Responses To My NY Times Post

Here is a conversation that is posted on Tara Parker-Pope's NY Times "Well" blog. Click here for original posts:

To: Dr. Abramowitz (#91),
Excellent post.

Continuing the thread from one of Tara’s other columns (Maybe you have already commented upon this), how would you suggest physicians address weight loss issues with obese or mobidly obese individuals who are metabolically unhealthy? Would it be better for doctors to not focus on weight per se, but to discuss life style changes generally known to be associated with improved metabolic health; while offering verbal praise during future visits for any incremental improvements in target biomarkers?

— Posted by W

Here's my response: RE: W - #113 Regarding your question: "Would it be better for doctors to not focus on weight per se, but to discuss life style changes generally known to be associated with improved metabolic health; while offering verbal praise during future visits for any incremental improvements in target biomarkers?" YES, W - This sounds like the perfect answer! The word "weight" should no longer be mentioned, in my opinion, and the ritualistic weighing of the masses should be extinguished for good.

There are many factors for health and longevity that can be suggested, including physical activity (regardless if weight is lost), eliminating transfats, listening to bodily signals of hunger and satiation, and drinking green tea or red wine. (The latter can be easily incorporated as tinctures or capsules; I put a few drops of green tea concentrate in my juice, and take a resveretrol capsule - all the benefits with minimal effort!)

Doctors must educate themselves about how to be fit at any size. They should ask patients questions about lifestyle, instead of assuming that overweight people are sloths. Gathering information about previous weight loss attempts and weight regain might be enlightening, as many overweight have tried numerous weight loss plans, which inevitably plan. It would be nice if doctors offered compassion and understanding for the struggles that fat people have endured when trying to follow damaging diets and discrimination from others. Overall, research has found that dieting leaves people fatter than those who have never dieted!

Here's another response:

108.
August 20th,
2008
11:46 am


Dr. Aronowitz, #91–
Thank you–I always enjoy your postings to this blog. I have a question about set-points, though.

Why is it that for many “yo-yo” dieters, our set-point seems to *rise* with each regain of weight after a substantial weight loss?

I am a 54 year old woman. Over the past nearly 4 decades, I have lost a total of well over 200 pounds and regained more like 280. Each time I’d lose between 40 to 60 pounds on a carefully-followed diet (Weight Watchers, 4 different times, and others as well); and then within 5 years I would have gained it all back PLUS about another 10 to 15 pounds.

The upshot is that I am now about 60 pounds heavier than my “setpoint” was when I was 18. I suspect that repeated weight loss and regain somehow nudges the setpoint ever higher and higher, but I wonder if you have any thoughts on that point. Thanks.
— Posted by me
_

My Response:

RE: #91. Thanks, ME! Regarding your concern, "I suspect that repeated weight loss and regain somehow nudges the setpoint ever higher and higher, but wonder if you have any thoughts on that point." YES! I believe that each time weight is lost and regained, the body's survival mode kicks in by making more "efficient" use of the calories it's given. This means storing more of them as fat, to ensure enough stored energy to use for the next famine. The body can't distinguish between self-imposed semi-starvation (i.e. a "diet") and a nuclear holocaust where food supplies are tainted, and we can't eat until the next harvest. I have watched hundreds of patients diet and regain weight, and believe that it takes a lot fewer calories to regain the lost weight than would be expected.

General knowledge states that a simple formula - calories in vs. calories burned results in a certain weight. However, our genetic blueprints vary tremendously in how our bodies use calories. Did you ever have a skinny friend who can eat all the crap in the world and still stay thin, while others practically gain weight with the smell of baked goods? There are so many factors operating, and we must treat our bodies as a miracle of nature - by taking pretty good care of it and being grateful for letting us experience pleasures on earth.