Shame on You, Dr. Oz!

Previously posted on Diet.com!

Once again I must take issue with you.

But I digress.

Has anyone ever heard of Garcinia cambogia?  It’s Oz’s newest darling. He was gushing over this stuff, calling it the “holy grail of weight loss!” 

 

Well, of course I was excited to drink the Koolaid too, but first I hungrily googled the heck out of it… which I wondered if Dr. Oz had done.

If so, he might have mentioned the study in the Journal of the American Medical Association, a twelve-week randomized, double-blind, placebo-controlled trial. “Garcinia cambogia failed to produce significant weight loss and fat mass loss beyond that observed with placebo.”

Oops!  Faux pas!!!

In fact, this study was actually criticized for using a high-fiber diet, which is thought to impair its absorption.  Criticized?  A high fiber diet is basically fruits, vegetables and whole grains.  Too bad eating healthfully is contra-indicated for this panacea.

The NYU Medical Center newsletter succinctly reviewed an eight week study of 60 overweight individuals finding some weight loss.  Another trial found no effect on appetite.  One more study tested to see if it could cause weight loss by altering metabolism, but no effects on metabolism were found.

Taken together, I’d say this is all very underwhelming.  Furthermore, I would toss the lot of them down the drain, because none have any long term follow-up.  Everyone knows that most people gain back lost weight, regardless of how it’s lost!  How dare he sing such glaring praises, before any credible evidence is in!

I could see why Dr. Oz might be giddy about it, before results are conclusive.  This natural extract supposedly boosts serotonin, which helps with mood, and might conceivably reduce emotional eating.  Furthermore, it supposedly inhibits an enzyme from turning sugar into fat, and instead encourages the liver to turn it into energy and lean muscle mass, instead of fat.

So what happens after people go off this?  Don’t know; there isn’t any research.  But there is a body of work to suggest that the body may overcompensate, such as losing weight on amphetamines, and then rebounding when going off.

I believe the two part system, of trying to lose weight and then trying to maintain that loss, has failed most people, regardless of how weight was lost.  We need one way of living healthfully forever. 

A healthy lifestyle includes a variety of natural foods, listening to hunger and satiety, coping effectively, and moving your body.  Genetics account for the rest, including actual weight.  The scale will reflect that ideal combination of heredity and lifestyle; nature and nurture.  Some people will be heavier, and some will be thinner, which is OK.  Diversity is natural, and desirable.

If someone was restricting food before moving towards a healthy lifestyle, they will gain weight.  If they were overeating and not moving their body, their weight will naturally move towards a healthier point in their set point range.  Weight fluctuation is a byproduct of living a healthy lifestyle, and not a valid goal or indicator in itself.

Let’s finally get off the scale, and focus more on health.

 

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“Obesity Crisis; Real or Imagined?”

As seen on DIET.com!

Being overweight (BMI  25–29)) was associated with LOWER mortality than “normal” weight, in an analysis of nearly 100 studies! This impressive review, published in a prestigious medical journal, included nearly 3 million people from around the world. Lower mortality rates were also found for “grade one obesity” (BMI 30-35), compared to normal weight people (BMI 18.5-24). 

Happy New Year to me!  I’ve been talking about this phenomenon for ages, based on many individual population studies.  But this is the mother of all studies!

So what do we do now?  Encourage people to gain weight instead of lose weight?  Should government subsidies provide cheaper, low quality, potentially toxic foods to fatten us up?  Should pharmaceutical industries create drugs that coax weight gain instead of weight loss?  Should surgeons be sued for weight loss surgeries that mutilate digestive systems, before having adequate evidence of creating long-term health?  These ideas sound may sound absurd, but no more absurd as the opposite.

My message has not changed.  People naturally come in all sizes, and everyone must strive to live a healthy lifestyle.  Every overweight person will not live longer; these studies simply reflect trends.  There are probably evolutionary advantages to all sizes, which ought not be messed with.  Super -obese people may live  longest if our food supply dried up, but may die off a bit sooner if not needed for survival.  Don’t they deserve respect for this important role?

So how can we reduce stigma, bias and discrimination against people of size, while helping everyone to become healthy?  First of all, stop beating yourself up for feeling fat!  It is abusive, demeaning, degrading, and counter-productive.  It is exactly the same as if you called other people those ugly names.  Offer yourself the same respect you would offer friends or strangers.

 Next, our government should eliminate ” ideal weights” and “BMI’s.”  Assess health according to lifestyles, biological markers, (blood pressure, cholesterol and insulin resistance), and perhaps some physical measures of strength and endurance.  

 Exercise often improves all of these indicators, for people of all sizes!

Nuts, avocados, dark chocolate, fruits, whole grains and salmon are healthier than partially hydrogenated oils, processed foods, and chemicals for everyone.  Responding appropriately to hunger and satiation might work better than portion control, and coping effectively is always a plus… regardless of pounds on a scale.

 Americans are living longer than ever, despite being fatter.  This doesn’t sound like a crisis to me!  In times of abundance, people maximize height, weight, and longevity, but we must realize the price for living longer.  Being mortal, we must die from something.  Deaths from cancer in the US are astronomically high, compared to cancer deaths in India, because they don’t live long enough in India for those cancers to develop!  It’s not because we’re fatter!

 So let’s stop the hysteria, and use the wonders of medical science to replace a knee, control diabetes and manage other maladies, without blaming fat people for being fat.  We don’t blame thin people for being thin, despite their higher death rate than overweight people!

 Genetics account for at least 60% to 80% of our weight, so let's do the best we can with what we have.

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Fed. Govt. Abandons Huge Failed Diet Study

As previously posted on Diet.com!

Unbelievably, a large federal study recently found that diet and weight loss DID NOT  reduce, strokes, heart attacks or cardiovascular deaths with overweight diabetics.  In fact, the
study was stopped 2 years ahead of schedule, because it just wasn’t working, after 11 years! 

It sounds shocking, but not in light of other recent research.  Normal weight diabetics were twice as likely to die than overweight or obese diabetics, and there are better survival rates for overweight people with heart failure, hypertension and kidney disease. (See previous posts)

Interestingly, those assigned to the diet and exercise group did manage to lose 5% of their weight, and keep it off, resulting in less medication usage.  My hunch is that the improvement in lifestyle helped, not the measly weight loss.  This is what “health at every size, naturally” means.

Although short-term studies find that weight loss lowers blood sugar, blood pressure, and cholesterol in the short term, they do not prevent actual occurrences of deadly events. 

The diet involved 5,145 overweight or obese people with Type 2 diabetes.  Those weighing less than 250 lbs ate 1,200 to 1,500 calories a day, while those weighing more ate 1,500 to 1,800.  They exercised moderately for at least 175 minutes per week; sounds like around 25 minutes a day.  The control group received general health information.

It is thrilling that every recent notable study has supported the idea of living a healthy lifestyle, and not worrying about weight loss. 

What a relief!  It still takes energy to move towards living healthfully, but the pressure is off.  We are meant to be diverse, and must strive towards becoming our personal best; not an artificially determined weight that is impossible to maintain, and ravages our self-esteem.

The trick now is to accept our body size as a result of living healthfully, even though it probably looks fatter than you like.  We have been brainwashed that thin is attractive, and see our own fat as gross.  Well, we all gotta get over it!

Accepting our bodies doesn’t mean we like them, or find them attractive.  It just means that it’s OK; not what we would prefer, but good enough.  Then stop thinking about it, and think of something else.

Let’s just take pretty good care, and focus instead on what our bodies allow us to do.  They help us to move around, give and receive love, smell beautiful scents, and taste delectable food.  The hell with cellulite, it’s time to live!

Do not wait to get on with your life till you lose weight.

Do not put your body down, publically or privately.

Just call a truce, and live in peace. 

You take care of it, and it will take care of you. 

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Great News for Health At Every Size, Naturally!

Previously posted on Diet.com

Here’s more exciting evidence supporting my work, about striving to be fit and healthy regardless of size. Ideal weight is naturally achieved by combining your genes with a healthy lifestyle.



These studies lend support to a previous body of research, finding that people can be fit and fat.

One study examined data from over 43,000 Americans from the Aerobics Centre Longitudinal Study between 1979 and 2003. Health was correlated to fitness more than weight. Obese individuals were metabolically healthy and fit from getting more exercise. Being overweight did not have to pose an added health risk.

The study showed that healthy obese people have the same overall prognosis as those in a normal weight range, with a lower BMI!

Another study, with 64,000 patients in Sweden, examined obesity and death rates from acute coronary syndromes.

The study found that for obese coronary patients with a BMI of less than 40, losing weight is always bad! Underweight heart patients had double the risk of dying than those of normal weight. Overweight and obese patients carried the lowest risk. Who’dathunkit???

Well, this might sound familiar. Why? Because my last post described a huge diabetes study, finding that normal weight diabetics were twice as likely to die than overweight or obese diabetics!

How can this be? We have been programed to believe that thin is healthy and fat is disgusting. But current research is in line with population studies around the world finding that overweight people tend to live the longest.

Funny, how research can’t compete with deep seated prejudice against fat, and profitable fad diets.

Let’s not do to ourselves, what our culture has done to us. Never put your body down. Do not participate in fat conversations! Just try to live a moderately healthy lifestyle, and move on!

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JAMA Research Breakthrough: Fat Helps Diabetes!

Previously posted on Diet.com!

The Journal of the American Medical Association reported that normal weight diabetics were twice as likely to die than overweight or obese diabetics! These findings involved over 2,500 diabetic patients in long term studies.

View THE NEW YORK TIMES article here!

As surprising as this sounds, the same effect has been previously documented in people with heart failure, hypertension and kidney disease.

Why is this surprising? Because we are constantly bombarded with messages proclaiming that thin is healthy and fat is disgusting. These messages come from industries making billions by training us to believe this. Scientists simply can't compete with their huge advertising and marketing budgets. Research makes headlines for a day and gets buried, while scientists quietly go about their work.

The "obesity paradox" is a term suggesting that people with certain chronic diseases tend to have lower mortality rates if they carry excess pounds. How much more evidence do we need, before we call it a blessing?

Researchers at Dallas' Cooper Institute studied 22,000 men for 8 years. They found that men who were overweight but fit were two times less likely to have died than those who were lean but unfit.

The Harvard Nurses' Health Study found that physically active people had lower death rates, regardless of weight, than thin people who exercised less than an hour per week.

Even our own government studies (NHANES) confirm that overweight people tend to outlive thin people.

How about we toss out the scale, and strive to live a healthy lifestyle? Eat more natural foods, listen to hunger and satiation, move your body and cope effectively. That's about the best we can do.

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Dr. Abby Gets Personal

Dr. Abby Gets Personal

As a passionate observer of weight fluctuation, I became fascinated by my parents’ recent journey.

Mom was skinny for most of her life.   I remember Dad making malted milkshakes to fatten her up, when I was young.  (None for me, though!)  As she hit her 70’s, she spread into a size 16, but retained her bean pole legs.  She never really dieted, but went through brief periods of “watching her weight.” 

Her weight gain seemed normal to me as she aged, and I was happy that it would protect her bones.  This was gratifying, since the most exercise she ever does is pushing a fork or remote control.

Early in her 70’s, she became ill, and lost about 20 pounds.  She was finally diagnosed with” Cdiff.”  After a few months it was under control, and she regained all 20 pounds.   

Dad always looked normal to me, though he developed some weight around the belly, as he aged.  He often did “calisthenics” at home, and before my time, was a very fit soldier.  His love for tennis kept him in good shape, and still helps manage diabetes, at 83. 

Last year, Mom underwent surgery for colon cancer, which resulted in a shortened colon.  There were some complications and scary moments, but in the end, she was cancer free, and able to live her life.

She lost 30 pounds over 6 months during the ordeal, yet gained every single one back in the next 3 months.

Dad was loyal and caring throughout, and moved into her hospital room for the duration.  They snuck him hospital food every day, and after six weeks, he lost 15 pounds. Afterwards, he also regained all of those pounds, in half the time taken to lose them.

Did Mom and Dad pig out, during the recovery?  Hardly.  They ate normally, and had absolutely no control over their weight.  Their bodies simply reverted to homeostasis – their normal weights.  In fact, they actually eat less than ever!  Mom says they used to have a steak each, and now simply split one.  Their bodies manufactured more weight from less food.

There was one other notable weight-related event.  About 8 months ago, Dad fell on the tennis court, and sustained some injuries.  He had to stop playing for a few months.  During those months, he lost about 7 pounds!  What could explain that?  Exercise is supposed to help you lose weight, not gain!

Perhaps he lost muscle tone, which is heavy, and perhaps he inadvertently ate less, since his body required fewer calories.  Who knows, but when he started playing again, he regained the weight.

What’s the moral of the story?  Our biological set points are tough, sturdy markers, which operate to maintain our optimal body weight.  People naturally come in small, medium, and large sizes, and try as we may to permanently alter our weight, it may be a losing battle.

These observations certainly reinforced my belief to strive for “health at every size, naturally.” Live a healthy lifestyle, to become your personal best.

I also believe this experience offered my parents a new perspective on people of size.  Perhaps they no longer believe that all fat people are gluttons.  Gaining 30 pounds in 3 months was eye-opening, and helped them to become more compassionate and respectful of diversity.

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Dessert for Breakfast!

Originally posted @ Diet.com

Here’s a headline to celebrate: “Dessert at Breakfast May Help Dieters!” I wanted to toast to it, with cookies instead of toast!

I hungrily continued reading about this extraordinary study. Researchers divided 144 obese subjects, into a low carb breakfast group (LC), and a high carb plus protein-and-dessert breakfast group (D). Dessert eaters could choose from cookies, chocolate, cake or ice cream. Daily calories remained the same for both groups, but the LC breakfast contained 300 calories, while the D group enjoyed 600 calories for breakfast. Everyone ate the same lunch, but dinner consisted of 600 calories for the LC’s and 300 calories for the D’s.

At the end of 16 weeks, both groups lost about 32 pounds. However, after another 16 weeks, the dessert group lost an additional 13 pounds, while the others regained all but 3.5 pounds! Isn’t this the best news ever?

Here’s the science: Those on the dessert regimen maintained lower levels of ghrelin, which is the hormone responsible for hunger. As a result, they reported being more satisfied, with significantly reduced hunger and cravings than the LC breakfast group. The LC breakfast group experienced increased cravings for sweets, fats, carbohydrates/starches and fast foods! 

But here’s the piece de resistance...

Both groups had similar insulin and glucose levels before the study, and both groups improved at week 16. However, by the end of follow-up, the dessert group enjoyed even better levels, while levels became much worse for the LC breakfast group!

The same thing happened with cholesterol and triglycerides. Both groups were similar, but by the end, total cholesterol, triglycerides and LDL (bad cholesterol) were significantly lower for the dessert-eaters, than the low carb breakfast group! In fact, the good cholesterol (HDL) was significantly higher! Yahooooo!!!!!!!!!!!

It looks like dessert-eaters were so satisfied at breakfast that they were able to continue their diet into the end zone. The joy of eating dessert at breakfast, combined with reduced ghrelin, is a winning combination that can probably be sustained forever. Would you complain if I prescribed that for you? The low carbers could not continue adhering to their regimen, and regained most of their weight.

I have often suggested that my patients eat treats for breakfast, such as a whole grain waffle, with natural ice cream, and a drizzle of chocolate syrup. Those who comply, never binge on ice cream later. It seems better to have preferred foods when there is more control, such as in the morning, which seems to get it out of their system.

Having treats for breakfast also eliminates the “forbidden food” syndrome, by lowering its reward value. If you know you can have cake for breakfast, there is less desire for it at other times. We call it “prescribing the symptom.”

Bottom Line: Eating a high carbohydrate, high protein breakfast including dessert, can help people to maintain a healthy weight management plan.

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