causes AIDS. If we choose to quit smoking to avoid the former, or to use condoms or abstinence to avoid the latter, that is our choice. The scientific obligation is first to establish the cause of the disease beyond reasonable doubt. It is easy to insist, as public-health authorities inevitably have, that calories count and obesity must be caused by overeating or sedentary behavior, but it tells us remarkably little about the underlying process of weight regulation and obesity. “To attribute obesity to ‘overeating,’” as the Harvard nutritionist Jean Mayer suggested back in 1968, “is as meaningful as to account for alcoholism by ascribing it to ‘overdrinking.’”
After the publication of Banting’s “Letter on Corpulence,” his diet spawned a century’s worth of variations. By the turn of the twentieth century, when the renowned physician Sir William Osler discussed the treatment of obesity in his textbook The Principles and Practice of Medicine, he listed Banting’s method and versions by the German clinicians Max Joseph Oertel and Wilhelm Ebstein. Oertel, director of a Munich sanitorium, prescribed a diet that featured lean beef, veal, or mutton, and eggs; overall, his regimen was more restrictive of fats than Banting’s and a little more lenient with vegetables and bread. When the 244-pound Prince Otto von Bismarck lost sixty pounds in under a year, it was with Oertel’s regimen. Ebstein, a professor of medicine at the University of Gottingen and author of the 1882 monograph Obesity and Its Treatment, insisted that fatty foods were crucial because they increased satiety and so decreased fat accumulation. Ebstein’s diet allowed no sugar, no sweets, no potatoes, limited bread, and a few green vegetables, but “of meat every kind may be eaten, and fat meat especially.” As for Osler himself, he advised obese women to “avoid taking too much food, and particularly to reduce the starches and sugars.”
The two constants over the years were the ideas that starches and sugars—i.e., carbohydrates—must be minimized to reduce weight, and that meat, fish, or fowl would constitute the bulk of the diet. When seven prominent British clinicians, led by Raymond Greene (brother of the novelist Graham Greene), published a textbook entitled The Practice of Endocrinology*2 in 1951, their prescribed diet for obesity was almost identical to that recommended by Banting, and that which would be prescribed by such iconoclasts as Herman Taller and Robert Atkins in the United States ten and twenty years later.
Foods to be avoided:
1. Bread, and everything else made with flour…
2. Cereals, including breakfast cereals and milk puddings
3. Potatoes and all other white root vegetables
4. Foods containing much sugar
5. All sweets…
You can eat as much as you like of the following foods:
1. Meat, fish, birds
2. All green vegetables
3. Eggs, dried or fresh
4. Cheese
5. Fruit, if unsweetened or sweetened with saccharin, except bananas and grapes
“The great progress in dietary control of obesity,” wrote Hilde Bruch, considered the foremost authority on childhood obesity, in 1957, “was the recognition that meat…was not fat producing; but that it was the innocent foodstuffs, such as bread and sweets, which lead to obesity.”
The scientific rationale behind this supposed cause and effect was based on observation, experimental evidence, and maybe the collected epiphanies and anecdotes of those who had successfully managed to bant. “The overappropriation of nourishment seen in obesity is derived in part from the fat ingested with the food, but more particularly from the carbohydrates,” noted James French in 1907 in his Textbook of the Practice of Medicine. Copious opinions were offered, but no specific hypotheses. In his 1940 monograph Obesity and Leanness, Hugo Rony, director of the Endocrinology Clinic at the Northwestern University Medical School in Chicago, reported that he had carefully questioned fifty of his obese patients, and forty-one professed a “more or less marked preference for starchy and sweet foods; only 1 patient claimed preference for fatty foods.” Rony had one unusual patient, “an extremely obese laundress,” who had no taste for sweets, but “a craving for laundry starch which she used to eat by the handful, as much as a pound a day….” So maybe carbohydrates are fattening because that’s what those with a tendency to gain weight eat to excess.
To others, carbohydrates carry some inherent quality that makes them uniquely fattening. Maybe they induce a continued sensation of hunger, or even a specific hunger for more carbohydrates. Maybe they induce less satiation per calorie consumed. Maybe they somehow cause the human body to preferentially store away calories as fat. “In Great Britain obesity is probably more common among poor women than among the rich,” Sir Stanley Davidson and Reginald Passmore wrote in the early 1960s in their classic textbook Human Nutrition and Dietetics, “perhaps because foods rich in fat and protein, which satisfy appetite more readily than carbohydrates, are more expensive than the starchy foods which provide the bulk of cheap meals.”
This belief in the fattening powers of carbohydrates can be found in literature as well. In Tolstoy’s Anna Karenina, for instance, written in the mid-1870s, Anna’s lover, Count Vronsky, abstains from starches and sweets in preparation for what turns out to be the climactic horse race. “On the day of the races at Krasnoe Selo,” writes Tolstoy, “Vronsky had come earlier than usual to eat beefsteak in the officers’ mess of the regiment. He had no need to be in strict training, as he had very quickly been brought down to the required weight of one hundred and sixty pounds, but still he had to avoid gaining weight, and he avoided starchy foods and desserts.” In Giuseppe di Lampedusa’s The Leopard, published in 1958, the protagonist, Prince Fabrizio, expresses his distaste for the plump young ladies of Palermo, while blaming their condition on, among other factors, “the dearth of proteins and the overabundance of starch in the food.”
This was what Dr. Spock taught our parents and our grandparents in the first five decades, six editions, and almost 50 million copies of Baby and Child Care, the bible of child-rearing in the latter half of the twentieth century. “Rich desserts,” Spock wrote, and “the amount of plain, starchy foods (cereals, breads, potatoes) taken is what determines, in the case of most people, how much [weight] they gain or lose.” It’s what my Brooklyn-born mother taught me forty-odd years ago. If we eat too much bread or too much spaghetti, we will get fat. The same, of course, is true of sweets. For over a century, this was the common wisdom. “All popular ‘slimming regimes’ involve a restriction in dietary carbohydrate,” wrote Davidson and Passmore in Human Nutrition and Dietetics, offering this advice: “The intake of foods rich in carbohydrate should be drastically reduced since over-indulgence in such foods is the most common cause of obesity.” “The first thing most Americans do when they decide to shed unwanted pounds is to cut out bread, pass up the potatoes and rice, and cross spaghetti dinners off the menu entirely,” wrote the New York Times personal-health reporter, Jane Brody, in her 1985 best-selling Good Food Book.
But by that time there had been a sea change. Now even Brody herself was recommending a diet rich in potatoes, rice, and spaghetti for the same purpose. “We need to eat more carbohydrates,” Brody declared. “Not only is eating pasta at the height of fashion…. It can help you lose weight.” The carbohydrate had become
