Monday, June 20, 2011

Why Diet and Exercise is Not a Treatment for Obesity

If going on a diet or starting an exercise program resulted in persistent weight loss,  we would not have an obesity epidemic.

Unfortunately, as anyone who has tried this knows, maintaining a significant degree of weight loss requires daily dedication, motivation and a limitless supply of will power – nothing short of developing a compulsive obsession.

As readers will recall, the biology of the post-weight loss state is nothing like the biology of someone who has never lost weight. There are countless ways in which the psychoneurobiology, energy physiology and metabolism in anyone who has lost weight are remarkably different from someone ‘naturally’ of that weight.

Simply stated, someone who was 150 lbs and has lost 20 lbs cannot hope to maintain that weight loss by simply eating the same amount of food or doing the same amount of exercise as someone who is ‘naturally’ a 130 lbs.

The 150 lbs person who has lost 20 lbs, to maintain their new 130 lbs, has to actually now live like someone who is ‘naturally’ a 110 lbs; just eating like someone who is 130 lbs but has never lost weight, will simply result in rapid weight regain.

This is why just cutting out a few ‘extra’ calories or walking a few ‘extra’ steps is not an effective or sustainable strategy for maintaining weight loss – for any clinically meaningful weight loss (when indicated) – we are looking at cutting hundreds of calories from the diet and adding hours of serious exercise per week – forever!

A comprehensive and fascinating overview of the fundamental changes that occur with weight loss to ultimately make sustaining this new weight an ongoing challenge, is discussed by Paul Maclean and colleagues from the University of Denver Colorado, in a paper just published in the American Journal of Physiology.

The authors provide a detailed synthesis of data from a wide range of weight loss studies that include studies in clinically overweight and obese adults, in diet-induced, polygenic animal models of obesity, and with dietary (non-surgical) interventions involving an energy restricted low fat diet.

The consistent finding from all such studies is that all individuals or animals in a post-weight-loss state face considerable ‘homeostatic pressure’ that aims to drive their weight back to initial levels.

The paper extensively discusses how changes in biological signals of fat stores (e.g. leptin) elicit profound metabolic and behavioural adaptations – a topic that I dealt with extensively in previous posts.

The key findings of increased hunger and appetite, reduced satiety and substantially increased ‘fuel efficiency’ have very real underlying biological drivers – drivers powerful enough to ultimately wear down even the most persistent dieter.

As the authors point out – persistent dieting is so difficult because it requires maintaining a remarkably large ‘energy gap’:

“Because both sides of the energy balance equation are affected after weight loss, the biological pressure to gain weight is a consequence of both increased appetite and suppressed energy expenditure.

During weight maintenance after weight loss, this energy gap reflects the magnitude of the daily burden that thwarts cognitive efforts to maintain the reduced weight.

Regardless of which side of the energy balance equation is most affected, the energy gap imparts a substantial pressure to eat in excess of the energy requirements.

The magnitude of the energy gap is greatest at the nadir weight after weight loss. Likewise, this energy gap does not dissipate with time in weight maintenance. Rather, studies in DIO (diet induced obesity) models indicate that the magnitude of the energy gap gradually increases the longer they maintain their reduced weight with an energy restricted diet .

The implications from these observations are that the biological pressures may strengthen with time and the amount of lost weight, gradually increasing their perceived influence.”

The paper also extensively discusses some of the lesser known metabolic adaptations to weight loss including profound changes in gut biology that enhance caloric extraction from food as well as alterations in liver function, skeletal muscle and fat tissue that promote weight regain.

While all of this may seem hopeless to readers, the authors actually end on the rather positive note that:

“… only by acknowledging that these homeostatic pressures emerge, we can proactively develop and implement regain prevention strategies to counter their influence. To ensure success, the regain prevention strategies will likely need to be just as comprehensive, persistent, and redundant, as the biological adaptations they are attempting to counter.”

Obviously, it is also important to note, that no ‘weight-loss strategy” actually addresses the many complex reasons why people may gain weight in the first place.

Whoever said that treating obesity was simply a matter of ‘eating less and moving more’ (ELMM) probably also believes that they can live forever by simply breathing less.

AMS
Burlington, Ontario

Maclean PS, Bergouignan A, Cornier MA, & Jackman MR (2011). Biology’s Response to Dieting: the Impetus for Weight Regain. American journal of physiology. Regulatory, integrative and comparative physiology PMID: 21677272

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34 Responses to “Why Diet and Exercise is Not a Treatment for Obesity”

  1. Jodi K says:

    Dr. Sharma,
    I often wonder if you worry about people that struggle with obesity and read your posts will get discouraged by the information your provide. After all, many of your posts highlight the poor odds on the ability to maintain a loss.
    I am someone that has maintained over a 100 pound loss for 4 years now. I am a regular reader and promoter of your site for many reasons that I will explain below.
    First and foremost, I find these posts extremely informative. Previous weight loss attempts had left me feeling like a failure mainly because I was completely misunderstanding how food, environment and functions happening in my body that were not within my control made things difficult or seemingly impossible to overcome. There is truly a sense of empowerment and encouragement that comes your information both positive and negative. So rather than feel downtrodden on the subject I actually feel like taking up the gauntlet. I suppose that comes being the glass half full kind of girl. Well I aim to be in the 2%-5% category. So not to worry here, a positive attitude goes a long way.
    In addition, I regularly take your posts and share these on my facebook page. It helps my family and friends better understand the problem and in turn helps them understand my situation. I find it has opened their eyes to a new perspective and makes less judgmental as a whole. So thank you for giving me this tool that others will consider as credible feedback.
    Also, as a result of your notes I have expanded my internet resource database for credible information. I figure that if you post a link you must support that link’s information. Your choice of articles are very interesting and readable to the layperson and I look forward to my daily reads. Continual reading and speaking to others about the subject helps me stay focused on what I need to do to keep going on my success. So thank you again for providing with extra my learning material.
    On a final note, you noticed I spoke on positivity going a long way. I haven’t seen any articles on this in your writing but I feel as a person that has experienced 35+ of dieting my success came when I was able to maintain a positive sense of my direction of life. I do consider myself a positive person and prefer to think and speak positively about the program I follow. In my previous attempts my negative thoughts, conversations and attitudes laid the foundation for quitting and regaining. I do believe in Gandhi’s saying:
    “Your beliefs become your thoughts,
    Your thoughts become your words,
    Your words become your actions,
    Your actions become your habits,
    Your habits become your values,
    Your values become your destiny.”
    I wasn’t sure of your thoughts on this but I thought I would mention my feelings on this subject.
    So your information is a tool I now use to help in maintaince- THANKS!

  2. Anonymous says:

    This info is pretty bleak.

    I’m looking forward to hearing from you on prevention strategies.
    As you say, there are “many complex reasons why people may gain weight in the first place.”

    One of the many reasons why people aren’t diligent about weight control is their idea that weight gain is reversible -but by the time people try to lose weight they are already in the hopeless state you describe.

  3. Jim says:

    Diet and exercise are good places to start, Dr. Sharma.

    Otherwise, what do you suggest – keeping in mind that psychological issues i.e. emotional eating, childhood sexual abuse, etc., etc., etc., is NOT the issue for a lot of people and bariatric surgery most certainly isn’t an option for some?

  4. Anonymous says:

    … probably explains why most of my friends and colleagues have regained every ounce… and more … after large weight losses …. and explains why the post weight loss period needs to be just as comprehensively monitored …. B

  5. Rachel says:

    The news related to obesity is dismal but I think its better to be informed than not.
    Is there any evidence that very slow or very small amounts of weight loss can avoid triggering the homeostatic reaction?

  6. NewMe says:

    I have to agree with Rachel. Even if the news is bad, we are better off knowing it.

    I also think Rachel’s question is very important. Any answers, Dr. S.? And further to Rachel’s question regarding the speed (or lack thereof) with which one loses weight: have researchers found any relationship between relatively rapid, massive weight loss and a corresponding rapid regain (with a few extra friends coming along for the ride)? Many of us have seen this phenomenon in ourselves or people we know, but the conventional weight-loss community still stresses quick weight loss at any cost. Have researchers compared the long-range outlook for fast losers as compared to slow ones?

    One last comment: These observations make me wonder about the wisdom of encouraging weight loss in people who have always been, shall we say, on the “chubby” side (as opposed to people who have been traumatized and who have sought solace in food)? By entering into the vicious cycle of weight loss followed by an almost inevitable regain, are they not setting themselves up for a heavier and heavier future?

  7. Janis says:

    The more I see what people say and what their experiences are, the more I think that exercise is more psychologically valuable than anything else. Someone who has lost a lot of weight but who has discovered a taste for activity in themselves is just … more likely to keep the weight off, I think, because they love moving their new, more mobile body and have concrete reasons to stay fit that don’t have to do with food. I don’t think it has to do with calorie burning at all — it can help you win the battle above the neck because it lifts depression and gets you away from the fridge.

    So much of this has got to be physical. I’ve known people who have terrible times with their weight who can eat a HUGE breakfast and be literally starving by noon. Then, there’s weirdos like me who can eat light all day, as happened yesterday, wake up this morning a little uncomfortable, and have to think my way through to, “Oh, I’m probably hungry, all I had to eat yesterday was some toast, hummus and pita, a container of tabouleh, and coffee.” There is no WAY that is willpower. It’s just how someone’s brain is set.

  8. DebraSY says:

    Truthful. Sigh.

    It makes me a bit edgy to read this descriptor of my life, however: “nothing short of developing a compulsive obsession.” I think calling it a third- to half-time unpaid job is marginally better and equally accurate. Weight-loss maintenance need not be joyless, but it is a time-consuming and difficult process. It requires a PhD in personal body knowledge, which is then “processed” into some daily action plan. Most people don’t have the time or fortitude for it, since they aren’t being paid. Or they’d simply rather devote their time to volunteering, if they’re going to do unpaid work, and advance some greater social cause than their own narcissism. I have come to grips with my “compusive obsession” (or “job,” as I prefer to call it) by convincing myself that my personal experiment, at some point, if I remain earnest and seek to nail down the most accurate language I am capable of, will contribute something to the marketplace of ideas.

    But many days I am discouraged. In year 8 of maintenance, I find I can’t fall back on positive thinking anymore, as Jodi K can. I’m not saying I’m right and she’s wrong. I just am . . . changed, and maybe not for the better. I used to be more “positive,” but some health challenges that I wouldn’t wish on others have sobered me. I find positivity to be a fickled friend of dubious value. I also notice that certain manic people use it to profiteer and self-promote, at the expense of others who will regain after trying their “fool-proof miracle breakthrough,” or some such.

    Honesty is best. Gutting it through on the days I must. Intentionally infusing my life with joy most days, while not sugar-coating how difficult weight-loss maintenance is.

    Thank you for aiming for truthfulness, too, even when your language puts me and my kind on edge. Like Jodi K, it gives me strange comfort. I prefer it to what I hear coming from my own doctors. “Oh, but the rewards certainly compensate for how challenging it is! Just keep up the good work, whatever you’re doing.” How can I respond in a 12-minute meeting that will convey anything of the complexity? Sigh, again.

  9. Debln says:

    I’m a person that’s lost 125 pounds, has successfully kept it off for 3 years and is now ready to lose a bit more. I’ve started reading your blog after being referred by a friend of mine. I find it very frustrating. I realize as a physician you are a man of science and therefore you understand facts and figures and evidence-based medicine. But I feel like you are covering up your true intentions under this blanket of science. You, like half the doctors in the world and every fat person, are looking for an easy way out. Seriously, should I get to have my cake and eat it too?

    What I am frustrated about is your statement: it’s going to take you more work than other people? Poor obese person. You can’t eat as much as someone else your weight? Poor you. I say, suck it up, buttercup. You spent how many years abusing yourself body by not eating properly or exercising – you’ve done some damage, made some changes (or maybe even were born like this).

    I had no real expectation that my body would ever be “normal” again. I had no real expectation that I would ever understand my hunger signals again. I came to terms wtih the fact I would have to live a very active lifestyle to maintain this body, and I would have to mostly plan and eat in a very healthy manner.

    What you’re not taking into consideration is that after three years, this is starting to be the new normal for me. I am beginning to make some choices automatically. Sure, working out a lot SUCKS for the first three years, but after that it becomes more a social event, a part of your day, even something you miss if you can’t get to a workout.

    What you’re saying (as a doctor YET!!!) is that you are also trying to find an easy way for someone to get thin and stay thin instead of doing what I did- getting up every day, making choices, planning, preparing, and just dealing with it. This is the body I was born into – I can make it work or not. It’s what alcoholics do, it’s what heroin addicts do.

    I think you need to quit looking so hard at biology and start making a mind body connection. And I think you need to admit that change is hard – any kind of change – but if someone is determined enough they can do it.

    As an author, I understand the power of words – and I think you should understand their power, too. The negatively of your posts can create a huge barrier to the fragile resolve of someone starting out on a new lifestyle. If you’re intersted in pure science, keep it among the scientists, otherwise, let’s talk about what CAN be done and be responsible for what you’re putting out there and the people you’re affecting with these posts.

    Thanks for your time.

  10. DebraSY says:

    Debln, you have only been doing this 3 years. You think you’ve found a new normal. I hope you have and your regimen lasts a good long time, perhaps even forever, for you. Chances are small, however. Life is ever-changing. Health is ever changing. You blow out a knee and it’s not as simple as adjusting your calories down a bit.

    These words, especially, you may come to regret someday:

    “Poor obese person. You can’t eat as much as someone else your weight? Poor you. I say, suck it up, buttercup. You spent how many years abusing yourself body by not eating properly or exercising – you’ve done some damage, made some changes (or maybe even were born like this).”

    For your own sake, consider tempering your vitriol in public. Hatin’ on fat people, even hatin’ on your old fat self is not productive.

    Dr. Sharma speaks the truth. Your friend was wise to refer you here. I hope you can use this information someday. You don’t want to hear this post in particular now, and I understand that (and it may be wise NOT to listen and just enjoy this period of balance in your life), but print the post off and tuck it in a drawer. There will come a time.

  11. DeeLeigh says:

    The 150 lbs person who has lost 20 lbs, to maintain their new 130 lbs, has to actually now live like someone who is ‘naturally’ a 110 lbs; just eating like someone who is 130 lbs but has never lost weight, will simply result in rapid weight regain.

    Actually, that 110 pound person might be able to eat more than the weight-reduced 150 pound person. People who are near the top of their set ranges will run up against the physiological resistance to weight gain. Until doctors and scientists start studying naturally thin people and figure out how this works, they are not going to understand weight regulation. Also, it’s potentially the most important part of the weight maintenance puzzle. Just pointing that out…

  12. Alexie says:

    I have had two periods of dramatic weight loss in my own life. The first was 20 years ago, when I was in my 20s and I got so engaged with life that I literally forgot to eat. Then I enjoyed how thin I was and ate abysmally – sometimes nothing more than a donut a day. What I discovered then was if I had a weekend of eating normally, e.g. if I was visiting friends who ate regular meals, I would find that for several days afterwards, I would experience acute hunger. Eventually, I moved into a house where people ate normally and the hunger defeated me. All the things that are being described – the hyperphagia – really undid me. It was crazy. One night, I was scarfing down uncooked pancake mix because I was so hungry. The demon was out of control. So basically, when I wasn’t eating, the hunger went away. When I DID start eating, I awoke the giant.

    My second dramatic weight loss has been completely different. For a start, it was caused by cachexia, not dieting. But having had cancer has made me focus on health and I’ve transformed my life. I cook now, eat only fresh foods and eat at regular meal times. My rule is: if it’s not on the table and I don’t have to sit down to eat it, then I don’t eat it. I count calories, more or less, and weigh myself every day.

    But the hunger hasn’t come back. Although I’ve lost a third of my body weight, I find that there is a very clear relationship between calories in and calories out. If I eat a bit more than the online calculators say I should, the scales creep up. If I eat less for a couple of days, the scales dip by 100g or so. It all happens like clockwork – and I never deprive myself of food. Within my calorie budget, I eat raw milk cheeses, meat, wine, the odd cake, you name it. I don’t even exercise that much, although I walk everywhere.

    Which makes me wonder about the way people lost weight in all the studies. Did they do it in such a way that made them hungry right from the start? Who were the people who were motivated to do extreme low calorie diets for science experiments? Can these results to extrapolated to the population at large?

    Could it be that we’re products of our social structures? I live in a European town, where old fashioned eating with fresh food and regular meal times is the social norm. If I ate here the way I used to – chaotically – I would violate social norms and bring down heavy disapproval upon myself. Snacking is simply not done, except in socially prescribed contexts (e.g. going to a cafe on Sundays and having a coffee and cake.) My behaviour has fundamentally altered in line with the world I live in. And – this is crucial – I was already beginning to lose weight before I got sick, because the environment fostered it.

    For someone who has lost a lot of weight in North America and the UK, it’s not just that they’re battling biological processes – they’re also battling a cruelly obesogenic environment. For many people, they are a lone good eater in a world where everybody wants to push bad food on them, and where they’ll run into social problems if they keep saying ‘no, no, no’. How much is that taken into account?

    I realise the point of the post is that there are major biological forces at work that will not be easily denied – but surely they work in tandem with the cultural environment, and the reason people find it nigh impossible to keep weight off must be related to the world at large they find themselves in.

  13. Anonymous says:

    Paraphrase: “For weight loss and then weight maintenance – cut 100′s of cals, do hours of exercise.
    Nothing else works.”

    I’m going to tell that to my family doctor. She counsels “moderation”, but it’s not working. She says “avoid extreme measures”, but what you describe sounds extreme.

    I’m fat enough for bariatric surgery, but I’m not sick enough – yet.
    If bariatric surgery patients, sicker than I am and also recovering from the trauma of surgery, can do this diet (cut 100′s of cals), then I can too. If they can do exercise even after recovering from surgery, so can I.

    I will need checkups to ensure I get adequate nutrition, perhaps with supplements, but testing must be routine for bariatric surgery patients, so it should be no problem for me to get it too. At least I won’t have nutrient deficiencies due to the surgery itself.

    This is wonderful news, Dr Sharma.
    My family doctor is a skinny athletic type. Probably she herself and her other patients are successful with the kind of moderate program she recommends. “If you gain a couple of pounds, just skip dessert and reduce portion size and you’ll soon be back to normal.” I realize that for me there is no “normal” to get back to.

  14. Princess Dieter says:

    I’ve accepted that I won’t have a normal metabolism and will always battle my addiction to food. I have had to drastically change my strategies, activity level, caloric level to lose 108 pounds and I’m still obese, though much stronger and more flexible and happier with how I feel. Doc says my prediabetes is resolved. I’m off BP meds. And except for my “fluffy” high LDL, other cholesterol markers are great. No inflammatory markers from the reactive protein test.

    But I know I can’t ever eat or treat food like a normal person. Will I keep it off? Will I be one of the focused and fortunate very few? God knows and God alone. I sure as heck don’t.

    But I know I must be exactly as posited: obssessive compulsive about monitoring intake (I eat as organic and fresh as I can the majority of meals, I have fewer meals, and I gave up almost all sugar and grains. I focus on veggies and protein and Primal fats with fruits and dairy as my special treats, cause I love both). I don’t go to McD’s or Taco Bell and their ilk anymore. I gave up my fave junk food and realize it’s not my friend.

    It’s a part-time job–shopping, cooking, reading, self-motivating, exercising. It’s expensive: My retirement funds don’t get the nice infusion they used to as I have had a personal trainer for 3 years. I figured I’d have no retirement if I remained 300 lbs and inactive and depressed. I’d be dead or in a nursing home, disabled. My husband supports me and most of my faimily is supportive at gatherings. I have a blog to self-motivate. I try to motivate others to keep fighting.

    I am resigned to the fact that the day I stop being a fat warrior, I will regain. My body’s signals will win. So, it’s a matter of focusing daily habits/strategies/meal commitments. And prayer.

    I do hope they study the other diets. Not everyone does low fat, and low fat maybe signals even more starvation to the body. Dunno. I do higher fat, lower carb, sorta Primal. It’s the way of eating that calmed my appetite so I’m not food obssessed (thinking about food all the time). I can skip meals. I can avoid desserts. I can feel kinda mentally normal in restaurants, bakeries, Thanksgiving. So, whether it’s the gov’t sanctioned way to eat or not, it’s the one thing that calms the hungry beast in me: more fat, fewer starches/sugars, more protein. I’d like to see them check how the body responds to the Primal/Paleo/Lower Carb versions of caloric restriction.

    Thanks for the reality check. All of us fighting the fatfight need it.

  15. Holly Nisson says:

    I find this topic very interesting and many of these comments were very good. I’ve struggled with my weight since I was a little girl and struggled with an eating disorder for years. I have watched many documentaries and I feel like we have not even scratched the surface of different body types. I watched a very interesting documentary called why thin people aren’t fat and it studies naturally thin people consuming I think it was around 5,000 calories extra a day and how there bodies took in the extra energy. Some gained more muscle some physically could not do it, (sick vomiting) some started twitching and moving more burning energy and some had their metabolic rate increase, overall they gained little weight and when they resumed to their regular eating ( whatever they want) they lost the weight and returned to their normal size. Obese individuals have an extra gene that converts energy into fat. That fat has a tiny oil molecule in the cell that is pure energy if starvation of famine comes along it’s released. (you can thank evolution and famine for this wonderful gene that is now unneeded) So when someone who only needs around 1500 calories eats more than that, they are going to gain fat, that is how the body works. When someone goes on a diet they slow down their metabolism and start psychologically feeling deprived which ends up many times in overeating on forbidden foods last supper type of meals, sneaking food and overall ignoring their bodies natural signals to stop. I could go on and on but basically. READ Intuitive eating and accept your body at it’s natural weight even if its not the standard of beauty.

  16. Anonymous says:

    Yes, losing weight and keeping it off is time consuming. (planning, shopping, cooking, exercising, attending counselling sessions and doctor’s appointments, getting blood tests, etc.)
    BUT it’s not as bad as dialysis or chemo.
    If obesity is a disease and not just a fashion faux pas, then treatment that requires time, effort, and even discomfort is to be expected.
    Being a bit obsessive does help.

  17. Marion@affectionforfitness says:

    I agree with the readers who say “suck it up” and, otherwise, get over it. I think I cried the first time I realized that I could not eat as much as other people, while still weighing more. Yes, all of my kids eat about twice as much as I do, but I’m the only one who struggles with my weight. You just have to “get over it” and strive for health. Is there really anything else a person can do?

    Exercise is still a very important aspect of eating well. Science may not back this up, but I know many people whose diet and fitness habits are intertwined. Either they are working out and eating well, or they are not doing either. An avid exerciser will keep off about 5 to 10 pounds just from exercising, but even more if they eat healthy with it.

    Lastly, some of your colleagues have pointed out that an overweight person who is in good physical shape can have very good health. Moderate consistent exercise dramatically changes the health of people.

    Today’s post on my blog, Being a Fitness Role Model, explains some of those health benefits of moderate exercise.

    :-) Marion

  18. anonymous says:

    I am torn and a bit disappointed by what I read. I understand critical appraisal of research; I understand the strengths and limitations of research. The evidence is strong that diet and exercise don’t work and yet, I have lost a total of 80 pounds and kept it off for nearly 10 years. I lost the first half when I started to run 10 years ago and the second half about 5 years ago when I made changes to my eating habits. I also have 4 good friends that I have seen lose 40-50lbs and keep it off in the same way I have. My experiential knowledge tells me that the research is wrong…..

    I work in healthcare and don’t know where to place this tension between current research and my experience in my day to day work and opinion.

  19. Nancy says:

    As an overweight dietitian, I have come to the firm conclusion that we need to restore the original meaning of the word “diet.” We must recognize the word refers to food intake; whether good nutrition or bad, highly dense calories or low.
    Food intake and exercise are contributors to weight because they impact the chemicals in the brain. The types of foods we choose to eat at one meal will strongly influence what we choose to eat at the next opportunity. Exercise increases brain chemicals that make us feel good and make us happy.
    Eating well is it’s own reward and we don’t have to be at an ideal body weight to benefit from eating well and exercising.

  20. Sean says:

    To those of you who feel trapped…You are not.

    First off, I would like to thank Dr. Sharma for the wealth of information he provides on his website. Most of the information is accurate, with an excellent scientific basis. In my opinion, however, Dr. Sharma does a great disservice to his patients and the public when he writes disheartening statements such as the following,

    “If going on a diet or starting an exercise program resulted in persistent weight loss, we would not have an obesity epidemic”.

    Those words should neither be written nor spoken by someone in a position of promoting an individual’s well being. The fact that a medical doctor who is considered one of the leading experts in his field writes such refuse is alarming to say the least. Statements such as these promote a sense of hopelessness. Ironically, the exact opposite of what Dr. Sharma should be instilling in his patients.

    Speaking as an individual who grew up morbidly obese (close to 260 lbs at the age of 15), I find statements such as these offensive and ignorant. Had I found this information such as this when I first began my journey, I would have never become the person I am today [22 years old, 195 lbs, 10-12% body fat, dipping into the single digit body fat percentage when I see fit (i.e. summer months)]. Rather, I would have been trapped in an obese body, having created a mental prison for myself. Contrary, to what Dr. Sharma believes, you do not have to sit and wait for obesity to be “cured”; you hold the solution within you…the willingness to change, and to take massive action. It is that simple, simple, but not easy. There will be times that you feel that you have failed, but that “failure” is just feedback that should be used to promote success in the future. There is no successful person in this world (financially, professionally, physically etc.) who has not “failed” hundreds or even thousands of times. The difference between those who are successful and those who are unsuccessful is their willingness to quit. Those who are successful refuse to give in when faced with adversity, while those who are unsuccessful quit when they become tired, bored and broken. Quitting overgrows any success that may have been gained through past attempts. It is better to try to fail, then to fail to try.

    As a side note, I would like to eliminate the idea of weight loss, throw it out; it should not be in your vocabulary. Your goal should never be weight loss, it should be body recomposition. That is, achieving a healthy ratio of lean body mass (muscle, bone, water) to adipose tissue (fat). The number on the scale is a good starting point, but when combined with body fat measurements, you gain an optimal method of progress tracking (by the way, throw out the idea of the Body Mass Index, even Dr. Sharma does not promote its use to the exclusion of other body measurement tools). Body fat measurements are important because they allow you to see what you are losing when the scale weight goes down. There are many people who work hard over a period of time, and at the end of the duration, they step on the scale to see that they have barely lost any weight or even worse, gained weight. However, when you utilize body fat measurements you gain a better insight as to what you have achieved. For example, someone at a starting weight of 200lbs, may find that after 6 weeks they still weigh 200 lbs, how can that be when they look and feel so much better. Well that person could have lost 10 lbs of fat, while gaining 10 lbs of lean body mass (Note: this is an extreme example, but results such as this are not uncommon). Therefore, tracking your progress through body fat measurements allows you to see that you have achieved a successful body transformation. However, an individual exclusively using the scale sees only failure.

    Here is the formula for a successful transition to a healthy lifestyle.

    1. First, make up your mind as to what you want to do, set and write out specific goals with deadlines that are backed by emotional and powerful reasons for why you want to achieve these goals. Next, map out your plan. Most importantly, never stop believing in yourself, no matter what your results (This is the most essential component to success, and what most people miss).
    2. Go to your medical doctor for a physical and medical clearance to start a new nutrition and exercise program.
    3. Nutrition – eat whole foods, eliminate man-made processed foods (do this gradually). Design meal plans to stay below your calorie limit to maintain your current weight (Note: only a small calorie reduction is needed i.e. 20% reduction. You should be creating most of your calorie defecit through exercise).
    4. Exercise – utilize both resistance (weight training, bodyweight resistance etc.) and cardiovascular training (cycling, walking, rowing etc.). Note you can combine the two into metabolic resistance training workouts (etc. intervals on a bike, circuit training with weights etc.). Get active utilizing baby steps, you do not have to become an Olympic athlete over night.
    5. Track your progress. Weekly weigh-ins and body fat testing. Adjust your plan to achieve desired results. If you do not receive positive feedback, adjust your plan (i.e. nutrition or exercise) so that you see the results you want for next weeks weigh in (generally 1-2 lbs and 0.5% body fat loss per week – slow and steady wins the race).
    6. Consult with your physician to make sure you remain in good health (i.e. metabolic and cardiovascular risks are being minimized/eliminated etc.)

    Most importantly, believe that you can achieve what you have set out to do. Exercise and Nutrition changed my life, and I guarantee that they will change yours. More often than not, your current state of being (physical and emotional) is a direct result of your current lifestyle. It doesn’t matter what we do, we will always receive a result, we may just not like that result (eg. obesity). Do not take this last statement as a personal attack on you (i.e. that you are lazy etc.). Rather, see it this way, “If I lead myself to this obese state through poor lifestlye choices, than I can create a lean and healthy body through healthy lifestyle choices”. In essence, if you can make yourself fat and unhealthy, you can make yourself lean and healthy. This is an important statement because it gives you the power to take control of your body and your life. I know you have tried in the past and you have felt like you have failed, but you only fail when you quit…Keep going, you are worth it.

    Note: For more information on body recomposition check out Tom Venuto’s e-book, “Burn the Fat, Feed the Muscle”. It will change your life if you apply the knowledge.

    Yours Respectfully,
    Sean

  21. bucky says:

    Thank you for shedding needed scientific information on the ELMM MYTH
    Please read Gary Taubes books, Good Calories, Bad Calories for the explanation of how insulin regulates the accumulation & retention of fat cells.

    Excellent book

  22. Sweat Science » Obesity, delayed gratification and the Marshmallow Test says:

    [...] More”-type advice is useless for losing weight, because it fails to understand the “countless ways in which the psychoneurobiology, energy physiology and metabolism in anyone who has l…” drive you to regain that [...]

  23. Bill Graber says:

    Which is why I advocate and practice the surgical option of a laparoscopic gastric bypass which causes a profound and fundamental change in how a person interacts with their enviroment.

  24. Eric says:

    I have been holding similar views, for a long while, based on my experience (I am in the medical field, mind you…). Studies started to come in confirming this view just in the last decade.I have met many people practicing medicine who actually held similar views. My friend, who practice in Toronto is struggling with the very same issue, and realizes the issue is not solvable via dieting, still advises patients to diet, since it is the standard practice. Same as the physicians who prescribe full dose chemotherapy, knowing full well it is extremely unlikely to do good, and causes damage to 100 percent of the patients, by devastating their immune system. But they still “do the standard practice of their time”… you are simply ahead of the standard practice of your time my friend.

  25. Luke says:

    Well this certainly makes sense it resonates with my natural pessimism too. Every single person I know who has lost weight through diet and exercise has always put the weight back on and gained even more weight than they had before.

    The worse case I saw was a friend who lost a lot of weight and kept it off for a couple of years by exercise. He became a serious cyclist and was even starting to enter competitive events.. But he had an accident on a training ride and injured both his legs, It took nearly 12 months for him to recover. At the end of it he was more overweight than he had ever been.

    I am starting to put on weight myself – having read this article I won’t bother doing anything about it. Maybe obesity is the price we have to pay for a civilisation that guarantees endless abundant food Still I guess its better than starving I guess.

  26. Me says:

    OK…but what if you are following a strict diet…eating the prescribed 3-6 meals a day…keeping your calories down and protein and carbs where they are supposed to be. Exercising hard enough to sweat for over an hour a day…everyday…for months…four months to be exact. and you are still at the same obese weight you started at? When do you stop being the obese person who needs to suck it up? Where is the logic that will help you understand what you can do that will work?

  27. Subliminal says:

    I know that it is very important to keep the liver and kidneys clean in order to keep the body’s metabolism going good. When the body starts getting clogged up – metabolism slows down for everything including fat burning. I do not believe in any diet really, each individual has to make up their own mind that they will change their nutrition intakes each day. Drinking green tea everyday along with your other unhealthy habits is not going to help you lose weight for example. The same goes for some of the other drugs on the martket, probably at least until you get into the ones that are $100 + for a simple bottle. I have to admit they do have some very advanced drugs on the market that will help an individual lose weight.

  28. Alex says:

    I have maintained my 120 lb+ weight loss for four years…easily! The moment I stopped listening to experts and their bad advice about eating whole grains and low fat foods and instead switched to an all real food low carb diet, the weight FELL OFF OF ME…. I continue to eat to my appetitie and avoid all processed foods and grains and stick to fats, meats, veggies, some fruit, nuts, etc. I do not gain weight. I am 52 years, female, 100% healthy. We must, as a country, agree that the advice that fat is dangerous and that grain is a fit food to base a diet around, has been so wrong all along and with staggering consequences! (and NEVER based in ANY science!)
    I will stick to a low carb paleo way of eating for the rest of, hopefully, long and healthy life.

  29. dodo says:

    if that’s your only concern,that’s fine,.many of us cannot do that,because non-carb diets tend to do this to many of us; we get short-tempered,cranky,snappish, or angry and even very angry. that’s because of our need for carbohydrates for our brains;a very low or no-carb diet has been proved to often short-change the brain.Not everyone gets this way,but it’s been tested, and there is even a “no-carbohydrate-emotional syndrome” among total non-carb eaters. short temper,angry, ect. irritable.

    I do have a friend who eats a lot of organic food, when she can afford it, and she feels much better at that time.she says she gets sick when she can’t afford it,and has to eat regular food.I believe it. But me get rid of whole-grain bread? cannot do it.(I only eat limited amts.) I can cut back, but am also not giving up real oats or oatmeal. I would be the wrong person for an all-meat diet;and the fat would do in my health. But if it works for you, fine; “one diet suits all” is not true.

  30. dodo says:

    I forgot to tell you; it’s possible to starve in the good old US of A; I used to make my own yogurt,and live off it, cause my income was so low,and my rent so high.i was, at that time, very thin.when you’re really poor, can’t afford meat,and eat a lot less, so you can still pay the rent, you DO LOSE WEIGHT.

    i know, i did it. in my dad’s family, we could live off sand, and still only lose 5 lbs. but less food WILL MAKE YOU THIN.i had an “efficient metabolism”, every single calorie was used up. people like me,may inherit the future; food is expensive, and getting more so. people with efficient metabolisms will survive, and Audrey Hepburn will not.

  31. Tina says:

    Diet and exercise can be a treatment for obesity–you just have to be willing, as Dr. Sharma points out, to live with a more restricted lifestyle forever, even after you reach goal.

    I’ve lost and maintained 115 pounds from my highest weight and have been maintaining for almost a year. This comes after 25+ years of yo-yo dieting. I made the decision once I got started this time that I was going to be as diligent about maintaining my weight as I was about losing it.

    Is it easy? Not usually. Am I surprised at how little I get to eat if I want to maintain? Yes, it’s probably a few hundred calories less than a non-formerly obese woman of my age, height and size. Is it worth it? Absolutely. I’ve achieved something I’ve never been able to do before and am finally living the happy, healthy and balanced lifestyle I’ve always dreamed of. If that means I have to make a few sacrifices here and there or continue to track my food, so be it. It’s what’s making me a five percenter!

  32. Alex says:

    Dr Sharma,

    What are you trying to say? Eating less and working out are not a cure for obesity? I would amend that to eating right and working out are! For over 30+ years…all of my adult life, I have subscribed to exercise and eating right. In the recent years, my 50 plus time, I have not been able to work out and my weight has soared. Now, using reduced impact aerobic type exercise (elliptical machines) and eating better meals, blasting with Nutribullet and juicing with a juicer, I am on my way back to a managed weight. In the mean time, I feel more fit, energetic and healthy.

    I was always taught that it was a matter of basic physical science…increased activity and decreased intake has to cause the body to burn something, agreed first it will be the simple sugars, but ultimately your body will have to go after the more complex carbs and fats.

    I agree with some of the other posted comments…there is no simple way…some amount of effort and dedication must be applied!

    Sorry, but I disagree with you and my 30+ years of adult life and time as a weight management officer in the military supports my comments….eat smart and work out more, finding the right type of workout, should work for better than 90% of your readers.

  33. Arya M. Sharma, MD says:

    It depends entirely on what you mean by the word “cure”. For me a “cure” is when a condition is resolved forever by a short term treatment – like an antibiotic taken over a few days will cure your sore throat – when you stop the antibiotic after a few days, the throat stays “cured”. Using this definition, diet and exercise is never a cure for obesity – it is a treatment! As you nicely show in your own case, when you diet and exercise your weight is “normal”, when you stop dieting and/or exercising you gain weight – which you lose again, when you diet and exercise. This is BECAUSE diet and exercise dose not “cure” obesity – it just treats it. If you think of diet and exercise like taking a pill to lower your blood pressure – when you stop the pill your blood pressure goes up, when you take the pill your blood pressure goes down – the pill does not “cure” high blood pressure – it treats it. I know of no “cure” for obesity – only “treatments”.

    The fact that diet and exercise are rather ineffective treatments for obesity (although efficacious) is simply the reality for most patients. Very few can do this in the long term – if everyone could do this your story would not merit any comment because “everyone could do it” – the reality is that everyone cannot.

  34. Very Upset says:

    Dear Dr Sharma,
    What on earth do we do then?
    This article is devastating to me.
    Thank you.

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