I have previously blogged that the real problem with “fast food” is in the “fast” and not the “food” – if you take the time to slowly chew and savour your junk food, it may not be all that bad (remember: you can also get plenty of sodium, transfats, and extra calories with the best of gourmet cooking).
The notion that eating too fast, especially till you actually feel full, drastically increases your risk for overweight and obesity was nicely demonstrated by Hiroyasu Iso and colleagues from Osaka University in a paper published last month in the British Medical Journal.
Iso and colleagues studied 3287 Japanese adults (1122 men, 2165 women) aged 30-69 who participated in cross-sectional surveys on cardiovascular risk from 2003 to 2006. The questionnaires included validated measures of dietary habits including “eating until full” and “speed of eating”.
571 (50.9%) men and 1265 (58.4%) women self reported eating until full, and 523 (45.6%) men and 785 (36.3%) women self reported eating quickly. For both sexes the highest age adjusted mean values for body mass index and total energy intake were in the “eating-until-full” and “eating-quickly” group compared with the “not-eating-until-full” and “not-eating-quickly” group. The multivariable odds ratio of being overweight with both eating behaviours compared with neither was 3.13 (2.20 to 4.45) for men and 3.21 (2.41 to 4.29) for women.
Importantly, the “eating-too-fast-till-full” group did not differ from the “not-eating-too-fast-and-not-eating-till-full” group in terms of other variable such as macronutrient composition of the diet, smoking or physical activity. Repeat questionnaires and other studies have shown that these eating behaviour traits stay stable over time – i.e. there appear to be “naturally” slow eaters and “natural” gorgers, the latter being at higher risk of obesity.
Based on these “cross-sectional” data, the big question now is whether or not making a conscious effort to eat slowly (play with your food?) and pushing away the plate before you are entirely full will actually lead to sustained weight loss. That is, of course, assuming that these behaviours can indeed be changed (knowing what I do about behavioural genetics, I believe some skepticism may be in order).
Obviously, both “eating too fast” and “eating till full” are behaviours that, just a few generations ago, would have had significant survival benefits – in fact, these behaviours are two of my six “Natural Laws of Weight Gain” (#3 and #4 to be precise).
The problem of eating too fast has also been recognized by the Alberta Government, which on its “Health U” website provides tips for “Eating on the Run“.
For us clinicians, perhaps, asking our clients to record the time taken for each meal and adding a measure of fullness (Lickert Scale) should become part of our standard recommendations for keeping a food diary.
Unfortunately, the use of “modern technology” that may work for pets (click here for a video of the hilarious “Brake-Fast Doggie Bowl” ), is perhaps not quite the solution for humans.
Nevertheless, as I’ve said before – obesity is a symptom of a society that does not take time to eat!
One of the basic principles in weight management is not to let yourself get hungry.
This is based on the simple rationale that when you are hungry, your hypothalamus “kicks in”, essentially overriding any “sensible” choices you may have intended to make.
For one, when you are hungry you are more likely to eat energy-dense foods.
But hunger also makes you eat faster, in turn making you more likely to overshoot your actual caloric requirements before satiety sets in. I have previously referred to this as ““homeostatic hyperphagia”“.
Skipping meals is perhaps the most common reason for people to get hungry. The meals most likely to be skipped are breakfast and lunch, resulting in the evening “binge”.
If the reason for skipping breakfast and lunch is lack of time and an irregular hectic schedule, commercial meal replacements can come in handy. The convenience of quickly drinking a shake or eating a bar is hard to beat.
Sure, a proper balanced meal prepared with fresh wholesome ingredients enjoyed in a relaxing setting would be best, but the reality is that that is rarely the reality.
Therefore, I would rather see my patients eating a meal replacement than skipping a meal. Meal replacements also promote portion control. Not least, meal replacements are cheap – costing as little as a couple of dollars per meal.
Because I have seen this strategy work over and over again, I was not at all surprised by the results of a recent randomised-controlled trial from John Hopkins (Baltimore), where a diet using portion-controlled meal replacements yielded significantly greater initial weight loss and less regain after 1 year of maintenance than a standard, self-selected, food-based diet in patients with type 2 diabetes (click here for abstract).
Obviously, this is not a strategy for people who “hate” meal replacements. And, like any weight-management strategy, it only works as long as you stick with it.
But for those who embrace it, using meal replacements to replace meals that they’d otherwise skip may prove a viable long-term strategy to regain control of their hypothalamus and their diet.
With all the talk of “thrifty genes” and how our “hunter-gatherer genome” is overwhelmed by the “obesogenic” environment, it may be time to revisit my favorite theories about the “Natural Laws of Weight Gain“.
This is something I came up with almost 10 years ago and have used in a lot of talks over the years. I’ve always wanted to put these ideas into a book but somehow never got around to it.
Simply stated, my Six Natural Laws of Weight Gain are as follows:
1. Always eat when food is around
2. Always go for the gravy
3. Always eat as fast as possible
4. Always eat as much as possible
5. Don’t move if you don’t have to
6. When fuel runs short, turn down the furnace
If anyone is thinking, “hey, that’s me”, you’re probably not alone (in fact it’s me too!).
If you take a minute to think about it, you’ll probably recognize just how deeply these Natural Laws are engrained in our biology and culture and may realize how we’ve actually designed much of our environment to accommodate these laws.
Suddenly terms like “mindless eating”, “fast”food restaurants, “all-you-can-eat” buffets, “poutine”, “super-size it” and “couch potato” take on a whole new meaning.
While through the millennia of evolution these Natural Laws guaranteed the survival of our species, in our current obesogenic environment, they also pretty much guarantee weight gain.
As I have often pointed out in my talks: “In today’s obesogenic environment, people have to develop “abnormal” behaviors to avoid gaining weight”.
Doing things that came “naturally” to most of us is a surefire recipe for weight gain – in today’s enviroment, fighting obesity literally means going against our “nature”! No wonder it is so hard to do.
OK, I realize that by now some of you are screaming that this must be wrong, that I am grossly oversimplifying the complex psychosociobiology of obesity, and that I am just providing obese people with an easy “excuse” to blame it all on nature.
Of course I realize that in reality things are way more complex and that there are many paths that lead to obesity ranging from childhood molestation to antipsychotics or from genetic defects to endocrine abnormalities (the list of possible causes if far longer than you may think!).
Nevertheless, I do believe that perhaps with the exception of such “special causes” the Natural Laws do provide a reasonable and useful framework for thinking about the root causes of the current obesity epidemic.
So in the next couple of weeks, I will be occasionally revisiting this theme and hope to explore some of these laws and how they apply to our current dilemma.
Perhaps the title of my book should be: “The Six Natural Laws of Weight Gain and How to Break Them“!
I wish someday to actually find time to write it – I could probably have a lot of fun with this.