Friday, February 18, 2011

Eating More Calories Increases Weight (In Some People – Sometimes – Maybe)

Simple but Completely Wrong Depiction of Energy Balance

Simple but Completely Wrong Depiction of Energy Balance

According to the laws of physics when [calories in] exceed [calories out] people gain weight.

Unfortunately, when you actually deal with people (read: biological systems), this simple law is anything but simple. This is because, thanks to complex biological feedback mechanisms, designed by nature to keep us alive and thriving, changing caloric intake in turn affects caloric expenditure and vice-versa.

Let me illustrate this important difference between physics and biology with a few analogies:

Consistently putting less fuel in your car will never make your car “learn” to run the same distance on less fuel, but our bodies actually quite readily and effectively adapt to eating less food by simply burning fewer calories (ultimately resulting in the most frustrating “weight-loss plateau”).

Regularly overfilling your gas tank will never make your car “learn” to burn more fuel, whereas eating too much actually does increase energy expenditure (we sweat, we get restless, we fidget).

Over or underfueling your car will never eventually lead to a bigger or smaller car, whereas this is exactly what happens to us, a fact that leads to a further complication: larger bodies (like bigger cars) need more fuel.

When you now consider that all of these biological reponses to changes in [calories in] and [calories out] vary considerably between individuals (due to genetics, age, sex, hormones, medications, etc.), you end up with a situation where trying to precisely predict weight changes by simply calculating [calories in] and [calories out] becomes more or less like forecasting next week’s weather – sometimes surprisingly accurate but, perhaps as often, completely off the mark.

This is probably why population studies have such a hard time figuring out why exactly we are all getting bigger.

As recently blogged, the recent Canadian Health Measurements Survey certainly does not convince me that overweight and obese people are any less physically active than non-obese Canadians – ALL Canadians seem to be inactive, period!

Now it turns out that overweight and obese people may actually not be simply “overeating” either.

At least not according to a study just published in the American Journal of Nutrition that reports on changes in energy intake in normal-weight, overweight, and obese individuals between 1971-2006.

In this study, Gregory Austin and colleagues from the University of Colorado Denver, compared carbohydrate, fat, protein, and total energy intake in adults aged 20-74 y from the first NHANES (NHANES I, 1971-1975; n = 13,106) to data from NHANES 2005-2006 (n = 4381).

While the prevalence of obesity increased from 11.9% to 33.4% in men and from 16.6% to 36.5% in women, there were rather modest changes in percentage of energy from carbohydrates (44.0% vs. 48.7%), fat (36.6% vs. 33.7%), or protein (16.5% vs. 15.7%). Importantly, these trends were identical across normal-weight, overweight, and obese groups, therefore it is hard to really blame the massive change in obesity rates simply on these rather modest changes in relative macronutrient intake.

But now comes the surprise: compared with NHANES I, normal-weight men consumed an additional 247 kcal per day, overweight men consumed an additional 165 kcal, and obese men consumed an additional 225 kcal in NHANES 2005–2006. In other words, ALL men were eating more – the normal-weight men in fact increased their caloric intake slightly more than the obese men!

In women, the results were not quite the same, in that normal weight women consumed an additional 183 kcal, overweight women consumed an additional 304 kcal, and obese women consumed an additional 341 kcal.

But once again, let us remember that larger people actually need more calories because they tend to have higher caloric expenditures (like bigger cars needing more fuel), so really it is not fair to simply compare the number of calories without adjusting these for higher requirements. Once you do such adjustments, the difference in increased calorie intake in obese women does not appear all that much greater anymore.

In their paper the authors go on to discuss the potential importance of the relative changes in carbohydrate, fat, and protein intake between the two surveys, but as these trends did not differ between the normal, overweight, and obese groups, I will not get into their arguments here.

The whole surprising point here is that it is actually by no means straightforward to deduce from these data that obese people are obese because they “overeat” compared to their non-obese peers. If anything, the thin guys are the ones who are actually “overeating” (and getting away with it).

So if obesity is not because of overeating or undermoving, why the heck are so many people so much heavier today than ever before?

Either our assessments of caloric intake (and expenditure) are simply completely off because of “underreporting” or other methodological problems – but in that case, this entire exercise of trying to figure out caloric intake and expenditure as a cause of the obesity epidemic is worthless.

What I believe this data actually shows is that we are seeing the population effect of the same changes in energy intake (and expenditure) affecting some people more than others.

Thus, readers will recall the recent post that heavier kids appear to be far more “sensitive” to obesogenic factors than thin kids – the “naturally” thin kids are just lucky and get away with their crappy lifestyles, while the poor “naturally” heavier kids pack on the pounds by doing exactly what the thin kids are doing (namely eating too much and sitting around all day).

Similarly, it seems that while EVERYONE is eating more calories now than they were back in 1971, “naturally” thin people somehow manage to stay thin, while “calorie-sensitive” folks get heavier.

Thus, the laws of physics which would tell us that obese people gain weight because they simply eat more and move less don’t quite tell us why thin people can eat more and move less and still stay thin.

So if the obesity epidemic is not simply due to people becoming obese because they’re eating more and moving less (than thin people), then the solution is probably not in simply having them eat less and move more – which, incidentally, is probably why “eat-less-move-more” (ELMM) so seldom works.

Somedays I wish life were simpler.

AMS
Edmonton, Alberta

Austin GL, Ogden LG, & Hill JO (2011). Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971-2006. The American journal of clinical nutrition PMID: 21310830

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29 Responses to “Eating More Calories Increases Weight (In Some People – Sometimes – Maybe)”

  1. AcceptanceWoman says:

    Beautifully written explanation.
    I’m going to link to this on my blog.
    Unfortunately, people who repeat “calories in = calories out” are unlikely to change their minds reading this. Or insist that it doesn’t matter how few calories someone needs to eat in order to lose weight or maintain weight loss, it’s still essential to do so in order to gain acceptability.
    Thanks again for all that you do!

  2. AcceptanceWoman says:

    Also, as far as solutions go — I come from a public health bent, and I would say that we decided to go after lead in our environment even though the people it impacted most were children and developing fetuses, not everyone equally — but we all (and major industries) had to agree to make changes in order to protect the most vulnerable to exposure. There are some who grumble that house paint colors aren’t as vibrant as they used to be, and that their cars won’t pass a smog check, but as a society, we determined that it was worth these sacrifices in order to preserve health.
    Exposure to environmental toxins rarely sickens everyone to the same extent or in the same way. Our food supply is like that, too — some people get fat on it while others do not. But if we keep blaming fat people, it’s like blaming the people who get sick from lead poisoning for not doing a better job avoiding the exposure in the first place — and then complaining about how we all have to foot the bill for their medical costs.
    I think the people who gain weight easily (I’m among them) do benefit from being aware of it, but expecting us to live our lives differently and to respond differently to all of the stimulus around us than everyone else is both cruel and illogical.

  3. Anonymous says:

    Research has shown that people with high BMIs are more likely to under-report their food intake. That could be part of the missing piece.

  4. Arya M. Sharma, MD says:

    “Research has shown that people with high BMIs are more likely to under-report their food intake.”

    Yes, but this was discussed in the paper and I don’t think it fully accounts for the difference. This explanation also comes too close to “fat people just lie about their intake” for my liking as I don’t think it is true – if at all I believe that both obese and non-obese people tend to make “honest” errors on dietary recall (which is a really crappy method to assess dietary intake in the first place).

    I tend to go with metabolic and compensatory changes that make some people more susceptible to increased caloric intake (or sedentariness) than others.

    As pointed out by AcceptanceWoman: not everyone exposed to lead gets lead poisoning but removing lead from paints is still a good idea.

  5. katjasawitsky says:

    Instead of comparing the number of calories, etc eaten between thin and fat people, I would love to see a study which assesses to what degree people act on their body’s internal feedback mechanism – the one that says “hey, I’m full now, stop eating”.

    My guess is that some poeple are much more finely tuned and know exactly when to stop based on internal messages that they heed, and some folks are more sensitve to external messages thay they also heed. The difference may be about how appropriatly we respond to our internal cues.

    The thin guys in the study decidedly at more but perhaps that was because that is exactly what they should do given their phsyiological need, their internal messages. We are measuring “objective” numbers (calories etc) when what we may actually do is start measuring the responsiveness of the human body system. (response time, corrections in direction, speed, slowing down and awareness of environment around us – as in a driving analogy).

    My personal experience is that when I was about 35 lbs heavier, I finished everything on my plate. This is what I call responsive to the extenal cue – a still not empty plate. Now a days, for some reason, I am acutely aware that one or two more bites are too much for what my body tells me I need. The upshot is that I leave things on it some times and sometimes I go back for seconds. I believe that being in touch with my feelings (about everything, not just about hunger/fullness) and being physically active make my ability to be responsive to my internal messages possible.

  6. Neha Singhal says:

    Dear Dr. Sharma,

    Thank you for increasing our knowledge on obesity and related disorders. I enjoy reading your posts everyday. This one is worth mentioning a praise. A very well written explanation. But did the authors consider the energy expenditure in these men and women? May be the ones who are normal weight, even though were consuming similar calories as obese/overweight, but are physically more active than them. And by physical activity, I don’t mean only leisure-time physical activity, but complete activity all through the day! I would request your feedback on this.

    Thank You,
    Regards
    Neha Singhal,PhD Scholar
    University of Delhi
    Senior Research Fellow
    Indian Council of Medical Research
    India

  7. Arya M. Sharma, MD says:

    “But did the authors consider the energy expenditure in these men and women?”

    Neha, you touch on a sore point in all of these studies: they are notoriously poor in capturing physical activity levels (almost as poor as in capturing actual food intake).

    All you can really say is that the evidence that people are now “fatter” than they were in 1971 because they simply eat too much is pretty lean (pun intended)

  8. Denise Bickel DVM says:

    I find this subject interesting for the following reason. Up until a few years ago, I was a very serious long distance/marathon runner. I truly believed I maintained my weight and muscle structure in large part because of the intense running I did . I was also pretty careful about my diet. Then I began having difficulties finishing workouts and was eventually diagnosed with mitochondrial myopathy. Despite lots of supplements, attempts to return to running beginning with a 1/4 mile, etc, I have never been able to return to my previous high level of activity. I assumed I would pork out, or at least have to struggle with my weight ( I have always been a short, stocky female although at peak athleticism my body fat was around 17%). To my surprise, my weight has not changed more than 5-8 lbs, and my muscle mass has changed some but no where near as dramatically as I thought it would. I probably DO eat less as I do not always feel well…but I do not consciously appreciate eating less–in fact while running I was constantly hungry and wanting to eat more than I felt I “should” where as now I never feel that way. I always believed in “calories in-calories out” and that if people were heavy it was from lack of will. I no longer believe that. I think my body “likes” my current weight–I stayed there while running 80 miles a week, and I am still there running zero miles a week. I think this is a very complex situation and I appreciate the article review.

  9. Neha Singhal says:

    Thank you for your feedback Dr. Sharma.

    Regards
    Neha

  10. Anonymous says:

    “… obesity epidemic … people becoming obese because they’re eating more and moving less (THAN THIN PEOPLE)…

    This is so totally not what I thought “eat less, move more” means.

    I always thought “eat less” meant “eat less than THE QUANTITY YOU USED TO EAT, because the quantity you used to eat is what made you overweight in the first place, and if you keep eating like that you’ll keep gaining weight.”

    Of course you could keep eating a lot and hope you’ll reach a break-even point where your larger body needs all the calories you feel like eating – that’s risky, because people can get to be overweight by 100′s of lbs.

    And you’d have to eat even less if you want to actually lose weight. (fewer calories with healthy nutrition of course).

    And if your situation changes – like, you get older! – you may need fewer calories just to stay the same weight.

    What does it matter if someone else can eat more calories and be skinny?

    To a scientist studying populations, that’s certainly interesting and important, but to an individual trying to maintain weight, what someone else can eat is irrelevant.

    To an individual, what is important is balancing your own calorie input and expenditure, and that might mean eating less than you used to (sigh!), and eating much less than someone else (which is totally unfair, but get over it!)

  11. DebraSY says:

    Dr. Sharma, thank you for ruminating, synthesizing (maybe even agonizing) to present human body weight as the complicated puzzle that it is. I am going to talk about this post on my blog too. I may not get to it till Monday, but this is such a thoughtful post and worthy of more than a flip “attaboy” here.

  12. Lisa says:

    Interesting post. As a fat person, it’s a pleasure to know that some in the medical community are finally acknowledging what fat people have been saying over and over and over again – we don’t (on average) eat more than our thinner friends/family. I only wonder how long it will take for this evidence-based information to get out into our culture’s common knowledge, because there are so many people I know – including highly educated health professionals – who continue to believe the Law of Thermodynamics literally applies, and all a fat person has to do is ELMM.

    And maybe the “solution” might be to just help people be healthier **at the weight they are at**, rather than continuing to try and directly change the weight – in other words Health At Every Size.

  13. Luke Tunyich says:

    Anonymous says: @ February 18th, at 8:20 am
    “Research has shown that people with high BMIs are more likely to under-report their food intake. That could be part of the missing piece.”

    All the research that apparently shows that that people with high BMIs are more likely to under-report their food intake where guided by the belief that every calorie in food intake above the maintenance requirement, if is not spend through increased physical activity, will be converted to fat mass. Until recently, the fact that a significant and variable amount of food intake will leave the body as metabolic waste was unknown to mainstream science.

    The belief that obesity is caused by eating too much and/or insufficient physical activity is based on a terrible misconception in the basic understanding of weight regulation. The article: “Misconception about Counting Calories and Weight Management” on my web site explains more. The link is: http://www.biomechanicsandhealth.com/calories.htm

    The wide public attitude towards people affected with overweight, obesity and severe obesity is possible to change only by publicly explaining the misconception in the basic science, which is based on the belief that obesity is caused by eating too much and/or insufficient physical activity.

  14. Anonymous says:

    Lisa says “We (fat people ) don’t eat more than our thinner friends and/family.”

    What does it matter how much her friends and family eat?

    As Dr Sharma points out, different people require different amounts of food.
    Her weight (whether high, medium, or low) is a result of how what she eats acts in HER body.

    If someone is allergic to nuts, they are not going to eat nuts just because other people are eating them.
    If someone is “calorie sensitive”, for any reason, they shouldn’t eat too much just because other people are eating that much food.

  15. Giridharan says:

    A certain amount of genetics is involved, in determining whether we remain thin or fat irrespective of what we eat or how much we eat ,vis a vis our activity.A thin man may eat more and do less activity and can continue to be thin at present, but he is certainly
    putting his future generations in to trouble ,by triggering epigenitic events in his genome. In other words the present so called ‘Obese’ are victims of their grand father’s overindulgence with food and less activity syndrome ( where in the grand fathers remained thin ,but their grand son had their obesogenic genes turned on).In such a scenario, more food ,less activity still holds good if not for this generation ,but for next generation to become obese.Convesely the present” obese’ can still help the future generation by following less food and more activity criteria and hope to swich off their obesogenic genes! Epigenetics studies reported currently shows that a grand mothers smoking habbits do not do much harm to her but her grand children are certainly prone to lung problems. So I still lsupport the view Caloririe in = Calorie out
    f for the control of obesity, if not, for present,but atleast for future.

  16. RD says:

    As a dietitian in my experience there may be little difference between the exercise and eating habits of those who maintain their weight vs those who gradually gain a pound or two a year, but for those who start gaining a significant amount of weight that is not typical for them there is usually a cause (an injury, staring a medication that increases appetite, changes in stress levels or sleep patterns, etc). Addressing the underlying causes is key to changing the weight gain in these cases.

  17. Denise Bickel DVM says:

    Anonymous–you miss a basic point here…that is, if your body is programmed toward a higher weight, it will take a very , very restricted diet to do that……let it be said, with the exception of my mitochondria which are in crappy shape, I am quite fit, so I am not emotionally entangled in this argument……rather, I have developed a new compassion I did not have when my own experience showed ALL my previous assumptions about weight, food intake, and activity to be wrong…….

    My mother has always been obese….she went on a 10 week, supervised medical fast with only liquid diet…She stuck to it…I lived with her, and I know…..This was 900 calories a day……she lost almost no weight on it…maybe 10 lbs, but no where near what she needed to.

    900 calories is simple NOT a sustainable life style…..A diet of that type eliminates every party, dinner out, celebration, etc…over time on a diet that restricted people develop abnormal behaviors, depression, etc…….So what is my mom to do? I say, accept her body at a higher weight, do physical activity she enjoys, and enjoy life…

    It is not really fair or justified to tell someone who is already eating a highly restricted diet to eat even less. I am not saying there is no one out there over-eating because there is. And possibly a number of them could lose weight by eating less. My older brother dropped almost 60 lbs by eliminating soda and sugared drinks from his diet….my mom, on the other hand, has drank Tab and black coffee her whole life to cut calories, and still remains too heavy….there is more at work here than math……

    I do not think the diet my mother must adhere to to lose weight is sustainable. Therefore, you can not just tell her ‘eat less”….There is a subset of the overweight population for which this is true and it is helpful for science to explore why and see if there is a way to help these people “reset” their bodies’ tendencies

  18. NewMe says:

    Anonymous’s flippant comments about just eating less and not jumping off the food cliff just because everyone else is doing it make my blood boil.

    Denise Bickel, thank you for putting that pompous fool in his (I’m assuming, but who knows) place.

    Most of the distressingly few people who actually manage to lose significant amounts of weight and keep it off report that weight loss maintenance is a gruelling (at very least) part-time job, involving large amounts of physical exercise and often a constant low-level of hunger. Their bodies are in fact punishing them for maintaining what the body, in its wisdom, considers an artificially low weight.

  19. Cynthia says:

    Can we lay to rest the myth that it’s possible for everyone to just go on a ridiculously low calorie diet? If I eat what Weight Watchers prescribes for a person my size, I will have no energy to exercise at all, and I’ll feel grindingly miserable and beset by grinding hunger pangs and cravings 24/7. It’s no way to live a life. If I eat more, a good bit more, but bump up my activity level to a point where I am in a calorie deficit (say, eating 2100 calories/day but exercising enough that my total burn for the day is 2600-2700) then I can lose. That represents a significant time commitment (1.5 or more hours a day of hard exercise) but it’s (barely) sustainable, while the physical pain I feel on a Weight Watchers type diet is not.

    Can we also lay to rest the myth that fat people are just liars? I may have a BMI of 26, but I also have a Ph.D. in a hard science, I can freaking use a food scale and a measuring cup, and I do.

  20. RNegade says:

    Why assume consistency from body to body regarding the ways in which different macronutrients (protein, fat, & carbohydrate)–and macronutrient food sources–are used and/or stored, yet hypothesize that calories are used and/or stored differently by different bodies?

    I guess I don’t understand why anyone would begin with the assumption that calories from different kinds of macronutrients, and calories from different types of foods within macronutrient groups (higher in fructose, for instance ), are stored and/or used as energy in the same manner by all 3 groups (listed by size), or, for that matter, used and/or stored in the same manner by different genders.

    Doctor, in your post you state, “In their paper the authors go on to discuss the potential importance of the relative changes in carbohydrate, fat, and protein intake between the two surveys, but as these trends did not differ between the normal, overweight, and obese groups, I will not get into their arguments here.”

    To me, it looks like these are the underlying assumptions of your position: 1) Because “the trends did not differ between” the 3 groups (regarding the percentage of macronutrient increase and decrease), and since the difference in the macronutrient change (as %) represent “rather modest changes” then the macronutrients essentially must have a consistent effect on all three groups. 2) Since the effect of the macronutrients on all 3 groups is (assumed to be) essentially consistent, then the differences in weight must be explained by some other factor(s). 3) The other factors may or not be related to calories-in-calories-out—because “maybe” different bodies use and/or store calories differently.

    Where is the evidence to support your assumption that different bodies use and/or store macronutrients in a uniform way?

    You appear to be suggesting that a calorie-is-a-calorie no matter the macronutrient from which it originates (independent of an individual’s physiological reaction to a macronutrient), while you simultaneously attempt to call into question the belief that a calorie-is-a-calorie no matter the body in which it is used.

    The increase in the percentage of carbohydrates, and the decrease in the percentage of fat and protein, may only seem small because you begin with the assumption, a priori, that carbohydrates affect different people equally (and fats affect different people equally, and protein…etc, as long as the percentage change of each remains consistent across groups.

    However, if the calorie content of the carbohydrates was all that mattered then the increase in the percentage of carbohydrates (and the corresponding decrease in fat % & protein %) might indeed be considered “rather modest”. However, not only has the % of calories from carbohydrates risen, but the actual amounts (grams) of carbohydrate consumed has also risen in the groups that increased overall calorie consumption (such as obese women). That increase in % of carbohydrates in the diet, as well as an increase (in some cases) in the total amounts (grams) consumed, could have a very different impact, physiologically, on different body types.

    For instance, if some people store the energy from carbohydrates more readily than they store the energy from fats and protein, as I notice with my own body, then that difference would explain the increase in adiposity which seems so out of proportion to one’s simple calorie intake.

    The primary food source(s) of the carbohydrate increase (both % increase and gram increase), such as from increased grain and sugar consumption, could also determine the way some bodies use that increase differently than other bodies.

    I’m not arguing that we should disregard factors such as medications, hormonal changes, age, and so forth, but neither should we disregard changes in macronutrient percentages and amounts, even though those % (of total) changes across groups are “identical” and the changes appear “rather modest.” The percentage of macronutrient change may be consistent across groups, but in the groups that increased calories too, for example, that percentage increase could represent a significant increase in overall consumption of obesogenic foods—resulting in moderately increased weight for some and massively increased weight for others.

  21. pat bowne says:

    Have there been any similar large-scale studies of the metabolic impact of different gut bacteria? I keep reading that this can be an important determinant of how much of one’s diet is absorbed, but I have not read anything quantitative.

    Also, I do not know how existing calorie values are obtained. Is it still done by bomb calorimeter? That would seem to bear little relationship to how much energy a human body actually obtains from the food in question, particularly if different people are aided to different extents by different bacterial flora.

    Thank you for an excellent and informative blog!

  22. Anonymous aka Pompous fool says:

    To Denise,
    Of course your mother should follow a diet that suits her own metabolism.

    Though 900 cal / day doesn’t seem like a “diet” to me – that seems more like a medical treatment, which a doctor may use if a patient needs it, like a cancer patient may need chemotherapy.

    To quote you on this diet,
    (it) is simply not a sustainable lifestyle. A diet of that type eliminates EVERY (emphasis added) party, dinner out, celebration, etc..

    True. Being on a 900/cal/day diet means you’d have to forgo the food part of a celebration because it would be counter to your medical treatment. You’d be in the same boat as the person who couldn’t participate in the dancing because their medical condition requires they stay hooked up to oxygen.

    However, there’s still a problem even if you’re on a 2000 cal a day diet if EVERY event is all about food. That is toxic.

    When I first ate at my boyfriend’s house it was weird. They asked if I wanted something, and when I said “no thanks”, that was it – they didn’t ask again. I realized that I was bracing myself, expecting to hear: “a little bit won’t hurt”, “I worked all day on this meal”, ” you don’t need to diet”, “enjoy yourself, life is short”, “it’s a celebration!! EAT!!”.

    For some people, like my now in-laws, a family event means talking, laughing, and an activity like a card game, music, a walk, a movie – sometimes including a simple basic meal .
    For my own parents and siblings, the focus of every event is tons of food, usually delicious and fattening, and eating a small (but reasonable) amount is considered odd.

    There are people in my own family who are skinny, so I always thought I was deprived because I couldn’t eat like they do and not get fat.
    Now I think my husband’s family are the ones with a proper diet, and the food environment I grew up in is toxic. My skinny sibs are just lucky to have metabolisms to survive.

    If you have to eat more than you should, just to fit in, the environment is toxic.
    If you can’t get out of the environment, be ready to eat only what YOU need while telling the food pushers to GET LOST (in more polite terms, of course, but stick up for yourself.)

  23. danielle says:

    what you say is true but people still need to be conscious that energy intake (quality and quantity) and energy expenditure are still important on an individuals level 1- for weight management BUT more importantly for health.

  24. Razwell says:

    I like your site a lot, Dr. Sharma.

    Obesity is rife with misconceptions, assumptions , stigmas and politics. Obesity is a hellishly complex condition, with the unknowns far greater than the knowns. Genuine science has turned up genetics, malnutrition, medications, gut microbiota, lack of sleep, common cold viruses, toxins and diseases as contributors to the onset of obesity.

    Science does not yet understand the chemical behavior of fat cell receptors. We NEED to know the full biochemical explnataiom of fat cell regulation to make signficant progress with obesity.

    The general public does not know this.

    I hope you like my blog which represents Dr. Linda Bacon’s and Dr. Jeffrey Friedman’s work. I think you will find it very useful and a representation of genuine science.

    Genuine science will alaways admit uncertainty and vast unknowns.

    Take care,

    Razwell

  25. Jen says:

    Have you ever considered that it may be the culture? Food differences?

    We should compare the Caucasian population in Europe and the Caucasian population in North America.

    This sounds unscientific, but I have observed that Asian kids who grew up in Canada/US tend to be physically “bigger”/more buff than those who grew up in China/Taiwan/Hong Kong.

  26. Robert says:

    Obviously today we live like couch potatoes compared to our ancestors. Also, we have more frankenfoods (food like, but not what your great grandmother would recognize as real food). Couldn’t the combination of poor food quality and greatly reduced activity levels be the main reason for our sorry state we find ourselves in today? Someone mentioned that 1.5 hours of activity was barely sustainable. In todays rushed, over automated world it might seem like too much but travel back in time just 80 years and it was the norm. If people can’t make the time for 1.5 hours of activity per day, doesn’t that alone set off an alarm? It does for me. Life today is too fast and we are filling our day with so many “important” things to do that we can’t even be the active creatures we are meant to be. We may be living in the 21st century but our physiology and our needs haven’t changed much, if at all, from the time we came out of Africa.

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  28. Craig Primack MD says:

    Dr. Sharma,
    It seems from this blog post (and I agree), if we are not accurately estimating caloric intake then we need to look other places. In these same people, we should attempt to estimate their average hours of sleep over the same time period and also their perceived levels of stress (trying to make some correlation to their cortisol levels).

    I also use the analogy of the balance in discussion as above with one side intake (total calories) and the other output (activity, not just exercise), In addition, I add sleep as the fulcrum of the balance. Without it, the system/balance will not work properly.

  29. J.S. says:

    Interesting… I actually have the opposite problem. i eat constantly, and can’t gain weight. I’m 5′ 11″ and 130 pounds! I know this is a common problem for many people, and I think a lot of these people don’t actually eat as much as they think they do, But I’ve counted my calories and i’m always in between 3000 and 6000 a day. i eat a lot of protein and fat. I lift weights about 4 days a week and i do build muscle and strength, but at about half the rate of my friends. Also, i have very little appetite in the morning, almost like my taste buds are too sensitive, but that has been slowly getting better over the past year. I know this is an old post but I would love some insight on this.

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Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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