Why we're obese and what to do about it
Key take-home points from the last 20 years of research
From one thing to another, right?
But when I saw that spicy (and over-simplified) headline on the new Biden admin appointee stating that obesity is mainly caused by genetic factors and can’t effectively be addressed with diet, I just had to bite.
Not least since at the very same time as these talking points are spinning around the world, they’re also pushing for “early treatment” of obesity in kids with surgery and drugs.
I’m a philosopher of religion (well, interdisciplinary researcher, but).
I’m a traditional Catholic with significant leanings towards mystical theology. It’s not really my job to point out the importance of basic physics or of incontrovertible evolutionary mechanisms, which I’m surprisingly often forced to do.
But to say that obesity cannot be effectively addressed with diet interventions is pretty much to toss the laws of thermodynamics out the window.
Obesity has almost nothing to do with anything except your diet.
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While genes can modify everything from energy expenditure to your propensity to generate adipose tissue (body fat), it’s physically impossible to expand your body mass over and above what’s permitted by your caloric intake. Can’t be done, no matter what genes you happen to possess.
But that doesn’t mean that the situation is quite so simple in practice.
The controversial Dr. Stanford is namely entirely correct in a sense which is obscured by the clickbait headlines. Her statement that genetics is the key factor is certainly correct if we take our current Western food environment and activity levels as a given.
In reality, it’s almost impossible for any normal human being with healthy hunger cues and reward-seeking patterns, to not become obese here. I’m not fat-shaming anyone. It’s rather that almost anyone who actually manages to avoid an insidious weight-gain over time is a behavioural or genetic outlier. A bit deranged.
Dr. Stanford’s position is exactly in line with the fact that prescribing a moderated calorie intake and a healthy diet for a population in relative poverty, completely awash in cheap, high-reward/high-calorie foodstuff, is almost completely useless.
But that doesn’t exonerate pharmacological solutions. We need much more radical ones.
But I disgress. Basically, human beings are adapted to an environment with limited and quite expensive (energy-wise) resources. The pre-agricultural food environment meant that you had to expend a good deal of energy to access foodstuff with generally a low-to-moderate reward.
High-calorie food (generally, but it’s not quite so simple) elicits high reward (through dopaminergic reward systems), and was comparatively rare in our ancestral evolutionary environment. Maybe you got hold of honey once in a while, and then you gorged. And maybe you caught a fat and juicy turkey (and roasted and ate its entire epidermis in one sitting).
But even with plenty of access to these foods, way more pleasurable than wild roots and herbs, you’re unlikely to overeat. A normal human being will get sick of raw honey pretty fast. Same with tallow, plain starchy tubers or what have you.
But combine simple or refined carbs with tasty fats (and preferably also that essential, life-giving salt), and almost everyone is going to overeat.
And this high-reward, high-calorie environment is basically what contemporary industrial “cuisine” amounts to.
Stephan Guyenet, Ph.D in biochemistry and a researcher on the biomechanics of obesity, is perhaps the single best resource on the finer details of the connection between modern industrial diets and obesity. I highly recommend his work for anyone interested in the minutiae of the issue.
But to reiterate, the overarching problem is that the signals and cues we’ve been relying upon for our entire evolutionary history have become essentially untrustworthy in the modern food environment.
So what can we do about this?
There are four basic strategies, which all are increasingly supported by relevant contemporary research (and really amount to obvious common sense). A couple of these are entirely sufficient in and of themselves, while the others are probably best regarded as supplementary.
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1.
The tried-and-true approach is to count calories. This is simpler than you might think, especially if you’re just interested in maintaining body weight, or if your goal is body recomposition.
But if you want to reduce body fat levels, the really important thing for a sustainable and healthy process is to not overdo your calorie restriction (either in terms of the reduction per day, or the total time frame of reduction). It also takes a certain anal-retentive tendency to really get the hang of it, but when you get used to it, it’s perfectly simple.
For this method, the easiest approach is to just use some calorie calculator app with a good pre-set list of foods. Cronometer.com is free and works fine. What you then need is a decent estimate of your daily calorie expenditure (which is based on body size, body fat percentage, and approximate activity level), after which you simply aim for a daily consumption of about 90-95% of your calorie expenditure. Macros (relative ratios of fats, carbohydrates and proteins) aren’t hugely important, but a decent protein intake is highly recommended (1 gram per pound of lean tissue, i.e. bodyweight except body fat), especially in light of strategy 4 below.
This will result in a slow but sustainable fat loss with minimal discomfort while you retain (or even increase) muscle mass, assuming you exercise. A much lower caloric intake than this means loss of lean mass.
Refeed days once per week are also hugely important for all but the very obese. These basically mean a caloric intake around 10% above maintenance, with the purpose of keeping your body and brain out of “starvation mode”.
2.
A modified eating window is another increasingly popular approach. The 5:2-diet is an example, as well as various forms of intermittent fasting. Here, the basic idea is to modify caloric intake by only eating during a certain set time frame every day (e.g. between noon and 6 pm), which will restrict caloric intake through basic satiety and leaves you relatively free to not think very much about numbers and percentages.
3.
Another approach is to simply change the diet to less palatable, highly sating, low-calorie, or low-reward food. Or a combination. The paleo template is one version, while the above-mentioned Guyenet (to my abject horror) suggested we only eat bland, low-reward food. If I get wine and tobacco, I guess it could work.
4.
Increase energy expenditure. While it’s very difficult to exercise your way to body fat loss without any diet interventions whatsoever, moderate exercise synergizes extremely well in combination with diet interventions. This will upregulate energy expenditure by several causal pathways, not least since lean mass takes more calories to just maintain, but it’s also going to help you become more active in a wide variety of ways. Mentally, socially, as well as physically.
I personally recommend weightlifting. Basic beginner’s program, three times a week, 45 minutes per training session is perfectly sufficient for anyone except advanced athletes.
You can also take ice baths or sleep with the window open during winter. But that’s no fun.
Excellent advice. I've used 1, 2, and 3, always in combination with 4. First year I dropped 50 lbs. Second year I got down to about 14% body fat, and was starting to get fairly shredded.
Weight training is hugely important. Caloric restriction on its own will be catabolic - the body will cannibalize that metabolically expensive muscle tissue before letting go of that valuable fat, so you'll lose weight but end up weak. Aiming for about 1 lb per week of weight loss while reminding the body that it needs that muscle by regularly challenging it with resistance training is the only way to go if the goal is to be fit and strong.
The other advantage of weight training is the afterburn effect. Repairing muscle tissue is metabolically demanding, meaning lots of calories get burned after the workout. The same is not true for cardio.
One thing I found worked well with fasting was to do my workout in the morning - weights, then a long walk of 5 miles or so, and during the summer finishing with a few dozen laps in the pool and 20 min or so of sunbathing. Then breakfast. By that point you're ravenous, but while working out the body can be trained to forget about the gastrointestinal system for a while.
Not to mention that the juicy turkey of hunter gatherer days had not been confined and artificially fattened for his whole life. My mother grew up rural poor, and used to say that chicken didn't taste like chicken any more; too many hormones and too little roosting in trees I guess.
but overall, the idea that we need surgical and medical interventions for everything is some strange sci-fi fantasy, really. But more nefarious on the part of dubious institutions like the american soc of pediatrics (who also support the "covid" jab for children).