsibility for effectively removing the concept of the fattening carbohydrate from the nutritional canon, and thus the carbohydrate-restricted diet as well. Virtually everything we believe about what constitutes an effective weight-loss diet can be traced back to the 1970s and the efforts of these two men.

Before Van Itallie decided to write what he called the AMA-sponsored “denunciation” of Atkins in 1973, his only substantive involvement in the science of obesity, as either a researcher or a clinician, was his work with Mayer twenty years earlier. In the intervening years, he had worked on intravenous feeding of hospital patients and dietary influences on cholesterol, among other subjects, but he returned to the subject of weight in 1971, only when one of his post-docs developed an interest in the subject. This led to what Van Itallie considered his primary contribution to obesity research, the development of a feeding machine to study food intake: “You could basically feed yourself by pushing a button,” Van Itallie explained. “The machine would deliver a measured quantity of formula diet into your mouth, and then keep a record of how much you took.”

Van Itallie felt that Diet Revolution was full of what he called “gross inaccuracies,” and that there were far too many reasons to believe that the diet could be dangerous to disseminate it so widely. There may have been some personal enmity as well: Van Itallie had been chief of medicine at St. Luke’s Hospital in New York when Atkins had served under him as a cardiology resident in the late 1950s. Van Itallie said he didn’t work with Atkins closely enough to know him personally, but he did not find him “an appealing personality” nonetheless. Stunkard, talking about all his colleagues in the field, said, “We just despised [Atkins]. We thought he was a jerk, an idiot, who just wants to make money.”

The critique that Van Itallie drafted and White edited, which was then published as the official AMA declaration on carbohydrate-restricted diets, was not a balanced assessment of the science, nor was it absent its own gross inaccuracies. It was akin to the diatribes that had been aimed at Banting in the 1860s, Pennington in the 1950s, and Taller, by White himself, in the early 1960s. Atkins, like Banting, Pennington, and Taller, was censured for advocating a diet that was “neither new nor revolutionary.” The article accused Diet Revolution of lacking “scientific merit,” primarily by implying that here was a “way of circumventing the first law of thermodynamics.” The diet itself was denounced as “grossly unbalanced,” because it “interdicts the 45 percent of calories that is usually consumed as carbohydrates,” and so cannot “provide a practicable basis for long-term weight reduction or maintenance, i.e., a lifetime change in eating and exercise habits.” That this was the opinion of a nutritionist and a physician, neither of whom had worked clinically with obese patients, was lost in the publication of the critique under the auspices of the AMA itself. Mayer dedicated one of his syndicated newspaper columns to condemning Atkins, based on the AMA critique, which he cited repeatedly as though it were the considered opinion of the entire American Medical Association and not just his former collaborator, edited by his former student. “The American Medical Association,” wrote Mayer, has “taken the unusual step of warning the U.S. public against the latest do-it-yourself diet as propounded in ‘Dr. Atkins’s Diet Revolution.’” The AMA report, Mayer wrote, “explains why the ‘diet revolution’ cannot work.”

After Van Itallie drafted the AMA attack on Atkins, he spent the next decade as the principal arbitrator of the risks and benefits of weight-reduction diets. This coincided with his rise to prominence in the field, after receiving a 1974 NIH grant—“a few hundred thousand dollars,” he says, “which was a lot of money at the time”—to start the first federally funded clinical obesity center in the United States, now known as the Theodore Van Itallie Center for Weight Control at St. Luke’s Roosevelt Hospital Center. That same year, Van Itallie gave the review presentation on dietary approaches to obesity at the First International Congress on Obesity, although he had yet to do any research personally on the dietary treatment of obesity, or to treat obese patients. In 1975, Van Itallie cowrote (with Pi-Sunyer) the review chapter on obesity and diabetes in the textbook Diabetes Mellitus, having now been in the field, in a part-time capacity, for at most four years. He then wrote the chapters on dietary therapy for obesity in the 1978 symposium report Obesity: Basic Mechanisms and Treatment, edited by Stunkard; in the 1979 NIH report Obesity in America, edited by Bray; in Bray’s 1980 textbook, Obesity: Comparative Methods of Weight Control; and in Stunkard’s 1980 textbook, Obesity. In 1983, Van Itallie cochaired the Fourth International Congress on Obesity. In 1984, he coauthored the obesity chapter in the fifth edition of Present Knowledge in Nutrition, which had been a standard nutrition reference since its first edition was published thirty years earlier. Because Van Itallie was also engaged as chair of the medical department at Columbia University’s Presbyterian College of Physicians and Surgeons, he says, he had no time to do research himself, and relied almost entirely on his collaborators for the few studies he did publish.