Michael E. Makover, MD FACP, Chief Medical Officer JIBEI
Winning a healthier life!
Exciting new information from nutrition experts. A report to our readers.
Understanding How Your Body Handles Food and Weight.
I’ve just attended a four-day, 36-hour conference at Columbia Medical School’s Institute for Human Nutrition. It was nice to go back to the medical school I attended, though it sure has changed. Top experts on many aspects of nutrition and weight problems spoke and I had a chance to discuss more with them afterwards.
What follows is information from this meeting, our own expertise and from many other sources.
Being heavier than you would like is not a crime!
Excess weight is not a crime. It is not a failure of character, a weakness, a lack of willpower or any of the many other things people say about themselves or others who are trying to achieve a healthy weight. People are overweight for a combination of reasons, which we will explore in depth in future reports. For all of us our weight is due to how our bodies work, our hormones, the way our brains work, the environment we live in, the genes we inherit and of course the choices we make for ourselves.
The term ‘obesity’ sends the wrong message and should be phased out. No one should be thought of as ‘obese’. Some people just have more severe weight problems, a matter of degree.
Excess weight is a medical problem. Period. It requires attention because it affects health. Too much excess weight is a very serious threat to health in many ways, but it is that person’s choice of what to do about it.
Being overweight is a cosmetic problem only in the eyes of some. Paintings in museums show that, in the past, full-bodied was considered glamorous and attractive, so size and fashion are only of the moment. Our society makes far too much of other people’s appearances in so many ways. Thinking less of people because they are not skinny is as bad as judging people in all the other unfair ways we all know are wrong.
Anti-weight bias is very widespread and hurts people as much as any other prejudice. It should stop.
No shame, no guilt!
People who are concerned about their weight for whatever reason should certainly not feel shame or guilt. Both are unfair and self-defeating. Achieving the weight you want is something to solve, not something to beat yourself up over.
While reducing excess weight and keeping it off is not as easy as we would like, it is far from a hopeless cause.
Ignore bad advice!
Almost everything you read in the media, find on the Internet or hear on TV or radio is…wrong, usually very wrong. Do not believe all the claims on popular TV shows about magic beans and the like, do not trouble yourself to follow endless silly diets pushed at you from all over the place. Ignore it all.
It is hard to solve a problem if you do not have correct information, so please read my future reports, attend our Wellness Workshops, talk to one of our dieticians if you’d like and read the other articles on this website and many more to come before you decide what to do. We work hard to make our information sensible, grounded carefully in scientific evidence and easy to use. Please let us know how we are doing and what topics you would like us to cover.
Once you have a good understanding of how your body works and how to keep it in good running order, then you can set to work designing the you that best for…you.
Why we eat and what happens when we do.
Your body is an amazing machine. It takes in chemicals (food, air and water) from the environment and turns them into two things – building and sustaining your body and providing the energy you use to live and move.
It is extraordinary that we begin as a single cell – a fertilized egg – and develop into an incredibly complex organism composed of 10 trillion cells, all extremely specialized in almost infinite variety.
How evolution led to our modern weight problems
So, we eat to survive and grow. Modern humans also eat for pleasure and for social and emotional reasons, which sometimes means we overeat, even though reasonable amounts of healthy food can make us just as happy.
The very earliest humans lived in times when food was scarce and very hard to get. There were very long periods without food, causing some to die of starvation.
Those early humans whose bodies could store more energy and food (in the form of fat), were much more likely to survive and reproduce, meaning that they passed on the genes that helped them store up energy in fat cells. Being too underweight makes a woman infertile, so there is also selection for higher weight because of fertility needs.
Built to keep excess weight
Humans only reproduce while young, so even if excess fat shortened their later lives, the genes were already passed on. Gaining too much weight thus did not affect evolution, so the end result was strong mechanisms to gain weight and few to limit excess weight. Humans therefore evolved to become very efficient in preserving fat in their bodies even if much more than needed.
Over time, human intelligence led to farming and to tools for hunting that eventually meant food was no longer scarce. Today we have supermarkets and bodegas everywhere and soon it will be delivered to our doors by drones (and even less reason to walk). However, evolution does not run backwards, so our powerful fat-saving mechanisms remain even though we need them very little today in all but the poorest areas of the world.
What does that mean for us now?
Your body is terrific at getting all the energy and nutrition you need out of what you eat and drink and saving it up in fat and other ways. It is also great at keeping the fat there for as long as possible. If you take in more calories than you need, that is stored in fat, which means a higher weight. (You can also gain weight by making larger muscles, but that is healthy and completely different.) Once you gain weight and it stays for a while, you have programmed your body to think that the higher weight is what it should maintain from then on. That is called the ‘set point’, and it can keep being set higher and higher if you continue to take in more calories than you need. When young, you create additional fat cells and when older you over-fill the fat cells you already have. Once created, fat cells do not go away.
Weight is really a brain problem
The fat cells inside your body (around the intestines, liver, and a few other places), and specialized cells in your stomach and intestines tell a part of your brain (called the Arcuate Nucleus) that you need to eat (you feel hungry or crave food) or not (that you are full and feel ‘satiated’). They do this by means of a whole variety of hormones.
The brain keeps getting set for higher levels of food if you eat more than you need and store it in fat for a period of time.
Thus once you gain weight and keep it for a while, you are prodded by your body to eat more to keep it that way. That is one of the biggest challenges we all face in trying to maintain a healthy weight.
The bad news
The bad news is that the hormones also do other bad things to us, throwing off our metabolism and leading to very serious diseases like diabetes and atherosclerosis.
It also seems very discouraging because it makes it seem like losing weight and keeping it off is impossible and that evolution has doomed us to be overweight.
The really good news!
The good news, the really great news is that it can be done! You can learn to enjoy healthy food in healthy quantities, maintain a reasonably healthy weight and still very much enjoy eating and living! It takes truly wanting to, understanding and commitment, but millions have succeeded and so can you and any of us.
Why do we overeat?
The simplest answer to why we overeat is that we can. We have lots of food around.
Furthermore, modern people eat for more reasons than just survival. Since few of us get too little food, most of us now eat mostly for pleasure and social reasons. Additional reasons are discussed below. We have gone from scarcity of food in earlier history to far more than we need in developed countries. Unfortunately, for those at the bottom of the economic ladder, while they can mostly get enough food with government assistance in many countries, they seldom know how to get properly nutritious food. Thus many of those with little money still become overweight and unhealthy anyway. (To our shame, news reports tell us that countless American children from low income families arrive at school hungry every day and that, for some, the school lunch is their only meal, but that important issue is not the subject here.)
One of the most important guiding concepts in medicine (and really for everything else) is the Goldilocks Principle. It means to find the point that is ‘just right’. For most things there is an amount or degree that is too little, another that is too much and one that is just right. Too little water and you die of thirst. Too much and you drown or suffer serious harm. Likewise, we need just enough food to function well but not too much to overfill our energy storage centers (our fat cells), since that causes many serious problems (covered in Report #3).
Most wild animals do not overeat even when exposed to excess food. Domesticated animals, such as dogs and cats, are subject to the same problems we are and can easily be overfed into being overweight.
As noted above, a cruel side effect of evolution is that while we are exquisitely designed to make sure we get enough food (our brains drive us to eat by making us crave food and feel hungry), those same mechanisms make it difficult to get rid of the excess fat once we have acquired it.
At least two thirds of Americans already have excess weight stored inside their bellies. The healthiest goal would be to reduce the excess to normal, or at least prevent it from getting worse and reduce it somewhat.
We have become overweight on our own. No one puts a gun to our heads and says “Eat or I’ll shoot!” We choose to overeat, but often in ways we do not even realize we are doing so. Luckily, that is not inevitable. We can learn to plan what we do and to make sensible decisions much more often. We are the masters of our own fate much more than we realize.
Overeating is bad for us only because of the serious problems it causes, but since good health is essential for everything else, learning to eat healthfully is extremely worth our attention and effort. Thus the first step to finding ways to enjoy healthy food in reasonable quantities is to understand the forces that affect our decisions.
Up to the late 1970’s, weight problems were less common. Since that time, the number of overweight people, especially those extremely so, has skyrocketed. As a result, diabetes has become epidemic along with many other weight and nutrition-related diseases. What happened to cause that change in eating habits is a subject for a whole book, but, among other things, how corporations made and sold food changed dramatically and that was a major cause for what we see today.
So, we overeat because of:
1. Our inner systems are designed to get us to eat enough, but they can lead to overdoing it. Our fat storage system is designed to keep us from eating too little, but the more fat we pack into our fat cells, the more our brains adjust to allow us to eat more and more. Excess weight is mainly a brain problem.
2. Too much food all around us. Americans are surrounded by too much food everywhere. We react like our pets rather than the wildlife in our forests. If they serve it, we usually eat it, all of it.
3. Food tastes better than in the distant past. There are no gourmets among wild animals as best we can tell and very likely early people ate food few of us would appreciate today. We have spent much of our history since then developing ways to make food more enjoyable. We have succeeded perhaps much too well. Fortunately, one can enjoy healthy food in reasonable quantities just as much as what passes for good food (but really isn’t) in many places. Eating well does not mean giving up enjoying food. In fact, if you let yourself be open to it, healthy food tastes much better. You have to learn to like bad food. No one comes out of their mother’s womb craving a hamburger. That taste had to be learned, so if you learned one way, you can teach yourself to be just as happy with different foods.
4. Serving sizes are much larger. Not only do we have too much food all around us, we are being served it in much greater quantities, in larger containers and on larger plates. Studies have shown that most people tend to eat food that is in front of them. The more there, the more they eat. Plates used to be eight inches, now they are as big as twelve to fifteen inches. A glass used to be 8 ounces; now supersized drinks are as big as 32 ounces. We are pushed toward the larger sizes because restaurants and supermarkets offer us bargains by charging only a little more for a lot more food, such as by ‘supersizing’. The bargains sound great, but along with them come bigger bellies and much less real food.
5. Food processing. Food makers are designing artificial ways of making food ever more tempting, more profitable and more practical to transport and sell. Food company scientists design potato chips so that you cannot eat just one. Even the crinkle of the package and the ‘mouth-feel’ of the food is carefully tested and designed to trigger your brain to want more, more, more… Modern food products (which really are not food anymore) are much more likely to be overeaten. Artificial food is poor quality and in too many cases quite harmful. Besides being designed to trigger all of our hidden food needs and cues, processed food tends to make us eat even more in a hopeless attempt to get real nutrition and satisfaction.
6. We are manipulated to overeat. Food companies and the advertising industry (sometimes called Food, Inc.) have devoted themselves to enticing us to eat more and more in order to sell us more. They are really good at selling us their fake food! Science should be employed to help people, not to find ways to trick them into eating bad stuff that makes higher profits for corporations.
7. Social pressures. Food has become a vital part of our social world, so we eat as part of our social being.
8. Social ‘contagion’. Human behavior is quite contagious. Associating with people tends to make all in the group behave more and more alike. When people with unhealthy habits join a social group, they often influence behavior in a negative way (fortunately good habits in friends and acquaintances can do the opposite)
9. Emotionally driven. Our emotional and thinking lives are much more complicated than animals (as best we can tell), so that we often eat for emotional reasons.
Reading this list makes one think we must all weigh 800 pounds. We do not, so it is not hopeless. One third of Americans manage to balance all of the above with reasonable control and maintain a healthy weight. Many overweight people do eventually find ways to reduce their excess weight to a reasonable degree and to maintain control over time. Unfortunately others do not, but knowing it is possible means that likely any one of us can find a way to be a reasonable eater, balancing enjoyment and need with learning to avoid the many pitfalls superabundance and Food Inc. throw in our way.
Why excess weight is bad for your health.
Fat occurs in three main areas in the body:
Added weight from all excess fat found in the body is very hard on backs, hips, knees and feet. Every excess pound of fat wears out those joints more and increases the likelihood of eventually needing a hip or knee replacement.
Bad as that is, excess fat unfortunately does much worse. Mainly visceral fat and to a lesser extent subcutaneous fat secrete hormones and other compounds into the bloodstream that affect your brain and many other parts of the body. That causes many effects:
As noted in the introduction above, if excess weight had no health consequences, it would be of no concern and simply an individual preference. Unfortunately, it is a major health concern and thus individuals should weigh those health problems in their decisions about their lifestyles.
How do I achieve a healthier weight and lifestyle?
There is a Garfield cartoon in which John points out to his very large cat that he would weigh less if he ate less. As Garfield is stuffing a giant hoagie into his mouth, he thinks what an interesting concept, someone should test it some time.
Calories are the measure of energy. When unused, energy is stored in fat cells, as explained in the sections of this article above. The simple math is that if you take in fewer calories than you burn up in your daily life, your body will eventually draw from the stored calories in your fat cells to make up the deficit of energy. That lowers the fat content of your fat cells, which also lowers your weight. The opposite results if you take in excess calories for too long.
Once you are where you want to be, you need to keep a reasonable balance between calories you eat and what you use up. It requires an ongoing effort because of all the physical and emotional reasons discussed above. The physiology of nutrition and weight is much more complicated than just described, but for practical purposes, this conception of it works very well.
A useful number is that one pound equals 3500 calories (not quite that exact and there is some variability, but good enough for our purposes). Thus for every 3500 calories fewer you eat than you burn up, you would lose about one pound, and vice versa.
Sounds easy, but unfortunately not quite as straightforward as we would like – there are many challenges to improving your nutrition, as noted above – but the extremely important fact is that you can do it!
Healthy nutrition means the following, as simple as one, two, three:
Vital to remember is that you can teach yourself to be as happy or happier with a healthy lifestyle as you think you were with the unhealthy ways you had grown used to. Choosing healthier ways gives up nothing (other than poor health), but gains enormous benefits.
How do you learn to be healthier?
The first step (as in most things) is asking the right questions.
What are the reasons you want to improve your nutrition? Here are some of the most frequent answers:
The next step is to study yourself. Be aware that, while the advice and information from others can be helpful and that they can see you from a perspective you do not have, no one knows you as well as you do. You need to realistically analyze the challenges that you face in making the behavior changes you would like to accomplish. The problems can be very hard and you should be honest with yourself about them so you can face them head on if you choose to.
There is always a way to change behaviors toward a better pattern for you, but it can be challenging to figure out how and sometimes more difficult than you might like. In almost every case where someone needs to change their own behavior, they have the answers already within themselves, they just do not realize it or are not yet ready to act.
Here are some questions to ask yourself:
How can JIB Medical and our Wellness Program help you?
Can you do it? Of course you can! You are the absolute, all-powerful ruler of the Kingdom of You!
Is it worth learning to enjoy a healthy way of life? Absolutely!
Will you do it? That is your decision and entirely up to you.
If you need us for information or resources or any other help, we are here and happy to do whatever we can to assist you.
We wish you success!