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David Katz, M.D.

David Katz, M.D.

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Introducing the National Exchange for Weight Loss Resistance

Posted: 05/23/11 08:31 AM ET

Over the years, I've had some patients tell me they only need to smell food to gain weight. Of course, I didn't entirely believe them -- and I'm sure they never expected me to! But they did expect me to believe the point they were exaggerating: that they gain weight more readily than others, that they don't need to "overeat" per se to get fat, and that they may find weight loss next to impossible.

And all of that, I certainly do believe.

Body weight is about energy balance, and that, in turn, is about calories in versus calories out. I have asserted this many times before, and the fact that I do so again is not stubbornness on my part. It is simply that the fundamentals of physics and the laws of thermodynamics have not changed over the span of my literary career! And therefore, neither has my opinion on this topic.

Despite the claims of some that weight is all about one kind of macronutrient; or of others that calories don't count -- the simple reality is that the relationship between matter and energy is fixed well above their pay grades (and mine). I believe that only the truly foolhardy enter an argument about physics with Einstein and Newton.

When calories are excessive, people can gain weight eating all carbs or no carbs; high fat or low fat; high or low sugar, or protein, or sassafras. When calories are restricted, I've found people can lose weight -- and have done so -- eating no cheese or nothing but cheese; no cupcakes, or nothing but cupcakes. When calories in exceed calories out, weight goes up; when calories out exceed calories in, weight goes down. Short of any hair splitting that, in my opinion, isn't worth our time, that's it.

But ... what determines how many calories in are needed to meet demands? What determines, for any given individual, how many calories in are required before calories out are exceeded -- or vice versa? Ah, there's the rub!

We know the basics, of course. Calories in can be counted in food, using a device calling a calorimeter. Within a modest range of error, we can say with confidence what calories are coming in.

And we know where calories out go. They go to resting energy expenditure, they go to fuel physical activity, they go to generate heat and, in children, they support growth. That's pretty much it.

But how many calories are required to support any given activity? How many calories are wasted in heat generation? How many are used at rest to support basal metabolism?

It depends.

Where calories in match calories out is highly variable, and not a matter of choice. Any two people, doing the same physical activity, will burn different numbers of calories due to a complex interplay of genes, body composition and physiology. Any two people, eating the same foods in the same quantities, may experience entirely different effects on weight -- one gaining, one losing -- dependent again on genes, resting energy expenditure, body composition, body mass and a long list of factors we are just beginning to appreciate.

Among those factors, one getting particular attention these days is the bacterial population of our GI tracts. The so called "microbiota" exert a profound and diverse influence on our health, including but by no means limited to our digestion. This is not surprising when one considers that bacteria in the human body outnumber cells of the human body by at least 20 to 1. With variation in GI flora, there is variation in how many calories are extracted from food, and in whether fiber is the non-caloric roughage we have long contended, or a source of additional calories.

Variation in gut flora can be a factor in weight loss resistance -- the inability to lose weight under conditions of physical exertion and calorie restriction that would do the trick for most people. Other factors might account for this as well, including some viral exposures; various hormonal imbalances involving insulin, leptin, thyroid hormone and cortisol to name a few; insomnia; and genetic polymorphisms (different versions of a given gene) that in some cases render entire ethnic groups, such as the Pima Indians, extremely vulnerable to weight gain and extremely resistant to weight loss.

If you happen to find yourself at the extreme end of the weight loss resistance bell curve, you live daily with the injury of gaining weight you don't want, and the seeming impossibility of losing it. You also likely live with the daily addition of insult to injury, because people look at you and assume you aren't really trying.

Unfortunately, we don't yet know how to identify and fix all the factors contributing to weight loss resistance. But we can identify, and fix, the stigma of illegitimacy that further burdens those who live with it -- we can at least admit it's real. We can acknowledge legitimacy, and cultivate solidarity.

And, ideally, we can do better than that. Two heads are better than one, and the hive mind more powerful still. Perhaps by sharing both frustrations and insights, a community wrestling with this can find solutions that have eluded individuals.

Let's try. In support of these very goals- understanding, and overcoming -- I have launched the National Exchange for Weight Loss Resistance. If you are affected, please join us. Weight loss resistance will be a tough nut to crack, but in unity, we may muster the strength.

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

 

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Over the years, I've had some patients tell me they only need to smell food to gain weight. Of course, I didn't entirely believe them -- and I'm sure they never expected me to! But they did expect m...
Over the years, I've had some patients tell me they only need to smell food to gain weight. Of course, I didn't entirely believe them -- and I'm sure they never expected me to! But they did expect m...
 
 
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HUFFPOST SUPER USER
raker
08:54 AM on 05/30/2011
I just finished the "attack phase" of the Dukan Diet, following it scrupulously for seven days. This is the part of the diet where pounds are supposed to drop off dramatically. I lost two pounds. What the...?
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DrJohnnySkeptic
The road to success is always under construction.
08:20 PM on 05/29/2011
One thing that I have noticed about my own body is that I completely lose my cravings for sweets when there is a ton of fresh fruit available at the ready - it makes me feel more alive, energetic, and vital at this time of year. Every time we make a big shopping trip, we get brightly colored fruits that have good hydration properties, like grapes, plums, citrus and other moisture filled fruits. For some reason, it also makes me want to drink water more and the energy I get from all the fruit makes me want to exercise more.

It's a win-win for me! :-)
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intellifran
insert clever line here...
06:48 AM on 05/27/2011
Here is my suggestion as I have struggled with my weight for the last couple of years: try eating plans that work for you. I went to weight watchers and nutrisystem and neither worked very well for me. I did a low fat, low calorie, high protein diet and I have lost the weight. It's not the adkins it's something something else with a local doctor in the NOVA area. They emphasize eating small portions and low fat stuff. High fatty red meat will clog your arteries so have chicken, fish and turkey. Of course you also need your veggies and they resquest 8 servings as opposed to the standard 3-5. I suggest this to anyone struggling. more protein, 1-2 servings of carbs and it will come off without exercise. You eventually need to exercise though b/c your body needs it.
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DrP
07:42 AM on 05/27/2011
Please explain the biochemistry of how "high fatty red meat will clog your arteries."
People constantly say that, but never present the science to explain that statement, just quote observational studies that prove nothing.
On the other hand, Gary Taubes, Tom Naughton, Joseph Mercola, and many others have explained in completely understandable detail the details on the biochemistry of human metabolism and the disease process which shows that it is excess dietary carbohydrate (sugars) that cause heart disease.
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WorkersUnited
04:31 AM on 05/27/2011
I see a lot of women make the mistake of not doing enough weight training or none at all. They just do endless cardio.

They sometimes say they don't want to be "bulky," even though that is pretty much impossible for the average women who has one tenth the testosterone of men.

Weight training builds muscle, which burns fat when they are NOT DOING ANYTHING throughout the day. It's all about raising your metabolism.
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hauruck
Bitten by a radioactive Welshman
02:46 PM on 05/27/2011
> "they don't want to be bulky"

...they need to ask themselves which is worse, having some muscle, or being obese? Besides, muscular women are hawt.
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Irene Rubaum-Keller
author of the book Foodaholic, psychotherapist
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dblueII
Share the kibble.
02:05 PM on 05/26/2011
lol, I said dessert.
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dblueII
Share the kibble.
02:02 PM on 05/26/2011
Thank you for this article, it is an oasis of sanity in the dessert of quackery that dominates so much of the weight loss discussion.
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pphhrogg
domestic clown goddess
01:04 AM on 05/26/2011
I've found that I have to both cut back on calories AND get more exercise before I can succsessfully lose weight. One or the other by themselves won't do the trick for me......but with both I've lost over 80 pounds.
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Widespread Panic
To the bang bang boogie, say up jump the boogie
04:14 PM on 05/25/2011
What works for me is eating in moderation. Anything I want, but in moderation. I also work out at least 5 days a week, so that helps me to keep my weight under control.

I notice that when I start to emotionally eat the weight piles on cause I'm not eating when I'm hungry I'm eating because of how I'm feeling at the time (bored, down, stressed, etc).
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VennyKC
02:41 PM on 05/25/2011
To some extent, I'm sympathetic to those who struggle with weight. I have also struggled with my weight. However, for the last five years I've watched my calories and exercised regularly. Spoiler alert: I lost 70+ pounds and kept it off. At the same time, many people close to me have refused to take similar actions. In some instances, they blatantly lie about their eating habits and physical activity. It is heartbreaking to watch your loved ones shorten their lifespans.
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dirtyliberal88
watch out, I teach your kids
10:34 AM on 05/26/2011
I see where you're coming from - I didn't excercise ONCE and lost 30 pounds in 5 months this year. It takes discipline, but a lot of people just don't have it. If you can't diet, exercise hard. If you can't exercise, limit your calories. If you can, do both.
Not rocket science.
07:58 AM on 05/25/2011
I think that as you get older especially it is important to do resistance exercise. I am a 53 yr old woman going thru menopause. And let me tell you, as you get older it is harder. So I am trying to get back into the weights. Trouble is, arthritis runs in my family. My left knee is still and sometimes hurts so it affects how much and how often I can work out. But I keep trying. Women tend to turn away from resistance training but as you get older you lose muscle mass so aerobics isn't enough. And even if you stay slim, if you don't do resistance training you can get flabby and weak as far as being able to lift things. I am now experimenting with different supplements to help with my joints. If anyone knows of a really good one I would appreciate a mention. I am using OsteoBiflex Triple Strength right now.
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jgarma
05:28 PM on 05/25/2011
You're spot on -- the older you get the more important is resistance training, because the body naturally sheds muscle tissue with age if exercise does not interfere.

Suggest you do some web surfing for arthritis supplements. I use various cartilage enhancement stuff, such as this stuff: http://wp.me/pA04z-2J

Note the Curcumin, or turmeric that's in the list. This has been getting rave reviews from health practitioners, such as Dr. Andrew Weil for its various health benefits, not the least of which is to reduce inflammation which can cause joint ache.
06:32 PM on 05/25/2011
Oops, I meant "stiff" knee not "still." Didn't catch that.
Thanks for the link. I will check it out. :)
06:22 AM on 05/25/2011
Simply, eat in the right manner and to not be in need of diet.
http://www.lifestyle-after50.com/nutrition.html
12:21 AM on 05/25/2011
Frankly, losing weight isnt always good...losing excess fat. Now thats a goal. From my personal experience, I have to agree with Gary Taubes. Fat loss is often about insulin response...its a beer belly, or hit em in the bread basket kids...its the carbs!
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jgarma
05:32 PM on 05/25/2011
Yes, indeed, it is the carbs, mainly the "fast" carbs found in processed food and while flour, white rice, white pasta.

"Fast" refers to the blood glucose uptake, meaning how fast the sugar in the food spikes your blood sugar and insulin response. We like the simple carbs because of the dopamine effect in our brains, similar to other drugs, like cocaine.

And like a drug, fast carb lovers have a hard time getting off them and are unlikely to do so without a lot of support.
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11:19 PM on 05/24/2011
I am one of those people who have had a horrible time losing weight now that I'm a woman of fifty but I've discovered kettlebells and swinging them in my workouts has been the key to my weight loss of forty pounds.
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jgarma
05:37 PM on 05/25/2011
Excellent!

Tim Ferris popularized this kettlebells for women in his new book, called "The Four Hour Body" (which is a potpourri of advice, not mainly about kettlebells).

The reason it works so well is that it combines the simultaneous resistance training of major muscle groups. Works large muscles and the core. Fast muscle growth results which stimulates increased metabolism.

Just be very careful about form... form is key; otherwise you can injure yourself.
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DrP
08:43 PM on 05/24/2011
An interesting study for those who maintain that if the overweight would just exercise more (expend more calories), then they would lose weight:
1989 Danish Study: Sedentary subjects were trained to marathons; 18 months of training, followed by running a marathon; 18 men lost an average of 5 pounds; nine women showed "no change in body composition."
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Fred Butters
11:55 PM on 05/24/2011
Here's one from 2011. According to this study, exercise will help you lose weight... about 4Lbs after one year of exercising three times a week for ~60 mins.

"Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial"
http://www.ncbi.nlm.nih.gov/pubmed/20820172

Here's another one from 2010. 77 hours of exercise required to lose 2Lbs.
http://www.ajcn.org/content/early/2010/09/29/ajcn.2010.29471.full.pdf+html
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Fred Butters
11:57 PM on 05/24/2011
Oops, hit post too soon. The point being, all that exercise and they only lost a couple pounds in one year. So yes, you can lose weight by exercising, but it's nowhere near the amounts people think.
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DrP
04:49 PM on 05/24/2011
I've been thinking about this article, and the comment about patients claiming they can gain weight just by looking at food, and I think there actually might be some truth to that.
Since it is scientific fact that insulin plays a major role in the ability/inability to utilize glucose for fuel and unused glucose is stored as fat due to the presence of high insulin levels, it makes sense that in some people, the mere presence of food may trigger an insulin release. That also explains the phenomenon that seems to puzzle nutritionists so much - the ability for zero calorie diet soft drinks to cause weight gain. I don't know why the "experts" are missing the role of insulin in this very common occurrence and keep trying to explain it away as "the body expects food when a person eats something sweet, so drinking diet soda makes people eat more. Since I have dramatic symptoms from insulin spikes, I know for a fact that I can get an insulin surge from diet soda, even when sweetened with a "natural," non-caloric sweetener like Stevia. It does not follow that I go on to eat ravenously in response, although one of my symptoms is a feeling of gnawing hunger pains.
As I've said in other posts, :calories in, calories out" does not come close to explaining the complexity of human metabolism, especially in the large proportion of us who are insulin-resistant.