The Eating Academy, Peter Attila, MD The thought provoking and oh-so-scienc-y blog of Dr. Peter Attila, a once overweight surgeon who has become thoroughly enmeshed in the low carb world and lives his hypotheses through self-experimentation.
Primal Body Primal Mind Site of Nora Gedgaudas, a writer who is interested in the science of health and athletic performance via primal diet
Weighty Matters The lively blog of Dr. Yoni Freedhoff, Canadian obesity physician.
The Nutrition Source - Harvard School of Public Health The web page for the nutrition arm of the Harvard School of Public Health. Dr. Walter Willett is their nutrition and preventive medicine guru. His approach toward nutrition is always sensible and based on the evidence.
You knew that an article as major as "The Fat Trap" would get the media going. Here is what I consider to be a particularly uninformed and unhelpful response by Slate Magazine (see article here). Summary: we're wasting our time trying to combat obesity and those who are maintaining are only doing it via some sort of eating disorder.
Scroll down to the comments section if you have any interest in seeing my response. Or leave your own. I'm sure this article will madden you.
Once a month, in a small room off the lobby of Lake West Hospital in Willoughby, Ohio, a special group convenes. For someone observing the group and unaware of its purpose, it might appear to be a simple mix of everyday people….young, old, racially diverse. The members would seem to be old friends but with a particular seriousness of purpose, perhaps a community group attending a lecture or learning some new skill together. What a casual observer would not guess is that each of these people was once obese, some having weighed over 100 pounds more than they do today.
Our Refuse to Regain group is an experiment, a safe haven for maintainers who have lost weight in many different ways and now face the reality of reconstructing their lives. We’ve had people from Weight Watchers, people who’ve undergone bariatric surgery, people I’ve treated in my practice and others who simply did it on their own. A weight loss diet is no different than emptying the trash. It doesn’t matter which technique you use to toss out the garbage. But learning how to avoid the reaccumulation of unwanted junk is a completely different skill. There are many basics in this process that will be the same for everyone. There are also many specifics that will vary from person to person and which must be individually discovered.
Here’s some of what we’ve learned so far:
Weight maintenance is possible. There is nothing in our group experience (or in my personal clinical experience) to suggest that the body “forces” one to regain.
Weight maintenance requires a separation from the world of “normal” American eating…which is not normal at all.
Some people are heavy simply because they are susceptible to the modern diet , no more no less. Others are heavy because they use food for soothing or sedation. Most people are a mix of both. If psychological issues are a major part of weight gain—significantly beyond the common enjoyment of food for pleasure, they need to be addressed during the maintenance phase.
Weight maintainers are special people who live on a kind of food island. It’s really nice to know that the island is inhabited, often with fascinating, determined people just like you. Rarely do maintainers get to meet and talk with one another.
This week, I gave my group a reading assignment. That was a first. I asked everyone to read Tara Parker Pope’s article on weight maintenance called The Fat Trap. This article is currently online and will appear in Sunday’s New York Times Magazine. Our group will be discussing it at our January meeting, but I’ll give you a preview of my reaction here. Many of you may be reading our blog because you read The Fat Trap and discovered Lynn Haraldson, my blogging partner on this site. The fact that you got here likely means that you are interested in knowing whether we are bound to regain the weight we lose, so please, read on…leave comments and join the discussion.
For those of you who are new to this blog, you should know that I am a physician who has specialized in weight management since the late 1980s. This is the only thing I do and that’s unusual. Why? Because most doctors are not particularly interested in obesity, and certainly weren’t back in the 80s. Over the past twenty years, a continuing source of frustration for me has been the willingness of doctors and the general public to accept “truths” about weight loss that are the beliefs of everyone except those who actually work with overweight people.
Scientific research needs to square with what we see in clinical practice. If it doesn’t, we should question its validity. “The Fat Trap” is an article that starts with a single, small research study and builds around it. Its point? That there are inevitable biological imperatives that cause people to regain all the weight they lose.
I don’t buy it.
Here is the opening paragraph of Ms. Parker Pope’s article:
For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again.
At one time, this was my experience too. But things have changed. After years of focusing my practice much more on weight maintenance, writing a book about it, and trying to figure out how to teach and encourage it, I no longer see patients with an “entire effort come undone”. Instead, I see more and more people learning how to become successfully anchored at their new weight. And these POWs (previous overweight people) are not from my practice alone. They are people like Lynn Haraldson and her friends “The Maintaining Divas”. They are the long term POWs who write to me via this blog, on Facebook and on Twitter. They are the people I hear about with increasing frequency every day.
I admire Ms. Parker Pope for acknowledging her own struggles with weight, but as someone who has not yet solved the maintenance problem I would submit that she is not the best person to rationally evaluate evidence that says that regain is inevitable. After talking to a number of scientists who believe that the body fights weight loss, her concluding paragraph says:
For me, understanding the science of weight loss has helped make sense of my own struggles to lose weight, as well as my mother’s endless cycle of dieting, weight gain and despair. I wish she were still here so I could persuade her to finally forgive herself for her dieting failures. While I do, ultimately, blame myself for allowing my weight to get out of control, it has been somewhat liberating to learn that there are factors other than my character at work when it comes to gaining and losing weight.
Those of us who come from families which struggle with obesity can believe one of two things. We can believe that biological and metabolic factors doom us to fatness or we can believe that we come from families who are very sensitive to the current food environment and perhaps need to live in a new and more creative way. It has been my experience that all successful maintainers have learned how to live a life that exists outside the current food norms. For some, this is a daily and difficult challenge and for others it becomes a simple and treasured way of life, but either way, it is not about some inevitable biological destiny. Rather, these maintainers have come to terms with the fact that they are ancient bodies and souls living in a modern environment and that our food culture is capable of killing them. Controlling that environment is their choice and their challenge.
Where I do agree with “The Fat Trap” is in its assertion that obesity is much more difficult to deal with once it is established. We would do well to focus intense and constant attention on healthful nutrition during pregnancy and in childhood. I believe that we can do this much more easily than we believe, if we would only adopt the idea that we should eat more like we did originally as hunter-gatherers. It has been my clinical experience that elimination (or major curtailment) of starches and sugars (including whole grains and the things that come from them, by the way) simply works. And this clinical observation makes sense, since the ancestors whose genes we carry were not exposed to the large amounts of starch and sugar we now eat. Along with consumption of real food…not things in boxes, cans, or packages.... this easy concept can change lives. We could make things so much easier by teaching this lesson to kids rather than endlessly focusing them on per cents of fat, protein and carbs and on counting calories.
But such approaches to weight maintenance are not easily sold. Its far simpler to believe that weight must be regained. I’m fond of using this example for patients: If you were to tell your friends that you are becoming vegetarian and that you will no longer touch a drop of red meat, fish, or poultry, no one would blink an eye. You’d probably be encouraged and congratulated. If, on the other hand, you announced that you were giving up sugar and grain, the same friends would be horrified. “You mean you’re never going to have another piece of bread???”
I believe that the resistance to finding the maintenance solution comes from the addictive nature of starch and sugar foods. I also believe that most of America and other SAD (standard American diet) countries are operating “under the influence” of addictive carbs. Life without them, or even with LESS of them, is too awful to contemplate.
But I digress. To return to my original point, I want to forcefully say that we must stop finding reasons we can’t maintain and start getting much, much better at teaching people how to do it. Support networks, communication between maintainers, and many more books, advocates, and techniques that focus on maintenance are key.
I believe I may scream if I see yet another book with a catchy title that touts yet another weight loss approach without ever talking about what happens in the after-diet world. January is the month for those glossy little productions.
Time to get serious. Maintenance can be done, and if you want to meet the people who are doing it, hang around this blog.
Hello to all new readers! I know that we are getting alot of traffic as a result of the NY Times article, "Fat Trap" which discusses weight maintenance and references Lynn. This is Barbara Berkeley posting and I just want to let you know that I will soon be writing a response to that article. Stay tuned if you are interested in reading more and in joining the discussion.
In the meantime, I hope you'll check out our archives and see what we've been doing at Refuse to Regain. Lynn and I started this blog in the hopes of providing a unique perspective on issues of long term weight control. There's simply too much written about losing weight when pretty much all of us have figured out how to lose. We all know that it's the keeping it off that's the issue, but where can we go for help? I hope that we've given maintainers some new ways to think about the process, some helpful guidance and most of all--the knowledge that there are other maintainers out there.
In addition to this site, Lynn blogs at Lynn's Weigh and we both maintain Facebook sites (see the links on the left of this page). I hope that you will also take a look at my book, "Refuse to Regain:12 Tough Rules to Maintain the Body You've Earned". It summarizes everything that I've learned in about 20 years of working with patients who want to avoid regain. Finally, I often post to Twitter and recently I've started a You Tube channel (search Barbara Berkeley MD) that reproduces some of the ideas and talks that I share with my private practice patients. All of this (except the book, of course) is free to you and I put it out there strictly to share and support. I hope you find these things helpful. Always love to hear from you!
A little something to think about when you are headed for the holiday buffet. How far will willpower take you? I think it's much smarter and more effective to take a realistic look at the strength of your opponent: modern trigger foods.
There are so many people selling pleasure in our world and it's so easy to be convinced that we can pay for our choices later. It's kind of like running up a big credit card bill. In particular it's easy to rationalize away bad diets. I'd be rich if I had a dollar for every time I've watched someone eat a greasy meal and a rich dessert and then say, "I'll just pop a Lipitor." As if any single medicine can oppose the extensive damage done to a body that is being treated badly.
Our world reminds me alot of the famous segment in Pinocchio in which a bunch of boys are lured to Pleasure Island---a place where every bad habit is encouraged. Although old-fashioned and heavily moralistic, these scenes are worth a watch. For many years, I worked as an ER doctor and the looks on the faces of people having acute heart attacks still haunt me. In fact, they remind me quite alot of the panic that Pinocchio's friend experiences when he realizes that his bad habits have come home to roost.
How do we lose weight? The answer is--- cut calories until the body is forced to burn itself for energy. This is so intuitively obvious that the converse would also seem to be true: if we lose weight by cutting calories, we must gain weight by accumulating them. But is this true? Perhaps weight loss has nothing much to do with weight gain. Perhaps they are two quite different things. '
For some time, I have been giving an introductory talk to new patients who enter my practice. I wanted to record it so that they could hear the talk again if they chose, or share it with those at home. At the same time, I thought that readers of this blog might find it interesting as well. While I can't claim to know the ultimate truth, I have found that the model of weight gain I describe in these videos works well as a basis for treating most of the overweight patients I've encountered. I hope you find it interesting.
The weight loss experience comes in two distinct forms: the temporary diet that induces weight loss and the (hopefully) permanent behaviors that lead to weight maintenance. Confusing the two is easy because successful maintainers continue to eat and exercise in a way that looks alot like their original diet. But there is an important difference: maintenance requires achieving balance while dieting requires inducing defecit.
This month, I posted a youtube video (scroll down to find it) that asked the following question: What is a Diet? I was referring to the weight loss portion of diet which I believe is firmly tied to two elements: 1. Recreating an ancient response to famine by consistently limiting calories and 2. Avoiding foods that stimulate insulin (starches and sugars). These beliefs are obvservational and based on my experience with thousands of dieters but they remain hypotheses as they (and most obesity theories) are not confirmed by research.
That's why I was fascinated by an article that appeared in today's Science Daily, a round up of ongoing scientific thought and research. Evolutionary anthropologist Erin Vogel from Rutgers provides thought provoking commentary into the eating habits of orangutans, a species that is closely related to our own. Like humans, orangutans store fat when calories are plentiful. The only time that they burn this fat is during times of significant calorie restriction. Orangutans normally eat alot of fruit, but when it is not available, they survive despite very low protein intakes. They do this by switching to a diet that contains other protein sources and by activating a response that burns their own fat and muscle. In other words, they activate an ancient famine response. This response is obviously meant to be protective and to allow the organism to survive a tough period.
And so it appears to be with humans. We won't lose weight unless we put our body into the same situation that provoked weight loss in ancient times....calorie deprivation. While we don't have to completely starve ourselves, we do need to convince the body that there is an ongoing lack of food, thus activating primal responses and fat burning. What usually scuttles a weight loss diet is periodic "cheating" or inadquately following the plan. (For more, see my previous post on why your diet isn't working.)
Weight maintenance is a different animal. The trick here is to rehabilitate the mechanism, normally automatic but malfunctioning in weight gainers, that decides whether food is burned or stored. The best way to do this is to avoid foods that turn into sugar, including starchy carbs and (in my view) grains. The reason? The axis which appears most broken is the one that partitions sugars for burning or storage. Since we don't need these foods to survive and can get plenty of healthful carbs from fruits and vegetables, it is easiest to avoid this mechanism entirely. That's the basis for the recommendation of Primal, Paleo or Primarian diet. When we look at our closest evolutionary relatives, we have a clear picture of ancient diet. It always pays to consider the thought that we are just a dressed up, modern version of our ancient selves.
For those of you who receive Refuse to Regain by feed or who check in with this blog periodically, please consider following me on Facebook as well. I post at least once a day to the Facebook page. These posts include thoughts, patients insights, and links to articles that I want to share with all of you. I don't always have enough material to write a full blog post, but things are happening in the worlds of medicine, obesity and maintenance every day. Facebook also provides an easier way for interested followers to give feedback. Over there, we can talk!
To access the Facebook page, simply search "Refuse to Regain: Barbara's World" and click on the "like" button. That will allow posts to appear on your wall. (Even easier: you can click on the Facebook badge that appears on the left lower side of this page).
For those of you who use Twitter, my Facebook posts appear there as well. In addition, I post some shorter thoughts and links to Twitter. You can find me there at BBerkeleyMD.
Onward and upward in the internet world!! Who thought that, at this late date, I'd be so connected?