The Skinny on Weight Loss

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.

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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.

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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.

  • Much less real food. Roasting a chicken is real food, but processed chicken nuggets are just made of fat and additives with very little actual meat left. Catsup is not a vegetable, as was once famously claimed by a President.  A real tomato (technically a fruit because it has seeds inside) is chock full of great nutrition and an entire pound of tomatoes is only 90 calories. Catsup and engineered tomatoes (see below) are nowhere as good.
  • Processing food destroys most of the nutrients and also the taste. That means they have to use chemicals to try to restore some nutrition and taste, but those are extremely poor substitutes for the real things and the additives can cause serious problems.
  • Engineered food. Some fruits and vegetables have been so engineered they have far less nutrition left in them. A modern tomato is seldom as good as the older ones (which were not bred for convenience and profit rather than taste and quality). They now breed tomatoes to be more squared in shape (so more can fit in a shipping container, making them cheaper), but they do not taste like your grandmother’s tomatoes.
  • Processing packs in the bad stuff. Processed foods have a lot more calories, unhealthy fats, sodium, additives and sugars, all of which make you less healthy and a lot bigger.
  • Lying. Food marketing lies by distortion and omission. They sell fruit drinks and even orange juice as healthy because fruits are good for you. The actual fruits are, but most commercial fruit drinks are processed out of some of their nutrition and loaded with sugar. The little containers of apple juice well-meaning mothers love to give their kids are helping make a generation of seriously overweight children (and richer corporations).

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.

  • Emotion inhibits the rational part of our minds. We all know that there is a painful price to pay for overeating and eating poor quality food. Yet too often we do it anyway. Scientific studies have confirmed what we all know: that when we get very emotional (joy, sadness, fear, anger, stress, lust, etc.) the logical, self-control parts of our brains lose out to our more primitive instincts and lead us to act much less sensibly and not in our own best interest. Thus the more our emotions rule, the more we succumb to eating more and of less quality.
  • Mother love. The very first thing our mothers did when we were born was to feed us. Throughout childhood, most mothers give their children food to feel better when they are down and to reward them when they are celebrating. Children know they will make their mother happy (and get her to stop nagging) if they eat everything on their plates (or manage to secretly slip some to the dog). Thus even as adults, food becomes a symbol of mother love that we often turn to when unhappy or joyful. That is why many call it ‘comfort food’.

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.

 

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Why excess weight is bad for your health.

 

Fat occurs in three main areas in the body:

  1. Subcutaneous fat – that means under the skin, above the muscle layer, the stuff that wiggles at you.
  2. Visceral fat – the worst kind, it is the fat hidden inside, wrapped around the intestines and heart and in the liver, as well as a few other areas.  A lot of it you do not even know is there, but the bigger your belly and the wider your waistline, the more visceral fat you have inside.
  3. Brown fat – this is the smallest amount except in infants. It tends to be good for you, but plays a minor role in adults.

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:

  • Excess fat leads to gaining even more fat. Excess fat is different from normal fat in ways that tend to make you get even heavier over time.
  • Overeating. Excess fats affect the hormones that influence whether you feel hungry or full, often leading you to eat more than you need.
  • Hardening of the arteries (atherosclerosis). Excess fat affects cholesterol and inflammation in ways that makes this much worse, which can lead to heart attacks, strokes, dementia and many other problems.
  • High blood pressure, which increases risk of heart attacks, strokes and kidney disease.
  • Inflammation.  Excess fat becomes inflamed and that affects the rest of the body in many bad ways.
  • Metabolism. All of the above changes cause alterations in the ways your body chemistry works.
  • Diabetes. Excess fat causes insulin to become less effective (called ‘insulin resistance’ because your cells start to resist the very important normal effects of insulin), which leads to higher blood sugars, diabetes and many complications. Diabetes has skyrocketed due to the rapid increase in weight among Americans since the late nineteen-seventies.
  • Hormones. As fat changes, it affects other hormones made by other organs.
  • Cancers become more likely, including breast, colon, prostate and ovary, the four most common in non-smokers.
  • Arthritis, including gout (very painful type of arthritis) and osteoarthritis, are much more likely when overweight.
  • Fatigue and reduced ability to get around.
  • Social and work problems, emotional stress and even depression sometimes result from the unfair but common attitudes about weight.

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.

 

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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:

 

  1. Eat foods that promote good health.
  2. Avoid those that do the opposite.
  3. Take in the right number of calories for the weight that is best for you.

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:

    • I do not like how I look and want to improve my appearance.
    • I want to be healthier.
    • I do not want to get diabetes or cancer or heart disease or arthritis in the future.
    • I want to get rid of feeling bloated and stop getting indigestion and feeling heavy and slow.
    • My back and hip and knee hurt.
    • I have diabetes or other medical conditions related to unhealthy lifestyle.
    • I am unhappy that I do not take better care of myself.
    • I want to be around for my children.
    • I want to set a good example for my children.

 

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:

 

  • Where do I want to end up and how do I get there step by step?
  • What obstacles will I need to overcome?
  • How ready am I to take action?
    • Where are you on a scale of zero to ten, where zero is ‘I couldn’t care less’ and ten is ‘this is the thing I am most passionate and sure about in my life’?
      • Suppose you rate yourself at a 3. That might seem low, but ask yourself, “Why am I at 3 and not 0?” You will likely cite some of the reasons above that make you want to change, but you are also pulled back by all the challenges you see to doing better.  (For example, ‘I don’t have time’, ‘I get too hungry’, ‘I can’t get access to healthier food’, etc.)
    • Sympathize with yourself about the challenges. They are real and they can be difficult.
    • Now, if you are ready, you can think to yourself, “How can I get to a 6? How can I overcome each challenge?”
      • What resources might I need and where can I find them?
    • Most of us only succeed in doing those things we truly want to do. When we think words like should, have to, ought to, supposed to or wish to, it rarely lasts very long, because those are words that are really orders from someone else.
  • When you are ready to take action – your decision, no one else’s – you will find yourself using action words like ‘I will…’, ‘I am going to…’, ‘I called for…’, ‘I arranged…’.

 

How can JIB Medical and our Wellness Program help you?

 

  • While only you can learn healthier behaviors and only you make your decisions about your own actions, it does help to have facts and information when you need them, which we can supply if you request them.
  • JIB Medical doctors and dieticians are ready to help when needed.
  • There is lots of very useful information on this website (wellness.jibei.org) and in handouts at JIB Medical.

 

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!