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wasn’t enough food. From birth through the early teens, West Indian children were exceptionally thin, and their growth was stunted. They needed more food, not just more nutritious food. Then obesity manifested itself, particularly among women, and exploded in these individuals as they reached maturity. This is the combination we saw among the Sioux in 1928 and later in Chile—malnutrition and/or undernutrition or subnutrition coexisting in the same population with obesity, often even in the same families.
    Here’s that same observation discussed more recently but now steeped in the paradigm that overeating is the cause of obesity. This is from a 2005
New England Journal of Medicine
article, “A Nutrition Paradox—Underweight and Obesity in Developing Countries,” written by Benjamin Caballero, head of the Centerfor Human Nutrition at Johns Hopkins University. Caballero describes his visit to a clinic in the slums of São Paulo, Brazil. The waiting room, he writes, was “full of mothers with thin, stunted young children, exhibiting the typical signs of chronic undernutrition. Their appearance, sadly, would surprise few who visit poor urban areas in the developing world. What might come as a surprise is that many of the mothers holding those undernourished infants were themselves overweight.”
    Caballero then describes the difficulty that he believed this phenomenon presents: “The coexistence of underweight and overweight
poses a challenge to public health programs
, since the aims of programs to reduce undernutrition are obviously in conflict with those for obesity prevention.” Put simply, if we want to prevent obesity, we have to get people to eat less, but if we want to prevent undernutrition, we have to make more food available. What do we do?
    The italics in the Caballero quote are mine, not his. The coexistence of thin, stunted children, exhibiting the typical signs of chronic undernutrition, with mothers who are themselves overweight doesn’t pose a challenge to public-health programs, as Caballero suggested; it poses a challenge to our beliefs—our paradigm.
    If we believe that these mothers were overweight because they ate too much, and we know the children are thin and stunted because they’re not getting enough food, then we’re assuming that the mothers were consuming superfluous calories that they could have given to their children to allow them to thrive. In other words, the mothers are willing to starve their children so that they themselves can overeat. This goes against everything we know about maternal behavior.
    So what’s it going to be? Do we throw out everything we believe about maternal behavior so we can keep our beliefs about obesity and overeating intact? Or do we question our beliefs about the cause of obesity and let our beliefs about the sacrifices mothers will make for their children remain intact?
    Again, the coexistence of underweight and overweight in thesame populations and even in the same families doesn’t pose a challenge to public-health programs; it poses a challenge to our beliefs about the cause of obesity and overweight. And it shouldn’t be the only thing that does, as we’ll see in the chapters that follow.
    * In 1968, George McGovern, a U.S. senator, chaired a series of congressional hearings in which impoverished Americans testified to the difficulty of supplying nutritious meals to their families on limited incomes. But most of those who testified, as McGovern later recalled, were “vastly overweight.” This led one senior senator on his committee to say to him, “George, this is ridiculous. These people aren’t suffering from malnutrition. They’re all overweight.”
    * Griffin was not the only one to comment on the fine health and leanness of the Pima in the mid-nineteenth century. The women “have good figures, with full chests and finely formed limbs,” wrote the U.S. boundary commissioner John Bartlett, for instance, in the summer of 1852; the men