The Truth Hurts (Then Helps)
Every year political correctness gets worse. We can't say anything that might hurt someone's feelings, even if it's true. And don't even think about doing anything that might make someone feel like they may be different. (Newsflash: We're all different.)
Because of political correctness, objective truths are prohibited even if speaking them could help people get better. Health practitioners can't tell patients that being obese can reduce their lifespan and raise their chances of developing Type 2 diabetes, cardiovascular problems, and even depression.
Telling people these things, even though it's based on sound science, is not acceptable anymore because it makes them feel bad.
But you know what? Maybe they should feel bad.
Feeling bad isn't always a bad thing. It's the best driving force behind change. If you tell me that I'm at risk of dying young, I'd feel bad too. And that'd be a necessary step towards better health.
Another side effect of extreme political correctness is that we can't say that people are obese simply because they ate too much food. No, we need to tell them it's not their fault, that obesity is not a self-imposed condition that occurred because of the choices they made every day for years, but rather, an illness.
Let me be blunt: Obesity has more in common with being addicted to cigarettes than it does with the common cold. You "catch" or develop an illness mostly due to factors beyond your control.
You gain a severe weight surplus as a result of the decisions you make: food choices, food quantities, and physical activity. Kinda like how you decide to put that cigarette in your mouth.
As far as social norms go, there's a huge difference between our treatment of obesity and smoking though. Since obesity affects the way you look, it's considered discriminatory or hateful to point out the problems associated with it.
You can point out the problems with smoking all day long and nobody will bat an eye. But talk about obesity out loud and you'll instantly be labeled a bigot.
But obesity is associated with a higher mortality rate. That's factual. You can find dozens of studies establishing a very strong connection between obesity and cardiovascular diseases and diabetes as well as shorter lifespan. Cancer, too.
Pointing that out is not hate. Hate would be hiding it from you so that you don't do anything about it.
To solve a weight problem, the first thing to do is take personal responsibility for getting to that point. Except for some rare exceptions, people are overweight simply because they ate more than they needed for a prolonged period of time.
This has been demonstrated scientifically. For example, Duvigneaud et al. concluded that "the main cause of obesity is the chronic overconsumption of energy compared to energy expenditure (1)."
We can look at both history and modern medicine to understand this better. During World War II, out of the millions of prisoners in the concentration camps, none were overweight. In fact, all of them were rail thin. Out of those millions, many likely had the genetic factors that could increase their risk of obesity, yet all were skinny.
Of course, that's an extreme example, but it illustrates that having a very low caloric intake and a high level of physical activity will lead to drastic weight loss in everybody. It's just a matter of finding the level of both that'll be sufficient to lead to the fat loss.
Another example is the significant weight loss in patients who undergo bariatric surgery. The main reason for the initial weight loss is the fact that you simply cannot eat a lot of food. Overeating will lead to throwing up in most cases. It also dramatically decreases hunger. Both of these things lead to a reduction in caloric intake.
Those who undergo bariatric surgery will regain the weight if they revert back to their old eating habits (over time you can tolerate more and more food even with the surgery) and start to increase portions or eat more calorie-dense foods.
Despite likely having worse hormonal conditions for becoming obese, a huge majority of people who get the surgery still lose fat, illustrating that consuming too much food is the main cause of fat accumulation.
There's good news though. If your decisions are the main reason for gaining fat, your decisions can also be the solution.
You've probably heard something like this before: "But I don't really eat more than other people."
There are overweight people who swear that they don't eat a lot. I've worked with hundreds of them. And every one has said that they eat "normally" or that they don't eat more than their leaner friends and family members.
Are they lying? Not necessarily. They may be eating a normal VOLUME of food while unknowingly consuming a greater amount of calories.
The idea of eating a "normal" amount – or eating a little, a lot, more, or less – is just too vague. These terms aren't adequate when it comes to quantifying nutritional intake.
Why? Because having a low-calorie stew might make you feel like you've eaten a whole lot, while having a stack of high-calorie cookies might make you feel as though you've eaten very little.
Food can be deceiving when you're measuring it by your perceived intake, especially when that intake is mostly made up of food that doesn't contain a whole lot of volume or nutrition.
If your appetite remains high – even after eating a large amount of calories (but low volume meal) – then you might think you've eaten very little. But if your appetite is blunted after eating a highly-satiating meal (with much fewer calories) then you might think you've eaten a lot.
So it's no wonder a lot of people report that they don't eat more than others. They may be using the way they FEEL as a barometer for how much they've eaten.
But then there's the problem of underreporting. And it's been studied... a lot.
Research shows that overweight individuals underreport caloric intake more than leaner ones. Participants were asked to fill out a nutritional journal to study this. And the more overweight the participants were, the lower the reported caloric intake was compared to reality (2).
When compared to normal-weight individuals, and those suffering from anorexia, overweight individuals underreport food intake. In a study, normal-weight individuals reported food intake correctly (slight over-reporting). And as you might guess, people suffering from anorexia over-reported food intake (ate less than they reported) even more. Obese individuals underreported food intake by 16 percent (3).
Why does this happen? Researchers from another study may have the answer. They found that obese individuals underreport because they don't evaluate portion size correctly or don't report snacks (4).
A classic study looked at obese people who couldn't lose weight despite being on a "1200 calorie per day diet" and exercising regularly. Turns out their metabolic rate was normal for their height and weight, but they were underreporting their food intake by a whopping 47 percent. They also overestimated their activity level by 51 percent (5). They literally ate twice as much as they reported and exercised half as much.
So, it seems as though we've been asking the wrong questions. The question ISN'T are people fat because they overeat? Because the answer (for the vast majority) is a resounding yes.
A better question is, why? What is it that causes obese people to perceive their food intake differently? Is it because they've never accurately weighed, measured, and tracked what they've consumed? Or is it because what they're choosing to eat never really satisfies?
The answer is likely a combination of both.
People conflate overeating with binging. While binging is an extreme form of overeating, it's not the only way to overeat, nor is it the most prevalent way to overeat.
Overeating simply means taking in more than your body needs to maintain your current body composition. If you maintain your body fat level at 2,500 calories per day, then eating 3,000 calories per day is overeating. Unless your activity level rises to match it, that consumption can lead to fat gain... even though it may be very gradual and hardly noticeable.
Now let's say that you dispersed those calories fairly evenly over the course of the day. You eat four meals (three main meals plus a snack). That's only a surplus of 125 to 187 calories per meal. That might not seem like much – especially if the food is low volume and has a low nutrient density.
Obese individuals aren't lying about their food intake. Sometimes they just don't realize the true quantity of what they're eating and the difference in calories between different types of foods... even healthy ones.
Many years ago, I was training a boxer who needed to lose weight. After being on a diet for four weeks his weight hadn't moved. I couldn't understand why because the guy was very disciplined. One day we went to lunch together and he drank two large glasses of orange juice. I asked him if he drank a lot of juice. He replied, "Four to five glasses per day."
Of course, juice wasn't in his diet plan. And those four to five glasses added around 800-900 calories to his daily total! No wonder he wasn't losing weight.
People who can't seem to lose weight are often unaware that their habitual consumption of certain things comes with a caloric impact. This is really what differentiates a "healthy" diet from a diet that allows you to lose fat. Nutritious foods are often not measured out in appropriate serving sizes, or even counted as part of the day's total caloric intake.
Anyone can fall into this trap by forgetting the caloric "cost" of healthy-ish things they've been eating for years.
Here are some of the biggest culprits: Oils that you can add to salads and cooked meals, handfuls of nuts, fatty cuts of meat, oversized portions of cheese, dates, honey and other high-calorie ingredients that can be added to recipes.
Even if you're not splurging, you could very well be overeating. And if you consume even a small surplus every day for years, it will eventually accumulate into a significant amount of fat.
Hormones are often blamed for fat gain and the inability to lose fat. They do play a role, but they're often not independent of overeating. In short, a lot of the hormonal problems which make it harder to lose fat are caused by what made you fat in the first place: chronic overeating.
When we think of the hormones that impact our capacity to lose fat, we normally think of insulin, leptin, cortisol, and thyroid hormones. So let's look at each of those individually.
It's probably the most maligned hormone in the human body. And if you ask a keto dieter about it, they'll tell you it's the "fat gain hormone."
But insulin actually doesn't make you fat. Yes, it's a "storage" hormone so it's easy to assume that more insulin equals more fat gain. But in reality, insulin can only lead to the storage of the energy that you consumed. You cannot store more calories than what you've eaten. So, it's still a matter of eating more than what your body needed.
When we talk about insulin and weight gain, we usually talk about insulin resistance being the problem. Insulin resistance means that your cells don't respond well to insulin and as a result you need to produce more of it to get the job done.
If you're insulin resistant and you eat a meal, you release more insulin than someone who's insulin sensitive (especially if the meal was higher in carbs). As a result, insulin stays elevated for longer.
Why is that relevant? Because when insulin is elevated above baseline, the body is less efficient at mobilizing stored energy. It can still do it, but to a lesser extent. This means that it's a bit harder to lose body fat.
Understand that insulin resistance doesn't lead to more energy storage. When you're insulin resistant you need more insulin to do the same job. The main difference is in the inhibition of fat mobilization because of the lengthened amount of time during which insulin is elevated.
While there are a lot of factors that can lead to insulin resistance, the two main ones are chronic insulin elevation and having the energy stores filled up. If you always produce a ton of insulin, your cells can become less sensitive to this hormone. You'll need more and more to get the job done.
What will lead to excessive insulin production? Eating too much, too often. And overeating foods that increase blood sugar levels.
The second factor is having the energy reserves (muscles, liver, fat cells) topped off. When you eat a meal, your blood glucose level and/or blood fatty acids levels will increase. The body releases insulin to clear the blood of these nutrients.
But if the energy stores are full, you can't send the nutrients anywhere. The body reacts by releasing even more insulin to try to force the body to store those nutrients. Eventually that can lead to the creation of the new fat cells.
What can cause these energy reserves to be full? How about eating too much?
So, overeating can easily lead to insulin resistance. That's why there's a higher occurrence of Type 2 diabetes among obese individuals (6) (7) (8).
It's a hormone released by the adipocytes (fat cells). When it reaches the brain, it connects to leptin receptors and essentially tells the brain that we're well fed. Metabolism stays normal, your appetite is kept under control, etc.
If you go on a diet, the more you lose fat the less leptin the fat cells will release. It's a way to tell your brain that you aren't getting enough energy in, and you need to do something about it. If leptin is low enough for long enough, the body will increase hunger to force you to consume more nutrients.
The less leptin you produce, the hungrier you get. If it stays low for long enough, it can even contribute to a slowing of your metabolism.
The fuller the fat cells are, the more leptin you produce. In theory, obese individuals should produce tons of leptin, which should also kill their appetites and lead to a lightning-fast metabolism, right? But that's not exactly what happens.
In fact, obese people produce so much leptin that they desensitize their leptin receptors. Their brain stops responding to leptin. Even though they produce a lot of it the result is the same as if they weren't producing much. They get hungry, they eat to satisfy that hunger, and their metabolism doesn't become powerful enough to counteract it.
In this case, yeah, hormones make it harder to lose fat. But the leptin problem they have is in fact due to their weight gain.
They overproduced leptin because they ate too much for too long, causing their fat cells to be completely saturated. Then when their cells were saturated, they produced new fat cells, which meant even more leptin. Over time this led to the leptin resistance that now makes it harder to lose fat.
It's not genetic. It's because of years of bad eating habits.
It's easy to make a connection between low thyroid levels and obesity. After all, thyroid hormones (mostly T3) regulate the metabolic rate – a large part of your daily energy expenditure.
Thyroid hormones regulate basal metabolism, thermogenesis, and play an important role in lipid and glucose metabolism, food intake, and fat oxidation (9). The theory is that when you have hypothyroid your metabolism slows down, which means you burn less fat and store it more easily. This leads to weight gain.
It sounds simple and elegant, but it's not as simple as that.
For one thing, hypothyroidism by itself only leads to a small amount of weight gain. It certainly wouldn't explain carrying an extra 100 pounds of fat. Hypothyroidism is certainly a risk factor that increases the chances of becoming obese, but by itself it's not enough.
More importantly, in most cases, it's what you did to gain weight in the first place that caused hypothyroidism.
Recent research has demonstrated that the excess in leptin production in obese individuals is one of the main causes of hypothyroidism in those individuals (10). Another cause is the fat cells' release of inflammatory cytokines which decreases the uptake of iodine, leading to lower thyroid hormone production (thyroid hormones are made from iodine and tyrosine).
So, like leptin and insulin issues, the thyroid problems seen in obese individuals will, more often than not, be caused by what made them obese in the first place or the obesity itself.
This idea that cortisol will make you fat was popularized by Charles Poliquin. In his system (Biosignature, then Metabolic Analytics), storing too much fat on your abdomen is a sign of high cortisol.
But cortisol is actually a fat-loss hormone. One of its main functions is the mobilization of stored energy (glucose, fatty acids, and amino acids). It's not a fat-gain hormone.
If cortisol becomes chronically elevated, it can make fat loss harder by decreasing the conversion of the T4 thyroid hormone into the T3 thyroid hormone, which can decrease metabolic rate. But it won't make you obese by reducing metabolic rate by around 5%.
As awful as it is to consider Nazi concentration camp victims, don't you think they had high cortisol levels?
You can't discount the impact of hormones on fat gain and the capacity to lose fat. However, in most obese individuals, these hormonal problems are caused either by chronic overeating or the obesity itself. This is good news. It means you can take responsibility and do something about it.
- Accept responsibility. You aren't obese because of some genetic defect, or because of society. If you have a surplus of body fat it's because you've been overeating. If you want to reverse the situation, you'll need to be ready to make changes.
- Measure your food. I know it's annoying, but there's not a big visual difference between 900 and 500 calories. You could easily be overeating 800 (or more) calories per day simply because of oversized portions.
- Slow down on high-fat sauces. At McDonald's, the salad provides more calories than a burger if you use their vinaigrette. You could easily add 400 calories to a meal only from oils or sauces alone. Look for lighter alternatives.
- Don't drink calories. Juices and soft drinks are one of the main causes of over-ingesting calories, and they won't make you satiated.
- Adjust food intake every two weeks if your weight doesn't go down as planned. Lower your caloric intake by a factor of one x body weight (in pounds) per day. For example, if you're 250 pounds, you'd decrease calories by 250 if you're not losing weight. This is also why it's important to record food intake. How can you lower your caloric intake by 250 if you have no idea how many calories you're eating? Don't eyeball it; eyeballing it is what got you there in the first place.
- Go easy on calorie-dense foods. These are foods that provide a lot of calories for a small volume of food. Because of leptin issues, you'll have a bigger appetite and will require more food volume. If you go with foods that are really dense in calories, this can lead to overconsumption of energy. Nuts can be part of a healthy diet, but they provide a very large amount of calories for a small portion. Dried fruits are similar.
- Measure and record your splurges too. Get mentally prepared to hate this task. The last thing anyone wants to do after splurging is recall what and how much they ate. But it'll make you conscious about the caloric impact of pigging out. Also, knowing you're going to have to record your intake will help you make better choices. You'll think twice about what and how much you choose to eat.
- Don't offset six days of eating right by pigging out on the seventh. One binge can destroy your efforts for the week. If you consumed a 500-calorie deficit per day for six days, but ate a 4,000-calorie surplus on Sunday, you might actually gain weight over the week.
- Move more in general. Overweight individuals tend to overestimate how much they move. Always be more active than you think you need to be. You can actually buy a pedometer and shoot for a total of 9,000-10,000 steps per day. While these devices are not 100 percent accurate, they'll help you estimate daily physical activity and will help you know if you're moving enough or not.
- Get more protein. If you want to lose fat, drink a protein shake 10 minutes before your main meals. First, it's very difficult to get fat from protein. More importantly, it'll go a long way to decrease hunger and will help you consume less food at your meals. A thicker protein blend like Metabolic Drive® Protein is the best choice.
- Don't eat while doing other things. Extra distractions can cause you to ignore satiety signals and overeat. More interestingly, by having two sources of stimulation, you'll get a greater pleasure response (dopamine release) in the brain, which won't just make you want to eat more in that moment, it'll make you want to continue the habit of eating while watching... or scrolling as the case may be.
Much like cigarette addiction, obesity is a self-imposed condition. But because it affects physical appearance, it's perceived as hateful or discriminatory to say that obesity is preventable and reversible.
Being obese doesn't make any person worse than a leaner individual. Just like smoking doesn't make you an inferior human being. However, being overweight does increase the risk of serious health issues. The solution to the problem is simple and entirely dependent on your actions.
You don't need to fit into the glorified and unattainable models of beauty we see in the media, but even moderate fat loss is associated with a significant reduction in health risks.
When it comes to weight management, as well as most important issues in our lives, taking personal responsibility is the key to empowerment and improvement.
- Duvigneaud, N., et al. Dietary factors associated with obesity indicators and level of sports participation in Flemish adults: a cross-sectional study. Nutr J 6, 26 (2007) doi:10.1186/1475-2891-6-26
- (Vance, V., et al. (2009). Self-reported dietary energy intake of normal weight, overweight and obese adolescents. Public Health Nutrition, 12(2), 222-227).
- Schebendach JE, et al. Accuracy of self-reported energy intake in weight-restored patients with anorexia nervosa compared with obese and normal weight individuals. Int J Eat Disord. 2012;45(4):570–574. doi:10.1002/eat.20973
- Heitmann BL, et al. Dietary underreporting by obese individuals–is it specific or non-specific?. British Medical Journal. 1995, 311: 986-989
- Lichtman SW1, et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med. 1992 Dec 31;327(27):1893-8
- Colditz GA, et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122(7):481–486
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- Fujimoto WY, et al. Diabetes Prevention Program Research Group. Body size and shape changes and the risk of diabetes in the diabetes prevention program. Diabetes. 2007;56(6):1680–1685
- Rosenbaum M, et al. Effects of changes in body weight on carbohydrate metabolism, catecholamine excretion, and thyroid function. Am J Clin Nutr. 2000;71:1421–32
- Debmalya Sanyal, et al. Hypothyroidism and obesity: An intriguing link. Indian J Endocrinol Metab. 2016 Jul-Aug; 20(4): 554–557