Refuse To Regain

What's Your FIQ? Take the Quiz

by Barbara Berkeley,

In the past twenty or thirty years it seems that Americans have become hyper-involved with food.  We spend inordinate amounts of time thinking about it and planning how to eat it. Food has become an entertainment rather than a pleasurable form of sustenance. I believe that most of us don't even realize how involved we truly are.  How did this happen?

We live in a culture that puts us into an extremely heightened contact with food.  Here's one simple example:  before 1950, most groceries were bought from small, local stores.  Shopping was done largely from day to day and choices were minimal.  The first supermarkets built in the 50s and 60s put us in contact with about 10,000 items during each shopping trip.  Huge on-site parking lots made it possible to cart large loads of food home thus assuring that we would be exposed to lots more food items every day and on our own shelves.   By 2006, the average number of items in a supermarket had quadrupled to 45,000 making a simple stop for milk an exercise is food immersion.

All of these new food items were forced to differentiate themselves in order to generate sales.  They continue to do this by advertising, both in the media and on their own labels.  They also do this by paying for an increased share of our awareness through placement in prime spots on supermarket shelves. Essentially, food forces us to pay attention at every turn.

As large amounts of food made their way into our lives for the first time, industrialization made it easier to take advantage of a growing interest in eating more and eating in more variety.  Fast food, convenience stores, and chain restaurants all made their appearance.  As David Kessler describes in The End of Overeating, food manufacturers soon figured out ways to make flavors that were more alluring and addictive.

We were seduced. A culture devoted to food interest soon sprung up in the face of increased consumption.  For the first time chefs became celebrities, whole television channels were devoted to eating, and endless magazine and newspaper articles were devoted to recipes. 

Unless you are 55 years old or more, you are unlikely to remember that this food environment represents an enormous shift from what it had been not very long ago.   And we can hardly call it progress.  The new oversaturation has generated an unprecedented amount of food obsession with a particularly worrisome twist:  younger people who have only known our current food environment don't see it as dangerous.  To them, it seems normal. If they are growing fat and getting ill, it must be their fault, not that of the environment.  All we have to do is look at our skyrocketing diabetes and obesity rates to see how deadly this assumption is.

It's been my observation that those who learn how to maintain lost weight are usually those who are able to disengage and put a healthy distance between themselves and today's food environment.  Essentially, they become less involved, less able to be stimulated.  They do this by eating actual food (not fake food from packages) in consistent, reproducible ways.  They cook less, bake less, spend less time thrilling to the menu of the newest restaurant, and fewer minutes watching what I call "food porn": television shows that are built around food and show lots of hyperstimulatory images of food.  

Food Involvement is very hard to break and is often the reason that dieters regain their weight.  After weight loss, most people go through what I call the "Bargaining Phase".  These are the days and months when new maintainers try to find a way around an essential truth: that they must abandon the SAD (standard American diet) if they want to stay thin.  Bargaining goes something like this: "I'm sure that I can keep this weight off if I just exercise more."  "I won't have a problem if I'm more moderate than I used to be."  "I'll be able to eat out and have whatever i want as long as I'm "good" on other days." "There are no bad foods, just as long as I only have a little." Or, in my practice:  "Dr. Berkeley is crazy.  I don't really have to give up all those things."

Bargainers have what I call a high "Food Involvement Quotient". And how could they not?  Being raised in our American food environment, they have been saturated with food for a lifetime and have come to rely on eating for a large part of their pleasure. 

Those who have made a food conversion have managed to break the pattern.  In my book, I reproduce some of the daily menus of successful maintainers quoted in People Magazine's "Half Their Size" series.  Their meals consist of unadorned fare like handfuls of nuts, a few shrimp and steamed vegetables and the like.   Awhile back, I wrote about the diet of Olympic figure skater Evan Lysacek, who ate simple fruits, veggies and protein while training to win the gold medal.   Jack LaLanne, who died recently in his late 90s and was a highly successful advocate for health, ate a spartan, Primarian style diet.  Yesterday's news featured an Associated Press article on the world' oldest Type 1 diabetic.  For 85 years this man has carefully controlled his diet eating small amounts of real foods that are extremely low in sugar.  This dietary approach, consistently applied, has enabled him to ward off the complications of one of our deadliest diseases.  These are people over whom the SAD (standard American diet) has lost power.

Perhaps you can make the case that clean-eating people are obsessed with food, just in a different way.  It's true that eating healthily requires attention but it's more of a defensive attention.  Non-SAD eaters must remain wary of falling prey to the siren song of the food culture. It's a strong magic and no one is completely immune.

What is your Food Involvement Quotient?  Take this quiz and find out.

Your FIQ

    1. Are you constantly on the look out for new eating experiences?

    2. If a new restaurant opens in your area, would trying it out be a top priority?

    3. Do you have a subscription to a cooking magazine or do you frequently purchase one?

    4. Do you routinely watch the Food Channel or other food related television?

    5. Are you frequently looking for new recipes and new ways to prepare the food you eat?

    6. Do you frequently blog, twitter or post on facebook about food or what you are eating?

    7. Is the subject of food, restaurants or cooking a frequent topic of conversation with friends?

    8. Do you believe that you have a weight problem because you are weak, lack willpower or have

        a metabolic problem and that if you were different you could control food?

    9. Do you control weight by trying to be "good" on most days and "treating" yourself on others?

    10. Do you long to try the latest version of your favorite sweet? (ice cream, cookies, cake, etc?)

    11. Is it impossible to imagine a birthday or celebration without cake and does that cake seem harmless because you "deserve" it?

    12. Do you frequently buy food on impulse because it looks good or the label is alluring?

    13. Are other pleasures significantly less pleasurable if you remove the food?  (For example: going to the movies, watching sports, being with friends)

 

        

 

Result Key:  Your Food Involvement Quotient

If you answered Yes to 5 questions or less:   Your FIQ is low and your ability to lose and maintain weight is high.  Modern food has become less of a part of your life which means you have the opportunity for real change.

If you answered Yes to 6-8 questions: You have a moderate FIQ. You are still very involved in the world of modern food.  While you may want to get out from under, you are not sure how to do it.

If you answered Yes to 9 to 13 questions: Your FIQ is high which means that you are very involved with food. Because food is still so seductive for you, this is likely making weight loss and maintenance impossible. 

 

Every one of us has an involvement with food.  The degree of involvement, however, impacts on our ability to remain healthy.  Each one of us faces the challenge of learning to see the modern food world as it really is:  supremely unhealthy, capable of seriously cutting your life short,  capable of robbing you of the joy of living through obesity and related disease, a killer that takes hundreds of thousands of American lives each year.  This reality is tough to see and tougher to hold in our minds because we live in an ether that constantly feeds us very different messages.  "Food is fun."  "Food is pleasure".  "Food is a hobby" and most damaging, "Food is harmless if you only know how to control it."   These messages are nothing more than a form of hypnosis.

In my next post: Tips on disengaging from the pack and lowering your Food Involvement Quotient.

 

 

 

 

 

 

 

 

 

 

 

a.

 

 

 

 

 

"

 

 

 

 

 

 

 

The Food Pyramid, Controversial American Dietary Icon, is Dead

By Barbara Berkeley, MD

Would it be too callous of me to say "YIPPEEE"?

The USDA Food Pyramid, which first appeared in 1992 and has served as the basis for American eating for the past 20 years, is dead and gone.  Score one for Michelle Obama and company. 

The Pyramid seemed like a good idea at the beginning; a way to graphically represent healthy diet.  But like most governmental efforts to improve American eating, the Pyramid quickly became mired in politics and the power of the food industry.  Eventually, the challenges of producing a Pyramid that told the truth became so great that its pictorial became completely uninterpretable.  This is perhaps the ultimate metaphor for the American eating experience.  Confusion, misdirection and frank disinformation are the ploys that keep us comfortably consuming as we do.  After all, if we can't figure it out, we are unlikely to see that it can hurt us.

As readers of my blog and book know, I am for simplicity when it comes to diet.  That's because the original human diet is simplicity itself and since that is the diet to which we are best adapted, why look further?  I advocated eating by "Plate Pattern" in Refuse to Regain. One quarter of your plate protein (food with a lean animal source), three quarters of your plate fruits and vegetables.  Can't get any simpler than that.  This is very similar to the new plate-based icon that the government will introduce on Thursday. But this easy formula presents a problem for the people who process and package foods.  Where do cereals, all that soy stuff, all those crackers and breads and bagels fit in?   What about those nice fatty steaks that come from the CAFOs where they stuff cows full of grain?   What about premium ice cream, candy and cake? What about all those corn based products (corn is a grain, not a vegetable)? The answer is simple.  They don't fit in, so they need to be relegated to the Itty Bitty Consumption category.  But companies that make millions producing these foods are not interested in itty bitty sales. 

The USDA is a governmental agency which supports food production, not a health agency.  Thus, the interests of food manufacturers have always gotten in the way of good nutritional advice where the Food Pyramid is concerned.  The struggles that contributing nutritional experts have had with each  Pyramid iteration are well documented in books like "Eat, Drink and Be Healthy", by Walter Willett and "Food Politics", by Marion Nestle. 

The most recent Pyramid (image on the left below)  is a masterpiece of obfuscation, a veritable Rosetta Stone of nutrition.  I have yet to meet a single person who understands it.  When this puzzling graphic first made its appearance, I tried to access the supporting web materials that were supposed to unearth its meaning.  The experience reminded me of a famous scene in the Marx Brothers "A Day at the Races".  A hustler sells Groucho a tip on a race, but it turns out to be just a code number for the name of the winning horse. The hustler then tells Groucho that he must buy a guidebook to figure out the code.  But of course he then needs yet another book to figure out the guidebook.  Then another and another. An exasperated Groucho winds up nearly broke with a backbreaking load of books.  Finally, he rushes to the window with the horse's name, but of course, the race has already been run.

The Food Pyramid age also seemed to usher in a new, and equally obfuscating age of Food Elementalism.  Suddenly, it seemed, we had passed from common sense guidance like "Don't eat before dinner, you'll spoil your appetite", to ridiculous and impossible regulations like, "

The Dietary Guidelines for Americans recommends this distribution for the energy nutrients:

• Fat: 20 - 35% of total calories (average 30%)
• Protein: 10 – 35% (average 15%)
• Carbohydrates: 45 – 65% (average 55%)

We were asked to monitor the consumption of myriad food elements like omega 3 fatty acids, folate, B vitamins, trans fats, anti-oxidants and so on.

When people are not using guidelines because they are not practical, there is obviously a problem with the guidelines.  Yet for the past 20 years, we have done virtually nothing to change our tack.  To the contrary,  I perceive a vague sense of annoyance on the part of the nutritional establishment, something like, "Here we are putting out all this information and no one is using it."   Until now, there hasn't been much reflection on the obvious: "Maybe the information we're putting out just isn't useful."

Simple formulas like plate pattern and simple rules like: eat only what you can hunt, pick, fish or gather are easy to follow and teach.  Imagining a food supply that looks like what a tribal hunter could eat is alot more visual and memorable for a child than asking him to figure out what per cent of his calories come from fat.  We need more of this.

Congratulations Michelle Obama on an important turn toward nutritional common sense.  

 

 

 

 

 

 

 

 

 

Kirstie's Weight Loss: Another Yo?

by Barbara Berkeley, MD

After watching this season of Dancing With the Stars I found myself in a strange state of mind, sort of a cross between bemusement and distaste.  Believe me, I can't blame anyone for grabbing the chance to dance with Maksim Chmerkovskiy ( by the way, I'm completely available for the first season of "Dancing With the Regular Folk"), but I found it hard to watch the dancing odyssey of famed yo-yo dieter Kirstie Alley.  I  guess I am having increasing trouble with the public show that passes for weight reduction these days. 

Alley, who apparently has millions of twitter followers and fans, has long been the poster child for really bad weight management.  There seem to be scads of people who relate to her battle with obesity and find her willingness to deal with it publicly laudable.  But it's the way she does it!  If it's just for laughs it's one thing, but if we are supposed to cheer on her excellent efforts, count me out.

 Although much oohing and ahhing was done on DWTS as Alley dropped from what she claimed was a size 12 (really?) to a size 6 (REALLY???), there was little redeeming value in the process.  Is it just me or was there a bizarre feel about the judges' comments throughout the season?  Despite missed steps, flailing arms and outright falling down, they enthused about her grace, her musicality and her "huge" talent.  It was almost as if her weight conferred a kind of handicapped status.  She needed to be measured by a more kindly yardstick. 

When Alley fell two times in rehearsal during early May she chalked it up to a starvation diet that had dropped her blood sugar too low.  Her dance partner Chmerkovskiy claimed she wasn't eating despite rigorous dance training 4 to 5 hours/day.  (See Maks calling Kirstie out in this video)

There is little to find inspiring in the story of a celebrity who is able to cut calories while exercising all day every day;  someone who might also be slightly motivated to avoid embarrassment in front of millions of people.  This experience does not exactly translate for the average person who wants to get thinner, nor are her methods to be recommended.  But then, not all television has to be instructive.  Some of it is just a train wreck.

Alley has repeatedly traded in on her size.  Her stint as Jenny Craig spokeswoman did not go well and she left after gaining weight in 2008.  She represents a diet product line at the moment which charges for on line guidance, meal plans and food.  Despite going on Oprah to push her plan, she remained very overweight right up until DWTS.  She repeatedly discusses her weight on TV talk shows and had a reality show called "Fat Actress" that was loosely based on her own life. In short, her recent personna has been based around being fat and she has not done much to approach the problem in a reasonable or systematic way.  Nor does she seem to care much about the good she could do as a public figure who struggles with weight. 

Britain's Daily Mail quoted Alley as saying,  'I haven't weighed myself in the last four weeks. I bought these dresses from a size twelve (UK size 16) to a two (UK size 6). Tonight I'm a six (UK 10). When I'm a two, I'm done, people!"

Done?  Anyone who's maintaining weight loss knows that this single word is the kiss of death for weight maintenance.  I think we all would place a bet on Alley's recent descent down the scale being just one half of her latest Yo. 

 

 

 

Medical Emergencies on Vacation: Be Prepared

by Barbara Berkeley, MD

This isn't my typical blog.  It isn't even about weight loss.  But a recent article in the New York Times reminded me of some recent experiences.  I thought they were worth sharing.

Airlines say that in-flight medical emergencies are rising and according to the Times article  this number only reflects incidents which are reported.  The majority of in-flight calls for a doctor are never documented.

My husband and I, both physicians,  had traveled for years without ever encountering a medical situation.  Recently, however, we have been involved in several.  We have heard the same story from many other doctors we know.

About a year ago, we were the only doctors on a crowded 737 when a middle aged woman became acutely short of breath.  She was able to tell us that she had undergone a recent heart evaluation at the Cleveland Clinic, but couldn't give us details of her treatment and wasn't sure of her history.  Luckily, her symptoms calmed down with reassurance and oxygen and we were able to continue to our destination.  Several months later, a call for help went out on a flight we took that still had about 3 hours to go.  This time, a 10 year old was having a grand mal seizure.  According to the parents, this child had no history of seizures and had been healthy.  They seemed strangely unconcerned, but we were much less sanguine.  First time seizures can indicate bleeding in the brain, tumors or other abnormalities.  This situation involved talking with the pilot and conferring with a medical service on the ground.  The airlines use such a service to make decisions about diverting the plane.  We were glad that the final decision was taken out of our hands, because diverting a flight means making the other passengers angry.  In this case, the consultants decided to continue on to our destination.  It worked out alright but made for a disconcerting flight.

During another trip, Don and I were sitting at the pool on a gorgeous day somewhere in the Caribbean when a frantic hotel worker came running outside calling for help from a doctor.  We followed in our bathing suits and found an elderly woman, covered in blood and unconscious, at the bottom of a flight of stairs. We had no immediate means of assessing her situation.  A relative was with her but was unaware of her medical history.  It appeared that she might have had a heart attack or stroke, collapsed, and fallen down the stairs.   What happened next was an education for us.  The hotel was part of a major American chain, yet they were utterly unprepared for a medical emergency.  The woman was breathing with extreme difficulty. We asked for oxygen, but they had none.  Don remembered that the hotel offered scuba lessons and we were able to rig up some oxygen from a tank provided by the scuba instructor.  Although we had to deal with blood, there were no gloves available.  Again, some quick thinking allowed us to get some gloves from the kitchen staff.  The hotel did have a portable defibrillator, but that was of no use since the woman's heart was beating regularly and she didn't need to be shocked.  We managed to stabilize the woman's neck and clear her airway.  We were able to put pressure on her bleeding with some kitchen towels.  We had no way to measure blood pressure or provide any other treatment. 

It took about 45 minutes for an ambulance team to arrive and once they did they discovered that their stretcher could not fit in the hotel's elevators.  A long delay ensued while the stretcher had to be wheeled through the basement, the laundry, the kitchen, out a service entrance, and up a ramp to the ambulance.  This woman had a serious condition which probably would not have had a different outcome even if immediate treatment had been available.  She later died.  However, the lack of medical equipment and slow response time taught us something, and I'd like to pass it along.

If you are traveling with a known medical condition, you should be aware that some destinations do not have the medical capabilities that we take for granted in the United States.  If you have an unstable medical issue, you would be wise to check out whether there are reasonable hospitals in the area to which you are travelling.  (Some smaller islands, for example, have very little in the way of medical care). 

If you take medicines, always be sure to carry a list with the name, dose, and frequency of your meds in your wallet.   You should also have a complete list of your diagnoses (for example: diabetes, high blood pressure, high cholesterol) and a short history of any major procedures you've had (such as coronary bypass or stents). record the names and telephone numbers of your doctors on the same sheet.  If you have an abnormal EKG (cardiogram) it's very helpful to carry a small copy.  You can have one reduced in size at any copy store and keep it in your wallet.  That is enormously important when a doctor who doesn't know you is evaluating a new problem.  Remember that it's hard enough to recall your medical history when you are not under stress.  Keep this information with you so that you don't have to remember it when a medical situation arises.

In addition, a sage friend turned us on to something that we now value greatly: emergency medical assistance for travelers.  After breaking a hip in Colorado, she needed to be transported back to Cleveland for surgery.  Because she had coverage, her assist company was able to pick her up by air ambulance and bring her home.  These services (Med Jet Assist and others) will transport you back to the United States from anywhere in the world if you need emergency care.  The yearly cost is quite reasonable and the degree of reassurance the coverage provides is priceless. 

As with everything we do in life, a little pre-planning makes a very big difference.  The next time you travel, be prepared.  It will make your trip easier and will lead to better care if an emergency should arise.  Remember:  when you call for a doctor on vacation you never know what you're going to get.  You're liable to wind up with a GI doc and an obesity specialist!  So travel healthy, know your history and meds, and (if you have chronic, unstable illness) make sure that you are going to a place where help is readily available.  

 

Talking Heads

by Barbara Berkeley, MD

Talking Heads. We're all familiar with them: the pundits that spout social and political opinion and are largely seen from the shoulders up.   But a recent experience in my ongoing tennis career led me to the conclusion that perhaps more of us fit this description than just TV commentators.

  If you consider it, I think you'll agree that we spend most of our time "in our heads".  With the exception of moments when our bodies are messaging us ("I have a stomach ache" or "I have to sneeze" or "get me to bathroom NOW") we are largely unaware of the bodily machinery that propels us.  We see through our eyes, talk and eat through our mouths and take in information via our ears.  That's alot of time spent north of the neck.

To a large degree, the focus of others is also on the upper reaches of our anatomy.  I have frequently heard people complain about a lack of attention from others despite substantial weight loss.  This appears to occur because most people are looking at the face rather than the body.  When the dieter's face starts to slim down, he is suddenly besieged by questions about his heretofore unnoticed change in size.

Living in one's head provides a certain cerebral satisfaction, but it ignores the workhorse that gets us to the dance each and every day: our body.  Like a kind of Cinderella, that body is often doing the work in some corner while we prattle on with our gussied up thoughts and intentions.  That body longs to go to the ball.

Which brings us to tennis.

About six years ago when I attempted to hit a tennis ball, I failed miserably at making contact with the racquet for quite a while.  A year later, I will still failing to hit any ball that was tossed over my head, which meant that I could not serve.  These are basic skills and I couldn't perform them. Recently though, I realized that I had gotten significantly better.   I was now asking my body to perform a number of complicated and coordinated tasks such as hitting with spin, varying pace, and selecting the direction of shots.  My brain was instructing my body to do these things and now, I found with amazement, my body was responding. 

After a recent lesson, I started reflecting on the tangible feeling that my mind and my body were in partnership.  I felt actually proud of what my body had accomplished and I felt an acute sense of wanting to nurture the physical part of me that made up my dynamic duo. 

I began asking my patients if they had any feelings of disconnect from their bodies.  Most of them admitted that they did.  The fact that most mirrors reflect us from the shoulders up doesn't help matters.  In addition, overweight people have often cultivated an avoidance of parts south of the neck. It occured to me that it might be impossible to truly gain health until some sort of rapprochement is reached.

I believe that this, and not the calories burned or the muscles cultivated, is the reason that physical activity is so very important.  Exercise, in whatever form, wakens us to the fact that there is a body below us.  Over time, it pleases us by becoming a partnership.  Once our body becomes a friend, it is suddenly endearing and we want to take care of it. 

Anyone who has a child, a good friend,  or a beloved pet knows that love has little to do with perfection.  In fact, it is the imperfection that often calls forth greater affection.  It can be this way with your body when you notice how hard it is trying despite all it's faults. 

If you have not already done so, try asking your body to learn some new physical skills.  Be patient.  Then sit back and watch in awe as a new and wonderful part of you emerges.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To Repeat is Human, To Transform Divine

by Barbara Berkeley, MD

With the recent killing of Osama Bin Laden, American unity is back at its peak.  As in the days after 911 we are all coming together.  Republicans are not only talking to Democrats, they are actually complementing them.  All of this congeniality is fueling speculation that perhaps this time,  maybe this time, things will change and petty political bickering will cease. 

We should know better.

Human beings are nothing if not tribal.  Give us a reason to band together against a common enemy and we will.  Right now, that enemy is Al Qaeda and the good guys are us, party politics aside.  But in a few weeks, we will divide into smaller groups and the Dems will vilify the Republicans once again.  We do this all the time.  In fact, endlessly.  Cleveland against Pittsburgh.  My little tennis club against the one across town.  Your son's T-Ball league against those awful cheaters from the other division.

When you think about it, human beings have an unfortunate lack of imagination and insight.  We have a few narratives in our lives.  We repeat them over and over, often learning nothing.  This is the essence of being human and the tragedy of history.

A friend of mine was complaining to me just the other day about the dynamics in her company.  That guy that always claims that he's overworked and underappreciated was sending out inflammatory emails yet again. Her boss was undermining her as she had done many times in the past.  A co-worker who liked stealing ideas and taking credit for them was at it again.  I told her that her business reminded me of a barnyard where each animal could only make one sound.  The cow moos, the sheep baas and the pig oinks.  They don't have another script.  In our human version of Animal Farm, it's often the same.

There's a reason that people relate to the myth of Sisyphus the unfortunate Greek who was condemned to roll a boulder up a mountain for all eternity, only to have it fall back to the bottom each time.  Sisyphus is the ultimate expression of our inability to change; of the human chains that bind.

But within this paradigm is another truth.  Great moments are made when people leap beyond the expected.  Great art comes from seeing the world in a way that it hasn't been seen before.  Great political change comes from those who are able to avoid repeating the cycles that have mired us in the past.  Great science comes from those who think in a completely different way.  We call these people "visionaries", because they have sight that sees into a different human dimension,  Another way to say this is that they think "out of the box", implying that the rest of us are sitting inside that box most of the time.

For the past month, I have been writing about transformation and transformation, by its very nature,is the ultimate breaking of the mold.  If you want to accomplish change in your life, if you want to eat differently, become a different size, reclaim health, make a permanent u turn on your road, the key is in bold vision.  Your default patterns will just return you to a Sisyphysean fate.  You will need to harness those forces that defy human predictability.  As I've said many times before, this is not an easy task, but it's fun, fascinating and fabulously worthwhile.  So dare to be great by breaking old patterns and imagining a life that is utterly different than the one you've endlessly repeated.  Set your sights on a divine future because amazing change is possible for each one of us if we only see clearly.

 

 

 

 

 

 

 

 

 

 

 

 

Liposuction vs. Transformation: Procedures Can't Change You, But YOU can!!

by Barbara Berkeley, MD

You know that person of your acquaintance who had bariatric surgery and gained it all back?  What happened?

The answer is simple.  They believed that the procedure alone could "fix" them.  But our current surgical treatments for obesity are sold the wrong way.  Rather than being fixes, they are helpers.  Most patients arent' told that.  What do I mean by "helpers"?  I mean that bariatric surgeries give you the time and inclination to transform.....if you want to.

As drastic as bariatric surgery may seem, it alone is not enough to create permanent weight loss in many people.  What it does do, quite effectively, is buy patients about a year and a half to change eating  habits.  During the early period after surgery, pain, nausea, vomiting, dumping syndrome and extreme fullness are enough to make the surgically-altered disinterested in eating.  But over time, many people regain their tolerance to larger amounts of food and to the toxic food elements of the SAD (standard  American diet).  If, during the first 18 months, the surgerized have jettisoned S Foods (sugars and starches) and fatty combo foods from their diet, the operation will help them stay slim forever.  If, as is often the case, they have learned to eat "through" the surgery, no amount of restriction or bypass is enough to keep weight from returning.  Thus, your obese-again acquaintance.

Liposuction is a surgical alternative that provides even less in the way of help.  Subcutaneous fat, the fat that lies right under the skin, is removed.  Dangerous deposits of visceral fat, the fat that hangs around inside your abdominal cavity, is left untouched.  Nothing about the procedure other than your slimmer thighs encourages you to change eating habits.  Now, a new study published this month in Obesity reveals worse news.   After liposuction, fat comes back but changes location.  Often, the new fat winds up in the belly.

The study divided women who were not obese, but who had fatty deposits in thighs and lower abdomen, into two groups.  One group got liposuction while the other did not.  Both groups were advised NOT to change lifestyle habits during the study, so food intake remained constant.  Please note this, as it is important.

 Immediately after the liposuction, the body fat percentage and amount of total body fat of the operated ladies was significantly lower than that of the control group (the ones who got no liposuction), but by 6 months this difference was vanishing and by one year it was gone.  The fat had returned and the amount of fat in both groups was now equal.  Strikingly, however,in the operated women the thigh and buttock areas remained less fat, while new fat appeared in the abdomen.  At the one year mark, both the liposuctioned women and the controls had more abdominal fat than they had at the beginning of the study.  Worse, there was a tendency for the liposuctioned women to gain more fat in the visceral area: inside the belly.  That area is the most dangerous area for fat accumulation as the deposits there produce toxic and inflammatory chemicals that affect the rest of the body.

Should we be surprised by these results?  I, for one, am not.  If the body is storing fat because of a diet that encourages this, it will find a place to put that fat.  Perhaps during liposuction, the local fat tissue is damaged or its ability to reproduce itself destroyed.  If that option is gone, the body will simply look for another place to store the fat.

What disturbs me most about this study is not the fact that fat comes back.  Instead it is this paragraph, found in the discussion section (the underlining is mine):

When AT mass (fat mass) increases or decreases, neurohormonal signals stimulate individual responses that promote a return to the original level . Weight-loss itself creates a context for weight regain linked to increases in appetite, food intake, and increased insulin sensitivity . In this study, outside of a weight-loss paradigm, undefined physiologic mechanisms seem to have restored the surgically induced imbalance between AT and fat-free mass.

Translation: Once you lose weight, your body responds by making lots of powerful chemical signals that tell you to eat more and put the weight back on.  You eat more and regain.  But who says so? In this study, the researchers controlled for food intake.  Theoretically, the women DIDN'T eat more after they were liposuctioned. According to these study results, the weight loss actually did not cause the stated "increases in appetite" and "food intake".   As a result, the researchers came to the conclusion that some"undefined" physiological mechanisms were at play.

Here's what I think happened.  Both groups were eating diets that tended to put on fat.  No attempt was made to alter that diet.  The liposuctioned group caught back up to the non-operated group within one year.  Both groups increased the level of visceral fat in their bodies at one year, so both were eating diets that promoted fat and nothing at all changed. Inserting a procedure into the equation didn't alter the basic problem.

If it were inevitable that "undefined physiologic mechanisms" caused weight regain, there would be no successful weight maintainers.  Having written this blog for over two years now and through it having met and corresponded with scores of successful maintainers, I know with certainty that regain is NOT inevitable.  But here is what IS inevitable: continued weight accumulation if you are eating a fat promoting diet.

It's time for those of us who are serious about getting healthy to face this hard truth.  No pill, no surgery, no liposuction catheter can do anything more than temporarily reverse the process.  But we can permanently disable the process with our own food transformation.  If we stop eating the foods that stoke the insulin machinery, our body can't make fat.  Is there some overarching compulsion that forces us to return to sugar, starch and high fat treats? Yes.  But I believe that the compulsion is less physiological (inside our body) and a lot more cultural.  And that's good news.  More and more of us are figuring out ways to accomplish a food conversion, a permanent and complete change in the way we eat.  As I've said numerous times before, the most important thing we can do to facilitate this conversion is to keep trying.  As time goes on, the chances that you will accept and come to love a diet that is made up of foods that never saw a factory and that have no starch and very little sugar increases.  So keep trying, and when you wake up tomorrow, ask yourself this question:  is today the day that I'm going to make the change and make it stick?  Am I ready?  One fine morning, the answer will be yes.