Most people seem surprised when I mention that America isn’t actually the fattest place on earth. Don’t get me wrong, we are close. Ignoring for the moment a handful of small island nations, that dubious distinction goes to Kuwait. Hot on our tail are Jordan, Saudi Arabia, Libya and Qatar. The basis of the Middle Eastern diet is starch and vegetable oil, unlike the French diet where the basis is starch and dairy fat. Let’s take a look. Obesity stats come from The CIA. It’s a strange world.

So what do they eat in Kuwait? I’m again pulling data from the FAO. This is the most recent data available from 2013. I’m going to do a three way comparison of modern Kuwait with two area that have already been discussed, 1970 France and 1983 Nanan. The matching intake of white flour in Kuwait and France is a weird coincidence.

Kuwait, 2013 France, 1970 Nanan, 1983 White Wheat Flour 721 721 0 White Rice 521 54 1370 Sugar 372 387 2 Starchy Tubers 63 177 600 Alcohol 0 296 135 Meat 207 488 34 Butter 32 177 0 Other Dairy 162 356 0 Moderately Unsaturated Vegetable Oils –

Canola, Olive, Peanut 29 110 77 Highly Unsaturated Vegetable oils –

Soybean, Corn, Sunflower 248 69 0 Total Calories 3435 3306 3578 OR 2400 Obesity Rate 37.9% Neglibible 0

There is a statistical quirk in The China Study that I can’t quite tease out that I’d like to discuss in regards to the people of Nanan. The authors of “Diet, Life-style and Mortality in China” stated that the caloric consumption they listed was for adult men in the lowest physical activity job such as office work. They listed that caloric consumption as 3578 calories per day for a 122 lb man working an office job. If that is true, that would be a gargantuan amount of calories. But the authors also listed the weight quantities of each food consumed and it doesn’t add up to 3578 calories, it adds up to around 2200 calories. Let’s call it 2400 calories when we add in vegetables plus a few other odds and ends I didn’t include in this table. Of course, these numbers are for each man, woman and child, so presumably the men would be eating more than the average of 2400. Now 80% of the people of Nanan were working in agriculture and so most of them WERE physically active. On the other hand the average adult only weighed 115 lbs and 2400 calories is a lot for someone at that weight. It’s a little hard to figure out exactly what’s happening, but I think the overall picture is this: food seems to be plentiful in Nanan. Most, but not all, of them are employed in agriculture. On average they eat a lot given their size. Here’s the thing, EVEN THOSE NOT EMPLOYED IN AGRICULTURE seem to have plentiful access to starchy foods and don’t become overweight.

Let’s consider the effects of physical labor on the other two areas. France in 1970 and Kuwait in 2013 are both Urban cultures. I’m sure that differences in physical activity exist between these cultures. But neither of them are out in the field doing hard labor, on average. Lastly, let’s consider that the caloric consumption from France and Kuwait is from “Food Disappearance Data” which doesn’t factor in food waste, and so those columns are going to be overestimates. This series of posts is called “armchair epidemiology”, it’s not meant to be rigorous science. Epidemiology is messy, but if you look if you can see patterns.

Now, having said all of that, let’s consider the different theories about obesity one by one.

Calories Makes you Fat: Certainly there is no significant difference in the caloric consumption of Kuwait in 2013 (3435) and France in 1970 (3306). Food is plentiful in both places and there is presumably significant food waste happening in both places. It seems safe to conclude that in both places people were well fed and yet in only one place were people getting fat. Also, the differences seen between Nanan and Huain contradict this theory.

Carbohydrate Makes you Fat: Even though the caloric consumption is a little inscrutable in Nanan, what is clear is that they are the starch champions. 2000 calories per day of rice and sweet potatoes were being consumed per man, woman and child, farm worker or not, with no signs of obesity.

Sugar makes you fat: It didn’t in France in 1970. 387 calories from sugar is a lot! Probably 15% of overall calories.

Food palatability makes you fat: It’s hard to justify making the argument that anyone other than France has the most palatable diet. White flour, sugar, butter, cheese, meat, potatoes, alcohol. The French diet has it all going on! Chocolate croissants, baguettes, dry cured meats. All the yes!

Fat makes you fat: Not in France it doesn’t. At least not when that fat is dairy fat.

A mixed diet of fat and carbs makes you fat: See the above answer.

A Mediterranean diet is best for weight maintenance: No country on a national scale has ever had a diet remotely close to the theoretical diet that is “The Mediterranean Diet”. Certainly none of these countries do! This is from The Mayo Clinic:

The main components of Mediterranean diet include:

Daily consumption of vegetables, fruits, whole grains and healthy fats

Weekly intake of fish, poultry, beans and eggs

Moderate portions of dairy products

Limited intake of red meat https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

Whole Grains – None of the three

Vegetables and Fruits – Everyone is a winner!

“Healthy” Fats – I’m guessing that means unsaturated fats so Kuwait would win this category. Nanan is basically fat free, which was cool in the nineties but which isn’t very Mediterranean. So I’m saying just Kuwait wins this one.

Weekly Intake of fish, poultry, beans and eggs – The people of Nanan don’t eat eggs or beans and they probably don’t eat poultry. France and Kuwait win this category.

Moderate portions of dairy products – Not in France!

Limited Intake of red meat – Not in France!

The Mayo clinic doesn’t mention sugar but I’m pretty sure it’s off the list so France and Kuwait are losers there as well.

Clearly France in 1970, the country whose Southern border is the Mediterranean Sea, had the lowest Mediterranean diet score. And they were protected from obesity.

The ROS Theory of Obesity: In this theory I have argued that saturated fat, alcohol, starch and sugar are all either burned immediately or stored by the body as a mixed of saturated fat and mono-unsaturated fat. I have also argued that the primary regulator of body fatness is the ratio of saturated to unsaturated fats. Looked at from this lens, the diets of France and Nanan are essentially the same. The entire diet can be stored as saturated fat, which doesn’t affect organism level energy balance.

The Kuwait diet, on the other hand, is high in polyunsaturated fats. The body can’t saturate them, it can only store them as is. Therefore, the high consumption of polyunsaturated fats seen in the Kuwait diet DOES effect organism level energy balance.

That is why the French in 1970 and the Chinese in 1983 were slim and the Kuwaitis of today are not.