My food gurus are not celebrity authors like Cameron Diaz or L.L. Cool, both of whom wrote decent books on food, exercise and health. I tend to rely on health professionals who have devoted their professional careers to researching and writing about weight and food, energy balance and the realities of why we weigh more than we should, and the best ways to go about trying to lose weight and keep it off, based on cutting edge science. Dr. Marion Nestle and Dr. George Blackburn are two such individuals. One leading expert that I hold in the highest regard is Dr. David Ludwig, who is director of New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital, and professor of pediatrics at Harvard Medical Center. He recently posted an opinion in the New York Times Sunday Review section. His insights into the difficulties of losing weight and keeping it off are sensible and somewhat illuminating, especially if you’ve been trying to use your willpower to permanently lose weight.
We know the age old equation when it comes to body weight - calorie intake (what you eat) minus calorie output (exercise and daily movement) equals calories stored (if your output is less than your input). So all you need to do is ignore all the tempting food around you, by harnessing your willpower, and eat less (especially if you’re not moving a whole lot). Dr. Ludwig says - not so easy, and not so fast. And if we look at the results of this effort by most dieters, it's clear that it doesn't seem to work very well, at least not for most people, and certainly not for long term, sustained weight loss. The rate of recidivism, when it comes to losing weight and gaining it back, is quite high. Most, who are overweight or obese, stay overweight or obese, despite best efforts to count calories, read labels, and do the dieter's math. Why can't willpower provide the results we so desperately desire? Maybe the formula and the theories have it wrong, says Dr. Ludwig. Let’s consider looking at this whole weight discussion in a different way. Is it overeating that is making us fatter or is the process of getting fatter, making us want to overeat….more and more?
Dr. Ludwig uses a pretty interesting medical condition, edema, to explore this theory. When a patient develops edema, a condition where fluids leak into surrounding tissue, the patient may have an overwhelming thirst, despite all the fluid still present. No matter how much they drink, the fluid doesn’t stay in the blood, but continues to leach out. And the person can continue to feel quite thirsty, despite their obvious fluid intake, and despite all the fluid building up (in the wrong space). Dr. Ludwig suggests that when fat cells suck up too much fuel (calories), and the calories end up stored in the fat cells instead of being expended as energy, a similar “I need more” phenomenon may occur, spurring the consumption of more excess calories. Is this really possible? The theory and research was serious enough to warrant an article in a recently published JAMA article. The article also reminds us that some ninety years ago, another editorial in JAMA (Journal of the American Medical Association) explored what it called “dietary bookkeeping,” and it wondered if obesity is really just “calories in versus calories out.”
If you look at people who diet, only 1 in 6 overweight or obese individuals has maintained a 10% weight loss, for at least a year, according to the best data we have.. And most professionals specializing in this field know that if you underfeed a person in order to make them lose weight, their hunger invariably increases and their metabolic rate often decreases (because the body begins to sense famine and because a smaller body needs fewer calories). It has also been observed that if you then increase their calories, the metabolic rate will pop up. Another irrefutable reality is that the over-consumption of refined grains has put our insulin levels into overdrive, and higher levels of circulating insulin puts fat cell storage into overdrive. Here's the kicker - refined or processed carbohydrates are superstars when it comes to driving up insulin levels.
A study back in 2004 by Dr. Ludwig and colleagues suggested that if you eat the same number of calories, but in one case they are predominantly refined carbohydrate calories while in the other case they source from a low carb diet, you burn fewer calories on the high carb diet and you also store more fat calories. Dr. Ludwig says that as far back as 1908, a German internist posed this very theory, calling it “lipophilia” or love of fat, and he explained it as a metabolic disorder, while dissing the calories in and out energy balance theory. But Dr. Ludwig admits that these stipulations are still just theories that have not been fully proven. He does make a good case for suggesting that the population at large needs to have at their disposal, affordable, readily available low carbohydrate choices that are healthy. Let's be clear - he is not suggesting we all start eating red meat three times a day, as we attempt to cut out refined carbohydrates. He is suggesting we focus on high quality foods, use portion control, and limit the consumption of refined carbs. Of course moving more throughout the day will also help our bodies to process calories, especially excess calories. It may be easier to start focusing on “what we eat” instead of “how much we eat,” though I think the two need to go hand-in-hand. The term enjoy in moderation is bandied about with such little regard as to how hard it is to be moderate. Of course, your definition of moderation (when it comes to food) and mine, may be miles apart. I have clients who think daily dessert, even as they try to lose weight, is eating with moderation principles in mind. I guess it is, if they were previously having a treat at every meal.
To Dr. Ludwig’s point about food quality, I have been writing extensively for years about choosing superstar foods from each food group as the framework of your daily diet. Portion control and exercise also help with energy balance. But I fear that the one area Dr. Ludwig seems to leave out of the discussion, emotional and stress eating, is pervasive and is really helping to fuel the obesity crisis. And we need to be willing to address and treat that behavioral pattern, in order to conquer our growing waistlines.
Amy Hendel is a Physician Assistant and Health Coach with over 20 years of experience. Noted author, journalist and lifestyle expert, she brings extensive expertise to her monthly shareposts. Her most recent book, The 4 Habits of Healthy Families is available for purchase online, and you can watch her in action on her shows Food Rescue and What's for Lunch? Sign up for her daily health tweets or catch her daily news report at www.healthgal.com.
Published On: May 22, 2014