Kamal, you've loaded this question from many, many directions. So, I am going to be selective and give you some information or food for thought, on just a couple. I partciularly take issue with this statement:
"Sure, metabolic derangement does mean something. But it does not mean that the laws of physics get circumvented."
I'd love to know just what that "something" is in your mind, that metabolic derangement means.
I am largely going to use an example of 2 or 3 other paleo women here, all much younger than myself, who are radical weight loss maintainers. This means, for my definition here, that we have lost in excess of 100 lbs and kept *it* off. This puts us in the 3% club off ALL who lose weight, meaning that only 3% are able to keep it off. 3 of us were never "doritos, cheetos, Dr. Pepper" etc consumers. Two of these battled the weight beast from early childhood. Two others of us, including myself, did not have issues until our early teens and then they were not "big weight" issues. Both of us had events or series of events in our growing up that are well known to affect neurobiology, which I would say figured heavily in our eventual obesity.
During the time I first became signifcantly overweight, I was on the board of an all organic co-op and lived in an area where the local supermarket also had abundant organic foods, free range chickens and grassfed beef. This was in the mid 1980's. I cooked primarily from scratch and ate all foodgroups, with grains being very sparing. I did use cooking oils like safflower, oliveoil and canola oil. I rarely ate fried food that was flouered . I ate frozen food if fresh of what I wanted was unavailable. I ate potatoes, corn, all kinds of legumes, and meat. I also raised my own chickens and ate them and their eggs. Compared to average Americans, I ate very little preprocessed stuff, though i did eat some, and ate some pretty dense caloric stuff like trail mix and dried fruit, along with regular fresh fruit. I grew up never having sodas and during these years drank diet sodas at a rate of probably a sixpack over two weeks. I drank some fruit juice. I juiced alot of fruit juice myself.
I also worked a work schedule during these years where I constantly flipped between dayshift, swing shift and nightshift. I was a single parent and had to pick my child up from his school up in the mountains at about 2:30P and it was a 30min trip up the mountain. i have never been a great sleeper and any noise wakes me up and once I am awake, typically, no matter how tired i am, there is no returning to sleep. During this time, which was several years in duration, I probably averaged 4-5 hours of broken sleep a day.I soon found myself about 30lbs overweight. I was in my early and mid thirties. I got the weight off doing a "food combining" diet that gradually transitioned into a vegetarian diet, whihc became a pescatarina diet for me as hypoglcemia made its entrance into mylife. I believe this is when my metabolism first began becoming deranged.
Second bout was when I was in the Arctic. At least 50% of the meat i ate, and often a greater percentage of that was caribou that was given to me in whole backquarters, abundantly supplemented with salmon that my s/o got from Kodiak +crab.There was also seal and whale organ meat, whale fat +skin as available. Again, eating from all food groups, relying very heavily on frozen veggies often, some fruits, and all kinds of corn, potatoes, legumes, as well as trail mix stuff I ate at work and organic tear off the top soups which were typically beans. Pasta in the form of spahghetti, homemade, about every wek to two weeks. Bottle cranberry juice. Bananas and peanut butter sometimes for breakfast.
And years of very hairy work schedules(never less than a 10-12 hour work day over 9 years) and other BIG stressors. Did I overeat sometimes? Indeed I did. And what I remember most, is how quickly the fat came on, and then how I was "ever-hungry." And I mean EVER-HUNGRY. I have rarely eaten candy in my entire life. I do like choclate and would sometimes have a chocolate bar as an "event" or ice cream.
All of this blabbing is to say that my diet looked pretty darned stunning, as far as REAL FOOD compared to about 95% of America at that time (in the 80's or 90's) as well as now. I didn't get fat on doritos. Obesity is absolutely a heterogeneous disorder and there is certainly a substantial and growing, in my opinion, "doritos group." But to suppose that this is the only or even primary group is a very facile assumption.
Metabolic derangement is very, very real. And indeed, it ends up defying the laws of physics. You are well read and you have read JS Stanton's work, Peter's work and others. If you don't read Arya Sharma's blog, you should. Sharma gets what we, the obese and post obese in particular, have learned through effort most cannot even comprehend. When UCSF treats obese people, and they usually don't even consider ppl for "diets" who are over about the 70lb or so overweight range, they treat them with either an 800cal , 1200 or 1400 cal diet. The very obese who might reject surgical interventions are always put on the 800cal diet because they are going to have to live on a 1200-1400 cal diet for the rest of their lives, and at least this will be a step up!(You are talking about people who if not formerly obese or weight reduced, would eat an average of 2000 cals and if exercising, add 300 or so to that.) If they don't, they will regain. And we are not even talking about people who necessarily get to an optimum weight. We are talking about anyone who is obese/morbidly obese and loses a substantial amount of weight. Those who go to optimal are the very, very, very rare. And as the National Weight Registry tells us (which was originally full of low-fat, high carb losers, but now has substantial numbers of low carbers) the typical amount of time spent in exercise daily is in excess of one hour, seven days per week to prevent regain. This is REALITY.
To answer your foolishly reductionistic fat-person-with-an-iv question, I have taken care of two obese people I will never forget. One was a 500lb woman who had been starving herself for two years. Her husband was older than she and retired and was with her 24/7. He purchased all food. He cooked. She never went anywhere other than from the bedroom to livingroom or bathroom. For two years, she starved herself, to the tune of NO food for as many days as she could stand, with only water, and then only broths and if he could stuff it down her some cottage cheese. When she was admitted to the hospital, she was a horribly ill person with constant diarrhea. In TWO years of constant starvation, she had lost 50lbs. She was in horrifying nutritional condition. How much would YOU lose if you ate maybe, at most, 800cals a WEEK for TWO YEARS?
Another man was a 600lber who was placed in a room with a camera and was on about an 800cal diet. He lost about one to two lbs a month. How much would YOU lose if you ate 800cals a day?
Your "fat-person-with-theIV" example makes me livid. These are real, suffering people.
Here's some interesting info to consider as well:
"This result, once again, kills the simplistic notion that body fat is determined exclusively by voluntary food consumption and exercise behaviors (sometimes called the "calories in, calories out" idea, or "gluttony and sloth"). In this case, a multivitamin was able to increase resting energy expenditure and cause fat loss without any voluntary changes in food intake or exercise, suggesting metabolic effects and a possible downward shift of the body fat "setpoint" due to improved nutrient status."
"He is currently investigating the contribution of biochemical, neural, hormonal, and genetic influences in the expression of the current obesity epidemic both in children and adults. He has defined a syndrome of vagally-mediated beta-cell hyperactivity which leads to insulin hypersecretion and obesity, and which is treatable by insulin suppression. This phenomenon may occur in up to 20% of the obese population. He is interested in the hypothalamic signal transduction of insulin and leptin, how these two systems interact, and how hyperinsulinemia contributes to leptin resistance."
"We are currently concentrating our research on the molecular mechanisms implicated in the hypothalamic effects of the adipocyte secreted, weight-regulating hormone, leptin. After describing the first leptin receptor mutation in severely obese humans, we found that genetic alterations in the Melanocortin 4 receptor (MC4R), a mediator of the hypothalamic effects of leptin, are responsible for a more common form of human obesity. Using large scale automated screening procedures we now further investigate the frequency of mutations in the MC4R gene in large cohorts of obese patients. In parallel we also search for obesity causing mutations in additional candidate genes downstream the leptin pathway. Finally, both through in vitro and in vivo studies we are aiming to understand how these mutations cause obesity and what the implications are for the treatment of this condition."
"His research into the role of stress hormones (glucocorticoids) in energy balance and obesity that originated during his graduate studies was continued in the Department of Physiology at UCSF, where he worked with Mary Dallman.
His research uses integrative physiological approaches to study the reciprocal interactions between brain and body in the regulation of metabolism and in the development of metabolic diseases, such as obesity, diabetes, and hepatic steatosis. His work explores two interrelated streams:
The interplay between, and sites of action of, glucocorticoids and insulin in the regulation of energy balance, glucose homeostasis and the stress response and the effects of disrupting the ratio of these two hormones in the development of obesity and insulin resistance.
The role of signaling in specific neuronal populations within the hypothalamus in the regulation of peripheral lipid metabolism, glucose homeostasis and energy balance, with special emphasis on the metabolic responses to different dietary conditions and stress."
I would say that the role of insulin in obesity is far, far from dead.
Lastly, I am 10 years out in radical weight loss maintenance. I won't be eating any ##$%^!! potatoes, especially since all of Stephan's food reward theory work. I have decreased my reward over the last 5 years as far as it is going to go. Along with many other tools in my toolbox, it has been very helpful in my maintenace and the decrease of another 10lbs in the last year. But I've decided I will be dead and gone before I sit down to dinner with dry potatoes. You can eat mine!!! I'll stick to rutabagas, beets and nuts for my "carb up" days!