At this moment I feel like I’ve arrived at the end of the line. 

As a 5’0” tall, “reduced obese” sedentary 70 year old female, my weight continues to creep upward, no matter what macronutrients I eat or don’t eat; no matter how small I keep my portions; or how hard I work to keep my calories low.

This last calendar year I continued with my best efforts at recording every bite taken in a computer food journal, every single day.  Sometimes I ate large amounts of food, and sometimes I ate tiny amounts of food.  Sometimes I ate a “balanced diet” and sometimes I ate “low-carb; sometimes I ate “high-fat, moderate protein, low-carb”;  sometimes I worked to keep my calories around 1000 calories per day; sometimes I worked to have only two 5-bite meals of whatever.  My computer eating records show that my overall 365 day calorie average was about 780 calories per day.  That number was the total of all my big eating days combined with my small eating days, divided by 365 days. 

At this point in my life, I am elderly, and although I am in excellent health overall, I have developed a problem with my right hip which restricts my activities, and I lack the ability to do physical “exercise” except for brief periods of slow walking.  However, over the past ten years I’ve run many extensive personal experiments on how various exercise affects my own bodyweight, and the results have proven to me that however much or however little I exercise has almost no effect.  Apparently my metabolism adjusts down to keep me from dropping weight during periods when I engage in heavy exercise… however it does NOT adjust up to keep me from gaining weight when my food intake goes up whether with or without exercise.

During most of this past year, I’ve weighed in my mid-130s - which gives me a BMI in the “overweight” range.  During the past 9 years I’ve worked and worked on maintaining my large weight-loss, and tried to drop as low as possible inside the “normal” BMI range.  The middle of a “normal” BMI range is, for me, 115 pounds.  I struggled to drop and stay below that number for the first couple of my maintenance years, without success, then … while continuing consistently with my ongoing struggle at a food intake averaging around 1050 calories daily … my weight began climbing.  Instead of bouncing within a 5 pound range between 110 and 115, it bounced between 115 and 120.   Then despite a few more years of working hard to drop back to those lower numbers, my weight climbed to bounce between 120 and 125; then over more time, while eating even fewer calories, and additional exercise, my weight climbed to bounce between 125 and 130; then between 130 and 135.  This past several months, my weight has been bouncing between 135 and 140. 

There appears to be no end in sight.  This has been happening over a 9 year period. Since my activity cannot go up, and it is unlikely that I can tolerate consistently eating under a daily average of 780 calories,  it looks like an ongoing lifetime struggle will result in - at best - a gain of a few pounds each year for the rest of my life.  The good news is if I live another ten years to age 80, maybe this creeping gain will only bring me another gradual 20 pound gain, bringing me just slightly over my BMI border of obesity, allowing me to retain a total net loss of approximately 110 pounds … which would still be better than the alternatives - which are: Morbid Obesity or Death (whichever first appears).

At this point, I’ve tried just about every type of dieting, way-of-eating, lifestyle, or “non-dieting” including all types of intermittent fasting.  In fact, this past month, I did a couple of weeks of 24 hour alternate day water fasts, one 36 hour water fast, and one 72 hour water fast combined with a High-Fat/Low-Carb/Moderate-Protein eating plan.  Same results as with most extreme plans, about a 7 pound loss initially, with a slow regain back up to baseline.   Discouraging, since I’ve consistently experienced that same result dozens of times while experimenting with many different food plans.

Some food plans actually eliminate my motivation to live.  Long-term water fasting tends to make me feel ill, AND eliminating my food rewards makes me long for death. The one plan I have refused to experiment with at all is a vegan diet.  Frankly, I find my death preferable to eating Vegan, which appears to start by eliminating all animal products, continue on to extremes like minus grains, salt, oil, sugar, and no cooked foods, all interspersed with long and short periods of intermittent total water fasting.

My body is now near the end point of a lifetime of dieting, and I must admit that I’ve lost hope that it will ever normalize to "intuitively" sustain a weight under morbid obesity.

Because of my own experience, and my close observation of the experiences of many others,  I’ve come to believe that the longer a person’s body has spent well over the borderline of obesity, the less ability that body has to ever recover itself back to the natural weight tendencies it may have had at birth.  My own body appears to be an example of this truth.

I don’t think the following article applies to me personally at this stage in my life - where, if unchecked, my body will naturally lead me only back to morbid obesity, but I believe it contains good advice for young women, or for older women who have recently become overweight or borderline obese.

Be Careful, because
your Mind is Affecting your Health and Metabolism.
         By Caroline Dooner  - Over the Moon Magazine

You actually can’t control your body with external factors like diets. You just can’t.  It backfires. Your body is smarter than you. Which is why dieting, ultimately, after the occasional brief time of “working”, always fails. Your body is wired to slow down when you try to control how you eat. When you restrict – even in the tiniest way- your amazing, smart body freaks the fuck out, and slows down.

Even when we think about restricting and eating less, it slows down our metabolism, keeps the hormone ghrelin high and makes us stay hungry. This is called “mental restriction”. And it is just as bad for us as physical restriction. Physical restriction is actually eating less. Mental restriction is just thinking about eating less.

Mental restriction manifests as guilt, shame, “I shouldn’t eat this”, “I hope I don’t eat this whole thing”, “I’ll let myself eat this, but I really shouldn’t”, “I’m gonna have to make up for this later at the gym”, and on and on. You know the voice. All of those thoughts are so normal in our diet culture. We are taught that thinking that way is responsible. We think, “If I don’t feel shame over food, how will I ever be healthy? How will I ever like my body if I’m not controlling what I put in my body?”

So I am here to lovingly tell you that we were taught was wrong. Food shame is not responsible or healthy, and not only does it rob us of joy now, it actually messes with our bodies. My anti-diet journey came about because of a genuine, no-joke epiphany after ten years of obsessive diets and seeing my entire life through the lens of weight.

“What I am doing is NUTS.”

I had the strongest sense that my body and appetite would normalize if I just freaking ATE. I knew it. And thankfully, I did a good amount of reading then that totally backed up my internal guidance. I adopted what I like to call “the nourishing mentality”. In my mind I had this image of actually repairing and “reviving” my metabolism by eating.

So every time I ate, instead of thinking “Oh man, this is so bad for me. This is going to make me gain weight. Ugh this isn’t quite on my diet”… I thought: “Yessss. Nourishment. This’ll repair everything. This’ll help. This is exactly what I need. My body can handle lots of food, and is happy to have all of this.”

That shift makes a big, big, big difference. And you might think it shouldn’t. But if you read about leptin, ghrelin, and how our bodies actually react differently to eating based on what we THINK about what we are eating, it makes total sense. And what that means is… you can control your metabolism with your mind. But not the old way. Not the punitive, perfectionistic, fear-based control. Not the way that will only let you be happy if you lose weight. No, that way doesn’t work.

Instead, we are supporting our metabolism in the way the celebrates our bodies and trusts them to take the lead on this whole “food thing”. Our bodies actually work better when they are nourished and amply fed. Let’s finally get your mind on the same side as your body.

About 23 years ago I had an RNY gastric bypass surgery. You can learn more about that, and my subsequent years of dieting, by reading ABOUT ME. This resulted in me eating an extremely low-calorie diet during the first 6 months after surgery, and a very-low-calorie diet during that following year. This type of eating caused me to lose 110 pounds during that time period.

The dieting industry makes billions of dollars every year by marketing its foods, supplements, and services. It encourages people to use MORE foods and other diet products, while people actually need to use far LESS. As a result, most people are unaware of how VERY LITTLE FOOD is required by a person wishing to lose weight - especially by a person who has an obese body with a great deal of stored fat which needs to be used as energy.

For the first few months following a gastric bypass surgery, a person’s calorie intake is between 300 and 600 calories per day. The recommended meal portion size is 1/4 cup for a solid meal and 1/2 cup for a liquid meal.

The volume of the plated meal in the picture at the top of the page is about 1/3 to 1/2 a cup which is MORE than 1/4 cup of food.  To reduce the amount food on that plate to 1/4 cup, visualize removing some of that little round potato. 

Immediately following surgery, the stomach size is very small - about 1/4 cup, or the size of an egg. The opening that allows food to pass out of one’s stomach is also very narrow. For this reason, it is important to take only two to three sips or bites at a time of any NEW food and then wait 10 minutes before taking more. This will help a person learn one’s limits and tolerance. Liquids will empty faster from the stomach than soft solids.

See Below for the standard Dietary Guidelines for after Bariatric Surgery, provided by the University of California San Francisco Medical Center:  

Dietary Guidelines After Bariatric Surgery

General Guidelines
• Eat balanced meals with small portions.
• Follow a diet low in calories, fats and sweets.
• Keep a daily record of your food portions and of your calorie and protein intake.
• Eat slowly and chew small bites of food thoroughly.
• Avoid rice, bread, raw vegetables and fresh fruits, as well as meats that are not easily chewed, such as pork and steak. Ground meats are usually better tolerated.
• Do not use straws, drink carbonated beverages or chew ice. They can introduce air into your pouch and cause discomfort.
• Avoid sugar, sugar-containing foods and beverages, concentrated sweets and fruit juices.
• For the first two months following surgery, your calorie intake should be between 300 and 600 calories a day, with a focus on thin and thicker liquids.
• Daily caloric intake should not exceed 1,000 calories.

Fluids
• Drink extra water and low-calorie or calorie-free fluids between meals to avoid dehydration. All liquids should be caffeine-free.
• Sip about 1 cup of fluid between each small meal, six to eight times a day.
• We recommend drinking at least 2 liters (64 ounces or 8 cups) of fluids a day. You will gradually be able to meet this target.
• We strongly warn against drinking any alcoholic beverages. After surgery, alcohol is absorbed into your system much more quickly than before, making its sedative and mood-altering effects more difficult to predict and control.

Protein
Preserve muscle tissue by eating foods rich in protein. High-protein foods include eggs, meats, fish, seafood, tuna, poultry, soy milk, tofu, cottage cheese, yogurt and other milk products. Your goal should be a minimum of 65 to 75 grams of protein a day. Don't worry if you can't reach this goal in the first few months after surgery.

Supplements
You must take the following supplements on a daily basis to prevent nutrient deficiencies. Please remember that all pills must be crushed or cut into six to eight small pieces. You are not able to absorb whole pills as well as before surgery, and it can be difficult for the pills to pass through your new anatomy.

Multivitamins
Take a high-potency daily chewable multivitamin and mineral supplement that contains a minimum of 18 mg of iron, 400 mcg of folic acid, selenium, copper and zinc. Brands that contain this formula include Trader Joe’s and Centrum Adult chewable multivitamins. Take two tablets daily for at least three months after your surgery, and then one tablet daily for life.

Calcium Supplement
Take 1,200 to 2,000 mg of calcium daily to prevent calcium deficiency and bone disease. To enhance absorption, take the calcium in two to three divided doses throughout the day - for example, a 500 to 600 mg supplement taken three times a day. Calcium citrate is the preferred form of calcium.

Vitamin D Supplement
Take a total of 800 to 1,000 International Units (IUs) of vitamin D each day. This total amount should be taken in divided doses of 400 to 500 IUs twice a day. Vitamin D should be taken with your calcium supplement. If you prefer, you can take a combination calcium-vitamin D supplement to avoid taking multiple pills, so long as it contains the proper dosages.

Vitamin B12 Supplement
Take 500 mcg of vitamin B daily. It can be taken as a tablet, or in sublingual forms placed under the tongue.

Other Supplements
Some patients need additional folic acid or iron supplements, particularly women who are still menstruating. Your dietitian will discuss this with you.

Diet Progression After Bariatric Surgery

Immediately following surgery, you will begin with a clear liquid diet. You may gradually start adding thicker liquids to your diet after you are discharged from the hospital.

Two weeks following surgery, you may progress to blended and pureed foods. You may use high-protein (more than 20 grams protein), low-calorie (less than 200 calories) liquid supplement drinks or powders to meet your protein requirements during this period.

It is important to know that following surgery, your stomach size is very small - less than 1/4 cup, or about the size of an egg. The opening that allows food to pass out of your stomach is also very narrow. For this reason, it is important to take only two to three sips or bites at a time of any new food and then wait 10 minutes before taking more. This will help you learn your limits and tolerance. Liquids will empty faster from your stomach than soft solids.

If you overeat or eat too quickly, you may experience nausea or pain. You should avoid rich, creamy liquids such as gravies, sauces and ice creams.

Diet in the Hospital

You will receive clear liquids such as juices, Jell-O and broth as your first meal following surgery. Juice and Jell-O are high in sugar content, but your portions will be very small at this stage. Gradually increase the amount you drink at each meal as you can tolerate it.

Diet for the First Two Weeks Post-Surgery

You will begin adding thicker liquids that are high in protein and low in fat and sugar. (For examples, see the list below.) You may use high-protein, low-calorie liquid supplement drinks or powders to meet your protein requirements during this period.
The goal is to consume small portions that will empty easily from your pouch. Begin with 1 tablespoon portion sizes and increase to 2 tablespoons as tolerated. Begin drinking 1/4 cup of liquid at a time and increase to a 1/2 cup as tolerated. Your daily caloric intake should not exceed 400 calories.

It is also very important to stay well hydrated. Drink 1 to 1.5 liters of water or other non-caloric liquids per day.
Recommended thicker liquids:

• Nonfat or 1% milk, if you can tolerate milk
• Lactose-free or soy-based low-calorie drinks
• Sugar-free pudding
• Sugar-free, nonfat yogurt
• Low-fat cottage cheese
• Blended broth-based soup or other low-fat soups
• Refined hot cereals that are low in fiber, such as cream of rice or cream of wheat. Make them with extra liquid to create a soup-like consistency. Do not eat oatmeal.
• Optional high-protein, low-calorie liquid supplement drinks (drinks containing less than 200 calories and more than 20 grams of protein in an 8- to 11-ounce serving).

To increase your protein intake, add 2 tablespoons non-fat dry milk powder, egg substitute or powered egg, or other protein powder to each 1/2 cup of nonfat or low-fat milk. You can also add these to soups, hot cereal and other thick liquids.
Remember to drink 1 cup of water or other non-caloric fluids between meals. Take a multivitamin supplement every day.

Diet for Weeks Two to Four Post-Surgery

Begin adding very small portions of pureed and soft foods as tolerated. Take very small bites and chew everything very well. Do not take more than two bites every 20 minutes when adding a new food.
Recommended pureed and soft foods:

• Applesauce
• Yogurt
• Cottage cheese
• Well-cooked, pureed vegetables
• Hot cereals
• Mashed potatoes
• Noodles
• Scrambled egg whites or egg substitute
• Canned fruits
• Canned tuna fish
• Lean fish
• Tofu
• Lean ground meats or poultry

Avoid all bread and meats that are not easily chewed.

Recommended Meal Plan For Weeks Two to Eight Until Two Months Post-Surgery

At this time, your caloric intake will probably be no more than 500 calories a day, divided into six to eight small meals.
Recommended portion sizes are 1/4 cup for solids and 1/2 cup for liquids.

Sample Menu
This sample menu includes different foods that are safe for you to eat. You may adjust the menu to fit your tastes and tolerance.

Breakfast
1/4 cup hot cereal made with non-fat milk
Mid-Morning
1/2 cup nonfat milk*
Late Morning
Two scrambled egg whites
Lunch
1/2 cup low-fat chicken noodle soup
Mid-Afternoon
1/4 cup low-fat cottage cheese
Late Afternoon
1/4 cup sugar-free, nonfat yogurt
Dinner
2 ounces lean ground meat
1/4 cup pureed or well-cooked vegetables
Bedtime Snack
1/4 cup non-fat milk
* Add 1 tablespoon non-fat dry milk powder to each 1/4 cup nonfat milk for additional protein.

Remember to drink 1 cup of water or other non-caloric fluids between meals. It is important to take a multivitamin and mineral supplement every day, plus additional iron if required, and calcium and vitamin D supplements two to three times per day.

Recommended Meal Plan for Two to Six Months Post-Surgery
Consume 900 to 1,000 calories and at least 65 to 75 grams of protein a day. For balanced nutrient intake, your daily servings should include:

• 3 servings milk and dairy products (nonfat and low-fat)
• 3 servings meat or meat alternative (lean and low-fat)
• 3 servings starch (limit bread and rice)
• 1 serving fruit (avoid dried fruits and fruits with skin)
• 2 servings vegetable (well-cooked only)

Recommended portion sizes are 1/4 cup for solids and 1/2 cup for liquids.

Discontinue taking high-protein liquid supplement drinks or powders if possible. We recommend meeting your protein needs with food.

Sample Menu
This sample menu includes different foods that are safe for you to eat. You may adjust the menu to fit your tastes and tolerance.

Breakfast
1 egg or 1/4 cup egg substitute
1/2 cup hot cereal
Mid-Morning
1/2 cup nonfat milk
Late Morning
1/2 cup chopped melon
Lunch
1/2 cup low-fat chicken noodle soup
Two Saltine crackers
Mid-Afternoon
1/4 cup low-fat cottage cheese
1/4 cup canned fruit packed in water or juice
Late Afternoon
1/2 cup sugar-free, nonfat yogurt
Dinner
2 ounces lean meat or fish
1/4 cup mashed potatoes
1/4 cup pureed or well-cooked vegetables
Bedtime Snack
1/2 cup nonfat milk

The sample menu offers eight small meals per day. You may wish to eat more or less often, but be sure to eat at least six times each day.

Remember to drink 1 cup of water or other non-caloric fluid between meals. It is important to take a multivitamin and mineral supplement daily, plus additional iron if required. In addition, you must take calcium and vitamin D supplements two to three times per day.

Recommended Meal Plan for Six Months Post-Surgery and Beyond

• Continue consuming 900 to 1,000 calories per day
• Decrease to three meals and only one to two snacks per day
• Discontinue taking high-protein liquid supplement drinks
• Increase the variety of low-fat, low-sugar and low-calorie foods, as tolerated
• Avoid raw vegetables, fresh fruits with skins, dried fruits, breads, popcorn, nuts and red meats only if poorly tolerated

Long-term Dietary Guidelines

Over time, you will be able to increase the variety and consistency of foods in your diet. Some foods may continue to be poorly tolerated, including red meats, chicken, breads, and high-fiber fruits and vegetables. Focus on low-fat, low-sugar and low-calorie foods and continue to count your calories every day. Try to meet your serving goals for all food groups based on the 900 to 1,000 calories diet plan described above.

To stay well hydrated, drink at least 2 liters of water or non-caloric fluids daily, unless this is contraindicated due to a medical condition.

Reviewed by health care specialists at UCSF Medical Center.
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

                                      
 I recently read a short e-book, “Talking Back to Diet Gurus” by Mike Howard, who is an online fitness guy. I like the way he expressed his point of view on the Calorie issue in the article below, which was posted at Tom Venturo’s website, burnthefatblog.com.

Calorie Denialism: Why It’s Hurting Your Fat Loss Efforts 
             by Mike Howard

Calories have become a perfect target for diet book authors and gurus alike to play on the emotions of those who struggle with weight. In the typical diet book and health blog world, calorie (and any mention of counting them) is met with an illogical amount of hostility. It has become one of the greatest sources of confusion in the world of fat loss and has undoubtedly led to much frustration for those looking to shed pounds. Rest assured you are not alone if you are befuddled by the whole thing…

My aim here is to untangle some of the misconceptions regarding calories, food and eating for fat loss. I wish to arm you with the best knowledge we have regarding fat loss to make the best decision for YOU.

The Anti-calorie Arguments

There are a number of different ways people will try dismiss or at least downplay the importance of calories when it comes to fat loss. How many of these have you heard before?

• Advice to eat less and move more implies that you are calling people gluttons and sloths.
  
  
• Overweight people eat no more than do skinny people.
  
  
• Counting calories doesn’t work.
  
  
• Counting calories is obsessive (extreme, OCD, orthorexic, etc)
  
  
• It’s the carbs/insulin that increases fat – not calories.
   
• Focus on the QUALITY of food because QUANTITY is less relevant/irrelevant
  

In essence, counting calories is responsible for the obesity epidemic, obsessive compulsive disorder and The Kardashians.

Is a Calorie a Calorie?

The answer to this question is a resounding …“kind of”. I’m going to make this as mercifully short and un-nerdy as possible. The calories in/calories out model is an imperfect one due mostly to the differing affects carbohydrates, proteins and fats have on the body during processing. In this case, protein is more metabolically costly to handle than carbs or fats. This renders the model imperfect but not incorrect.

My thesis then is that calories matter the MOST when it comes to fat loss and fat gain. You cannot escape the fact that you have to be in a consistent calorie deficit to lose or a chronic caloric surplus to gain fat – regardless of your macronutrient composition. Adequate protein then is the trump card when it comes to the impact of calories.

Anti-Calorie argument #1: Quality of food trumps Quantity

I start here because fundamentally I don’t disagree with this concept. To be clear, eating wholesome, minimally processed, nutrient-dense foods is the best way to ensure good health. It can also be a means of attaining fat loss – albeit not for the reasons you typically hear. Again it comes back to protein – the equalizer in this equation. Eating adequate protein leads to… (wait for it)… EATING LESS. That’s right, you eat less food when you eat more protein. In a study by Weigle, subjects who ate double the recommended daily level of protein (30% vs 15%) reduced overall calories by 441 per day! This was WITHOUT CARBOHYDRATE REDUCTION.

As sensible and sexy as the idea sounds that eating “clean” will magically make you lose weight without eating less, it is simply the conduit to lowering calories. You CAN still gain weight eating unprocessed foods. Unsexy but true!

Anti-Calorie Argument #2: Calorie theorists think you are gluttons and sloths

This rhetoric seems to be parroted quite often – particularly in the extreme low carb world. This is nothing more than false dichotomy appeal to emotion – implying that advice to eat less and move more is akin to calling someone lazy and greedy. We live in a world of hypersensitivity where people don’t want to hurt feelings and diet book authors have leveraged this to gain the trust of already-emotionally vulnerable and desperate dieters.

Eating less and moving more is actually sensible (albeit vague and incomplete) advice – the financial world equivalent to “buy low, sell high”. The solution, then lies in finding individual strategies – both nutrition/exercise and mindset/emotional on how to accomplish these objectives for long-term success.

Anti-Calorie argument #3: Fat people eat no more than skinny people

For years this was simply assumed based on observation, anecdote and poor science. We’ve all seen and heard the lamentations of those who “barely eat” and can’t lose an ounce while their skinny friend eats “baconators” for breakfast and never gains. Studies appeared to substantiate our observations when subjects were asked to record their food intake…that is until they actually decided to see for themselves and monitor them more closely. And guess what? Overweight people are prone to underreporting food intake – to the tune of up to 47% in some studies!

So someone claiming to eat 2000 calories was actually consuming almost 3000 calories. At the risk of sounding obvious – that’s a pretty big difference.

Oftentimes we have to take an honest look at what we are eating and how many calories we are actually expending. If you do feel you are eating in enough of a deficit, do a thorough 5 day nutrition and activity log. Only when you are CERTAIN you aren’t eating more than you think you and/or exercising less, then it’s time to explore other possibilities (hormone dysfunctions).

Anti-Calorie argument #4: Counting Calories Doesn’t work

Aside from the absurdity of making such blanket statements, the simple truth here is that diets have a high failure rate…PERIOD. Whether it’s counting calories, carbs, fat, or subsisting on cabbage soup, grapefruits or twinkies. To suggest that counting calorie counting is unanimously responsible for our dietary failures is as short-sightedly as it is ludicrous.

Let’s put research aside for one second and just apply some common sense. I am by no means endorsing Weight Watchers or Jenny Craig (appealing to popularity) but do you honestly think that these long-running programs would be successful as they are if they didn’t work at all? Clearly it does work for many.

To back this up with science, take a look at the long term data on weight loss diets and you’ll find that 4 popular diet programs (that range in carb, fat, protein intake) yield similar results when participants cut 750 calories from their diet.

Anti-Calorie Argument #5: Calorie Counting is Obsessive, Extreme, Orthorexic

File this one under the “appeal to emotions” category. Gurus conjure up images of obsessed dieters pulling out scales and measuring devices that would confuse Walter White. This bears repeating: Dietary obsessiveness does not discriminate. Let that sink in… and while you’re marinating on that, I will ask you to ponder the irony of those calling calorie counting obsessive while they meticulously avoid anything that didn’t exist more than 10,000 years ago or voraciously scan ingredients lists to make sure there are less than 3g of carbs per serving or ensuring they are devoid of gluten.

Anti-Calorie argument #6: Hormones drive fat gain (insulin – blood sugar – carbs = carbs make you fat)

Blaming fat gain on hormonal imbalances has become en-vogue in the past decade. Just about every best-selling book has a hormone angle to weight management with insulin being the whipping boy.

Insulin has many functions in the body and while it CAN inhibit fat loss under transient circumstances, the weight of evidence does not support insulin as being a causative factor in weight gain. I’m going to cut to the chase here and go straight to the metabolic ward studies to disprove the insulin-makes-you-fat theory. These are the gold standard when it comes to dietary studies as participants are essentially locked in a tightly controlled environment where their food intake is tightly measured as is their movement. These studies have almost unanimously shown no advantage of low carbohydrate diets vs. high carbohydrate diets when it comes to weight regulation.

The undeniable irony in the world of diet books and diet gurus is that they will emphatically rail against counting calories – blaming excess fat on hormonal disharmony. Now take a look at the menus/diet plans in some of these books and notice that meal plans are meticulously within a certain caloric range. The Zone and The South Beach Diet are prime examples of this sleight-of-hand tactic.

Take Home Points

• Fat loss is a numbers game where calories matter most – this is an undisputable scientific reality.
  
  
• Despite the countless fad diets out there, there is no magical hormone solution, supplement or method can escape the calorie reality.
  
  
• Do you HAVE to count calories to lose fat? Absolutely not. There are other strategies to lose fat that don’t require vigilant calorie counting. You can focus on an easier target such as protein intake. Figure out your protein requirements (about .8-1.0g per lbs of body weight) and aim there first. This can help you spontaneously reduce overall calories.
  
  
• Counting calories should, however be deployed as a second-line strategy if you are stalling. The goal with counting calories is creating awareness – not compulsiveness.
  
  
• The best diet is the one that can get you into a calorie deficit without feeling too hungry or deprived.
  
  
• To figure out your daily caloric needs, use the Harris-Benedict equation and multiply by an activity factor. Choose a deficit anywhere between 10-30% for your calorie target.
  
  
• Cutting out many carb sources can help with fat loss but this is due to a drop in calories and increase in protein rather than the carbs per se.
  
  
• Enjoy guilt-free calorific kind of days once in a while! Taking fat loss seriously paradoxically requires you to relax and enjoy life too!

  Actually, the Mifflin equation has been found to be more accurate than Harris-Benedict. Using these fomulas can be helpful as a starting place to get an estimate of one’s caloric needs. HOWEVER, all of the numbers based on such formulas are AVERAGES only, and there are many people who, like me, have calorie needs which fall BELOW those stated “averages”.

 
Much of the weight-loss and maintenance information available to us is both inaccurate and unhelpful. Like Dorothy of Oz and Alice of Wonderland, during my lifetime of research on those issues, I've seen some "weird shit".

Here in my DietHobby online scrapbook I work to sort out and save reasonably accurate information that might prove helpful to me and perhaps to others.

The article below deals with the issue of Energy In and Energy Out, which is not as simple as most people believe.

People have different body weights because each of them has an individual physiology and psychology which ultimately determines their own individual levels of "energy in" and "energy out" AND which also determines how their own individual bodies respond to it. 

A snapshot of the unaveraged data contained in scientific research of Individual BMR or RMR (metabolism rates) bears a strong resemblance to a blood spatter pattern at a violent crime scene. Metabolism rates are all over the place, but these widely varying numbers are then averaged out to create the calculations we see formulas like Harris-Benedict, Mifflin, etc.  An Average is a Statistical number for mathematical convenience. It is not an accurate number for Everyone, and sometimes is not even accurate for Anyone ... similar to the following joke: 

A biologist, a chemist, and a statistician are out hunting.  The biologist shoots at a deer and misses fifteen feet to the left, the chemist takes a shot and misses fifteen feet to the right, and the statistician yells "We got 'em!"

People the same sex, age, and size can take in the same amount of "energy" and do their best to engage in the same amount of activity, but wind up with very different weight results. 

In tightly controlled feeding studies, the same absolute amount of extra calories can result in very different amounts of weight gain. Also, the exact same amount of caloric deficit will result in widely different amounts of weight loss. 

In general, this basic fact of human nature is overlooked, or ignored. 

Here is a recent article by obesity specialist, Dr. Sharma addressing this problem. 

Why The Energy Balance Equation Results In Flawed Approaches To Obesity Prevention And Management

    by Dr. Arya Sharma, MD 
         @ Dr Sharma's Obesity Notes 

Allow me to start not with the first law of thermodynamics (energy cannot be created or destroyed) but rather, the second law of thermodynamics, according to which entropy (best thought off as a measure of disorder), in any closed system, increases till it ultimately reaches thermodynamic equilibrium (or a state of complete disorder).

As some of us may recall from basic biology, the very definition of “life”, which tends to move from a state of lesser organization to a state of higher organization, is that it appears to defy the second law of thermodynamics (this is often referred to as “Schroedinger’s Paradox”).

In actual fact, we can easily argue that the second law does not apply to living organisms at all because living organisms are not closed systems and life’s complex processes continuously feed on its interactions with the environment.

Yet, when we consider the first law of thermodynamics and how it applies to obesity, we seem to forget the fact that we are again dealing with a complex living organism.

Thus, in what has been referred to as the “Folk Theory of Obesity”, we simply consider weight to be a variable that is entirely dependent on the difference between energy input and energy output (or “calories in” and “calories out”). And in our arithmetical thinking, we consider “energy in” and “energy out” as simple “modifiable” or “independent” variables, which if we can change, will result in any desired body weight.

In fact, our entire “eat-less-move-more” approach to obesity is based on this concept – the central idea being, that if I can effectively move “energy in” and “energy out” in the desired directions, I can achieve whatever weight I want.

This notion is fundamentally flawed, for one simple reason: it assumes that weight is the “dependent” variable in this equation.

However, as pointed out in a delightful essay by Shamil Chandaria in my new book "Controversies in Obesity", there is absolutely no reason to assume that weight is indeed the “dependent” or “passive” player in this equation.

Indeed, everything we know about human physiology points to the fact that it is as much (if not more) body weight itself that determines energy intake and output as vice versa.

Generally speaking, heavier people tend to eat more because they have a stronger drive to eat and/or need more calories to function – in other words, body weight itself may very much determine energy intake and output (and not just the other way around).

Similarly, losing weight tends to increase hunger and reduce energy expenditure – or in other words, changes in body weight can very much determine changes in energy intake and expenditure (and not just the other way around).

Thus, the idea that we can control our body weight by simply controlling our energy intake and output, flies in the face of the ample evidence that it is ultimately our physiology (in turn largely dependent on our body weight) that controls our energy intake and output.

Thus, to paraphrase Chandaria’s key argument, it is not so much about what “energy in” and “energy out” does to our body weight – it is more about what our body weight does to “energy in” and “energy out”.

Once we at least accept that this equation is a two-way street, rather strongly biased towards body weight (or rather “preservation of body weight”) as the key determinant of “energy in” and “energy out”, we need to ask a whole different set of questions to find solutions to the problem.

No longer do we restrict our focus to the exogenous factors that determine “calories in” or “calories out” (e.g. our food or build environments) or see these as the primary targets for decreasing caloric intake or increasing caloric output.

Rather we shift our focus to the physiological (and psychological) factors (often dependent on our body weights) that ultimately dictate how much we “choose” to eat or expend in physical activity.

Chandaria’s essay goes on to discuss the many “derangements” of physiology that we know exist in obese individuals (and probably already exist in those at risk for obesity), including leptin resistance, impaired secretion of incretins like GLP-1, insulin resistance, alterations in the hypothalamic-pituitary-adrenal (HPA axis), and sympathetic activity. (Any keen student of human physiology or psychology should have no problem further extending this list.)

In Chandaria’s view, it is these physiological (and psychological) processes that ultimately determine whether or not someone is prone to weight gain or ultimately gains weight.

In fact, the only factor that determines why two individuals living in the same (obesogenic) environment will differ in body weights (even when every known social determinant of health is exactly equal), is because of their individual physiologies (and psychologies) which ultimately determine their very own individual levels of “energy in” and “energy out” (and how their bodies respond to it).

Readers may be well aware that in tightly controlled feeding studies, the same absolute amount of extra calories can result in very different amounts of weight gain.

Similarly, the exact same amount of caloric deficit will result in widely different amounts of weight loss.

Ignoring this basic fact of human nature distracts or, at the very least, severely limits us from finding effective solutions to the problem.

This “physiological” view of the first law of thermodynamics should lead us away from simply focusing on the supposedly “exogenous” variables (“energy-in” and “energy-out”) but rather draw our attention to better understanding and addressing the biological (and psychological) factors that promote weight gain.

This would substantially change the aims and goals of our recommendations.

Thus, for e.g., rather than aiming exercise recommendations primarily at burning more calories, these should perhaps be better aimed at improving insulin sensitivity and combating stress. Thus, rather than counting how many calories were burnt on the treadmill, the focus should be on what that dose of exercise actually did to lower my insulin or stress levels.

Indeed, we may discover that there is a rather poor relationship between the amount of calories burnt with exercise and the physiological or psychological goal we are trying to achieve. While more exercise may well help burn more calories (which I can eat back in a bite or two), it may do little to further improve insulin resistance or combat stress thus leaving my weight exactly where it is.

Similarly, rather than trying to restrict caloric intake, dietary recommendations would be based on how they affect human physiology (e.g. gut hormones, reward circuitry or even gut bugs) or mood (e.g. dopamine or serotonin levels).

In other words, fix the physiology (or psychology) and “calories in” and “calories out” will hopefully fix themselves.

Given that our past efforts primarily focusing on the “energy in” and “energy out” part of the equation have led nowhere, it is perhaps time to focus our attention and efforts elsewhere.

Or, as I often say in my talks, “We’re not talking physics here – we're talking physiology – that’s biology messing with physics”.

We cannot mess with the physics but we sure can mess with the biology.

Shamil A. Chandaria: The Emerging Paradigm Shift in Understanding the Causes of Obesity. In Controversies in Obesity.  Eds: Haslam DW, Sharma AM, Le Roux CW. Springer 201

 Here at DietHobby there are many articles about my weight-loss and maintenance of that weight-loss.

For more details see ABOUT ME in the Resources section, and various Status Updates etc. in the ARCHIVES.

I've consistently recorded all my food into a computer food journal every day for more than NINE years.

I've also recorded my weight daily or weekly during that time. Those detailed records show a large weight loss, followed by a couple of years holding pattern, followed by about five years of gradual weight-gain while eating a calorie average of around 1050 calories daily.

Despite my careful adherence to calorie budgets, and detailed documentation, people tend to disbelieve this truth. I'm tired of being considered a liar. In fact, involving myself further in discussions on the issue is becoming too exhausting to even contemplate. My records are helpful to me personally, but are generally discounted by others as inaccurate, mistaken, or faulty in some way because … what these records show "simply cannot be true".

This is a common phenomenon.
 
Medical personnel and weight loss gurus get to openly doubt the claims of any and all failed dieters because their fat bodies are the visible proof that they are lying.

Former dieters who claim diets don’t work were probably just doing it wrong all along, or else they didn’t try Guru X, Y or Z, who would have set them straight right away.

However, the bottom line is, diets don’t fail because failed dieters are liars, but because the only diets that yield substantial, noticeable weight loss in a statistically significant portion of the population are the same diets that are largely unsustainable for many, many reasons.

The problem isn’t lying dieters, it’s that the expectations surrounding diets and weight loss are built on lies, half-truths, insinuations, flawed research and cults of personality.

It is important to realize and understand that people regain lost weight due to biological reasons which are totally out of their control.

When a person engages in the kind of severe caloric restriction necessary to lose significant amounts of weight, it triggers hormonal changes in their body that pushes back against that caloric deficit, both physically and emotionally.

The body's response to caloric restriction involves issues involving leptin, ghrelin and adaptive thermogenesis. In a nutshell, one's body does everything it can to preserve what few calories it is taking in. This is the semi-starvation neurosis that is most noticeable in the infamous Minnesota Starvation Experiment. Those continual, ongoing, unpleasant symptoms are the body’s way of trying to urge a person to find more calories. Most people find that kind of lifestyle unsustainable.

The 3500 kcal per pound Theory was derived by estimating the energy content of weight lost, but it ignores dynamic physiological adaptions to altered body weight that lead to changes of both the resting metabolic rate as well as the energy cost of physical activity.

Calorie-restricted diets are unsustainable for the vast majority of people and the ubiquitous expectations of 3,500 calories per pound lead to inevitable disenchantment with lifestyle changes. Weight regain is incredibly complicated and simply assigning blame to the dieter is inadequate when you look at the totality of evidence.

People have been given unrealistic expectations for what caloric restriction achieves. When someone jumps on a restricted-calorie "lifestyle change" and only loses a net 5% or 10% after two years, and that restricted-calorie diet is so miserable due to hormonal responses and/or whatever life changes may occur, that they tend to give up those changes and regain the weight.
 An analogy would be if you’re a runner and you push yourself further and further, harder and harder because you believe that if you just work hard enough you’ll be the fastest runner alive. But there are internal cues like soreness, fatigue, and injury which are your body’s ways of telling you to knock it off. You can ignore those cues and continue your training regimen, but many people will find the increased regimen unsustainable, then fall back either to their less rigorous habits or quit training all together.

So whose fault is it if a person doesn't keep training at that higher level? In a simplistic sense, we can say the runner. If they just stuck with it, their body may eventually yield the results desired, but something interfered. That “something” is the unsustainability of the goal for that runner's body.

When people gain weight, their energy needs increase to keep the extra tissue alive and move it around. Likewise when weight is lost, their baseline needs decrease. So when people cut calories below the baseline requirement - thereby triggering weight loss - the gap between their intake and their baseline energy needs begins to shrink. At some point, it may disappear altogether, at which point weight loss stops. This can happen even BEFORE a formerly fat person becomes underweight or even of "normal" weight.

A 3500 calorie deficit might roughly equal one pound of fat. But what starts as a 3500 deficit in week 1 of a "lifestyle change" will be closer to a zero calorie deficit in week 100.  The 3500 =1 lb Calorie Theory has a tendency to breakdown further at very high weights, and at very low weights, in that it appears to be far less accurate when applied to extremely obese people who maintain a very high weight long-term, as well as for extremely "reduced" obese people who are working to maintain a low weight long-term.

Fat bodies require more calories than slimmer ones. However, the human body is not a budget, and individual mileage varies.  All formulas which calculate the calories required by any person of any size, age, or weight are based on "averages" of the people who were included in specific, limited, research studies, and the numbers given by the use of any such forumla are ESTIMATES only.  Ten to twenty percent deviations are common, below and above, and even within those limited research studies some of the people's calorie needs fell even lower.

People who successfully lose weight can explain how they did it, but when people who fail at losing weight explain how they did it, they're assumed to be liars.

The common assumption is that the reason a majority of people fail to lose weight on a diet, is because they don't follow the diet, and those people who claim that they do follow the diet but haven't lost the expected amount of weight are liars.

There is no specific scientific evidence that proves weight regainers are actually following the diet when they regain the weight. However, there is a great deal of anecdotal evidence. There are many, many, many people who say that they have tried anything and everything from caloric restriction to low-carb eating and have not gotten results. They’ve exercised, followed the rules and done everything right, but not had the same experience that the successful people have. This is when the successful people begin their diagnostic check. “Have you tried X? Have you tried Y? Have you tried Z?”

Anecdotal evidence that diets don’t work is immediately dismissed. However, there is no other evidence available… no long-term, peer-reviewed research which reliably monitors the dietary habits of subjects. Scientific evidence on this issue is hard to come by because it would be incredibly expensive and difficult for any research team to do a long-term controlled study that actually proves subjects do or do not follow diets when they do not lose much weight.

The only such study in existence is the Minnesota Starvation Experiment, which only happened due to a remarkable set of circumstances around WWII, involving a rigidly controlled environment and a limited number of selected subjects who started as healthy, young, normal-weight men.

What CAN be asked and answered is “What happens when we have subjects follow a particular diet and/or exercise routine after X number of years?” This kind of evidence simply shows us how that diet fares in “normal” life, and the fact that the long-term failure rates of all known weight loss approaches simply means that they either they don’t work for the vast majority of people or that they are unsustainable. Either way, all available evidence shows that this path does not generally provide the desired results…i.e. long-term maintenance of weight-loss.

Every year, there are hundreds of thousands of people who lose 50 or 100 or 150 pounds, but we don't consistently learn of their ultimate success or failure after one, two, or five years. Successful people are self-selecting, and we never know the true followup rate of these amazing success stories.

Those hundreds of thousands of people who achieve their goal of losing 50 pounds or more are only a sliver of the millions of people who try and don't get anywhere the expected weight-loss results.

The vast majority of people who try to lose weight regain it, regardless of whether they maintain their diet or exercise program. This occurs in all studies, no matter how many calories or what proportions of fat, protein or carbohydrates are used in the diet, or what types of exercise programs are pursued.

What current scientific studies do prove is how woefully inadequate our claims of diet efficacy are. Even in those controlled settings, when intake and expenditure is strictly controlled and it comes closest to recreating your budget analogy, the results still show that the human body is not a bank account.

Energy out - the human body is a dynamic system with metabolic inconsistencies that we cannot easily account for on an individual basis.

Energy in - even if we measure our food, calorie estimates are merely best guesses, and to say: "just eat less" simply tells people that over time they need to eat less and less and less food to continue losing weight at a steady rate. (Or in my own case… to continue maintaining weight-loss long-term.)

It ultimately comes down to this:

One argument is: "We have proof that weight loss works” which is supported by a cohort of people who provide anecdotal evidence that caloric deficits provide the desired result of significant, long-term weight loss. However, there is no scientific evidence in existence proving this proposition to be true.

The other argument is: “We have proof that the vast majority of people who try to lose weight regain it, regardless of whether they maintain their diet or exercise program”. There are reams of scientific research which support that argument AND a cohort of people who provide supporting anecdotal evidence.

Whatever argument one chooses to accept, all studies have proven that our bodies are not machines. They have organic differences, and they continually adapt. Although a calorie budget can be useful, weight loss is far more difficult and complicated than setting a budget and adhering to it.