2012 ASBP Obesity Conference (Part 1)

Saturday, May 5, 2012
denver Every year I look forward to the Nutrition and Metabolism symposium, which I'll be writing about soon. This symposium comes after the spring Obesity Conference of the American Society of Bariatric Physicians. This year, the conference was in Denver, CO on April 20 and 21. One of the things that has been fascinating to me over the years I've been attending is being able to watch the changing emphasis and assumptions that underlie many of the talks about obesity and weight loss. This year, I was impressed by these trends:

1) Many of the scientific presentations referred to benefits of low-carb diets simply as part of their talks -- as if it was an underlying assumption that low-carb diets can be helpful. This is a big change from even a few years ago. It seems that the value of low-carb diets is much more taken for granted than it used to be.

2) On the other hand (but, I think, related), totally absent from the conference was the "eat less and exercise more" emphasis on calories that has been the traditional focus. Even Dr. Robin Blackstone, the bariatric surgeon who gave the keynote address, said that "we know that weight loss surgery doesn't work through calorie restriction or malabsorption, but through metabolic effects". It's all about metabolic changes, and guess what? As far as dietary changes go, carbohydrate restriction is a chief driver of these favorable effects.

3) In addition to general mentions of carbohydrate reduction or restriction, more of the speakers mentioned what has been called the "diabetes spectrum", and that different individuals do best with different amounts of carbohydrate in their diets, depending on their degree of carb sensitivity and the amount of progression along the spectrum. I was cheered by what seems to be a strong move away from one-size fits all recommendations, as well as realizing that a low-carb diet does not mean the same thing for each person.

4) Paleo comes to ABBP! There has certainly been an explosion in the interest in paleo eating, but I was pleased to see that it has reached the point where physicians are hearing about it, at this conference in the form of Loren Cordain, who gave talks at both conferences.

Four Contrasting Diets

Probably the most interesting segment of the conference for my readers took place on Friday afternoon, when we heard from experts representing four different diets and how they can cause weight loss:
  • Joel Fuhrman, who advocates tons of vegetables and fruit as the foundation of a micronutrient-rich vegan (or almost-vegan) diet
  • Loren Cordain, who famously advocates and researches the effects of the Paleo Diet (link)
  • Jeff Volek, researcher of reduced-carbohydrate diets and author or co-author of several low-carb books (although his talk focused on saturated fats)
  • Scott Rigden, who wrote a book about eating according to metabolic type, and spoke about the Mediterranean diet (turns out that the weight loss version he uses with patients is low in carbs).
Obviously, there was a lot of disagreement among these four, and during the panel discussion afterwards, things got a little heated! But one audience member (Dr. Mary Vernon), pointed out that there are a lot of common elements in these approaches, including 1) no sugars or refined grains, 2) a promotion of nuts and seeds, 3) avoidance of high omega-6 oils (soy, corn, cottonseed, etc) and 5) an emphasis on vegetables and some fruit.

I could easily do a long blog post about Dr. Fuhrman's talk, but I realistically won't (it's off-topic for me, for the most part), but I did want to say a few things because it was attention-getting. Although I think it's very clear that our biology and physiology has evolved to be omnivorous (and that we would not have gotten to the point where we would have an Internet if our ancient ancestors remained vegan) I am also sure that Fuhrman is not lying when he talks about his patients who have benefitted greatly from his approach. There is definitely a lot to be said for a high-nutrient diet, which is the main reason that vegetables are at the base of my low-carb pyramid, and different people do respond to different diets. Problems come in, though, when there is an assumption that "what works for me will work for everyone".

To me, the main thing that contrasted Fuhrman with the other speakers was not only the lack of a scientific basis for his talk (I'm used to seeing lots of research cited, graphs, and explanations of biological mechanisms cited at these conferences, which Fuhrman's talk was lacking), but his throwing in loads of scientific-sounding things that gave the impression he was just making things up. This may fly when you are "preaching to the choir" and people are hanging on your every word, but it will not wash in a scientific conference. For example, he said that "the reason skim milk causes prostate cancer" is because it has more protein than whole milk. First of all, although there is an association between skim milk and prostate cancer in a couple of studies that I'm aware of, it's by no means even clearly associated at this point, let alone "causing" prostate cancer. Secondly, the difference in the amount of protein between skim and whole milk is half a gram per cup (8.4 vs 7.9 grams of protein)! And yet, he sprinkles these types of claims through his talk in a very energetic and self-confident way. When pressed for the science behind his thinking, he kept mentioning the book The China Study, much of which has been very thoroughly debunked. I know Dr. Fuhrman was included to represent a wide spectrum (which is, in theory, a good idea), but I'm afraid he stood out like a sore thumb. Plus, he yells or borderline-yells much of time, and I find it off-putting, and, again, this was a big contrast with the other speakers and participants.

A Highlight

I can't go further without talking about the wonderful gathering on Friday evening with folks in the low-carb and paleo communities in the Denver area. We had a fabulous meal together and I got to meet physicians, bloggers, and quite a few readers -- a real highlight. I spend my time in my little room and my computer, and while it's great to hear from readers via email, it does my heart extra-good to meet people in person. I look forward to more of this at the upcoming Low-Carb Cruise (and I think it's not too late to come along)! Thanks to Jimmy Moore, Dr. Jeff Gerber and Bridget Hart of Sweet Enough Personal Chef and Catering Service for organizing this! Bridget made some yummy low-carb and paleo muffins, crackers, and desserts!

Well, it was three packed days and I got home late last night, so this is all I've had time to write about. Stay tuned for more about the Obesity Conference and the Nutrition and Metabolism Symposium.

Photo of Denver: James Balog/Getty Images

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