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Books, Journals, New Media
April 9, 2003

Fat LandFat Land

Author Affiliations
 

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor.

JAMA. 2003;289(14):1859. doi:10.1001/jama.289.14.1859-a

This is a good little book. The format is only slightly larger than the usual paperback. There are 176 pages of text, 37 pages of notes, a few tables, and a useful index. The style is breezy and readable. In this relatively small space the author tries to explain the causes underlying the national obesity explosion, and by and large he succeeds.

Over the past decade, the largest change in our diet has been the increase in the use of high-fructose corn syrup (HFCS). Between 1980 and 1998 the total use of sweeteners in the United States rose from 123.0 to 155.1 lb per person per year (26%). Use of HFCS rose from 19.0 to 63.8 lb per person per year (236%). We were warned about the metabolic effects of fructose, but the general view was that sugar is sugar and fructose is a natural product like glucose or sucrose. However, metabolically, fructose is markedly different. Fructose is processed more rapidly and more efficiently than glucose; fructose catabolism leads to increased fatty acid synthesis and esterification and secretion of very low-density lipoprotein. Thus, we have ingested what can be viewed as fuel for a fat factory. The author cites a 19-month study of more than 500 schoolchildren (average age 11 years) showing that one HFCS-rich soft drink daily added a mean 0.18 points to a child's body mass index.

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