Tag Archive for: obesity

Eat Less, Eat Better, Move More—for Life

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In Tuesday’s Memo, Dr. Donal O’Shea suggested that there’s compelling evidence that eating less and moving more won’t result in permanent weight loss because the set point theory is just too strong and will defeat the effort of 90% of the people. However, he didn’t provide any evidence that’s true. I’ll give him the benefit of the doubt, because every study done on diets shows that people do gain back some or all of the weight they lost. He attributes that to the complexity of obesity.

The Complexity of Obesity

Take a good look at the graphic used in the heading. What you can’t read are the 198 determinants (all those gray lines) that contribute to obesity. He narrows them down to just seven categories, five of which are not under the control of people once they are fat. In case it’s difficult to read, here is the list.

  • Societal influences
  • Food production
  • Activity environment
  • Biology
  • Individual psychology
  • Food consumption
  • Individual activity

He also gives a compelling argument that the immune system, working in conjunction with fat cells, causes inflammation in a variety of ways which prevents people from losing weight.

The problem that I have is two-fold. First, it seems the last three are under the control of the individual: eating, moving, and deciding to do so. The exterior forces are what they are, but biology can change. Aging is the perfect example of that.

As for immunity, here’s the real question about the immune system: is it cause or effect? The increase in inflammation is remarkably similar to the increase in cortisol found in people who are obese. Is it the cause of obesity or is it the result of being obese? It makes a difference.

Why Medication Won’t Be the Permanent Solution

Before I get into this, I think that medications may play a role in the solution for some, maybe even most severely overweight people. But they will not be a permanent solution, and the reason may be found in the proteome. You may remember that those are the proteins coded for in our DNA; they range from hormones such as insulin to catalysts for other chemical reactions. There are about 5,000 proteins that are the most researched, but with about 20,000 genes, there may be at least 15,000 more genes that are not researched. That doesn’t count the post-translational modifications, modifications made to the protein as it’s being made; the total could get into the millions.

It’s unrealistic to think that a combination of three, five, or even ten receptor agonists will solve obesity and not cause issues elsewhere in the body by interfering with the production of other necessary proteins. I’m not suggesting that temporary use to get the bulk of weight off an individual won’t be a good way to start, but it’s not a permanent solution as I see it, even if you can afford to take it the rest of your life.

The Bottom Line

The issue with O’Shea’s approach is that it comes from a strictly medical perspective. A nutritional solution isn’t considered and somewhere along the line, just like with gastric bypass, people will exceed their desired caloric intake and regain weight. Why? Because they haven’t learned anything.

Remember, in those seven categories he cited, food consumption and activity levels are under the control of the individual. That means both the quantity and the type of food as well as the amount of activity are under the control of the individual. I’ll say it again: it was, it is, and it will always be about the calories—how much you take in versus how much you use. Take in more than you use, and you gain weight. It’s that simple.

Obesity is complex because our bodies are complicated, but this is still my recommendation: eat better, eat less, and move more. If I were to add two more words that I’ve implied but haven’t stated, they would be “for life” because the only way to hold on to your progress is to keep working on your lifestyle.

What are you prepared to do today?

        Dr. Chet

References:
1. SETU. Understanding Obesity: Rethinking Diagnosis & Treatment. 2024.
2. Nat Chem Biol. 2018 Feb 14; 14(3): 206–214.

Should You Forget “Eat Less, Move More”?

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Eat less. Eat better. Move more.

If you’ve been reading the Health Memo for any length of time, you know that’s my simplified solution, my mantra, to the problem of excess body fat we face in the U.S. and around the world. That’s why an article about an endocrinologist from Ireland who said “Eat less, move more is not the treatment for obesity—get over it” caught my attention. The quote was taken from a talk and interview given by Dr. Donal O’Shea that included a series of recommendations to primary care physicians on how they should approach the topic of excess body weight with patients. He went on to suggest that in a short time, medicine will have solutions for obesity that will essentially render obesity obsolete. Semaglutide is just the first jab at it—pun intended.

I went a little further and listened to a talk by Dr. O’Shea in which he went into detail about why 90% of weight gain is irreversible in 90% of the people. Then he used this example: if you donate a pint of blood, your body will replace it over the next six weeks to get your body back to its blood-volume set point. He says your body weight also has a set point and once it’s raised, it cannot be reversed; no matter what you do, your weight will return to its set point. Therefore, medications such as semaglutide and the ones being developed that will impact other receptors are the only solution.

Should we just buy stock in pharmaceutical companies and forget about nutrition and exercise? Dr. O’Shea is a good scientist and is certainly compassionate toward patients. But is he correct? No, and I’ll explain why on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Eilish O’Regan. Irish Independent. 04-28-24
2. SETU. Understanding Obesity: Rethinking Diagnosis & Treatment. 2024.

Nobody Got It Right

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The topic of the last Memo came from an article co-written by writers from The Examination and the Washington Post. The “exposé” was that credentialed nutritionists and registered dieticians (RDs) were accepting sponsorships and payments from industries they covered, especially the cereal industry. The “angle” was that the influencers were using the anti-diet movement to promote the consumption of cereals to adults and children—not just granola and oatmeal, but every sugar-laden cereal.

I don’t watch TikTok videos, and I don’t have a TikTok account. But to be fair, I used the hashtag #DerailTheShame to check out some of the videos that were mentioned in the article. It was a couple of weeks after the article was posted, so there were responses from some RDs that typically use TikTok. To say they were upset was an understatement. But in the responses, no one addressed the real issues in the TikToks and the article, so I will.

Both Sides Made Mistakes

The writers who collaborated on the article were all investigative journalists with a lot of experience, but none had a nutrition background. How do you know what’s good or bad from a nutrition perspective? This happens a lot in non-scientific journalism. I’m not saying such articles aren’t worth reading, just keep in mind that an important viewpoint is missing.

Some of the RDs certainly made it seem like they were promoting the sugar-laden cereals only. That’s the problem with using short videos; you don’t get to address the issue completely, and it would appear you have to sell yourself more than anything else.

On the other hand, the RDs were using elements of “fat shaming is bad” together with eating all foods. Fat shaming is bad and should never happen; you don’t know what kind of stressors people are dealing with or the medical, physical, psychological, and budget issues that keep them from losing weight right now. But eating as much processed food as you want isn’t a good solution.

At least one of the authors of the article wrote about Big Food and their sponsorships of RDs. The results were new laws legislating that compensation must be revealed when it comes to such influencers. On the other hand, I didn’t find any criticism by the RDs of Big Food companies who oppose new and plainly written food labels to reveal exactly what’s in processed foods.

Partial Solutions

I think the article writers should have spent more time on the Big Food angle rather than the influencers, credentialed or not. Many health insurance companies will not pay for nutritional counseling for obesity. One of the results is that nutrition professionals turn to other venues to be able to earn a living, and sponsorships can help them do that.

As for the credentialed influencers? With all the mind-numbing music, graphics, and dancing around in kitchens, it seems appropriate to post the serving size and calories from the cereal (or whatever food is being promoted) and to emphasize sticking to reasonable portions per day. That solves the issue in my mind. I’m not opposed to earning a living.

The Bottom Line

While cereals and any processed food have their place in a healthy diet, they should be eaten in the proper serving size and servings per day. I am opposed to the anti-diet sentiment. The only way to lose weight and maintain it is to eat less, eat better, and move more. (Ozempic isn’t magic; people lose weight because the drug causes them to eat less.) We all have to figure out for ourselves how to do that, and it won’t be the same for everyone, but it’s the only way to solve the obesity epidemic we face.

However, a physician from across the pond says that eating less and moving more just won’t work. That’s our topic for next week.

What are you prepared to do today?

        Dr. Chet

Reference: 04-03-24. Washington Post. As Obesity Rises, Big Food and Dietitians Push ‘Anti-Diet’ Advice.

What Should You Believe?

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What happens when you mix:

  • Social media
  • Certified expert influencers such as dieticians
  • The food industry paying or sponsoring food influencers
  • The message that dieting is wrong

You get up to 40% of the social media influencers saying, “Why diet? Love yourself and eat whatever you want!”—especially cereals or other highly sweetened grain products. You get partial truths that bastardize the original concepts of loving yourself and end up with people confused and, in some cases, fatter than they have ever been.

Welcome to a new reality. I think we expect that people who talk about health will have their own point of view; I certainly do. Some people believe that being a vegan is the only way to eat while others believe that a ketogenic diet is the absolute best. Both can selectively use research to support their opinion—and do. That seems normal because everyone can have a point of view.

But what if an organic farming association were paying the vegan supporter to promote a vegan diet? How about beef producers paying the ketogenic diet promoter to favor not only meat but especially beef? That connection must be reported in any scientific study about specific diets, but if you’re an influencer, that’s not mandated.

What about nutritionists and registered dieticians that are supported in part by the food industry? Could they take that too far? We’ll see on Saturday.

And just for the record, no company pays me—only you do when you join drchet.com, buy my health-info products, attend my seminars and webinars, or book me to speak to your group. I work for you.

What are you prepared to do today?

        Dr. Chet

Reference: 04-03-24. Washington Post. As Obesity Rises, Big Food and Dietitians Push ‘Anti-Diet’ Advice.

Obesity and Prenatal Omega-3s

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Scientists continue to research the causes of obesity. For many, as we’ll see, it’s not as simple as eating less and moving more; in the study I’m going to review this week, the researchers are going prenatal.

The Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC) is an ongoing longitudinal study to examine the effects of omega-3 supplementation in the third trimester of pregnancy on a number of factors. The primary objective was to see if allergies and asthma were reduced in the offspring of women who took the omega-3s versus those who took a placebo. Asthma or persistent wheeze showed a 31% reduction in risk in the group receiving fish oil compared to 23% the placebo group.

The researchers also collected a variety of anthropometric data, plus blood samples for metabolic and blood lipid analysis, and assessed body composition. In a prior paper when the children were age six, the omega group were about one pound heavier but with a proportional increase in lean and fat mass.

In the current analysis at age ten, the omega group were determined to have an increased BMI, increased risk of being overweight, a tendency for increased fat percentage, and higher metabolic syndrome score when compared to the placebo group. That doesn’t sound good. Does this mean women should avoid omega-3 fish oil during pregnancy, especially the third trimester? I’ll let you know on Saturday.

Tomorrow is the monthly Insider Conference Call. I’m going to cover starvation but not the Minnesota Starvation Study—you’ll come away stunned. I’ll also answer your questions. If you’re not an Insider, become one by 8 p.m. tomorrow and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. BMJ 2018. doi: https://doi.org/10.1136/bmj.k3312
2. AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

The Ridiculous: Obesity and Weight Loss Scams

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As I planned this series of Memos, I wrestled with using the word “obesity” because everyone appears to hate that term—especially when directed at themselves. I decided to stick with it because it afflicts close to 40% of us in the United States. Before I get to ridiculous weight loss plans people are hawking, how did we get here?

Obesity is the product of success. We’ve been successful in creating so many labor-saving devices, we can’t burn enough calories in everyday activity anymore. We’ve successfully produced so much food, available just about everywhere, and made to appeal to all our tastes—sweet, salty, fatty, and umami. They’re hard to resist. The U.S. and Canada have worked hard to produce so much food. But with that success comes overconsumption. Pure and simple.

I question whether obesity is a disease. The dieticians and nutritionists have tried health education without success. Now the medical community has taken over with surgery and pharmaceuticals. And we’re still getting fatter, not because we’re failures but because we’re reaping the rewards of success. We have to change our approach to how we treat food if we’re going to be successful in changing the outcome.

In this series, I’m going to cover recent ads, commentaries, and research on obesity and weight loss. Let’s begin with a Facebook ad my daughter-in-law sent Paula the other day.

The Ridiculous

Paula got a text from Kerri that showed the benefits of MagnaGermanium earrings; these magnetic earrings will activate your lymphatic system, drain away toxins, detox your body, and allow you to lose weight naturally. I had to check it out—after all, it was FDA approved!

It was just a bunch of testimonials. No science, even though the ad referred to it. Claimed to be made in an FDA-approved facility, but there’s no such classification. It’s a pure scam but reasonably priced: just $22.97 a pair in the ad I reviewed. Look around a little, and you can find them for one cent; that tells you all you need to know about the quality.

I don’t think I have to say anything else. By the way, those Kelly Clarkson “ads” for Keto-ACV Gummies? Worst artificial intelligence effort I’ve seen so far. They’re also in the ridiculous category.

We’re just getting started. Next week, a look at fish oil and the potential for overweight children. You don’t want to miss it.

What are you prepared to do today?

        Dr. Chet

Another Theory of Obesity

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It’s been a while since someone has proposed a new theory of obesity. I’m still a believer in “a calorie is a calorie” but it’s always good to find out what may be driving us to overeat.

The latest addition is the Fructose Survival Hypothesis for Obesity. The diagram above was taken from an article published in the journal Obesity. The authors claim that their new theory explains and is consistent with the other theories that include the energy-balance hypothesis, the carbohydrate-insulin model, the protein-leverage hypothesis, and the seed-oil hypothesis. They’re depicted in the large red circles and also include genetics and the microbiome. It all seems complicated, to say the least.

Fructose Survival Theory Simplified

Let’s just focus on the fructose in the blue box and follow those arrows. The arrow that goes up simply suggests that people who eat more fructose-containing food and drinks increase their food intake and gain weight. Simple.

The arrow that angles down to mitochondrial stress leads to a whole host of metabolic changes, all of which result in the decrease or blockage of production of ATP and the increase in fat storage. The result is obesity, altered blood lipids, and a fatty liver.

This pathway is apparently related to getting ready for hibernation, but one gene with the ability to store fat to protect against starvation kicks in and we just gain weight. Of course, it’s more complicated with multiple enzymes involved, but in reality it just goes back to one thing: eating and drinking too much of, in this case, refined carbohydrates.

Questions about the Fructose Theory

We know how this potential theory of obesity involving fructose metabolism seems to work. There are at least three questions:

1. Does the source of fructose matter? In other words, is high-fructose corn syrup (HFCS) more likely to impact weight more than the fructose in grapes or watermelon? The research in animals and a human trial involved eating and drinking the calories in prepared mixtures, but what about real food?

2. They suggest a pathway where glucose can be made into fructose by being exposed to salt, umami, and dehydration. In the animal trial, I couldn’t find total body water ascertained nor what type of sodium might be more hazardous: table salt? MSG? Pink salt?

3. Would the theory apply to normal weight people eating just enough to maintain their weight as it is, regardless of diet composition? Or would people gain weight even while not overeating, regardless of diet? They tested for outcomes in animals and people who were overweight to begin with, but there’s no evidence that people couldn’t lose weight if they cut calories even while eating a high-fructose diet.

Chemical drivers of food behavior such as those proposed must be studied, if for no other reason than to see if there are negative effects for people who don’t follow the mainstream dietary recommendations and yet maintain a healthy body weight. All this research has led to the research group being awarded a patent on a pharmaceutical that would interfere with a specific enzyme called fructokinase. We’re interfering with what they claim to be a natural process against starvation. Is that safe?

The Bottom Line

The researchers and drug developers have spent over a decade researching the fructose theory of obesity and spent millions of research dollars. They have a patented pharmaceutical that may address the issue. But the one question that they must answer, besides discovering any harms in clinical trials, is this: would someone who ate a diet high in fructose and sodium be able maintain a normal body weight? Is a calorie a calorie? Until then, I’m not convinced.

What are you prepared to do today?

        Dr. Chet

References:
1. Obesity. 2023. https://doi.org/10.1002/oby.23920
2. Phil.Trans. R. Soc. B 378:20220230. https://doi.org/10.1098/rstb.2022.0230

The Cause of Obesity

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On Tuesday, I said that I couldn’t get past the word disease in the statement from CDC Head of Disease Prevention and Health Promotion: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics, and certain medications.” While we can agree that there may be a genetic or medication contribution to obesity, there is only one real cause.

The definition of disease is a disorder of structure or function in a human, animal, or plant, especially one that has a known cause, and a distinctive group of symptoms, signs, or anatomical change. There’s no question that obesity has anatomical changes that result in symptoms.

But understand the numbers of obesity. Not everyone is massively oversized; the average height for a man in the U.S. is 5’9” and over 202 pounds to be considered obese, while for the average height of a women is 5’4” and over 173 pounds. There are many people who can hide that weight well. My point is that it’s not the largest individuals who are tipping the scales in the increase in obesity; it’s all of us above normal weight contributing our share.

The disorder part of the definition is one that is clear.

The Cause of Obesity

The cause of obesity is the systematic overconsumption of calories, usually taking years, if not decades, to manifest itself.

The Evidence for the Cause

There are two examples I’ll cite, both related to World War II. The first was the Minnesota Starvation Experiment. Male conscientious objectors had to lose 25% of their body weight in six months. They were normal weight when the study began, and their caloric intake was adjusted weekly to maintain the required weight loss. The result was a linear loss of 25% of their weight in six months.

This one is extreme but applies nevertheless. No one walked out of concentration camps overweight after being liberated—no one. They were systematically starved until they no longer had the energy to work.

In both cases, there was not a change in structure or function; the people were simply starved. The result was weight loss. There’s no change in structure or function when we systematically overeat. However, once we’re overweight and obese, there are changes in the structure and function of our bodies that must be dealt with. But it still comes down to this: a calorie is a calorie. No matter what genetics we have or what medications we take or how little we move, we won’t get fat if we don’t overeat.

The Bottom Line

We are obese because we consistently eat too many calories. We can reduce our weight if we systematically eat less. Yes, there are challenges to overcome because of those structure and function changes caused by chronically overeating. You just have to find the way to reduce your caloric input that works for you. Eat less. Eat better. Move more.

I frequently am asked which calorie-counting app is best, and I don’t have an answer. Do you? Have you found one that’s easy to use? Drop me an email and let me know which app you like and why. I’ll give them a try and let you all know which ones perform best.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/obesity/data/prevalence-maps.html

Fatter Than Ever

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It seems ironic that the last Memo was titled “Make Every Bite Count” while the CDC was in the process of releasing the latest obesity statistics. This shouldn’t be any newsflash, but as a country we’re fatter than ever. In 2021, 19 states exceeded 35% obesity among the residents; in 2022, it jumped up to 22 states. Three states exceeded 40% of residents were considered obese: Louisiana, Oklahoma, and West Virginia.

Which age group is the fattest? Those between 45–54 years with 39.9% obese. The leanest? Young adults at 20.5%. This link to the maps shows where your state scored; it’s not a pretty picture.

This is a statement by Karen Hacker, the head of the CDC’s Center for Chronic Disease Prevention and Health Promotion: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics, and certain medications.” I can’t get past the word “disease” and I’ll explain why on Saturday.

In the meantime, if you have access to Netflix, I urge you to watch the short series “Live to 100: Secrets of the Blue Zones.” It has slightly changed my opinion on how to age with a vengeance; I’m going to give you my thoughts on it beginning next week.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/obesity/data/prevalence-maps.html

Aging Stressor: Excess Body Weight

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The last major stressor that comes with age is excess body weight. The first book that I ever bought in grad school was about obesity. In it, there was a chart of almost 100 health issues that were linked by research to carrying extra body fat and one that was not. In the 40 years since then, the list of negative effects of obesity has grown.

If you remember my answer to the question from last week’s Memo about what one thing would I do differently in my life, that’s the reason I chose getting to a healthier weight and staying there. Pick a body system, any system, and you’ll find the deleterious impact of excess fat on that system. Immune system? Yes. Joints? Yes. Liver? That too. Pancreas? Yes—and on and on and on. That’s why it’s important to get to a healthy weight as young as you can and stay there.

But what about now? It’s been a 50-year fight for me, and I still have not succeeded to the extent I would like. Getting to a healthy weight is not about a specific diet or foods or anything other than one thing: the quantity of food we eat.

I’m going to give you the simplest approach to losing excess body fat I can with two ways to do it.

  • Use a smaller plate when you eat meals and fill it only once. Moving from a dinner plate to a salad plate will cut off about 20 to 25% of the calories you eat. You can use the same logic with smoothies or cereal or soups. Smaller portions yield fewer calories.
  • As an alternative, reduce your caloric intake by 250 to 500 calories per day if you already track your food intake. That’s it.

Can you work on the quality of food? Sure. How about fewer carbs or less fat? If you want. What I’m saying is that to attack the excess body weight you carry, you have to attack your number of calories and eat fewer of them. Start with the sledgehammer to break down the wall. You can get to the chisel later on to fine-tune your lifestyle.

That one benefit of being overweight? It reduces the risk of osteoporosis. I don’t think that’s worth the hundreds of other risks it increases.

Aging with a Vengeance

The first Aging with a Vengeance webinar will be on Super Bowl Sunday; the topic will be increasing muscle mass. I’ll be covering a specific strength training program together with nutrition approaches including diet and supplements. The approach is based on the practical application of the most recent research. The first Memo of 2023 will give details on how to sign up for the webinar and the materials you’ll get.

Have a Very Merry Christmas from all of us at DrChet.com! Talk to you again on January 1, 2023.

What are you prepared to do today?

        Dr. Chet