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Do you have any thoughts or experience on irreversible obesity?

by (4086)
Updated about 12 hours ago
Created June 29, 2011 at 4:16 PM

Stephan Guyenet:

"Obesity is not always going to be 100 percent reversible. I know no one wants to hear that, but I'm not in the business of selling snake oil. Some people can reverse it completely; others won't lose any fat at all; the majority can probably lose a substantial amount of fat but not all of it. Highly controlled diet studies in rodents show that obesity due to eating highly rewarding/palatable refined food is mostly reversible when they are placed back on low-palatability whole food, but they don't usually lose all of the excess fat, and the longer they've been obese, the less fat they lose (1, 2, 3). The capacity for the fat mass "setpoint" to re-establish at a lower level may diminish over time, varies between individuals, and probably also depends on other factors that no one currently understands. I think it's important to be kind to yourself, and not set unreasonable expectations."

link: http://wholehealthsource.blogspot.com/2011/06/food-reward-dominant-factor-in-obesity_28.html

I understand the point about setting reasonable expectations depending on one's health history, and that "not always going to be 100 percent reversible" means some may only change from obese to overweight. This is an intriguing statement and with so many success stories out there I would like to know if you (or anyone you know) are one of the very few who have not been able to lose any fat at all through diet alone?

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5477 · June 30, 2011 at 9:02 PM

@Jac: Oh yeah, re: MRIs, etc. A large portion of my MH work has been with traumatized kids. Got deep into Bruce D. Perry's work (MD, PhD, internat'l trauma tx expert.) Brain changes as well as cardiovascular marker changes - sometimes permanently increased resting pulses pushing 100bpm and increase BPs, among many other things. And cortisol, cortiol, cortisol...

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4086 · June 30, 2011 at 1:53 PM

@Ambimorph, yes we must be missing each other. I have not seen you post in a while, so I am glad to know you are still around!

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1196 · June 30, 2011 at 7:25 AM

Mem, we're very similar in our outlook I think! I'm a mh nurse among other things, working hard on getting people to see the synergies with mental and physical health - have you seen MRIs of traumatised people? Experience impacts on biology and vice versa.

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5477 · June 30, 2011 at 5:51 AM

And Jac, my fav part of your post is: "It's a very cool language I'm learning." YES!!! And it is a new language with our deepest, WHOLE selves, not selves split in all kinds of artificial pieces, that we must learn on this journey. And it *is* a journey for those "deranged" and with significant wt issues among us. "Jac is singing our song!!!"

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5132 · June 30, 2011 at 5:48 AM

So let's say your "calories in" is 500. Your "calories out" is probably around 2,000, at least. Believe in the calorie theory for a minute. You have a daily deficit of -1,500. Even if you lie down all day and move a few fingers, you'll still burn at least 1,500. Why isn't the deficit of -1000 or -1500 not being shed as lost pounds? Answer: it's not calories in calories out. Taubes is right. It's hormones and metabolism. It's sad that most people don't realize that.

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5477 · June 30, 2011 at 5:45 AM

+1 Jac - wonderful post. Now I'll share my fav quote and I might get darts thrown at me, but this is something I have been trying to get across to both the "physical/medical" side of healthcare and the "psych" side for 30 yrs: "The truth is you cannot talk about emotion without talking about physiology and you can’t talk about physiology without talking about emotion. They’re not connected; they’re just the same system." Chris Kresser And then there's Candace Pert in the 90's at NIH. Her research showed emotions register in cells - molecules. They can be SEEN. We are NOT "separate systems."

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11986 · June 30, 2011 at 4:38 AM

By the way, this is why I laugh when people say my zero-carb eating is "extreme." They should've seen what I *used* to do. (Although I've had some people tell me that 500 cals/day of salad and apples "makes more sense" than 1,800 cals/day of just meat.)

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11986 · June 30, 2011 at 4:35 AM

Namby, in my case, your guess is right on the money. My birth mother was morbidly obese, her mother was obese, and *her* mother was pretty large. On my father's side, he was a big, but not obese, man, but his sister, my aunt, was over 300 pounds at just over five feet tall. Generational obesity, yes.

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24271 · June 30, 2011 at 4:14 AM

Eric yes I think it's a good tool but only for very limited time frames. Have you read Lyle McDonald's Rapid Fat Loss? You go only a few weeks at most then take a 2 week break mandatory then start up again. It's a great plan! Brutal and not for the novice but again an effective tool for those who have a good deal of insight on who they are in relation to food already.

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24271 · June 30, 2011 at 4:09 AM

Excellent answer and great comments! Hit that nail right on its head!

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13692 · June 30, 2011 at 1:35 AM

Very nice post Jac

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5132 · June 30, 2011 at 1:28 AM

That's eyeopening. Extreme diets will shed pounds but they're not sustainable. Before, I didn't think anyone couldn't lose weight on a 1,200 diet. My feeling is that this is generational obesity: i.e., children of obese parents (both), who were themselves children of obese grandparents (all 4). If all 4 grandparents and the majority of 8 great grandparents were obese, you may have inheritied a metabolism that just will not behave normally. It truly is a raw deal. You cannot imagine the plight until you see this with your eyes - e.g., family pictures, which show consistently obese offspring.

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1196 · June 29, 2011 at 11:32 PM

Jan - I'm post menopause (total hysterectomy 8 years ago), but I know where you're coming from re the hormones. Nothing like taking a challenging situation and exploding the hell out of it with estrogen levels, lol

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18671 · June 29, 2011 at 11:31 PM

Hi, Texasleah! Maybe we're just hanging out on different threads?

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1196 · June 29, 2011 at 11:29 PM

So glad my story has something to offer. Finding that I'm not emotionally deficient has had a freeing effect on my life, and knowing that one day I'll feel like I have energy to exercise takes all the guilt away. Harris's typology in Aravind's post is hugely encouraging because it also explains non-or-very-slow weight loss as a recovery process. My biggest challenge is to not play with macronutrients and deficits too soon, or I'll undo the healing.

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2081 · June 29, 2011 at 10:50 PM

Excellent answer! You and I are the same age, Jac, and in the same boat all around - you explained me and my situation to a T. You know, it also doesn't help that we're both probably smack-dab in the middle of perimenopause (I am, anyway); those ever-decreasing estrogen levels can make it even more difficult.

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25467 · June 29, 2011 at 10:16 PM

@ lucky here is the link www.jackkruse.com/why-sleep-and-leptin-are-yoked/

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25467 · June 29, 2011 at 10:07 PM

I wrote about it recently in my blog leptin and sleep link. The mechanism is the autoimmune destruction via molecular mimicry. MSG also destroys the HC neurons by excitotoxic effects of the NMDA receptor.

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11986 · June 29, 2011 at 10:06 PM

Yes, a thousand times yes! We so often reach for the psychological explanation when we don't understand what's happening physiologically. This was a great post (and inspiring, too -- go Jac!).

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4086 · June 29, 2011 at 10:06 PM

Thank you for sharing your experience so systematically! I think it is a very helpful accounting.

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25467 · June 29, 2011 at 10:02 PM

There are a small number of the morbidly obese who destroy hypocretin neurons. They are the ones who never get back to baseline unless they get access to certain non approved drugs. Thankfully it is not many of them.

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18701 · June 29, 2011 at 9:43 PM

I don't think most of the medical establishment even knows what to test for to see if it is something that the obese person cannot fix with diet/exercise. They just assume the are not following the directions.

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18701 · June 29, 2011 at 9:37 PM

I don't remember how much I weighed when I was 12! I do know I wear a smaller size than I did Freshman year of high school though.

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12407 · June 29, 2011 at 8:48 PM

How does obesity destroy these neurons and by what mechanism does this happen? Fill us in because I'm pretty sure your answer meant nothing to the vast majority of ppl reading this

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12407 · June 29, 2011 at 8:43 PM

Congrats. I now weigh less than I did when I was 12 also. Funny how unique a perspective that gives us.

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11986 · June 29, 2011 at 8:23 PM

Nice post, Namby. I'm one of those people who couldn't lose on 1200, but did on 500 (a diet of my own crazy design). I did the 500 cal/day diet for 2-3 months at a time, every few years when my weight would balloon up to a new high. Each time I started at a higher "high" weight, and ended at a higher "low" weight, too. It was crazy-making. And yes, dangerous, too. The first time I did it I passed out at around the three-month mark; after that I was more observant and would stop before I got to that point. But the weight always came back. :(

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11986 · June 29, 2011 at 8:18 PM

Absolutely; *why* is critical. But in the case of the women Ambimorph is talking about (at least a couple of them are mutual acquaintances), the "why" remains a mystery. Also, while I don't doubt that there's a mental component to weight loss (after all, I had to change my opinion of meat and sat fat to go zero-carb), I'm generally more inclined to look to physiology first. AAMOF, there's a new study about "comfort food" and ghrelin (in stressed mice, though, so don't be a stressed mouse): http://www.sciencedaily.com/releases/2011/06/110623130336.htm

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25467 · June 29, 2011 at 7:27 PM

they just are not available yet because the FDA has not cleared them for this use.

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1801 · June 29, 2011 at 6:44 PM

Are you looking for the word adherence perhaps?

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12407 · June 29, 2011 at 6:07 PM

eric, 1-2 lbs a week is good, solid fat loss. psmf is a good tool to jumpstart plateaus, but if you haven't plateaud and are still dropping weight, i would stick with what's working. psmf is very taxing on the body and mind. i was ok with it for the most part but alot of people have some depression issues and other things from hormone signalling being messed from basically only eating ltd greens and maintenance protein for days on end. if you hit a plateau, try lyle mcdonald's rapid fat loss plan but if you haven't, keep doing what you're doing...

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4086 · June 29, 2011 at 6:06 PM

probably so, Thomas! Aravind, enjoyed your post and it reminds me another old KGH post where he basically said some problems don't have a solution.

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78422 · June 29, 2011 at 5:56 PM

I have never been obese. However, I have known my share of rodents and none of them gave a damn about losing weight. Think that might have something to do with it?

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4086 · June 29, 2011 at 5:55 PM

so true, sherpamelissa

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1716 · June 29, 2011 at 5:41 PM

I'd really like to cut a lot more fat off this summer and have slowed down dramatically with my weight loss. Do you think PSMF is a good approach for a period of time (say 30 days, then back to what I'm doing now), or better just to go with what's working until I reach my goal? Would I be likely to have a hard time re-acclimating to a primal lifestyle following that period? Or, is it so deprivatory that I would be likely to give up altogether? (I was losing between 10 and 15 pounds every 2 weeks, now I lose 1-2 / week tops).

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13692 · June 29, 2011 at 5:24 PM

@LB - Thanks! Also, I love your alias. I think any of us that have found a way to take our health into our own control are lucky bastards!

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13692 · June 29, 2011 at 5:21 PM

I want to believe this also but as I noted above, since I have not walked a mile in these shoes, I do not want to exclude the possibility that there are some unfortunate individuals that are screwed. Having said that, like many diseases of civilization (e.g. cancer), perhaps there is a point of no recovery. Perhaps some reversal/control and adequate quality of life, but not reversal. Is it not possible that obesity is in the same boat? Maybe in your case you didn't hit the point of no recovery. Regardless, that is so wonderful you were able to make the transformation you did :-)

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13692 · June 29, 2011 at 5:20 PM

I want to believe this also but as I noted above, since I have not walked a mile in these shoes, I do not want to exclude the possibility that there are some unfortunate individuals that are screwed. Having said that, like many diseases of civilization (e.g. cancer), there is a point of no recovery. Perhaps some reversal/control and adequate quality of life, but not reversal. Is it not possible that obesity is in the same boat? Maybe in your case you didn't hit the point of no recovery. Regardless, that is so wonderful you were able to make the transformation you did :-)

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12407 · June 29, 2011 at 5:08 PM

@aravind i didn't take it in a negative way. btw, i think you always give good, thoughtful comments on stephan and kh's blogs and i'm glad you've been popping up here more lately.

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18701 · June 29, 2011 at 5:07 PM

I think the key is finding out WHY you are obese, be it medical or mental. Then you can fix it. You may stumble upon it trying lots of different diets, but that's taking a huge chance. It would be so much easier to "cure" obesity if they looked at it that way instead of thinking people are just fat and lazy.

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18701 · June 29, 2011 at 4:59 PM

I've been doing this protocol lately and it definitely works. I can't imagine who it would not work for, though I am sure there are a few.

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4086 · June 29, 2011 at 4:53 PM

Thank you Aravind :) I am also curious about the same issue as is everyone else I would imagine--the hormonal issues that would completely inhibit any fat loss. craziness!

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4086 · June 29, 2011 at 4:49 PM

Hey Ambimorph I am happy to hear from you, I have not seen you in a while!

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13692 · June 29, 2011 at 4:42 PM

@LB - To clarify I made my comment before reading any answers in anticipation of responses from perpetually thin people. So not directed at you specifically. That is great that you have overcome your since birth condition. Maybe instead of "luckybastard" you are "determinedtoovercomegeneticsbastard" :-)

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12407 · June 29, 2011 at 4:38 PM

@aravind. i started off obese basically from birth. i'm a "hard loser" if there ever was one. having dealt with my situation and with others from varying backgrounds who got to an obese state, i'm of the mind that unless there are some serious physiological hormone issues, there are various ways- with differing degrees of difficulty- for people to lose weight...

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13692 · June 29, 2011 at 4:34 PM

Good question. I'm curious, particularly to hear from those that actually started as obese vs the thin/slightly overweight people that are providing their thoughts without having walked a mile in the shoes of the obese. I am in the latter category so I am refraining from answering. Hot picture by the way!

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16131 · June 29, 2011 at 4:33 PM

I like your delivery - that opening was killer.

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4086 · June 29, 2011 at 4:26 PM

Howdy, gilliebean :)

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13983 · June 29, 2011 at 4:24 PM

P.S. I think this is a great question.

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13983 · June 29, 2011 at 4:24 PM

Gig'em Aggies!!

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8 Answers

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1196 · June 29, 2011 at 9:55 PM

I'm 'morbidly obese' according to my doctor, with an apparently normal blood profile except for some slightly unhealthy lipid counts (this all according to the doc). At 48, I have a lifetime of experience with diets that worked (protein focused, skip dinner) and diets that I didn't lose a damn thing on (microdeit - shakes only for 2 weeks, and not 1 oz lost). Fair to say I'm metabolically deranged.

The thing I'm liking about the question and the answers so far is that there's an acknowledgement that there are 3 different things going on here 1) the metabolic state of the body, 2) the behaviour that occurs as a result of the metabolic state, and 3) the emotional state. From my perspective, until I read Taubes and began to view some of my behaviours as metabolically based, all my 'non-compliant' behaviour was seen as being emotional. The thing is that my eating behaviour (prior to paleo, but that's another story) seemed to indicate that I have emotional problems, which is an idea that just doesn't fit with the evidence from the rest of my life. I'm a balanced, happy person - a good wife, loving mother, high flyer at work. . . yet I'm fat!! It seemed that there should be some deep trauma that I'm hiding, and may my parents forgive me, I ended up in therapy trying to find out how they'd damaged me.

Taubes freed me from that thought pattern, and since then I've soaked up information about metabolism and our animal nature. Cravings can, for me anyway, be redefined from personality/trauma issues into messages my body is sending. Since I know I'm metabolically deranged (a term that I totally adore, it sounds so deviant!) then I can't trust those signals. I also believe that I'm not in Harris's final category permanently, so I can temporarily override the cravings in the certainty that things will improve. I can avoid sugar today, because if I do, then tomorrow I'll want it less. Does that make sense to you?? At the same time, I'm teaching myself to interpret my body's signals differently. Want sugar?? Oops, need to increase fat. Want fruit? I'm thirsty. Still want fruit? Add some carbs to the next meal. Cake looking good right now? I didn't eat enough protein yesterday. It's a very cool new language I'm learning.

The take home message I get from all this is that healing the metabolism HAS to happen for me, in order to then deliberately change my behaviour in terms of calorie restriction and adding strength exercising, which will then enable me to change my weight.

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1196 · June 29, 2011 at 11:32 PM

Jan - I'm post menopause (total hysterectomy 8 years ago), but I know where you're coming from re the hormones. Nothing like taking a challenging situation and exploding the hell out of it with estrogen levels, lol

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11986 · June 29, 2011 at 10:06 PM

Yes, a thousand times yes! We so often reach for the psychological explanation when we don't understand what's happening physiologically. This was a great post (and inspiring, too -- go Jac!).

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13692 · June 30, 2011 at 1:35 AM

Very nice post Jac

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24271 · June 30, 2011 at 4:09 AM

Excellent answer and great comments! Hit that nail right on its head!

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5477 · June 30, 2011 at 5:51 AM

And Jac, my fav part of your post is: "It's a very cool language I'm learning." YES!!! And it is a new language with our deepest, WHOLE selves, not selves split in all kinds of artificial pieces, that we must learn on this journey. And it *is* a journey for those "deranged" and with significant wt issues among us. "Jac is singing our song!!!"

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4086 · June 29, 2011 at 10:06 PM

Thank you for sharing your experience so systematically! I think it is a very helpful accounting.

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1196 · June 29, 2011 at 11:29 PM

So glad my story has something to offer. Finding that I'm not emotionally deficient has had a freeing effect on my life, and knowing that one day I'll feel like I have energy to exercise takes all the guilt away. Harris's typology in Aravind's post is hugely encouraging because it also explains non-or-very-slow weight loss as a recovery process. My biggest challenge is to not play with macronutrients and deficits too soon, or I'll undo the healing.

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2081 · June 29, 2011 at 10:50 PM

Excellent answer! You and I are the same age, Jac, and in the same boat all around - you explained me and my situation to a T. You know, it also doesn't help that we're both probably smack-dab in the middle of perimenopause (I am, anyway); those ever-decreasing estrogen levels can make it even more difficult.

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5477 · June 30, 2011 at 5:45 AM

+1 Jac - wonderful post. Now I'll share my fav quote and I might get darts thrown at me, but this is something I have been trying to get across to both the "physical/medical" side of healthcare and the "psych" side for 30 yrs: "The truth is you cannot talk about emotion without talking about physiology and you can’t talk about physiology without talking about emotion. They’re not connected; they’re just the same system." Chris Kresser And then there's Candace Pert in the 90's at NIH. Her research showed emotions register in cells - molecules. They can be SEEN. We are NOT "separate systems."

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1196 · June 30, 2011 at 7:25 AM

Mem, we're very similar in our outlook I think! I'm a mh nurse among other things, working hard on getting people to see the synergies with mental and physical health - have you seen MRIs of traumatised people? Experience impacts on biology and vice versa.

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5477 · June 30, 2011 at 9:02 PM

@Jac: Oh yeah, re: MRIs, etc. A large portion of my MH work has been with traumatized kids. Got deep into Bruce D. Perry's work (MD, PhD, internat'l trauma tx expert.) Brain changes as well as cardiovascular marker changes - sometimes permanently increased resting pulses pushing 100bpm and increase BPs, among many other things. And cortisol, cortiol, cortisol...

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18701 · June 29, 2011 at 5:00 PM

As someone that has gone from morbidly obese to normal BMI, I know it takes a lot of work. It takes resetting your whole life and mindset. It's not just food. It's not just exercise. I think anyone who truly wants to lose the weight can find something that works, the question is are they willing to work that hard to find the answer.

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13692 · June 29, 2011 at 5:20 PM

I want to believe this also but as I noted above, since I have not walked a mile in these shoes, I do not want to exclude the possibility that there are some unfortunate individuals that are screwed. Having said that, like many diseases of civilization (e.g. cancer), there is a point of no recovery. Perhaps some reversal/control and adequate quality of life, but not reversal. Is it not possible that obesity is in the same boat? Maybe in your case you didn't hit the point of no recovery. Regardless, that is so wonderful you were able to make the transformation you did :-)

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13692 · June 29, 2011 at 5:21 PM

I want to believe this also but as I noted above, since I have not walked a mile in these shoes, I do not want to exclude the possibility that there are some unfortunate individuals that are screwed. Having said that, like many diseases of civilization (e.g. cancer), perhaps there is a point of no recovery. Perhaps some reversal/control and adequate quality of life, but not reversal. Is it not possible that obesity is in the same boat? Maybe in your case you didn't hit the point of no recovery. Regardless, that is so wonderful you were able to make the transformation you did :-)

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25467 · June 29, 2011 at 10:02 PM

There are a small number of the morbidly obese who destroy hypocretin neurons. They are the ones who never get back to baseline unless they get access to certain non approved drugs. Thankfully it is not many of them.

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13692 · June 29, 2011 at 5:51 PM

Ok, I lied and have decided to post something. I am going to post a few snippets from something Dr Kurt Harris wrote on another blog (not his), so I claim no originality, as usual, which I am totally comfortable with. I saved this snippet because it was so cogent that it was a keeper for me. This was in the context of low carb eating and the relevance of calories-in/calorie-out with respect to weight loss. His words are in I - IV:

I. Normal weight people eating a healthy whole foods diet don't need to do anything - their weight is spontaneously regulated with zero conscious thought the same way their breathing and thier thirst are regulated, They don't accidentaly die of cerebral edema from polydypsia, nor do they die of dehydration because they forget to drink enough. If the brain and gut and liver are as unbroken as the kidneys, no conscious thought need be given to the weight or energy content of food, ever

II. Some metabolically damaged people can heal their damage with time and abstinence from what caused the damage. Then they can be like the people in I, and need never weigh, or measure their food or their exercise output, ever. These people exist. I am one of them

III. Some metabolically damaged people may be so metabolically deranged that they must always eat a particular diet, say low carbohydrate diet, in order to maintain weight. Otherwise, they gain.

IV. Some people may be further damaged, and have to eat LC and consciously eat to less than satiety - probably because of persistent leptin resistance. Such people, in their frustration, may then speculate that categories I-III don't exist. It is not fair, but these people may be stuck with being food conscious forever, like alcoholics who can't avoid the drink without daily AA meetings. It's not their fault. But the existence of such people doesn't prove that CICO is the only thing we can say about fat loss, anymore than the existence of people with diabetes insipidus would imply that all people have to worry about how much water they drink all the time.

So my one (arguably) value-added comment to this question, how many people are truly irreversibly obese vs category IV and require the determination to overcome their fate? I stand by my previous comment that opinions from those having walked in or currently walking in the shoes of the obese are most interesting to me.

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78422 · June 29, 2011 at 5:56 PM

I have never been obese. However, I have known my share of rodents and none of them gave a damn about losing weight. Think that might have something to do with it?

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4086 · June 29, 2011 at 6:06 PM

probably so, Thomas! Aravind, enjoyed your post and it reminds me another old KGH post where he basically said some problems don't have a solution.

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18671 · June 29, 2011 at 4:41 PM

I know of several people who have dieted in every way imaginable and still cannot get below obese, or for some of the luckier ones, just overweight. This set of people are all women, all long-term obese/overweight. It's possible Guyenet is right on this point, though I'm hoping we just haven't hit upon the way to reverse it yet.

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4086 · June 29, 2011 at 4:49 PM

Hey Ambimorph I am happy to hear from you, I have not seen you in a while!

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18701 · June 29, 2011 at 9:43 PM

I don't think most of the medical establishment even knows what to test for to see if it is something that the obese person cannot fix with diet/exercise. They just assume the are not following the directions.

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18701 · June 29, 2011 at 5:07 PM

I think the key is finding out WHY you are obese, be it medical or mental. Then you can fix it. You may stumble upon it trying lots of different diets, but that's taking a huge chance. It would be so much easier to "cure" obesity if they looked at it that way instead of thinking people are just fat and lazy.

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4086 · June 29, 2011 at 5:55 PM

so true, sherpamelissa

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4086 · June 30, 2011 at 1:53 PM

@Ambimorph, yes we must be missing each other. I have not seen you post in a while, so I am glad to know you are still around!

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11986 · June 29, 2011 at 8:18 PM

Absolutely; *why* is critical. But in the case of the women Ambimorph is talking about (at least a couple of them are mutual acquaintances), the "why" remains a mystery. Also, while I don't doubt that there's a mental component to weight loss (after all, I had to change my opinion of meat and sat fat to go zero-carb), I'm generally more inclined to look to physiology first. AAMOF, there's a new study about "comfort food" and ghrelin (in stressed mice, though, so don't be a stressed mouse): http://www.sciencedaily.com/releases/2011/06/110623130336.htm

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18671 · June 29, 2011 at 11:31 PM

Hi, Texasleah! Maybe we're just hanging out on different threads?

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11204 · June 29, 2011 at 5:40 PM

Excess fat isn't always just about excess storage, but it is sometimes a protective response, so I could imagine that there could be a few people out there who simply could not lose weight because their bodies were damaged enough to feel the need for the fat was permanent.

And yet, now weighing less than I did when I was twelve, I believe that for all practical purposes most people get stuck because of bad information plus poor conformity. I'm using the word conformity, but I don't know if I really want to use that word. I certainly don't want to say self-discipline, because I know that didn't work.

I lost weight with a Shangri-La Diet+low carb+paleo+ (eventually) limiting my calories to about 1500 a day. SLD is more of a technique than a diet, but you do have to do it every day, so you have to conform. SLD gave me the appetite suppression necessary to stop acting like a crack addict with food, so I was able to add the rest of the protocols in as I noticed which foods helped me eat less and which foods didn't. There are all sorts of similar concepts along the way- avoiding wheat and soy like the plague, even when 'cheating', for instance, or saturated fat being healthy. We have to learn and then apply it consistently, and even when it seems blindingly simple, it is still some sort of small miracle when we do.

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18701 · June 29, 2011 at 9:37 PM

I don't remember how much I weighed when I was 12! I do know I wear a smaller size than I did Freshman year of high school though.

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1801 · June 29, 2011 at 6:44 PM

Are you looking for the word adherence perhaps?

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12407 · June 29, 2011 at 8:43 PM

Congrats. I now weigh less than I did when I was 12 also. Funny how unique a perspective that gives us.

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12407 · June 29, 2011 at 4:24 PM

4 words: protein sparing modified fast.

barring someone having a condition such has prader willi syndrome or are clinically leptin deficient, i don't see how hardcore dieting such as the aforementioned method won't work. however, i'm not a scientist or a physician so maybe someone can tell me of a mechanism by which someone without serious hormone issues can't lose weight on severe calorie restriction.

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12407 · June 29, 2011 at 6:07 PM

eric, 1-2 lbs a week is good, solid fat loss. psmf is a good tool to jumpstart plateaus, but if you haven't plateaud and are still dropping weight, i would stick with what's working. psmf is very taxing on the body and mind. i was ok with it for the most part but alot of people have some depression issues and other things from hormone signalling being messed from basically only eating ltd greens and maintenance protein for days on end. if you hit a plateau, try lyle mcdonald's rapid fat loss plan but if you haven't, keep doing what you're doing...

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16131 · June 29, 2011 at 4:33 PM

I like your delivery - that opening was killer.

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1716 · June 29, 2011 at 5:41 PM

I'd really like to cut a lot more fat off this summer and have slowed down dramatically with my weight loss. Do you think PSMF is a good approach for a period of time (say 30 days, then back to what I'm doing now), or better just to go with what's working until I reach my goal? Would I be likely to have a hard time re-acclimating to a primal lifestyle following that period? Or, is it so deprivatory that I would be likely to give up altogether? (I was losing between 10 and 15 pounds every 2 weeks, now I lose 1-2 / week tops).

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24271 · June 30, 2011 at 4:14 AM

Eric yes I think it's a good tool but only for very limited time frames. Have you read Lyle McDonald's Rapid Fat Loss? You go only a few weeks at most then take a 2 week break mandatory then start up again. It's a great plan! Brutal and not for the novice but again an effective tool for those who have a good deal of insight on who they are in relation to food already.

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18701 · June 29, 2011 at 4:59 PM

I've been doing this protocol lately and it definitely works. I can't imagine who it would not work for, though I am sure there are a few.

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25467 · June 29, 2011 at 7:26 PM

If the obesity has destroyed the hypocretin neurons I would agree with him the obesity is not reversible by regular means. But are the ways to over come this too......yes there are.

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25467 · June 29, 2011 at 10:16 PM

@ lucky here is the link www.jackkruse.com/why-sleep-and-leptin-are-yoked/

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12407 · June 29, 2011 at 8:48 PM

How does obesity destroy these neurons and by what mechanism does this happen? Fill us in because I'm pretty sure your answer meant nothing to the vast majority of ppl reading this

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25467 · June 29, 2011 at 10:07 PM

I wrote about it recently in my blog leptin and sleep link. The mechanism is the autoimmune destruction via molecular mimicry. MSG also destroys the HC neurons by excitotoxic effects of the NMDA receptor.

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25467 · June 29, 2011 at 7:27 PM

they just are not available yet because the FDA has not cleared them for this use.

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5132 · June 29, 2011 at 7:13 PM

You might want to look in to the recent British study which is being bruited about as having "reversed" T2 diabetes. The hypothesis was that if these obese British subjects went on a severe, calorie-restricted diet for 8 weeks, not only would they lose their "fatty liver" and "fatty pancreas" --- conditions which typically precede T2 diabetes -- but they would also reverse insulin resistance.

They put 11 subjects on a 600 kcal Optifast (Nestle) diet. Even though daily total carbs were around 70g, because of overall calorie restriction, the diet was ipso facto ketogenic. The mean BMI prior was 33 (225 lbs., mean weight both men and women), deep in the "obese" category. After 8 weeks, it was 29 (194 lbs. mean weight), at the high end of the "overweight" category. Out of 11, 7 seem to have "cured" their insulin resistance.

What to take away from this study is this: while 7 out of 11 could arguably no longer be t2 diabetics, they "reversed" insulin resistance BEFORE actually becoming lean themselves. 600 kcal is a starvation-level diet, one that is dangerous and probably outrageous for health and sustenance. I know that there are some obese peopel who can't lose weight on a 1200 diet, which I thought was at the low-end of the acceptable calorie range.

But at 600, they were "only" able to reduce their BMI from 33 to 29, or a 30 lbs. loss ... which is still not a lot if you consider the "calories in". A metabolically normal person would have lost a lot more than that because it basically amounts to starvation. Yes, there were no obese person in Auschwitz. But you cannot sustain yourself on a 600 cal diet. So for the obese, it's a fight against hunger, i.e., your hormone, which is a battle rarely won.

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11986 · June 30, 2011 at 4:35 AM

Namby, in my case, your guess is right on the money. My birth mother was morbidly obese, her mother was obese, and *her* mother was pretty large. On my father's side, he was a big, but not obese, man, but his sister, my aunt, was over 300 pounds at just over five feet tall. Generational obesity, yes.

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5132 · June 30, 2011 at 1:28 AM

That's eyeopening. Extreme diets will shed pounds but they're not sustainable. Before, I didn't think anyone couldn't lose weight on a 1,200 diet. My feeling is that this is generational obesity: i.e., children of obese parents (both), who were themselves children of obese grandparents (all 4). If all 4 grandparents and the majority of 8 great grandparents were obese, you may have inheritied a metabolism that just will not behave normally. It truly is a raw deal. You cannot imagine the plight until you see this with your eyes - e.g., family pictures, which show consistently obese offspring.

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5132 · June 30, 2011 at 5:48 AM

So let's say your "calories in" is 500. Your "calories out" is probably around 2,000, at least. Believe in the calorie theory for a minute. You have a daily deficit of -1,500. Even if you lie down all day and move a few fingers, you'll still burn at least 1,500. Why isn't the deficit of -1000 or -1500 not being shed as lost pounds? Answer: it's not calories in calories out. Taubes is right. It's hormones and metabolism. It's sad that most people don't realize that.

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11986 · June 30, 2011 at 4:38 AM

By the way, this is why I laugh when people say my zero-carb eating is "extreme." They should've seen what I *used* to do. (Although I've had some people tell me that 500 cals/day of salad and apples "makes more sense" than 1,800 cals/day of just meat.)

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11986 · June 29, 2011 at 8:23 PM

Nice post, Namby. I'm one of those people who couldn't lose on 1200, but did on 500 (a diet of my own crazy design). I did the 500 cal/day diet for 2-3 months at a time, every few years when my weight would balloon up to a new high. Each time I started at a higher "high" weight, and ended at a higher "low" weight, too. It was crazy-making. And yes, dangerous, too. The first time I did it I passed out at around the three-month mark; after that I was more observant and would stop before I got to that point. But the weight always came back. :(

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