Taubes begins with the question,

“Why does insulin only make some of us fat?”

He says it’s a question of Nature –our genetic pre-disposition,
and that the aspects of Diet or Lifestyle don’t trigger this difference.

He says the answer is:

“..Hormones don’t work in a vacuum, and insulin is no exception.
The effect of a hormone on any particular tissue or cell depends
on a host of factors, both inside and outside cells
-- on enzymes, for instance…

This allows hormones to differ in their effect from cell to cell,
tissue to tissue, and even at different stages of our development
and our lives. “

Insulin is a hormone that determines
how fuels are “partitioned” around the body.
When thinking about whether fuel will be burned or stored,
Picture a fuel gauge like on your car.
Except the “F” on the Right, stands for Fat
and the “E” on the left sands for Energy.

If the needle on the gauge points to the right – toward the “F”,
then insulin puts a larger share of your calories into storage for fat,
instead of use for energy by the muscles.
If you want to be active, you’ll have to eat more to
compensate for this loss of calories into fat.

“The further the needle points to “F”,
the more calories stored and the fatter you’ll be.
The morbidly obese live on the far end of this side of the gauge.

If the needle points the other way –toward the “E”,
the larger share of your calories are burned as fuel.
You’ll have plenty of energy for physical activity,
and little will be stored as fat.
You will be lean and active and you’ll eat in moderation.

What determines the direction in which the needle points?
There is more than one factor.

(1) How much insulin you secrete.

(2) How sensitive to insulin your cells are,
and how quickly they become insensitive, (insulin resistant).

(3) And also, cells respond differently to insulin.

“Fat cells, muscle cells, liver cells don’t all become resistant
to insulin at the same time, to the same extent, or in the same way,
This means the same amount of insulin
will have differing effects on different tissue.

The response of the tissues differs, as well—
from person to person, and over time in the same individual.”

As you get older, you can get more insulin resistant,
and as a result, in middle age, it’s harder to remain lean.

Taubes says that in middle age

“our muscles become increasingly resistant to insulin,
and this partitions more of the energy we consume into fat,
leaving less available for the cells of the muscles
and organs to use for fuel.

These cells now generate less energy, and this
is what we mean when we say our metabolism slows down.
Our “metabolic rate” decreases.

What appears to be a cause of fattening
--the slowing of our metabolism –
is really an effect.

You don’t get fat because your metabolism slows;
your metabolism slows because you’re getting fat.”

Taubes says

“Fat children tend to be born of fat parents,
in part because of all the ways that our genes
control our insulin secretion, the enzymes that respond to insulin,
and how and when we become resistant to insulin.

He gives further details about how fat mothers
produce babies who are also fat, or have a tendency toward fat.
He says it is a vicious cycle.

“As the obesity epidemic took off,
and we all began getting fatter,
we began to program more and more of our children
from the first few months of their existence to get fatter still.”

Taubes says that each successive generation may find
it harder to under this problem.

 This is an interesting concept,
and I think that Taubes makes it understandable.
It sounds right, and seems to make a lot of sense.

Plus, my limited medical knowledge doesn’t give me
the ability to dispute this information, even if I wanted to do so.

Due to my own observation and experience,
I do believe that there are many differences between people,
and in the personal behaviors that are required to avoid being fat.

 In this chapter Taubes talks about the Science issues
of how some hormones and enzymes work
(issues that weren’t, and still aren’t, controversial)
which were worked out between the 1920s and 1980s.

Most of the chapter is about those “Basics” physical concepts
that are connected with the issue of Why anyone Gets Fat.
There is a small part at the end about the “Implications” of those Basics.
Taubes says that fat tissue is more like a wallet than a savings account.

“You’re always putting fat into it, and you’re always taking fat out.
You get a tiny bit fatter…during and after each meal,
and then you get a tiny bit leaner again…after the meal is digested.
And you get leaner still while sleeping.

In an ideal world,
one in which you’re not getting any fatter,
the calories you store as fat immediately after meals during the day
are balanced out over time
by the calories you burn as fat after digesting those meals
and during the night. “

He says,

“Anything that works to promote the flow of fatty acids into your fat cells,
where they can be bundled together into triglycerides,
works to store fat, to make you fatter.

Anything that works to break down those triglycerides
into their component fatty acids
so that the fatty acids can escape from the fat cells
works to make you leaner.

There are dozens of hormones and enzymes
that play a role in these processes, but one hormone dominates the action.
That’s insulin, and this has never been controversial.

We secrete insulin primarily in response to the carbohydrates in our diet,
primarily to keep blood sugar under control.
But insulin also does other things including,
controlling fuel storage in our fat tissue.
Because of this, insulin is the “principle regulator of fat metabolism”.

 Taubes continues talking in technical terms about various body functions,
then says..

"In short, everything insulin does in this context
works to increase the fat we store
and decrease the fat we burn.
Insulin works to make us fatter.”

After describing in detail how insulin is activated and how it works,
ahe says,

“The bottom line is something that’s been known
(and mostly ignored) for over forty years.
The one thing we absolutely have to do if we want to get leaner
--if we want to get fat our of our fat tissue and burn it –
is to lower our insulin levels and to secrete less insulin to begin with.”

Leaving the “Basics”, Taubes goes on the “Implications”.

“When insulin levels go up,
we store fat.
When they come down,
we mobilize the fat and use it for fuel”

He states that when insulin is high, the fat from storage is not available;
that insulin also works to keep the protein stored away in muscles;
and insulin keeps the carbohydrate supply that is stored in the liver
and muscles locked up as well.

“As a result, the cells find themselves starved for fuel,
and we quite literally feel their hunger.
Either we eat sooner than we otherwise would have
or we eat more when we do eat, or both. …
Anything that makes us fatter will make us overeat in the process.
That’s what insulin does.“

 Taubes ends this chapter with

“…as we fatten, our energy demand increases,
and our appetite will increase for this reason as well
--particularly our appetite for carbohydrates,
because this is the only nutrient our cells will burn for fuel
when insulin is elevated.

If we’re predisposed to get fat,
we’ll be driven to crave precisely those
carbohydrate-rich foods that make us fat.”

The insulin issue is interesting to me personally
because all during my lifetime I’ve felt
driven to crave carbohydrate-rich foods
…..and I’ve spent much of my lifetime as a fat person.

I have discovered that for me
(and I’ve learned it is also true for many others),
I can eat sweet and starchy foods until my stomach hurts,
and just a very short time later,
I want and I’m ready to eat more of them.
The more I eat, the more I want. 
and on…and on…and on…
until I’m so full and tired that I just go to sleep. 
 This is the “binge” behavior that I’ve had to deal with my entire life,
and it comes from a very physical feeling, which is often totally unrelated
to any positive or negative emotional issues I might be having.

I have never experienced this with foods that are primarily protein and fat,
only with foods that contain a lot of sugar and/or starch.
For me, personally, even dense whole grain bread,
white and sweet potatoes, corn, as well as cooked dry beans
tend to set this “binge mechanism” off in me.
I tend to crave those foods, and have eaten massive amounts of them. 
  I am a person who has always kept my refrigerator and pantry
supplied with food that I’ve been taught are the “basic necessities”
like: eggs, milk, butter, flour, sugar, oatmeal,
oil, spices, condiments, fresh, canned and frozen vegetables;
fresh, canned and frozen meat/fish/poultry…among others.
Therefore, in my own lifetime,
that Behavioral therapy technique of eliminating all “trigger” foods
from my house…that almost every diet recommends…
…(even some Intuitive eating experts)…..
was always pretty much meaningless to me.

After I cleared my house of cookies, cake, pie, candy, chips, crackers etc.
I would still binge on bread and butter. If I didn’t have bread,
I would make some from my supply of flour, fat, and spices on hand.
If there were no “sweets” in the house, I’d sprinkle sugar on my bread and butter, 
 or I’d bake “sweets” with the flour, sugar, and oil or butter on hand.

Enough said for now,
more about that binge behavior
and how it might relate to these issues at another time.

 Taubes begins by talking about how pre-World War II scientists
studied genetics and endocrinology and developed the theories
that he presents in this book.

He cites 1908 German scientist Von Bergmann who first
used the term “lipophilia” which means “love of fat”.

Von Bergmann considered obesity a disorder of fat accumulation,
and worked to learn about how fat tissue was regulated.

 Von Bergmann said this is different from tissue-to-tissue and person-to-person.
Just as some parts of the body tend to grow hair and some don’t,
some people are hairier than others; and some people are fatter;
and these people fatten easily, and it often seems
that there’s nothing they can do about it.
Other people are lean and have trouble gaining weight.

Taubes says that in the 1920s Bauer, a genetics and endocrinology scientist,
adopted Von Bergmann’s ideas. At that time it was a new idea that
genes could give characteristics and a predisposition for diseases to people.

Bauer said that fat tissue in obesity is like malignant tumors….

“In those who are predisposed to grow obese,
fat tissue is driven to grow, to expand with fat,
and it will accomplish this goal, just as the tumor does,
with little concern about what the rest of the body might be doing.

The abnormal…fat loving…tissue seizes on food-stuffs,
even in the case of undernutrition…
It maintains its stock, and may increase it
independent of the requirements of the organism.
A sort of anarchy exists; the fat tissue lives for itself
and does not fit into the precisely regulated
management of the whole organism”

Taubes says that by the late 1930s the concepts of these German Scientists
were accepted in Europe and were catching on in the U.S.
but within 10 years, because of World War II, they vanished.

Germans and Austrians had founded and done most of the research
in nutrition, metabolism, endocrinology, and genetics,
which are all the fields relevant to obesity. 
 But World War II interfered with their studies,
and after WWII, anti-German sentiment in the U.S. resulted in authorities
treating the German medical literature as though it didn’t exist.
Taubes states:

“Once the psychologists took over in the 1960s
and obesity officially became an eating disorder
--a character defect but in kinder words—
any hope that authorities would pay attention
to how the fat tissue was regulated effectively vanished.”

Taubes says that after World War II
only a few researchers continued with the genetic line of thought.
Endocrinologist, Astwood, was one of them.

 In 1962 Astwood states that many enzymes and hormones
have been indentified that influence fat accumulation.
Some of those liberate fat, others put it there.
Ultimately, these competing regulatory forces
will determine the amount of fat to be stored in any single person
or at any single location on the human body.

What if something went wrong it one of these regulatory processes?
Astwood said

“Suppose that the release of fat or its combustion
(burning for fuel) was somewhat impeded,
or that the deposition or synthesis of fat was promoted;
what would happen?

Lack of food is the cause of hunger,
and to most of the body (fat) is the food;
it is easy to imagine that a minor derangement
could be responsible for a voracious appetite.

It seems likely to me that hunger in the obese
might be so ravaging and ravenous
that skinny physicians do not understand it.

This theory would explain why dieting is so seldom effective
and why most fat people are miserable when they fast.[/b]
It would also take care of our friends, the psychiatrists,
who find all kinds of preoccupation with food,
which pervades dreams among patients who are obese.

Which of us would not be preoccupied with thoughts of food
if we were suffering from internal starvation?
Hunger is such an awful thing
that it is classically cited with pestilence and war
as one of our three worst burdens.

Add to the physical discomfort the emotional stresses of being fat,
the taunts and teasing from the thin, the constant criticism,
the accusations of gluttony and lack of “willpower”,
and the constant guilt feelings,
and we have reasons enough for the emotional disturbances
which preoccupy the psychiatrists.”

 Taubes believes we need to understand what Astwood understood,
and what the Obesity Experts before World War II accepted.
Taubes says

“Both gluttony (overeating) and sloth (sedentary behavior)
will be the side effects of any regulatory derangement, minor as it may be,
that diverts too many calories into fat tissue for storage.”

This concept is extremely interesting to me, and, upon reflection,
I can see how it does align with my own experience.

It’s a bit scary to think that in certain instances,
my Fat, even when I’m starving, could work to protect itself,
and might even work toward increasing itself,
taking away energy/calories that the rest of my body needs.

However, this idea is the only Theory I’ve come across
that might explain to me what has actually been happening
with my own body during the past 2 years of my 5 years of maintenance.
Calories-in/calories-out simply doesn’t explain it.

In my current experiment, I am basing my eating Behavior
on the possibility that this Theory could be true.
An interest in my Results motivates me to follow through…day-by-day.

 Taubes starts out by talking about lab rats that had their ovaries removed,
became ravenously hungry, overate and became obese. Then, in a second experiment
the researcher took other lab rats, and after this surgery, put them on a strict diet
where they couldn’t eat any extra food. These rats got just as fat by becoming
completely sedentary. When estrogen was returned, the fat rats became normal weight.

The researcher explained it this way

“The animal does get fat because it overeats
It overeats because it’s getting fat.
The cause and effect are reversed.
Both gluttony and sloth are effects of the drive to get fatter.

They are caused fundamentally by a defect
in the regulation of the animal’s fat tissue.
The removal of the ovaries literally makes the rat stockpile body fat;
the animal either eats more or expends less energy, or both, to compensate”

Taubes talks more about enzymes,
and then says that in dealing with Obesity, medical experts have
ignored the fat tissue because they’ve decided the problem is Behavioral,
and lies in the Brain, not the Body.
He says, if medical experts were discussing growth disorder instead of fat disorder
the subject would be hormones and enzymes regulatory growth.
But when discussing a fat disorder,
which is defined by the symptom of abnormal growth of fat tissue,
the hormones and enzymes that regulate fat growth are considered irrelevant.

Taubes says…
this is the cause of obesity.

“those who get fat do so because of the way their fat happens to be regulated
and that a…consequence of this regulation is to cause the eating behavior (gluttony)
and the physical inactivity (sloth) that we..assume are the actual causes.”

He states Three Laws of Fat (Adiposity),
and gives examples and explanations of how they work.

The First Law
Body fat is carefully regulated.

The Second Law
Obesity can be caused by a regulatory defect so small
that it would be undetectable by any technique yet invented.

The Third Law
Whatever makes us both fatter and heavier will also make us overeat.

Taubes gives illustrations and examples of each of these laws, a
nd how they work….
One of his examples was the Zucker rats, which are genetically predisposed to get fat.

“when these obese rodents are starved to death…
the animals die with much of their fat tissue intact.
In fact, they’ll often die with more body fat than lean animals have
when the lean ones are eating as much as they like.

As animals starve, and the same is true of humans,
they consume their muscles for fuel, and that includes,
eventually, the heart muscle.

As adults, these obese animals are willing to
compromise their organs, even their hearts and their lives,
to preserve their fat."

 Taubes says….

“If this is true of humans,
and there’s little reason to think it’s not,
it is the explanation for..
the extremely poor but overweight mothers with thin stunted children.
Both mother and children are indeed half-starved.

The emaciated children, their growth stunted, respond as we’d expect.
The mothers, however, have fat tissue that has developed its own agenda…
It will accumulate excess fat, and does so,
even though the mothers themselves, like their children,
are barely getting enough food to survive.
They must be expending less energy to compensate.”

 Taubes then talks about the existence animals
whose genes have been manipulated
so they are leaner than they’d otherwise be.
Those animals will remain lean even when force fed,
and he says this is probably done
by increasing their expenditure to burn off calories.

He says just like gluttony and sloth
are side effects of a drive to accumulate body fat,

 eating in moderation and being physically active
are not evidence of “moral rectitude”.
Rather, they are simply metabolic benefits
of a body that’s programmed to remain lean.

Taubes concludes by saying that the evidence implies
that we don’t remain lean because we’re virtuous
and get fat because we’re not.
He says when we grow taller,
it’s hormones and enzymes that are promoting our growth,
and we consume more calories than we expend as a result.
When we grow fatter, the same is true as well.

“We don’t get fat because we overeat;
we overeat because we’re getting fat.”

I find it easy to believe in those three “laws” that Taubes states.

It is harder to accept Taubes’ Reversal of what is commonly believed
about the Causation of Obesity, and consider overeating and inactivity
to be “side-effects” of a (perhaps genetic) “defect of our fat regulation”,
because it is very Different from my usual Way to Think about Obesity.
Still….it COULD be true…..
I need to spend a lot more time considering this whole concept.

What Taubes said about the Zucker rats really struck home for me.
That parallel provided me with a possible answer to a question
that has been bothering me for some time.

Due to my interest in Eating Disorders,
I’ve spent quite some time studying Anexoria.
I am aware that the teenage dream of looking like a fashion model
is beyond the capability of most Anexorics,
because losing weight doesn’t turn an Endomorph
into an Ectomorph…only into an Emaciated Endomorph.

However, I’ve been puzzled by Documentaries that
follow real-life young females with Anexoria
who are in danger of death from loss of heart muscle
….when I can SEE many of those girls
are STILL A BIT PLUMP.

Many of the females in those studies are very, very thin
but also, some of them are not.
I’m seen plump cheeks, large (natural) breasts,
rounded tummies, large thighs…
and in fact…they appear to be “overweight” .

These girls clearly still have quite a lot of fat on their bodies,
but according to medical authorities,
their bodies are shutting down life-supporting functions.

This sounds like the same problem as with those Zucker rats.
 

Taubes says calories-in/calories-out is a damaging theory.
It reinforces what appears to be obvious, which is:

“Obesity as the penalty for gluttony and sloth”

He says it is Harmful because…
It is partly responsible for the growing number of obese;
It directs attention away from the real reasons we get fa;,
It reinforces the perception that fat people have no one to blame but themselves.

Instead of making us question our assumptions
about calories-in/calories-out..... .

...The fact that eating less FAILS as a CURE for obesity
is taken as evidence that fat people
are incapable of following a diet and eating in moderation
and they are blamed for it.

Taubes says

“There has to be a reason…
why anyone would eat more calories than he or she expends,
particularly since the penalty for doing so is
to suffer the physical and emotional cruelties of obesity.
There must be a defect involved somewhere;
the question is where.”

“The logic of calories-in/calories-out
allows only one acceptable answer to this question.
The defect cannot lie in the body—in the enzymes and hormones
that control how our bodies turn what is eaten into fat—
--because this would imply that something other than overeating
was fundamentally responsible for making us fat.
And that’s not allowed.

So the problem must lie in the brain.
And more precisely, in behavior,
which makes it an issue of character.

So, both eating too much and exercising too little are Behaviors,
not Physiological states,
a fact made even more obvious by the use of the…terms -- gluttony and sloth.”

Suggesting as an answer that fat people
respond to food restriction just as animals do
--that they reduce their energy expenditure
while experiencing increased hunger—
opens up the possibility that
the same physiologic mechanism that drives fat people
to hold onto their fat—even when semi-starved—
--might be the cause of their obesity in the first place.

This thinking is not allowed under the calories-in/calories-out theory.
So instead it is said the diet didn’t work
because the fat persons failed to stay on it.
They are blamed lack of willpower,
a lack of strength of character
to eat in moderation the way lean people do.

Once the fundamental cause of obesity
is established as overeating, 
blaming behavior—a lack of character and willpower—
is the only acceptable explanation.
The fat have a “perverted appetite”.

Taubes talks about the History of how this “insidious logic”
invaded the American science community in the 1920s,
and continued through the second world war.

He says the only thing different now
is that experts word it in less demeaning terms.
Like referring to obesity as an Eating Disorder,
which has become common since the 1960s. 
 He says by the 1970s “Behavioral Medicine” emerged to treat fat people with
“behavioral therapies” which are ways to make the fat eat like the lean.
When speaking of these behavioral treatments, Taubes says

“None of these therapies has ever been shown to work..
even so..many are still with us today.”

Taubes says that today most of the leading authorities on obesity
are psychologists and psychiatrists…
people whose expertise is in the ways of the mind,
not of the body.

He points out

“Imagine how many more dead diabetics we’d have
if victims of that disease
were treated by psychologists instead of physicians.

And yet diabetes and obesity are so closely linked…
...that some authorities have taken to calling the two disorders “diabesity”,
as though they’re two sides of the same pathological coin,
which they assuredly are.”

Taubes concludes with

“So long as we believe that people get fat because they overeat,
because they take in more calories than they expend,
we’re putting the ultimate blame on a mental state, a weakness of character,
and we’re leaving human biology out of the equation entirely.”

He says it’s a mistake to think this way,
and he will give us a better way to think about it in the rest of the book.

This chapter very much rings true for me.

I have a life-time of personal experience
in being blamed for failing to eat in moderation,
despite extensive and almost continual efforts to do so.

For me, this started at puberty and continued until
this present time when I began weighing in the normal range.

 I’ve experienced this issue with regards to
parents, siblings, boyfriends, husband, children, and other relatives;
friends, acquaintances, and strangers, teachers, potential employers,
Doctors, Psychologists, “Eating Disorder” specialists, Diet Counselors,
but most of all with my own accountability.

Details of my History are in the "About Me" section.
Personally, I’d very much like to have a better way to think about it.