Most of the obesity epidemic is being driven by added sugar. You do not have to eat dessert to have had several desserts, throughout the day, from products that are savory.
Sugar sales have declined in recent years, while obesity has increased exponentially. This is because no one needs to buy sugar anymore, to add to anything, as it's already been added for them by the food manufacturers.
2. 'Whole 30' is a great diet to follow for carbohydrate restriction.
Whole 30 is a diet that emphasizes whole foods and is moderately carbohydrate restricted. It's sort of like Paleo, but without the "natural" sugars. This diet eliminates sugar, alcohol, grains, legumes, soy and dairy for 30 days. So, its emphasis is more on "food allergies" than obesity.
I never added Whole 30 to my list of recommended diets, because it makes too many concessions for people to continue eating foods they shouldn't. The elimination of dairy is also asinine, as that would have no effect on obesity, unless the dairy eliminated had added sugar.
3. Fructose cannot be harmful as it has no effect on some people.
This is dependent on how much fructose is being consumed, for how long and individual ability to metabolize it, which is genetically determined. Some people have a much harder time metabolizing fructose than others. This should not be surprising as we see this same variability in alcohol tolerance, since it's metabolized in the same way.
This genetic component can be commonly seen in certain ancestries. For example, Native Americans and people of South American ancestry, appear to be especially susceptible to fructose induced fatty liver disease.
4. If a person is strictly adhering to their diet, they will lose weight.
We know that yo-yo dieting and starvation protocols can negatively affect metabolism and eventually cause for the person to become unable to lose weight. This is caused by poor leptin expression, which can cause hypothalamic damage in the long term. But, there is another situation that can cause intractable obesity and it has not been well studied, so the exact mechanisms behind it are unknown - fructose consumption.
We have long known that there is something particularly obesogenic about sugar, which is not found in any other saccharide. Fructose is a known liver toxin and its effects, when combined with glucose, are not entirely known. The liver is at the center of metabolic function, so for interventions to work, the liver must be responsive to them. It has long been observed that people who became obese/diabetic, specifically from fructose consumption, develop the most intractable forms of obesity and insulin resistance. This is related to leptin expression and since we know that the taste of sweet, affects the brain, we know that something unique occurs when obesity is the result of sugar consumption.
The consumption of fructose mainly comes in the form of sweetened beverages. Most of these beverages are fruit juices, smoothies, shakes, coffees and sodas. Desserts, candy, fruit and savory food items, containing added sugar, come in second. People who became obese from fructose consumption usually have a similar obesity pattern:
- They become obese earlier in life, often in childhood. Their children also tend to be obese.
- They gain large amounts of weight, usually of 100 + lbs. or more. These people are not just simply overweight, they are morbidly obese. In fact, they can pack on an incredible amount of body fat, before they show any abnormal metabolic markers. This is indicative of extreme insulin sensitivity of the fat mass. Again, this goes back to leptin dysregulation.
- They usually do not develop any of the symptoms of metabolic syndrome or show abnormal blood work. Surprisingly, a lot of these people do not display the symptoms of common metabolic disease that we would associate with having such massive body fat. Many have normal HbA1C's, do not display hyperlipidemia, nor develop high blood pressure or a blood glucose within the diabetic range. This causes them to live with morbid obesity for a longer time period. Obesity is a time dependent disease, so the longer you have it, the harder it is to reverse.
There is a "quiet storm" occurring with these people's metabolism, which is not normal by any stretch of the imagination. Because these people have this uncanny ability to maintain "health" at such an extreme level of body fat, it's led to the creation of the "metabolically healthy obese" myth. But, these people are not metabolically healthy. In fact, they may have the most severe form of metabolic disease, as they simply cannot lose weight and must resort to drastic interventions like bariatric surgery, to keep from eventually dying.
The ability to accumulate such massive fat mass is a sign of severe metabolic dysfunction, that goes well beyond insulin abnormalities, but is directly correlated with leptin malfunction. The more their fat mass gains insulin sensitivity, the more every other tissue, in their body, becomes resistant. Not only can these people not lose weight, but when they do, they can regain weight quickly and a greater amount than they started with.
Though much still has to be learned about this type of obesity, we know that fructose consumption is at the center of it. It appears that fructose damages metabolism, in a permanent way, most likely at the hypothalamus and so it doesn't respond to treatment. This is precisely why we tell readers, of this blog, to refrain from sugar and sweeteners, as sugar affects the body and sweetness affects the brain. If you end up with hypothalamic damage, your body will never be able to regulate its weight.
The course of intervention, for these people, will be dependent on their lifestyle and habits. We know that they first must abstain, 100%, from any type of fructose and/or any sweeteners. From that point, carbohydrate restriction along with caloric restriction, must be implemented, as most of these people have severe disordered eating patterns and require caloric restriction in order to abstain from excess food consumption.
5. There should be one intervention for addressing obesity and not so much confusing and conflicting information.
The confusion comes from a simple fact, that most people are ignorant of or choose to conveniently ignore, - there is a major difference between weight gain and obesity. You will not find any obesity experts, online, selling books or pushing weight loss programs. This is mostly because obesity is very different from weight gain and cannot be treated the same way. It also has no known cure so writing a book about it is not going to be very helpful out of academia.
There is something peculiar going on in the bodies of the obese. You can see this clearly, by just observing people in public places. You can’t tell who’s a few pounds overweight, but you certainly can tell who is obese. Obesity is an entirely different metabolic state. This poses a huge problem in the health and diet sphere, because you are left with many people offering weight loss advice, to the obese, that’s not going to work. The obese don't need to simply lose weight, they need to lose enough weight to resolve their obesity.
It’s ridiculous to tell an obese person to go get fit at the gym. They have no muscle mass and their bodies aren't capable of producing any significant muscle mass to bypass their ever expanding fat mass. It’s also ridiculous to tell an obese person to just restrict calories, as this does not address their body's caloric mismanagement. The obese person's metabolism is working in a completely different way, than a person who just simply gained some weight and is now upset that their jeans are getting tight.
There is no doubt that the metabolism of someone who needs to lose 20 pounds is very different from someone who needs to lose 100 pounds. The metabolic dysfunction that accompanies obesity changes the rules, as to what will work for addressing it. Not to mention the long term metabolic effects of an obese person who loses weight. There is a big difference between the metabolism of someone who lost 20 lbs. and someone who lost 100 lbs. I wrote in detail about this here.
Most studies on weight loss have been done on metabolically healthy individuals, who are not obese, but more than likely "obesity resistant". The majority of studies done on the truly obese have been limited to the effects of bariatric surgery. But, the fact that the obese commonly end up needing bariatric surgery is telling in of itself. It means that what works for simple weight loss, never worked for the obese.
All animals have the capacity of gaining weight. Weight fluctuates and is never static, in any animal. This type of weight gain is not pathological. Only in industrialized societies do we see obesity, both in humans and their pets. This means that obesity is not exclusively a "human" problem. Weight gain is observed in animals and hunter/gatherers, while in there natural environment, but never obesity. There is something unique about modernity that results in the state of obesity. I suspect it has to do with the ability to sustain blood glucose abnormalities chronically, which just cannot be done in a hunter/gatherer environment.
So far, most interventions have not curbed obesity nor gotten the obese to lean. We know this, because the most common difference between modern man and hunter/gatherer tribes is energy availability. But, when energy is reduced in modern man, weight loss occurs, but obesity doesn’t budge and when energy is increased in hunter/gatherers, weight gain occurs, but obesity does not. So, though simple interventions like "eat less/move more" help reduce weight, it does nothing for obesity.
I’m not yet completely convinced enough to claim that obesity is a “disease”, though many do. I see it more as an adapted metabolic state, caused by certain lifestyle choices, that can lead to pathology. So, the cure for obesity is not to lose weight, exactly, but rather to change this abnormal metabolic adaptation through lifestyle interventions, as many behaviors are implicated in it. The natural consequence, of a multifactorial intervention, will be weight loss.
6. People with metabolic syndrome/diabetes should restrict protein, unless they are trying to grow muscle.
The only people who believe this, are people that know nothing about obesity and have very limited knowledge of diabetes.
People with metabolic syndrome/diabetes better be "trying to grow muscle", because if they aren't growing muscle, they are only growing fat, since growth doesn't stop at will. So, growing muscle is not optional.
Muscle loss goes hand in hand with diabetes. Diabetics have very high body fat and very low muscle mass. If they lose even more muscle, they get fatter by volume. For this reason, diabetics need to lose body fat, while preserving their muscle mass, because muscle mass is extremely important for a diabetic. Muscle mass drives metabolism for you to be leaner. Fat mass drives metabolism for you to be fatter. You choose who you want your driver to be, but the body always has a driver.
Muscle mass is so important for a diabetic, that you can be an obese diabetic and gain, just a little, muscle and your diabetes will improve. That's how vital muscle mass is. The diabetic wants to give their insulin something better to do than just grow fat mass. They need to divert its attention to growing muscle mass instead. Muscle helps regulate blood glucose.
If you are following fad dietary protocols, which achieve weight loss mostly through the loss of lean muscle mass, you are not getting better, regardless of what the scale says. Protocols that cause weight loss, through the diminishment of muscle mass, are starvation protocols like caloric restriction (deficits), extended fasting and protein restricted diets. None of these protocols can sustain metabolic health and weight loss.
The followers of these protocols lose some scale weight from the direct loss of lean muscle mass. In the end, they put all that weight back on, and then some, as fat. So, in essence, their fad diet just made them fatter. They swapped out muscle mass for more fat mass. You are either muscle or fat. One or the other, since no one is made of rainbows and glitter, unless you're a unicorn. Becoming more fat, worsens metabolic outcomes. Fat people only get fatter. The more body fat you put on, the fatter your future self will be.
The older you get, the more this fact affects you. Children grow organs, tissues, bones, muscle and fat, but adults only grow muscle and fat. The older you get the more that scale tilts towards fat growth, as you lose the ability to synthesize protein efficiently, making it harder to grow muscle. This is why the older you become, the more at risk you are for metabolic dysfunction.
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