Read Health At Every Size: The Surprising Truth About Your Weight Online

Authors: Linda Bacon

Health At Every Size: The Surprising Truth About Your Weight (14 page)

 
Patients are complimented on their weight loss after surgery. The increased social approval makes them unlikely to admit the painful side effects publicly or acknowledge that the quality of their lives is far worse. Even patients who experience complications often report improved quality of life post surgery.
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As one post-surgery client explained to me: “We’re ashamed to talk about the negatives. After all, we’ve failed all our lives and now we’ve failed again. So we pretend that it’s all rosy. We accept the compliments and quietly soil our pants, quietly tolerate the hours of excruciating pain that results from one poorly chewed piece of food, the ongoing hospital visits to treat our nutritional deficiencies. But what scares me most is the denial. Scratch a ‘success story’ and you find someone having numerous complications, but they are so brainwashed to believe they were going to die from fat, and so desperate for social approval, that they actually believe they are healthier and better off for having the surgery. Of course, their doctors support them in that view. And they’re the ones raving about the results and recommending surgery to others!”
 
We don’t get the full story. And you can’t predict
your
outcome when you’re considering the surgery.
 
Wouldn’t it be amazing if bariatric medicine shifted its focus to helping fat people get or stay healthy rather than thin?
 
Bringing It Home
 
As this chapter illustrates in exhaustive detail, there is no magic solution to losing weight and keeping it off in a healthy manner. If you continue to seek the Holy Grail of weight loss, you may be feeling depressed right now. There are no guaranteed solutions—and the commonly recommended methods just aren’t showing results.
 
But fantastic news lurks beneath:
You don’t have to worry about your weight!
Just trust yourself and everything’s going to be okay. Your body can take good care of you. It did this instinctively from day one, and with a little effort, you can re-engage with these powerful mechanisms so they take good care of you once again.
 
So be patient. A little more background will be helpful, and then part 2 will give you strategies to put your body back in the driver’s seat.
 
Of course, we can’t leave food out of a discussion about weight. Not surprisingly, the highly processed, calorie-dense, nutritionally bereft foods that make up the modern diet also play a role in our difficulty maintaining a healthy weight. Let’s talk about nutrients next.
 
FOUR
 
We’re Eternally Hungry
 
N
ow you understand that dieting is more likely to encourage weight gain than sustained weight loss. You aren’t falling for the common perception that exercise is the magic weight loss panacea either. Maybe you’re wondering whether you can lose weight if you just change
what
you eat.
 
Let’s cut to the chase.
What you eat
—
at least from the perspective of weight loss
—
probably just doesn’t matter a whole lot.
Nobody has yet proven that any particular dietary habit results in sustained weight loss. This statement makes sense: Our weight regulation system was designed to encourage weight gain rather than support weight loss. In other words, while it may be true that what we eat has contributed to a small degree to the raised setpoints we see today compared to the past, changing your diet won’t necessarily result in lowering your setpoint and weight loss. This observation may seem downright unfair in our current cultural milieu, but it is where evolution has taken us.
 
Of course, what you eat does matter for good health.
 
Let’s look more closely at how certain dietary styles may contribute to ratcheting our weight up.
 
It’s the Food!?!
 
Clearly what we eat today—and many other details of our lives—differs significantly from foods commonly consumed in the past. Many foods common on today’s menu don’t activate our weight control system as readily as the foods we used to eat, leaving us hungry despite getting sufficient—or more than sufficient—calories.
 
We first started seeing Americans gaining weight in the late 1970s. That’s also when our food supply underwent a significant shift and we started eating more. Not just a little more: Between 1970 and 2000, according to the USDA’s Economic Research Service, our daily calorie intake jumped over 500 calories per person, a 25 percent increase
d
.
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But don’t make the assumption that heavier people are responsible for this caloric leap. Interestingly, studies show that large people eat no more than lean people, despite a popular misconception that large people consistently overeat.
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In the words of the National Academy of Sciences from their report on Diet and Health: “Most studies comparing normal and overweight people suggest that those that are overweight eat fewer calories than those of normal weight.”
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One review examined thirteen studies and found the intake of heavier people to be less than or equal to thin people in twelve of those studies.
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In one interesting study, investigators unobtrusively observed customers at fast-food restaurants, snack bars, and ice-cream parlors and found that the fatter customers ate no more than the thin ones. These are only casual observations, of course, and this particular study may be obscured by differences in what people eat in public versus what they eat in private, but many studies support these results, and few show otherwise.
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What’s likely is we’re all eating more on average—and some are more genetically predisposed to hang on to it.
 
You also don’t want to make the assumption that our dietary habits play a large role in weight gain. As we’ll see in chapter 6, the weight gain we’ve experienced over the past few decades is not as dramatic as we’ve been led to believe. All told, our current lifestyle probably only accounts for an increase in weight of less than 10 pounds or so for the average person (but significantly more for a small subset of the population that is particularly genetically vulnerable). That weights appear to have leveled off now may mean that our regulatory system has recalibrated to adjust to this dietary change.
 
Also, there are many other contributors to our collective weight gain. Ironically, the 1970s also marks a time period when more people turned to dieting.
2
As discussed previously, dieting is another likely contributing factor to our collective increase in calories, as restrictive behavior frequently triggers overeating in the short term and may cause the body to preferentially store more body fat in the long term.
 
Along with the increase in calories has come a shift in the type of food we’re eating. If foods could be scientifically engineered to encourage weight gain, our modern food processing industry has done it. It does not surprise me that the introduction of high-fructose corn syrup, trans fats, fiber-free carbohydrates, and super-sized menus directly mirrors increases in weight.
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The Changing Tide of Nutrition
 
It used to be that the only foods available to us were generally nutritious. Their nutrients registered on our weight control monitors, turning off our appetites after we received sufficient calories.
 
Modern food processing has changed that. It’s easy now to get concentrated calories that bypass our weight regulation system, adding calories without necessarily sending comparable signals that trigger feelings of fullness or satiety and otherwise register on our weight control meters. And many of us consume fewer foods that do register in that weight regulation system and turn off our hunger drive.
 
The problem? Our high-fat/high-sugar diet, rich in processed foods and animal foods.
 
For, it turns out,
what
we eat seems to be more important when it comes to keeping our weight regulation system functioning optimally than
how much
we eat. For instance, several studies find that vegetarians get the same amount of or significantly more calories than their meat-eating counterparts, yet remain slightly slimmer.
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In part, this observation is because what we eat influences our metabolic efficiency and how much energy our bodies expend. What we eat also drives hunger and satiety signals, thus influencing how much we put in our mouths.
 
 
Myth Buster
 
Eating less will not help you to live longer. In fact, the 17-year NHANES I study found that exercise and eating more were better defenses against heart disease deaths than exercise and restricting calories.
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This fact became clear when researchers studied data from almost 10,000 participants in the first National Health and Nutrition Examination Survey (NHANES I).
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They concluded that eating less did not necessarily make people thinner, and eating more did not necessarily translate into heavier weights.
 
Then there are the Chinese. Studies find that people in China take in about 20 percent more calories per person than Americans (about 270 additional calories a day) but are much slimmer than Americans.
 
While the sedentary American lifestyle may account for some of this difference, there is more to it than exercise alone. For instance, one study compared American and Chinese office workers—both with similar couch potato tendencies—and found pretty much the same results.
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There’s no doubt about it: Continually eating certain foods increases the drive to eat and reduces the energy spent, while eating other foods has the entirely opposite effect.
 
Precisely controlled animal research demonstrates this point well. You may think it’s just common sense that rich or good-tasting food would result in overeating, leading to becoming fatter than would occur on blander food. Research does support this theory. For example, human research shows that with more variety, people eat more.
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But how this happens defies common sense.
 
One experiment divided ordinary rats into three groups.
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One group was fed rat chow mixed with vegetable shortening (kind of like a rat’s version of cheesecake); these rats grew fatter than normal rats do. The second group received rat pellets that look and smell a little like condensed straw; these rats maintained a typical weight. The third group received rat chow that was made to taste bitter; these rats lost weight. After a brief period on these diets, the rats all stabilized at their new weights.
 
Next, the researchers tried to force the rats to change their weight, to see if this would be met with resistance. Rats were kept in refrigerated cages, and they had to eat more to compensate for all the heat they were losing; all three groups increased what they ate by the same amount, to avoid losing weight. In another trial, they had a chance to eat less: They were given a rich food solution through a stomach tube. (The food wasn’t given through the mouth to ensure that the sensory input didn’t alter results. This is obviously not an experiment many humans would volunteer for!) All of the rats ate less on this regimen; again, they ate precisely enough to maintain a constant weight. Essentially the researcher was asking, “Do you care more about how fat you are, or how much you eat?” The rats’ response was clear: how fat we are.
 
The chain of causation is not what we accept as common sense: tasty food stimulating appetite, and overeating leading to weight gain. Instead, it works like this: Tasty food raises the setpoint, and the rats eat enough to maintain the new setpoint; unappetizing food lowers the setpoint, and these rats also eat the precise amount to maintain their new setpoint. (Be sure to read on—I wouldn’t want you to jump to the conclusion that eating delicious food makes us fat; it’s a lot more complicated than that!)

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