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Archive for December, 2008

Prepare For Weight Loss, Part 2: The Energy Balance Equation

Saturday, December 6th, 2008

An old joke from my medical school days asks, “How many psychiatrists does it take to change a light bulb?”  Only one, but the light bulb must want to change.

How many weight-loss programs does it take before you lose that weight for good?  Only one, but…

Where does the fat go when you lose weight dieting?  Metabolic reactions convert it to energy, water, and carbon dioxide, which weigh less than fat.  Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism.  Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.  Even at rest, a kilogram of muscle is much more metabolically active than a kilogram of fat tissue.  So muscular lean people sitting quietly in a room are burning more calories than are fat people of the same weight sitting in the same room.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat.  Heredity plays a lesser role.

Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity.  Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity.  Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity.  Excess energy not used in resting metabolism or physical activity is stored as fat.

If you want to lose excess weight and keep it off, you must learn the following equation:

The energy you eat,

          minus the energy you burn in metabolism and activity,

               determines your change in body fat.
Or, more succinctly:

Energy Intake minus Energy Expenditure Equals Change in Energy Stores

This is the Energy Balance Equation.

Energy is measured in calories.  For example, if you eat 2,000 calories of energy daily, but burn up 2,300 calories daily, you will have a negative energy balance and your fat stores will go down.  That is, you lose weight.

Now, a pound of body fat contains 3,500 calories, so you have a way to go before you lose a pound on the bathroom scale.

Overweight and obesity result from an imbalance between energy intake and expenditure.

It’s just that simple.  The degree of this imbalance is quite small.  Over the course of a year, you will gain three and a half pounds of fat just by adding a teaspoon of butter to your dinner roll every day, assuming all other variables are unchanged.  Simply avoid a 10 minute walk daily for a year and you will gain five and a half pounds.  Taking the walk and avoiding the teaspoon of butter sound easy, and they are, but if not done you will gain 35 pounds over the course of five years.

While we don’t have much control over our basal metabolic energy requirements (roughly 1,200–1,500 calories daily), many of us are able to adjust food intake and activity levels to strike a happy balance in the energy equation, minimizing unwanted fat.  For a lucky few, that desirable balance is automatic and unconscious.  The rest of us have to think about it, work at it, make it a priority at times.

Right now your balance is tipped in favor of excess energy stores (fat). It will soon be tipped in the other direction. You will convert fat to energy and lose weight in the process. Once you achieve your goal weight, the energy equation must be balanced again.

There is no doubt that the energy balance equation applies to you.  People who swear they can’t lose weight on extreme low-calorie diets have been locked up (with consent) in university medical center metabolic wards with access to food strictly controlled by staff.  On appropriate calorie-restricted diets, everyone loses weight. When an exercise program is added, they lose more weight.

Steve Parker, M.D.

Prepare For Weight Loss, Part 1: Motivation

Friday, December 5th, 2008

New Years Day 2010 is coming at us like a freight train.  And with it comes New Years Resolutions, often including loss of excess weight.  10 PM December 31, with a couple glasses of champagne on-board, is not the best time to flippantly add “4. Lose weight starting tomorrow” to your resolution list.  That’s a set-up for failure.

Success requires careful forethought.  Questions beg for answers.

Which of the myriad weight-loss programs will I follow?  Can I design my own program?  Should I use a diet book?  Sign up for Nutri-System, Weight Watchers, or Jenny Craig?

Should I stop wasting my time dieting and go directly to bariatric surgery?

Can I simply cut back on sodas and chips?  What should I eat?  What should I not eat?

Do I need to start exercising?  What kind?  How much?  Do I need to join a gym?  What methods are proven to increase my odds of success?

How much weight should I lose?

Should I use weight-loss pills or supplements?  Which ones?

What’s the easiest, most effective way to lose weight?  Is there a program that doesn’t require willpower?

Now, what were those “top 10 super-power foods” that melt away the fat?  Am I ready to get serious and stick with it this time?

Today I start a eight-part series: Prepare for Weight Loss.  The series will answer many of these questions and get you teed up for success.  Teed up like a golfer ready to hit his first shot on hole #1 of an 18-hole course.  [For non-golfers: a tee is a little wooden stick the golfer places his ball on top of for the first shot of any hole.]

We start with Motivation.

Immediate, short-term motivation to lose weight may stem from an upcoming high school reunion, swimsuit season, or a wedding. You want to look your best. Maybe you want to attract a mate or keep one interested. Perhaps a boyfriend, co-worker, or relative said something mean about your weight. These motivators may work, but only temporarily. Basing a lifestyle change on them is like building on shifting sands. You need a firmer foundation for a lasting structure. Without a lifestyle change, you are unlikely to vanquish a chronic overweight problem.  Proper long-term motivation may grow from:

  • the discovery that you feel great and have more energy when you are lighter and eating sensibly
  • the sense of accomplishment from steady progress
  • the acknowledgment that you have free will and are responsible for your weight and many aspects    of your health
  • the inspiration from seeing others take charge of their lives successfully
  • the admission that you have some guilt and shame about being fat, and that you like yourself more when you’re not fat  [I’m not laying shame or guilt on you; many of us do it to ourselves.]
  • the awareness of overweight-related adverse health effects and their improvement with even modest weight loss.

Appropriate motivation will support the commitment and willpower that will be needed soon.

Steve Parker, M.D.

PS: I’m thinking of how Dave Ramsay, when he’s counseling people who have gotten way overhead in debt, tells them they have to get mad at the debt.  Then they can attack it.  Maybe you have to get mad at your fat.  It’s your enemy, dragging you down, trying to kill you.  Now attack it!

Updated December 19, 2009

Does Olive Oil Help With Weight Loss? [Shangri-La Diet Review]

Wednesday, December 3rd, 2008

A while back, I was listening to “talk radio” in my car and heard Dennis Prager say that olive oil helps to suppress appetite, leading to loss of excess weight.  I only caught the tail end of it, and let it go.  Evelyn Tribole, M.S., R.D. brought to my attention recently an article regarding hunger suppression by fatty foods, such as olive oil.  I found the time to research Prager’s statement. 

The olive oil/appetite suppression link seems to emanate from Seth Roberts, Ph.D., who was (and still is?) a psychology professor at the University of California - Berkeley.  He self-experimented with the theory that sugar water or olive oil taken on an empty stomach suppresses appetite naturally.  He stumbled upon his theory on a trip to France when he noticed that soft drinks unfamiliar to him seemed to suppress his appetite.  His theoretical underpinnings are based on rat studies, and on the idea - not his own - that our bodies have a weight set-point that mostly determines our weight. 

The set-point is like a thermostat that can be reset.  Set-point theory explains that after a spell of weight loss, we usually return to our previous heavy weight because that’s where the thermostat (set-point) is set.  We need to reset the thermostat.   How do you do that?  Drink either 1) one tbsp of extra light olive oil, or 2) one or two tbsp of fructose or sucrose (table sugar) in water, and do this not at mealtimes but at least one hour after meals, one to four times daily.  Don’t eat anything else at the time of the supplement, nor for one hour thereafter.  Total calorie content of these supplements is 100-400 calories per day.  You experiment to find the dose that suppresses your appetite.  And eat healthy meals of your choice.  Dr. Roberts says the extra light olive oil is better than the sugar.  Not extra virgin olive oil, which has too much flavor.   

The pure, unadulterated sweetness of sugar, and the near-tastelessness of the olive oil are important, according to Dr. Roberts.  They trick your weight set-point into resetting.  At least this is the theoretical framework he gave to Prager and TheDietChannel.com in 2006.  ABC News in 2005 reported he “suggests it works by suppressing a basic ‘caveman’ instinct from days when access to food was intermittent. The diet tricks the body from thinking it needs to eat every last bit of food before an impending famine.”  My sense is: If it works, it works, and the underlying mechanism is less important.    

Dr. Roberts easily lost 50 pounds with his method and wrote The Shangri-La Diet: The No Hunger Eat Anything Weight-Loss Plan to share with the world.  The blogosphere and the authors of Freakonomics helped spread the word rapidly.  In 2006, Dennis Prager allocated an entire hour of his show to Dr. Roberts, and volunteered that the olive oil indeed was suppressing his (Prager’s) appetite.  According to the book reviewers at Amazon.com, the Shangri-La Diet clearly works miraculously well for some, not at all for others.  You can find much more information and testimonials at www.sethroberts.net., perhaps enough that you don’t need to purchase the book if you want to give it a go.  Last I checked, the paperback was $3.99 plus shipping at Amazon.com.   

I’m not sure if this diet is a hoax or not.  It’s possible it is a social psychology experiment.  Maybe Dr. Roberts had a bet with someone that “anyone can write a popular diet book if they just use the formula.”  You can find the formula at www.sethroberts.net under “Reviews and Media.”   Listen to Dr. Roberts’ interview with Dennis Prager and decide for yourself.  He sounds earnest. 

I suspect it’s a hoax but, then again, Dr. Roberts may himself be a true believer.   What’s the evidence for hoaxiness?  The subtitle was my first clue: The No Hunger Eat Anything Weight-Loss Plan.  Legitimate, scrupulous doctors would be embarrassed to use that phrase.  The second clue is that Dr. Roberts seems to be a former contributor to Spy magazine.  This is precisely the sort of hoax the editors of Spy would concoct.  The third clue is that he uses just enough quasi-legitimate scientific theory and jargon to rope in many readers. 

[I know “hoaxiness” isn’t a word.  Neither was truthiness until Stephen Colbert coined it in 2006.]

I was particularly interested in the olive oil aspect of the Shangri-La Diet since olive oil is the predominant form of fat in the traditional healthy Mediterranean diet.  I searched PubMed.gov for scientific clinical studies in overweight humans showing that olive oil suppresses appetite and leads to weight loss.  I found none as of October 12, 2008.  Note that extra light olive oil is refined oil and has less of the healthy phytonutrients found in extra virgin olive oil. 

Dr. Roberts’ program, and its apparent success in some users, exemplifies the idea that losing excess weight is, in part, a matter of trial and error.  For example, the Atkins diet may work great for you, but not your next-door neighbor, who lost with Shangri-La, which didn’t work for your mother-in-law.  To some extent, weight-loss efforts are “an experiment of one.”  What works for you is partially based on genetics (idiosyncratic metabolic processes), personal preferences, early childhood experiences, financial resources, preparedness for change, personality type, etc.    However, two themes unify most people who have lost a significant amount of weight and kept it off long-term: 1) they don’t eat as much as in the past, and 2) they exercise more.  Look for these when you search for effective weight-loss programs.

The aforementioned article brought to my attention by Evelyn Tribole suggests how olive oil and other unsaturated fats could curb hunger.  Oleic acid, a prominent monounsaturated fatty acid in olive oil, is transformed into oleoylethanolamide (OEA) in the small intestine.  OEA then activates a brain circuit that gives you a feeling of fullness, reducing appetite, and potentially promoting weight loss.

A 2007 article in the Journal of Molecular Medicine exposes a genetic variation that seems to prevent high fat consumption from contributing to overweight.  Read about it at FuturePundit.com.  The gene variant may be found in 10-15% of the U.S. population.  Consumption of monounsaturated fats, as in olive and canola oil, almost seems to protect against overweight in people who carry this genetic variation.  I’m talking about single nucleotide polymorphisms of the apolipoprotein A5 gene, specifically, -1131T>C.  But you knew that, right?  Nutritional genomics may eventually allow us to customize our food intake to work best with our personal genetic make-up.

A number of people, including Dr. Roberts, swear by the Shangri-La Diet.  It works for them.  I don’t think most of them are lying.  Maybe they are in the subset of the population with the appropriate genetic variant.

It would be easy to design and execute an experiment on 100 subjects to test the efficacy of the Shangri-La Diet.  Until that’s done - and it probably never will be - you could inexpensively try the Shangri-La “experiment of one” on yourself.  From what I’ve read, you’ll know within the first week if you achieve the natural appetite suppression that substitutes for the willpower and discipline required by effective diets.  As always, get your personal physician’s OK first.  

If it is a hoax, I complement Dr. Roberts on his ingenuity.  His book was a bestseller in 2006.  For those he may have duped, it didn’t cost them much and probably caused no harm. 

Steve Parker, M.D.   

References:

Corella, Dolores, et al.  APOA5 gene variation modulates the effects of dietary fat intake on body mass index and obesity risk in the Framingham Heart Study.  Journal of Molecular Medicine, 85 (2007): 119-128.

Schwartz, Gary, et al.  The Lipid Messenger OEA Links Dietary Fat to Satiety, Cell Metabolism, 8 (2008): 281-288.  doi: 10.1016/j.cmet2008.08.005


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