The China Study (22 page)

139
OBESITY
searching. Simply trust your observations on who is slim, vigorous
and healthy, and who is not. Or trust the findings of some impres-
sive research studies, large and small, showing time and time again
that vegetarians and vegans are slimmer than their meat-eating
counterparts. People in these studies who are vegetarian or vegan
are anywhere from five to thirty pounds slimmer than their fellow citi-
z e n s . 7 J3
-
In a separate intervention study, overweight subjects were told to
eat as much as they wanted of foods that were mostly low-fat, whole-
food and plant-based. In three weeks these people lost an average of
seventeen pounds. 14 At the Pritikin Center, 4,500 patients who had
gone through their three-week program got similar results. By feeding a
mostly plant-based diet and promoting exercise, the Center found that
its clients lost 5.5% of their body weight over three weeks. 15
Published results for still more intervention studies using a low-fat,
whole foods, mostly plant-based diet:
•   About two to five pounds lost after twelve daysl6
About ten pounds lost in three weeks l7 . 18
•
Sixteen pounds lost over twelve weeks l9
•
Twenty-four pounds lost after one year 20
•
All of these results show that consuming a whole foods, plant-based
diet will help you to lose weight and, furthermore, it can happen quick-
ly. The only question is how much weight you can lose. In most of these
studies, the people who shed the most pounds were those who started
with the most excess weight. 21 After the initial weight loss, the weight
can be kept off for the long term by staying on the diet. Most impor-
tantly, losing weight this way is consistent with long-term health.
Some people, of course, can be on a plant-based diet and still not lose
weight. There are a few very good reasons for this. First and foremost,
losing body weight on a plant-based diet is much less likely to occur if
the diet includes too many refined carbohydrates. Sweets, pastries and
pastas won't do it. These foods are high in readily digested sugars and
starches and, for the pastries, oftentimes very high in fat as well. As
mentioned in chapter four, these highly processed, unnatural foods are
not part of a plant-based diet that works to reduce body weight and pro-
m o t e health. This is one of the main reasons that I usually refer to the
optimal diet as a whole foods, plant-based diet.
Notice that a strict vegetarian diet is not necessarily the same thing

THE (HINA STUDY
140
as a whole foods , plant-based diet. Some people become vegetarian only
to replace meat with dairy foods, added oils and refined carbohydrates,
including pasta made with refined grains, sweets and pastries. I refer to
these people as "junk-food vegetarians" because they are not consum-
i n g a nutritious diet.
The second reason weight loss may be elusive is if a person never en-
gages in any physical activity. A reasonable amount of physical activity,
sustained on a regular basis, can pay important dividends.
Thirdly, certain people have a family predisposition for overweight
bodies that may make their challenge more difficult. If you are one of
these people, I can only say that you probably need to be especially rig-
orous in your diet and exercise. In rural China, we noticed that obese
people simply did not exist, even though Chinese immigrants in West-
e r n countries do succumb to obesity. Now, as the dietary and lifestyle
practices of people in China are becoming more like ours, so too have
their bodies become more like ours. For some of these people with ge-
netic predispositions, it doesn't take much bad food before their change
in diet starts to cause problems.
Keeping body weight off is a long-term lifestyle choice. Gimmicks
that produce impressively large, quick weight losses don't work in the
long term. Short-term gains should not come along with long-term pain,
like kidney problems, heart disease, cancer, bone and joint ailments
and other problems that may be brought on with popular diet fads. If
the weight was gained slowly, over a period of months and years, why
would you expect to take it off healthily in a matter of weeks? Treating
weight loss as a race doesn't work; it only makes the dieter more eager
to quit the diet and go back to the eating habits that put them in need
of lOSing weight in the first place. One very large study of 21,105 veg-
etarians and vegans 13 found that body mass index was" . . . lower among
those who had adhered to their diet for five or more years" compared to
people who had been on the diet for less than five years.
WHY THIS WILL WORK FOR YOU
SO there is a solution to the weight-gain problem. But how can you ap-
ply it to your own life?
First of all, throwaway ideas about counting calories. Generally speak-
ing , you can eat as much as you want and still lose weight-as long you
eat the right type of food. (See chapter twelve for details.) Secondly, stop
expecting sacrifice, deprivation or blandness; there's no need. Feeling

OBESITY                                  141
hungry is a sign that something is wrong, and prolonged hunger causes
your body to slow the overall rate of metabolism in defense. Moreover,
there are mechanisms in our bodies that naturally allow the right kind
of plant-based foods to nourish us, without our having to think about
every morsel of food we put in our mouths. It is a worry-free way to eat.
Give your body the right food and it will do the right thing.
In some studies, those who follow a whole foods, low-fat, plant-based
diet consume fewer calories. It's not because they're starving themselves.
In fact, they will likely spend more time eating and eat a larger volume
of food than their meat-eating counterparts.22 That's because fruits, veg-
etables and grains-as whole foods-are much less energy-dense than
animal foods and added fats. There are fewer calories in each spoonful
or cupful of these foods . Remember that fat has nine calories per gram
while carbohydrates and protein have only four calories per gram. In
addition, whole fruits, vegetables and grains have a lot of fiber, which
makes you feel full 22 , 23 and yet contributes almost no calories to your
meal. So by eating a healthy meal, you may reduce the calories that you
consume, digest and absorb, even if you eat Significantly more food,
This idea on its own, however, is not yet a sufficient explanation
for the benefits of a whole foods, plant-based diet. The same criticisms
I made against the Atkins diet and the other popular "low-carb" di-
ets (chapter four) can also be applied to short-term studies in which
subjects consume fewer calories while eating a plant-based diet. Over
the long term, these subjects will find it very difficult to continue con-
s u m i n g an abnormally low level of calories; weight loss due to calorie
restriction rarely leads to long-term weight loss. This is why other stud-
ies play such a crucial part in explaining the health benefits of a whole
foods, plant-based diet, studies that show that the weight-loss effect is
due to more than simple calorie restriction.
These studies document the fact that vegetarians consume the same
amount or even Significantly more calories than their meat-eating counter-
parts , and yet are still slimmer. 11 , 24, 25 The China Study demonstrated that
rural Chinese consuming a plant-based diet actually consume signifi-
c a n t l y more calories per pound of body weight than Americans, Most
people would automatically assume that these rural Chinese would
therefore be heavier than their meat-eating counterparts. But here's
the kicker: the rural Chinese are still slimmer while consuming a greater
volume offood and more calories. Much of this effect is undoubtedly due
to greater physical activity ... but this comparison is between average

142                          TH E CH I NA STU DY
Americans and the least active Chinese, those who do office work. Fur-
thermore, studies done in IsraeF4 and the United Kingdom,ll neither of
which represent primarily agrarian cultures, also show that vegetarians
may consume the same or significantly more calories and still weigh
less.
What's the secret? One factor that I've mentioned previously is the
process of thermogenesis, which refers to our production of body heat
during metabolism. Vegetarians have been observed to have a slightly
higher rate of metabolism during rest,26 meaning they burn up slightly
more of their ingested calories as body heat rather than depositing them
as body fat. 27 A relatively small increase in metabolic rate translates to a
large number of calories burned over the course of twenty-four hours.
Most of the scientific basis for the importance of this phenomenon was
presented in chapter four.
EXERCISE
The slimming effect of physical activity is obvious. Scientific evidence
concurs. A recent review of all the credible studies compared the rela-
t i o n s h i p between body Weight and exercise 28 and showed that people
who were more physically active had less body weight. Another set of
studies showed that exercising on a regular basis helped to keep off
weight originally lost through exercise programs. No surprise here,
either. Starting and stopping an exercise program is not a good idea. It
is better to build it into your lifestyle so that you will become and con-
t i n u e to be more fit over all, not just burn off calories.
How much exercise is needed to keep the pounds off? A rough es-
timate derived from a good review28 suggested that exercising a mere
fifteen to forty-five minutes per day, every day, will maintain a body
weight that is eleven to eighteen pounds lighter than it would otherwise
be. Interestingly, we should not forget our "spontaneous" physical activ-
ity, the kind that is associated with chores of daily life. This can account
for 100-800 calories per day (kcalJday)?9, 30 People who are regularly
"up and about" doing physical things are going to be well ahead of those
who get trapped in a sedentary lifestyle,
The advantages of combining diet and exercise to control body
weight were brought home to me by a very simple study involving our
experimental animals. Recall that our experimental animals were fed
diets containing either the traditional 20% casein (cow's milk protein)
or the much lower 5% casein. The rats consuming the 5% casein diets

143
OBESITY
had strikingly less cancer, lower blood cholesterol levels and longer
lives. They also consumed slightly more calories but burned them off
as body heat.
Some of us had noticed over the course of these experiments that the
5% casein animals seemed to be more active than the 20% casein ani-
mals. To test this idea, we housed rats fed either 5% or 20% casein diets
in cages equipped with exercise wheels outfitted with meters to record
the number of turns of the wheel. Within the very first day, the 5% casein-
fed animals voluntarily "exercised" in the wheel about twice as much as the
20% casein-fed animals. 31 Exercise remained conSiderably higher for the
5% casein animals throughout the two weeks of the study.
Now we can combine some really interesting observations on body
weight. A plant-based diet operates on calorie balance to keep body
weight under control in two ways. First, it discharges calories as body
heat instead of storing them as body fat, and it doesn't take many calo-
ries to make a big difference over the course of a year. Second, a plant-
based diet encourages more physical activity. And, as body weight goes
down, it becomes easier to be phYSically active. Diet and exercise work
together to decrease body weight and improve overall health.
GOING IN THE RIGHT DIRECTION
Obesity is the most ominous harbinger of poor health that Western na-
tions currently face. Tens of millions of people will fall prey to disability,
putting our health care systems under greater strain than has previously
been seen.
There are many people and institutions working to reduce this prob-
lem, but their point of attack is often illogical and misinformed. First,
there are the many quick-fix promises and gimmicks. Obesity is not a
condition that can be fixed in a few weeks or even a few months, and
you should beware of diets, potions and pills that create rapid weight
loss with no promise of good health in the future. The diet that helps to
reduce Weight in the short run needs to be the same diet that creates and
maintains health in the long run.
Second, the tendency to focus on obesity as an independent, isolated
disease32 . 33 is misplaced. ConSidering obesity in this manner directs our
attention to a search for specific cures while ignoring control of the other
diseases to which obeSity is strongly linked. That is, we sacrifice context.
Also, I would urge that we ignore the suggestion that knowing its
genetic basis might control obeSity. A few years ago,34-36 there was great

THE (HINA STUDY
144
publicity given to the discovery of "the obesity gene. " Then there was
the discovery of a second gene related to obesity, and a third gene, and
a fourth and on and on. The purpose behind the obesity gene search is
to allow researchers to develop a drug capable of knocking out or inac-
tivating the underlying cause of obesity. This is extremely shortsighted,
as well as unproductive. Believing that specific identifiable genes are the
basis of obesity (i.e. , it's all in the family) also allows us to fatalistically
blame a cause that we cannot control.
We can control the cause. It is right at the end of our fork.

...1
.
Diabetes
TYPE 2 DIABETES, the most common form, often accompanies obesity. As
we, as a nation, continue to gain weight, our rate of diabetes spirals out
of control. In the eight years from 1990 to 1998, the incidence of diabe-
tes increased 33%.1 Over 8% of American adults are diabetic, and over
150,000 young people have the disease. That translates to 16 million
Americans. The scariest figure? One-third of those people with diabetes
don't yet know that they have it. 2
You know the situation is serious when our children, at the age of
puberty, start falling prey to the form of diabetes usually reserved for
adults over forty. One newspaper recently illustrated the epidemic with
the story of a girl who weighed 350 pounds at the age of fifteen, had the
"adult-onset" form of diabetes and was injecting insulin into her body
three times a day.3
What is diabetes, why should we care about it and how do we stop it
from happening to us?
TWO FACES OF THE SAME DEVIL
Almost all cases of diabetes are either Type 1 or Type 2. Type 1 develops
in children and adolescents, and thus is sometimes referred to as juve-
n i l e - o n s e t diabetes. This form accounts for 5% to 10% of all diabetes
cases. Type 2, which accounts for 90% to 95% of all cases, used to occur
primarily in adults age forty and up, and thus was called adult-onset
diabetes.2 But because up to 45% of new diabetes cases in children are
Type 2 diabetes,4 the age-specific names are being dropped, and the two
forms of diabetes are simply referred to as Type 1 and Type 2.4
145