Why do we get fat

Chapter 7 Diet to lose weight, is it really good?

In the early 20s, the National Institutes of Health (NIH) set out to investigate some of the key factors affecting women's health.The results of the survey were compiled in the Women's Health Initiative (WHI), a nearly $90 billion research effort.

Among the questions the researchers answered was whether a low-fat diet (at least in women) could actually prevent heart disease or cancer.To this end, they randomly selected 50000 of the 20000 women who registered to participate in the survey, and suggested that they follow a low-fat diet and eat more fruits, vegetables and foods rich in dietary fiber.The women also received regular counseling to motivate them to maintain their dieting habits.

This health counseling, which encouraged dieting, led these women to decide, consciously or not, to eat less.According to the Women's Health Initiative researchers, the women typically ate 360 ​​fewer calories per day than when they initially agreed to participate in the survey.If we believed that obesity was caused by overeating, we might say that these women "eat less" by 360 calories per day, which equates to about 20 percent fewer calories than the public health agency recommends.

The results of it?After eight years of dieting, the women lost an average of 8kg each, while their average waist circumference (which is known to be one of the ways to measure belly fat) increased.This suggests that if these women did lose weight, no matter how much weight they lost, it wasn't fat, it was muscle tissue!That wasn't the only disappointing result from the study. Investigators for the Women's Health Advocate also noted that low-fat diets do not prevent heart disease, cancer or other diseases.

How could this happen?If weight is indeed determined by the difference between calories in and calories out, the weight loss in these women should be significant. 0.5 kg of fat is equivalent to about 3500 calories.If the women were indeed eating 360 fewer calories per day, they should have lost at least 1 kg (7000 calories) in the first three weeks and at least 16 kg in the first year.It stands to reason that these women can lose a considerable amount of fat.Moreover, when the survey began, almost half of the women were obese, and the vast majority were somewhat overweight.

One possibility, of course, is that the researchers, unfortunately, were unsuccessful in assessing how much the women were eating.Perhaps these women deceived investigators as well as themselves.Maybe they didn't lose 360 ​​calories a day.As Michael Pollan noted in The New York Times: "We don't know exactly how much these women ate. Just like most men lie when asked about their diet."

However, there is another possibility: Years of sticking to a controlled diet has allowed them to eat fewer calories, but alas, it has not achieved the desired effect.

Of all the reasons for questioning "overeating causes obesity," the most obvious has always been the fact that eating less does not cure obesity.

Yes, this is true.If you're stranded on a desert island starving for months, you'll eventually lose weight whether you start out fat or skinny.Even if you're only semi-starved, your fat will go off, as will most of your muscle.Trying the same strategy in the real world and sticking with it forever, keeping the weight off and not gaining it back - the chances of this strategy working, if at all, is slim to none.

This conclusion is not surprising.As I've talked about before, thanks to the wisdom and experience of Hildebruch, most obese people spend most of their lives "trying" to eat less.If nothing happens, decades of hard work have paid off for all the ills that accompany obesity—social exclusion, compromised immune function, increased disease rates—just because the pundits in the health white paper insist Let's try again, can we really expect eating less to work?
There are very few obese people who have never tried to control food intake to lose weight."Even if eating less helps you achieve some short-term success when you're very fat, if you're still fat, it's reasonable to assume that eating less won't solve your particular problem," Bruch notes.

However, since the idea of ​​"eating less to lose weight" was put forward, this basic policy has rarely changed.

In 1959, psychologist Albert Stunkard and colleague Mavis McLaren-Hume published a book discussing whether eating less could cure obesity.Stuart claims their research was spurred by what he calls a "paradox" in which he himself repeatedly failed to use diet-based approaches to treat obese patients in outpatient departments at New York hospitals.But people at the time generally believed that this treatment was convenient and effective.

Stuart and McLaren-Hulme combed through the medical literature and found eight articles that mentioned doctors' success in treating obese people in their clinics.The findings were "pretty similar, pretty anemic," Stuart said.Most clinics prescribed obese people eating just 800 to 1000 calories a day (half of what the Women's Health Initiative recommends for women), and still only a quarter of patients lost significant weight.

斯图卡特也提到了他自己的经验，他在自己的诊所对100名肥胖患者开了“平衡饮食”的处方，要求他们每天只摄入800到1500卡路里。结果仅有12人减轻9千克。斯图卡特还写道：“治疗结束后2年，仅有2名病人能维持他们的体重不反弹。”

More assessments have benefited from the use of computers and sophisticated statistical analysis, yet the end result, as Stuart puts it, remains "pretty similar, pretty anemic."According to a 2007 review by Tufts University, the best results of low-calorie diets prescribed to obese and overweight patients are only "transient," meaning temporary, modest weight loss.Usually, you can lose 6 to 4 kilograms within 4.5 months of dieting and weight loss, but after a year, most of the lost weight will be regained.

The Tufts University evaluation is aimed at the analysis of all dietary experiments published in medical journals since 1980. So far, this experiment is the most detailed and comprehensive analysis of dieting and weight loss with calorie restriction. We have no reason to ignore its conclusion.

Another authoritative study came to a similar conclusion, by researchers from Harvard University and the Pennington Biomedical Research Center in Baton Rouge, Louisiana, the most influential obesity research institute in the United States.Together, they recruited more than 800 obese people to conduct a survey and randomly assigned them one of four diets to lose weight.The recipes differed slightly in their ratios of nutrients (protein, fat, and sugar), but the 750-calorie cut per day for respondents was essentially the same.In order to ensure the dieting status of the survey subjects, they will also receive a "behavioral advice" to ensure that the dieting subjects receive professional weight loss help.Every two weeks, they even get a meal plan to help them figure out how to cook tasty, low-calorie meals.

The respondents who participated in the study were on average 22kg overweight, but as a result, they lost only 4kg on average.Then, again as predicted by the Tufts University evaluation, most of the participants who lost weight within the first six months regained the weight after a year.Undoubtedly, very few people really lose weight successfully.Even if eating less is effective for weight loss, the effect cannot be maintained for several months.

However, this reality does not prevent authorities from recommending this approach, leading people who read such recommendations to fall into a state that psychologists call "cognitive dissonance," an attempt to maintain two incompatible " Faith" creates tension.

In 1998, three of the most prominent authorities on weight loss, George Bray, Claude Bouchard, and WPT James, co-authored The Obesity Handbook.The book argues: "Diet therapy remains the cornerstone of weight loss, and calorie reduction is the basis for successful weight loss." But just a few chapters later, it states that the results of such calorie reduction and dietary restriction "are considered less effective than Good and not long."So why are the "cornerstones" of treatment less effective? The Obesity Handbook ignores this issue.

The latest 2005 edition of the textbook "Jaslin Diabetes" is also a recent case of cognitive dissonance.The chapter on obesity was written by weight loss expert Jeffrey Flier, then dean of Harvard Medical School, and his wife and colleague Terry Maratos-Flier. Co-authored.The Freers also describe cutting calories as "the cornerstone of weight loss."But among the various methods they listed, this "cornerstone" still failed.

From the slightest calorie-adjustment diet (for example, eat 100 calories a day less, hoping to lose 5 kg every 0.5 weeks), to a low-calorie diet that only consumes 800 to 1000 calories a day, to eating only 200 calories a day. From very low-calorie diets to 600 calories, to complete starvation—after examining all methods, they concluded: "None of the methods prove that dieting is really worthwhile."

Ugh!
In the medical literature, low-calorie diets were once referred to as "half-starvation" diets.At the end of the day, these diets want us to eat half as much, or even so little as to be figuratively called "eat."But we can't hope to half-starve ourselves for more than a few months, let alone starve endlessly, and that's exactly what this type of diet suggests we need to do—if we want to maintain the weight we started off with. Weight, we have to be hungry all the time.A very low-calorie diet is called "fasting" because basically it does not allow any eating.It's hard to imagine someone fasting for more than a few weeks, maybe a month or two at most.What is certain is that once our excess fat is reduced, it is impossible for us to fast all the time.

In summarizing the methods used to treat obesity around the world, two researchers from Harvard Medical School, George Blackburn and Bruce Bistrian, may have the best results. In the 20s, they began using a "70-calorie-a-day diet" consisting of only lean meat, fish, and poultry to help patients lose weight.They've treated thousands of patients, and half of them lost 600kg or more, Bisterling said.He also believes, "This is an effective and reliable method for significant weight loss."

But Bisterling and Blackburn later abandoned the therapy because they didn't know what to do next after the obese people lost weight.Obese people cannot be expected to live on 600 calories a day forever.As long as they return to their normal diet, the weight they lose will be regained immediately.Bisterling said the only medically acceptable option was to suppress appetite with drugs, and that was something no one wanted to do.

So, even if you follow one of these recipes and lose most of your excess fat, you still won't be able to get rid of the uncertain future of obesity.If you rely on eating 1200 or even 600 calories per day to lose weight, then when you revert to a diet of 2000 or more calories per day, you end up gaining weight again.Are you surprised by this?That's why experts say dieting is a lifelong commitment -- it's a way of life.But how is it possible for us to remain semi-starved or fasted for long periods of time?When I interviewed Bisterling a few years ago, his answer can also be seen as a response to Bruch half a century ago.He believes that eating less does not treat or cure obesity, it only temporarily alleviates the most obvious symptoms.

Since eating less doesn't treat or cure obesity, it's clear that eating more isn't the cause of obesity either.

(End of this chapter)