Obesity day in Gothenburg

Written by Annika Dahlqvist on 11 February, at 13:52


Margareta Lundström, Gothenburg, has written an abstract:

”Doomsday is near”
A summary report of a public lecture on 2010-02-08 organized by the Sahlgrenska´s
”Center for Cardiovascular and Metabolic Research”


”Doomsday is near” someone bent forwards behind me and whispered in my ear when I left a lecture yesterday.” If we are to follow these advice, he continued. It was not a religious fundamentalist, but someone who became as excited as I am of what we just heard.
Carl-Johan Behre Chief of Obesity Clinic at Sahlgrenska University Hospital spoke on the subject “The risks of obesity and how do you do to reduce them”.


Ingrid Larsson, Clinical nutritionist, Ph. D., at the same Medical Health Center spoke on the subject ”Good and healthy food – what science says and how to avoid getting lost in the jungle of dietary guidelines”.


Behre began by saying that the WHO classified obesity as a disease. He also stressed about how strong force hunger is and how difficult it is to master. After then came an account of increase of obesity and sprawl in the U.S. and in Sweden. All diseases and complications which caused by obesity were described. In this context the alarming increase in the U.S. by non-alcohol related fatty liver also was mentioned.


He rejected, in principle, the following treatment options as long term unsustainable; life style changes, diet, diet powder, cognitive behavioural therapy, drugs with some exceptions for Xenical. The only treatment that was described as sustainable in the long run and that was perceived as positive for the patient was Gastric Bypass surgery – the amputation of parts of the digestive tracts. Gastric Bypass was the main option for obese patients with various obesity-related diseases.


How they would do who just wanted to loose and where not sick was unclear.
Operation method was demonstrated in pictures and there was no doubt that this was what the lecturer saw as the best solution. He said it was a way to shorten the sufferings of the patients and provides a lasting improvement. He said that if he had been in some of his patient’s situation, he had not hesitated to undergo the operation. Not a hint about trying a low carbohydrate-high lipid diet.


The survival rates after a Gastric Bypass surgery was said to be in the medium 20 years and the risk of dying was 1-4/1 000. Nothing was mentioned about sequelae, side effects or other problems.
Many different factors were involved in obesity, among other things a number of both old and newly discovered hormones. Insulin was not mentioned. Behre described the fatty tissue of a gland with its functions and its hormones. The energy balance was emphasized, that is calories in and calories out. More out than in, if one is to lose weight. If you want to keep the weight it is Mediterranean diet which applies, without further definition. Free for everyone to form their own opinion.
In the next part of the lecture, we saw many fine bar graphs of exercise impact of survival. Summary of the message is that you live longer if you exercise and that it is better to be to be over weight and exercise than to be thin and not exercise. One needs not to exaggerate the exercise for it to have beneficial effects on survival. I would add that it is neither fun nor safe to exercise when you are severely overweight. The summary of Behre´s message was that overweight and obesity and its sequelae increase epidemically and that the only solution in the long term seems to be Gastric Bypass surgery. Moderate exercise, and “Mediterranean diet” is good and do not eat more than you use up.


Then Ingrid Larsson spoke.
She began by telling us that she fully understood that we were lost in the jungle of diets. But now she would lead us right.


I know about where Ingrid Larsson and her colleagues are in the diet debate, so I had no great expectations. But I was a little curious if she took to herself a bit of diet debate and as a good researcher questioned some of her own dogmas. But no, here all the old mantras were hammered convincingly and uncompromisingly, stacked on each other; lean, fibres, one pound of ”fruits and vegetables”, margarine, oils, regular meals, heavy porridge for breakfast, wholemeal bread, lean cold cuts.


One thing that nutritionists have a fondness of is to show picture after picture of candies, sweets and chocolate and tell us show many calories they contain. This is what you eat rather than to obey our dietary guidelines do I interpret it.
We are going to a lecture on diet and health and are already aware and want a bit more intellectual level of a lecture and not being treated like day nursery children. Images of how pastries being steadily growing in size was illustrated. It was the increasing fat content which was commented on – not a word about sugar, not a word about hydrogenated lipids, not a word about carbohydrates.



In a timid question from the audience about if Larsson could explain why we have become so ill during the last 30-40 years she replied that it depended on many factors as car use, industrialization and prosperity!

Ingrid Larsson said explicitly that we must increase the carbohydrates and reduce the lipids. When a lady asked if we are allowed to eat a little butter because she had heard it would be beneficial. She got the answer: “Is it vitamin A you are after it goes well with carrots:”



Calorie term return again and again. Ingrid Larsson had an interesting theory that one should follow a defined medium intake of calories a week. If it becomes a bit too much on Friday evening, so one can eat a little less the next day, so it evens itself out. But you should not eat the remains of the fatty Sunday dinner on Monday, because it increases the calorie level that day. The main thing is the average intake.



Both speakers returned again and again about the energy balance. You have to make rid of more calories than you add to lose weight. In the statement a reference to scientific studies was interjected now and then.



In the case of successful diets to lose weight, Larson claimed that there was no difference. All diets worked, if you only are persistent. The problem was that people could not manage to hold out in the long run.



The lecture ended with a reference to the National Food Administration and the confirmation that it is still their advice and instructions that apply.



From the SBU report”Obesity problems and measures” Larsson quoted the following:
”Any treatment that gives a negative energy balance, that the consumption of energy (calories) exceeds the food supply leads to weight loss. If consumption is equal to the intake body weight remains constant. This is absolute the nature of science-based truths that need not to be proved further. The studying of dietary treatment studies are rather methods to achieve this negative energy balance”.



So Larsson did get this inevitable question.

“What do you think about Annika Dahlqvist?” Ingrid Larsson then looked very worried, looked down and waited a bit with the answer. But the answer seemed something like this:
When the National Board approved Annika Dahlqvist´s dietary guidelines they did not know/did not realize that it was such a small content of carbohydrates in Annika Dahlqvist´s dietary guidelines. “It was believed then that this was much higher proportion of carbohydrates, “Larsson said. Perceived 30-40? Against 5-10? Do not guarantee that the numbers are correct. But the difference was significant.
The conclusion then must be that the National Board, according to Ingrid Larsson, has approved Annika Dahlqvist´s dietary guidelines on false assumptions!



I respect the difficulty to lecture on such a large topic during one and an half hour. It must necessarily be superficial and hard haul. We can not let in issues on Glutamate and E-numbers, but have to provide”No response answers” – which it did. But we had a clear agenda and the message was crystal clear. The message follows the official line, something else was not to be expected.
I think open lectures are exemplary. Good to hear even if you have to question. But one must not underestimate their audience.



I m not so dogmatic that I don’t think there are people who can follow Ingrid Larsson’s dietary guidelines and adhere both slim and healthy. Ingrid Larsson is an attributable sight of tradition. But the problem is all those who can’t do it, those who become obese and sick. I an also imagine that there could be overweight people, where nothing but a Gastric Bypass Surgery helps. But it should never be a general method or a commercial interest.



Now it is said.

If moreover, can be said that the hall was crowded with an estimated 250-300 persons. Most of the audience was middle-aged and senior citizens, but also many of these who took notes frantically (dieticians and medical students?)
The speakers represented a radar couple in the sense that Ingrid Larsson with her dietary advice provided Carl- Johan Behre with patients, he can pass on to the amputation of parts of the digestive tracts. Two speakers with prestigious titles and positions who obviously for our tax money representing nothing more than public health. It is frightening to think of the financial resources and the platforms available to them.

You can choose to ignore their advice, but you will still not be excluded, because that is the message which has influence on what is served in school and hospital.



I think it is frightening that obesity is explained as a disease (even though it in some cases can be so). It opens of course another huge market for the pharmaceutical industry to experiment with, giving people false hope, and we our learned belief in strengthened.
Referring to repeated allegations of energy out and energy in so it would be noted that both speakers master the law of thermodynamics, but they need to be informed about the second law of thermodynamics.



Then I wonder how did the lady who asked if she may eat some butter? Did she cook a delicious Mediterranean meal when she came home? Did she throw her butter away and ate a carrot instead? Did she calculate how many calories she ate today in order to adjust the day after?