Wednesday, December 28, 2011

Is Being Fat Really a Trap?

I can see the marketing world gearing up.  More ads for exercise equipment, "diet" plans, and other things to tempt us into spending money to kick-start our fitness goals.  I hope you're feeling motivated as the new year approaches.  I know I am.  I hope 2012 is the year I *finally*, after what will be 5 years, reach my goal.  I could go on and on about how, in many ways, I've already reached my goal and so much more, but the number goal is still out there and that's the one I'm speaking of.

So many of us have been down this weight loss path before and for many of us it can start to feel like a lost cause.  But it's not.  Though I am a firm believer that how you go about losing weight matters.  A friend posted this article, The Fat Trap, from the New York Times and I found it thought provoking.   It's written by Tara Parker-Pope, a self proclaimed overweight person who's tried time-and-again to lose weight, only to end up heavier in the end.

In summary it proposes that once we become fat our bodies strive to re-gain the lost weight.  That hormonally we are driven to seek out those lost pounds, otherwise we stay in starvation mode.  I've heard various reasons for this over the years, empty "fat" cells just waiting to be plump again is the one I've heard most often.

The thing that gets me is that in the first study Tara cites they put participants on a starvation diet
...the extreme low-calorie diet, which consisted of special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks.
After 10 weeks on this "diet" participants lost an average of 30 pounds.  Does the following come as a surprise to anyone?
After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.
I know it doesn't surprise me.  They were starving for 10 weeks.  That's not a lifestyle change one can sustain.  And it obviously wreaks havoc on the body.
A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.
What I want to challenge here is the conclusion that "dieting" will leave you worse off than when you started.  I think the conclusion should be something more like extremely low-calorie diets will leave you worst off than when you started
“What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”
NO, NO, NO!  What explains the high failure rate (in this case) is the extreme, un-maintainable, starvation diet.  And I believe that making changes that are not sustainable, trying to lose too fast, trying to make too many changes at once, trying to change yourself but not your environment, not finding exercise you enjoy - these are the causes of failure in maintenance.  You must make changes in  your life that you can sustain, for the long term, forever - or at least for as long as you want to be thin.
For years, the advice to the overweight and obese has been that we simply need to eat less and exercise more. While there is truth to this guidance, it fails to take into account that the human body continues to fight against weight loss long after dieting has stopped. This translates into a sobering reality: once we become fat, most of us, despite our best efforts, will probably stay fat.
This rubs me the wrong way.  I feel like I'm being told that no matter what I do, I'll probably become fat once again.  And if not me, than most of my peers on this journey.  And that just makes me mad.  Don't tell us that.

The article goes on to talk about a “biological determinism” that can make a person susceptible to weight gain or loss.  I think there must be some truth to that.  But while reporting on the genetic factor Tara noted this:
...after testing positive for fat-promoting genes, some people were more likely to eat fatty foods, presumably because they thought being fat was their genetic destiny and saw no sense in fighting it. 
Eeeexactly. And that's why I don't like this article.  Don't tell people they are likely doomed to fail based on a study that utilized a starvation diet for weight loss.  It's just not good science, in my humble, non-scientist, opinion.

Later in the article they talk about The National Weight Control Registry and go on ad-nausea about a woman who lost over 100 pounds, Janice Bridge, and how much she has to do to maintain that loss.  She's keeping a food log, weighing daily, measuring all her food, etc, etc.  The article says she "never" lets up and goes on about how she avoids sugar, white flour, etc... Tara (the writer of the article) feels overwhelmed and hopeless after hearing all this woman has to go through to maintain her weight loss. 
"Just talking to Bridge about the effort required to maintain her weight is exhausting. I find her story inspiring, but it also makes me wonder whether I have what it takes to be thin." 
But then Janice is sharing a Ben & Jerry's ice cream with her husband.  And she includes gardening as exercise.  So she does get to let up now and then.  Just not entirely.  It's called balance.  Janice is a food junkie (that's my preferred term) and is working to overcome a lifetime of bad habits coupled with using food for emotional fulfillment.

So ok, Janice Bridge has to eat 300 less calories a day to maintain her weight (than a person who was never fat).  300 calories is not a lot.   

Later the article references another study in which participants are placed on an 800 calorie diet and, lo-and-behold, they are "metabolically different than a similar-size person who is naturally the same weight."  Sure they are, after starving them.
After weight loss, when the dieter looked at food, the scans showed a bigger response in the parts of the brain associated with reward and a lower response in the areas associated with control. This suggests that the body, in order to get back to its pre-diet weight, induces cravings by making the person feel more excited about food and giving him or her less willpower to resist a high-calorie treat.  
But could it be that prior to weight loss they weren't as "excited" about food because they were indulging all the time?  But after becoming a "dieter" the food becomes more exciting?  I know that's been true for me.  Back when I posted my Top 10 Changes After Losing 67.4 Pounds my #4 change was "I actually enjoy junk food more since it's now a treat and not just an every day thing."  The kicker though, is that the areas of the brain responsible for restraint are less active.  Perhaps that's because the participants didn't really build restraint during their starvation, short-term, "quick" liquid diet.

Tara writes about another weight-loss success story.
She (Lynn) has also come to accept that she can never stop being “hypervigilant” about what she eats. “Everything has to change,” she says. “I’ve been up and down the scale so many times, always thinking I can go back to ‘normal,’ but I had to establish a new normal. People don’t like hearing that it’s not easy.”  
No, she can't go back to "normal".  But remember, Lynn's normal involved being 300 pounds.

They are addressing my concern.
One question many researchers think about is whether losing weight more slowly would make it more sustainable than the fast weight loss often used in scientific studies. Leibel says the pace of weight loss is unlikely to make a difference, because the body’s warning system is based solely on how much fat a person loses, not how quickly he or she loses it. Even so, Proietto is now conducting a study using a slower weight-loss method and following dieters for three years instead of one.
I still think they are missing a big point though.  It's not just losing weight slowly, but making sustainable changes, changes you can live with.  It's not about the pounds lost, it's about how they are lost.  That point couldn't have been made better than by Tara's statement here:
Losing a few pounds may be good for the body, but it does very little for the spirit and is unlikely to change how fat people feel about themselves or how others perceive them.
If it does little for the spirit, I suggest the person doing the losing needs to take another look at their goals and motivations.  I believe that there's hope for all of us.  I am in love with Tara's closing sentences...
"And even though all the evidence suggests that it’s going to be very, very difficult for me to reduce my weight permanently, I’m surprisingly optimistic. I may not be ready to fight this battle this month or even this year. But at least I know what I’m up against."
I would say this to Tara - yes, it's going to be hard.  Very hard. But not for the reasons you might think.  It's going to be hard to tap into that drive, to change your habits, to change your environment.  It's going to be hard to prioritize yourself, to learn new ways to cope. It might be hard to gain a higher level of fitness but the real challenge is in finding that physical movement, "exercise" that you enjoy. And yes, sometimes it's going to be hard to be hungry. 

I would say Tara - when you are ready, when you want it...go slow, make one change at a time, balance, move, do things you love that don't involve food ... to steal ww line - Stop Dieting, Start Living!

10 comments:

  1. Of course, being biased, I think that people fail to take into consideration the mental health aspects of eating/relationships w/ food as well. Genetics and biology come into play, but that's not 100% of it. There's also 1) learned behaviors and 2) reasons why people have a poor relationship w/ food (e.g., depression, anxiety, etc). Wish articles would highlight those aspects as well!

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  2. I agree with you Michelle, it is hard and if you've been obese it's never going to be easy for you - but that does not make it impossible nor is it a reason to give up completely.

    And Pittles, you hit the nail on the head. Far too many people disregard the mental/emotional side of overeating. We don't overeat because we are hungry, it's the exact opposite. We overeat because of some emotional turmoil that we are avoiding. I'm an avid fan of the Biggest Loser and every single one of those contestants end up facing some emotional issues they have no matter how hard they deny it in the beginning.

    So yeah, crappy study, crappy science, and really crappy reasons.

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  3. Thank you for the feedback. Pittles, of course, I agree with you. The article didn't talk about the whys of people being 100+ pounds overweight to begin with. And Flo, the negative energy of the article, that it might make even *one* person feel like not trying made me mad.

    Thanks for the support you two!

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  4. Very interesting Michelle. Love to read your blog. You are quite the inspiration.

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  5. Michelle,

    Great article! I hope Tara reads it, though I suspect she won't. She seems to have a very narrow (and unchanging) viewpoint regarding 'health' issues, and only supports the medical status quo.

    Which is, of course, what has made us fat to begin with. Gary Taubes dissects this insane (but money-making!) medical/nutrition/obesity paradigm in both his books: Good Calories, Bad Calories and Why We Are Fat.

    Michelle, you hit it on the head when you said it was about what you eat. I am on the National Weight Registry and have been for years, having lost over 100 pounds and kept it off for years as well. Do I diet? Nope. Exercise? Not unless you consider a slow stroll with the pooch 'exercise'. Am I young? No, I'm a senior citizen (so much for 'middle-age spread'), though my blood tests, and especially my lipid panels, show the interior of a woman half my age.

    So what's my secret? SCIENCE. Once I learned what doctors learn in Biology 101: that only insulin can store fat, and that carbohydrates drive insulin -- losing weight by eating lots of fat (and calories) while dropping all sugar and most, but not all, carbs -- was easy. And it has remained easy to keep it off because I don't do it -- my now insulin sensitive (as opposed to insulin resistant) body does it all for me.

    And once I understood I had a particular form of insulin resistance -- PCOS, which is so common with so many women, including Tara, I believe -- I set up a blog that lays out the science of obesity and have been running a 'real-time' experiment with many, many women who participate in my Protocol. All have lost weight, but most especially fat and inches, not lean muscle mass. Insulin resistance has been reversed. Diabetes Type II has been put into remission.

    Most exciting of all -- every single inch lost stays lost. Once on the Maintenance phase, there's no cutting calories and no exercise required to keep it off. The body changes from fat-storing to a truly normal fat-burning machine. Of course, you can never go back to eating sugar or sugared foods, but once you understand how toxic it is, you never want to eat it. :)

    I hope you'll visit, Michelle, and read some of the articles about the science of nutrition and obesity. Who knows, maybe we can get Tara there, too.

    http://sugarfreegoodies.wordpress.com/2011/04/09/calories-in-calories-out-cico-debunked

    SugarFree
    http://sugarfreegoodies.wordpress.com/2011/03/15/hello-world

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  6. Awriter (sugarfreegoodies) - I read what you wrote and took a look at your blog. I don't support cutting anything out entirely - even sugar, white flour, etc. I know it works for many people but I also know it's not realistic for me. I think it's sad that so many people are focused on losing weight fast and looking for the most effective way to do so (HCG, for example). It's so NOT about losing the weight, that's the fun/easy part - it's about maintaining. And for me, maintaining has to include ice cream and other sugary treats now and again.

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  7. Great article Michelle. Your commentary was thought provoking. I enjoyed everything you said. But I would have added this in at the end: "when you are ready, when you want it...go slow, make one change at a time, balance, move, do things you love that don't involve food ... Stop Dieting, Start Living, AND ENJOY YOUR NEW BODY!"

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  8. Michelle, you wrote: "for me, maintaining has to include ice cream and other sugary treats now and again."

    Exchange the words "sweet treats" for "sugary treats" and you'll be describing exactly how I eat: ice cream, brownies, cheese cake, pasta, biscuits, mashed potatoes, bread, etc.

    It's just that mine are all homemade, they're made with healthy fats like butter, lard and coconut oil -- and none of them have processed sugar or artificial sweeteners! Except for the tiny amount of sugar in the Lindt 85% chocolate I also eat on occasion, my life has easily become sugar -- not carb -- free.

    I don't eat all those treats above every day of course, and when I do eat them, they're in small quantities. But once you heal your metabolism, which is the goal of my Protocol (weight and fat loss is incidental to getting healthy again) -- and you are no longer insulin resistant, you can eat all those things because your body will know how to burn, not just store them.

    As for sugary treats -- there's a myriad of good scientific reasons not to eat them, and not just because of the high fructose corn syrup, which is destroying the livers of our children with Non-Alcoholic Fatty Liver Disease. It's because all processed sugar is toxic to the human body, even in what our society would now consider small amounts. Take a look at this 4-minute video and see for yourself:

    http://www.youtube.com/watch?v=aH47sGmJZaQ

    Btw, my name is SugarFree, not awriter -- though I can't figure out how to sign in that way. :)

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  9. I lost it slowly, and I'm maintaining 25% loss, but I think the article is mainly correct, and the science totally so. I would gain the weight if I ate ad-libitum, I always have to eat a bit less than I want, though my food tastes/appetite have changed, so it's not usually so uncomfortable. Like you, I still eat everything, just not as often, smaller portions. I exercise enough to shock most normal-weight people, who think I should be skin and bones. I think the article validates my experience, though I'm not as obsessed as the couple they mention. I also wasn't 150 lbs overweight, just 75 or so. As it is, I'm having a hard time losing the last 20 pounds that would make me slim, and I remain mildlychubby, though weight stable.

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  10. justjuliebean - I agree, there is much to be said for the validation of that article, I think in the end it scared me and my response was my fight-back, if that makes sense. I don't choose to believe a lot of what is in that article and maybe that's because denying those things fits better into my weight loss/fitness world view, or better support my motivations.

    I just read a bit of your blog, I like your thinking about food, real food, less processed, reasonable eating, etc. Mildly chubby, I like that, but I saw a picture of you (the hiking one) and I think you look fabulous. It seems to me you've made changes in a way that are sustainable, which is so important. And while you might want to lose those last 20 pounds, don't lose sight of where you are now. I have decided that, for people like me who've lost a lot of weight, constant dissatisfaction and a never-arrived-at goal is a risk for relapse.

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If you don't want to login, use the Name/URL option (just type in your name...or any name for that matter). If you use the "Anonymous" option your comment won't get posted. - Michelle