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Dr. Ornish also offered a week-long retreat at various times and places throughout the year. The cost, not covered by insurance, was $3,200, excluding accommodations. When Dr. Ornish published Eat More, Weigh Less, the reviews on Amazon.com ranged from “Exceptional guide for safely losing weight,” to “book title should be ‘How to become a rabbit.’” [17]

America had swung to a low-fat diet in the 1970's with the beginning of the U.S. government endorsed food pyramid, but the American Heart Association withdrew their recommendation after a randomized controlled trial showed that compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. [18] [19] The wide range of potential diets included: Paleo, Atkins, South Beach, Mediterranean, Low-Fat, and Ornish. Each varied the percentage of calories from three basic nutritional groups: fats, proteins, and carbohydrates. In a clinical trial of over 7,000 patients published in the New England Journal of Medicine, a Mediterranean diet reduced the incidence of major cardiovascular events compared with advice to reduce dietary fat intake. [20] Ornish’s data, while compelling, were based on only 48 patients. [21] [22]

Overweight and Obesity

Origin

While the percentage of adults considered overweight has not changed significantly since the late 1970s, [23] the number of obese adults more than doubled. Adults defined as morbidly obese were the fastest-growing segment. [24] (See Exhibit 1 for the prevalence of overweight and obesity.) [a]

One article reported that studies of twins confirmed a strong genetic influence, regardless of the force of the environment. [25] Other studies suggested that about 25% to 40% of differences in body mass may be attributable to genetics, [26] with the remaining differences are influenced by social, behavioral, physiological, and metabolic factors. Some speculated that differences in bacteria in the gut may explain obesity patterns. While the origin was poorly understood, in its simplest form, obesity is caused by an energy imbalance over a long period of time: calories consumed are greater than calories expended.

Men’s average caloric consumption increased by 11.3%, from 1974 to 2006, and women’s by 21.3%. [27] Some of this was attributable to the increasing abundance and accessibility of prepackaged foods, snack and fast foods, and soft drinks. While these foods were convenient for increasingly busy lifestyles, they also tended to be high in fat, sugar, and calories. Additionally, portion sizes increased considerably over the years. While calorie consumption increased, calories expended decreased. Advances in technology played a major role. Numerous labor-saving devices reduced physical activity at work (desk jobs) and at home (riding lawnmowers). In addition, sedentary behaviors increased, such as watching television. Less than one-third of adults met the recommended 30 minutes of moderate physical activity at least five days a week. [28]

[a] Overweight and obesity are most commonly defined as a function of the body mass index (BMI). A BMI less than 18.5 is considered underweight; 18.5 to 25, ideal; 25 to 30, overweight; 30 to 40, obese; and over 40, morbidly obese. (Source: National Institute of Health, Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults, September 1998, p. xvii.)

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