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People want to lose weight, but they struggle to do so. That's why weight loss is the number one New Year’s resolution.
Why is weight loss so hard? The first step is to understand why we gain weight.
The medical community, media, and health experts have been telling us for years that the way to lose weight is to eat less and exercise more. This method works on the premise that all calories we eat are essentially the same. If you eat more calories than you burn in a day you will gain weight. If you exercise and diet, and burn more calories than you consume, you will lose weight. It sounds simple right?
If losing weight really worked in this way, would 1/3 of Americans be over weight? Most people dieting initially get some results, but often gain the weight back within a year. Fortunately, in the field of obesity medicine, the pendulum is starting to swing towards a new approach to maintaining a healthy weight.
A crash course in what causes weight gain
Here is the current science on weight gain–it is caused by a hormonal imbalance. Hormones are molecules that deliver messages to target cells within our bodies. Virtually every bodily function is controlled by hormones. Weight gain is to a large degree an effect of the hormone insulin.
What does insulin do?
Insulin is a storage hormone. It is the key that unlocks fat cells and tells them to store any extra glucose in the blood stream. When your insulin levels are high, your body is in storage mode. The fat cells actively remove glucose from the bloodstream, and store it as fat. The key to maintaining a healthy weight is therefore to understand how to balance the body’s storage mode with a fat burning mode.
Food is made up of three macronutrients:
- Carbohydrates (sugar, bread, pasta, etc)
- Protein (meat, egg whites)
All food stimulates insulin to some degree, however the amount of insulin stimulation varies greatly depending on the type of food. The chart below shows that carbohydrates cause your insulin levels to elevate the most. Protein causes a modest elevation of insulin, and fat consumption results in a very minimal rise in insulin levels.
This demonstrates that all calories are not created equal. When your insulin levels are high, you are actively storing fat, resulting in weight gain. Our traditional teaching of eating a low fat, high carbohydrate diet has resulted in overall weight gain over time.
What happens when you eat a meal?
After you eat a meal, especially one high in carbohydrates, you have glucose circulating in your bloodstream. Insulin levels rise, and the body starts to take action to get the glucose out of the bloodstream. Glucose is first stored in the liver as glycogen. The liver has limited storage space and cannot hold much glucose. If insulin levels remain elevated, the fat cells start storing the glucose as fat.
After several hours, the glucose is removed from the bloodstream, and insulin levels start to fall. This happens every night while you're sleeping.
The body needs a baseline level of glucose in the bloodstream at all times to power the cells of the body, especially the brain. At first, the liver uses its glycogen to keep your blood sugar at the level needed for basic body functions. Once that starts to be used up, the body will access its fat stores and turn fat into glucose, essentially burning fat for fuel.
Why is obesity becoming an epidemic?
Why is it that obesity has become an epidemic over the past 50 years? The answer lies in both the timing of meals as well as the types of food we are eating.
If you think back to early America, where many people were farmers, they generally ate only three meals per day. They typically went to bed earlier and did not eat late night snacks. Their foods consisted of eggs, meat, and vegetables–with far less sugar and highly refined carbohydrates. Their insulin levels likely looked like this:
Contrast this with the average American today. Many Americans start their day with a carbohydrate filled breakfast such as cereal, yogurt, pastry, bagels, or something that comes in a wrapper. We eat a mid morning snack, lunch, a mid-afternoon snack (or two!), and dinner. Many people today stay up late and eat a late snack, dessert, or have a beer while watching late night TV. This is followed by getting up at six in the morning the next day to have breakfast. Many Americans have insulin levels that look like the following:
As you can see, our insulin levels are always up, except for a short time while we're sleeping. This means we're constantly in storage mode, and over time our weight will slowly creep up.
How can we use this information?
Looking at how insulin acts as a hormone in the body, we realize that if we control our insulin levels, we can control our rate of fat storage and fat loss. This is a function of the timing of eating as much as it is about the actual food we're eating.
In this series we'll discuss how to use this information to promote weight loss and maintain a healthy weight. To get started, I have my patients start keeping a food journal. Many people use apps to do this, but honestly, I feel that they're too complicated and time consuming. Do not count calories–as we just discussed, not all calories are created equal, so counting them is of limited benefit. Just go into your notes on your phone and list what you ate for the day. Here is an example of a simple journal:
- 7am: yogurt, granola, grande caramel macchiato
- 10am: apple
- 12:30: boxed sandwich with chips, soda
- 2pm: Soda
- 3:30pm: trail mix
- 5pm: cookie
- 6:30pm: spaghetti dinner, wine
- 8pm: ice cream
Focus on the timing of when you're eating, and what types of foods you're eating. This includes any beverages other than water, tea, or black coffee. Most importantly, note how often you're eating, and how much time you're giving your body without any food or sugary sodas.
To get started, keep this simple food journal for a week to establish a baseline.
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