Obesity and My Musings on What We Know For Sure

“It ain’t what you don’t know that gets you into trouble; it’s what you know for sure that does.  –Mark Twain”

This is such a popular quote, you may have heard it. I love how it succinctly summarizes my beefs with nutrition. I mean, how would you feel if your mommy brain (or daddy brain, Google says that’s a real thing) realized one day, after spending 7 years of your life on higher education, that everything you learned “for sure” is fundamentally wrong? And, oh by the way, you are still paying for that higher education? (The only bright side is consolidation at an extremely low rate…but I digress.)

Well, I can tell you how I felt. Somewhat stupid. In trouble even. But only at first, because I realized for a moment I fell into the very nutrition trap non-experts can get sucked into—taking everything at face value and not digging deeper. Well, if I believe it’s not the destination, but the wandering journey that’s important, I can at least find some peace (i.e., forgiveness for my moments of professional weakness) and resolve to make things better for myself and anyone who will listen. The fact is, my education (both in school and in life since) has given me all the skills I need to analyze nutrition science and its many influences, i.e., politics, economics, society, etc. And in so doing, I like to think I’m able to provide information you don’t often find on the Internet. (And so, to B, I say: really, it’s priceless, this “negative dowry” I brought to our marriage. That’s my story and I’m sticking to it this time.)

So, in this first “overview” post, let’s consider this morsel: why do we get fat? I thought we knew the answer 20 years ago when I started my career: we get fat because we eat too much, or exercise too little, or both. Calories in exceed calories out, so we store them as fat. End of story, right?

Well, as sure as we were, it appears that is not true. After decades of being urged by the USDA to eat more carbohydrates (mainly grains, breads and starches) and fewer fats (particularly saturated fat from meats, eggs and dairy products) and proteins (meats and eggs, for example),1,2 the obesity epidemic has steadily increased,3 and diabetes along with it.4 Researchers have learned diet affects many systems in the body (see Figure 15), so that they now realize we have grossly oversimplified weight gain. In fact, we have been looking at it all wrong.

Dieteffects copy

We don’t eat too much to get fat.  Getting fat makes us eat too much.6

What exactly does that mean? Obesity is considered a disease condition, which occurs in some people who have the genetic metabolic misfortune that causes their body’s hormones (namely insulin, and others) to drive them to overeat the wrong type of foods, thereby causing weight gain.5,6

Another way to say it is this: a calorie is not a calorie. That is, if you are prone to obesity your body handles carbohydrates (especially refined carbohydrates and sugar) differently than protein and fat.7,8 This may not sound like that big of a deal, especially if you are thin as you read this, but the implications are indeed huge (pun intended):

  1. Being overweight or obese is considered a medical condition—not simply gluttony and a lack of willpower. Some people have genes that make them more susceptible to obesity. That, coupled with the poor quality of food (rich in refined carbohydrates) that has become our culture, creates a serious medical problem. When we consider studies in which thin people try like crazy to gain weight and can’t no matter how much they eat or how little they exercise, the theory of gluttony falls apart.9 In short, some people have thin genes and stay thin no matter what they eat, some people have obesity genes and can keep weight off by choosing better foods, and a small percentage of people have obesity genes that are expressed regardless of what they eat. But I am ashamed to say in the past I have judged patients who have not been successful with the “simple” advice I have given them. If you’re honest, you have probably done the same, sizing up strangers at the grocery store or out at a restaurant when they choose unhealthy foods. Still worse, if you’re like most people, you have probably felt ashamed of yourself for not being able to get to or stay at a healthy weight. I’d love for us all, individually and as a society, to leave the shame out of it and instead focus on figuring out what to do next.
  2. If you are overweight or obese, you can change how you eat and still feel satisfied. Most people who are overweight have tried many diets. Most of these leave you feeling hungry and deprived. You do have a choice to make—to change how you eat—but you don’t have to starve yourself when you are choosing the healthiest foods for your body. Real, whole foods as part of a diet that is lower in carbohydrates (especially refined ones) and processed foods will leave you feeling satisfied, improve your health, and help you lose inches and/or weight…but I’ll elaborate much more on that soon and over time!
  3. You do not need to count calories to eat for better health and lose weight. I have always hated calories. Calorie counting is a lot of work, takes the fun out of eating, and usually towards the end of the day, leaves you feeling short-changed. If you’re eating the healthiest foods for your body, they will satisfy you and you will be able to stop eating when you feel full.  When some people eat too many carbohydrates and highly refined carbohydrates, it can cause a cyclical hormonal response that causes frequent hunger and subsequent overeating.6 Side note: have you ever wondered why we even use calories to measure the energy food provides? Burning foods in a laboratory to obtain their caloric value makes no sense when that’s not what happens when we eat them. Let’s forget about calories and commit to choosing better quality foods and see what happens
  4. You don’t even need to exercise to lose weight. Don’t get me wrong, it is very important to exercise for many health benefits, such as heart health, stress relief and mood, improved sleep, and maintaining muscular and bone strength, especially as we age. And exercise also helps people with diabetes or impaired glucose metabolism use carbohydrates better, which indirectly may make weight loss more achievable. But studies show when we exercise in an attempt to lose weight, we compensate with an increase in appetite and intake of food.10 We also may unknowingly compensate by decreasing activity later in the day after we’ve exercised.11 So, the effects are balanced pretty evenly by the body. Think of all the people who run marathons but are not extremely thin. The take home point is this: weight control in overweight people is more about changing how you eat than changing how much you exercise.
  5. Even if you’re not overweight, this information still applies to you. I hear many people tell me they never had a problem with obesity, until suddenly they did in middle age. So, you never know if you might have to deal with obesity yourself and it’s easier to prevent weight gain than it is to lose weight. At the very least, it is possible you know people who are overweight or obese and knowing this information can modify your perceptions—and society itself over time—to become more accepting and helpful to those plagued with obesity and all that goes along with it. But even if you could guarantee obesity would never be a problem for you, there are many other diseases such as diabetes, Alzheimer’s, and cancer that may possibly be prevented by eating a healthier lower carbohydrate, low sugar diet. Diabetes, Alzheimer’s and cancer have been shown to be related to obesity.12,13,14  Alzheimer’s has even been dubbed “type 3 diabetes.”15,16 The research linking obesity to refined carbohydrates and sugar is mounting.17,18,19 And inflammation may be part of the process by which certain diseases are precipitated by dietary factors.20,21 It is altogether possible these other diseases are related to refined carbohydrates and sugar intake even in the absence of obesity. Although there is research about decreasing risk of type 2 diabetes with lifestyle approaches including decreased refined carbohydrates,22 much more research is needed in other areas. But to this self-diagnosed “control freak,” it’s fascinating to think that through our nutrition we might have this much natural control over many aspects of our health.

Are you with me so far? I’m cruising through topics because this is a “big picture” of where we are headed, together I hope. I will conclude with this for now: sometimes, as in the case of obesity, we think we know something for sure. But if we let bias get in the way and are not diligent in considering the old and new evidence fully, we get into trouble and may even have to retract our words…I hate it when that happens! There is always going to be a tremendous amount of misinformation about nutrition and your health circulating the Internet. I can’t change that. But I can sift through it carefully and share fascinating topics, elaborating on what I’ve started to explain here, and how it’s made my family change the way we eat on a daily basis. Although if you’re looking for perfection, you won’t find it here. But we are redefining our taste buds and keeping things healthy, simple and tasty. And yes, I’m working on recipes!

For the record, misinformation isn’t just the case with science; although Mark Twain is usually referenced as the author to the quote above, there is actually no record he said it. But even film makers (The Big Short) have credited him for it. Even though I expect movies to take creative liberties, I was nonetheless disillusioned to find out the quote was erroneous. Checking the facts—scientific or otherwise—is labor-intensive, but because I believe we are better off for it, I am happy to do it for you whenever I can. Thanks for waiting for my posts and reading! Please ask questions or share your comments if I have piqued your interest…or even made you feel uncomfortable.

References

2 thoughts on “Obesity and My Musings on What We Know For Sure

  1. jetagada May 2, 2016 / 5:22 am

    Thank you for sharing your thoughts Diana. The one thing I really wish people would stop blaming their obesity on is their genetics. I often tell people, you are obese because you learn the bad habits from your family rather than that you have the “obesity” gene in your family. While it is true, there are some people who are prone to obesity, our genetic makeup, as a whole, hasn’t shifted. What has is the way we eat. Way too much processed foods, ridiculous amount of refined sugar. If you look at the Blue Zone on TED Talk…the way to be healthy and living a long, healthy life is to eat whole foods, mostly plants, exercise with natural movements, have a purpose for living, and develop a sense of community. I look forward to seeing you and Brian down the road in our Naval career. Come and visit SD.

    v/r
    William

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    • thewanderingrd May 2, 2016 / 9:27 pm

      Thank you for your comment, William! I wholeheartedly agree that Americans eat far too many processed foods and refined carbohydrates. While the science strongly supports a genetic link to obesity, yes, the vast majority of us have a choice about what foods to put in our bodies. I don’t think the two are mutually exclusive. In fact, I think it is possible we are seeing more and more obesity because these low-quality foods are precipitating an inherent genetic problem, and potentially creating a vicious cycle of overeating based on genetically driven hormones. There may even be an addictive nature of carbohydrates contributing to the problem, although this is controversial.

      With regard to the Blue Zone project, it is very enlightening to study the habits of people indigenous to four areas of the world where longevity prevails. And while I agree exercise, plant-based foods, and other social and cultural behaviors appear to all play a role in health and longevity, the Blue Zone observations don’t completely disprove a genetic link to obesity. They also don’t provide conclusive evidence on how to eat, or whether eating a particular way will be as effective outside of these four geographical/cultural areas. And frankly, I have always wondered if there isn’t more than one “proper” way to eat, depending on a person’s genetics and maybe other factors. So, while the scientists figure that out, my aim is to help people make a conscious and positive effort to change their eating to try to prevent or break the obesity cycle and promote good general health as best we can. Enjoying real whole foods and minimizing processed foods as much as possible can truly satisfy us, so it can hopefully be sustainable–for ideally 100, or at least as many years as we have!

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