The Obesity Code

[MPMD]

Zaphod wrote:

There still seems to be a lot of desire against calories in vs out as a basic first framework. It’s not the end all, and some refining can make it better, but it does and will work. That I guarantee. There isn’t a single food type I could lose or gain weight on given time or tolerance limits.

If you want to make it really morbid, just think about anorexia or something worse, say places where people weren’t fed and starved. Calorie restriction certainly “works”. What were saying is the way people go about it in today’s world leads to failure. That’s different and mostly behavioral. And I agree that if that’s the case it’s not very helpful as a framework to prescribe in general. People swing too hard in the one direction and bounce back hard the other way. They feel like a failure and it spirals from there.

Thats why slowly building on better decisions is a nicer framework. Its tolerable and real, maybe unnoticeable change week to week, but look back a decade and it should be a transformation. Little wins, let them build.

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Good point and on the flip side when you see really, really obese people I think you'd be hard pressed to find an example of someone who was really eating well and still just experiencing uncontrolled weight gain.

[Zaphod]

@mpmd

yes, sorry didn't tag you.

I do think it's likely people in both sides of the spectrum exist just given variability in people and the billions out there. Just meant high probability case is that isn't the problem. It's more likely were just surrounded by wonderful tasty food.

They shouldn't be ignored and if someone was very good at hitting their 1200 calorie per day diet and no progress, it's definitely time to look for other issues before taking them to 900. Outliers will certainly exist with billions of us out here.

[Miss Bonnie MD]

Those who have not read it are missing the whole point. I cannot distill the book into a post. It is not a simple eat less, move more. Or eat more protein or eat more fat. There are actionable items in the book - BUT what I think THIS audience (as doctors who patients and friends and etc look to for advice) can really gain is learning about the data behind it. Most of the book is reviewing studies and data on numerous things and what he says is backed by data. He did not make this up one day to sell books.

Fine if you wanna say it's another fad, but don't knock it until you read it. It really isn't about another way to diet - although that is the "end point" in terms of how to reverse obesity. Like I said, more than half the book isn't about how to diet, it's reviewing studies and presenting a totally different way of what causes weight gain. And discussing what/how the government/medical associations and food industry play into all this.

If you have the time to read (or listen to it, as I did on my commute), it is worth the read.

[Miss Bonnie MD]

I was hoping there would be more docs who have read it and could discuss a bit how this may have changed how they practice and counsel patients. I know you're out there!

[pierre]

Bears. Penguins. Two animals that willingly fast in nature.

[wideopenspaces]

LizOB wrote:

gap55u wrote:

I want to check out the book. In primary care I see plenty of people who make poor choices or who don’t want to do the work – and want pills or a quick fix. But I do also see people (more women than men) who honestly log proper# of calories per day, right kind of calories, and work out w trainer etc and just plateau or even fail to lose. And normal labs of course.

My wife logged 1200 calories and worked out 6 days a week >1 hr including with a trainer after our first, and wasn’t able to lose to pre-pregnancy weight. Her doctor at the time told her to go to 900 calories. That’s when we found a new doc.

I am pretty lucky – I lose fast. But build muscle mass really slowly.

So it’s absolutely more complicated than it’s oftentimes made out to be.

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Of course the best way to lose the pregnancy weight is to not gain too much in the first place. 20lb basically melts off between the baby and excess fluids, more if breastfeeding. And yet I’m “body-shaming” when I tell patients they’re gaining too much and need to cut back.

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I can only speak from my own experience but I think it is extremely difficult to control how much weight you gain in pregnancy. I have always been small, I have been running daily since junior high and and I eat a consistent diet. But everything went out the window with my two pregnancies. I had lots of morning sickness that lasted well into second trimester. So I ate whatever I thought I could keep down. With the first pregnancy at 26 I kept running until the day I delivered. With the second at 34 I was too out of shape after I felt well enough to exercise so I just walked a few times a week. I gained 38 lbs with both. I honestly think your body just does whatever the ************************ it wants to! And this business about breastfeeding making it easy to lose weight drives me up the wall. I never lose the last 10 lbs until I stop breastfeeding which is pretty annoying and I know a lot of women who have had the same experience. I do think it is easier to lose pregnancy weight than other weight but definitely those hormones screw with the process.

[Zaphod]

Fasting is interesting as it pertains to many of the common traps of modern society, our bodies physiology not being tuned to having everything available all the time. Even if fasting periods isnt the best method, it was mosts reality and what we adapted to, and we dont have to anymore. Just like our high attention to danger narratives, assigning agency, etc...all very helpful in the past, still helpful but leads to irrational and sometimes dangerous behavior now.

[Zaphod]

Miss Bonnie MD wrote:

Those who have not read it are missing the whole point. I cannot distill the book into a post. It is not a simple eat less, move more. Or eat more protein or eat more fat. There are actionable items in the book – BUT what I think THIS audience (as doctors who patients and friends and etc look to for advice) can really gain is learning about the data behind it. Most of the book is reviewing studies and data on numerous things and what he says is backed by data. He did not make this up one day to sell books.

Fine if you wanna say it’s another fad, but don’t knock it until you read it. It really isn’t about another way to diet – although that is the “end point” in terms of how to reverse obesity. Like I said, more than half the book isn’t about how to diet, it’s reviewing studies and presenting a totally different way of what causes weight gain. And discussing what/how the government/medical associations and food industry play into all this.

If you have the time to read (or listen to it, as I did on my commute), it is worth the read.

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I read a book for endurance athletes so definitely not for everyone that had a similar bend. Just going over all the data, its reliability and applicability and of course it was geared specifically to endurance athletes so very different plans than those looking to lose weight. Racing Weight I think it was called.

Joe Rogan also has a few nutritionists and biochemical types (taubes, rhonda patrick) on the show pretty often and they discuss some of these interesting topics like hormones, fasting, restricted time eating etc....if a video/podcast thing is more up your alley.

[AR]

Miss Bonnie MD wrote:

Has anyone else read this book? I am about halfway in and my mind is being blown.

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I've read a bunch of Fung's stuff.  It's true he cites a lot of stuff in the literature.  However, if you actually go read the studies themselves it's all hogwash.  Sometimes the studies are misinterpreted, sometimes misrepresented, sometimes they're just poorly done studies and sometimes it's all of them.  If you're interested in some thorough critique, Alan Aragon and many others point out in detail the many flaws.

It's kind of sad that even some scientifically literate people can't see that stuff for what it is.   "Calories in/calories out doesn't work"  Seriously?  Literally the only way to lose weight is to eat fewer calories than you burn.  I suppose on the fringes we can take isocaloric diets and radically change macronutrient compositions to get some marginal differences in weight loss over long periods.  I also would agree that some of the suggestions may help with compliance.  But at the end of the day, no amount of handwaving about insulin sensitivity is going to undo the fundamental laws of thermodynamics.  All of these other considerations are at best minor compared to caloric balance.

[Dicast]

I'm going to pick this book up and have a look at it. I've been overweight for a long time. Poor diet choices, lower than needed activity levels.

The best I have ever done was eating a small plant based lunch and taking 2 1.5 mile walks to be park with my kid on every day off I had. Something about baseline activity levels is very important. I try to keep on my rowing machine, elliptical, weights but I never quite stick to using them. Rotating shift schedules kills my workout drive. Walking though, walking I can do every day because it just isn't that hard. As soon as my kids get school age I'm going to be walking a golf course as much as possible in the pursuit of a good bmi.

[Complete_newbie]

AR wrote:

Miss Bonnie MD wrote:

Has anyone else read this book? I am about halfway in and my mind is being blown.

Click to expand…

 

 

I’ve read a bunch of Fung’s stuff.  It’s true he cites a lot of stuff in the literature.  However, if you actually go read the studies themselves it’s all hogwash.  Sometimes the studies are misinterpreted, sometimes misrepresented, sometimes they’re just poorly done studies and sometimes it’s all of them.  If you’re interested in some thorough critique, Alan Aragon and many others point out in detail the many flaws.

It’s kind of sad that even some scientifically literate people can’t see that stuff for what it is.   “Calories in/calories out doesn’t work”  Seriously?  Literally the only way to lose weight is to eat fewer calories than you burn.  I suppose on the fringes we can take isocaloric diets and radically change macronutrient compositions to get some marginal differences in weight loss over long periods.  I also would agree that some of the suggestions may help with compliance.  But at the end of the day, no amount of handwaving about insulin sensitivity is going to undo the fundamental laws of thermodynamics.  All of these other considerations are at best minor compared to caloric balance.

Click to expand...

I haven't read Fung but plan to check it out but this makes sense. I mean is there empirical evidence that somehow laws of simple mechanical dynamics don't work on human body? I occasionally skip lunch and in a week where I do it 4-5 times, I lose two pounds or so. When I eat regular those are made up. So hey atleast thats how it is for me. I'll check out the studies (which I guess are not prospective controlled trials...)

[Zaphod]

Complete_newbie wrote:

AR wrote:

Miss Bonnie MD wrote:

Has anyone else read this book? I am about halfway in and my mind is being blown.

Click to expand…

 

 

I’ve read a bunch of Fung’s stuff.  It’s true he cites a lot of stuff in the literature.  However, if you actually go read the studies themselves it’s all hogwash.  Sometimes the studies are misinterpreted, sometimes misrepresented, sometimes they’re just poorly done studies and sometimes it’s all of them.  If you’re interested in some thorough critique, Alan Aragon and many others point out in detail the many flaws.

It’s kind of sad that even some scientifically literate people can’t see that stuff for what it is.   “Calories in/calories out doesn’t work”  Seriously?  Literally the only way to lose weight is to eat fewer calories than you burn.  I suppose on the fringes we can take isocaloric diets and radically change macronutrient compositions to get some marginal differences in weight loss over long periods.  I also would agree that some of the suggestions may help with compliance.  But at the end of the day, no amount of handwaving about insulin sensitivity is going to undo the fundamental laws of thermodynamics.  All of these other considerations are at best minor compared to caloric balance.

Click to expand…

I haven’t read Fung but plan to check it out but this makes sense. I mean is there empirical evidence that somehow laws of simple mechanical dynamics don’t work on human body? I occasionally skip lunch and in a week where I do it 4-5 times, I lose two pounds or so. When I eat regular those are made up. So hey atleast thats how it is for me. I’ll check out the studies (which I guess are not prospective controlled trials…)

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There are some likely important (though not more than base td) aspects to certain things. Eating beyond a 12h cycle is interesting and can mess things up potentially, and this is being investigated further. Obviously I agree most of these studies are not only poorly done, but then even more inappropriately presented and the magnitudes of their effects greatly out stated.

Also obviously, some foods cause you too want more of those foods behaviorally. Its not that a calorie isnt a calories, its that some foods (sugar eg) really hit your reward centers and make you have a very positive mental drive towards eating more of that terrible food which sets up a bad cycle. Some types of calories make it more likely you have more total in a day than if had via other sources say protein/healthy fats vs. refined sugars. Im comfortable with that, but you dont have to throw out the baby with the bath water. Im also comfortable with the sad likelihood that artificial sweeteners may still drive that desire for sweets even without the calories, idk it totally true, but I wouldnt be shocked and maybe they are to be avoided if possible as well.

There are simply terrible food choices all around us every day, its hard to avoid them forever. The average person sits around snacking on things like flaming hot lime cheetos, starbucks drinks, etc...which are absolutely awful foods and sugar laden, all the while sitting at a desk. A venti chai tea latte at starbucks is 340 calories, I used to love these. Then I was bored in conference one day and looked up the nutrition of it and the apple fritter I was eating as well (460 calories). Thats a quick 900 calories! I had already had breakfast, this was just Im sitting around why not food. Do that four times a week and thats an extra pound and habit setting. People dont count these kind of things as food/meals for the most part, even though its 40-60% daily allowance of calories. You cant keep that up without consequences.

[toothcarpenter]

Yet - every time they lock people into a metabolic ward and track calories and macros - there is no difference in weight loss.  Now there may be some difference is hunger or satiety, but unfortunately, it really comes down to calories.  People on Keto or IF rave about it - for about a year until they plateau and never reach their goal.

 

 

[hightower]

I look forward to reading this.  Very timely book for me.  I've struggled off and on with my weight since college.  I was fairly fit in highschool, ran track, skateboarded, etc.  I was 155 lbs and 5'10" senior year highschool.  Haven't grown an inch since.  In college, I started partying and eating whatever I felt like and as a result my weight yo-yo'd quite a bit and continued throughout med school and definitely in residency.  I've been anywhere between 175-230 since.  I see myself as one of these people who are overweight, but still somewhat fit.  I have no difficulty going for a 3-4 mile jog through downtown (did it this morning) once or twice a week.  My wife and I are active when we travel.  We do several fairly intense backpacking trips in the mountains each year.  But, I'm still overweight.  I'm 36 y/o and recently found out I have very mild OSA.  Because of this, I'm now more motivated then ever to lose weight and keep it off for life.  I do not want to have to start using a CPAP machine.

My plan was to completely eliminate added sugars and simple carbs, stick to a whole foods diet, mostly plant based, but lean chicken, eggs, moderate dairy, and seafood ok, and increase my activity as much as possible.  I just started 2 weeks ago and I'm already down 9 lbs, so I know it will work to a certain degree.  However, I've hit a plateau in the past and know I will need to do more this time to be successful long term.  I'm very interested in trying out this idea of regular fasting to see if it does the trick of keeping the weight off and let's me push through the plateau when I get to it.  I've had lot's of bad habits over the years, but snacking at night is probably the worst.  If nothing else the fasting should help me stop doing that.  There's a large psychological component to weight gain/loss too.  I blame a lot of the bad habits I developed on poor stress management and anxiety.  These were really big problems during med school and residency and the first few years of practice.  Fortunately, those are mostly behind me now, so I hope to stay more focused this time around.

[PhotonsRGR8]

Racing Weight: How to Get Lean for Peak Performance / 6-Step Plan for Endurance Athletes by Matt Fitzgerald. I highly recommend for Endurance Athletes. Marathon/Triathlon etc

Spoiler Alert: Racing Weight is generally lower than "ideal weight". i.e. There's a 7 lb difference for me between racing weight and ideal weight. When I use BMI calc, that puts me at

"Underweight". So, I generally don't recommend this to patients. But I do make very specific recommendations when I counsel patients who could lose 50-100 lbs. i.e. "Keto-lite".