The Biggest Loser
What I have learned over the last 10 years has made me dogmatic about what it takes to cure obesity. Notice that I did not say “lose weight”. “The Biggest Loser” (TBL) TV show demonstrated that in just a few weeks, one can lose a lot of weight. This is particularly true if one is well above the BMI of 30, separating overweight from obese. To lose 20-30% of your body weight, countless hours of daily exercise would seem to be essential. The TBL contestants did exactly this. One of the show’s now celebrity trainers is Jillian Michaels. Even today, she emphasizes a “healthy diet” and exercise as the means to lose the undesired weight. What Michaels does not discuss much is the results of a follow-up study. Published in 2016, this study found that most contestants had regained the weight lost during the show.
Contestants with the greatest loss at the end of the competition had the greatest slowing of resting metabolic rate. Those with greater long-term weight loss also had greater ongoing metabolic slowing. A slower basic metabolic rate means that to maintain the loss, the individual would have to continue to restrict calories. They either increase their exercise routine intensity or duration or further restrict their caloric intake. I would argue that although they reduced body weight, they did not cure their obesity. Sooner or later the weight will creep up and once again break the overweight-obesity barrier (BMI=30). They are not treating the cause of their obesity.
Calories in, calories out.
The reason I said I felt dogmatic about the cure of obesity is that I see it differently than the conventional wisdom of caloric balance. In my recent trip, while in a shuttle bus to the airport, I overheard a lady talk to her traveling companions. With absolute conviction, she said that to lose weight there is only one thing you need to know: “Calories in, calories out”. The message is that it is the balance of our caloric intake and our expenditure what determines our body fat. I had a hard time remaining quiet, though irritated by her conviction in saying something I know is so wrong. In fact, there is a competing alternative to the caloric balance theory of obesity. It is the hormonal theory of obesity. The former indicates that it does not matter whether you eat 100 calories of sugar or 100 calories of broccoli.
The hormonal theory of Obesity
In the hormonal theory of obesity, the culprit is insulin. Obesity results from excessive blood insulin levels leading to insulin resistance that in turn stimulates further insulin secretion. Insulin resistance is a cellular mechanism of self-regulation by which cells downregulate the expression of insulin receptors. The cells do this when they have more than sufficient glucose to meet their needs. The consequence is rising levels of glucose in the blood that could be dangerous, so more insulin is secreted to compensate. Excess glucose is then transformed into fatty acids by “de novo lipogenesis”. So you see, the more sugar you eat, the more insulin gets produced forcing the storage of energy in the form of body fat. Energy storage as fat is an elegant survival mechanism that gives us accessible energy in days of scarcity. Ironically, in today’s society the cheapest sources of calories are in processed carbohydrates.
Low fat or low carb dieting
If we don’t eat enough calories, our bodies attempt to down-regulate all metabolic functions, including thermogenesis, exercise, organ functions, cellular repair, and replenishment of food stores. When we eat too many calories, in particular nutrients with high glycogenic index, our bodies store it for days of scarcity. The issue is not how we lose weight in the short term. Rather, it is how do we permanently cure obesity? Dieting has been an obsession in developed countries for decades. Until the 1950’s the restriction of carbohydrates was the recommended approach. Then, cardiologists recommended low-fat diets and forced us all to compensate for the caloric deficit with carbohydrates. The popular Atkins diet (1980s-1990s) severely restricted indulgent foods, proven to be as difficult as calorie counting. Eventually falling in disrepute for not being sustainable in the long run.
Sustainability
In my case, I stumbled across the cure 10 years ago, when I was 52 years of age and had a BMI=32.6. I have been at BMI=24 since 2014, and my fat percentage has been below 20 and still declining. For years I simply applied my method without question. Only recently I began to study the reasons for my success in permanently curing my obesity. I applied my method and studied science years later. Now I know that I cured my obesity by curing downregulating my insulin production while eating a high-carbohydrate low-fat diet I had eaten for decades. At first, I kept my preexisting daily walk routine of 2-3 miles (45 min), but as my weight declined I felt the urge to increase the duration and intensity of my exercise.
I then changed my three meals to only one a day. But now I understand that this method reduces my insulin secretion to only one time a day. Glucose is stored in the liver and muscle as glycogen to the maximum possible. The remaining glucose is processed for energy during my fasting and during my fasted exercise routine. There is no need for my cells to downregulate the insulin receptors, nor do I ever have high insulin blood levels.
Best of all, I can eat any forms of food I desire. My only problem is how to eat sufficient calories in one meal a day. I assure you, that is a very easy problem to have. I have adapted in such a way to this new lifestyle that I never feel hungry, except around meal time. I eat at 11:00 am and feel hungry at 10:30 am, not at 7 pm nor at 7 am.
Are you restricting calories?
Do you believe in the caloric balance theory of obesity? Are you still reducing your caloric intake every so often just to keep up? Do you still feel hungry after eating 3 meals a day and are still trying to cut calories? Are you planning to progressively reduce caloric intake in an effort to maintain your current body weight loss? Calorie counting has been debunked as a viable method of treating obesity because caloric balance is not the obesity cause. Your body is going to try to raise your hunger to maintain your weight set point. Your sugar cravings will never go away, in fact, they will increase. What you need to do is to switch from a glucose-centric metabolism to a lipid-centric metabolism. This way our bodies will not be preserving energy if we are short in calories or storing fat if our caloric intake is high.
You may have been successfully losing weight in a calorie-restrictive diet. I suggest that you contemplate what to expect in the future. Do you think that you will cease dieting once you reach your “ideal” goal weight? If so, do you think that you’ll avoid the inevitable rebound once you resume your previous regimen? If your basal metabolic rate continues to decline, it will be harder, not easier, to maintain your current body weight. You may have lost weight but have you cured obesity?
References
Fothergill E., et al. Persistent metabolic adaptation 6 years after The Biggest Loser competition. Obesity (Silver Spring). 2016 August; 24(8): 1612–1619.
Anton S.E., et al. Flipping the Metabolic Switch: Understanding and Applying Health Benefits of Fasting.Obesity (Silver Spring). 2018 February; 26(2): 254–268
