by Barbara Berkeley, MD
Every once in a while, I feel the need to write a post about the basics and I think today is the day. Have you lost weight only to find that it is piling back on again? Let me try to give some help. As always, I want to offer the following disclaimer. I am not suggesting that what you are about to read is gospel. It is my opinion based on my experience with overweight patients over the past 20 years. Always weigh "expert" information within the context of what you know about yourself and what works for you.
First, a little reality check. My practice sees 70 to 90 patients per week. The majority of these people lose weight and a great many lose between 50 and 100 pounds. Our patients come in weekly during the weight loss phase and are encouraged to continue to come frequently (weekly to monthly) while they are maintaining. We make it possible to keep contact forever by giving free visits to those who are maintaining very well and half price visits to those who are struggling. Despite this, the majority of our patients will regain weight.
Because we understand the difficulty of maintenance and do not see regain as a personal failure, many patients thankfully return for treatment prior to complete weight regain. It is also important to note that our program has a significant number of very long term maintainers, people who appear to have found a permanent solution. We are very proud of this, but we always wish we could do more.
The point is that weight regain is very hard to avoid, even for those who invest money in weight loss, are educated about it, and stay under supervision. We are lacking in drug therapies to treat weight regain and that means that current solutions must involve deep behavioral change. If you are not ready and willing to make such changes, you can be sure that you will find yourself back at starting weight...or higher.
If you are ready, it's vital that you understand exactly what changes are necessary. By and large, these are dietary changes, NOT changes in physical activity.
Remember that the process of controlling weight is divided into two very different parts.
Part I: Weight Loss
Dieting for weight loss is no different than emptying the trash. Say you have a chronic problem with messiness. You easily recognize that cleaning up your room--while it might make you feel better temporarily--- doesn't solve the problem. Somehow, we have confused weight loss--a temporary clean-up--- with fixing something. Weight loss is simply the first thing one must do in order to start the process of weight control. It is really a preamble. But we treat it as if it is the finale.
What must you do to lose weight? It's simple. You need to convince your body that it can't survive unless it burns the fat that it has been keeping locked up. That involves lowering calories enough to frighten the body into unlocking the closet. It also involves lowering insulin enough to allow fat to leave the fat cells. Any diet with a good track record does these two things. All diets lower carbs (either by having you minimize them via "points", or by minimizing them simply because you can't eat very much). All diets also lower calories. The key to losing weight on any given diet is consistency day after day; following all diet rules scrupulously. If you can do this--and most people can summon the energy to get this done at least once in their life--you will empty the trash.
Part II: Changing the Way Your Body Deals With Food
Now that you've cleaned up your room, it's time to deal with the chronic problem of your body's "messiness".
Your body isn't really messy. It just has a disordered way of dealing with food. You gained weight because your body did not burn what you ate, but chose to store it instead. Under normal circumstances, your body should keep your weight stable within a large range of calories and exercise choices. You only need to look at skinny kids and skinny adults to see this principle at play. Skinny people don't think about what they eat or how much they exercise (as a formerly skinny person, I can vouch for this).
The body keeps a skinny person's weight stable by handling his food choices appropriately, sending some to an incinerator and some into storage. I call this mechanism the IBM (internal balance mechanism) and you can read more about it here. While it is true that you can completely overwhelm this balancing machine by eating so much that it simply can't handle the load, I don't believe that this is the case for most overweight people. I say this because there are many lean people who can eat just as much as heavier people do. Thus, I don't believe that most of us are overweight because we eat too much. Rather, I believe that most of us are overweight because we have built a diet out of foods that destroy the IBM. Once this process occurs, you will not be able to eat the destructive foods again in any appreciable amounts without gaining your weight back.
So what destroys our normal ability to balance off what we eat? I believe the answer is carbohydrates (not counting the carbs in fruits and non-starchy vegetables). To be specific, these carbs are:Sugars: Table sugar, high fructose corn syrup, honey, maple syrup and any other sugar. Grains (including whole grains and remembering that rice and corn are grains) and their products: cereal, flour and the things made from flour (bread, pasta, bagels, chips, crackers, tacos, etc..). Potatoes
Simply put, our bodies are very, very ancient and were designed before any of these foods appeared on earth in any appreciable amount. The IBM is essentially a shorthand term I've invented for your insulin system, the balancing system that has to work to burn or store sugars and starches. For reasons that are probably quite complex, a great many of us have insulin systems that are on their last legs. It is probable that environmental toxins and chemicals have hastened their destruction. It also seems likely that the enormous amount of sugars and starches we eat over a lifetime have contributed to their demise. When the IBM goes, sugars and starches go into a landfill, rather than a bodily incinerator. That landfill--the fat mass--- generally forms in the center of the body. ( To see more about this, please watch the videos on my YouTube channel titled, "What Causes Weight Gain? Parts 1 and 2. You can access YouTube through the side bar on the left of this post).
While we remain unsure about what is causing this IBM epidemic, we can understand that it is likely happening because there is stress on a system that is fragile and vulnerable. We are not designed to process tons of carbs over a day, no less a year, 20 years, or a lifetime. Any bodily system can be overwhelmed if we push it to extremes, and we have pushed this one clear over the cliff.
On the other hand, it is very difficult to overwhelm a robust system like the one that processes the foods we ate for the past couple of million years. Just as the lion is a meat eater, you are designed as a hunter gatherer...someone who has great genetics for meat (as it originally existed, grazing on grass), poultry, fish, seafood, eggs, vegetables, lower sugar fruits, berries, seeds, some nuts and other products of the earth. Grain, rice, potatoes and corn do not grow wild and your genes weren't exposed to them for most of human history. They are recent additions to the human diet that date back about 10,000 years rather than 2 million and whose growth was made possible by agriculture. At the time of their addition, the added carbohydrate load was not accompanied by sugar (which made a major appearance only in the 1700s). Nor were these foods part of a diet loaded with calories. Grains were also not pulverized by commercial mills into flours that could easily release their stored sugars.
But no matter. Once the IBM is malfunctioning and you are diverting your sugars and starches into fat, these carb sources will cause regain if you re-introduce them into your diet. You will do just fine eating the foods that we ate for millions of years, and you won't need additional carbs beyond them.
So how do you prevent a room from reaccumulating its clutter? We would all agree that there are two techniques:
1. Avoid bringing new objects to your nice, organized space.
2. Clean up right away if things start to get messy. Don't wait until you have to call in the dumpster.
Translating this into weight talk, we get the following:
1. Don't eat carbs other than fruits or vegetables, as they will be stored as fatty clutter on your body.
2. Weigh yourself daily and clean up your "room" each and every time weight starts to get away from you by 5 to 10 pounds. Do this by cutting carbs to less than 50 grams/day or by following the basic weight loss plan that succeeded in getting your weight off in the first place. Do this until you've gotten back down toward base weight.
But how are you to live without bread, pasta, desserts, chips and so on? First of all, let me tell you that you can. In America are we are all in a continual state of EUI (eating under the influence). EUI is a side effect of the carbs in our diet. We have been conditioned to think that we can't live without these foods, but it's simply not true. You can even have fun and enjoy yourself without eating them!!!
A more complete answer is that you don't have to get rid of carbs completely, but you do have to vastly curtail them. Dr. Atkins used a term that I think was a good one: the Critical Carb Level (CCL). He believed that each person had a level of carbohydrate intake beyond which they would gain weight. If they stayed below this intake, they would remain stable. Your unique point of carb tolerance is personal to you. To be a success in long term weight control, you will need to find it.
CAUTION: I think that it's vitally important to point out that carbohydrates are highly addictive. In my observation, the factor that most often destroys weight control is not having enough respect for carbs. Carbs will take over your brain and destroy your weight control efforts in the blink of an eye. They look harmless and you feel strong. Don't believe it for a second.
When you are searching for your CCL, do so in the context of a diet that is 95% carb free (except for fruits and vegetables). Add a few carbs here and there...for example in yogurts, meal replacement bars or diet ice cream. Remain alert and aware to your trigger foods; the ones that call to you and destroy your willpower after consumption. Only you know what they are, but for me they are bread, bagels, pasta and desserts. Cereal is not my downfall. Neither is a potato. I feel less strongly about occasionally having a taste of these, and I'm much more controlled about staying away from the other stuff. After many years of eating this way, I no longer miss them at all.
Remember that you have to love your new way of eating, so experiment with new foods and combinations that can make it fun. If you like shakes, many people enjoy blending protein powders with fruit, ice and maybe a little yogurt. The possibilities are endless. Remember too that human beings are capable of forming the strangest habits. The longer you stay low on the carbs, the more normal it will seem. On the other hand, if you are constantly breaking your resolve in order to celebrate something or indulge with friends, you'll soon be at your original weight.
If you are a lucky person who can tolerate grain without gain, have fun. Most of us are not so fortunate. Remember that any diet that works to keep your weight stable and avoids medical problems like high cholesterol, blood pressure and diabetes is probably a good one for you. Tailor these recommendations to your own situation. Most importantly, it's just food. Keep a sense of humor about it all and remind yourself each day that the benefits of looks, energy, health and lessened anxiety that come along with your new weight truly outweigh that piece of bread you passed up.