1. Can chronic calorie restriction be sustained? If it can, does it override the body's compensatory systems?
Yes. When true starvation is forced, it can be sustained, and it will override the body's compensatory systems. External forces like famine or other conditions, where food availability is not consistent, uncertain or non existent, causes a sustained state of chronic starvation.
In this state, the body compensates but this compensation never results in overweight/obesity because the person will die of malnutrition before any metabolic adaptation, resulting in metabolic syndrome, can take place. Metabolic syndrome is starvation without the death.
2. You can't predict who would get fatter and sicker on protocols like extended fasting and fad "keto".
Those type of programs are detrimental for people who:
- Have been overweight/obese for most of their life.
- Have metabolic syndrome/diabetes.
- Have dieted frequently using some sort of starvation (most diets).
It's these people who will suffer the most in the long run as these protocols will cause their metabolism to double down its starvation adaptation increasing body fat over time and worsening metabolic outcomes regardless of any initial improvements. You can find multiple in vivo case studies of this online, in the fasting/"keto" community.
3. I recently left a protocol I had been following for some months. I didn't really lose much weight, but I did drop some inches and then stalled. I left the program because there was too much strenuous exercise involved and I'm a senior who can't keep up. I felt like I was being blamed for not being able to lose more weight than I did. I feel lost as to what to do now.
It's sad to see people get duped, over and over again, by these weight loss programs, usually run by fit body building trainers. These people cannot help you. These people can help someone in their twenties achieve muscle tone and drop 20 lbs. but they cannot help someone in their sixty's reverse overweight/obesity and their metabolic syndrome. It's not going to happen.
Calorie centered protocols that work using deficits and a large amount of energy "output" is just not going to tackle the "disease" known as obesity. People on these programs will end up blaming you, when the protocol does not work. They are true believers that go into a rage when reality shows them otherwise. For them, if it's supposed to work, then it simply cannot fail. Their logic is that if it works for 30-year-old Debbie who is 30 lbs. overweight, then it must work for 50-year-old Sarah who is 100 lbs. obese. It doesn't. Being a few pounds over your "ideal weight" is not obesity.
This is why we focus on meal composition, sustainable exercise and behavior modification in order to get long term results. In other words, a lifestyle approach. Overweight/obesity and metabolic syndrome only respond to long term, consistent, lifestyle interventions.
4. Are there fasting protocols which are not based on calorie restriction?
Intermittent fasting protocols like 16/8 and 20/4 are not based on calorie restriction because the person can eat all of their required calories in the 2 - 3 meals they would have during their 8- or 4-hour eating period. Once the fasting protocol becomes longer like one meal a day (OMAD) or less, then it produces an overall calorie deficit.
Doing an OMAD or up to 72 hours of fasting, once a week, is not a prolonged enough calorie deficit to cause adverse metabolic side effects for the overweight/obese who are generally otherwise healthy, but not everyone responds the same way. The more obese the person, the less chances of negative side effects to these longer intermittent fasting protocols but, metabolic syndrome puts you at high risk for these protocols to become detrimental.
5. I’m Asian and in good health. I’m slim and do not have metabolic syndrome. I consume my traditional Cambodian diet which consists mainly of rice and vegetables. I’m considering giving up my diet because of all the anti-carb info I’ve been reading online.
No. If it's not broken, don't fix it. You’re not in any danger and you shouldn’t change your diet. As long as you continue consuming your traditional low to no sugar diet, without any Standard American Diet (SAD) processed items, you will continue to be fine.
Low to zero carb diets are the recommended diets for people tackling metabolic syndrome and overweight/obesity. They can no longer negotiate with carbs. Traditional Asian diets for healthy Asians are the best diets they can follow as it's their original diets which they genetically evolved with. Asian diets combined with the SAD diet is deadly. So, as long as your healthy, don’t change anything.
6. I have heard you mention "obesity mindset" before and I would like for you to elaborate on what that means. I have never heard anyone else mention this.
We don't see obesity as solely a biological or a behavioral problem, on this blog. Obesity is both. Both biology and psychology play a role in obesity, and one cannot exist without the other as they depend on each other. There must be fertile ground for obesity to take hold and that's where mindset, which influences behavior, plays its role. Obesity is a lifestyle choice. This means that the person must be living a lifestyle that promotes obesity (obesogenic) and this goes well beyond dietary choices.
There are certain behavioral characteristics that are similar, across the board, in most obese. These behaviors existed long before the person ever reached obesity. This is why obesity is a time dependent condition, on all levels, because it begins long before excess fat accumulation becomes visible.
To put it in perspective athletes are never obese. Now you could chop this up to simple calories in/calories out (CICO) theory, but you can also look at an athlete's mindset, long before they became an athlete. Athletes are known to be persistent, tenacious, consistent and determined. The person that gets up at 5 am to go jogging whether it's cold, hot, raining or snowing, is never obese and will most likely never develop obesity in their lifetime. Hint: It's not just because of the jogging.
Obesity characteristics are not as simple as just "gluttony and sloth", though you can see how this stereotype took hold, since many of these characteristics below mimic just that. The most common characteristics that I have experienced in the obese are:
- Entitlement - They feel they have a "right" to things. "I have the right to eat what I want and shouldn't be kept from it". "Because I am older, fatter, weaker and sicker, I have a right to not be expected to eat or move like others". "Because I am stressed, I have a right to this cookie. I deserve it".
- Avoidance - They will address the problem without ever doing what it takes to resolve it even when the resolution is known. They avoid difficulties and address "the issue" in a way that's comfortable, both physically and mentally for them, even if it provides no results.
- Excuses - Usually these excuses are part of the avoidance. Excuses come in dozens for the obese. From social gatherings to holidays to "I only ate a little bit" to once again, stating how old, sick and fat they are.
I notice this clearly in aging. For instance, in my Cuban culture the elderly are very entitled. They basically are not required to move while the young are obligated to do everything for them. Well, what this has caused is a very sick elderly population in our community. They become immobile younger and develop serious health conditions sooner. In contrast, American elderly people are out jogging, golfing, swimming, traveling and remain active for longer while older. This is because loss of mobility and knowing you can't really depend on the young to do for you, keeps them active by force. Invalids don't just use crutches, crutches make invalids.
Most obese use their mindset as a crutch to perpetuate and justify their obesity in one way or another. Once you are obese, biology will not make it easier to become lean. It will only make it easier to become more obese. So, this mindset has to be changed and preferably, not allowed to take hold early on in a person's life because it will make them obese later on. The ones who succeed in becoming lean, don't just change what they do, they change how they think.
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