Refuse To Regain

Where's the Beef? Here's Mine.

by Barbara Berkeley, MD

For those of you who are old enough to have lived in the pre-modern era, Wendy's "Where's the Beef?" ad campaign likely remains a sweet, if dated memory.   Produced in the 1980s, before the obesity epidemic began in earnest, these commercials (see one here) featured Clara Peller, a feisty octogenarian who gave voice to the tagline.  They were hugely popular, and like the development of the Pillsbury Doughboy, Speedy Alka-Seltzer, and Betty Crocker, gave a specific face to the Wendy's brand.

Yesterday's New York Times published an article that announced Wendy's intention to revive the "Where's the Beef?" campaign.  But times have changed.  Dave Thomas, self-proclaimed hamburger lover and founder of Wendy's, underwent quadruple coronary bypass surgery in 1996.  His well-known form, as seen in many of the company's commercials, was unapologetically overweight and featured the pronounced pot belly that often presages health disaster.  (Thomas died of liver cancer in 2002 at age 66).  

Thomas, who had been adopted shortly after birth, was an advocate for adoption rights and reforms.  He did much good.  But we know a great deal more about fast food today than we did in the 80s and one has to wonder what Dave would really think of his company's decision to intensify the marketing of the very foods that make obesity and coronary bypass more likely for those kids he sought to protect.

The Times article contains many statements that are written without irony but seem oddly out of touch, to say the least. It also contains a link to the current "Where's the Beef" commercial featuring Little Wendy, Dave Thomas's daughter, now 50 years old. I will let you take a look  and come to your own conclusions about the use of the Little Wendy name.   

Does Wendy's believe it is doing good by promoting double and triple cheeseburgers with a budget that is "probably twice what we would normally do in a launch of a new product", in the words of their senior vice president?   The Times says that "the bleak economy is the chief reason for the intensification of the burger wars, which pit Wendy's against chains like Burger King, Carl's Jr., Checkers, Five Guys, Hardee's, In-N-Out and, of course the mighty McDonald's."  The article goes on to say, "Consumers who are struggling financially are turning to fast-food chains to save money on meals."  But oh, the irony!  The self-same NY Times featured an article by it's food writer Mark Bittman just last week that fully debunked the claim that fast food is cheaper than plain old healthy home cooking.  (Read Bittman's article here).  

In another ironic twist, Wendy's has chosen to name it's new, juicier burgers "Dave's Hot and Juicy" line, after it's founder.   His daughter "beams", "These would've made Dad say, "Here's the beef!'".  

When I was 15 years old, I was sitting at lunch with my Dad while he ate a big, juicy hamburger.  Half-way through his meal he developed chest pain, started sweating and had a heart attack.   He later had a sextuple vessel coronary bypass and was dogged with health issues related to the habits of his younger years, smoking, eating lots of fatty and fried foods, and being sedentary.   Unlike Dave Thomas, he survived it all and was able to change the way he lived and ate.  It is to that experience at the lunch table that I attribute my desire to help people lose weight and make a food conversion.  

Is it the job of business to help their customers make healthy choices?  No.  Do their over-the-top advertising campaigns and endless reach allow them to do good should they decide to?  Yes.  

Wendy's has the beef, but my beef is that they--and other large corporations-- don't have the conscience to use their brand to make a real change in American health. 

You're On a Diet...So Why Aren't You Losing Weight?

by Barbara Berkeley, MD

This post is an update of a previous entry.  Hope our new readers enjoy it and our long-term readers will consider re-visiting these ideas. 

Refuse to Regain is primarily designed for maintainers--- that small and exclusive group of people who have managed to lose weight and are stabilizing (or stable) at their new size.  But comments to our site reveal that many of those who read us are still in the process of active weight loss.  As a result, I wanted to devote a full posting to a question I hear with great frequency:  Why is my weight loss diet not causing me to lose weight?

New patients to my practice often say that they can't lose weight no matter what they do.  They chalk this up to a bad metabolism or to something that must be extremely dysfunctional about them.  Over the years, however, I'm hard pressed to remember anyone who was not able to lose weight once they began an effective diet.  No matter how impossible weight loss once seemed, it became possible once the diet was properly adjusted.  Naturally, this result depends on the dieter following the diet exactly as prescribed. 

Why then the frustration? And why do many diets seem to fail?  Here is what I've come to believe (followed by some suggestions that may help):

1. Diets Fail Because We Fail to Understand What They Are

I like to think of dieting as an unnatural act.  (Strange that I would make my living by encouraging unnatural behavior, isn't it?).  But seriously, if you could revisit ancient times, you would not find any humans forcing themselves to lose weight.  Having a bit of extra fat would have conveyed a survival advantage, so why would anyone have wanted to get rid of extra pounds?  Our twenty-first century bodies still behave this way.  In fact, they seem to completely ignore weight as we gain it.  

Knowing the body's propensity to defend itself against harm, one would think that storing a lot of dangerous fat would cause the appetite to shut down, or perhaps prompt the release of a cascade of hormones to dissipate the excess. But that doesn't happen. We can carry even hundreds of pounds of extra fat without the body paying any attention.  Perhaps the reason is this: our ancient genes (the ones we still harbor) never thought we could gain a dangerous amount of weight.  Since it used to be a good thing to store some extra fat, our genes never developed a program for aborting weight gain.

Since the body ignores our fat, how do we create weight loss?  We do it by recreating an ancient situation...one that forced the body to notice its own fat.  That situation was a significant food shortage. In actuality, a modern weight loss diet is simply the process of tricking the body into believing that there is a famine in the outside world.  Once the body gets the idea that there is very little food coming in, it suddenly wakes up to the presence of stored fat and starts to use it up.   This state of awakening was doubtlessly designed as a survival response hundreds of thousands of years ago. Let's call this bodily state: "The Ancient Famine Response".

This response consists of two parts, one of which makes dieters happy and the other frustrated.  First, the body starts looking for energy to sustain itself in the face of famine.  It turns its attention to its own fat, recognizes it, and starts burning it.  Second, the body wisely decides to burn this fat as slowly as possible in order to outlast any extended food shortage.  It does this by slowing down its bodily processes, heating itself less, and using other tricks to conserve energy.  This is annoying to dieters, but is a built-in and unavoidable feature of the Famine Response.

Having discussed the reason we lose weight, let's next think about what would have constituted normal eating for the same ancient ancestors.  Since they hunted and gathered, they probably had days of ample food one day and days when food was scarce.  To adjust to this, human bodies likely developed a very flexible system for using food. If food is temporarily in short supply, the body can slow down , burn fewer calories, and be more efficient.  If we eat more, the body can speed up.   These mechanisms allowed our ancestors to stay at stable weight even when food intake fluctuated.  Let's call that the "Normal Ancient State".

Most of us start a diet with all intentions of following the rules exactly.  That works!  We lose weight because we are consistently telling the body that there is very little food coming.  We've mimicked the"Ancient Famine Response" or, as I sometimes tell patients, "we've turned on an emergency light in the brain".   But we soon start to get creative.  We eat things which seem to be minor but which aren't on plan Or, we don't eat on some days and we eat more on others.  All of these behaviors put us back into the "Normal Ancient State".  We can't figure it out, because when we look at the intake for a whole week, we ate very little...certainly many fewer calories than we used to eat before dieting.  Why aren't we losing???  It's because food intake is intermittent and not sufficiently restrictive.   The body adjusts to intermittent eating, lowers its burn, and keeps weight stable, just as it's programmed to do.

Suggestion:  Pick a diet that you can follow to the letter.  Stay as compliant as you possibly can.  Resist the temptation to go off the diet on some days and resume on others.

2. Diets Fail Because We Don't Have a Way to Get Calories Low Enough

In our practice, we create weight loss with a diet that has approximately 1200 calories.  Larger women and/or men may use 1500 calories or so.  This sounds simple, but it isn't.   Calorie counting is complete guesswork in the modern world.  Using packaged foods which have known caloric content can help.  Once you start eating out in restaurants, as most of us do, counting becomes impossible.   Although I do not like processed foods over the long run, dieting may be a good time to use them.  If you can construct a diet from bars, supplements, frozen diet entrees, low fat dairy products and other foods which have calories already listed,  you can be pretty sure of the number of calories you are getting. 

In our program, we use three diet shakes or bars (each 160 cals) per day and have patients eat a dinner which is composed of about 1/4 of a dinner plate of lean animal protein (chicken, fish, meat), a large mixed vegetable salad, a big portion of cooked green vegetables,  a piece of fruit, and a 100 cal fat free pudding.  You can work out your own plan, but knowing that you are getting the right calorie count is important. 

Suggestion: If you aren't losing, check your calories.   Make more use of foods which have calorie labels.  Try to avoid eating out if it is scuttling your weight loss. And of course, remembering the information above, remain consistent each day.

3. Diets Fail Because We Don't Get Our Insulin Low Enough 

Insulin is a mega-important hormone for dieters because it stores fat.  It not only puts fat away into the fat cells, but it also stands guard outside the cells to make sure the fat stays put.  Only by lowering your insulin levels can you break down fat.  Imagine insulin as a jailer that keeps fatty prisoners trapped on your body.  Put him to sleep and they can escape. 

Insulin is made whenever we eat starch or sugar because those two things turn into blood sugar once they are absorbed.  (Insulin's other job is to control the levels of blood sugar).  Dieters have already intuited the role of insulin. What is the first thing they do when they start a diet?  They begin with salad and chicken breast.  They eliminate bread, pasta, crackers, rice and dessert.  Insulin goes to sleep and weight loss follows.  But before long, their carb addiction begins to howl.  That piece of pita doesn't have that many calories.  That rice cake is a diet thing, right?  Wrong.  This part isn't about calories.  Wake up your insulin enough and you won't lose weight.

Suggestion:  Keep starch and sugar to a bare minimum when dieting.  (BTW, this works for maintenance too!).

4. Diets Fail Because We Rely Too Much on Exercise as a Weight Loss Tool

Exercise is great.  I love it!  But alone, it will not cause weight loss (unless you are running the ultra-marathon or something).    Remember the Ancient Famine Response: unless you create a consistent state of calorie reduction, you won't lose.   In my practice I have many skilled tennis players, marathon runners, volley ball enthusiasts, and other athletes.  If exercise caused weight loss, they would not be visiting me to get off the 30 extra pounds they've accumulated.   Be especially careful with the temptation to over-exercise.  This can create hunger and entitlement (as in, "I earned that bag of M and M's").  Exercise by all means, but during weight loss, put most of your faith in calorie reduction that is consistent and calculable. 

Suggestion: During weight loss, think of exercise as secondary to caloric reduction. 

Remember this:  magazine covers would lead you to believe that weight loss is simple and that pretty much everyone in America is having their pounds "melt off".  This is the big lie.  Weight loss is tough and takes a tough effort.  What remains true is that the rewards for this effort are great; the endpoint incredibly worthwhile.  So keep at it and always congratulate yourself for taking on such an important and challenging task.

 

Controlled by a Cookie: When Foods Become Drugs

by Barbara Berkeley, MD

Do you take medicine to treat your blood pressure?  Once you swallow your pill, can you control your blood pressure via sheer willpower?  While such feats of bodily control are reported by swamis and other advanced body-mind practitioners, they are not in the average person's repetoire.  And a good thing too, because the power of drugs to take over ailing body systems is the reason they work. Medicinal drugs are substances which enter from the outside and take control of inner processes.  They cause chemical changes that in turn change those who take them..hopefully with positive effect.  But, as we well know, drugs can have negative effects too, especially when their chemical properties are used to create pleasure.

Consider these two definitions of the word "drug":

1. a chemical substance that affects the processes of the mind or body.  

2. a substance used recreationally for its effects on the central nervous system, such as a narcotic.

 

Every overweight person I've ever encountered recognizes that certain foods have drug-like properties. During an intake visit, a new patient will generally put his finger right on the foods that are submarining him.  He or she will often use the language of addiction to describe these foods:  "I'm addicted to sweets",  "I'm a chocoholic", "I just can't stop eating bread."  It's not coincidence that such language should leap to the lips.   Foods DO alter the processes of the mind and/or body.  Foods ARE substances that are used recreationally and which do have effect on the central nervous system.  In fact, certain foods can be viewed very much as drugs.  Despite this, we believe that once ingested, we can control these particular "drugs" by sheer willpower. 

Perhaps you do not agree that food and drugs are similar.  After all, we are designed to eat food and even if ingesting food does cause changes within the body, they should be natural, expected changes.  Until recently, this has certainly always been the case, but let me suggest two reasons why things may have changed.

First: There can be no question that eating food is a natural behavior that provokes natural responses. I would make the case, however, that in a very real way we no longer eat "food".  Processed foods that are chock full of preservatives, colors, and chemicals have little resemblance to what our body is equipped to handle.  Foods that hit us with enormous punches to the insulin system---the sugar and starch foods---are also very new to human experience.   

Second: Many of us who eat the western diet or SAD (Standard American Diet) have developed inappropriate reactions to eating these newer foods.  This is especially true for those foods that turn into sugar after digestion (the sugars themselves and the starchy carbs like grain, cereal, pasta, flour based foods and potatoes).  If we have begun to develop a "broken" reponse...in the form of what we call insulin resistance... we will react in a new and negative way to eating.  We will experience more hunger, more craving and less ability to control these foods.

 

Recent research into the modern epidemic of insulin resistance suggests that those of us whose insulin is no longer properly interacting with our body may also have a problem with insulin's role in the brain. The brain's form of insulin resistance occurs when insulin-related signals which normally tell us to stop eating are blunted.  Thus, foods that cause insulin release are no longer equipped with the satiety safety valve that nature intended.  Indeed, these foods may make cause more hunger rather than less.   And who among us has not experienced the inexplicable carbohydrate craving that follows a day of bread, pasta and cookie consumption? 

 

Thus, my hypothesis is that foods become drugs when our body no longer tolerates them well.  As a child, you might have been quite able to eat a cupcake and simply stop.  As an adult, one doughnut might lead to an entire box.  When drugs are at the helm, you can forget willpower.  Be they medicines in pill form or cookies that are decorated like Grover, your physiology is co-opted and someone else is driving the bus.  

 

Sometimes I use the following analogy in the office:  think of your trigger foods as concealed aliens. Remember the movie Men in Black?  An innocuous shop-keeper might look harmless, but was actually a man-eating cockroach!  Drug-foods are like that.  They look attractive, luscious, and controllable, but allow them past your lips and you are under their control.  You can bemoan your lack of willpower all you want, but if you've given yourself over to the aliens you are likely to spend quite some time doing things you didn't intend. 

 

Many people simply can't understand how something as small as a cookie could cause them to abandon all resolve.  But there is the error!  A cookie isn't small at all.  The chemical signals and bodily changes that start the moment a susceptible person sees and smells that cookie are quickly overwhelming.  Eat that cookie and it is very possible that---diet-wise---all is lost. 

 

This illustrates  the problem I have with advice that suggests that it's ok to eat everything in moderation.  Yes, if you are a person whose food-processing systems are all in good shape, this may be a fine strategy.  In fact, if this works for you, you might well be unable to understand why it wouldn't work for everyone.  But most people who are overweight have gotten heavy because food has become drug-like for them.  To me, this is part of a larger picture which includes fundamental physiological changes in the way their body handles that food (mostly the starches and sugars).  If you have been wrestling with willpower and blame yourself for being weak, I advise you to start seeing the true nature of your trigger foods.  Start with a healthy respect for their power and a strategy of avoidance whenever possible.  Remember, if you don't take a drug it can't own you.