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Is Weight a result of eating? Or is eating a result of weight?

27 Feb

I need to eat a skinny person


I love Dr. Sharma’s thoughtful articles. Here’s a provocative one that explains why “Energy in vs. Energy out = Weight” is a flawed equation for so many of us.

The whole article is available here, but the fundamental flaw in our thinking may be that we weigh too much because we eat too much. What if, instead, the amount we ate was a function of our weight? That weight was not the result of eating too much but that in fact, those who weigh more eat more?

“Generally speaking, heavier people tend to eat more because they have a stronger drive to eat and/or need more calories to function ‚Äď in other words, body weight itself may very much determine energy intake and output (and not just the other way around).”

The premise is, fix the physiology that leads to increases in weight, and you fix the weight. My own experience has led me to believe that for me, insulin sensitivity and an increase in ghrelin as my body fought to regain the 40 lbs I lost in 3 months while sick, led to an insatiable hunger that I could not control. Once I got the insulin sensitivity under control by eating lower carb meals, the hunger corrected. A combination of that plus the sleeve got to me to the point I am today.

Very curious to hear others’ perspective on this article.

What’s wrong with you…

12 Feb

I just saw this and I like it. I think maybe this is the source of many a disappointment. After all, if I hadn’t heard of others’ weight loss “instant” and huge success with every program, let alone VSG, wonder if I wouldn’t have been happier with where I am today? Definitely something to think about.


Body fat calculator

30 Dec

So many people don’t know their body fat percentage. I’ve been using a scale that is quite reliable, but I also found a calculator that seems to return the same results as the scale, so I thought I’d link to it.

It also was very reliable for my son and my husband so there we are! ūüôā

Here we go:

10 Unbelievable Diet Rules Backed by Science

29 Dec

I love this article. Very effectively separates fact from myth.¬†I have no idea however, why it is accompanied by a shot of cleavage. Whatever. Enjoy! ūüôā

10 Unbelievable Diet Rules Backed by Science

By¬†¬†|¬†Healthy Living¬†‚ÄstTue, Sep 3, 2013 2:48 PM EDT

by Adam Bornstein for

Ready for this? Everything you thought you knew about nutrition is wrong!Ready for this? Everything you thought you knew about nutrition is wrong!When describing how you really feel about the latest miracle fix in the diet and fitness world, you’d probably like to drop an F-bomb-as in, what the fad? After all, how many times have you trusted logical sounding ideas or put all your faith in a diet strategy, only to find out that the time you invested was a waste–and you still haven’t dropped the weight?

Consider this your F-bomb-free zone. No fads, no faking, and no frustration. You see, when you really dig into the research, most of what you assume is correct about dieting is actually wrong. Discover the truth here and the only f-words coming out of your mouth will be “Finally. Fat loss!”

1. Skip breakfast if you want.
The one diet rule we’ve heard more than any other: A healthy diet begins with a great breakfast. There’s just one problem: A good breakfast doesn’t guarantee an overall healthy diet. In fact, according to a survey conducted by the NPD group, nearly 90 percent of Americans now eat breakfast, and yet nearly 50 percent of Americans are either overweight or obese. There are two things you should know about breakfast:

1. Timing isn’t as important as you think.
You don’t need to eat immediately (or even within one hour) after you wake up. Your metabolism won’t be harmed.

2. Eating an early breakfast means you’re creating a bigger eating window (you eat for more total hours during the day), which might lead to more fat storage and more health problems, according to scientists at the Salk Institute for Biological Studies. If you eat your first meal at 7 a.m. and eat a late-night snack at 10 p.m., that’s 15 hours of eating-which might be more than your body wants.

The fad-free truth:¬†No one meal is more important than any other. What matters most is total calorie intake, food selection (think salad versus Big Mac), and then how much time you spend eating each day. So if you don’t love breakfast, skip it. If you do, enjoy your morning meal but keep an eye on your feeding window to make sure you’re not eating more calories than you need.

2. It’s OK to eat a big dinner.
We all know that dinner is the most popular meal to eat with friends and family, but most people think eating after dark is the cardinal sin of weight loss. Nothing could be more incorrect. Italian researchers compared eating earlier in the day (10 a.m.) to eating later in the day (6 p.m.) In that study, there was no difference in weight (pounds) lost, but the late eaters lost more fat. Several follow-up studies concluded the same thing-timing doesn’t matter. This statement from University of Oregon researchers sums it up well: “Eating too many calories causes weight gain regardless of when you eat them.”

The fad-free truth:¬†Living in a world where you can’t eat at night and can’t enjoy food with your friends and family is restrictive and doesn’t adhere to any science-backed rules of weight loss. You won’t become fat by eating at night-that will only happen if you overeat at night. If you’re aware of how much you should be eating within any given day, you can place those calories in whatever meal works best for your body.

3. Snacking does not affect metabolism.
We know that when you eat, you burn calories. So about 30 years ago, it was determined that if you eat more frequently, you must burn more calories overall, and thus the “grazing” method was formed and a nation of people began consuming four to six small meals per day. One small problem: French researchers found that there is “no evidence of improved weight loss” by eating more frequently. They even went one step further to show that when it comes to the number of calories you burn per day (i.e. your metabolism), it does not matter if you graze or gorge, assuming that you’re eating the total number of calories you need to lose weight.

The fad-free truth:¬†If you’re told to eat 2,000 calories per day, it doesn’t matter if it’s separated into five 400-calorie meals or two 1000-calorie feasts. (However the composition of those meals does matter.) What works best for your schedule should determine the number of meals you eat. When Canadian researchers compared eating three meals per day to six meals per day, breaking the six into three main meals and three snacks, there was no significant difference in weight loss, but those who ate three meals were more satisfied and felt less hunger.

4. Eat carbs to get lean.

From Atkins to the Paleo movement, carbohydrates have been criticized more than all of the ladies on the Real Housewives shows-combined. Here’s the real reason why carbs get such a bad reputation: Up to 50 percent of the carbohydrate intake in the typical American diet is in the form of highly processed carbs and sugar. So when people say carbs are bad, they’re usually just talking about eating lots of sugar. But that’s not really fair to every other food that also is labeled a carbohydrate.

When compared to a typical American diet, a low-carb diet looks like the undisputed champ. However when compared to a good carb-based diet that is low in sugar, refined foods, and gluten (like the “Japanese Diet”), the results are very different. Before 1991, when Japan was considered a carb-dominate society, diabetes and obesity rates were never greater than three percent of the population. If carbs in general were the enemy, with their high starch intake via rice and sweet potatoes, the Japanese would be the fattest, most diabetic, and unhealthy population on the planet. However this was not the case, and their levels of obesity are a “problem” people in the United States wish they had.

The fad-free truth:
¬†Your body needs carbohydrates. If you completely remove this essential nutrient from your diet, you could experience a down-regulation of the hormones that control fat loss, making it harder to have the lean, sexy body you want. A good general rule: Eat more carbs on the days you’re active and fewer carbs on the days you’re sedentary. And make sure most of your carbs come from whole foods such as fruits and vegetables.

5. There is a weight-loss pill worth buying.
Most miracle “fat-burning supplements” are about as effective as an hour of Prancercizing. But if you want to take a pill to help promote fat loss, your best bet is a vitamin that you associate with the sun. Researchers from Canada found that people with higher levels of vitamin D also have lower levels of body fat. The connection isn’t a coincidence. Vitamin D helps you feel fuller because, according to Australian researchers, it releases more leptin, a hormone essential to weight loss. It also helps you store less fat by decreasing parathyroid hormone, which makes you hold on to your love handles. Best of all, vitamin D literally burns more fat by reducing production of the stress hormone cortisol.

The fad-free truth: Buying supplements to help you lose weight is not the best use of your hard-earned money. Your foundation is a healthy diet and exercise. But some supplements can help fill nutritional gaps that will help your body function more efficiently. Supplementing with 2,000 to 3,000 IU of Vitamin D3 is a smart investment for your overall health and fat-loss goals.

6. Exercise on an empty stomach.
If you exercise with a high intensity, there’s nothing worse than feeling sick to your stomach because you felt forced to eat before you hit the gym or pavement. There’s a lot of science that shows eating before a workout is important, but “before a workout” is a much wider time range than you might think.

In the simplest sense, your digestive process is very complicated. When you eat, the food does not go directly to your muscles or your gut. It takes time-a lot of time, in fact. So if you eat many hours before you train, there’s still plenty of fuel to help you perform and feel great.

The fad-free truth:
¬†Research published in the¬†International Journal of Sport Nutrition and Exercise Metabolism¬†found that the protein you eat digests anywhere between one gram per hour and 10 grams per hour. So if you have a meal consisting of 25 grams of protein, that meal could last in your system for up to 25 hours. Hydration level and sleep patterns also play a significant role in performance, so make sure you’re well rested and have plenty to drink, and then eat when it feels best for your body, even if it means a small meal or no meal at all.

7. Eat saturated fat.
Books like The China Study and movies like Forks Over Knives have pointed the finger at saturated fats-and all animal fats-as the reason for countless health problems. Yet all the research used to support this hypothesis took a very slanted bias and completely ignored populations that were incredibly healthy despite diets based on saturated fats. For example, people who live in Tokelau (a territory off of New Zealand) eat a diet that is 50 percent saturated fats, and they have cardiovascular health that is superior to any other group of people. Even Walter Willett, chairman of the Department of Nutrition at Harvard, has publicly stated (after a 20-year review of research) that fats-and more specifically saturated fats-are not the cause of the obesity crisis and are not the cause of heart disease.

The fad-free truth:
 Cholesterol actually acts as an antioxidant against dangerous free radicals within the blood. When there are high levels of undesirable substances in the blood (caused by inflammation in your arteries from eating highly processed foods and large quantities of sugars), cholesterol levels rise in order to combat these substances. Cholesterol is also necessary for the production of a number of hormones, some of which help fight against heart disease. Plus, research shows diets higher in saturated fats are often lower in total calories consumed.

8. Consider fasting for better health.

Any diet that has you not eat at all is not a diet-it’s starvation. But there’s a difference between withholding what your body needs and reprogramming your body so that you can control your hunger and let your body recharge. The idea of fasting is nothing crazy. You do it every night when you sleep, which is a time that that is essential for optimal health. Yet the idea of going several hours without eating during daytime is frowned upon.

When done correctly, fasting can actually help your body burn fat, recharge, and stay healthy. You’ve probably heard of cleanse diets that supposedly rid your body of toxins, improve the functioning of your internal organs, and help you age better. Most of these don’t work as advertised. The only real cleanse occurs at the cellular level. It’s called autophagy, and it’s your body’s ability to regenerate and become better. Autophagy makes your brain function a little better, helps with fat loss, and even assists in your ability to walk and breathe. But the more time you spend eating-as in actual hours during the day eating-the less time you spend in the autophagic process, which is why fasting isn’t a bad thing.

The fad-free truth:¬†Researchers at the University of Utah found that people who fasted just one day per month were 40 percent less likely to suffer from clogged arteries. While there are many ways to fast, the important point is that you shouldn’t feel forced to eat if you’re not hungry. Short daily fasts (for 12 to 16 hours) or a once-per-week daily fast can have health benefits, and it will teach you to separate boredom or thirst from genuine hunger.

9. Going organic won’t help with weight loss.

I love my local farmer’s market, and I always do my best to purchase products from the best sources. That said, slapping “organic” on a label does not mean it will help you lose weight, and in some instances it won’t even guarantee that a food is healthy. Research published in the¬†Annal of Internal Medicine¬†reviewed 200 studies that compared the health benefits of organic foods to conventional foods and the results were surprising: There were no clearly distinguishable benefits of eating organic foods, whether measured by preventing disease or an assessment of overall health. Specific to weight loss, a random comparison of organic to non-organic foods found no significant difference in nutritional information, including calories.

The fad-free truth:
¬†More research on organic foods needs to be conducted. There’s no doubt organic foods have fewer pesticides and toxins, the real question is if the sometimes-small difference in toxins makes any scientifically significant difference on your health. More importantly, labeling a food as organic does not mean its weight-loss friendly. Organic sources of sugar are still sugar. And organic products loaded with 1,000 calories are still 1,000 calories. If you want to reduce the potential of anything bad entering your body, feel free to purchase organic products but still keep an eye on the label.

10. There’s no such thing as too much protein.
You may have heard that eating lots of protein can cause all sorts of health problems, including kidney stones and gallstones, but this is a moot point for most people. Why? Because there’s no research showing any relationship between eating a lot of protein and developing kidney problems. In fact, a study published in the¬†Journal of Strength and Conditioning Research¬†tested eating up to 400 grams of protein per day without any negative consequences.

If you have a preexisting kidney problem, it’s possible that a higher protein diet could be hard on your body. But if you have a kidney problem, you should be talking to your doctor about your diet anyway.

The fad-free truth:¬†If you’re healthy, you are clear to eat protein and not worry about any health problems-because there are none. What’s more, protein is one of the most metabolic macronutrients, meaning that the more protein you eat, the more calories you burn. Just remember that calories are still calories so the rules of total intake still apply.

Why did you get fat?

17 Dec

I really liked this approach of determining the underlying reasons for why we got fat. I suspect most of us will have multiple reasons and do a “1 from column A, 2 from column B” type of approach, but it helped me think through what underlying behaviors need to be be addressed for different people.


Synopsized from Dr. Sharma’s Obesity blog post, ¬†Are There Merits To Subtyping Obesity?



Regular readers may recall that several years ago we proposed that it was time to move beyond considering obesity a homogeneous entity (as defined by BMI alone) and suggested that clinicians may be better off using an ‚Äúetiological framework‚ÄĚ for assessing and addressing the diversity of factors that drive weight gain.

This notion, that obesity is not a homogeneous condition, is something other researchers are now slowly catching up with.

One example of how ‚Äúmainstream‚ÄĚ thinking is gradually embracing the concept of heterogeneity in obesity is a recent paper by Allison Field and colleagues from Harvard Medical School published in¬†JAMA.

In this paper the authors state that,

‚ÄúOne reason for the lack of stronger associations with risk factors or more consistently successful treatment is that all types of overweight and obesity are often grouped together. This approach potentially obscures strong associations between risk factors and specific subtypes of obesity.‚ÄĚ

While the the etiology of obesity applies to the many drivers of obesity (which we have categorized as predominantly affecting metabolism, ingestive behaviour and/or physical activity), the phenotype of obesity applies to the many consequences of obesity (which we have categorized as affecting physical, mental and functional health). As we have previously pointed out, the two are not necessarily related.

Thus, two individuals, gaining weight for entirely different reasons (e.g. food insecurity vs. binge-eating syndrome), may well present with exactly the same amount of excess body fat and identical clinical complications (e.g. diabetes, reflux disease and urinary incontinence).

On the other hand, two individuals, gaining weight for exactly the same reason (e.g. on anti-psychotic medications), may present with quite different complications (e.g. sleep apnea vs. osteoarthritis).

The authors are certainly correct in their statement that,

‚ÄúObesity is a heterogeneous and complex disease influenced by exogenous and endogenous exposures. Stratifying obesity into meaningful subtypes could provide a better understanding its causes and enable the design and delivery of more effective prevention and treatment interventions.‚ÄĚ





Happiness, Self-Esteem, and WLS

15 Dec

Happiness, selfesteem and wls from

Today, I’m re-posting something that my friend Faye Fleming posted. It really made a big impact on me, and several others, and I think it’s great reading for anything who thinks the sleeve will solve all their problems. So here we go.

I’m going to lay out some thoughts I’ve been having.¬†¬†My intent is not to minimize the experience of anyone else, but simply to offer my own thoughts and beliefs.¬†¬†I know this journey is different for all of us, but I am always saddened when I see a post about how a pre-op person can’t wait to “be skinny” or “look hot” or “feel good about myself again”.¬†¬†Skinny does not equal happy.¬†¬†Skinny does not equal hot.¬†¬†Skinny does not equal feeling good about ourselves.¬†¬†There are just as many skinny people who are unhappy, unattractive, and down on themselves as fat people.¬†¬†Happiness, feeling attractive, and feeling good about oneself are characteristics generated from within, not without.

A few years ago, at a very low point in my life, happiness seemed to me like a foreign concept.¬†¬†I could not remember the last time I had felt genuinely joyous or happy about anything.¬†¬†Intellectually, I knew that there were many things in my life that were desirable.¬†¬†I had a good job, a comfortable house, a dependable car, some money in the bank, food in the fridge, etc.¬†¬†But despite these things, I was unhappy.¬†¬†Now, I had good reasons to be unhappy, or so I thought.¬†¬†My marriage was failing, I was coming to grips with the fact that I would never be a mother, I wanted desperately to change my life but felt completely stuck, and so on.¬†¬†I remember reading somewhere that happy is a verb…it’s an action, not a passive condition.¬†¬†I began to wonder…if I truly felt that there was no spark of happiness or joy in my life, who’s fault was that?¬†¬†Who was responsible for my happiness?¬†¬†The answer, of course, is me.¬†¬†I was failing myself.¬†¬†I was not loving myself, or being kind to myself.

I decided that if happy was an action, I was going to try and exercise my happy muscle.¬†¬†I was going to try and find one thing to feel happy about for a few minutes every day.¬†¬†My goal was 3-5 minutes a day of active happiness.¬†¬†I thought that would be super easy.¬†¬†After all, I had been able to identify good things in my life, so how hard could it be to think about them for a couple of minutes every day?¬†¬†Well, it was actually harder than I expected, but I stuck with it.¬†¬†I had to set a timer in the beginning, but I made myself do it every single day.¬†¬†Gradually, I noticed it got easier.¬†¬†Some days all I could come up with was something like the weather, or the fact that my bills were paid on time, but damn it…if that was all I had, then I was damn well going to focus on it & feel happy for 3 freakin’ minutes.

I eventually began to notice that I felt happier overall.¬†¬†I’m not sure why, because by this time I was just divorced and trying to figure out dating at 270 lbs & maintaining my new house, etc, but regardless, I felt happier.¬†¬† After meeting the man who has become my 2nd husband, he said that one of the things that attracted him to me was that I always seemed happy.¬†¬†I’m not saying that this is somehow a magic bullet against bad stuff happening, but holding happiness in my mind for a few minutes every day helps me to deal with the inevitable downs of life.¬†¬†It seems to me that consciously taking time to feel happy each day has somehow made a state of happiness more accessible in my brain.

It’s been almost 7 years since I began my happiness quest, and I can honestly say I feel happier today than I ever have in my life. To quote Charlotte in the Sex and The City movie, “I feel happy every day.¬†¬†Not all day every day, but every day I feel happy.” In choosing to have the sleeve, I absolutely do not expect it to make me happy, because I’m already happy.¬†¬†I feel pretty good about myself today, this minute, at 300+ lbs.¬†¬†Yes, there are things I want to do, but I can’t right now.¬†¬†Yes, I have pain every day & difficulty walking, but I still feel good about who I am and what I have to offer in my small corner of the world.¬†¬†I am aware that I am probably judged negatively by some people because of my weight, but I don’t even really notice that.¬†¬†Today, I find it so much easier to find things in my life that make me genuinely happy.¬†¬†I am definitely looking forward to weighing less and seeing an improvement in my mobility, but I don’t think it will make me somehow better or more acceptable or a more worthy person.¬†¬†I am enough, right now, just as I am.¬†¬†We all are, and we are all so very precious.¬†¬†Today, right now, at this very moment, we are beautiful, and we are valuable, and we are enough.

I believe that with all my heart, and I hope you do, too.

Bmi Less Important Than Other Markers For Good Health

2 Dec

So here’s an excerpt from an interesting article that showed up in my inbox today. The rest of the article goes on to discredit a study conducted by others who had a different definition of the dependent variable, blah blah, so I omitted that.

My main takeaway from this excerpt is this: you could have a high or low BMI, but what really indicates risk factors for future ill-health are other markers, such as those typically associated with Metabolic Syndrome or Syndrome X.

To me, the most telling line was:¬†“We have previously shown that Stage 0 obese individuals, even with a BMI Of 40 or greater, have virtually no increased risk of dying even over a 20 year period.”

Stage 0 is essentially people with no apparent risk factors as shown in the diagram below.

Speaking for my husband, although his BMI is still 28.3 or Overweight, he used to have, and no longer has since the surgery the following markers:

  • High blood pressure
  • Elevated Glucose
  • Elevated cholesterol
  • Insulin resistance
  • Elevated triglycerides.
  • Much less abdominal adiposity since the surgery
  • (quit smoking 4 years ago)

‚ÄčI am so glad he had this surgery!

For me, I have reduced my insulin resistance, abdominal adiposity, and lowered my triglycerides (I didn’t have trouble with sugar, cholesterol and BP pre-op)

So if you too have succeeded in getting your labs back to normal on these measures as well as the ones listed below, no matter your BMI, you have decreased your risk of dying significantly. I know we all talk about getting this surgery to save our lives, but these measures make it concrete what risk factors we have now decreased.

Be happy ūüôā

Which of these markers has improved for you since the surgery? Are you now noticeably healthier than before WLS?

from¬†Dr. Sharma’s blog.¬†


Regular readers are quite familiar with the concept of the¬†Edmonton Obesity Staging System, which ranks obese individuals based on how ‚Äúsick‚ÄĚ rather than on just how ‚Äúbig‚ÄĚ they are.

To be at Stage 0, obese individuals have to be not only free of any medical abnormalities (e.g. in their labwork) but also have no associated impairment of mental health or quality of life ‚Äď in other words, Stage 0 = healthy ‚Äď end of story!

We have previously shown that Stage 0 obese individuals, even with a BMI Of 40 or greater, have virtually no increased risk of dying even over a 20 year period.

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