An easy-to-follow, encouraging approach can offer evidence-based strategies to help you lose weight and avoid gaining it back. The weight-loss tactics will guide you in customizing your own healthy weight-loss plan-one that works for you, without calorie-counting, starving, and deprivation. It is important to understand the dangers of carrying extra weight, along with the countless benefits of losing weight. To address physical fitness needs, a mix of aerobic, strength training, and balance exercises is recommended. Chronic stress can exact a toll on us-physically, emotionally, and psychologically.
Understanding Obesity and Bariatric Options
Dr. Ellner explains the disease of obesity, how the different operations work, risks and complications and what to expect, using her own patients as teaching examples in educational videos. Dr. Ellner requires that all of her patients watch the video, even if they have attended a live seminar, as the video is far more detailed than the brief overview of the topic that is presented in the live lecture.
The Quest for Truth in Weight Loss
If there was some safe, simple, side-effect-free solution to the obesity epidemic, we would know about it by now, right? It may take up to 17 years before research findings make it into day-to-day clinical practice. To take one example that was particularly poignant for my family: heart disease. You know, decades ago, Dr. Dean Ornish and colleagues published evidence in one of the most prestigious medical journals in the world that our leading cause of death could be reversed with diet and lifestyle changes alone-yet, hardly anything changed. Even now, hundreds of thousands of Americans continue to needlessly die from what we learned decades ago was a reversible disease. In fact, I had seen it with my own eyes. So, if effectively the cure to our number-one killer of men and women could get lost down some rabbit hole and ignored, what else might there be in the medical literature that could help my patients, but that just didn’t have a corporate budget driving its promotion? Well, I made it my life’s mission to find out. There are no ads, no corporate sponsorship. It’s strictly noncommercial, not selling anything. I just put it up as a public service, as a labor of love, as a tribute to my grandmother.
Evidence-Based Weight Loss: Beyond Anecdotes
The science shows the best way to lose weight. Testimonials and before-and-after pictures are not enough; the evidence is what matters. The problem is that even just sticking to the peer-reviewed medical literature is not enough as, “False and scientifically [misleading] unsupported beliefs about obesity are pervasive” even in scientific journals. The only way to get at the truth, then, is to dive deep into the primary literature and read all the original studies themselves. There are more than half a million scientific papers on obesity with a hundred new ones published every day. Even researchers in the field might not be able to keep track beyond their narrow domain. NutritionFacts.org combs through tens of thousands of studies a year so you don’t have to. There is a treasure trove of buried data, like simple spices, for example, proven in randomized, double-blind, placebo-controlled trials to accelerate weight loss for pennies a day, but with so little profit potential, it’s no wonder those studies never saw the light of day. 100 percent of the proceeds I receive from all of my books, and DVDs, and speaking engagements are all donated to charity.
Calorie Density: The Key to Satiety
Weight loss isn’t just about eating less and moving more. The notion that a calorie from one source is just as fattening any other is a trope broadcast by the food industry as a way to absolve itself of culpability. In a tightly controlled laboratory setting, 240 calories of carrots (10 carrots) would have the same effect on calorie balance as the 240 calories in a bottle of Coke, but this comparison falls flat on its face out in the real world. You could chug those liquid candy calories in less than a minute, but eating 240 calories of carrots would take you more than two-and-a-half hours of sustained constant chewing. Our stomach is only so big.
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Once we fill it up, stretch receptors in our stomach wall tell us when we’ve had enough, but different foods have different amounts of calories per stomachful. Some foods have more calories per cup, per pound, per mouthful than others. This is the concept of calorie density, the number of calories in a given amount of food. Three pounds is about what the average American eats in a day. For example, oil, has a high calorie density, meaning a high calorie concentration, lots of calories packed into a small space. Drizzling just a tablespoon of oil on a dish adds over a hundred calories. For those same calories, you could have instead eaten about two cups of blackberries, for example, a food with a low calorie density. So, these two meals have the same number of calories. You could swig down that spoonful of oil and not even feel anything in your stomach, but eating a couple of cups of berries could start to fill you up.
The average human stomach can expand to fit about four cups of food; so, a single stomachful of strawberry ice cream, for example, could max out our caloric intake for the entire day. For the same two-thousand calories, to get those same two thousand calories from strawberries themselves…you’d have to eat forty-four cups of berries. That’s eleven stomachfuls. Some foods are just impossible to overeat. They are so low in calorie density, you just physically couldn’t eat a enough to even maintain your weight. Traditional weight-loss diets focus on decreasing portion size, but we know these “eat less” approaches can leave people feeling hungry and unsatisfied.
Researchers in Hawaii tried putting people on more of a traditional, Hawaiian diet with all the plant foods they could eat, unlimited quantities of fruits, vegetables, whole grains, and beans. And, the study subjects lost an average of seventeen pounds in just twenty-one days. Calorie intake dropped by 40 percent, but not because they were eating less food. They lost seventeen pounds in three weeks eating more food, in excess of four pounds a day. How could that be? Because whole plant foods tend to be so calorically dilute, you can stuff yourself without getting the same kind of weight gain. As noted before, Americans appear to average about three pounds of food a day.
Processed vs. Unprocessed Foods
A landmark study found that, even when presented with the same number of calories, and the same salt, sugar, fat, fiber and protein, processed foods led to weight gain, two pounds gained over two weeks; and unprocessed foods led to weight loss, two pounds down in the same two weeks. Here’s one of their processed food meals…which is probably healthier, actually, than what most people eat. Non-fat Greek yogurt, baked potato chips, sugar-free diet lemonade with a turkey sandwich, has the same number of calories as this…what the unprocessed-meal-food folks were eating, kind of a southwest entrée salad with black beans, avocados, nuts…that’s the calorie density effect. Same calories but there’s just more food, no wonder it satisfied their hunger. And they ended up four pounds lighter in two weeks eating more food.
Decreasing Calorie Density: Fat Content and Water Content
How can you decrease the calorie density of your diet? Method number one: Covertly put people on a relatively low-fat diet, and they tend to lose body fat every day even though they can eat as much as they want. In a famous prison experiment in Vermont, lean inmates were overfed up to ten thousand calories a day to try to experimentally make them fat. This turned out to be surprisingly difficult. Most starting dreading breakfast and involuntarily threw it up. The researchers learned how difficult it was to have people to gain weight on purpose- unless, you feed them lots of fat. To get prisoners to gain thirty pounds on a regular diet, it took about 140,000 excess calories per certain amount of body surface area. To get the same thirty-pound weight gain just by adding fat to their diets, all they had to do was feed them about an extra 40,000 calories. When the extra calories were in the form of straight fat, it took as many as a hundred thousand fewer calories to gain the same amount of weight.
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A calorie is not a calorie-it depends what you eat. In this case, lowering fat content effectively made up to 100,000 calories, disappear. There are, however, two important exceptions. Processed foods with “reduced-fat claims” are often so packed with sugar that they can have the same number of calories as a higher fat product.
The biggest influence on calorie density is not fat, but water content. Since water adds weight and bulk without adding calories, the most calorie-dense foods and the most calorie-dense diets tend to be those that are dry. Some vegetables, on the other hand, are more than 95 percent water, and not just iceberg lettuce. Cucumbers, celery, turnips, cooked napa cabbage, bok choy, summer squash, zucchini, bean sprouts, and bamboo shoots can top out at 95 percent water. They’re basically just water in vegetable form. A big bowl of water-rich vegetables is practically just a big bowl of trapped water. The effect on calorie density is so dramatic the food industry wants in on the action.
When dozens of common foods, pitted head-to-head for for their ability to satiate appetites for hours, the characteristic most predictive was not how little fat or how much protein it had, but how much water it had. That was the number one predictor of how filling a food is. Water-rich foods like vegetables, topping the charts with most more than 90% water by weight, followed by most fresh fruit, coming in around the 80s. Starchier vegetables, whole grains, and canned beans are mostly 70s, meaning three-quarters of their weight: pure water.
The Power of Preloading with Water-Rich Foods
In a famous series of experiments, researchers at Penn State decided to put water-rich vegetables to the test. Study subjects were served pasta and told to eat as much or as little as they’d like. On average, they consumed about 900 calories of pasta. What do you think would happen if, as a first course, you gave them a hundred calories of salad composed largely of lettuce, carrots, cucumber, celery, and cherry tomatoes? Would they go on to eat the same amount of pasta and end up with a thousand calorie lunch, 900 plus 100? Or would they eat a hundred fewer calories of pasta, effectively canceling out the added salad calories? It was even better than that. They ate more than 200 fewer calories of pasta. Thanks to the salad, a hundred calories in, 200 calories out. So, in essence, the salad had negative 100 calories. Preloading with vegetables can effectively subtract a hundred calories out of a meal.
Of course, the type of salad matters. The researchers repeated the experiment, this time adding a fatty dressing and extra shredded cheese, which quadrupled the salad’s calorie density. Instead, it turned it into a meal with calories in the quadruple digits. So, what’s the cut-off? Studies on preloading show that eating about a cup of food before a meal decreases subsequent intake by about 100 calories; so, to get a “negative calorie” effect, the first course would have to contain fewer than a hundred calories per cup. But, hey, give people a large apple to eat before that same pasta meal, and rather than consuming two hundred calories less, it was more like three hundred calories less.
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You can see the same thing giving people vegetable soup as a first course. Hundreds of calories disappear. One study that tracked people’s intake throughout the day even found that overweight subjects randomized to pre-lunch vegetable soup not only ate less lunch, but deducted an extra bonus hundred calories at dinner, too, a whole seven hours later. Even just drinking two cups of water immediately before a meal caused people to cut about 20 percent of calories out of the meal, taking in more than 100 fewer calories. No wonder overweight men and women randomized to two cups of water before each meal lost weight 44 percent faster. Two cups of water before each meal, 44 percent faster weight loss.
Negative Calorie Preloading and Weight Loss Boosters
“Negative Calorie Preloading” is on my list of weight loss boosters: all the things I could find that can accelerate weight loss regardless of what you eat the rest of the time. Negative calorie preloading just means starting a meal with foods containing fewer than a hundred calories per cup.
Amping AMPK: The Fat Controller
Is there anything we can put on that first-course salad to boost weight loss even further? In my “Amping AMPK” section I talk about ways to activate an enzyme known as the “fat controller.” Its discovery is considered one of the most important medical breakthroughs in the last few decades. Big Pharma is all over it. After all, obese individuals may be “unwilling to perform even a minimum of physical activity,” wrote a group of pharmacologists, “thus, indicating that drugs mimicking endurance exercise are highly desirable.” So, “it’s crucial that oral compounds with high bioavailability are developed to safely induce chronic AMPK activation” for “long-term weight loss and maintenance….” But, there’s no need to develop such a compound since you can already buy it any grocery store.
When vinegar-acetic acid-is absorbed and metabolized, you get a natural AMPK boost. Enough of a boost to lose weight at the typical dose you might use dressing a salad? A randomized, double-blind, placebo-controlled trial on the effects of vinegar intake on the reduction of body fat in overweight men and women. The subjects were randomized to drink a daily beverage containing one or two tablespoons of apple cider vinegar or a controlled drink developed to taste the same as the vinegar drink, but prepared with a different kind of acid so it didn’t have actual vinegar in it. Three months in, the fake vinegar group actually gained weight (as overweight people tend to do), whereas the genuine vinegar groups significantly lost body fat, as determined by CT scan. A little vinegar every day led to pounds of weight loss achieved for just pennies a day without removing anything from their diet. The beauty of the vinegar studies is that they were not just randomized, controlled trials, but placebo-controlled trials.
The Importance of Controlled Studies
Some studies aren’t controlled at all. Women asked to eat a ripe tomato before lunch every day for a month lost about two pounds, but without a control group you don’t know if the tomato had anything to do with it. Just being enrolled in a weight-loss study where you know they’re going to come back and weigh you again in a month can have people to change their diets in other ways. I mean it’s certainly possible. Stronger studies have control groups. At least, for example, randomize people to a weight-loss diet with or without one to two cups of low-sodium vegetable juice and those drinking the vegetable juice lose significantly more weight. Or split people into two groups and give half about two tablespoons of goji berries a day, and forty-five days later, the goji group appeared to cut two-and-a-half inches off their waistline compared to no change in the control group. But any time you have one group do something special, you don’t know how much of the benefit is due to the placebo effect. In drug trials it’s easy: you give half the people the …
The Body's Innate Wisdom vs. Psychological Factors
Anyone can lose weight eating less food. Anyone can be starved thin. Starvation diets are rarely sustainable, though, since hunger pangs drive us to eat. We feel unsatisfied on low calorie diets; unsatiated. For example, you can consciously hold your breath. Try it right now. How long can you go before your body’s self-preservation mechanisms take over and overwhelm your deliberate intent not to breathe? Your body has your best interests at heart ,and is too smart to allow you to suffocate yourself-or starve yourself for that matter. If our body was really that smart, though, how could it let us become obese? Why doesn’t our body realize when we’re way too fat, and allow us the leeway to slim down? Maybe our body is actually very aware, and actively trying to help, but we’re somehow undermining those efforts?
So many variables go into choosing what we eat and how much. There are psychological, social, cultural, and aesthetic factors. To strip all that away and stick just to the physiological, Columbia University researchers designed a series of famous experiments using a “food dispensing device.” The term “food” is used very loosely here. Their feeding machine was a tube hooked up to a pump that delivered a mouthful of bland liquid formula every time you pushed a button. Research subjects were instructed to eat as much or as little as they wanted at any time. In this way, eating was reduced to just the rudimentary hunger drive. Put a normal-weight person in this scenario and something remarkable happens. Day after day, week after week, with nothing more than their hunger to guide them, they eat exactly as much as they need, perfectly maintaining their weight. They needed about 3,000 calories a day, and that’s just how much they unknowingly gave themselves.
Put an obese person in that same scenario, and something even more remarkable happens. Driven by hunger alone with the enjoyment of eating stripped away, they wildly undershoot, giving themselves a mere 275 calories a day- total. They could eat as much as they wanted, but they just weren’t hungry. It’s as if their body knew how massively overweight they were, so it dialed down their natural hunger drive to almost nothing. One subject started out at 400 pounds and steadily lost weight. This groundbreaking discovery was initially interpreted to mean that obesity is not caused by some sort of metabolic disturbance driving people to overeat. In fact, the study suggested quite the opposite. Instead, overeating appeared to be a function of the meaning people attached to food beyond its use as fuel, whether as a source of pleasure, or perhaps relief from boredom or stress. In this way, obesity seemed more psychological than physical.
If you take the lean study subjects and covertly double the calorie concentration of the formula, they unconsciously cut their consumption in half to continue to perfectly maintain their weight. Their body somehow detected the change in calorie load and sent signals to the brain to press the button half as often to compensate. Amazing! Do the same with obese persons, though, and nothing changes. They continue to drastically undereat just as much as before. Might the brains of obese persons somehow be insensitive to internal satiety signals? We don’t know if it’s cause or effect. Maybe that’s why they’re obese in the first place, or maybe the body knows how obese it is, and is shutting down the hunger drive regardless of the calorie concentration. Indeed, the obese subjects continued to steadily lose weight eating out of the machine, regardless of the calorie concentration and the food being dispensed. It would be interesting to see if they regained the ability to respond to changing calorie intake once they reached their ideal weight.
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