Refuse To Regain

Welcome to Refuse to Regain

If you are new to this site, I want to welcome you.  Please visit frequently!  You can do this most easily by subscribing to our blog feed.  Just click  the "subscribe" tab you see above.  

RTR (the website) was created to further support: Refuse to Regain:12 Tough Rules to Maintain the Body You've Earned, the book I wrote in 2008.  This book sums up what I've learned so far in over 20 years of practice as an obesity specialist including my strong advocacy for a variant of Primal Diet for weight loss and maintenance.   I sincerely hope you'll read and enjoy!

Whether you are losing weight, maintaining a weight loss, contemplating a change in diet, or struggling with the frustrations of regain, I think you will find something that makes you think within these pages.  Please browse through the archives (see them listed in the right sidebar)  to see articles of interest posted from 2008 to the present. 

For daily postings about weight and maintenance, and for more opportunities to interact, please visit and/or  "like" my Facebook page at Refuse to Regain: Barbara's World.   I can also be found on YouTube by searching bberkeleymd. 

As always,  I welcome your comments and feedback.

Thanks for joining us!

Barbara Berkeley, MD

 

You Say Yes, I Say No: Contradictory Diet Advice and How to Cope

by Barbara Berkeley, MD

Take salt.

The American Heart Association says:

 It is estimated that if Americans cut their average sodium intake by more than half – to an average of 1,500 milligrams a day – there would be a nearly 26 percent decrease in high blood pressure and a savings of more than $26 billion in healthcare costs over just a year.

The American Heart Association recommends foods with little or no salt to reduce the risk of cardiovascular diseases. Aim to eat less than 1,500 mg of sodium per day.

But yesterday, the New York Times reported that the Institute of Medicine concludes that there is no good reason to reduce salt levels to those suggested by the Heart Association.   In a report commisioned by the CDC, the Institute concluded that, based on review of randomized control trials, there is no obvious benefit to lowering sodium below 2300 mg/day.  The report also suggested that there might be a harmful effect of going too easy on the salt for patients with congestive heart failure and poor heart muscle contraction.  

The latest kerfuffle about sodium is just one example of the near-daily contradictory messages we get about diet.  Making the confusion much worse is the fact that the media sensationalizes these studies and vastly over-emphasizes their importance.  In a country which skims headlines on the internet and may not get to the full story, the way medical news is trumpeted borders on the shameful.  A Fox article on the internet summarizes the Institute's findings this way:  "Pass the Salt: Study Debunks Current Sodium Recommendations."  Yet the IOM study still says that eating more than 2300 mg of salt daily is a danger.  "Pass the salt" is a complete misrepresentation of the conclusions.  A 2300 gram sodium diet is still less than 1 teaspoon per day!!! (2400 mg sodium per tsp of salt).  How many of you truly eat less than 1 teaspoon of salt in an entire day?  PASS THE SALT? This exhortation is diametrically opposed to the study conclusions. 

So truly, let's look at the big to-do about salt.  Do we really care whether the recommendations show that we eat 1/2 tsp a day or 1 tsp a day?  To me, this discussion borders on the insane.  If we eat out at all we have no control over the salt that is added to our food, so on what planet are we able to figure out whether we are getting a half teaspoon or a whole one?  Why not just tell people to avoid salty foods in restaurants and not to use the salt shaker when cooking or eating at home?

It's been awhile since I wrote about "nutritionism", but now is a good time to re-activate the discussion.  The term nutritionism has been mostly promoted by author Michael Pollan and refers to our modern habit of dissecting foods into their multitudinous elements.   You can enjoy a lovely dinner or you can worry about whether it has enough vitamin D, B12, Folic Acid, Omega 3 fatty acids, essential amino acids, calcium, magnesium, zinc, phytonutrients.....ad infinitum.  You can worry about whether the balance of fats to carbohydrates is exactly right.  You can worry about whether it contains too many milligrams of cholesterol and an overadbundance of salt.  You can worry about the glucose, the fructose, the purines, the gluten and the lactose.  And every time you think you are worrying about the right element, someone will come along to tell you that you are worrying about the wrong thing or the wrong amount.

I have counseled thousands of people about obesity and diet over the years and I find our focus on nutritionism to be mostly useless.  While it's fine for science to endlessly dissect foods into their component parts, promoting this information as a way to construct healthy diet is just silly.  It's like saying that you need to know all about the chemsitry of polymers and fibers in order to buy a couch.  

Nutritionism is bad because:

1. It's impossible to keep track of all the rules, and virtually no one does.

2. The rules keep changing.  Frequently.

3. Eating is about the gestalt of the experience; the totality.  In the end, very few people think about the elements involved.

4. It distracts us from ways to eat that would be much more useful, like following whole, unprocessed diets and primal-style plans. 

5. It creates anxiety.

6. We have no control over many of these elements anyway. 

So how to cope with a "Nutrtionistic" world where the terrain keeps shifting?  Here's my advice.

Pick your basic parameters for health and make a commitment to control them.  The most important ones are healthy weight (a weight that is reasonable for you and which minimizes health concerns and stress on your joints), controlled blood pressure, controlled blood sugar and reasonable cholesterol and triglyceride numbers.  All of these should follow as a result of weight control.  

Next, pick a kind of diet that you believe in, that you can follow with commitment and which keeps all the above in check.  For some, this will be a diet that consists of 90% whole, unprocessed foods.  For those with weight issues, I believe this diet should also be primal...meaning having a 90 plus percent avoidance of grains, flour based foods, sugar and starchy foods.   Your choice of diet can be individual and should be individual.  If it is doing what it needs to do and you have excellent health markers, good energy, healthy hair and skin and a general sense of well-being you can stop worrying about the zillions of nutritional elements.  

There are a few basic nutritional components that I would still consider (although eating whole or primal will likely take care of these automatically).

1. Salt:  don't add any and don't eat salty stuff.

2. Type of fats: Eating meat and poultry that is raised in a more original way (not stuffed with grains for example) will give you better fats to eat.

3. Sugar: don't add and don't eat sugary stuff.

4. Grains:  I personally advocate avoidance for those who have weight problems or auto-immune issues, but figure this out based on your tolerance and weight.  Consider the fact that many people appear to do better with bowel issues, acne, fibromyalgia-like syndromes and other non-specific symptoms when they go grain-free.  

In short, to avoid going crazy from contradictory food advice, view food from the macro perspective.  Look at general diet parameters and what they offer rather than at the teeny tiny components that you can't measure or control anyway.  Monitor the success of your diet by looking at your basic health markers and by that best-of-all parameter: how you feel.   Remember that finding the best diet for you is an art, NOT a science.  Keep tweaking it and changing things up until you've got it!

 

 

 

Sweet 100: Counting Carbs for Weight Loss

by Barbara Berkeley, MD

Since my world view revolves around insulin, I believe that the final common pathway for weight gain and weight loss is carbohydrate consumption.  Carbohydrates trigger the release of insulin and cause fat storage in those who are so pre-disposed.  Eliminating carbohydrates stops any significant insulin release and allows fat to be burned as fuel.   

An insulin-centric world view in no way denies the myriad other contributors to weight gain.  There is no doubt whatsoever that neurotransmitters, food additives, endocrine disruptors, gut micro-organisms and a whole host of other factors are involved in the perfect storm that creates fat.  But I believe that everything has to channel through insulin ultimately.  Control insulin and you control your fat destiny. At least that's how it appears to me as of this writing.  

With this in mind, keeping carbohydrate consumption low is vital to successful weight loss.  Last December I blogged about dropping carb consumption to 50 grams to reverse holiday weight gain. Now I want to share the success that one of my patients is achieving by assiduously counting carbohydrate grams and keeping the total below 100. 

Miss B. is a 240 pound woman who has had lots of problems losing weight and whose issues are compounded by the need to take several weight promoting medications.  She was not doing particularly well on our standard diet, which combines meal replacements with a Primarian dinner meal.  Because of issues with insomnia,  Miss B was feeling hungry at night and was often choosing to depart from the diet.  Several months ago, I presented Miss B with the option of going on a full food diet that counted carbohydrates.  We generally get good weight loss with about 100 grams of carbs per day, so that was the figure we picked.  Miss B is facile with the internet and likes tracking things.  She became quite good at figuring out her daily carb count and this enterprise became something of a motivating game for her.  She has done extremely well achieving weight losses of between 2 to 3 pounds per week using this strategy.  In addition, Miss B has encouraged several of her friends to go on the same plan.  All appear to be losing weight. 

While I mostly discourage counting things as a long term weight maintenance strategy, keeping track certainly has its place.  First, there are some people who simply feel more in control when they count.  Second, counting allows the dieter to reach a specific goal each day and this can provide daily motivation.  Third, counting is a learning tool.  Within a short period of time most dieters will have internalized the counts of foods they commonly eat.  At that point, they will know what to do without calculation and this kind of knowledge is necessary for long term success.

If you would like to try the hundred carb count (C100), simply carry a small notebook or scrap of paper with you throughout the day.  Make sure you have access to a counting book (like the one made by Calorie King) or website (My Daily Plate, Calorie King).  Alternatively, you can just google your food by entering something like "number of carbs in one slice of bread".  Look up any food that you are not sure of.  For example, a grande skim latte has 16 ounces of fat free milk, but that adds up to 24 grams of carbohydrate, something that may not be intuitively obvous.

Here are a few additional suggestions:

1. Don't bother counting non starchy vegetables  (DO count the carbs in peas, cooked carrots, corn and potatoes)

2. Make use of foods that are already labeled.  It saves time and makes your count more accurate.  You will already know, for example, that one of the OPTIFAST bars we use in our practice has 20 grams of carbs or that a an Oikos pineapple yogurt has 19 grams.   For diet products, I prefer that you use the total carb count rather than the one labeled "net" carbs.  Err on the side of the larger number.

3. Don't use salt and avoid foods that are salty in restaurants.

4. Don't forget to count carbs in salad dressings and don't use restaurant dressings unless you know the count.

If anyone out there decides to do a couple of weeks (or more) on 100C, please be kind enough to send me some feedback.  I would like to see if this is an effective strategy for weight loss in the general population (in other words, for those who are not seeing a doctor or dietitian or are in an organized diet program).  I would be interested in knowing about ease of use, hunger levels, degree of weight loss and anything else on which you'd like to comment.   Good luck!

 

 

 

 

Nature Deficit Disorder and Other Deficiencies

by Barbara Berkeley, MD

A couple of days ago I was listening to a public radio program about bird watching.  The ornithologist who was being interviewed bemoaned the fact that birding is becoming less popular with young people.  This, he felt, was a symptom of a more technological society with fewer connections to the planet.  And with this, he referenced something called "nature deficit disorder".   

A Google search of Nature Deficit Disorder reveals that it is more term than diagnosis.  The term was coined by journalist Richard Louv in 2005 and refers to his hypothesis that many of the ills that plague kids today are related to a disconnect from nature.  While this "disorder" is not accepted as a diagnosis or medical condition, it has garnered some support on the internet.  

It's certainly easy to make a disorder out of just about anything, something that leads to viewing people as broken and sick.  That's something I don't support.  On the other hand, the term Nature Deficit Disorder perked up my ears because I do believe that we have sacrificed contact with many of the crucial elements that make us human in order to spend more time watching what's on our DVRs.   I tend to agree with Louv that a lack of these crucial exposures can have profound consequences.

Rather than looking at all of this as a disorder, we might consider it a series of deficiencies, sort of like having low vitamin D.  You can add your own elements to the list, but here are the things that I think we've become deficient in and which we would benefit from replenishing.

1.  Sun deficiency

2. Sleep deficiency

3. Conversation about deep thoughts deficiency

4. Exposure to evening and darkness deficiency

5. Deficiency of contact with animals

6. Natural rythm of sleep and wakening deficiency

7. Untainted food deficiency

8. Recovery time after eating (hours without eating again) deficiency

9. Reading real books with real pages that expand the mind deficiency

10. Interesting smells, sights and tactile experiences deficiency

11. Spiritual contact with whatever is beyond us deficiency

12. Time with an empty mind deficiency

13. Joy deficiency

14. Creativity deficiency

15. Exposure to nature deficiency

As I watch our old golden retriever Toby instruct our new puppy Winston in the methods of dog existence, it's abundantly clear that those creatures spawned by this planet cannot escape from its pull and its rules.  And further, why would they want to?  If we raised Winston entirely indoors and deprived him of smells, exercise, play and exposure to other dogs, he would be a poor dog indeed and a sad one.  Since we are just as much of this Earth as Winston, our greater health demands that we pay attention to those things that have always informed human existence and continue to do so.   

 

Fecal Transplants and Worms: We Are What We Harbor

by Barbara Berkeley, MD

In these pages I frequently lament the fact that we keep exploring the same old solutions for obesity despite the fact that eating less and exercising more have performed pitifully when it comes to shrinking the American waistline. 

Recently, however, a number of researchers have begun to think out of the box...big time.  Taking a cue from research on C. difficile infection and with an eye on the gut microbiome, researchers have begun to explore fecal transplants for obesity.  Fecal transplant is exactly the icky thing you are thinking it is. Stool from a healthy animal (or human) is transplanted into a sick one.  This is usually done via a number of enemas following preparation of the recipient with antibiotics.  The antibiotics are intended to decrease the number of recipient gut bacteria thus making him more able to integrate the new transplant.   Fecal transplant has potential for those infected with C. diff, an often intractable bug which causes severe diarrhea after antibiotic exposure.   

Recently, some animal research has suggested that transplanting the bowel flora of lean animals into fat ones may make them lose weight.  A human study in the Netherlands is currently looking at a similar endpoint.  While it is too early to draw any conclusions, this research leads us to consider many disease processes in a new light.  Perhaps we develop certain dysfunctions because of a disruption in our "ecology".  We are host to millions of micro-organisms, yet until now we have assumed that these micro-partners have no particular role and therefore can be indiscriminately harmed and changed by antibiotics, poor food choice and toxins.  Perhaps we are not so much what we eat, but whom we harbor.   

On the other side of the coin, we now have research that suggests that purposefully infecting ourselves with parasites might heal certain illnesses.   Studies have shown that worm infection may benefit inflammatory bowel disease, perhaps by stimulating the immune system or, again, through an effect on the microbiome.  Most recently, roundworm treatment is being looked at as a potential treatment for obesity and related metabolic disorders.  

While both of these interventions have cringe potential, they are in early, crude stages.  If they prove to be helpful, they will undoubtedly be refined to become more acceptable.  What is incredibly exciting is the idea that researchers are finally looking at novel hypotheses to explain obesity and metabolic disease.  It has always been clinically apparent that some people gain weight just by 
"looking" at food where others can eat with abandon and remain thin.  Despite this fact, easily observable by every one of us, we blame the heavy person for gluttony and sloth while the thin person's lifestyle is never examined.  Imagine the shock if we were to discover that it's a simple matter of the bacteria that "eats" our food before we do?  Perhaps the thin person's bacteria simply wastes more calories where the heavy person's microflora send every last morsel into the body.   Obesity remains a highly complex phenomenon and we are unlikely to find one simplistic answer, but I firmly believe that the final answer will not have very little to do with eating too much and exercising too little.  Stay tuned.   

This is completely unrelated to weight loss, but I just had to share this--published in a research review from the Cleveland Clinic. It sounds too bizarre and unbelievable to be true, but you never know! I might try taking a Tylenol the next time I am wondering about the meaning of life....

Small Study: Acetaminophen May Ease Feelings Of Existential Dread.

The New York Daily News (4/18, Miller) reports that according to a study published April 11 in the journal Psychological Science, "Tylenol may relieve not just physical aches and pains, but feelings of existential dread." The medication's "active ingredient, acetaminophen, appears to dull the mechanisms in the brain that make us worried and uneasy when faced with uncertainty."
The Houston Chronicle (4/18, Damante) reports, "Researchers at the University of British Columbia conducted a double-blind study. ... Members of the Tylenol groups said they felt less upset following conversations about death and other existential topics."
LiveScience (4/18, Gannon) reports that 120 college students participated in the study. Participants were randomized "to take either 1,000 mg of Tylenol-brand acetaminophen or a placebo." The piece adds, "Previous studies have shown that acetaminophen may also ease the blow of social snubs, and some researchers have argued that both physical pain and feelings of rejection are caused by activation in the brain's dorsal anterior cingulate cortex."

This Pill Guarantees Weight Loss

by Barbara Berkeley, MD

It's unfair.  I got your attention with the title of this post, and now I must deliver the blow.  There is no such pill.

But I was driven to write this post after following a link for yet another one of those clever pop-ups that promise "the hormonal secret to weight loss".  This particular one...you may have seen it....claims to be posted by a physician.  He even touts his impressive credentials.  He tells you that he will deliver his secrets for free, out of the goodness of his heart.  And he seems to begin that way, treating you to a long, cleverly animated discussion about weight related hormones.  But at the end of the day, the solution to controlling these rogue hormones comes in a little bottle, actually a few little bottles, in the form of yet another magic formula for weight loss.   There is plenty of opportunity to key in your credit card.

Googling reviews on this product turns up very little in the way of positive experience.  Oddly, the pills come with directions to eat an incredibly strict diet.  Those few who do report weight loss are smart enough to wonder whether the diet, and not the pills, might have caused it.  

This is the same technique used by the purveyors of HCG, another miracle cure that has no science whatever to back it up.   Several years ago, my husband and I went to a tennis camp out west for a few days.  The camp was part of a spa and we ate in a communal dining room with those who were seeking balance and rejuvenation.  (We, on the other hand, were simply trying to play as many hours of tennis a day as possible.)  This created a bit of a problem because the spa food which was served was so spare.  After running around in the desert sun for five hours, we needed food and fluid.  Seriously.  We found ourselves making after hours-raids on the kitchen in search of the few scraps left over from meals.   Starving even more than we though, were the small band of people who were staying at the spa for HCG treatment.  These folks sat at their own separate table, got daily HCG injections, and were served a 500 calorie per day diet.  For this privilege, they paid over $3000 per week.  Think they were losing weight?  You bet.  They were miles from civilization and I can tell you, there was nothing in that refrigerator!  Weight loss retreats are yet another form of "miracle cure".  I'm thinking of starting one at my home.  All I would need to do is lock people in the house, feed them very little (a great savings for me!) and have them do all the work  around my property.  Come to think of it, haven't I just described the Biggest Loser?

The problem with miracle cures for obesity is that they are strictly about weight shedding and not about weight permanence.  Most of them don't even work to speed weight loss.  But the worst part of miracle cures is who they target.  These cures sell because people who are suffering are vulnerable.  I am continually impressed with just how vulnerable they are.

In my own practice and via my blog and facebook page, I am frequently asked about various products, treatments and devices.  Those doing the asking are smart, educated people.  But their judgement has been subverted by the enormous desire to believe.   Maybe just this once it will turn out that this newly discovered herb from the magical tree in Peru really "melts" away fat without effort.    Maybe this berry, this belt, this injection, this body wrap, this suction procedure, this way of thinking, this vitamin combination, this herbal brew of the ancients will end my problem with food for good.

Here is my simple, foolproof way of vetting such treatments, devices and claims:  If the cure you are investigating has not gone viral on the internet, it doesn't work.  

Our modern hyper-connected world insures that good news (and bad) spreads fast.  You can be sure that any weight loss intervention that succeeds "miraculously" would be the subject of every headline on every mass media site faster than you can say "egg mc muffin".   Those things that do work pretty well, like supervised diet programs, Weight Watchers, anorexic medications, surgery and so on are already well documented.  They are not the subject of viral enthusiasm because they all require hard work and commitment and have problems with achieving long term weight maintenance.  That is the state of obesity treatment in 2013.  We can create weight loss but can't assure it will stick.

Thus this blog for those of you who want to prove that paradigm wrong.

If you are someone who finds yourself going all starry-eyed over the latest raspberry ketone, please stop and think before you open your wallet.  Here are a few suggestions:

1. If it's slick, it's probably schtick.   

    Highly produced commercials and weight loss sites have invested money in their product and expect to make it back.  They are counting on you.  Real and helpful weight loss information often comes in a low-tech package.  See, for example, Robert Lustig's You Tube Sugar: The Bitter Truth  (or my own What Causes Weight Gain)

2 Look for 80% positive reviews      

    When Googling reviews of any product or process, you will always find positive endorsements.  Many of these are planted.  A treatment that truly works will have an overwhelmingly more positive endorsement profile than one that is a fake. 

3. Inspect the package      

    Is the pill or procedure accompanied by incredibly strict diet or exercise regimen?  If so, consider the possibility that it is these interventions, and not the ones that cost money, that are causing any change.

4. Whatever the level of endorsement, do your own thinking 

    Many of the current weight loss fads (none of which work by the way) became popular through the endorsement of TV personalities, celebs, etc...  Remember that TV and mass media gobble up information at a breakneck pace and always need new stories.  Anything that relates to weight sells, so new pills, products and cures get reported on even when there is no science to back them up.  Regardless of who tells you this product works, please step back from your wallet, take a deep breath and make sure this "cure" passes the smell test. 

 

 

 

 

 

 

 

 

Real Bodies: Dealing With the Changes of Aging and Weight Loss

by Barbara Berkeley, MD

Weight maintainers and the over 50 crowd (not mutually exclusive!) have something in common:  a body that is not what it once was.

One of the earliest posts to this blog described the "Green House" philosophy, a term coined by Lynn Haraldson to describe her relationship with a body that had suffered battle scars in the war of weight.  Like the quirky house she lived in, Lynn's body had flaws.  Despite efforts to change both, the essences of both house and body remained and Lynn came to accept each with fondness and respect.  

It goes without saying that such bodily equanimity is impossible to maintain 100% of the time.  Who among us has not experienced that random reflection in an unexpected mirror?  Ouch.

The struggle within oneself to accept bodiy imperfection, whether from weight, weight loss or aging can be very destructive to our goals of strength, health and longevity.  Having said this, I do not pretend to have a foolproof method for tamping down the anxiety.  Each of us must deal with it in our own way.  But heck, it's nice to note that none of us is alone.

A recent article in the NY Times illustrates the point.  "At Ease With a Body Fighting Gravity" is the title.  But the text exposes an underlying bodily unease, rather than the wholehearted acceptance suggested by the title.  The writer repeatedly references to her age and to the fact that she looks good 'for someone who is almost  60'.  She also is able to reassure herself that she is still desirable because her husband remains admiring.  There is a shakiness to the contention that she has come to peace with aging and we wonder how she will feel about the whole thing ten years from now.  This is not meant to be criticism.  It is a reality for all of us. And why not?  Bodily change is a tough challenge and very hard to negotiate.  

There are many mantras and cultural memes in our shorthanded "lifestyle" culture.  As most of you know, one of my least favorites is "just eat everything in moderation".  Many of these lifestyle tidbits seem true but are simply constructed in the service of making tough things seem easy.  Another?  "Just walk off the weight".  It's only my opinion, but I believe that the idea that we can easily make peace with bodily imperfection by just "accepting ourselves" is another one of these unrealistic shortcuts.  

Out of struggle and tension comes inspiration, art, depth, new perception.  So let's not fear the struggle.  Let's engage it with thought, humor and creativity.

My own approach at age 65 has been less acceptance than the Dylan Thomas view of the world.  

"Do not go gentle into that good night," he wrote,"Old age should burn and rave at close of day;
Rage, rage against the dying of the light."

If you are interested in joining this discussion, please send me a photo of yourself and tell me how you are working through the issues of bodily change.  If you give me permission, I will post your picture and your (edited) story.  I will use initials only, no names.   I'd love to hear from you.

 

 

 

Study Points to New Culprit in Heart Disease - NYTimes.com

Research showed that the association between red meat and heart disease risk might be related not just to fat but to bacteria that thrive on a component of red meat.

For the sake of science, these six men and women ate every last juicy bite of the 8-ounce steaks. Then they waited to have their blood drawn.

Dr. Stanley Hazen of the Cleveland Clinic, who led the study, and his colleagues had accumulated evidence for a surprising new explanation of why red meat may contribute to heart disease. And they were testing it with this early morning experiment.

via www.nytimes.com

We are complicated, integrated organisms and one thing seems certain, the food we eat affects us on countless levels. We've been so narrow minded in the way we've searched for dietary culprits in the past 30 years, rounding up the usual suspects over and over. Suddenly, an interest in gut bacteria has opened up whole new worlds of possibility. And you can be sure that this is just one of the fascinating areas that will be open for exploration as we get smarter about deciphering the true role of the food we eat.

Factcheck: Bloomberg's bloated obesity claims

When we asked Bloomberg’s office about the mayor’s remarks, spokeswoman Samantha Levine told us that the mayor meant that this year, there would be a continuation of the years-long trend, not that this year would be the first time obesity-related deaths would outnumber underweight-related deaths. “The Mayor was noting that more people are dying from obesity than from hunger and that — over [the] course of human history — this is the only period of time that has occurred. This year that trend will continue,” she said in an email.

That point may be lost on viewers and listeners of Bloomberg’s interviews on this topic, particularly since he uses the future tense and the “first time” stipulation.

It’s unclear exactly when this change occurred for worldwide statistics, but it would be sometime between 1990 and 2005, according to figures provided to us by the Institute for Health Metrics and Evaluation, which publishes the Global Burden of Disease Study with the help of hundreds of coauthors. The study determined that in 1990, childhood underweight was the sixth leading risk factor for premature death worldwide while having a high body mass index (being overweight or obese) came in ninth. The institute told us that in 2005, childhood underweight had dropped to the 11th leading risk factor while high body mass index moved up to seventh.

via www.philly.com

Here's an example of shooting the messenger and of media's shameful tendency to construct mountains out of molehills just to make a point which isn't true. This article announces that Bloomberg's facts on obesity were "bloated" (we assume this means wrong and/or overstated). The body of the article does not support this at all. In fact, Bloomberg was probably too gentle in his assessment. More of the world's population has been dying of obesity than of starvation for quite some time, making obesity a matter of extreme global urgency. Even Bloomberg's direct quotes are not really indicative of the claim that the trend started "this year". But who cares whether he erred on this point? Isn't the message stark enough? Do we really need to parse the tenses and call him to task for "bloated" misstatement? Anyone who brings up the fact that we might be out of control in our consumption or perhaps being manipulated into eating unhealthfully will expose themselves to ridicule and criticism.

Is "Intuitive Eating" Possible?

by Barbara Berkeley, MD

It is a reoccuring theme, always pitched as a brand new idea:  in order to lose weight we simply must stop dieting and eat "intuitively".  

Recently Lynn Haraldson's Facebook page featured a post on intuitive eating.  The Intuitive Eating school of thought holds that we will do better if we learn the proper signals of satiety sent by our body and if we face our "demons" by exposing ourselves to the foods we fear...in other words, our trigger foods.  

For those who prefer the Cliff Notes, here's a summary of the article Lynn posted:

1. The idea of anti-dieting is "new thinking".  (This is not true, by the way, this school of thought has been around for a long time.

2. The basic principles are to eat only when hungry, stop feeling guilty about food, and eat whatever the body tells you to eat.

3.If you stop focusing on eating less, you'll actually eat less.

The article gives an example of allegedly successful intuitive eating.  Jill, 36, was addicted to a certain flavor of Ben and Jerry's ice cream.  Instead of avoiding it, she stocked her entire freezer with ice cream and gave herself permission to eat as much as she wanted.  While she ate too much of it in the beginning, she eventually grew sick of it.  To quote Jill, "It lost its sparkle," she said. "I knew at that point that ice cream -- or any food -- no longer had an unhealthy grip on me." The article goes on to enthuse, "Jill ended up dropping 50 pounds -- without trying!"

Dear readers, let's be honest with one another.  There is a reason that Americans spend millions each year on HCG drops, garcinia cambogia, electrified tummy belts and raspberry ketones.  Despite our knowing very well that there are no easy cures for obesity, it's hard to stop believing.  As a clinician, I put intuitive eating into the same category I assign to other miracle cures.  It simply doesn't pass the common sense test.

The principles of intuitive eating are based on the idea that the obese person has an unhealthy relationship to food (so once again, it's all the fault of the overweight person) and that this relationship can be altered by "understanding" the signals of the body better.  But there is a major flaw in this seemingly straightforward reasoning.  Suppose it is the body's signals that are damaged and not the "relationship with food" at all?  We have every reason to believe that this is the case; that the biochemical and hormonal milieu of those who gain weight easily has been altered and is no longer normal.  How then are we supposed to rely on signaling if the signals themselves are crossed?  This is akin to asking someone to get to California by simply following a road map and then giving them a road map with routes that lead to New Jersey.  When you are significantly overweight, your body is unable to tell you when you are full and when you are sated.  Your body is unable to give you the right information to make healthy choices.  In short, your signals are messed up.  Moving yourself onto a clean, healthy diet and avoiding triggers allows your vision to clear and your signals to start healing.

Intuitive eating is a good strategy for those whose physiology has healed, usually after weight has been lost.  This return to normal does not happen for everyone.  There are many weight maintainers who would not dream of exposing themselves to trigger foods, even long after weight has stabilized.  In my own life, I am maintaining a fairly modest weight loss and have normal eating urges.  Yet I am uncomfortable when in the presence of a great deal of modern food.  It very definitely encourages hunger and craving.  I much prefer to eat from my own menu.  The idea of bringing bread and Mallomars into my house borders on the insane.

 Which brings me to another hole in Jill's story above.  Even if she did find that, after drowning herself in Ben and Jerry's, her favorite ice cream no longer looked good, how does that translate to exposure to Doritos, cupcakes and cinammon buns?   There is always another trigger food out there.

While a couple of the commenters to Lynn's post say that the intuitive approach worked for them, most say that it either does not work or they would be afraid to try it.  Of course they are afraid.  What is novel about exposing oneself to dangerous foods 24/7?  We call that America, and we've all been there, done that.

Eating intuitively is an advanced skill for those who have already done the difficult work of stabilizing their weight.  It is a way of looking at eating that may be helpful to employ here and there along the way.  And of course, there will be some people for whom it works.  My suspicion is that that number is small.  I'm sure you will let me know about your personal experiences.