Ending Addiction for Good

What Really Causes Obesity?

Research suggests that a strategy to reduce glycemic load rather than dietary fat may be helpful for accomplishing weight-loss. Read More

Lets not over complicate

Lets not over complicate this. You need a certain amount of protein based on your size to maintain muscle while dieting, you need a certain amount of fats to have your hormones function and other things work well, and the rest can be whatever. This isn't rocket science, if you eat less than you burn you will lose weight. If you treat it as a lifestyle and not a diet, you will keep it off. If you really WANT it and not just desire it, it will happen. Fat is a choice for just about everyone who is fat, but excuses are legion.

Luckily science has already come up with what you should do in terms of food here. You want about .8g of protein per LEAN pound of body weight, aka if you are 200 lbs and 50% body fat, you would need .8*100 of protein daily. This lets you keep muscle. You want also about .35 at least in fat. The rest can be whatever up to your TDEE which can be found easily online (if you can't get it tested directly) with a simple google search.

While losing weight it IS going to be harsh at times, you WILL be hungry, it can't be helped, your body is literally starving, and it doesn't want to burn fat unless it HAS to. It took years for an obese person to get that way and its going to take time to get back to normal again.

Its the will that fails, its immediate gratification over long term goals that wins. If you are obese and fail, its your fault. Period.

Fat Shaming Has No Place Here

"Its the will that fails, its immediate gratification over long term goals that wins. If you are obese and fail, its your fault. Period."

What a horrifying and unfair comment.

There are many reasons a person may become overweight, even obese that have nothing to do with will. Hypothyroidism, for example, is one cause. Recuperation from surgery is another. I could make a long list, but I think you will get the point.

The issue is that controlling weight is not as simple as calories in, calories out. The kind of food you eat, the portions, the processing, the frequency with which you eat, etc. -- it all plays a role in how you feel and your overall health.

"The issue is that

"The issue is that controlling weight is not as simple as calories in, calories out. The kind of food you eat, the portions, the processing, the frequency with which you eat, etc. -- it all plays a role in how you feel and your overall health."

I'm sorry but you are completely wrong. If your TDEE (total daily energy expenditure) is 2000 calories a day and you eat 1500 a day, you will lose about a pound a week. It can be hard to see this with water fluctuations etc, but do that for a few weeks, see where you are at. If you are losing, keep doing it, if you are not, lower your calories slightly. TDEE changes day to day and methods of calculation are not perfect. Most people overestimate their physical activity levels which is why for me I go by my RMR (Resting metabolic rate) and not TDEE.

WHAT you eat can matter somewhat, especially in terms of hormones and muscle retention (you want some fats and higher protein then normal) BUT do yourself a favor and google "twinkey diet" to see what really matters here, calories.

(Here I'll do it for you. http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/)

Worrying about meal frequency, processing, GI, portions are all pretty minor. If YOU were to follow what I laid out YOU would lose weight, you just have to stick to it.

You don't need exercise, in fact exercise for some people makes it worse because they feel they can eat more because they exercised and end up eating far more than they burn (studies support this one too).

When I lost weight (maybe 50 lbs of fat, I gained muscle as well but thats another topic) I had around 50 people I knew through my practice ask me how like I did some sort of magical feat. I even had some obese ones mad at me telling me I was too thin (190 lbs 6'0" with muscle is "too thin" apparently). It was just simple math and STICKING to it long term, not just whining I didn't lose weight a few days in a row and quitting.

So doctor, you can either over complicate this, and be doing you and your patients a horrible disservice, or you can educate yourself on current research on the subject, and try not to cherry pick results, there is a LOT of bad research out there and I'm hoping your education was enough to identify the papers with poor methodology vrs the good ones.

Good luck in your journey, I found going through life unhappy with my body was worse then missing a few meals for a number of months. I also found my health has GREATLY improved by doing so. I've had one cold in the last 3 years, it lasted maybe 3 days. I don't have to worry about what clothes look good on me, they all do. I smile when I look into the mirror shirtless. I hope someday you feel you can too based on what you see.

it's not fat shaming

Surely there are some fat people recuperating from injury or with thyroid issues. But that's not the, um, bulk of obese people, and surely not the bult of obese children.

It's diet, willpower, and motivation. Our overindulgent, pseudo-attachment parenting has raised two generations of wimps who can't tolerate discomfort. The obsesity rate should be 80% lower than it is, and motivation and willingness to tolerate discomfort is the problem.

We'd believe you much more if you would just admit the truth

Your readers are skeptical, because we know the science and the biology. So why don't you just admit the truth? The truth is, in the vast majority of cases, people are obese because they take in more calories than they burn. A person who walks seven miles a day, even doing no formal exercise, can eat more than a person who walks 1.5 miles a day, because that person is burning more calories. However, even a person who walks seven miles a day has a calorie number that they cannot exceed on a consistent basis if that person wants to maintain his or her weight.

All this flapdoodle about glycemic indices, insulin, and whatnot is cover for the vast majority of people who simply do not have the willpower or motivation to keep their calorie count where it needs to be. For the vast majority of people, it is deck chairs on the Titanic.

I read your reader's link to the Twinkie diet thing. It is compelling.

If you do not admit to this basic truth about food and weight, it is hard to take you seriously when it comes to other addictions.

You Are Entitled to Your Own Opinion, But Not Your Own Facts

If you read the work of bariatric physicians, MDs who work with obese patients and researchers in the field of obesity, they are telling us that while calories in calories out is certainly part of the equation -- and yes, Cynthia, someone who exercises intensely will burn more calories than someone who does not -- they are ALSO telling us that the type of calories a person eats matters.

Bariatric physicians put their patients on low calorie diets AND low glycemic diets (and usually low fat too). Lean protein and vegetables. Even fruits are to be limited or avoided because of the way the body reacts to and metabolizes the sugars.

You may not want to believe that this is true, but those are the best facts science currently has to offer.

Calorie dense foods are

Calorie dense foods are avoided. This does not mean they matter beyond being calorie dense. Try to eat 3000 calories of broccoli and grilled chicken sometime and you will see.

It really has nothing to do with GI or the like. Lost 1.5 lbs myself last week. Ate fruit salad every night. If you want real research on this look not at poorly controlled studies on obese people.

Facts we can share: a calorie is a calorie is a calorie

But Dr. Scharff, don't take my word for it. This is from the website of the federal Department of Health and Human Services. Believe me, with Obamacare? The feds have a real interest now in reducing obesity, and it has been Michelle Obama's main platform for quite some time, especially with kids:

" We've been talking a lot about calories. Why? Because the number of calories you eat and drink, and use up through daily activities, is closely associated with your weight. Does it matter what types of foods the calories come from? Yes and no.

When it comes to calories and managing your weight, the answer is no. A calorie is a calorie is a calorie. Choosing healthy foods is important, and we'll address that in the next chapter, "Calories + Nutrients = Food." But first you need to learn about calories: what a calorie is, how to count calories, and how to set your calorie goal. This information will help you assess how close you are to your calorie goal. Then, you will be able to choose the kind of changes that will get you on your way to a Healthier You. "


And this is from JAMA, summarized at Greatist:

"Think a balanced diet is the key to avoiding weight gain? A new study suggests otherwise. Researchers say calories— not the ratio of protein, fat, and carbs— are the main reason we plump up.

In the study, 25 men and women ages 18 to 35 ate about 1,000 extra calories a day (who suckered them into that?) for eight weeks. But nutritional values varied among three groups— some ate a low-protein diet and others ate a normal or high-protein diet. Results showed all participants accumulated about the same amount of body fat, although the low-protein group gained slightly more fat. Study authors conclude excess calories mean extra body fat, regardless of whether those calories come from grilled chicken or Krispy Kremes."


And finally this, from PBS' famous show NOVA:

"From our reading of the research, we conclude that, while the precise nature of the relationship between diet composition and weight maintenance needs more research, the number of calories consumed relative to those expended matters more to weight loss than where the calories come from. To lose weight, eat less; it works every time."



Now, would I recommend that a person get all their calories from meat, or all from pasta, or all from Gulp trout fishing bait? :) No way. Weight is not the only measure of health. But when it comes to weight, a calorie is a calorie is a calorie. Those aren't my facts. Those are the facts.

Calories Matter -- So Does What You Eat

No one is suggesting that calories do not count, but even the studies cited in the conversation here recognize that the TYPE of food you eat ALSO matters to prevent weight gain and for good health. Read the studies carefully. Those who ate diets low on the glycemic index had less weight gain than others. No diet is going to work if a person eats without regard to calories. That said, the latest research indicates that efforts to lose weight and/or keep it off are aided by a low glycemic diet.

it's still motivation and willpower

The starting point for this dispute was the issue of willpower. It is still the issue of willpower. If a person does not have the willpower to eat fewer calories, that person will not lose weight. If the person does not have the willpower to eat foods lower on the glycemic index, that person will not keep weight off and/or be healthier (though the anecdotal data of the Twinkie diet self=study cited above seem to indicate that "healthier" can even be achieved with a diet purely made of Twinkies, so long as the daily caloric intake is cut significantly.

Willpower. Motivation. Discipline. Focus. Willingness to suffer for a larger cause. The keys to any achievement, from winning the Second World War to losing 50 pounds.

I've lost about 5 lbs since I

I've lost about 5 lbs since I first posted on this on June 4th. I gained a bit over the last few months and I have a goal to get to 175 for abs by no later than Nov. I had 434 calories for lunch, 59g protein.

Yesterday I cheated a bit and had 2 English muffins with butter, but was still just over 2000 calories for the day.

Its simply counting and will power. Its not giving up after a bad day and sticking to the plan.

Everything else is just added fluff, which makes things more complicated than they need to be.

Whats funny is take the "experts" out of this equation, go to a fitness forum where instead of excuses and theory, people have actually DONE it, and you will see how this is really done.

JAMA and the New York Times: A calorie is a calorie, and glycemic index makes no difference.

Here's the quote from the article from today's NYT:

Dieting and Weight
Questioning the Idea of Good Carbs, Bad Carbs
By Anahad O'Connor
December 16, 2014 4:00 pm

"The study, published in JAMA, found that diets containing low glycemic foods did not lower cholesterol and other heart disease risk factors compared to diets containing mostly high glycemic foods. Nutrition experts argue that low glycemic diets improve blood sugar levels and insulin sensitivity. But the new study found that low glycemic diets actually made insulin sensitivity worse."

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Constance Scharff, Ph.D. is the Senior Addiction Research Fellow and Director of Addiction Research at Cliffside Malibu Treatment Center.


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