by Barbara Berkeley, MD
At the end of the year I like to look back at what has changed in my field and how I have changed in my practice and beliefs. Has new information about weight and weight loss come to the fore? Am I using different techniques than I used to? And most importantly, what have I learned from my patients this year? My interactions with patients are always the most powerful teachers. This fact reflects what is most compelling about medicine: it's as much of an art as it is a science.
I encourage you to review your year as well. Have you changed your approach toward weight and health? What has influenced you?
This is where I'm at as 2015 draws to a close.
1. This year marked the true emergence of the micro biome (read a NY Times article about the micro biome here). Suddenly, we began to see that we humans live in concert with billions of micro-organisms, many of them lining our gut. There are as many as ten times the number of micro organisms in our body as there are human cells and our biological tenants may weigh as much as three pounds.
'Humans, said Dr. David Relman, a Stanford microbiologist, are like coral, “an assemblage of life-forms living together.”'
Our biology is vastly complicated yet our view of medicine incredibly simplistic. The new focus on the micro biome validated my suspicion that we have long been barking up the wrong tree where obesity is concerned. Yes, what we eat is important, but what the billions of little guys who see that food before it's absorbed choose to do with that meal is a whole other story. We are an ecology rather than an organism. If our inhabitants are sick and/or unhappy....we probably are too.
2. In 2015, I further solidified my belief that the axis of weight gain is insulin and carbohydrate. I believe that we would do everyone a great service if we dropped the whole calorie, exercise, eat too much thing and instead distilled weight gain into a single sentence: "Our carbohydrate processing mechanisms have been damaged, so when we eat carbs the body throws them into a garbage dump (the fat mass) rather than burning them." We don't know all the details of this damage or why we have become so susceptible, but the advice to stop eating carbs or risk finding them forming a beachball around our waist is pretty easy to dispense, understand and act on.
3. This year I became more of a believer in intermittent fasting. This post contained some strategies for how to increase our non-eating hours. It has always made intuitive sense that our original design prepared us for eating periods followed by non-eating periods. But modern life has erased our eating-free times with the exception of sleep hours---and those have become shorter for many. For me, the idea of grazing which became so popular in the past twenty years would seem to subvert the body's ability to clean itself out. This year, I personally found that my own maintenance was vastly aided by a simple technique. About two times a week I don't eat dinner, have a light snack instead and then go exercise. I may have a little fruit or a diet ice cream when I come home. These days-- when I burn more calories at night and put fewer calories into the mix ---have helped me to maintain my weight more easily and I have come to look forward to them.
4. In 2015, I gained an even greater belief in the value of exercise. At the same time, I continue to have little respect for exercise as a weight loss creator. You can love exercise and still not expect it to cause the pounds to fall off. During the weight loss phase, exercise is great for putting you in touch with your body, making you stronger and perhaps more shapely, and speeding the process slightly (in some). Following a calorie restricted, lower carb diet is key with or without exercise. But in maintenance, exercise is a lifeline that can often reverse mental lapses and slight regains. And the older I get, the more I must exercise to keep my muscle mass from melting away and my strength from evaporating. Exercis is the best, but it suffers from being constantly folded into the weight loss equation. Practice exercise for the joy of it and for its life-promoting benefits, and forget about its effect on your weight.
5. A big lesson I learned this year is that weight loss programs can work spectacularly well in workplace settings. My practice is more than two years into running a fairly large program for a local corporation. We see patients on-site at their job once a week. What we have discovered is that there is enormous value to working with patients where they spend most of their day. Our efforts are amplified by the creation of a culture throughout the corporation as more and more people lose weight and change the way they eat. If you are a reader in the Cleveland area who would like to establish a workplace program, we would be happy to work with you. You can give us a call at 440 338 6009. We would love to do more of these.
6. For me personally, I learned that after about 25 years as a clinician specializing in obesity I am increasingly frustrated that the lack of insurance reimbursement for weight loss means that I haven't been able to treat as many people as I would have liked. In the coming year, I want to work on doing more on social media and also on scheduling many more speaking engagements. If you know a group or organization which is interested in talks on weight loss, maintenance, our modern food culture, or how our diet affects our health I can be reached at refusetoregain@gmail.com.
7. Lastly, in terms of weight maintenance, I have strengthened my belief in the "Food Constitution". A Food Constitution is simply a way of defining daily eating style...what you believe in. I wrote about Food Constitutions in Refuse to Regain and in this post. I've come to believe even more strongly in this idea. In order to oppose the modern food world and to keep it from overwhelming you, you must know what specific diet elements keep you healthy and at good weight. You then must be relentlessly consistent in defending this dietary style. Vegetarians are an excellent example of people who have decided to eat in a certain way and won't be deviated. You can be like them but it requires a strong understanding of the specifics of what keeps your particular body healthy in maintenance. Almost every re-gainer I have ever treated got there because he allowed himself to make exceptions or to believe that some modulated form of the modern diet would allow success. Rather than make a New Year's resolution to simply eat better or exercise more, why not design a detailed Food Constitution and resolve to pledge allegiance. Happy New Year and best of health and happiness to all.