Dear Dr. Yildiz, thank you so much for your insightful post that addresses a very relevant issue. Relevant, that is, for the larger part of the population (in the developed countries), as the normal-weight person is on the endangered species list.
As an aside: You’ll find references to many of the comments that I am going to make in three of my previous posts:
https://medium.com/right-to-rejuvenation/a-solution-to-the-obesity-epidemic-part-2-2a328b090f7
Your title immediately struck me as positive. You emphasize that your post is about the “nuances of weight and fat loss”. That signals to the reader what to expect: not a proselytizing treatise about the causes of overweight and obesity, but rather a “case study” and personal experience.
I have to apologize upfront for probably sounding a bit harsh at times, but so many apologists have hijacked the obesity discussion that I have made it a point to start any conversation on that subject by setting the goalposts straight. These goal posts are the 4 common misperceptions that, if not corrected, give every weight loss discussion a BS-soaked narrative.
Here they are
1. I eat so little, and I still gain weight
2. It’s my genes
3. It’s the hormones
4. I have heavy bones
None of them are acceptable:
Number 1 violates the 1st law of thermodynamics. That law states that energy can neither be destroyed nor created but only converted from one form to another. So weight gain on a negative calorie balance is as probable as a virgin birth.
What the 1st law can’t say is why the weight gainer obviously is in positive energy balance, even if the perception of low-calorie intake turns out to be objectively true. Indeed, there exists a subset of obese individuals who stay obese on remarkably little food intake. I’ll get to them after having addressed the remaining 3 goal posts.
Number 2 (It’s the genes)
Yes, absolutely correct, ONLY NOT in the way the accusers present their argument.
For 2 reasons. First, the obesity rate in the US has tripled over the past 50 years (with 40% of US adults having a BMI north of 30 today), but the human genetic code doesn’t change over such short time frames. That is, with the same genes that obese people have today, most of the previous generation were not obese.
Second, if genes were the cause, we could predict which kid will become obese. But we can’t. The few genetic tests we have miss 80% of the cases.
An exception to the rule: the very rare cases in which a single aberrant gene is the monogenetic cause of extreme obesity.
Number 3 (It’s the hormones)
Yes, of course, it is the hormones. But, again, NOT in the way most people think of them.
The sensation of hunger, the drive to eat, the preferences for the sweet and fatty, the compulsion to stop eating, where do all those sensations come from? Hormones. They are encoded in our genes. So, if those genes haven’t changed, the only other explanation for a hormone-driven obesity pandemic is that the expression of hormones and the sensitivity of their receptors must have changed. (BTW, that’s why Ozempic works, as I have described in one of my posts). That’s exactly what we frequently see when we compare obese with normal-weight people. These changes neither happen out of the blue nor overnight. Before I’ll get to that let me address the last goal post, which is my absolute favorite:
Number 4 (I have heavy bones)
Ever seen an MRI scan of an obese person? You begin to wonder how those fragile thin lines that are the bones carry a huge 300-pound frame without breaking. But seriously, total bone mass makes up only about 10-14% of body weight in a normal-weight person. If anything, the process of constant remodeling of bone mass results in slight losses of bone mass throughout adult age (accelerated in women post-menopause).
Even if we consider a physiologically unrealistic relative increase of bone mass of 10% in the “heavy boned” 80-kg bodyweight apologist. That would translate into a weight difference of barely 1 Kg.
Now I have set the goalposts, so let’s dive a little deeper into the true reasons for overweight/obesity, and your story.
By now, you will probably expect me to claim that obese people are to be blamed for their predicament. After all, I have taken away all the excuses.
But you would be wrong. Obesity is not the result of being weak-willed or lazy (with some exceptions which I’ll address in a moment). Even though that stigma pervades our society on all levels, even among health care professionals, and already among children of primary school age.
Here is why: The agony load that comes with being obese is so great (I discuss this, particularly for children in one of the above posts) that it should out-motivate any hesitation for behavioral change. Look at children. The perceived agony load of an obese child is on par with that of a pediatric cancer patient on chemo.
So, that’s where I subscribe to the hormonal drive idea. BUT, the overweight/obese person is not entirely blameless. Weight gain does not happen overnight.
The average US adult gains roughly 8 kg from their late 20s to their late 30s, another 6.5 kg during the next decade and another 4.2 kg from their 40s to their 50s. Women more, men less than these averages. Initially, during a weight-gaining period, the human organism balances it out by increasing its metabolic rate. But it doesn’t do that forever. It adapts. And at some point then begins to defend against weight loss that would ordinarily be the result of dietary restriction. This “derailed” defense is hormonal. Getting there is behavioral. And not noticing it is simply negligent.
In your case (you mentioned that you struggled with excess weight 40 years ago) you were on a much better footing for re-adaption to the “hormonal normal” that preceded your weight gain. Compare that to a 50- or 60-year-old, whose doctor has just told them to lose weight because otherwise they’ll be diabetic and hypertensive in no time. With a decades-long history of wearing the XXXL sizes, re-calibrating their hormonal drives is next to impossible. Well, not entirely, I have coached some individuals to achieve that. But the younger they are, the more likely they’ll be successful.
And that brings me to the no-pain-no-gain mantra. Contrary to your suggestion, I fully, 100% subscribe to it.
I see it so many times: people in our fitness studio doing the same routines year-in and year-out and not changing their body composition or their contour one bit. Why? Because they always stay within their physical comfort zone. That’s not the zone where adaptation (muscle growth, increased cardiorespiratory fitness, fat loss) happens. Stepping out of one’s comfort zone is where progress (not only in the fitness context but in all of life’s aspects) happens. And stepping out of your comfort zone is painful. When it comes to exercise, not in a bad way. You probably know as well as I do that there is a difference between bad and good pain in exercise. But many obese/overweight individuals shun away from that pain.
Then there is the issue of weight loss vs. fat loss.
Let’s look at it in numbers. A 1.8m tall person weighing 95 Kilos has a BMI of 29. Unless that guy is a serious bodybuilder, he is just a few kilos shy of being officially obese. He would have to lose 15 Kilos to make it into the normal-weight category. By current population standards for whites, 10-12 of these 15 Kilos would have to come from fat loss.
Your suggestion (at least I understood it as such) that this person might not see much on the scale while their exercise regimen makes them lose significant amounts of fat weight, is something I can’t subscribe to. The necessary compensatory muscle gain is simply too large to be realistic. (I know how hard I have to train to gain just one or two kilos of muscle mass. And those gains don’t come from staying inside the comfort zone.)
This is particularly true for the average couch potato. If they start a strength training regime they will initially (first 3 months or so) not see much gain in muscle mass. Challenged with unfamiliar loads, the body first optimizes neuromuscular coordination. It increases the efficiency of what it has (muscles) to cope with greater loads before it packs on additional muscle.
I have seen this to frustrate so many obese people’s attempts at changing their body composition. They don’t see much on the scale, and they see virtually nothing on the bodycomp scale.
To sum it all up, weight loss is a difficult business. The longer one has been overweight/obese the more determination, grit, and willingness to suffer pain is required to achieve a clinically relevant weight loss.
That’s why in my eyes, our approach to beating the obesity pandemic (on a population level) needs to change fundamentally.
We have to honestly acknowledge that we can’t do much for the currently obese. To put a substantial dent into their numbers will be impossible without drugs like Ozempic. I don’t like them, though, for two reasons. First, people need to take them for life, which is an expensive proposition. And, after having turned the rich fat ones into normal-weight rich ones, the only fat ones remaining are the poor. Imagine what that will do to stigmatization. OK, I know that this portrayal is exaggerated, but it illustrates a valid concern.
Second, we don’t know what happens with this off-label use of a drug that was designed to treat diabetes.
That’s why my team and I have developed a simple tool to train one’s 6th sense for calorie balance. Our pilot subjects have had very good success with it. I also described it in one of my above-mentioned posts and even invited readers to test-drive it. But I have had not enough readers/followers to really get this noticed.
I’ll probably reintroduce this in another post on the subject of weight management.
