If you think you have an eating disorder, or need mental medical care, don’t be ashamed. There is help out there. The National Eating Disorder Organization is a good place to start.
Health (April 23, 2019) If you have ever visited any forum involved with weight loss, you will be immediately struck by the amount of both personal pain, and myths, surrounding this. From science, we know a few things about weight loss.
First off, if you want to lose weight, you need to create a caloric deficit. There are safe ways to do it, and this calculator, among many, will help you. However, you need to be careful not to starve your body or you will lull it into thinking that you are starving. In that case, your body will do the only logical thing it has evolved to do. It will hold on to anything you eat stubbornly so. It will become more efficient. And no, this is not a bad thing. Why? If you lived in this world even fifty years ago, crop failure was all it took for humans to face starvation.
We also now know that genetics plays a factor in obesity, and there are genes associated with it. These genes are not necessarily maladaptive, even if in our modern world they seem to be. Why obesity is becoming a public health crisis. Over the last 200,000 years, humans have faced both times of plenty and lean times. Being able to store more fat to prepare for those lean times is an evolutionary advantage. In our society, where we have plenty of calorie dense, heavily processed foods, well our bodies think this is time to store fat for the time we will face starvation. Given that about 40 percent of the population has multiple copies of the FTO gene, it was passed down for survival.
However, it has downsides as well. And they become apparent when we have so many choices of calorie dense foods. It’s not like it took you two thousand calories to bring down that antelope!
Three years ago, geneticists reported the startling discovery that nearly half of all people in the U.S. with European ancestry carry a variant of the fat mass and obesity associated (fat mass and obesity-associated gene)FTO gene, which causes them to gain weight — from three to seven pounds, on average — but worse, puts them at risk for obesity.
However, this information has not made it to the general population and some doctors still fat-shame their patients. They should know better, but they either are victims of social pressures or have not paid attention during Continuing Education classes, or they do not care. It could be all these, and more. Here is what happens with multiple copies of the gene.
More commonly, people who have obesity have multiple genes that predispose them to gain excess weight. One such gene is the fat mass and obesity-associated gene (FTO), which is found in up to 43% of the population. In the presence of readily accessible food, those with the fat mass and obesity-associated gene may have challenges limiting their caloric intake. The presence of this gene and other genes can cause:
- Increased hunger levels
- Increased caloric intake
- Reduced satiety
- Reduced control over eating
- Increased tendency to be sedentary
- Increased tendency to store body fat
This does not mean that genetics is destiny. Yes, it may be more difficult to lose weight, and in the future genetics may help to point to people who have a tendency, allowing for early intervention. I dabble in science fiction from time to time so this is also possible. Research into gene editing technology, such as CRISPR may allow for the removal of these extra genes from the gene pool. No FTO and there are some serious complications, however. We need this gene. Removing extra copies is not necessarily good either, But that is not the present, however, not is this in that distant of a future. The ethics of gene editing are starting to take shape, as I type this.
This may also explain why diets rarely work. They rarely work because most people tend to lose excess weight only to regain it. It is called yo-yo dieting. There are many reasons for it, and some of them are environmental. We simply have food available 24/7/365. We also have lost any proportion of what a normal portion is, and our serving dishes have grown to the point that a dinner plate used to be a serving plate forty years ago. This translates to about 200–300 extra calories on a plate or more.
Here is a life hack. If you intend to lose weight, get yourself salad plates, or baby plates that are divided. This will help your mind to see a full plate and trick itself into eating fewer calories per sitting, all other factors remaining the same. We replaced ours for the Corelle dishes above.
Last time I attended Weight Watchers, back in the Pleistocene, I do not remember them mentioning serving dishes as a life hack. However, you can buy them from them. They do sell dishes to help with portion control. No, I am not surprised. They might help you to visualize healthy portions, so if you need something like this, Ebay carries them, and so does Amazon. And baby plates you can get at the supermarket are cheaper as well, though less nice looking.
In my view, the diet industry is also not motivated to help their clients develop life long habits that will help them maintain a healthy weight. Yes, you may get portion controlled meals from insert company here. Does that mean that you know what a portion of green beans is? What about meat? What about an apple? There are apples at the store that are a portion of fruit. These are usually the lunch sized ones, not the huge, oh my god, they are truly three to four portions. So you need to watch for that. Large bananas are two to three portions. Another life hack. I buy single ones and look for the smallest I can find.
Most food is also portioned in such a way that you will eat too much if you stick to a commercial package. This is a problem. Those almonds are lovely, but surely there are three actual portions in what is sold as a single package. And let’s be honest, most people do not count their almonds. (I do, I do, but I got into this happy habit a while ago. If you can, do so.) There are some that are sold in 100 calorie packages. That is a portion.
The FDA approved new labels, and they now reflect added sugar. This could help in our battle of the bulge. This could help people who need to control the amount of raw sugar due to inflammation or other issues. Some new labels even come with the full container and the size of an individual portion.
The diet industry is worth $70 billion, and they depend on you buying their products and fad diets. We are also seeing a strong presence of over the counter protein drinks, shakes etcetera. I will have something to say bellow about special diets though.
We as a society have done things to ourselves that make it very easy to eat in excess. And we have also become increasingly judgmental. We like to tell ourselves that fat people lack willpower. They sit at home and eat donuts all day. If they stopped, they could lose. The genetics tells us that perhaps it is not just willpower preventing people from sticking to a diet. Yes, some people will be more hungry than others and will need more food to feel full. It is biology, and at this point we also believe how we taste food changes with obesity, leading to a vicious cycle of searching for higher calorie foods.
There are other issues, such as food deserts and poor education on diet, exercise, and even basic skills such as cooking. Many people have lost the ability to cut vegetables, let alone cook them. We also have lost the ability to cook food that tastes good and is less calorie dense. Culturally we look down on healthier choices as well. However, the food industry formulates foods that fit the great triad of taste. The ratio of fat, salt and sugar are designed to make you eat more and crave more. And no, not even commercial salads are free from this.
And then there are the myths…
Did you know that if you follow a Keto program you will lose weight? Of course, there is the alkaline weight loss program. Did I mention Atkins, Weight Watchers, South Beach, and so on? They all share one thing. They try to get the dieter into a caloric deficit, that will lead to weight loss. They all have different explanations as to why their magic works. However, their magic works for one simple reason. They all try to get the dieter to be more active while eating fewer calories than they need to remain at their present weight. This is hardly magic. It is quite honestly well understood.
However, dieters do not follow one program but follow another because they believe in a slew of dubious claims. They are told that ketosis is good for you and burns fat. This is not necessarily the case, but there is that. If you drink water before a meal you will lose weight. If you are well hydrated this will not help you, and will not hurt you. However, if you feel full, you should eat less only if you are able to tell you are full. Some people with weight issues cannot. See what I posted about the FTO gene or rather multiple copies of it.
Then there are some dangerous diet fads. Fasting seems to be a popular one. The problem with fasting is that it does not please the body, and if you are a diabetic it could lead to a visit to your neighborhood Emergency Room, even the Intensive Care Unit. It also tends to put the body on we are starving regime. So short term you will lose weight, likely more water than fat, but long term you will do damage to your metabolism. In fact, it could lead to your body believing you are starving…and this will make weight loss more difficult in the future.
Gluten-free diets seem to be on the upswing. Yes, there are some people who are allergic to gluten. It is an autoimmune response, and whether they have Celiacs or are just intolerant, the treatment is the same: Avoid the protein. However, most people who are following a gluten-free diet are eating their money since gluten-free specialty products tend to be more expensive. Yes, corn, quinoa, beans, amaranth, and rice are gluten-free, naturally, so are root vegetables. But the money for the companies is not in the naturally gluten-free foods, but the specialty bread and the rest of it. Those of us who are intolerant love the fad. We now have decent bread that we can eat from time to time. However, I tend to stick to foods like tortillas, but I still read the labels, since some corn tortillas have wheat flour added to them.
If you are not allergic to gluten, by all means, enjoy that pizza, or that pasta, or that piece of bread. It is all about portion control. If you have symptoms of intolerance, talk to your doctor. You may want to be tested for Celiacs, and trying the diet to make sure it is intolerance and not something else. Going gluten-free is not the chore it was once, but reading labels for everything can be a pain. And I find it funny when people who eat gluten-free go to a Chinese restaurant and enjoy some Chop Suey. Especially when the restaurant does not have gluten free soy sauce. Yes, it is a thing, and the second ingredient in regular soy sauce IS wheat.
There are so many fads and myths that is amazing to me. One of those is that protein powders are either excellent for you, or will bulk you up. They come from people lifting weights, who have developed a whole subculture of things you should do to maximize the benefits of a workout. Protein is good for you and will keep you satiated longer. However, like all foods, it’s hardly a magic bullet. Higher protein in your diet could be part of your toolset to lose weight. However, calories are calories and will be processed by the body. Too much, and they will be stored as fat, end of discussion.
Both Carbohydrates (the eternal bad boy of diets) and protein contain four measly calories per gram. Fat contains nine. Fun fact, alcohol has seven calories per gram, and an alcoholic drink can bust your calorie budget.
Then there are the carb-free diets, which is also a fad. If you happen to be a diabetic, yes, you should limit the amounts of carbs you eat. It has to do with the glycemic response. And some foods are worst at this than others. Sugar in the raw is sugar. It will raise your blood glucose levels just as bad as white sugar. However, beans, which have carbs, also have a lower glycemic index (they have fiber), and will rise it at a much slower rate. Your brain needs carbohydrates to function. In fact, your brain is quite hungry for carbs. So cutting them as much as you can, can lead to sugar lows, or “brain fog.”
It is how much you eat off the stuff and keeping a balance.
Medical Conditions that make Weight Loss Hard
While the simple rule of fewer calories in than what you burn applies to all weight programs, there are medical conditions that make this hard. There are also medications that have as a side effect weight gain. Oh, I could regale you with Avandia and the lovely side effect.
If you have things like PCOS, or Thyroid Issues, the latter quite common, the former more common than we used to think, part of your weight loss will include visits to your endocrinologist. The road to getting thinner will be harder, because of physiology.
You need fewer calories than the average person, and just keeping your weight from going up may mean the same calories that allow another person to lose weight. You may need to go for a weight loss proigram under medical supervision. This leads to many issues of mental health, which are now recognized as a serious issue. The old idea that if you have will power is quite dead, in my opinion.
You can lose, but you need support.
To a certain extent, diabetics have a harder time shedding the pounds as well. Why? Insulin resistance, which makes it harder to lose weight. It is also a consequence of obesity. So it triggers quite the witches brew. Late stage diabetics actually start losing weight and sometimes do so spectacularly fast.
The psychology of obesity
And here we enter into a virtual minefield. People who have struggled with their weight all their lives have faced a few issues. Young kids in school are bullied, for being fat. There is discrimination across society. Our puritan thinking leads to the idea that overweight and obese people are just sitting on their bums, doing nothing, eating chocolates.
Quite frankly this stereotype is not just wrong, but harmful. It does not help that the media tends to portray people who are morbidly obese in this way. Whether it is shows like “The Biggest Loser” or “My 600 pound life.” These shows rely on moral outrage, and yes, get yourself moving.
There is also quite a bit of discrimination towards this population. This is not just limited to the media, but also in jobs, and professional life. Those who are severely overweight are treated as less than human. This creates a series of self-confidence issues. No, the first time somebody just giggles at you in the street is not nice. Then there are the fat shakers who frequent gyms.
I have faced my fair share of these people. They tend to be very thin, and young. And when they make fun of people who have weight challenges but are trying to move, they hurt the chances of these people coming back to the gym. Some people have such a high level of anxiety, that coming to the gym is but one more of their challenges towards a healthier weight.
Personally, I not only challenge these people, but I tend to report them to management. It may be in a code of conduct for your facility, but not fat shaming is hardly enforced. So insist that they are dealt with.
There are a series of mental health issues that come with this, which should be understood as a syndrome. Self-confidence is one of them. Also believing that the person in question is not nice looking, or beautiful, or handsome. This can lead to depression and other mental health challenges.
Then there is food addiction. The problem is that you need food to live, and you just cannot quit eating. So you need to figure out why you eat and when you eat.
This leads me to the next issue, disordered eating. This is a problem and could lead to eating disorders. According to the Academy of Nutrition and Dietetics these are the criteria:
Signs and symptoms of disordered eating may include, but are not limited to:
- Frequent dieting, anxiety associated with specific foods or meal skipping
- Chronic weight fluctuations
- Rigid rituals and routines surrounding food and exercise
- Feelings of guilt and shame associated with eating
- Preoccupation with food, weight and body image that negatively impacts quality of life
- A feeling of loss of control around food, including compulsive eating habits
- Using exercise, food restriction, fasting or purging to “make up for bad foods” consumed
In time this could lead to Anorexia Nervosa and other issues. And no, having Anorexia is not necessarily limited to very thin people either. In fact, people who are overweight or obese have a hell of a time getting a diagnosis.
If you think you have an eating disorder, or need mental medical care, don’t be ashamed. There is help out there. The National Eating Disorder Organization is a good place to start.
However, it is time we speak about eating disorders beyond disordered eating, in overweight and obese individuals.
A recent study (Lipson & Sonneville, 2017) examined 9713 students from 12 different colleges and found that body weight was the most consistent predictor of eating disorder symptoms. Students with a BMI in the “overweight” or “obese” range were at the highest risk and students with a BMI in the “underweight” range were surprisingly at the lowest risk. A history of elevated body weight is common in patients seeking eating disorder treatment. A 2015 study by Lebow et al. examined patients seeking treatment for restrictive eating disorders, such as anorexia nervosa, and found that over 36 percent of patients had a history of BMI above the 85th percentile. And disturbingly, symptoms in these patients are often not diagnosed until later and more severe stages of the illness. A 2013 article by Sim et al. that I wrote about in an earlier post found that eating disorder symptoms in adolescents with a weight history in the “overweight” or “obese” range not only were under-diagnosed, but symptoms were actually encouraged by medical professionals who congratulated these patients for losing weight.
Why are people at higher weights at increased risk of eating disorder symptoms? For one, we live in a culture that villainizes fat. Inhabiting a fat body is seen as a moral failing, evidence of being a sub-par human being. Fat people face the scorn of society and are open targets for discrimination and bigotry. It’s no wonder that so many will try anything possible to lose weight, even if that means engaging in eating disorder behaviors that compromise their health. This is not to say that eating disorder symptoms are the first line of action for people trying to lose weight. More commonly, weight loss efforts start with dieting or “healthy eating,” which gives way to disordered eating.
This is one issue that we may encourage. After all, fat is unhealthy, we tell each other. And a person should lose weight at any cost. It would be best if they maintained it, but if they gain any, it’s due to lack of will.
As a society, we need to face the fact that not everybody is going to be a runway model. We also need to face the music, our widely available of calorie dense food is not a historic norm. It is literally a phenomenon of the last two generations, at most. We have genetic factors that predispose about half of us to higher weights. There are also other environmental forces that push people to overeat.
There are some changes we could all make. We can demand that companies make smaller dinner plates for example.
We can go out for walks more often. Hey, doing the laundry and vacuuming are a form of exercise. Hitting the gym is not necessarily the only way to exercise. From studies among traditional societies, moving all day is one way to get your exercise. There are ways to get it, including bikes you place under your desk and standing desks. Our far more sedentary life makes it easier to gain weight.
But we also need to move away from an ideology that demonizes those who are overweight and socially isolates them. There is a strong genetic factor, and people who are thin (and active) in their youth may very well win the genetic lottery and gain weight later in life.