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Jeff Halevy

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Obesity: How We Got Here

Posted: 03/30/2012 9:37 am

Surrounding many behavioral health issues there frequently seems to be a contingency that attempts to downplay and mitigate the severity of a serious health problem -- whether it was big tobacco downplaying the deadly effects of smoking for decades, or even casual drug users making the "everything in moderation" argument -- it seems like there will always be those who either don't recognize the severity of a health problem or, for some reason unbeknownst to me, attempt to discredit the hard data indicting a harmful behavioral pattern. And unfortunately, the most at-risk group participating in a harmful behavior will usually be the first to adopt the argument of those attempting to discredit its ill effects, because let's face it, it doesn't feel good to acknowledge you might be killing yourself!

Such is the climate surrounding the obesity problem our country faces. While the first lady and many others have taken massive steps to help bring awareness and remediation to the obesity issue, there are many who feel there simply is no problem -- that we're crying wolf or exaggerating the severity of the issue for the benefit of the health, pharmaceutical, and weight loss industries.

The truth is that there IS a problem. And the truth is that despite the "benefit" to industries that deal with obesity, if we lose the battle against obesity, everyone loses. We will become a society for whom chronic manageable illnesses become the norm, with poor quality of life... and a lifespan that will likely shorten (though medicine seems to miraculously outpace us with life-sustaining innovations -- note the word "sustain").

I'd like to preface the data I'm about to present with a piece of helpful information: I wasn't always the in-shape trainer, gym-owner, and public health advocate I am today. I was once not only overweight, but in fact obese.

I mention this because I am not a genetically-gifted-washboard-abs-elitist; I'm an empathetic and supporting voice of reason, who has gone through the hardship of obesity and an unhealthy lifestyle, and is now bringing about healthy change supported by scientific fact. And there are over 1,500,000 reasons that make me believe so in Newark, N.J.

As for the "The Big Fat Facts," I find that amongst those who do not believe obesity is a serious health problem there are a few common misunderstandings and errors in logic:

1. "Overweight" and "obese" are not the same.

Just as going 10 mph over the speed limit may theoretically increase your chance of an accident, chances are it's not going to kill you. But we can agree that going 40-50 mph over the speed limit starts to pose some very real risks, and upwards of there, one is really playing with his life.

So, too, is your body composition in regard to body fat. Being 10-20 pounds overweight will not kill you. And no, we don't all need washboard abs to live a long, healthy life. Might it statistically increase your chances for disease and other health complications? Yes, but as some have pointed out, it may actually increase longevity. Overweight is defined as having a BMI over 25 (body mass index -- a crude measurement of body composition based on height and weight). It's not all that difficult to fool the system at this level however; at 5'11, 10 percent body fat, and 195 pounds, I am in fact "overweight."

Obesity, on the other hand, is an entirely different story. Obesity is defined as a BMI over 30. For perspective, at 6 feet tall and over 225 pounds, one is obese, and at 5 feet tall and over 155 pounds, one is also considered obese. We're no longer talking about being a benign 10-20 pounds overweight. We're now talking about a level of fat that greatly raises your risk for a host of medical conditions including: diabetes, cardiovascular disease, cancer, and arthritis.

Understanding this difference is key. Obesity is a medically dangerous condition. The health efforts surrounding obesity are not "a war against body types," as some believe; the efforts surrounding obesity -- note the use of the term "obesity" -- are to improve the medical condition of people who are at extreme risk.

Returning to the speed limit analogy, would it be absurd to deploy a special task force to combat speeders who are breaking the limit by 10 mph? Of course. But if we faced a rampant, widespread wave of speeders going 40 or 50 mph or more over the speed limit, wouldn't we want to actively address and correct the problem?

2. Obesity isn't an isolated condition; it's a lifestyle.

Obesity, or significant excess body fat, doesn't occur in isolation. Obesity is almost always found in the presence of very limited physical activity and/or exercise and a consumption of a surplus of calories, usually of unhealthy foods. In fact, having worked with many obese clients, I can't recall a single client who didn't have these two other components accompanying his/her obesity.

I'm not going to get in a "chicken-or-the-egg" discussion about obesity and its accompanying lifestyle factors, but it's important to understand that the two go together.

Why I am making such a big fuss over this? Well, those seeking to discredit obesity as a public health threat try to focus on fat itself not being the problem, but rather lifestyle factors, that you can in fact be "healthy at every size" if you care for yourself. But this logic is circuitous at best: The day that I see the obese exercising with the same frequency as those who are normal weight or overweight, maybe I'll buy that line of thinking.

3. Obesity kills and makes us sick.

This may surprise you, but I agree with those who argue that we're made to fear body fat, and that fat isn't the monster it's often made out to be. Fat is essential to our metabolic function. Fat is in fact considered the largest "organ" in our bodies. Without fat our brains, liver, muscles, and endocrine and immune systems wouldn't function correctly. So fat is not the bogeyman, but obesity is.

And despite claims that obesity doesn't shorten life spans, the very study that has been used to support these claims -- in no uncertain terms -- says exactly the opposite! "Obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category." And if death isn't enough to scare you, obesity has a very strong correlation with Type 2 diabetes. Notice I said correlation, not causation, but correlative data shouldn't be taken lightly. Let's look at a simple statistic I'm intimately familiar with due to my work with the Let's Move! campaign: New Jersey's obesity rate and Type 2 diabetes rates doubled concurrently. Set aside all of the scientific data we have that stops just shy of causation to explain the mechanism by which obesity causes diabetes, isn't a strong correlation like this strong enough to make you want to avoid obesity? There's a ton of smoke here; I don't need to see the fire.

There are other mechanisms by which obesity makes us sick, including chronic low-level inflammation, stress on our cardiovascular systems, and stress on our joints. Even if I could be "healthy at every size" and maintain health 50 pounds heavier, would I want my poor joints to feel it? And would I want to even exercise at that point? No way!

Despite the above, a few inaccurate arguments have been made to support attempts at discrediting obesity as a serious health issue: that stable fat and even "tummy fat" are blown out of proportion as a health risk, that obesity leading to early death is wrong, and that life spans have lengthened almost lockstep with our expanding waistlines.

Wrong on all three counts: "Stable" obesity shortens lifespans, particularly because of "tummy fat" (a.k.a. "visceral fat," surrounding your organs, mind you!). And considering how skeptical the obesity naysayers are of all the correlative scientific data regarding obesity's harmful effects, I can't understand how they could really believe that our longer lifespans have anything to do with us getting fatter as a population. Could it be that better healthcare and advances in medicine might play a role? And even with these advances, the obese remain in a much greater risk category. Take for instance a well-known study from the New England Journal of Medicine, which found -- over a 16-year study of nearly one million people -- that "Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women." Do you want to roll the dice, or would you want your loved ones to?

Obesity is serious and shouldn't be pooh-poohed. There's a confusion I believe, not just amongst the public, but amongst even health experts as well, about the sometimes unclear line between aesthetics and health when it comes to body fat. We're not talking about the pursuit of six-pack abs; we're talking about preventing the heart disease that is six times more likely in the obese. And we're not talking about "losing the final 10"; we're talking about preventing the diabetes that is 10 times more likely in the obese. We all should care not about our body shape, but deeply, about the shape of our bodies.

For more by Jeff Halevy, click here.

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HUFFPOST SUPER USER
William Anderson LMHC
Licensed Psychotherapist, Weight Control Expert
01:55 PM on 04/06/2012
Excellent, excellent article!

I hope you read my book. I think you'll love it, and it will add to your obviously sound body of knowledge. I lost 140 pounds after 25 years of obesity and weight loss failure when I discovered the solution as a behavior therapist and addictions counselor. I've been helping others to succeed with weight loss since, and now train other therapists in these methods.

Welcome to The Huffington Post blogging community. I'll have my eyes open for your next post.

William Anderson, LMHC
Author of 'The Anderson Method - Secrets of Permanent Weight Loss'
www.TheAndersonMethod.com
07:32 PM on 04/03/2012
The people who claim it is just "eat less, move more" - well, I'd just like to take some of them out back and..... well, you know. Of course we can start with that, it is a great first step, but there are just so many more factors: Stress, sugar/food additives, environmental toxins, hormones, sleep, medications, and other mental health issues, etc. All of this boils down to sometimes an extremely difficult time maintaining a healthy lifestyle in spite of the best attempts. I'd like to think medicine and science have our best interests at heart but, when weight loss has turned into a huge money-making industry, I would have to definitively say they do NOT. Even the folks I know who have turned to gastric bypass as their "last result" - well, they may be thin now - but it seems that the majority of them now have new addictions - instead of food, they now are addicted to alcohol, gambling, shopping, sex, or a combination of several of those.

So, readers, I guess my point is this. This is NOT the easy issue many people would have us believe. I would love to see some truly in-depth research addressing the myriad issues surrounding this obesity epidemic and their various long-term solutions. I suspect much of this may lie in the mental health realm and address the root causes of WHY we eat and WHY we do not want to make exercise a priority in our lives.
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03:03 AM on 04/04/2012
I think one of the problems is that people wait until they're too overweight before they address the weight issues. Maintaining a normal weight is much easier, than trying to lose the extra pounds. Yo-you dieting and not seeing weight loss as a health style change is also an issue. For ex., trying to lose 40 lbs in 6 months. Those 40 lbs, weren't acquired in a short amount of time, therefore it's best, to make long term realisitic goals.
01:09 PM on 04/03/2012
I pose a question to the readers. It is said that the average woman is 165 pounds and wears a size 12-14. The industry is catering to this reality with more plus size fashion lines and stores, more bashing of the fashion models slender frames and more editorial on acceptance rather than change. Is this the right way to handle America's reality with weight, health and fitness?
11:57 AM on 04/03/2012
I think body fat percentage is more important that the sometimes inaccurate BMI. Total body weight is not the best indicator of body composition either. Isefull as a go/no-go indicator, but not a live or die-by number either.
02:35 AM on 04/03/2012
This was a very informative piece. But what was not mentioned is that obesity equals dinero! Whether your spending money on all that extra good high fat, high calorie food, or spending money and all gym memberships or spending money on all the low-calorie Weight Watchers crap or spending money to "sustain" obesity related illnesses, or buying all the weight loss literature - money is being made by many hand over fist! America essentially wants to keep people fat so they can continue to live phat! The second part of this and yes it's sounds super crazy, but people would rather eat a grilled cheese sandwich made with a glazed donut cut in half (saw this grossness on "the Chew") than be concerned about weight. Overweight, fat, obese whatever you call it - they covet food over a slim waste and good health any day. In this day and age, everyone with TV a computer knows how to lose weight but we're steadily trying to educate these adults who know exactly what to do, but just lack desire to do it. There's the rub!
05:09 PM on 04/02/2012
But in this culture me and her talked about it alot and she stood up for me too. People didn't get how sick she was and being a size zero....lots of men want meat on their women....sure yea right until she walked in.

Me I was ignored, judged as being lazy when I was slim a size 4 healthy but the raped and then as a teen seeing abuse my drug of choice was food and hers starving and cutting herself. I didn't trust men at all only seen the worse of them......and still don't trust them only feel they can do harm and shallow bean pole lovers.

Now im 24 and losing weight and have to learn to cope with growing male attention which makes me sick now they notice me even the fat ones have the nerve. Im getting healthy to save myself and never dated and likely never will. Losing weight is not simple eat less more more. I have done that eating 1000 cal and exercise and stayed the same my body fights it................taking zantrex 3 helped me yes gave me stomach aches, but it hurts my feet carrying all my weight and joints I had enough.

Highest weight: 311
Today:270 one day at a time....
05:09 PM on 04/02/2012
We cope together, and bonded through our eating disorders that gave me chest pains and landed her in hospital with failing organs.

Her hair would fall out, she then had to use a wheel chair, she was white, but her great grandmother (a blk woman) gave her that envy me natural tan which she became so pale....and guess what folks? She got more respect then me, even in wheel chair great guys asked her out.....she was a self cutter, hated herself, depressing and the only thing in common we had as well was in hopes that our disorders would kill us so we don't have to suffer each day waking up.
02:13 AM on 04/03/2012
Sad story. Not sure where you are mentally but good luck making it thru your journey!
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Irene Rubaum-Keller
author of the book Foodaholic, psychotherapist
10:35 PM on 04/01/2012
Great blog Jeff. Here is some more info on the subject http://www.huffingtonpost.com/irene-rubaumkeller-/why-are-we-americans-so-f_b_197298.html. The maps are very telling. We are eating 30% more than we did in the 50's, 60's and 70's and moving less.
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charleyvldm9
He thinks outside the box.
08:17 PM on 03/31/2012
Two words, inactivity and food.
01:56 PM on 04/01/2012
One word, wrong.
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12:05 AM on 04/02/2012
Absolutely! There is so much data on this subject, that it's unbelievable that some people would claim otherwise.
02:22 AM on 04/02/2012
Lovely to see you commenting here Canuck, even if it IS only one word. Myself, I wrote a lovely, detailed and very polite response to the article here and find that it was arbitrarily deleted by HuffPo. It has been happening a LOT lately. One doesn't need to break any rules to have a post deleted, one only has to not be in agreement with the prevailing and conventional "wisdom" of the moment it seems!
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Tom Hendricks
see wikipedia
12:10 AM on 03/31/2012
Jeff Halevy, I would encourage you to add these points. There seems to be a correlation between those who are not breast fed and obesity, and lack of sleep and obesity. I seldom see those comments made. The studies for both are pretty strong.
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06:19 PM on 03/31/2012
I haven't seen those studies, but they might be worth considering. However at the end of the day it comes down to the amount of calories you take in, versus what you expend. If you take in calories from more nutrient dense food and you work out or at least lead an active life style (BMI of 24), you WILL be healthier than a a thin person with a BMI of 20, who subsists on less nutritious, fattier foods. I was never breast fed, nor were my sisters, cousins, friends etc., yet we all have a BMI in the 19 - 24 range. Why? I think it's because we grew up with parents who did the following: 1. cooked every meal, 2. mother did not drive, so walked everywhere to pick up groceries, go to school, etc., 3. soda cans/fruit juices were strictly for parties, 4. parents did not fixate on weight, in other words, being the "right weight" was not a neurotic obsession that was passed on to their children, 5. dinner started right after school at 3:30/4 pm, 6. did not have desert after dinner or every meal, 7. participated in competitive sports. Anyway, I think the most important thing is that you pass down healthy eating habits to your children, and make staying active fun (not hard work). Healthy foods can include a variety of foods, not just greens and flaxseed oil.
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Tom Hendricks
see wikipedia
11:58 AM on 04/02/2012
Your points make sense, but they may not be correct in this way. The ENS, or enteric nervous system, seems to have a lot if not most control of the digestive system, This part of our nervous system, is more concerned with taking in breast milk, and dealing with gut flora, then any aspect of the world outside of us. This suggests that to really understand the digestive system, we've got to look at it, how it works, and what really is important in digestive terms: that would be breast feeding, most infants first nurturing; and first solids which set up the digestive system. And because the intestines is where food comes in, it is where danger from bacteria is the worst. To understand all this we need to look less at social and outside issues, and more at biological aspects and digestive issues.
04:27 AM on 04/03/2012
The BMI is an extremely crude measurement and should not be used (nor was it designed to be used) in more focused research.

People overeat, yes. Of course they need to "cut calories" so to speak. But that is not the entire story. Eating healthy, of course, the main ingredient to finding an "ideal" body mass composition. I refuse to use "losing weight" because just losing weight doesn't mean health. Eating healthy and proper excercise lead to a proper expulsion of energy. But I know that undereating does not lead to weight loss and actually can lead to weight gain. So, calories in/calories out isn't as generic as it sounds.

Sounds like your parents did a most excellent job at keeping nutrition and exercise balanced. Kudo's to them! Most parents haven't a clue what proper nutrition is, sadly. too much televsion, WII, Playstations, driving to the mailbox. I live in Germany and we walk EVERYWHERE. For example, I walk abt a half mile to work, home for lunch, back to work, to the gym, then home... I get about 1-2 miles a day in just living my life. That's what is missing in the US!
02:56 PM on 04/01/2012
Although there may be a correlation between bottle feeding babies and obesity, I'm not sure it's that strong. Certainly breast fed babies receive many benefits and I believe bottle fed babies tend to be heavier.

In any case, breast feeding has been championed in the US since the 70's and I believe that generally breast feeding rates have gone up since the 60's. However, we are facing the epidemic of infantile obesity now and not back in the 40's, 50's and 60's when many mothers weren't encouraged to breast feed at all.

Regarding sleep debt and obesity, on that score I'm sure you're right. I've worked nights for many years, at some points only nights. It is much more difficult to organize your life with the rest of the world as a night shift worker and most people working nights do not get enough sleep.

It's my opinion at least, as I haven't seen any specific studies, that you're much more likely to gain weight working nights as getting appropriate sleep and exercise and eating properly is more problematic. Night shift workers have to make an extra commitment to their health in order to not gain weight and that is often very difficult to impossible what with the demands of family, etc.

Doug Spurr, MD
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Tom Hendricks
see wikipedia
12:26 AM on 04/02/2012
Here's some quotes to consider:

"Before 1900, most mothers breastfed their infants. Breastfeeding rates declined sharply worldwide after 1920, when evaporated cow's milk and infant formula became widely available. These were promoted as being more convenient for mothers and more nutritious than human milk. Breastfeeding rates began rising again in the late 1950s and early 1960s." - faqs.org

Before I have suggested that breast feeding may set up a pattern of food in and waste out. But how? This study may explain at least one way.
Breast milk sets up the small intestines : " The lining of a newborn's gut is particularly vulnerable to damage as it has never been exposed to food or drink. The new study highlights the importance of breastfeeding in the first few days after the birth.... (and)
Scientists at Queen Mary, University of London have discovered that an ingredient in human breast milk protects and repairs the delicate intestines of newborn babies."
http://www.sciencedaily.com/releases/2009/06/090629200754.htm

This article suggests that breast feeding reduces blood pressure
http://news.bbc.co.uk/2/hi/health/4572185.stm

Numerous studies have documented that breastfeeding strengthens the immune system, protects the gastrointestinal system, and protects against food allergies. These health benefits continue for as long as the child is breastfed, and in many cases continue well into adulthood (American Academy of Pediatrics 1997).
I add, The best diet drink in the world, is taking in breast milk during infancy.
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Tom Hendricks
see wikipedia
12:28 AM on 04/02/2012
I will augment my answer with one other factor that may play a minor part. We are living now with the first generation to have all the protein they want. There may be an excess of protein. There are no real studies to support this though, unlike the vast studies that show the health benefits of both enough sleep and breast feeding. - it's my opinion alone. Take it for what it's worth.
11:39 PM on 03/30/2012
It has been proven that the BMI index is not something that should be used for everyone. Anyone that carries any muscle mass will give an incorrect reading.

The Difference Between Weight Loss and Fat Loss
http://exerciseandnutritiontips.com/the-difference-between-weight-loss-and-fat-loss
Kali03
I am an Obama supporter
08:51 PM on 04/01/2012
Thank you! My BMI has me at obese but I am super muscular for a woman and my body fat percentage is within reason. And I'm small--I can still fit in a size six in shops like Anthropologie and need a petite in adult women's clothes (Banana Republic, for instance). I'm in no way obese, but I do weigh a lot.
10:18 AM on 04/02/2012
So that's when you use common sense and LOOK at the person. You can tell when a person's BMI is too high just by looking at the shape of their body.
noahmarder
Exposing the regressive lies, one by one
05:15 PM on 03/30/2012
Despite the increased statistical probability of the obese being in poorer health, the body mass index (BMI) remains a terrible tool for judging just how fat someone is. There are very large person to person variations in lean body mass that are independent of height.

The author himself is 5'11 and 195 pounds with 10% bodyfat. That gives a BMI of 27.25. If he gained 20 pounds of fat, he would have 18.4% bodyfat, and have a BMI of 30.05, which would be considered obese. There are plenty of men with bodyfat levels above 18.4%, but since they don't have as much muscle as does the author, they aren't considered obese. They would also likely be in worse condition than would be the author if he gained 20 pounds of fat.

Building strength and muscle is a very important part of fitness, and the last thing we should be doing is using a metric that penalizes people for that muscle mass.
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urkiddinme
Former fatty turned fitness freak
05:06 PM on 03/30/2012
So easy to spot the fat commenters...ahemcoughcoughjunesahemcoughcough.....

Sure, it's your own business if you want to disrespect your body. I know plenty of people who have smoked cigarettes for over 60 years and didn't get lung cancer, does that make smoking okay?
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12:07 AM on 04/02/2012
I know!!!
03:52 PM on 03/30/2012
I don't think it's any of Mr. Halevy's or the government's business what I choose to do with my body. I think this is another way for health elitists to exert their snobbery. I know plenty of people who have lived well into their nineties who are "obese", as Mr. Halevy would say.
07:56 PM on 03/30/2012
It is when your poor lifestyle choices cause everyone else's health insurance premiums to go up.
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One more Thing
12:50 AM on 04/01/2012
Or when they sit next to you on a plane!

(Even when wearing a sweat shirt with the picture of the American flag over the words "PATRIOT")
07:33 PM on 04/01/2012
Well-said.
09:50 AM on 04/06/2012
And I know plenty of smokers who've lived well into their nineties. And plenty of drunk drivers who never hit a tree, wrecked their car, or killed another motorist.
01:14 PM on 03/30/2012
The most current research demonstrates that unless there are other risk factors, obesity does NOT shorten life span. In fact, unless there are other risk factors, it has been determined that there are no differences in all-cause mortality risk between obese individuals and normal-weight individuals. The research states that weight loss may not be beneficial for reducing health risk. Applied Physiology, Nutrition, and Metabolism, 2011, 36(4): 570-576, 10.1139/h11-058
04:48 PM on 03/30/2012
"May???" That's like saying, that in certain car accidents, you have a better chance of surviving if you don't wear your seat belt!!!! I think the author does an excellent job of explaining why obesity and health seldom co-exist "e.g. the obese don't exercise, a mitigating factor for any health complications that may be an underlying factor."
10:37 AM on 03/31/2012
Unfortunately, the author uses overbroad generalities about obese people. It is true that exercise is good for people in general. Both normal weight people and obese people are at higher risk if they don't exercise. The research shows that approximately one third of obese people are very healthy. The obese INCREASE their risk of illness when they lose weight and then regain it, even when they lose it again.
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07:38 PM on 03/30/2012
You forgot to mention the critical link between Diabetes and Obesity. Diabetes is a disease that affects EVERY blood vessel in your body. It is pervasive and once diagnosed, you will face a much higher rist of heart disease, kidney issues, vascular issues, etc. These people are the 'frequent flyers' of hospital's, who come in for a new graft, an infected graft, a bypass graft, dialysis, etc. Diabetes is a BIG deal. "From 1997 to 2003, there was a 41% increase in the incidence of diagnosed diabetes. In 2003, two out of every 1,000 normal-weight people had diabetes. In the same year, diabetes struck 18.3 out of every 1,000 obese people, and 5.5 out of every 1,000 overweight people.You can't just lump obesity into one." See link. http://diabetes.webmd.com/news/20060420/diabetes-up-obesity-to-blame
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DrP
09:58 PM on 03/31/2012
People with insulin resistance will both lose weight and normalize blood sugar with carbohydrate restricted, high fat diets. For many, both obesity and high blood sugar are the result of excess carbohydrate consumption. This is not a case of cause and effect - both the weight and blood sugar issues (and the health complications that result from high blood sugar/insulin levels) are the result of eating foods the body cannot tolerate due to genetic glucose intolerance/insulin resistance.