1. Bariatric surgery should never be pursued.
I never remove any treatment from the table because obesity is very difficult to treat, and many different approaches can be successful for addressing it. There is no one treatment for obesity. Well, actually that is a fib. There is one treatment for obesity - proper leptin expression. In theory, that can be achieved by the normalization of insulin through better blood glucose control, but success usually means the person already had it.
All obesity should be deemed difficult until it proves to be impossible. But surgery should not be the first course of action. It should be the last. There are two common types of intractable obesity but only one of them has a true biological cause:
- Disordered eating habits - The person simply fails at every dietary and exercise intervention they try because they are unable to sustain it. Inability to sustain a protocol is different from the protocol simply not working. Instead of the protocol not working, these people just always revert back to disordered eating and sedentary habits. Even when following a proper dietary protocol, they change it to fit their disordered eating habits taking away any effectiveness. This is all psychological and behavioral in nature. It can be something as simple as refusing to cook proper meals or as complex as the inability to even identify what a proper meal looks like. A lot of these people require "hand holding" to keep "motivated" or someone diligently watching over them for "accountability". Of course, all of this is futile. No one can do for you, what you can't do for yourself.
- Hypothalamic damage - This is a true biological issue that is caused by a defect in hypothalamic cross talk between leptin/dopamine and the fat cells. This usually occurs from obesity that was sustained from fructose (sugar) consumption, particularly soda, among other factors. These are the people who simply cannot lose weight regardless of the protocol used or their strict adherence to it.
Both of these conditions usually cause for your doctor to recommend bariatric surgery, as everything else has been tried and failed. But how successful is bariatric surgery for these conditions? Well, not very much considering what weight loss surgery is targeting. It’s targeting the ability to intake food. Basically calories. Calories do not address disordered eating habits or the malfunction of leptin. For this reason, most weight loss surgeries fail to produce long term weight management for these individuals, and they soon put on weight again.
I still don’t remove surgery from the table because there is a small segment who do have beneficial results after going through such an invasive treatment. Even if they are unable to reverse their obesity, they do lose enough weight to at least delay the onset of associated pathologies.
2. I recently started following a protocol and I lost about five pounds. I also lost ten inches. Then I gained back three pounds, but the inches remain lost. Are these lost inches fat loss?
Fat loss occurs over time. This is why you shouldn't concern yourself with anything that happened "recently". You will know you are losing body fat, when you are becoming slim. This is why we don't deal with such small weight fluctuations on this blog. They don't show anything other than the body's natural ups and downs in water retention.
Water bloat causes an increase in inches. This is why it's hard to button up your pants when you are bloated. When water bloat is reduced, inches are obviously going to be lost. These inches lost may not return if your current diet prevents water retention. That is not fat loss.
3. I keep losing and gaining the same four to five pounds while getting nowhere with fasting and "keto". I have been doing this for years.
Like I wrote above, this is why we don't deal with such small weight fluctuations on this blog.
The body compensates to whatever it's exposed to and continues on its trajectory of dysfunction as long as the underlying cause is not addressed. We see this with seizures for example. The person takes medication to stop seizures in one area of the brain and eventually develops seizures in another. Calories are another example. Calories coming in are reduced and the body simply reduces calories going out to match what's coming in. Soon you can't eat any less.
Obesity is an adaptation to starvation. Period. Until that metabolic state is changed, it will continue on. You can't change this adaptation through more starvation. Fasting and chronic ketosis are two states of starvation. All you have done these years is train your body to spare fat and build more of it from everything you eat.
What I don't understand is why people continue with protocols, for this long, which prove to not be working. It should not have taken "years" for you to realize that this wasn't treating your condition. It should have only taken a few months. Six months max is what any protocol should be given to prove itself. A protocol is not a failure because it doesn't work in the first month, but it is also not successful when it still hasn't worked in the sixth.
Yo-yoing up and down such small amounts of weight is the first indication that the protocol you are on is an epic failure. Your weight can fluctuate this way on no protocol whatsoever. If fact, dump the protocol and watch it for yourself. The body naturally goes up and down in water weight on any diet it's on. This means that your fasting and "keto" protocol has addressed nothing, all of the years you have been following it.
I understand that you want to believe in an "ancient miracle cure" but that promise, in itself, is full of lies. First, obesity is not "ancient". It is a modern condition, so there is no "ancient cure" for it. Only the adaptation that causes it is ancient. That adaptation is not a disease, so there is no "cure" for it. I'll let you believe in "miracles" if you want but I can tell you from experience that when it comes to weight loss, there are no miracles. There are only interventions that achieve results or do not.
4. I was told that boredom causes "nibbling and snacking" so I should eat a huge meal in order to prevent this. The huge meal should be composed of "large amounts of vegetables".
That is total hogwash. We have all heard about these "large amounts of vegetables" protocols before, haven't we?
First, boredom doesn't cause "nibbling and snacking". Disordered eating habits do. You will be bored many times in life since the majority of us do not live lives of consistent excitement. Life is mostly boring, unless some calamity occurs. Then when the calamity occurs, you will end up blaming it for the "nibbling and snacking".
People with disordered eating habits are always blaming external events and conditions for their bad behavior. The advice you were given is only reinforcing the fallacy that your bad behavior is not your fault but it's instead being caused by something outside of you, that's out of your control. That will only make you a slave to your unfortunate circumstances. Life's unfortunate circumstances will only increase as you get older so you will never be free.
Eating a "huge meal", especially one based on carbs, is not going to help with this. Vegetables are carbs which are low in glucose but high in air. Air is starvation. Starvation interferes with blood glucose regulation. Also, huge meals do not take away this mysterious "boredom". Huge meals are usually finished in about thirty minutes. The day is 24 hours long. This means, you now are left with 23 hours of boredom, if you eat twice a day.
Instead, be disciplined and eat appropriate, protein centric, meals during mealtimes only. Eat them at consistent times daily to adapt your satiety hormones and ward off hunger. If you are serious about treating your obesity, this should not be difficult. It's a no brainer. You have to do what you have to, in order to get the results, you want.
Lastly, find a hobby if you are bored. The hobby should be done with your hands or feet, not your mouth. A great hobby for people with metabolic syndrome/diabetes is walking.
5. I was told that I have to exercise in order to have the "luxury of eating higher protein".
You have to exercise in order to have the luxury of better leptin expression which helps you burn body fat. Exercise also promotes the luxury of muscle preservation/building.
You must have gotten the above advice from a calorie centric protocol. Because people who are trying to build muscle must intake enough protein calories, often times at a surplus, they try to match their training to their intake in order to keep with their caloric goals. On this blog, we do not recommend those types of protocols for the obese. Those protocols are great for obesity resistant people who are training for muscle gain or some athletic competition. The obese metabolic state is different.
The obese should eat adequate protein, without caloric restriction, regardless of exercise, because they are wasting away daily into glucose from hyperglucagonemia. It is very difficult for them to build muscle for various reasons, aside from that.
The calories of protein are used for preserving lean body mass. That is why the body expends a lot of calories to metabolize protein. This is released as heat or the "thermic effect of food". Protein has the highest thermic effect.
The body doesn't directly store protein as fat. Instead, it converts it into glucose and that is stored as fat. This is the process of gluconeogenesis. Most of the protein converted into glucose is from your own lean muscle mass, not from the protein you eat, though it tends to ramp up postprandially due to a rise in insulin. This is a very controlled process in the healthy but over expressed in metabolic syndrome/diabetes due to abnormalities in insulin/glucagon ratios (hyperglucagonemia).
But for the person who is trying to address these conditions, this alone is not significant enough to cause a progression in these pathologies, if the diet is low in carbs and moderate in fat. This breakdown of protein into glucose will taper off with time as insulin sensitivity improves. So, it's a worthwhile trade off in the short term.
6. I decided to take your advice and increase my meals to three a day, rather than just two, as I have been stalled for a while and decided f** it. What harm could it do? Keep me stalled? Well, it didn't do any harm at all. In fact, I started losing weight rapidly! I can now see a gap between my thighs, when I hold them together, and my clothing is falling off. How could eating more cause me to lose this much weight?
Leptin. There are many overweight/obese people who can easily obtain proper leptin expression and they are being duped into eating less by calories in/calories out (CICO) programs, causing them to remain obese. Eating less under expresses leptin and the person simply does not burn any body fat. Just because you are overweight/obese does not automatically make you permanently "leptin resistant". Many obese people are, but some aren't.
People who have:
- Not been overweight/obese in childhood, or who...
- Recently became overweight/obese, or who...
- Became obese from starch consumption rather than sugar (soda) and sedentary behaviors, are the most likely ones to regain leptin sensitivity when these issues are corrected.
Leptin sensitivity will allow you to lose weight from body fat and keep it off. You just have to eat enough and exercise sufficiently to kick start this. You did the right thing is incorporating an extra meal to your day. Now that you are no longer "starving", your body has agreed to burn body fat.
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