Top Ten Sheep

The Top 10 of 2018 in Obesity & Health

2018 is quickly fading into history. All in all, it’s been a year of some remarkable progress in obesity and health. Much of it is steady and encouraging. More healthcare providers building skill in obesity care. Less explicit weight bias. More options and a little less misinformation about obesity. Those are some of the good things happening quietly in the background. But in the foreground we have milestones, studies, and hot trends that insist on grabbing our attention. Here’s our take on the top 10 that stood out in 2018.

1. Killer Carbs

Near the top of Altmetric’s top 100 list of widely-read studies for 2018 were two studies of carbs. First was a study of dietary carbs and mortality. The findings were all about moderation. Researchers found that extremes of low-carb or high-carb diets both carry a risk of higher mortality. Next was the DIETFITS study, which found no difference in weight loss outcomes for a low-carb versus a low-fat diet.

But neither of these studies did anything to quell hot debates about the carbohydrate-insulin model for obesity.

2. Toxic Misinformation

We have a split decision on the word of the year. Oxford says it’s “toxic.” But dictionary.com says it’s “misinformation.” No matter. We’ll take them both and say that toxic misinformation is the concept of the year. Because our most read post of the year was about “Bogus Weight Loss Clichés,” it fits.

What’s more, two of the most of the most-read stories on the Altmetric hit list were all about misinformation. One dealt with the spread of false news online. The other was all about weaponized health communication.

3. Intermittent Fasting

This year gave us some interesting new science on intermittent fasting, along with some unfortunate hype. Jason Fung is busy selling his book on the subject and telling the world that we should change everything about diabetes care based on his case study of three patients. It’s an unfortunate mixture of puffery and promise.

But if you can set aside the hucksterism, the science of intermittent fasting promises to yield important insights in the years to come.

4. Keto

The number one most searched diet for 2018 is keto. So says Google. And we’re willing to believe them. Don’t tangle with the keto evangelists. They don’t like infidels who question their beliefs.

However, this is another case were you have to set aside the extreme dogma. Ketogenic diets have a role for specific patients, guided by nutrition professionals.

5. Physical Activity and Mental Health

Near the very top of Altmetric’s Top 100 scientific studies of 2018 was a study of the relationship between mental health and physical activity. Though more exercise is not always better, it’s pretty clear that regular physical activity promotes good mental health.

6. Tantalizing Progress on Obesity Meds

In August, we got our first good look at a next-generation obesity med – semaglutide. And we like what we see so far. It appears to deliver outcomes in the range of 15 percent weight loss, based upon a patient’s starting weight. Older drugs work in the range of five to ten percent weight loss, so this is a step in the right direction. And we’re hopeful that even better drugs will follow.

7. Coming to Terms with the Dynamic Physiology of Obesity

In an August, the National Academies of Sciences, Engineering, and Medicine presented an impressive view of the counter-intuitive and dynamic physiology of obesity. Certainly, we’re not suggesting that a single workshop is a milestone. But the importance is that it marks a growing recognition of that obesity presents a challenge of physiology – not just behavior. Old ways of thinking about this disease are melting away in the face of science.

8. Diabetes Remissions

Studies that show intensive obesity treatment can deliver remissions for people with type 2 diabetes garnered well-deserved attention this year. We’ve understood this for a while with bariatric surgery. But the DiRECT study caused quite a stir this year by showing that remissions are possible with a very low calorie diet in primary care. This publication in the Lancet landed at number 20 on the Atmetric top 100 list.

9. A Hot Debate about HAES

Evangelists for the Health at Every Size Movement came out for a debate at FNCE. People were looking for a hot debate and the HAES fans formed a cheering section. But in fact this event helped highlight a bit of common ground with weight management professionals. The debate will no doubt continue, because some in the HAES movement remain uncomfortable with the science of obesity.

10. Dings for Nudges

An unfortunate milestone in 2018 was the resignation of Brian Wansink from Cornell University after a year of contesting allegations of scientific misconduct. Wansink had a knack for publishing fascinating research to show the value of little nudges to promote healthier behaviors related to food and nutrition. Unfortunately, with all of this controversy, journals have retracted a large number of his important studies. Nothing to celebrate here, but certainly much to learn.



Our top 10 is admittedly a subjective exercise, so we invite you to tell us what we’ve missed, using the comment function below. Above all, we’re grateful for your thoughts and your readership.

Top Ten Sheep, photograph © Riccardo Cuppini / flickr

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December 17, 2018

2 Responses to “The Top 10 of 2018 in Obesity & Health”

  1. December 17, 2018 at 9:23 am, David Brown said:

    Regarding the “Killer Carbs” issue, there’s something that bothers me. Why do scientists choose sides and engage in academic debate? Doesn’t it make more sense to simply exchange information? And why do these debates become heated? Is it because scientists become emotionally attached to narratives they embrace? It would seem so.

    What bothers me most is so called consensus science. What possible use is consensus in the teeth of uncertainty? A majority of experts agreeing on a narrative does not make it so. That said, I urge those who read this comment to google “arachidonic acid” in conjunction with obesity, diabetes, heart disease, cancer, depression, or any other physical or mental malady that comes to mind. I recently did so with “lower back pain” and was rewarded with this excellent discussion. https://gettingstronger.org/2013/12/banish-back-pain-and-sore-muscles/

  2. December 22, 2018 at 11:13 pm, Carrie Quinn said:

    Has anyone followed the participants in the DiRECT study (or similar) to see how many of them end up with eating disorders after eating 800 calories per day? Seems pretty irresponsible.