Fri, Dec-30-11, 13:08
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Plan: Muscle Centric
Stats: 238/153/160
BF:
Progress: 109%
Location: UK
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Quote:
December 29, 2011
The Fat Trap: My Response
By Barbara Berkeley, MD
Once a month, in a small room off the lobby of Lake West Hospital in Willoughby, Ohio, a special group convenes. For someone observing the group and unaware of its purpose, it might appear to be a simple mix of everyday people
.young, old, racially diverse. The members would seem to be old friends but with a particular seriousness of purpose, perhaps a community group attending a lecture or learning some new skill together. What a casual observer would not guess is that each of these people was once obese, some having weighed over 100 pounds more than they do today.
Our Refuse to Regain group is an experiment, a safe haven for maintainers who have lost weight in many different ways and now face the reality of reconstructing their lives. Weve had people from Weight Watchers, people whove undergone bariatric surgery, people Ive treated in my practice and others who simply did it on their own. A weight loss diet is no different than emptying the trash. It doesnt matter which technique you use to toss out the garbage. But learning how to avoid the reaccumulation of unwanted junk is a completely different skill. There are many basics in this process that will be the same for everyone. There are also many specifics that will vary from person to person and which must be individually discovered.
Heres some of what weve learned so far:
1.Weight maintenance is possible. There is nothing in our group experience (or in my personal clinical experience) to suggest that the body forces one to regain.
2.Weight maintenance requires a separation from the world of normal American eating
which is not normal at all.
3.Some people are heavy simply because they are susceptible to the modern diet , no more no less. Others are heavy because they use food for soothing or sedation. Most people are a mix of both. If psychological issues are a major part of weight gainsignificantly beyond the common enjoyment of food for pleasure, they need to be addressed during the maintenance phase.
4.Weight maintainers are special people who live on a kind of food island. Its really nice to know that the island is inhabited, often with fascinating, determined people just like you. Rarely do maintainers get to meet and talk with one another.
This week, I gave my group a reading assignment. That was a first. I asked everyone to read Tara Parker Popes article on weight maintenance called The Fat Trap. This article is currently online and will appear in Sundays New York Times Magazine. Our group will be discussing it at our January meeting, but Ill give you a preview of my reaction here. Many of you may be reading our blog because you read The Fat Trap and discovered Lynn Haraldson, my blogging partner on this site. The fact that you got here likely means that you are interested in knowing whether we are bound to regain the weight we lose, so please, read on
leave comments and join the discussion.
For those of you who are new to this blog, you should know that I am a physician who has specialized in weight management since the late 1980s. This is the only thing I do and thats unusual. Why? Because most doctors are not particularly interested in obesity, and certainly werent back in the 80s. Over the past twenty years, a continuing source of frustration for me has been the willingness of doctors and the general public to accept truths about weight loss that are the beliefs of everyone except those who actually work with overweight people.
Scientific research needs to square with what we see in clinical practice. If it doesnt, we should question its validity. The Fat Trap is an article that starts with a single, small research study and builds around it. Its point? That there are inevitable biological imperatives that cause people to regain all the weight they lose.
I dont buy it.
Here is the opening paragraph of Ms. Parker Popes article:
For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinics program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again.
At one time, this was my experience too. But things have changed. After years of focusing my practice much more on weight maintenance, writing a book about it, and trying to figure out how to teach and encourage it, I no longer see patients with an entire effort come undone. Instead, I see more and more people learning how to become successfully anchored at their new weight. And these POWs (previous overweight people) are not from my practice alone. They are people like Lynn Haraldson and her friends The Maintaining Divas. They are the long term POWs who write to me via this blog, on Facebook and on Twitter. They are the people I hear about with increasing frequency every day.
I admire Ms. Parker Pope for acknowledging her own struggles with weight, but as someone who has not yet solved the maintenance problem I would submit that she is not the best person to rationally evaluate evidence that says that regain is inevitable. After talking to a number of scientists who believe that the body fights weight loss, her concluding paragraph says:
For me, understanding the science of weight loss has helped make sense of my own struggles to lose weight, as well as my mothers endless cycle of dieting, weight gain and despair. I wish she were still here so I could persuade her to finally forgive herself for her dieting failures. While I do, ultimately, blame myself for allowing my weight to get out of control, it has been somewhat liberating to learn that there are factors other than my character at work when it comes to gaining and losing weight.
Those of us who come from families which struggle with obesity can believe one of two things. We can believe that biological and metabolic factors doom us to fatness or we can believe that we come from families who are very sensitive to the current food environment and perhaps need to live in a new and more creative way. It has been my experience that all successful maintainers have learned how to live a life that exists outside the current food norms. For some, this is a daily and difficult challenge and for others it becomes a simple and treasured way of life, but either way, it is not about some inevitable biological destiny. Rather, these maintainers have come to terms with the fact that they are ancient bodies and souls living in a modern environment and that our food culture is capable of killing them. Controlling that environment is their choice and their challenge.
Where I do agree with The Fat Trap is in its assertion that obesity is much more difficult to deal with once it is established. We would do well to focus intense and constant attention on healthful nutrition during pregnancy and in childhood. I believe that we can do this much more easily than we believe, if we would only adopt the idea that we should eat more like we did originally as hunter-gatherers. It has been my clinical experience that elimination (or major curtailment) of starches and sugars (including whole grains and the things that come from them, by the way) simply works. And this clinical observation makes sense, since the ancestors whose genes we carry were not exposed to the large amounts of starch and sugar we now eat. Along with consumption of real food
not things in boxes, cans, or packages.... this easy concept can change lives. We could make things so much easier by teaching this lesson to kids rather than endlessly focusing them on per cents of fat, protein and carbs and on counting calories.
But such approaches to weight maintenance are not easily sold. Its far simpler to believe that weight must be regained. Im fond of using this example for patients: If you were to tell your friends that you are becoming vegetarian and that you will no longer touch a drop of red meat, fish, or poultry, no one would blink an eye. Youd probably be encouraged and congratulated. If, on the other hand, you announced that you were giving up sugar and grain, the same friends would be horrified. You mean youre never going to have another piece of bread???
I believe that the resistance to finding the maintenance solution comes from the addictive nature of starch and sugar foods. I also believe that most of America and other SAD (standard American diet) countries are operating under the influence of addictive carbs. Life without them, or even with LESS of them, is too awful to contemplate.
But I digress. To return to my original point, I want to forcefully say that we must stop finding reasons we cant maintain and start getting much, much better at teaching people how to do it. Support networks, communication between maintainers, and many more books, advocates, and techniques that focus on maintenance are key.
I believe I may scream if I see yet another book with a catchy title that touts yet another weight loss approach without ever talking about what happens in the after-diet world. January is the month for those glossy little productions.
Time to get serious. Maintenance can be done, and if you want to meet the people who are doing it, hang around this blog.
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http://refusetoregain.com/refusetor...y-response.html
Quote:
December 30, 2011
More on the same....
You knew that an article as major as "The Fat Trap" would get the media going. Here is what I consider to be a particularly uninformed and unhelpful response by Slate Magazine (see article here). Summary: we're wasting our time trying to combat obesity and those who are maintaining are only doing it via some sort of eating disorder.
Scroll down to the comments section if you have any interest in seeing my response. Or leave your own. I'm sure this article will madden you.
http://refusetoregain.com/refusetor...n-the-same.html
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November 15, 2010
Should We Accept Our Size and Forget All This?
Barbara Berkeley, MD
For most people who have struggled with weight, there is the persistent, nagging suspicion that permanent body change may be a fiction. When we look around, we see very few people who have lost weight and kept it off...yet every magazine cover proclaims the ease of bodily reconstruction. Just walk off the weight! Lose 33 pounds by Christmas!.... As author Gary Taubes once famously asked, "What if it's all been a big, fat lie?"
Way back in 1959, obesity expert Albert Stunkard published a seminal paper which showed the dismal failure rates of programs treating overweight people. Stunkard demonstrated that, in multiple clinical settings, very few people lost weightand practically no one maintained the loss. In a 1983 commentary on this work, Stunkard recalled, "This study grew out of an attempt to resolve a paradox--the contrast between my difficulties in treating obesity and the widespread assumption that such treatment was easy and effective." Any reflective professional who deals with obesity will tell you that they often feel like Sysyphus, rolling an endless boulder up the mountain only to see it tumble back to the sea. Dieters feel the same way.
If we have been lied to, if it is in fact impossible to get rid of excess weight in any permanent way, we may want to circumvent the frustration and simply accept ourselves. We may even want to rejoice in the size we've been dealt. This outlook is attracting a growing number of people and has come to be known as Size Acceptance. If you are unfamiliar with this viewpoint, you might want to take a look at websites like Big Fat Blog or the writings of Linda Bacon, Phd.
The growing size acceptance movement together with the very real failures of conventional weight loss treatment have given me quite a bit of food for thought. As always, I can only give my own opinions and I remain respectful of those who disagree. Here are some of the questions raised by size acceptance as I see them:
1. Is long lasting weight loss unattainable?
2. Is overweight unavoidable for some?
3. Is overweight unhealthy and if so, do we bear any responsibility for keeping ourselves healthy? Can we be healthy and overweight?
4. What is causing us to be obese? Who are the potentially responsible parties?
For me, here are the answers:
1. Is long lasting weight loss attainable? Yes. Long lasting weight loss is possible. There may be periods of relapse or regain, but increasingly I see people who have been able to engineer permanent change. This is not to minimize the profound nature of this change. It is not for everyone. But I do think that we are getting better at figuring out how to do this and at creating connections between those who have. I am also hopeful that the FDA will finally approve medications that we can use during the early phases of weight maintenance. Drugs that blunt appetite would be very helpful is allowing Maintenance Juniors (Just Reduced) to get used to a new eating style. They might also bridge the period when hormones and brain chemistry are altered following the starvation-like period of dieting.
2. Is overweight unavoidable for some? Yes. Likely there are many people for whom weight gain is unavoidable in our current environment. These people may have more sensitive responses to modern foods or may have been so metabolically damaged by modern eating that weight loss is too great a task. However, I believe that there are fewer of these people than we might think.
3. Is overweight unhealthy? Unequivocally yes. There have been many critiques written that cast doubt on the veracity of reported health consequences of overweight and obesity. As a physician, however, I must say that the degree of ill health that comes directly from weight is utterly convincing and completely astounding. How can I be sure that these problems are coming from weight? I can be completely sure because I am able to watch them dissolve and disappear as weight is lost. I am able to watch them re-occur as weight is regained. In addition to the obvious big killers: high blood pressure, atherosclerosis, diabetes, high cholesterol and an increased risk of cancer, there are the things that make life miserable like gastric reflux, gout, arthritic pain, shortness of breath, sleep apnea, fatigue and depression.
Do we have a responsibility to choose healthy habits? That depends on your world-view. America has never been a society that has looked down on those who chose to race motorcycles, smoke, or drink. Those choices have always been the personal business of the individual. However, the choices of individuals become more profound when they are part of a sweeping health epidemic. There is no question that the societal costs of treating the panoply of obesity related disease are staggering. Perhaps we finally do have some social responsibility to attempt to curb these costs.
Can we be healthy and overweight or obese at the same time? We can certainly strive to be healthier at any level of body size, but certain realities remain: we cannot make up for the fact that our heart has to chronically power a body that is 30 to 100 pounds larger. We cannot make the loading on our back and joints disappear if we remain overweight. We also know that intra-abdominal fat is viewed as an invader by the body and causes a brisk inflammatory response which goes on internally. While we can try to be healthier, we cannot be sure that we do not remain chronically inflammed: a state which leads to diabetes and vascular disease.
4. What is causing us to be obese? This is the sticking point. While it is completely legitimate to say, "This is who I am. I choose to accept it", I remain troubled by one major thought. Suppose this is NOT who you are? Suppose you are only this way because you have been manipulated, brain-washed, culturally drowned, poisoned or otherwise hurt? You can still choose to accept and enjoy your size, but the landscape suddenly looks alot different. I can't be sure that obesity has skyrocketed because of the way our culture has accepted and promoted food. I can't be sure that we don't all have a virus or haven't succumbed to an environmental toxin. It may be a combination of the two, but nevertheless, a healthy skepticism about the SAD and an unwillingness to participate in it, seems to be the pre-requisite for making complete bodily change. We see the same phenomenon in those who have gastric bypass surgery. The surgery initially causes withdrawal from the SAD. Eating modern foods causes the patient to feel sick. Once a year or two has passed, some patients become able to tolerate SAD foods again. Those who succumb regain weight. Patients who remain SAD-free also remain lean.
Having said all of this, I find that a big part of my job is convincing some patients that they should accept their size. Torturing oneself with failed weight loss attempts, hating oneself for perceived inadequacies is no way to live. Many of the people who come to my practice are charming, accomplished, lovely people who simply can't get past their weight and can't accept that losing weight is not in the cards. That unhappiness is a tragedy. Thus, it seems to me that there are two equally legitimate strategies for personal overweight. One is to fight the fat...but with the knowledge that the fight is infinitely more difficult than we've been led to believe. The other is to accept it and try to remain as healthy as possible at any given size.
The best advice I can give as a practitioner is this: Rather than wedding ourselves to absolute beliefs about size, perhaps we would do better to periodically re-evaluate our positions. We may want to attempt weight change now only to find that we accept ourselves at a larger size later. We may be happy eating the SAD today, but decide that we want to trade in for better health as time goes on. The one thing that we should never do is use our belief to hit someone else over the head. Obesity and it's cultural roots are way too complicated to allow them to divide us into angry camps. Like other ethically challenging decisions, the decision as to whether to accept size or continue to work against it remain deeply personal and should be respected.
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http://refusetoregain.com/refusetor...t-all-this.html
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