by Barbara Berkeley, MD
I have now been specializing in obesity for close to 22 years. With each passing day I become more certain that the endlessly repeated weight "truths" are utterly wrong. We are doing irreparable harm to ourselves and our society by believing in them. These supposed truths? Overeating makes you fat. Exercise makes you thin. Calories are the be all and end all of weight control. People who are overweight lack willpower. Obesity is, in some way, a moral failing.
The body is far too complicated for such (excuse me) dumb explanations.
I don't claim to have all the answers, but I know that the answers we've been giving (eat less and exercise more) are leading us down the garden path.
Here's where I stand today.
The entire body is built on homeostasis, (simply a fancy word for balance). This balance is achieved automatically through hugely sophisticated systems which monitor each aspect of our biology and keep each controlled within a narrow range. Small perturbations in normal are enough to make us very ill indeed, as for example when the ph of our blood becomes too acidic, or the calcium levels get too high. To kill someone, we need only overwhelm the capacity of our body to balance potassium. Inject enough of it and death will quickly ensue.
There are many people in the world (and each of you knows several) who can eat without much thought and exercise sporadically or not at all, yet remain thin. This is as it should be. The process of staying at stable weight is another one of the homeostatic mechanisms of the body. Under conditions of normal balance, your body knows who to choose to either burn food or store it in order to keep you at a stable weight. Just as you do not have to run to the gym and sweat to burn off the salt you ate at the local deli, you don't have to run to the gym to correctly apportion food so long as balance functions are working.
Thus, I see weight gain as a dysfunction of the normal balance apparatus for fat storage. This leads to two interesting questions:
1. Where is this balance mechanism located?
2. What might be the reasons the balance function is injured or broken?
I believe that the answer to question one is most likely the insulin system. We know that insulin controls fat storage and that excessive insulin produced when the body starts to resist normal levels leads to obesity. We know too that the elimination of carbohydrates, as demonstrated by diets like the Atkins diet, Primal diets, and low carb plans that go back as far back as the Banting diets of 19th century England, cause and preserve weight loss. Carbohydrates call for insulin, where animal proteins ask for very little. Thus these diets lower insulin. Low levels allow for fat burning rather than fat storage. In truth, most standard diets also vastly reduce carb consumption because they rely on calorie cutting. If you are only eating 1200 calories per day, the total carbohydrate consumption cannot be very high. There may be many other pieces and parts to this explanation, but why bother about them? Controlling carb consumption works. Eating diets that are made up of natural carbs like low sugar fruits and vegetables and high quality animal proteins work exceedingly well for weight loss and maintenance. I believe we have made an end run around the broken system when we eat this way.
The answer to the second question is much more problematic. We may have become increasingly broken in the insulin department as a result of chemicals in our world. We are certainly exposed to enough of them. And we know that certain drugs, like SSRI antidepressants and many antipsychotics are strong promoters of weight gain. If these chemical compounds can make us fat, why not others?
Another explanation may be simply that we have passed a crucial limit of tolerance for insulin stimulating foods. Children born since the second half of the 20th century have been exposed to increasing levels of carbohydrates in utero. Perhaps we have created a number of generations who are already weakened in the insulin department. Further repeated stimulation of this system by eating carbs multiply at every meal and snack for years on end leads to its destruction.
A combination of the two elements is most likely. And there are many other potential explanations.
However, knowing the reason we break does not necessarily help us. There are no drugs in the pipeline and no particularly promising lines of research at the moment. What does help us is an understanding of what is broken and how we can work around it. I have described that above and in my book.
What about overeating? Well, just like the ability of a potassium infusion to kill you, any homeostatic system can be overwhelmed by enormous overconsumption. There are some obese people out there who fit this description. These are people who are consuming 30,000 calories a day, or who have binge eating disorder, or have other derangements of normal eating. However, the vast majority of patients I see and overweight people I speak to, eat within normal American limits. That is, they eat too much but not at a level that should explain their degree of overweight. They often eat similar amounts of food to what is consumed by thinner friends. They describe gaining weight when they "just look at" certain foods. In other words, they pay more for what they eat. I theorize that these people have broken weight homeostasis.
It is not easy to become a Primal or Primarian eater at first. But I assure you that with each day that you eat this way, it will become easier and more preferred. The power of making that end run around what is malfunctioning is intense, and the freedom that comes from eating without gaining weight is completely delightful. Finally, as you know, I believe that the original diet of humans is the healthiest diet we can adopt. Without the modern elements, your diet will allow your body to run on the proper fuel for the first time.
The voice inside of you that says that you can't give up bread, cereal, rice and cake is not you talking. It is the voice of the food itself. Try purging yourself of these things and you will be amazed that in the ensuing quiet, you will be able to hear your own healthy inner voice for the first time.