Cause v Consequence
Or, the important distinction between the proximate and the ultimate cause
👋 Hey there! Welcome to a new edition of The Sunday Wisdom! My name is Abhishek. I read a lot of books, think a lot of things, and this is where I dump my notes and (so called) learnings.
I mostly write to educate my future self, but if you like what you read here, I would say this hobby of mine just became a bit more purposeful. Now… time for the mandatory plug!
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Enough talk! On to this week’s essay. It’s about 2,000 words.
Q: How should we investigate universally accepted truths that aren’t truths?
The standard prescription for weight loss is “Eat Less, Move More.” It assumes that we have conscious control over what we eat. It sounds perfectly reasonable. But this belief ignores the extremely powerful effect of the body’s hormonal state.
“Eat Less, Move More” it doesn’t work!
What causes weight gain? We spend no time considering this crucial question because we think we already know the answer. It seems so obvious: it’s a matter of Calories In versus Calories Out.
When the number of calories we take in exceeds the number of calories we burn, weight gain results, we say. Eating too much and exercising too little causes weight gain, we say. Eating too many calories causes weight gain, we say. These “truths” seem so self-evident that we do not question whether they are actually true. Are they?
Let’s examine.
“A calorie is a calorie” implies that the only important variable in weight gain is the total caloric intake, and thus, all foods can be reduced to their caloric energy.
It means 100 calories of cola is just as likely as 100 calories of broccoli to make you fat. But show me a single person that grew fat by eating too much steamed broccoli. I know it. You know it. We all know it.
So we must ask again. What really causes weight gain?
The defining characteristic of the human body is homeostasis, or adaptation to change. Our body deals with an ever-changing environment. In response, the body makes adjustments to minimise the effects of such changes and return to its original condition.
And so it is, when the body starts to lose weight.
There are two major adaptations to caloric reduction. The first change is a dramatic reduction in total energy expenditure of the body immediately and indefinitely — in order to conserve the available energy. The second key change is the hormonal signals that stimulate hunger increase.
Calorie loss significantly increases ghrelin — a hormone that essentially makes us hungry — level in body compared to the usual baseline.
What does that mean? It means that you feel hungrier and continue to feel so, while we are losing weight. The body starts pleading with us to eat in order for it to regain the lost weight.
Several satiety hormones, including peptide YY, amylin and cholecystokinin, all of which are released in response to proteins and fats in our diet and serve to make us feel full. This response, in turn, produces the desired effect of keeping us from overeating.
In calorie reduction, even more than a year after initial weight loss, the levels of all three satiety hormones remain significantly lower than before.
What does that mean? It means that you feel less full — even after you’ve lost weight. No wonder why most people who drastically lose weight also gain them back quickly.
Functional Magnetic Resonance Imaging (fMRI) studies show that areas of the brain controlling emotion and cognition light up in response to food stimuli. Areas of the prefrontal cortex involved with restraint show decreased activity. In other words, it is harder for people who have lost weight to resist food.
People on a diet tend to feel hungrier, and that effect isn’t some kind of psychological voodoo, nor is it a loss of willpower. Increased hunger is a normal and expected hormonal response to weight loss.
In other words, reduced metabolism and the increased hunger are not the cause of obesity — they are the result.
Losing weight causes the reduced metabolism and increased hunger, not the other way around. We do not simply make a personal choice to eat more. One of the great pillars of the caloric-reduction theory of obesity — that we eat too much because we choose to — is simply not true.
We do not eat too much because we choose to, or because food is too delicious, or because of salt, sugar and fat. We eat too much because our own brain compels us to.
Today, let’s talk about causes and consequences. More precisely, let’s talk about how sometimes the consequence isn’t truly the consequence, and instead is the cause.
The fields of food and health are marred with contradiction and hubris. Most people don’t know what they are talking about, and yet display maximum confidence. It’s also a field where there’s a lot of fraud and malpractice due to the heavy involvement and biased agenda of Big Food companies. If you really start eat healthy they would go out of business. Therefore, the chances of reading peer-reviewed empirically-tested fake research is extremely high.
However, this is also the field where universally accepted “laws” are debunked every other day by dogged researchers, scientists, and writers such as Daniel E. Lieberman, Michael Greger, Michael Pollan, Gary Taubes, Jason Fung, and the likes.
Sometimes the facts are off, the causes are unknown, and the trends are hidden. And sometimes they are apparent and universally accepted but fake. This is especially dangerous because when the guiding model itself is wrong, no matter how much effort you put, you are not going to get the desired effect.
Mark Twain supposedly once said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”
Food and health (and perhaps finance) are the best fields to challenge universally accepted “truths” such as what should we eat, what causes weight gain, how much should we exercise, etc. It is in this field where we can find “interesting” discrepancies and get to flex our critical thinking muscles.
In other words, food and health is the best field where we are very likely to stumble on “what you know for sure that just ain’t so.”
Oprah Winfrey has waged her weight loss battles publicly for several decades. At her heaviest, she weighed 107kg. By 2005, she’d battled her way to 73kg. She was thrilled! She did everything right. She’d cut her carbohydrates. She’d exercised. She had a personal chef and a personal trainer. She had every advantage not available to the rest of us.
So why did she gain back 18kg by 2009?
The universally accepted norm is that eating causes obesity. So, naturally, if you eat less — go on a calorie deficit diet — you would lose fat/weight. This is doesn’t work because we’ve got the guiding principle of the weight loss strategy flipped. When you are already obese, the tendency to eat more is not the cause, it’s the consequence.
But this is a much simpler use case, where the cause and consequence have merely flipped. There are however cases where the supposed cause is a consequence of some other cause.
For example, a business might say: Users aren’t buying our products (consequence) because the price is high (cause).
Here’s the cause is not the real cause — it’s simply the proximate cause. It is a consequence of several other factors — the ultimate causes — that are causing the business to set a high price for their products.
Either the manufacturing cost and marketing costs are high; or there’s some pressure from the top to increase revenue, thereby forcing the business to increase prices; or there’s a scarcity of some parts of the product in the market, which raised its demand and hence price.
Proximate causes are usually first-level causes that are at best superficial and at worst rarely inform us on what’s really going on. Until you really know what’s going on, it’s impossible for you to devise an action plan.
Excess calories may certainly be the proximate cause of weight gain, but not its ultimate cause.
What’s the difference between proximate and ultimate? The proximate cause is immediately responsible, whereas the ultimate cause is what started the chain of events. The proximate cause is merely a consequence of the ultimate cause.
Consider alcoholism. What causes alcoholism? The proximate cause is “drinking too much alcohol” — which is undeniably true, but not particularly useful. The question and the cause here are one and the same, since alcoholism itself means “drinking too much alcohol.”
If the typical treatment advice directed against the proximate cause — “Stop drinking so much alcohol” — would have worked, Alcoholics Anonymous (AA) wouldn’t have existed.
The crucial question, the one that we are really interested in, is: What is the ultimate cause of why alcoholism occurs? The ultimate cause may include family history of alcoholism, excessive stress in the home situation, an addictive personality, and many other factors.
The consequence of all these factors is “drinking too much alcohol” — it’s the consequence of alcoholism, not the cause.
What causes something is very different from what really causes something. Once we identify the real cause, we can work something out. Otherwise, we are simply shooting in the dark.
We are addicted to chairs, especially those with backrests. Whenever you sit on the ground or use a stool without a backrest, muscles in your back and abdomen must do a little work to hold up your torso. When you squat, muscles in your legs, especially your calves, are also active.
Interestingly, squatting and standing use about the same degree of muscle activity. But you cannot squat for long since your muscles involved don’t have enough strength.
But a reliance on chairs with backrests is a recent phenomenon. In most cultures chairs with backs were used primarily by high-ranking personages, while peasants, slaves, and other labourers mostly had to sit on stools and benches.
In art from ancient Egypt, Mesopotamia, India, Mesoamerica, China, and elsewhere, the only folks seated on comfy chairs with backrests are gods, royalty, and priests. In Europe, it was not until the late sixteenth century that chairs with supportive backs started to become common among the growing middle and upper classes who could afford furniture.
Then, during the Industrial Revolution, a German manufacturer, Michael Thonet, figured out how to mass manufacture bentwood chairs with backrests that were light, strong, beautiful, comfortable, and affordable to the needy masses. In 1859, Thonet perfected his archetypal café chair, which sold like hotcakes and remains popular in coffeehouses even today.
As chairs with backrests became less expensive and more common, some experts condemned them. To quote one alarmed physician in 1879: “Of all the machines which civilisation has invented for the torture of mankind…there are few which perform their work more pertinaciously, widely, or cruelly than the chair.”
Despite these and other warnings, the popularity of chairs has continued to exceed concerns, especially as workplaces have shifted from forests, fields, and factories to offices. An entire profession, ergonomics, was invented to help us cope with modern industrial environments, including chairs.
The universal truth is that chairs without backrest are the primary cause for afflictions related to the lower back. Doctors and physiotherapists don’t think for a moment before recommending chairs with good back support.
Interestingly, rural teenagers in India who rarely sit in chairs with backrests have 20 to 40 percent stronger backs than teenagers from the city who regularly sit in the sorts of chairs you and I usually use. On top of that, despite having the best of chairs, the urban population is perpetually suffering from back problems.
We can’t prove that rural Indians have stronger backs solely because of their chair habits, but studies show that backrests demand less sustained muscular effort — and hence result in weaker back muscles.
It is reasonable to conclude that those of us who regularly sit in chairs with backrests have weak back muscles that lack endurance, making it uncomfortable to sit for long on the ground or on stools, thereby forcing us to sit on chairs with good back support. It’s a vicious cycle.
In other words, weak back muscles is the consequence of ergonomic chairs, not the cause.
When you know this, you know what you really have to do: hit the gym, work on your back muscles, and get rid of that expensive ergonomic chair so that you are strong enough to squat on the ground.
Timeless Insight
When you ask, “Would I use it?” and, “Will it improve my users’ lives?” you can twist your answers to bend the truth. For example, you like to play video games, so it’s no harm if you play Fortnite in your free time. Games do help relieve stress, so yeah, it definitely improves lives, you say.
When you answer things in such black and white manner, you miss the asymmetry of the upside and downside. Relieving stress via Fortnite (which is highly addictive in nature) has a lot of downside than upside. Therefore, what you also have to ask is, “Would I encourage my kids and family members to use it the way I intend my users to use it?” This will give you perspective.
What I’m Reading
If happiness is a skill, then sadness is, too. Perhaps through all those years at school, or perhaps through other terrors, we are taught to ignore sadness, to stuff it down into our satchels and pretend it isn’t there. As adults, we often have to learn to hear the clarity of its call. That is wintering. It is the active acceptance of sadness. It is the practice of allowing ourselves to feel it as a need. It is the courage to stare down the worst parts of our experience and to commit to healing them the best we can. Wintering is a moment of intuition, our true needs felt keenly as a knife.
— Katherine May, Wintering
Tiny Thought
If your anger decreases with time, you did injustice. If it increases, you suffered injustice.
Before You Go…
Thanks so much for reading! Send me ideas, questions, reading recs. You can write to abhishek@coffeeandjunk.com, reply to this email, or use the comments.
Until next Sunday,
Abhishek 👋
Excellent post! As a physician with a keen interest in health and fitness, I find your article to be so true in my experience. Our thinking processes, as a whole, are distorted by so many cognitive biases.