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.

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.

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.

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.

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.

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.

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.

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.