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Everything We Know About Obesity is Wrong, Right?

About 2 weeks ago a lengthy article came out in the Huffington Post by Michael Hobbes titled “Everything You Know About Obesity Is Wrong” I was both impressed and disappointed with the article - Just the subtitle was impressive: It’s time for a new paradigm.

We absolutely need a new paradigm - we’ve been trying and failing with calories in=calories out for too long, so I was hopeful. He got a lot of it right, however, he suggested that we need to be content with our size and weight, and this is where I disagree.

I loved Mr. Hobbes’ story about scurvy and how the cure was known and delayed for too long. Like scurvy, the reasons for weight gain have been known and understood for years, yet the knowledge is ignored and we continue to try to fix the epidemic by rejecting good research and pushing bad advice. Mr. Hobbes paints a compassionate picture of different people’s struggles with bullying as they suffer from obesity both from people they know and those they don’t. His descriptions paired with the beautiful photography illustrated strength and vulnerability in his subjects, which he then ruins by referring to them over and over again as “fat people.” Using the words “fat people,” is one of the most degrading ways to talk of someone who has elevated BMI (see link).

A key point that Mr. Hobbs is trying to make is that diets do not work. He suggests that in order for people to successfully lose weight, they must reduce their metabolisms, change their hunger hormones, and fight their body’s energy-regulation systems while battling hunger all day, every day, for the rest of their lives. This type of diet or weight-loss regimen follows old dogma - eat less, exercise more to maintain weight loss. The story he creates is one of sheer hopelessness when it comes to people who strive to lose weight.

I don’t agree. There is hope.

It is a lifestyle change. It takes effort. It takes planning. It is a complete overhaul of how you fuel your body.

  1. Eat real food, focusing on protein and fat and vegetables.

  2. Significantly reduce carbohydrates in your diet, especially the highly processed sugars and grains.

  3. Eliminate vegetable oils and processed foods.

When you eat real food and reduce carbohydrates, your blood sugar and insulin levels are naturally reduced. As a result, your body adapts to burning fat for energy instead of using glucose and glycogen stores, and the end result is that you will store less fat.

Over the years, The Standard American Diet (SAD) has become quick and easy, overly processed, food-like substances. Sugar and processed vegetable oils are in most of the foods that are found in the aisles of the supermarket. It is packed with addictive sugar which encourages us to buy more. They add words like “heart healthy” and “whole grain” so that we’ll continue to think they are selling us consumable healthy food. Mr. Hobbes touches on the state of our food, but only minimally. This, in my opinion, is the key issue when discussing obesity.

While it is true, as Mr. Hobbes states, that weight and health are not perfect synonyms, the majority of people who suffer from obesity have at least one weight related chronic condition that will improve with weight loss. For every pound lost, the pressure on your knees is reduced by 4-5 pounds, which reduces pain and also reduces risk of future arthritis. Losing weight also reduces a woman’s risk of weight related cancers (breast and uterine). He discusses large numbers of people who suffer from obesity who currently have no signs of metabolic disease, however, if they continue in their current lifestyle, eating the Standard American Diet, they are as likely to get diabetes as anybody.

Mr. Hobbes states that the training that most physicians received in nutrition is not adequate. I concur, but as a trained obesity medicine doctor and family physician, I would also argue that the training is not acceptable. Doctors are still trained in the same USDA guidelines that accompanied the increase in obesity rates we have seen since about 1980. Doctors have been taught that most diseases are chronic and progressive and not reversible. If a doctor gives dietary guidance, it is generally a food plan that will continue patients down the “chronic progressive disease” pathway that will eventually require more and more medications instead of a plan that may improve the diseases. I am truly sad for the patients, ashamed that they are treated in the unacceptable manner by physicians and other health care providers.

Unfortunately, the system rewards doctors who document talking about obesity to patients as mentioned in the article, and punishes those that do not. This results in discussions of weight that are too quick and without much care about the patient's response, often ending with orders to “eat less, move more". Patients absolutely need to be their own advocates and do research on the doctors and other health care providers that they see, and find someone who will actually spend time teaching about health and wellness.

This is an important article as Mr. Hobbes gives an eye opening description of the bias that exists against people who suffer from obesity. He makes a great point about trying to attain happiness with the bodies we have. As stated, “There’s a lot we can do right now to improve fat people’s lives - to shift our focus for the first time from weight to health and from shame to support”. He is right, we need to stop shaming people who have excess body fat. Unfortunately Mr. Hobbs does not give any hope for weight loss. I have experience both personally overcoming weight issues, as have many other people who have successfully achieved weight loss and even a “normal” weight. There are also many studies that show you can achieve significant weight loss through a well formulated ketogenic diet or eating low carb with healthy fat with moderate protein - real food.

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