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Fat Chance
by Robert H. Lustig, M.D.

Fat Chance
by Robert Lustig, M.D.

I'm not qualified to judge the science presented in this book. I am, much to my chagrin, overly qualified to judge the judgments that Dr. Lustig makes about being obese--and that is why I highly recommend this book.

There are two sides to the issue presented in Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. On the one hand, you have the science mentioned above. Lustig delivers a strong case--as strong a case as you can make in layman's terms for a very technical argument--that the obesity pandemic that is now ravaging the world is largely the product of the over consumption of sugar, specifically fructose in processed foods. Making heads or tails of the effects of leptin, insulin resistance, ghrelin, and other hormones on the hypothalamus, and how all that translates into weight gain and "metabolic syndrome," can be a bit of a slog, especially if you're not technically minded. Suffice it to say, Lustig explains these medical matters with enough simplicity and clarity that a reasonably well-informed reader will likely judge his thesis to be sound and consistent.

On the other hand, there is the matter of the experience of obesity, both from Lustig's patients (related as illustrative anecdotes throughout the book's chapters), and the reader's own understanding of that experience. This is where the rubber meets the road--or, to be more apt, where the sugar hits the liver--for making the case that Fat Chance represents an honest, accurate reflection of what has happened to people all over the world, what is happening to more people as time goes by, and what the legacy of that crisis will be for our world if nothing is done to change society's course.

If you read this book as someone who has suffered through a lifetime of weight problems, you can't help but recognize in this text descriptions of the mechanics of obesity that dovetail perfectly with your own life story. Who hasn't grown up fat and wondered why you were made that way? What fat person hasn't felt the frustration of failure to control his or her behavior--supposedly the key aspect of how people get to be obese? Lustig has answers for these and other questions that contradict the received wisdom about obesity: the long-standing philosophical position that if you're fat, it's because you make bad choices.

Not so, according to the author; Lustig presents ideas that explain why so many of the treatments for obesity that have been preferred up till now--by the medical community, by government, by fat people themselves--simply haven't worked. He argues that behavior follows biology, not the other way around; that a calorie is not a calorie (meaning, different types of calories affect the body differently); that changing environment is more effective than changing diet; that our modern food industry has a stake in making us sick, despite the costs to the rest of society. All of this rings all too true, both to someone who has been trapped in an overweight life, and to anyone who has been paying attention to the overarching trends in our world, especially societal and political trends regarding the production of our food supply. In that ring of veracity the reader finds a forceful argument in favor of Lustig's view of the problem, and thus the utility of this book.

While Lustig makes it clear that the odds are indeed stacked against us, he does offer a blueprint for fixing the problem, for both the individual and society. The doctor's advice on how to overcome your personal obesity challenge--raised awareness about sugar in the foods you eat, getting more fiber in your diet, exercising as much as you can, and having manageable expectations about your health--may not seem revolutionary, but it strikes this reader as the best possible message on the subject. Lustig's prescriptions for societal cures--higher taxes on sugar, changes to subsidies and tariffs on various foodstuffs (discouraging sugar, encouraging fresh foods, etc.), using the fight against tobacco as a model for fighting the food industry--seem more far-fetched, if reasonable given the scope of the problem, simply due to the corruption and intransigence of governmental agencies. But at least the ideas are there, and given the seemingly insurmountable odds against putting any of those top down reforms in place, perhaps that hopelessness itself can spur the individual to take the necessary steps himself. After all, can you really expect help to come from Congress, or McDonald's? Fat chance, as the doctor might say.

I can't recommend this book highly enough, especially to anyone who is obese and wants to understand what has happened to him or her. Knowing about science and politics is all well and good, but knowing about yourself is always the key to any number of mysteries. In Fat Chance, anyone who cares about the obesity pandemic may indeed find that crucial key.