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The Obesity Code_ Unlocking the Secrets of Weight Loss

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This foreword introduces Dr. Jason Fung and his book The Obesity Code. It summarizes that Dr. Fung realized modern medicine focuses on treating symptoms rather than underlying causes of disease. He determined that type 2 diabetes and obesity are reversible through diet. The foreword explains that Dr. Fung argues the standard treatment model for type 2 diabetes is wrong and actually harms patients. It states Fung provides a coherent framework to understand obesity by explaining its true biological causes, not just symptoms. The foreword asserts Fung has provided a blueprint to potentially reverse the obesity and type 2 diabetes epidemics through understanding their causes rather than symptoms.

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THE OBESITYCODE UNLOCKINGTH ESECRETSOF WEIGHTLOSS JASONFUNG,MD
Thisbookisdedi cated to mybeautifulwife ,Mina. Thank you for yourloveand thestrengthyougive me.Icouldnotdoitwi thoutyou,norwould Ieverwantto.
FOREWORD CONTENTS INTRODUCTION PART1:TheEpidemic CHAPTER1:HowObesityBecameanEpidemic CHAPTER2:InheritingObesity PART2: TheCalorieDeceptionCHAPTER3:TheCalo rie-ReductionErrorCHAPTER4: TheExerciseMythCHAPTER5:TheOverfee dingParadox PART3:ANewModelofObesity CHAPTER6:ANewHope CHAPTER7:InsulinCHAPTER 8:Cortisol CHAPTER 9: The Atkins OnslaughtCHAPTER10:InsulinResistance:Th
eMajorPlayer
PART 4: The Social Phenomenon of ObesityCHAPTER 11: Big Food, More Food and theNewScienceofDiabesity CHAPTER12:PovertyandObesity CHAPTER13:ChildhoodObesity PART 5: What’s Wrong with Our Diet?CHAPTER14:TheDeadlyEffectsofFructose CHAPTER 15: The Diet Soda DelusionCHAPTER16:CarbohydratesandProtect iveFiber CHAPTER17:ProteinCHAPTE R18:FatPhobia PART 6: The SolutionCHAPTER19:Whatto EatCHAPTER20:WhentoEat APPENDIXA:SampleMealPlans(withFastingProto cols) APPENDIXB:Fasting:APracticalGuide APPENDIXC:MeditationandSleepHygieneto
ReduceCortisol ENDNOTESINDE X
FOREWORD DR. JASON FUNG IS a Torontophysician specializing in the care ofpatients with kidney diseases. His keyresponsibility is to oversee the complexmanagement of patients with end-stagekidney disease requiring renal (kidney)dialysis. His credentials do not obviouslyexplain why he should author a booktitledTheObesityCodeorwhyheblog son the intensive dietary management ofobesityandtype2diabetesmellitus.Toun derstand this apparent anomaly, weneed first to appreciate who this man isandwhatmakeshimsounusual. Intreatingpatientswithend-stage
kidney disease, Dr. Fung learned twokey lessons. First, that type 2 diabetes isthe single commonest cause of kidneyfailure. Second, that renal dialysis,however sophisticated and even lifeprolonging,treatsonlythefinalsympto ms of an underlying disease thathasbeenpresentfortwenty,thirty,forty or perhaps even fifty years. Gradually, itdawned on Dr. Fung that he waspracticing medicine exactly as he hadbeen taught: by reactively treating thesymptoms of complex diseases withoutfirst trying to understand or correct theirrootcauses. He realized that to make a differencetohispatients,hewouldhavetos tartbyacknowledgingabittertruth:thatour
venerated profession is no longerinterested in addressing the causes ofdisease. Instead,itwastesmuchofitstime and many of its resourcesattemptingtotreatsymptoms. He resolved to make a real differenceto his patients (and his profession) bystrivingtounderstandthetruecausesthatu nderliedisease. Before December 2014, I wasunaware of Dr. Jason Fung’s existence.Then one day I chanced upon his twolectures— “TheTwoBigLiesofType2Diabetes” and “How to Reverse Type 2DiabetesNaturally”— onYouTube.Assomeone
withaspecialinterestintype 2diabetes, not least because I have theconditionmyself,Iwasnaturally
intrigued. Who, I thought, is this brightyoung man? What gives him the certaintythat type 2 diabetes can be reversed“naturally”?And howcanhebebraveenough to accuse his noble profession oflying? He will need to present a goodargument,Ithought. It took only a few minutes to realizethat Dr. Fung is not only legitimate, butalso more than able to look after himselfin any medical scrap. The argument hepresented was one that had beenbouncingaround,unresolved,inmyo wnmind for at least three years. But I hadnever been able to see it with the sameclarity or to explain it with the sameemphaticsimplicityashadDr.Fung.B ytheendofhistwolectures,IknewthatI
had observed a young master at work.Finally,IunderstoodwhatIhadmissed . What Dr. Fung achieved in those twolectures was to utterly destroy thecurrentlypopularmodelforthemedical management of type 2 diabetes— themodelmandatedbyallthedifferentdiab etes associations around the world.Worse,heexplainedwhythiserrone ousmodel of treatment must inevitably harmthehealthofallpatientsunfortunateen oughtoreceive it. According to Dr. Fung, the first big liein the management of type 2 diabetes isthe claim that it is a chronicallyprogressive disease that simply getsworse with time, even in those
whocomplywiththebesttreatmentsmoder n
medicineoffers.But,Dr.Fungargues,this is simply not true. Fifty percent ofthepatientsonDr.Fung’sIntensiveDiet ary Management (IDM) program,which combines dietary carbohydraterestriction and fasting, are able to stopusinginsulinafterafewmonths. Sowhyareweunabletoacknowledge the truth? Dr. Fung’sanswerissimple:wedoctorslietoou rselves. If type 2 diabetes is a curabledisease but all our patients are gettingworse on the treatments we prescribe,then we must be bad doctors. And sincewedidnotstudyforsolongatsuchgreat cost to become bad doctors, this failurecannot be our fault. Instead, we
mustbelievewearedoingthebestforour
patients, who must unfortunately besuffering from a chronically progressiveand incurable disease. It is not adeliberate lie, Dr. Fung concludes, butone of cognitive dissonance— theinabilityto acceptablatanttruthbecauseaccepting it would be too emotionallydevastating. Thesecondlie,accordingtoDr.Fung,is our belief that type 2 diabetes is adiseaseofabnormalbloodglucoselevels for which the only correcttreatment is progressively increasinginsulin dosages. He argues, instead, thattype 2 diabetes is a disease of insulinresistance with excessive insulinsecretion— incontrasttotype 1diabetes,aconditionoftrueinsulinlack. To treat
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bothconditionsthesameway— byinjectinginsulin— makesnosense.Whytreat a condition of insulin excess withyet more insulin, he asks? That is theequivalentofprescribingalcoholforthet reatmentofalcoholism. Dr.Fung’snovelcontributionishisinsight that treatment in type 2 diabetesfocusesonthesymptomofthediseas e—anelevatedblood glucoseconcentration —rather than its root cause, insulinresistance. And the initial treatment forinsulin resistance is to limitcarbohydrate intake. Understanding thissimple biology explains why thisdiseasemaybereversibleinsomecases —and, conversely, why the
moderntreatmentoftype2diabetes,whichd oes
notlimitcarbohydrateintake,worsensth eoutcome. But how did Dr. Fung arrive at theseoutrageous conclusions? And how didtheyleadtohisauthorshipofthisbook? In addition to his realization,described above, of the long- term natureof disease and the illogic of treating adisease’ssymptomsratherthanremovingit s cause, he also, almost by chance, inthe early 2000s, became aware of thegrowingliteratureonthebenefitsof low-carbohydrate diets in those withobesity and other conditions of insulinresistance. Taught to believe that acarbohydrate-restricted, high-fat dietkills, he was shocked to discover theopposite:thisdietarychoiceproduces
a
range of highly beneficial metabolicoutcomes, especiallyinthosewiththeworstinsulinresi stance. Andfinallycamethecherryonthetop —a legion of hidden studies showingthat for the reduction of body weight inthose with obesity (and insulinresistance), this high-fat diet is at leastas effective, and usually much more so,thanothermoreconventionaldiets. Eventually, he could bear it no longer.Ifeveryoneknows(butwon’tadmit) thatthe low-fat calorie-restricted diet isutterly ineffective in controlling bodyweight or in treating obesity, surely it istime to tell the truth: the best hope fortreating andpreventing
obesity,adisease ofinsulinresistanceand
excessiveinsulinproduction,mustsurely be the same low-carbohydrate,high-fat diet used for the management ofthe ultimate disease of insulin resistance,type 2 diabetes. And so this book wasborn. In The Obesity Code, Dr. Fung hasproduced perhaps the most importantpopularbookyetpublishedonthis topicofobesity. Its strengths are that it is based on anirrefutable biology, the evidence forwhich is carefully presented; and it iswrittenwiththeeaseandconfidenceofam aster communicator in an accessible,well-reasoned sequence so that itsconsecutive chapters systematicallydevelop,layerbylayer,ane vidence-
based biological model of obesity thatmakes complete sense in its logicalsimplicity. It includes just enoughscience to convince the skepticalscientist,butnotsomuchthatitcon fusesthosewithoutabackgroundinbiology. This feat in itself is a stunningachievementthatfewscience writerseveraccomplish. Bytheendofthebook,thecarefulreader will understand exactly thecausesoftheobesityepidemic, whyourattempts to prevent both the obesity anddiabetes epidemics were bound to fail,and what, more importantly, are thesimple steps that those with a weightproblem need to take to reverse theirobesity.
The solution needed is that which Dr.Fung has now provided: “Obesity is... amultifactorial disease. What we need isa framework, a structure, a coherenttheorytounderstandhowallitsfact orsfit together. Too often, our current modelof obesity assumes that there is only onesingle true cause, and that all others arepretenderstothethrone.Endlessdebate sensue...Theyare allpartiallycorrect.” In providing one such coherentframework that can account for most ofwhat we currently know about the realcauses of obesity, Dr. Fung has providedmuch,muchmore. Hehasprovidedablueprintfortherev ersal of the greatest medicalepidemicsfacingmodernsocie
ty—
epidemics that he shows are entirelypreventableandpotentiallyrever sible,but only if we truly understand theirbiological causes—not just theirsymptoms. The truth he expresses will one day beacknowledgedas self-evident. Thesoonerthatdaydawns,thebetterforus all. TIMOTHYNOAKESOMS,MBChB,MD,DSc,PhD (hc), FACSM, (hon) FFSEM (UK), (hon)FSEM(Ire) EMERITUSPROFESSOR UNIVERSITYOFCAPETOWN,CapeTown, SouthAfrica
INTRODUCTION THE ART OF medicine is quite peculiar.Onceinawhile,medicaltreatm entsbecome established that don’t reallywork.Throughsheerinertia,theset reatments get handed down from onegeneration of doctors to the next andsurvive for a surprisingly long time,despitetheirlackofeffectiveness. Consider the medicinal use of leeches(bleeding)or,say,routinetonsillec tomy. Unfortunately, the treatment of obesityis also one such example. Obesity isdefinedintermsofaperson’sbodymassind ex,calculatedasaperson’sweightinkilogra ms divided by the square of theirheightinmeters.Abodymassindex
greater than 30 is defined as obese. Formore than thirty years, doctors haverecommendedalow-fat,calorie- reduceddiet as the treatment of choice forobesity. Yet the obesity epidemicaccelerates. From 1985 to 2011, theprevalence of obesity in Canada tripled,from 6 percent to 18 percent.1Thisphenomenonisnotuniqueto NorthAmerica, but involves most of thenationsofthe world. Virtually every person who has usedcaloric reduction for weight loss hasfailed.And,really,whohasn’ttriedit? By every objective measure, thistreatment is completely and utterlyineffective.Yetitremainsthetreat mentofchoice,defendedvigorouslyby
nutritionalauthorities. As a nephrologist, I specialize inkidney disease, the most common causeof which is type 2 diabetes with itsassociated obesity. I’ve often watchedpatients start insulin treatment for theirdiabetes, knowing that most will gainweight. Patients are rightly concerned.“Doctor,”theysay,“you’vealw aystoldmetoloseweight.Buttheinsulinyou gavememakesmegainsomuchweight.How isthishelpful?”Foralongtime,Ididn’thave agoodanswerforthem. Thatnagginguneasegrew.Likemanydoc tors, I believed that weight gain wasa caloric imbalance—eating too muchand movingtoo little. Butifthatwereso,whydidthemedicationIp rescribed—
insulin—cause such relentless weightgain? Everybody, health professionals andpatients alike, understood that the rootcause of type 2 diabetes lay in weightgain. There were rare cases of highlymotivated patients who had lostsignificantamountsofweight.Theirtyp e2 diabeteswouldalsoreversecourse. Logically, since weight was theunderlying problem, it deservedsignificant attention. Still, it seemed thatthe health profession was not even theleast bit interested in treating it. I wasguiltyascharged.Despitehavingworke d for more than twenty years inmedicine,Ifoundthatmyownnutritionalk nowledgewasrudimentary,atbest.
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Treatment of this terrible disease— obesity—was left to large corporationslikeWeightWatchers,aswell asvarioushucksters and charlatans mostlyinterested in peddling the latest weight-loss “miracle.” Doctors were not evenremotely interested in nutrition. Instead,the medical profession seemed obsessedwith finding and prescribing the nextnewdrug: Youhavetype2diabetes?Here,letme giveyoua pill. You have high blood pressure?Here,letmegiveyoua pill. You have high cholesterol? Here,letme give youa pill.
Youhavekidneydisease?Here,let
megiveyoua pill. But all along, we needed to treatobesity. We were trying to treat theproblems caused by obesity rather thanobesity itself. In trying to understand theunderlying cause of obesity, I eventuallyestablished the Intensive DietaryManagementClinicinToronto,Ca nada. The conventional view of obesity as acaloricimbalancedidnotmakesense. Caloric reduction had been prescribedfor the last fifty years with startlingineffectiveness. Reading books on nutrition was nohelp. That was mostly a game of
“hesaid, she said,” with many quoting“authoritative”doctors.Forex ample,
Dr. Dean Ornish says that dietary fat isbadandcarbohydratesaregood.Heisares pected doctor, so we should listen tohim. But Dr. Robert Atkins said dietaryfatisgoodandcarbohydratesarebad. Hewasalso arespecteddoctor, so weshouldlistentohim.Whoisright?Whois wrong? In the science of nutrition,there is rarely any consensus aboutanything: Dietaryfatisbad.No,dietaryfatisgood . There are good fats and badfats. Carbohydrates are bad. No,carbohydratesaregood.Therea regoodcarbsandbadcarbs. Youshouldeatmoremealsaday.
No, you should eat fewer meals aday. Countyourcalories.No,caloriesd on’tcount. Milk is good for you. No, milk isbadforyou. Meatisgoodforyou.No,meatisbad foryou. Todiscovertheanswers,weneedtotur n to evidence-based medicine ratherthanvagueopinion. Literally thousands of books aredevoted to dieting and weight loss,usually written by doctors, nutritionists,personal trainers and other “healthexperts.” However, with a fewexceptions,rarelyismore thana
cursory
thoughtsparedfortheactualcausesofobe sity.Whatmakesusgainweight? Whydowegetfat? Themajorproblemisthecompletelack of a theoretical framework forunderstanding obesity. Current theoriesare ridiculouslysimplistic,oftentakingonlyo nefactorintoaccount: Excesscaloriescauseobesity.E xcess carbohydrates causeobesity. Excess meat consumption causesobesity. Excess dietary fat causes obesity.Toolittleexercisecausesobe sity.
Butallchronicdiseasesare
multifactorial, and these factors are notmutually exclusive. They may allcontribute to varying degrees. Forexample, heart disease has numerouscontributing factors—family history,gender, smoking, diabetes, highcholesterol, high blood pressure and alack of physical activity, to name only afew— andthatfactiswellaccepted.Butsuchisnott hecase inobesityresearch. Theothermajorbarriertounderstanding is the focus on short-termstudies. Obesity usually takes decades tofully develop. Yet we often rely oninformation about it from studies that areonly of several weeks’ duration. If westudyhowrustdevelops,wewouldneedt oobservemetaloveraperiodofweeks
tomonths,nothours.Obesity,similarly,is a long-term disease. Short- termstudiesmaynotbeinformative. While I understand that the research isnot always conclusive, I hope this book,which draws on what I’ve learned overtwenty years of helping patients withtype 2 diabetes lose weight permanentlyto manage their disease, will provide astructuretobuildupon. Evidence-based medicine does notmean taking every piece of low- qualityevidence at face value. I often readstatements such as “low-fat diets provento completely reverse heart disease.”The reference will be a study of fiverats. That hardly qualifies as evidence. Iwillreferenceonlystudiesdoneon
humans, and mostly only those that havebeen published in high-quality, peer-reviewed journals. No animal studieswill be discussed in this book. Thereason for this decision can beillustratedin“TheParableoftheCow”: Two cows were discussing the latestnutritional research, which had beendoneonlions.Onecowsaystotheother, “Did you hear that we’ve been wrongthese last 200 years? The latest researchshows that eating grass is bad for youandeatingmeatisgood.”Sothetwocow s began eating meat. Shortlyafterward,theygotsickandtheydie d. One year later, two lions werediscussing the latest nutritional
research,whichwasdoneoncows.Onelions aid
to the other that the latest researchshowed that eating meat kills you andeating grass is good. So, the two lionsstartedeatinggrass,andtheydied. What’s the moral of the story? We arenot mice. We are not rats. We are notchimpanzeesorspidermonkeys.Wear ehumanbeings,andthereforeweshouldco nsider only human studies. I aminterested in obesity in humans, notobesity in mice. As much as possible, Itrytofocusoncausalfactorsratherthanass ociation studies. It is dangerous toassume that because two factors areassociated,oneisthecauseoftheother. Witness the hormone replacementtherapy disaster in post-
menopausalwomen.Hormonereplaceme nttherapy How Jones loss his weight without any exercise you want to learn this special method than click here
wasassociatedwithlowerheartdisease,bu tthatdidnotmeanthatitwasthecauseoflow erheartdisease. However, in nutritional research, it isnotalwayspossibletoavoidassociationst udies, as they are often the bestavailableevidence. Part 1 of this book, “The Epidemic,”explores the timeline of the obesityepidemic and the contribution of thepatient’sfamilyhistory,andshowshowbo thshedlightontheunderlyingcauses. Part 2, “The Calorie Deception,”reviews the current caloric theory indepth, including exercise andoverfeedingstudies.Theshortcomin gsof the current understanding of obesityarehighlighted.
Part 3, “A New Model of Obesity,”introducesthehormonaltheoryo fobesity, a robust explanation of obesityas a medical problem. These chaptersexplain the central role of insulin inregulatingbodyweightanddescribethev itally important role of insulinresistance. Part 4, “The Social Phenomenon ofObesity,” considers how hormonalobesity theory explains some of theassociationsofobesity.Whyisobesity associated with poverty? What can wedoaboutchildhoodobesity? Part 5, “What’s Wrong with OurDiet?,”explorestheroleoffat,protein and carbohydrates, the
threemacronutrients,inweightgain.In
addition, we examine one of the mainculprits in weight gain— fructose— andtheeffectsofartificialsweeteners. Part 6, “The Solution,” providesguidelines for lasting treatment ofobesity by addressing the hormonalimbalance of high blood insulin. Dietaryguidelines for reducing insulin levelsinclude reducing added sugar andrefined grains, keeping proteinconsumption moderate, and addinghealthy fat and fiber. Intermittent fastingis an effective way to treat insulinresistance without incurring the negativeeffects of calorie reduction diets. Stressmanagement and sleep improvement canreducecortisollevelsandcontrolinsuli
n.
The Obesity Code will set forth aframework for understanding thecondition of human obesity. Whileobesity shares many importantsimilarities and differences with type 2diabetes,this is primarilyabookaboutobesity. The process of challenging currentnutritional dogma is, at times, unsettling,butthehealthconsequencesaret ooimportant to ignore. What actuallycauses weight gain and what can we doabout it? This question is the overalltheme of this book. A fresh frameworkfortheunderstandingandtreatm entofobesity represents a new hope for ahealthierfuture.
JASONFUNG,MD
PART ONE TheEpidemic
(1)
HOWOBESITY BECAMEANEPIDEMIC Ofalltheparasitesthataf fecthumanity,Idonotkn owof,norcanIimagine, anymoredistressingtha nthatofObesity. WILLIAMBANTING HERE’S THE QUESTIONthat has alwaysbotheredme:Whyaretheredoctors whoare fat? Accepted as authorities inhumanphysiology,doctorsshouldbetrue expertsonthecausesandtreatmentsof obesity. Most doctors are also veryhardworking and self-disciplined. Sincenobodywantstobefat,doctorsin
particular should have both theknowledge and the dedication to staythinandhealthy. Sowhyaretherefatdoctors? The standard prescription for weightlossis“EatLess,MoveMore.”Itsou nds perfectly reasonable. But whydoesn’titwork?Perhapspeoplewanti ngto lose weight are not following thisadvice.Themindiswilling,buttheflesh is weak. Yet consider the self- disciplineand dedication needed to complete anundergraduate degree, medical school,internship,residencyandfellowshi p.Itis hardly conceivable that overweightdoctors simply lack the willpower tofollowtheirownadvice. Thisleavesthepossibilitythatthe
conventional advice is simply wrong.And if it is, then our entire understandingofobesityisfundamentallyf lawed. Given the current epidemic of obesity, Isuspect that such is the most likelyscenario. So we need to start at the verybeginning, with a thorough understandingofthediseasethatishumanob esity. Wemuststartwiththesinglemostimport antquestionregardingobesityoranydisea se:“Whatcausesit?”Wespend no time considering this crucialquestion because we think we alreadyknow the answer. It seems so obvious:it’s a matter of Calories In versusCaloriesOut. Acalorieisaunitoffood
energyusedbythebodyforvariousfunctions suchas
breathing,buildingnewmuscleandbone, pumping blood and othermetabolic tasks. Some food energy isstored as fat. Calories In is the foodenergy that we eat. Calories Out is theenergyexpendedforallofthesevarious metabolicfunctions. Whenthenumberofcalorieswetakein exceeds the number of calories weburn, weight gain results, we say. Eatingtoo much and exercising too little causesweight gain, we say. Eating too manycaloriescausesweightgain,wesay. These “truths” seem so self-evident thatwe do not question whether they areactuallytrue.Butarethey?
PROXIMATEVERSUSULTIMATECA USE EXCESS CALORIES MAY certainly be theproximatecauseofweightgain,butnot itsultimatecause. What’s the difference betweenproximateandultimate?Theprox imatecauseisimmediatelyresponsible,w hereas the ultimate cause is whatstartedthechainofevents. Consider alcoholism. What causesalcoholism? The proximate cause is“drinkingtoomuchalcohol”— whichisundeniably true, but not particularlyuseful.Thequestionandthecau sehereareoneandthesame,sincealcoholis mmeans “drinking too much alcohol.”Treatmentadvicedirectedagain
stthe
proximate cause—“Stop drinking somuchalcohol”—isnotuseful. Thecrucialquestion,theonethatweare really interested in, is: What is theultimate cause of why alcoholismoccurs.Theultimatecauseincl udes the addictive nature of alcohol,anyfamilyhistoryofalcoh olism,excessive stress in the homesituationand/or anaddictive personality. There we have the real disease, andtreatment must be directed against theultimate,ratherthantheproximatecause. Understandingtheultimatecauseleadstoeff
ectivetreatmentssuchas(inthis Do you want to loss your weight without any exercise than click here
case) rehabilitation and social supportnetworks. Let’stakeanotherexample.Whydoesa plane crash? The proximate cause is,“there was not enough lift to overcomegravity”—again, absolutely true, but notin any way useful. The ultimate causemightbe human error,mechanical fault and/orinclementweathe r. Understandingtheultimatecauseleads to effective solutions such asbetter pilot training or tightermaintenance schedules. Advice
to“generatemoreliftthangravity”(larger
wings,morepowerfulengines)willnotre duce plane crashes. This understanding applies toeverything. For instance, why is it so hotinthisroom? PROXIMATE CAUSE: Heat energycominginisgreaterthanheatener gyleaving. SOLUTION: Turn on the fans to increasetheamountofheatleaving. ULTIMATECAUSE:Thethermostatissettoo high. SOLUTION: Turn down the thermostat.Whyistheboatsinking? PROXIMATE CAUSE: Gravity is strongerthanbuoyancy. SOLUTION:Reducegravitybylig hteningtheboat.
ULTIMATECAUSE:Theboathasalargeholei nthehull. SOLUTION:Patchthehole. In each case, the solution to theproximate cause of the problem isneitherlastingnormeaningful.Bycontras t,treatmentoftheultimatecauseisfarmore successful. Thesameappliestoobesity:Whatca usesweightgain? Proximatecause:Consumingmorecalori es thanyouexpend. If more calories in than out is theproximatecause,theunspokenanswerto that last question is that the ultimatecause is “personal choice.” We chooseto eat chips instead of broccoli. WechoosetowatchTVinsteadofexercise.
Through this reasoning, obesity istransformed from a disease that needs tobe investigated and understood into apersonal failing,acharacter defect. Insteadofsearchingfortheultimatecau se of obesity, we transform theprobleminto eating too much (gluttony) and/orexercisingtoolittle(sloth). Gluttony and sloth are two of theseven deadly sins. So we say of theobese that they “brought it onthemselves.” They “let themselves go.”It gives us the comforting illusion thatwe understand ultimate cause of theproblem.Ina2012onlinepoll,161
percent of U.S. adults believed that“personal choices about eating andexercise” were responsible fortheobesity epidemic. So we discriminateagainstpeoplewhoareobese .Webothpityandloathethem. However, on simple reflection, thisidea simply cannot be true. Prior topuberty,boysandgirlsaveragethesame body-fat percentage. After puberty,women on average carry close to 50percent more body fat than men. Thischange occurs despite the fact that menconsume more calories on average thanwomen.Butwhyis thistrue? What is the ultimate cause? It hasnothingtodowithpersonalchoices.Itisn otacharacterdefect.Womenarenot
moregluttonousorlazierthanmen.Thehorm onal cocktail that differentiates menand women must make it more likely thatwomen will accumulate excess caloriesasfatasopposedtoburningthemoff. Pregnancy also induces significantweightgain.Whatistheultimatec ause?Again, it is obviously the hormonalchangesresultingfromthepregnan cy —not personal choice—that encouragesweightgain. Having erred in understanding theproximate and ultimate causes, webelievethesolutiontoobesityis toeatfewercalories. The“authorities”allagree.TheU.S.Dep artment of Agriculture’s DietaryGuidelinesforAmericans,updated
in
2010, forcefully proclaims its keyrecommendation:“Controltotalcalo rieintaketomanagebodyweight.”TheCen ters for Disease Control2exhortpatients to balance their calories. TheadvicefromtheNationalInstitutesof Health’s pamphlet “Aim for a HealthyWeight”is“tocutdownonthenum berof calories... they get from food andbeverages and increase their physicalactivity.”3 Allthisadviceformsthefamous“EatLe ss, Move More” strategy so belovedby obesity “experts.” But here’s apeculiar thought: If we alreadyunderstand what causes obesity, how totreat it, and we’ve spent millions
ofdollarsoneducationandobesity
programs,why arewe gettingfatter?
ANATOMYOFANEPIDEMIC WEWEREN’TALWAYSsoobsessedwithcalorie s. Throughout most of humanhistory,obesityhasbeenrare. Individuals in traditional societies eatingtraditional diets seldom became obese,even in times of abundant food. Ascivilizationsdeveloped,obesityfollow ed. Speculating on the cause,many identified the refinedcarbohydratesofsugarandstarches . Sometimes considered the father of thelow- carbohydrate diet, Jean AnthelmeBrillat-Savarin (1755–1826) wrote theinfluential textbook The Physiology ofTaste in 1825. There he wrote: “Thesecond of the chief causes of obesity
istheflouryandstarchysubstanceswhich
manmakestheprimeingredientsofhisdaily nourishment. As we have saidalready, all animals that live onfarinaceous food grow fat willy- nilly;andmanisnoexceptiontotheuniversa llaw.”4 All foods can be divided into threedifferent macronutrient groups: fat,protein and carbohydrates. The “macro”in“macronutrients”referstothefa ctthatthebulkofthefoodweeatismadeupoft hese three groups. Micronutrients,which make up a very small proportionof the food, include vitamins andmineralssuchasvitaminsA,B,C,D,Ean d K, as well as minerals such as ironandcalcium.Starchyfoodsandsugarsa
re allcarbohydrates.
Severaldecadeslater,WilliamBanting (1796–1878), an Englishundertaker, rediscovered the fatteningpropertiesoftherefinedcarbohyd rate.In1863,hepublishedthepamphletLett eron Corpulence, Addressed to thePublic, which is often considered theworld’s first diet book. His story israther unremarkable. He was not anobese child, nor did he have a familyhistory of obesity. In his mid- thirties,however, he started to gain weight. Notmuch; perhaps a pound or two per year.By age sixty-two, he stood five foot fiveandweighed202pounds(92kilograms ).Perhaps unremarkable by modernstandards, he was considered quiteportlyatthetime.Distressed,hesought
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adviceonweightlossfromhisph ysicians. First,hetriedtoeatless,butthatonlyleft him hungry. Worse, he failed to loseweight. Next, he increased his exerciseby rowing along the River Thames, nearhishomeinLondon.Whilehisphysicalf itness improved, he developed a“prodigious appetite, which I wascompelled to indulge.”5Still, he failedtolose weight. Finally,ontheadviceofhissurgeon,Banti ngtriedanewapproach.Withtheideathatsug aryand starchyfoodswerefattening, he strenuously avoided allbreads,milk,beer,sweetsandpotatoesth at had previously made up a largeportionofhis diet.(Todaywewould
call this diet low in refinedcarbohydrates.) William Banting notonly lost the weight and kept it off, buthe also felt so well that he wascompelledtowritehisfamouspamphle t.Weight gain, he believed, resulted fromeating too many “fatteningcarbohydrates.” Formostofthenextcentury,diets lowin refined carbohydrates were acceptedas the standard treatment for obesity. Bythe 1950s, it was fairly standard advice.If you were to ask your grandparentswhat caused obesity, they would not talkabout calories. Instead, they would tellyou to stop eating sugary and starchyfoods. Common sense and empiricobservationservedtoconfirmthetr uth.
Nutritional“experts”andgovernmento pinionwere notneeded. Caloriecountinghadbegunintheearly 1900s with the book Eat Your Wayto Health, written by Dr. Robert HughRose as a “scientific system of weightcontrol.” That book was followed up in1918 with the bestseller Diet andHealth,withKeytotheCalories,writte n by Dr. Lulu Hunt Peters, anAmerican doctor and newspapercolumnist. Herbert Hoover, then the headof the U.S. Food Administration,convertedtocaloriecount ing.Dr.Petersadvised patients to start with a fast, oneto two days abstaining from all foods,and then stick strictly to 1200 caloriesperday.Whiletheadvicetofastwas
quicklyforgotten,moderncalorie- counting schedules are not verydifferent. By the 1950s, a perceived “greatepidemic” of heart disease wasbecominganincreasingpublicconcer n.Seemingly healthy Americans weredeveloping heart attacks with growingregularity. In hindsight, it should havebeen obvious that there was really nosuchepidemic. The discovery of vaccines andantibiotics, combined with increasedpublic sanitation, had reshaped themedical landscape. Formerly lethalinfections, such as pneumonia,tuberculosis and gastrointestinalinfections,becamecu rable.Heart
disease and cancer now caused arelatively greater percentage of deaths,giving rise to some of the publicmisperception of an epidemic. (SeeFigure 1.1.6) Figure1.1.CausesofdeathintheUnitedS tates1900vs.1960. The increase in life expectancy from1900to1950reinforcedthepercepti
on
of a coronary-disease epidemic. For awhite male, the life expectancy in 1900was fifty years.7By 1950, it hadreached sixty-six years, and by 1970,almost sixty-eight years. If people werenot dying of tuberculosis, then theywould live long enough to develop theirheart attack. Currently, the average ageat first heart attack is sixty-six years.8The risk of a heart attack in a fifty-year-old man is substantially lower than in asixty-eight-year-old man. So the naturalconsequence of a longer life expectancyisanincreasedrateofcoronary disease. Butallgreatstories needavillain, and dietary fat was cast into that
role.Dietary fat was thought to increase theamountofcholesterol,afattysubstance
that is thought to contribute to heartdisease, in the blood. Soon, physiciansbegantoadvocate lower- fatdiets.Withgreat enthusiasm and shaky science, thedemonization of dietary fat began inearnest. There was a problem, though wedidn’t see it at the time. The threemacronutrients are fat, protein andcarbohydrates: lowering dietary fatmeantreplacingitwitheitherproteinorc arbohydrates. Since many high- proteinfoods like meat and dairy are also highin fat, it is difficult to lower fat in thedietwithoutloweringproteinaswell. So,ifone were torestrictdietaryfats,then one must increase dietarycarbohydrates
andviceversa.Inthe
developed world, these carbohydratesalltendtobehighlyrefine d. Low Fat = High CarbohydrateThisdilemmacreate dsignificant cognitive dissonance. Refinedcarbohydrates could not simultaneouslybe both good (because they are low infat)andbad(becausetheyarefattening).T he solution adopted by most nutritionexperts was to suggest thatcarbohydrateswerenolongerfattenin g.Instead,calorieswerefattening.Without evidence or historical precedent, it wasarbitrarily decided that excess caloriescausedweightgain,notspecificfo ods.
Fat,asthedietaryvillain,wasnowdee med fattening—a previouslyunknownconcept.TheCal ories-
In/Calories-Out model began to displacethe prevailing “fattening carbohydrates”model. But not everybody bought in. One ofthe most famous dissidents was theprominent British nutritionist JohnYudkin (1910–1995). Studying diet andheart disease, he found no relationshipbetween dietary fat and heart disease.Hebelievedthatthemainculpritof bothobesity and heart disease was sugar.9,10His 1972 book, Pure, White andDeadly:HowSugarIsKilling Us,iseerily prescient (and should certainlywin the award for Best Book TitleEver). Scientific debate raged back andforth about whether the culprit
wasdietaryfatorsugar.
THEDIETARYGUIDELINES THE ISSUEWASfinallysettledin1977,notby scientific debate and discovery, butby governmental decree. GeorgeMcGovern, then chairman of the UnitedStates Senate Select Committee onNutrition and Human Needs, convened atribunal, and after several days ofdeliberation, it was decided thathenceforth, dietary fat was guilty ascharged. Not only was dietary fat guiltyof causing heart disease, but it alsocaused obesity,sincefatiscaloricallydense. The resulting declaration became theDietaryGoalsfortheUnitedStates.Ane ntire nation, and soon the entire world,wouldnowfollownutritionaladvice
from a politician. This was a remarkablebreak from tradition. For the first time, agovernment institution intruded into thekitchens of America. Mom used to tell uswhat we should and should not eat. Butfrom now on, Big Brother would betelling us. And he said, “Eat less fat andmorecarbohydrates.” Severalspecificdietarygoalsweresetf orth.Theseincluded raiseconsumptionofcarbohydratesu ntiltheyconstituted55percentto60pe rcent ofcalories,anddecrease fat consumption fromapproximately 40 percent ofcalories to 30 percent, of which nomorethanone- thirdshouldcome
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fromsaturatedfat. With no scientific evidence, theformerly “fattening”carbohydratemadeastunningtra nsformation.Whiletheguidelines still recognized the evils ofsugar, refined grain was as innocent as anuninaconvent.Itsnutritionalsinswereex onerated, and it was henceforth rebornandbaptizedasthehealthywholegrai n. Was there any evidence? It hardlymattered. The goals were now thenutritionalorthodoxy.Everythingelse was heathen. If you didn’t toe the line,you were ridiculed. The DietaryGuidelinesforAmericans,
areportreleasedin1980forwidespreadpu blicconsumption,followedthe
recommendations of the McGovernreportclosely.Thenutritionalla ndscapeoftheworldwas foreverchanged. TheDietaryGuidelinesforAmericans, now updated every fiveyears, spawned the infamous foodpyramidinallitscounterfactualglory. The foods that formed the base of thepyramid— thefoodsweshouldeateverysingleday— werebreads,pastasand potatoes. These were the precisefoods that we had previously avoided tostaythin.Forexample,theAmericanHear tAssociation’s1995pamphlet,TheAmeri can Heart Association Diet: AnEatingPlan forHealthyAmericans,declared we should eat six or
moreservingsof“breads,cereals,pastaan d
starchy vegetables (that) are low in fatand cholesterol.” To drink, “Choose...fruit punches, carbonated soft drinks.”Ahhh. White bread and carbonated softdrinks—the dinner of champions. Thankyou,AmericanHeartAssociation(AH A). Entering this brave new world,Americans tried to comply with thenutritionalauthoritiesofthedayandmad e a conscious effort to eat less fat,less red meat, fewer eggs and morecarbohydrates. When doctors advisedpeople to stop smoking, rates droppedfrom33percentin1979to25perce ntby1994. When doctors said to controlblood pressure and cholesterol, therewas a 40 percent decline in high
bloodpressureanda 28percentdeclineinhigh
cholesterol. When the AHA told us to eatmore bread and drink more juice, we atemorebreadanddrankmorejuice. Inevitably, sugar consumptionincreased. From 1820 to 1920, newsugar plantations in the Caribbean andAmerican South increased theavailability of sugar in the U.S. Sugarintakeplateauedfrom1920to1977 . Eventhough“avoidtoomuchsugar”was anexplicitgoalofthe1977DietaryGuideli nes for Americans, consumptionincreasedanywayuntiltheye ar2000. With all our attention focused on fat, wetookoureyesofftheball.Everythingwas “lowfat”or“lowcholesterol,”andnobody
waspayingattentiontosugar. Food processors, figuringthisout,
increasedtheaddedsugarsinprocessedfood forflavor. Refined grain consumption increasedby almost 45 percent. Sincecarbohydrates in North America tendedto be refined, we ate more and morelow- fatbreadandpasta,notcauliflowerandkal e.11 Success! From 1976 to 1996, theaverage fat intake decreased from 45percentofcaloriesto35percent.Butterco nsumptiondecreased 38 percent. Animal protein decreased 13 percent.Egg consumption decreased 18 percent.Grains andsugarsincreased.
Figure1.2.Increaseinobeseandextre melyobeseUnitedStatesadultsaged2 0–74. Until that point, the widespreadadoption of the low-fat diet wascompletelyuntested.Wehadnoideawh at effect it would have on humanhealth. But we had the fatal conceit thatwe were somehow smarter than 200,000yearsofMotherNature.So,turnin
g
away from the natural fats, we embracedrefined low-fat carbohydrates such asbread and pasta. Ironically, theAmerican Heart Association, even aslate as the year 2000, felt that low- carbohydratedietsweredangerousfads,de spitethefactthatthesedietshadbeeninusea lmostcontinuouslysince1863. Whatwastheresult?Theincidenceofhea rt disease certainly did not decreaseas expected. But there was definitely aconsequencetothisdietarymanipulation — anunintentionalone.Ratesofobesity,define d as having a body mass indexgreater than 30, dramatically increased,starting almost exactly in 1977, asillustratedbyFigure 1.2.12 Theabruptincreaseinobesitybegan
exactly with the officially sanctionedmove toward a low-fat, high- carbohydrate diet. Was it merecoincidence?Perhapsthefaultlayinou rgeneticmakeupinstead.
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INHERITING OBESITY IT IS FAIRLYobvious that obesity runs infamilies.1Obese children often haveobese siblings. Obese children becomeobese adults.2Obese adults go on tohaveobesechildren.Childhoodobesityi s associated with a 200 percent to 400percent increased risk of adult obesity.This is an undeniable fact. Thecontroversy revolves around whetherthis trend is a genetic or anenvironmental problem—the classicnatureversusnurturedebate. Familiessharegeneticcharacteristics that may lead to obesity.
However,obesityhasbecomerampantonl ysince
the1970s.Ourgenescouldnothavecha ngedwithinsuchashorttime. Geneticscanexplainmuchoftheinter- individual risk of obesity, but not whyentirepopulationsbecomeobese. Nonetheless, families live in the sameenvironment,eatsimilarfoodsatsimi lartimesandhavesimilar attitudes. Families often share cars, live in thesamephysicalspaceandwillbeexpose dtothesamechemicalsthatmaycause obesity—so-called chemicalobesogens. For these reasons, manyconsider the current environment themajorcauseofobesity. Conventional calorie-based theoriesof obesity place the blame squarely onthis“toxic”environmentthatencourages
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eating and discourages physicalexertion. Dietary and lifestyle habitshavechangedconsiderablysincet he1970sincluding adoption of a low-fat, high- carbohydrate diet,increased number of eatingopportunitiesperday, moremealseatingout,more fast-food restaurants,more time spent in cars andvehicles, increased popularityofvideosgames, increased use of computers,increasein dietary sugar,increaseduseofhigh-
fructosecorn
syrupand increased portionsizes. Anyorallofthesefactorsmaycontribute to the obesogenicenvironment. Therefore, most moderntheories of obesity discount theimportanceofgeneticfactors,believin ginstead that consumption of excesscalories leads to obesity. Eating andmoving are voluntary behaviors, afterall,withlittlegeneticinput. So— exactlyhowmuchofaroledoesgeneticsplayi nhumanobesity?
NATUREVERSUSNURTURE THE CLASSIC METHODfor determining therelative impact of genetic versusenvironmental factors is to studyadoptive families, thereby removinggeneticsfromtheequation.Byco mparing adoptees to their biologicaland adoptive parents, the relativecontribution of environmental influencescan be isolated. Dr. Albert J. Stunkardperformed some of the classic geneticstudies of obesity.3Data aboutbiological parents is often incomplete,confidential and not easily accessible byresearchers. Fortunately, Denmark hasmaintained a relatively complete registryof adoptions, with information on bothsetsofparents.
Studyingasampleof540Danishadultado ptees, Dr. Stunkard compared themto both their adoptive and biologicalparents. If environmental factors weremost important, then adoptees shouldresemble their adoptive parents. Ifgenetic factors were most important, theadoptees should resemble theirbiologicalparents. Norelationshipwhatsoeverwasdiscover ed betweentheweightoftheadoptiveparentsa ndtheadoptees. Whetheradoptiveparentswerethinorfat made no difference to the eventualweight of the adopted child. Theenvironment provided by the adoptiveparentswaslargelyirrelevant. Thisfindingwasaconsiderable
shock. Standard calorie-based theoriesblame environmental factors and humanbehaviors for obesity. Environmentalcues such as dietary habits, fast food,junkfood,candyintake,lackofexerci se,number of cars, and lack of playgroundsandorganizedsportsarebelie vedcrucialinthedevelopmentofobesity. Buttheyplayvirtuallyno role. Infact,the fattest adoptees had the thinnestadoptive parents. Comparing adoptees to theirbiologicalparentsyieldedaconsider ablydifferentresult.Heretherewas a strong, consistent correlationbetween their weights. The biologicalparents had very little or nothing to dowithraisingthesechildren,orteaching
themnutritionalvaluesorattitudestoward exercise. Yet the tendencytoward obesity followed them likeducklings. When you took a child awayfromobeseparentsandplacedthemint oa “thin” household, the child stillbecame obese. Whatwasgoingon? Studying identical twins raised apartis another classic strategy to distinguishenvironmentalandgeneticfac tors. Identicaltwinsshareidenticalgeneticm aterial, and fraternal twins share 25percentoftheirgenes. In1991, Dr. Stunkard examined sets of fraternal andidentical twins in both conditions ofbeing reared apart and reared together.4Comparisonoftheirweightswo
uld
determine the effect of the differentenvironments. The results sent ashockwave through the obesity- researchcommunity. Approximately 70 percent ofthevariance inobesityisfamilial. Seventypercent. Seventypercentofyourtendencytogai n weight is determined by yourparentage. Obesity is overwhelminglyinherited. However, it is immediately clear thatinheritance cannot be the sole factorleading to the obesity epidemic. Theincidenceofobesityhasbeenrelativel ystable through the decades. Most of theobesityepidemicmaterializedwithina single generation. Our genes have notchangedinthattimespan.Howcanwe
explainthisseemingcontradiction?
THETHRIFTY- GENEHYPOTHESIS THE FIRST ATTEMPTto explain the geneticbasis of obesity was the thrifty- genehypothesis, which became popular in the1970s. This hypothesis assumes that allhumans are evolutionarily predisposedtogainweightasasurvivalmec hanism. Theargumentgoessomethinglikethis: In Paleolithic times, food wasscarceanddifficulttoobtain.Hungeri sone of the most powerful and basic ofhuman instincts. The thrifty genecompels us to eat as much as possible,and this genetic predisposition to gainweighthadasurvivaladvantage. Increasingthebody’sfoodstores(fat)permitt
edlongersurvivalduringtimesof
scarce or no food. Those who tended toburnthecaloriesinsteadofstoringthem were selectively wiped out. However,thethriftygeneisilladaptedtothe modern all-you-can-eat world, as itcauses weight gain and obesity. But weare simply following our genetic urge togainfat. Likeadecomposingwatermelon,thishyp othesisseemsquitereasonableonthesurfac e. Cut a little deeper, and you findthe rotten core. This theory has longceasedtobetaken seriously.However,it is still mentioned in the media, and soits flaws bear some examination. Themost obvious problem is that survival inthe wild depends on not being eitherunderweightoroverweight.Afatani
mal
is slower and less agile than its leanerbrethren.Predatorswouldpreferenti allyeat the fatter prey over the harder-to- catch, lean prey. By the same token, fatpredators would find it much moredifficulttocatchleanandswiftprey. Body fatness does not always provide asurvival advantage, but instead can be asignificant disadvantage. How manytimes have you seen a fat zebra orgazelle on the National Geographicchannel?Whataboutfatlionsa ndtigers? Theassumptionthathumansaregenetica lly predisposed to overeat isincorrect. Just as there are hormonalsignals of hunger, there are multiplehormonesthattelluswhenwe’refu llandstopusfromovereating.Consider
the all-you-can-eat buffet. It isimpossibletosimplyeatandeatwithoutst opping because we get “full.”Continuing to eat may make us becomesickandthrowup.Thereisnogeneti cpredisposition to overeating. There is,instead, powerful built-in protectionagainstit. The thrifty-gene hypothesis assumeschronic food shortages preventedobesity. However, many traditionalsocieties had plentiful food year round.Forexample,theTokelau,aremotet ribein the South Pacific, lived on coconut,breadfruit and fish, which wereavailableyearround.Regardless,obe sity was unknown among them untiltheonsetofindustrializationandthe
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Westernization of their traditional diet.Even in modern-day North America,widespreadfaminehasbeenunco mmonsince the Great Depression. Yet thegrowth of obesity has happened onlysince the 1970s. In wild animals, morbid obesity israre, even with an abundance of food,exceptwhenitispartofthenormallife cycle,aswithhibernatinganimals. Abundant food leads to a rise in thenumbers of animals, not an enormousincrease intheirsize.Thinkaboutratsorcockroaches. When food is scarce, ratpopulations are low. When food isplentiful, rat populations explode. Therearemanymorenormal- sizedrats,notthesamenumberofmorbidlyo
beserats.
There is no survival advantage tocarryingaveryhighbody- fatpercentage.A male marathon runner may have 5percent to 11 percent bodyfat. Thisamount provides enough energy tosurviveformorethanamonthwithouteatin g.Certainanimalsfattenregularly. For instance, bears routinely gain weightbefore hibernation—and they do sowithout illness. Humans, though, do nothibernate. There is an importantdifference between being fat and beingobese. Obesity is the state of being fat tothe point of having detrimental healthconsequences.Bears,alongwithwh ales,walruses and other fat animals are fat,but not obese, since they suffer no
healthconsequences.Theyare,infact,
genetically programmed to become fat.We aren’t. In humans, evolution did notfavorobesity,butrather,leanness. The thrifty-gene hypothesis doesn’texplain obesity, but what does? As wewill see in Part 3, “A New Model ofObesity,” the root cause of obesity is acomplex hormonal imbalance with highblood insulinasitscentralfeature.Thehormonal profile of a baby is influencedby the environment in the mother’s bodybefore birth, setting up a tendency forhigh insulin levels and associatedobesity later in life. The explanation ofobesity as a caloric imbalance simplycannot account for this predominantlygenetic effect, since eating and exercisearevoluntarybehaviors.Obesitya
s a
hormonalimbalancemoreeffectivelye xplainsthisgeneticeffect. But inherited factors account for only70percentofthetendencytoobesitythat we observe. The other 30 percent offactors are under our control, but whatshouldwedotomakethemostofthis? Aredietandexercisetheanswer?
PART TWO TheCalorieDeception
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THECALORIE- REDUCTIONERRO R TRADITIONALLY,OBESITYHASbeenseen as a result of how people processcalories, that is, that a person’s weightcouldbe predictedbya simpleequation: Calories In–Calories Out=BodyFatThiskeyequationperpetra teswhatI call the calorie deception. It isdangerous preciselybecauseitappearsso simple and intuitive. But what youneedtounderstandisthatmanyfalseass
umptions arebuiltin. Assumption1:CaloriesIn
and CaloriesOutareindepende ntofeachother THISASSUMPTIONISacrucialmistake. As we’ll see later on in this chapter,experimentsandexperiencehave proventhisassumptionfalse.Caloricintake andexpenditure are intimately dependentvariables. Decreasing Calories IntriggersadecreaseinCaloriesOut.A30 percent reduction in caloric intakeresults in a 30 percent decrease incaloric expenditure. The end result isminimalweightloss. Assumption2:Basalmet
abolicrateisstable WEOBSESSABOUTcaloricintakewith
barely a thought for caloric expenditure,except for exercise. Measuring caloricintake is simple, but measuring thebody’stotalenergyexpenditureiscomp licated. Therefore, the simple butcompletely erroneous assumption ismade that energy expenditure remainsconstant except for exercise. Totalenergy expenditure is the sum of basalmetabolic rate, thermogenic effect offood, nonexercise activitythermogenesis, excess post- exerciseoxygen consumption and exercise. Thetotal energy expenditure can go up ordown by as much as 50 percentdepending upon the caloric intake aswellasotherfactors.
Assumption 3: We exertconsciouscontrolov erCaloriesIn EATINGISAdeliberateact,soweassume that eating is a conscious decision andthathungerplaysonlyaminorroleinit.B ut numerous overlapping hormonalsystems influence the decision of whento eat and when to stop. We consciouslydecide to eat in response to hungersignals that are largely hormonallymediated. We consciously stop eatingwhen the body sends signals of satiety(fullness) that are largely hormonallymediated. Forexample,thesmelloffryingfoodmake syouhungryatlunchtime.
However, if you have just finished alarge buffet, those same smells maymake you slightly queasy. The smells arethe same. The decision to eat or not isprincipallyhormonal. Ourbodiespossessanintricatesystem guiding us to eat or not. Body- fatregulationisunderautomaticcontrol,lik e breathing. We do not consciouslyremind ourselves to breathe, nor do weremindourheartstobeat.Theonlywayto achieve such control is to havehomeostatic mechanisms. Sincehormones control both Calories In andCaloriesOut, obesityisahormonal, notacaloric,disorder. Assumption4:Fatstoresare
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essentiallyunregulated EVERY SINGLE SYSTEM in the body isregulated.Growthinheightisregulatedb y growth hormone. Blood sugars areregulated by the hormones insulin andglucagon, among others. Sexualmaturation is regulated by testosteroneand estrogen. Body temperature isregulated by a thyroid- stimulatinghormone and free thyroxine. The list isendless. We are asked to believe, however,that growth of fat cells is essentiallyunregulated.Thesimpleact ofeating,without any interference from anyhormones,willresultinfatgrowth. Extracaloriesaredumpedintofatcellsliked
oorknobsintoasack.
This assumption has already beenprovenfalse.Newhormonalpathway sin the regulation of fat growth are beingdiscovered all the time. Leptin is thebest-known hormone regulating fatgrowth, but adiponectin, hormone- sensitivelipase,lipoproteinlipaseandadi pose triglyceride lipase may all playimportantroles.Ifhormonesregulatef atgrowth,then obesityisahormonal, notacaloricdisorder. Assumption5:Acalorieisacal orie THISASSUMPTION ISthemostdangerous ofall.It’sobviouslytrue.Justlike adogis a dog or a desk is a desk. There aremanydifferentkindsofdogsanddesks,
but the simple statement that a dog is adog is true. However, the real issue isthis: Are all calories equally likely tocausefatgain? “A calorie is a calorie” implies thatthe only important variable in weightgainisthetotalcaloricintake,andth us,all foods can be reduced to their caloricenergy. But does a calorie of olive oilcause the same metabolic response as acalorie of sugar? The answer is,obviously, no. These two foods havemanyeasilymeasurabledifferences. Sugar will increase the blood glucoselevel and provoke an insulin responsefrom the pancreas. Olive oil will not.Whenoliveoilisabsorbedbythe smallintestineandtransportedtotheliver,
thereisnosignificantincreaseinbloodgluco se or insulin. The two differentfoods evoke vastly different metabolicandhormonalresponses. These five assumptions—the keyassumptions in the caloric reductiontheory of weight loss—have all beenprovedfalse. Allcaloriesarenotequally likely to cause weight gain. Theentirecaloricobsessionwas afifty- yeardeadend. So we must begin again. What causesweightgain?
HOWDOWEPROCESSFOOD? WHAT IS Acalorie? A calorie is simply aunit of energy. Different foods areburnedinalaboratory,andtheamountofh eatreleasedismeasuredtodetermineacalor icvalue forthatfood. All the foods we eat contain calories.Foodfirstentersthestomach,wher eitismixed with stomach acid and slowlyreleasedintothesmallintestine. Nutrients are extracted throughout thejourney through the small and largeintestines.Whatremainsisexcretedass tool. Proteins are broken down into theirbuilding blocks, amino acids. These areused to build and repair the body’stissues,andtheexcessisstored.Fatsa re
directly absorbed into the body.Carbohydrates are broken down intotheir building blocks, sugars. Proteins,fats and carbohydrates all providecaloricenergyforthebody,butdi ffergreatly in their metabolic processing.This results in different hormonalstimuli.
CALORICREDUCTIONISNOTT HE PRIMARY FACTOR INWEIGHTLOSS WHY DO WE gain weight? The mostcommon answer is that excess caloricintakecausesobesity.Butalthoug htheincrease in obesity rates in the UnitedStates from 1971 to 2000 wasassociated with an increase in dailycalorie consumption of roughly 200 to300 calories,1it’s important toremember that correlation is notcausation. Furthermore, the correlation betweenweight gain and the increase in calorieconsumptionhasrecentlybrokendo wn.2Data from the National Health andNutritionExaminationSurvey(NHANES)
in the United States from 1990 to 2010finds noassociationbetweenincreasedcalorie consumptionandweightgain. While obesity increased at a rate of 0.37percentperyear,caloricintakeremaine dvirtually stable. Women slightlyincreased their average daily intake from1761calories to 1781, but men slightlydecreased theirs from 2616 calories to2511. The British obesity epidemic largelyran parallel to North America’s. Butonce again, the association of weightgainwithincreased calorieconsumptiondoes not hold true.3In the Britishexperience, neither increased caloricintake nor dietary fat
correlated toobesity— whicharguesagainstacausal
relationship.Infact,thenumberofcalories ingested slightly decreased,evenasobesityratesincreased. Otherfactors, including the nature of thosecalories,hadchanged. Wemayimagineourselvestobeacalo rie-weighingscaleand maythinkthat imbalance of calories over timeleadstotheaccumulationoffat. Calories In–Calories Out=BodyFatIfCaloriesOutremainssta bleover time, then reducing Calories In shouldproduce weight loss. The First Law ofThermodynamicsstatesthatenergycann either be created nor destroyed in anisolated system. This law is ofteninvoked to support the
CaloriesIn/CaloriesOutmodel.Promine nt
obesity researcher Dr. Jules Hirsch,quotedina2012NewYorkTim esarticle,4explains: Thereisaninflexiblelawofphysics— energy taken in must exactly equal thenumberofcaloriesleavingthesystemwh enfatstorageisunchanged.Caloriesleaveth esystem whenfoodisusedtofuelthebody.Tolowerfa tcontent—reduceobesity— onemustreducecaloriestakenin,orincrease theoutputbyincreasingactivity,orboth.Thi sistruewhethercaloriescomefrompumpkin sorpeanutsorpâtédefoiegras. But thermodynamics, a law ofphysics,hasminimalrelevancetohuman biology for the simple reason that thehumanbodyisnotanisolatedsystem.
Energy is constantly entering andleaving. Infact, theveryactwearemostconcerned about— eating—puts energyintothesystem.Foodenergyisalsoe xcreted from the system in the form ofstool. Having studied a full year ofthermodynamics in university, I canassure you that neither calories norweight gain were mentioned even asingle time. If we eat an extra 200 calories today,nothing prevents the body from burningthat excess for heat. Or perhaps thatextra 200caloriesisexcretedasstool.Or perhaps the liver uses the extra 200.We obsess about caloric input into thesystem,butoutputisfarmoreimportant.
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thesystem?Supposeweconsume2000ca lories of chemical energy (food) inone day. What is the metabolic fate ofthose2000calories?Possibilitiesforth eiruse include heatproduction, new protein production,new bone production,new muscle production,cognition (brain),increasedheartra te, increased stroke volume (heart),exercise/physicalexertion ,detoxification (liver),detoxification(kidney),di gestion (pancreas and
bowels),breathing(lungs),
excretion(intestinesandcolon)andfat production. We certainly don’t mind if energy isburned as heat or used to build newprotein,butwedomindifitisdeposited as fat. There are an almost infinitenumberofwaysthatthebodycandiss ipate excess energy instead ofstoringitasbodyfat. Withthemodelofthecalorie-balancing scale, we assume that fat gainor loss is essentially unregulated, andthat weight gain and loss is underconscious control. But no system in thebody is unregulated like that. Hormonestightlyregulateeverysinglesyst eminthebody.Thethyroid,parathyroid,
sympathetic, parasympathetic,respiratory, circulatory, hepatic, renal,gastrointestinalandadrenalsystemsa reall under hormonal control. So is bodyfat. The body actually has multiplesystemstocontrolbodyweight. The problem of fat accumulation isreally a problem of distribution ofenergy. Too much energy is diverted tofat production as opposed to, say,increasing, body-heat production. Thevast majority of this energy expenditureis controlled automatically, withexercise being the only factor that isunder our conscious control. Forexample, we cannot decide how muchenergy to expend on fat accumulationversusnewboneformation.
Sincethese
metabolicprocessesarevirtuallyimpossib le to measure, they are assumedto remain relatively stable. In particular,CaloriesOutisassumednottoch angeinresponsetoCaloriesIn.Wepresume thatthetwo areindependentvariables. Let’stakeananalogy.Considerthemoney thatyouearninayear(MoneyIn)and the money that you spend (MoneyOut). Suppose you normally earn andalso spend $100,000 per year. If MoneyInisnowreducedto$25,000 peryear,whatwouldhappentoMoneyOut? Wouldyoucontinuetospend$100,000pery ear? Probablyyou’re notsostupid,asyou’dquicklybecomebank rupt. Instead,youwouldreduceyourMoneyOutto $25,000peryeartobalancethe
budget. Money In and Money Out aredependent variables, since reduction ofone willdirectlycause areductionoftheother. Let’sapplythisreasoningtoobesity. Reducing Calories In works only ifCalories Out remains stable. What wefind instead is that a sudden reduction ofCalories IncausesasimilarreductioninCalories Out, and no weight is lost asthebodybalancesitsenergybudget. Some historic experiments in caloriereductionhaveshownexactlyth is.
CALORIC REDUCTION:EXTREME EXPERIMENTS,UNEXPECTE D RESULTSEXPERIMENTALLY,IT’SEAS Ytostudy caloric reduction. We take some people,give them less to eat, watch them loseweight and live happily ever after. Bam.Case closed. Call the Nobel committee:Eat Less, Move More is the cure forobesity,andcaloricreductiontrulyisthe bestwaytoloseweight. Luckily for us, such studies havealreadybeendone. A detailed study of total energyexpenditure under conditions of
reducedcaloric intake was done in 1919 at theCarnegie Institute of Washington.5Volunteersconsumed“sem i-starvation”
diets of 1400 to 2100 calories per day,an amount calculated to beapproximately 30 percent lower thantheirusualintake.(Manycurrentweigh t-loss diets target very similar levels ofcaloric intake.) The question waswhethertotalenergyexpenditure(Calo ries Out) decreases in response tocaloric reduction (Calories In). Whathappened? The participants experienced awhopping 30 percent decrease in totalenergy expenditure, from an initialcaloric expenditure of roughly 3000calories to approximately 1950 calories.Even nearly 100 years ago, it was clearthat Calories Out is highly dependent onCaloriesIn. A30 percentreductionin
caloric intake resulted in a nearlyidentical30percentreductionincalor icexpenditure. The energy budget isbalanced. The First Law ofThermodynamicsisnotbroken. Several decades later, in 1944 and1945, Dr. Ancel Keys performed themostcompleteexperimentofstarvatio never done—the Minnesota StarvationExperiment, the details of which werepublished in 1950 in a two- volumepublication entitled The Biology ofHuman Starvation.6In the aftermath ofWorld War II, millions of people wereon the verge of starvation. Yet thephysiologic effects of starvation werevirtually unknown, having never beenscientificallystudied. TheMinnesota
study was an attempt to understand boththe caloric-reduction and recoveryphases of starvation. Improvedknowledge would help guide Europe’srecovery from the brink. Indeed, as aresult of this study, a relief-worker’sfield manual was written detailingpsychologicalaspectsofstarvat ion.7 Thirty-sixyoung,healthy,normalmen were selected with an average height offive foot ten inches (1.78 meters) and anaverage weight of 153 pounds (69.3kilograms). For the first three months,subjects received a standard diet of3200caloriesperday.Overthenextsixm onths of semi-starvation, only
1570calories were given to them. However,caloricintake wascontinuallyadjusted
to reach a target total weight loss of 24percent (compared to baseline),averaging 2.5pounds(1.1kilograms)perweek.Some meneventuallyreceivedlessthan1000calo riesperday. The foods given were high incarbohydrates,similartothoseavailable in war-torn Europe at the time— potatoes,turnips,breadandmacaroni. Meat and dairy products were rarelygiven.Inaddition,theywalked 22 milesper week as exercise. Following thiscaloric-reduction phase, their calorieswere gradually increased over threemonths of rehabilitation. Expectedcaloricexpenditurewas3009 caloriesperday.8 EvenDr.Keyshimselfwasshocked
by the difficulty of the experiment. Themenexperiencedprofoundphysicalan dpsychologicalchanges.Amongthemostc onsistent findings was the constantfeeling of cold experienced by theparticipants. As one explained, “I’mcold. In July I walk downtown on asunny day with a shirt and sweater tokeepmewarm.Atnightmywellfedroom mate, who isn’t in the experiment,sleeps on top of his sheets but I crawlundertwoblankets.”9 Restingmetabolicratedroppedby40 percent. Interestingly, thisphenomenon is very similar to that of theprevious study, which showed a drop of30percent.Measurementofthesubjects’ strengthshoweda21percentdecrease.
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Heartrateslowed considerably, fromanaverage of fifty-five beats per minute toonly thirty-five. Heart stroke volumedecreased by 20 percent. Bodytemperature dropped to an average of95.8°F.10Physical endurance droppedby half. Blood pressure dropped. Menbecameextremelytiredanddizzy.The ylosthairandtheirnails grewbrittle. Psychologically, there were equallydevastating effects. The menexperienced a complete lack of interestin everything except for food, whichbecame an object of intense fascinationto them. Some hoarded cookbooks andutensils. They were plagued withconstant,unyieldinghunger.Somewe
reunabletoconcentrate,andseveral
withdrew from their university studies.There were several cases of franklyneuroticbehavior. Let’s reflect on what was happeninghere.Priortothestudy,thesubj ectsateand also burned approximately 3000calories per day. Then, suddenly, theircaloric intake was reduced toapproximately 1500 per day. All bodyfunctions that require energyexperienced an immediate, across-the-board 30 percent to 40 percentreduction, which wrought completehavoc.Consider thefollowing: Caloriesareneededtoheatthebod y.
Fewercalorieswereavailable,sob odyheatwas
reduced. Result: constant feeling ofcold. Caloriesareneededforthehearttopu mp blood. Fewercalorieswereavailable, so the pump sloweddown. Result: heart rate and strokevolume decreases. Calories are needed to maintainbloodpressure.Fewercalor ieswereavailable,sothebodyturnedt he pressure down. Result: bloodpressuredecreased. Caloriesareneeded forbrainfunction, as the brain is verymetabolically active. Fewercalorieswereavailable,s ocognition was reduced. Result:lethargyandinabilityto
concentrate. Calories are needed to move thebody.Fewercalorieswereavail able, so movement wasreduced.Result:weaknessduri ngphysicalactivity. Caloriesareneededto replacehairandnails.Fewercalories wereavailable, so hairandnailswerenot replaced. Result: brittle nailsandhairloss. The body reacts in this way— byreducing energy expenditure— becausethe body is smart and doesn’t want todie. What would happen if the bodycontinuedtoexpend3000caloriesdai lywhiletakinginonly1500?Soonfat
stores would be burned, then proteinstores would be burned, and then youwoulddie.Nice.Thesmartcourseofacti on for the body is to immediatelyreduce caloric expenditure to 1500caloriesperdayto restorebalance. Caloric expenditure may even beadjusted a little lower (say, to 1400caloriesperday),tocreateamarginof safety.This isexactlywhatthebodydoes. In other words, the body shuts down.In order to preserve itself, it implementsacross-the-board reductions in energyoutput. The crucial point to remember isthatdoingsoensuressurvivaloftheindivi dualinatimeofextremestress. Yeah,youmightfeellousy,butyou’ll
live to tell the tale. Reducing output isthesmartthingforthebodytodo. Burning energy it does not have wouldquickly lead to death. The energy budgetmustbebalanced. CaloriesInandCalories Outarehighlydependentvariables. With reflection, it should immediatelybeobviousthatcaloricexpen dituremustdecrease. If we reduce daily calorieintake by 500 calories, we assume that 1pound (0.45 kilograms) of fat per weekis lost. Does that mean that in 200weeks, we would lose 200 pounds (91kilograms)andweighzeropounds?Ofc oursenot.Thebodymust,atsomepoint, reduce its caloric expenditure tomeetthelowercaloricintake.Itjustso
happens that this adaptation occursalmost immediately and persists longterm. The men in the MinnesotaStarvation Experiment should have lost78 pounds (35.3 kilograms), but theactual weight lost was only 37 pounds(16.8kilograms)— lessthanhalfofwhatwas expected. More and more severecaloric restriction was required tocontinuelosingweight.Soundfamiliar? Whathappenedtotheirweightafterthes emi-starvationperiod? During the semi-starvation phase,body fat dropped much quicker thanoverall body weight as fat stores arepreferentially used to power the body.Once the participants started therecoveryperiod,theyregainedthe
weight rather quickly, in about twelveweeks. But it didn’t stop there. Bodyweightcontinuedtoincreaseuntilitwa sactually higher than it was prior to theexperiment. The body quickly responds to caloricreduction by reducing metabolism (totalenergy expenditure), but how long doesthis adaptation persist? Given enoughtime, does the body increase its energyexpenditurebacktoitsprevioushigh erlevel if caloric reduction is maintained?The short answer is no.11In a 2008study, participants initially lost 10percent of body weight, and their totalenergy expenditure decreased asexpected.Buthowlongdidthissituationla st?Itremainedreducedover the
course of the entire study—a full year.Evenafteroneyearatthenew,lowerbo dyweight,theirtotalenergyexpenditure was still reduced by anaverageofalmost500caloriesper day.In response to caloric reduction,metabolism decreases almostimmediately, and that decrease persistsmoreorless indefinitely. The applicability of these findings tocaloric-reductiondietsisobvious. Assume that prior to dieting, a womaneats and burns 2000 calories per day.Following doctor’s orders, she adopts acalorie-restricted,portion- controlled,low-fat diet, reducing her intake by 500calories per day. Quickly, her totalenergyexpenditure alsodropsby500
caloriesperday,ifnotalittlemore.Shefeel s lousy, tired, cold, hungry, irritableand depressed, but sticks with it,thinking that things must eventuallyimprove. Initially, she loses weight, butas her body’s caloric expendituredecreases to match her lowered intake,her weight plateaus. Her dietarycompliance is good, but one year later,things have not improved. Her weightslowly creeps back up, even though sheeats the same number of calories. Tiredof feeling so lousy, she abandons thefailed diet and resumes eating 2000calories per day. Since her metabolismhas slowed to an output of only 1500calories per day, all her weight comesrushingback— asfat.Thosearoundher
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silentlyaccuseheroflackingwillpower.Sou nd familiar? But her weight regain isnot her failure. Instead, it’s to beexpected. Everything described here hasbeen well documented over the last 100years!
ANERRONEOUSASSUMPTION LET’S CONSIDER Alast analogy here.Supposewemanageacoal- firedpowerplant. Every day to generate energy, wereceive and burn 2000 tons of coal. Wealso keep some coal stored in a shed,justincasewerunlow. Now,allofasudden,wereceiveonly150 0 tons of coal a day. Should wecontinuetoburn2000tonsofcoaldaily? We would quickly burn through ourstores of coal, and then our power plantwould be shut down. Massive blackoutsdevelop over the entire city. Anarchyandlootingcommence.Ourbosste llsushow utterly stupid we are and yells,“YourassisFIRED!”Unfortunatelyfor us,he’sentirelyright.
In reality, we’d handle this situationanotherway.Assoonaswerealiz ethatwe’ve received only 1500 tons of coal,we’d immediately reduce our powergeneration to burn only 1500 tons. Infact, we might burn only 1400 tons, justincasetherewerefurtherreductionsin shipments.Inthecity,afewlightsgodim, but there are no widespreadblackouts. Anarchy and looting areavoided. Boss says, “Great job. You’renot as stupid as you look. Raises allaround.”Wemaintaintheloweroutputo f1500tonsaslongasnecessary. Thekeyassumptionofthetheorythatreduc ing caloric intake leads to weightlossisfalse,sincedecreasedcalorici ntakeinevitablyleads todecreased
caloric expenditure. This sequence hasbeenproventimeandagain.Wejustkeep hoping that this strategy willsomehow,thistime,work.Itwon’t.Fac eit. In our heart of hearts, we alreadyknow it to be true. Caloric reduction andportion- controlstrategiesonlymakeyoutired and hungry. Worst of all... youregain alltheweightyouhavelost.Iknowit.Youkn owit. We forget this inconvenient factbecauseourdoctors,ourdieticians,ou rgovernment, our scientists, ourpoliticiansandourmediahaveallbeens creamingatusfordecadesthatweightloss is all about Calories In versusCalories Out. “Caloric reduction isprimary.”“EatLess,MoveMore.”We
haveheard itso oftenthatwedo notquestionwhetherit’sthetruth. Instead,webelievethatthefaultliesino urselves.We feelwe havefailed. Some silently criticize us for notadhering to the diet. Others silently thinkwe have no willpower and offer usmeaningless platitudes. Soundfamiliar? The failing isn’t ours. The portion- control caloric-reduction diet isvirtually guaranteed to fail. Eating lessdoes notresultinlastingweightloss.
EATING IS NOT UNDERCONSCIOUSCONTR OL BY THE EARLY 1990s, the Battle of theBulge was not going well. The obesityepidemicwasgatheringmomentum ,withtype 2 diabetes following closelybehind. The low-fat campaign wasstartingtofizzleasthepromisedbenefits had failed to materialize. Even as wewere choking down our dry skinlesschicken breast and rice cakes, we weregetting fatter and sicker. Looking foranswers, the National Institutes ofHealth recruited almost 50,000 post- menopausalwomenforthemostmassive, expensive, ambitious
andawesomedietarystudyeverdone. Publishedin2006,thisrandomized
controlledtrialwascalledtheWomen’sHea lth Initiative Dietary ModificationTrial.12This trial is arguably the mostimportantdietarystudyeverdone. Approximately one-third of thesewomen received a series of eighteeneducation sessions, group activities,targeted message campaigns andpersonalized feedback over one year.Their dietary intervention was to reducedietary fat, which was cut down to 20percent of daily calories. They alsoincreasedtheirvegetableandfruitintak eto five servings per day and grains to sixservings. They were encouraged toincrease exercise.Thecontrolgroupwas instructed to eat as they normallydid.Thoseinthis
groupwereprovided
with a copy of the Dietary Guidelinesfor Americans, but otherwise receivedlittlehelp.Thetrialaimedtoconfir mthecardiovascular health and weight- reductionbenefitsofthe low-fatdiet. Theaverageweightofparticipantsatth e beginning of the study was 169pounds (76.8 kilograms). The startingaverage body mass index was 29.1,putting participants in the overweightcategory (body mass index of 25 to29.9), but bordering on obese (bodymass index greater than 30). They werefollowed for 7.5 years to see if thedoctor- recommended diet reducedobesity, heart disease and cancer asmuchasexpected. Thegroupthatreceiveddietary
counseling succeeded. Daily caloriesdropped from 1788 to 1446 a day—areduction of 342 calories per day foroversevenyears.Fatas apercentageofcaloriesdecreasedfrom38. 8percentto 29.8 percent, and carbohydratesincreased from 44.5 percent to 52.7percent. The women increased theirdaily physical activity by 14 percent.The control group continued to eat thesamehigher-calorieandhigher- fatdiettowhichtheywere accustomed. The results were telling. The “EatLess, Move More” group started outterrifically, averaging more than 4pounds (1.8 kilograms) of weight lossoverthefirstyear.Bythesecondyear,th eweightstartedtoberegained,andby
the end of the study, there was nosignificant difference between the twogroups. Did these women perhaps replacesome oftheirfatwithmuscle? Unfortunately, the average waistcircumferenceincreasedapproximate ly 0.39 inches (0.6 centimeters), and theaverage waist-to-hip ratio increasedfrom 0.82 to 0.83 inches (2.1centimeters), which indicates thesewomen were actually fatter than before.Weightlossover7.5yearsofthe EatLess,MoveMorestrategywasnoteven onesinglekilogram(2.2pounds). This study was only the latest in anunbroken string of failed experiments.Caloricreductionastheprimar
ymeans
of weight loss has disappointedrepeatedly. Reviews of the literature bythe U.S. Department of Agriculture13highlight this failure. All these studies,ofcourse, serveonlyto confirmwhatwealready knew. Caloric reduction doesn’tcause lasting weight loss. Anybody whohasevertrieditcantellyou. Manypeopletellme,“Idon’t understand. I eat less. I exercise more.But I can’t seem to lose any weight.” Iunderstand perfectly— because thisadvice has been proven to fail. Docaloric-reduction diets work? No. TheWomen’sHealthInitiativeDietaryMo dification Trial was the biggest,baddest, most kick-ass study of
the EatLess,MoveMorestrategythathaseven Do you want to loss your weight without any exercise than click here
beenoreverwillbedone— anditwasaresoundingrepudiationofthatstra tegy. What is happening when we try toreduce calories and fail to lose weight?Part of the problem is the reducedmetabolism that accompanies weightloss.Butthat’sonlythebeginning.
HUNGERGAMES THECALORIESIN,CaloriesOutplanforweig ht loss assumes that we haveconsciouscontroloverwhatweeat.B utthis belief ignores the extremelypowerful effect of the body’s hormonalstate. The defining characteristic of thehuman body is homeostasis, oradaptation to change. Our body dealswith an ever-changing environment. Inresponse,thebodymakesadjustmentsto minimizetheeffectsofsuchchangesandretu rn to its original condition. And so itis,whenthe bodystartstolose weight. There are two major adaptations tocaloric reduction. The first change, aswe have seen, is a dramatic reduction intotalenergyexpenditure.Thesecondkey
change is that the hormonal signals thatstimulate hunger increase. The body ispleadingwithus toeatinorderforittoregainthe lostweight. This effect was demonstrated in 2011,in an elegant study of hormonaladaptation to weight loss.14Subjectswere given a diet of 500 calories perday, which produced an average weightlossof29.7pounds(13.5kilograms ). Next, they were prescribed a low- glycemic-index,low- fatdietforweightmaintenance and were encouraged toexercisethirtyminutesperday.Despitet
heir best intentions, almost half of theweightwasregained. Varioushormonallevels,includingg hrelin—ahormonethat,essentially,
makes us hungry—were analyzed.Weight loss significantly increasedghrelin levels in the study’s subjects,even after more than one year, comparedtothesubjects’usualbaseline. Whatdoesthatmean?Itmeansthatthesubj ects felt hungrier and continued tofeelso,rightuptoendofthestudy. The study also measured severalsatiety hormones, including peptide YY,amylin and cholecystokinin, all of whichare released in response to proteins andfatsinourdietandservetomakeusfeelful l.Thisresponse,inturn,producesthedesired effect of keeping us fromovereating.Morethanayearafterinitia lweightloss,thelevelsofallthreesatietyhor monesweresignificantlylowerthan
before. Whatdoesthatmean?Itmeansthatthesubj ectsfeltlessfull. Withincreasedhungeranddecreasedsati ety,thedesiretoeatrises.Moreover,these hormonal changes occur almostimmediately and persist almostindefinitely. People on a diet tend to feelhungrier, and that effect isn’t some kindof psychological voodoo, nor is it a lossof willpower. Increased hunger is anormal and expected hormonal responsetoweightloss. Dr. Keys’s Minnesota StarvationExperimentfirstdocumentedth eeffectof “semi-starvation neurosis.” Peoplewholoseweightdreamaboutfood. Theyobsessaboutfood.Alltheycanthink
about is food. Interest in all elsediminishes. This behavior is not somestrange affliction of the obese. In fact,it’s entirely hormonally driven andnormal.Thebody,throughhungerands atiety signaling, is compelling us to getmore food. Losing weight triggers two importantresponses. First, totalenergyexpenditure is immediately andindefinitely reduced in order to conservethe available energy. Second, hormonalhunger signaling is immediately andindefinitely amplified in an effort toacquiremorefood.Weightlossresultsini ncreased hunger and decreasedmetabolism. This evolutionary survivalstrategyhasasinglepurpose:to
makeus
regainthelostweight. Functional magnetic resonanceimagingstudiesshowthatareasoft hebraincontrollingemotionandcognitionli ghtup inresponseto food stimuli. Areas of the prefrontal cortex involvedwith restraint show decreased activity.In other words, it is harder for peoplewho have lost weight to resist food.15Thishasnothingwhatsoevertodo with a lack of willpower or any kind ofmoral failure. It’s a normal hormonalfact of life. We feel hungry, cold, tiredanddepressed. Theseareallreal,measurable physical effects of calorierestriction. Reduced metabolism and theincreased hunger are not the cause ofobesity— theyaretheresult.Losing
weight causes the reduced metabolismand increased hunger, not the other wayaround.Wedonotsimplymakeaperson al choice to eat more. One of thegreat pillars of the caloric-reductiontheory of obesity—that we eat too muchbecause we choose to—is simply nottrue.Wedonoteattoomuchbecausewec hoose to, or because food is toodelicious, or because of salt, sugar andfat.Weeattoomuchbecauseourownbra incompelsusto.
THEVICIOUSCYCLEOFUNDER- EATING ANDSOWEhavetheviciouscycleofunder- eating. We start by eating less andlose some weight. As a result, ourmetabolism slows and hunger increases.Westarttoregainweight.Wedou bleourefforts by eating even less. A bit moreweight comes off, but again, total energyexpenditure decreases and hungerincreases. We start regaining weight. Sowe redouble our efforts by eating evenless. This cycle continues until it isintolerable. We are cold, tired, hungryand obsessing about calories. Worst ofall,theweightalwayscomesbackon. At some point, we go back to our
oldwayofeating.Sincemetabolismhas
slowed so much, even resuming the oldwayofeatingcausesquickweightgain, up to and even a little past the originalpoint. We are doing exactly what ourhormonesareinfluencingustodo.Butfri ends, family and medicalprofessionals silently blame the victim,thinkingthatitis“ourfault.”Andwe ourselvesfeelthatweare afailure. Soundfamiliar? All dieters share this same sad storyof weight loss and regain. It’s a virtualguarantee. The cycle has beenscientifically established, and its truthhas been forged in the tears of millionsof dieters. Yet nutritional authoritiescontinue to preach that caloric
reductionwillleadtonirvanaofpermanent weight
loss.Inwhatuniversedotheylive?
THE CRUELHOAX CALORICREDUCTIONISaharshandbitterdisa ppointment. Yet all the “experts”still agree that caloric reduction is thekey to lasting weight loss. When youdon’tloseweight,theysay,“It’syourfau lt. You were gluttons. You weresloths. You didn’t try hard enough. Youdidn’t want it badly enough.” There’s adirty little secret that nobody is willingto admit: The low-fat, low-calorie diethas already been proven to fail. This isthecruelhoax.Eatinglessdoesnotresulti nlastingweightloss.It.Just. Does.Not.Work. It is cruel because so many of us havebelieved it. It is cruel because all of our“trusted healthsources”tellusitistrue.
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It is cruel because when it fails, weblame ourselves. Let me state it asplainlyasIcan:“EatLess” doesnotwork.That’safact.Acceptit. Pharmaceutical methods of caloricreduction only emphasize the spectacularfailure of this paradigm. Orlistat(marketed in the U.S. as Alli) wasdesigned to block the absorption ofdietary fat. Orlistat is the drugequivalent of the low-fat, low- caloriediet. Amongitsnumeroussideeffects,themo st bothersome was euphemisticallycalled fecal leakage and oily spotting.The unabsorbed dietary fat came out theother end, where it often stainedunderwear.Weight-
lossforumschimed
in with useful advice about the “orangepoopoil.” Neverwearwhite pants. Never assume it’s just a fart. In 2007,Alli won the “Bitter Pill Award” forworst drug from the U.S. consumergroup Prescription Access Litigation.Thereweremoreseriousconce rnssuchas liver toxicity, vitamin deficiency andgallstones. However, orlistat’sinsurmountable problem was that it didnotreallywork.16 In a randomized, double- blindcontrolled study,17four years of takingthe medication three times daily resultedin an extra 6 pounds (2.8 kilograms) ofweight loss. But 91 percent of thepatients complained of
side effects. Ithardlyseemedworththe trouble.Sales
of the drug peaked in 2001 at $600million. Despite being sold over thecounter,by2013,saleshadplummetedt o$100million. The fake fat olestra was a similarlyill-conceived notion, born out ofcaloric-reduction theory. Released togreat fanfare several years ago, olestrawas not absorbed by the body and thushad no caloric impact. Its sales began tosink within two years of release.18Theproblem? It led to no significant weightloss. By 2010, it landed on Timemagazine’s list of the fifty worstinventions,justbehindasbestos.19
(4)
THEEXERCISE MYTH DR. PETER ATTIAisthe cofounder ofNutrition Science Initiative (NuSi), anorganization dedicated to improving thequality of science in nutrition andobesity research. A few years ago, hewas an elite long-distance swimmer, oneof only a dozen or so people to haveswum from Los Angeles to CatalinaIsland. A physician himself, he followedthe standard prescribed diet high incarbohydrates and trained religiously forthree to four hours daily. He was also,by his own estimation, about fortypounds (18 kilograms) overweight
withabodymassindexof29and25percent
bodyfat. Butisn’tincreasingexercisethekeytow eightloss? Caloricimbalance— increasedcaloricintake combined with decreased caloricexpenditure—is considered the recipefor obesity. Up until now, we’veassumed that exercise was vitallyimportant to weight loss— that byincreasing exercise, we can burn off theexcesscaloriesthatweeat.
THE LIMITS OF EXERCISE: AHARSHREALITY CERTAINLY, EXERCISE HAS great healthbenefits. The early Greek physicianHippocrates, considered the father ofmedicine, said, “If we could give everyindividual the right amount ofnourishment and exercise, not too littleand not too much, we would have foundthe safest way to health.” In the 1950s,along with increasing concern aboutheartdisease,interestinphysicalacti vity and exercise began to grow. In1955, President Eisenhower establishedthePresident’sCouncilonYout hFitness.By 1966, the U.S. Public Health Servicebegan to advocate that increasingphysicalactivitywasoneoftheb
est
ways to lose weight. Aerobics studiosbegan to sprout like mushrooms after arainstorm. The CompleteBook ofRunningbyJimFixxbecamearunawayb estsellerin1977. The fact that he died at age fifty-two of a massive heart attack was only aminorsetbacktothecause.Dr.KennethCo oper’s book The New Aerobics wasrequired reading in the 1980s where Iwent to high school. More and morepeople began incorporating physicalactivityintotheirleisuretime. It seemed reasonable to expectobesity rates to fall as exercise ratesincreased.Afterall,governmentsaro undthe world have poured millions ofdollarsintopromotingexercisefor
weight loss, and they succeeded ingettingtheircitizensmoving.IntheU nitedKingdomfrom1997to2008,regu lar exercise increased from 32percent to 39 percent in men and 21percentto29percentinwomen.1 There’s a problem, though. All thisactivity had no effect on obesity at all.Obesityincreasedrelentlessly,evenas we sweated to the oldies. Just take alookatFigure 4.1,2.
Figure4.1. Theincreasingworldwideprevalenceof obesity. The phenomenon is global. A recenteight-country survey revealed thatAmericans exercised the most— 135days per year compared to a globalaverage of 112 days. The Dutch
came inlastat93days.3Weightlosswasthe
main motivation for exercise in allcountries. Did all this activity translateintolowerratesofobesity? Glad you asked. The Dutch andItalians, with their low exercise rates,experienced less than one-third theobesity of those iron- pumpingAmericans. The problem was apparent in theAmerican NHANESdata as well. From2001 to 2011, there was a generalincrease in physical activity.4Certainareas (Kentucky, Virginia, Florida andthe Carolinas) increased exercise atHerculean rates. But here’s the dismaltruth:whetherphysicalactivityinc reasesordecreases,ithasvirtuallynorelat ionshiptotheprevalenceof
obesity. Increasing exercise did notreduceobesity.Itwasirrelevant.Certain states exercised more. Other statesexercised less. Obesity increased by thesameamountregardless. Is exercise important in reducingchildhood obesity? The short answer isno.A2013paper5comparedthephysical activity (measured usingaccelerometry) of children aged three tofive years to their weight. The authorsconcludedthereisno associationbetween activityand obesity. Whatwentwrong? Inherent to the Calories In, CaloriesOut theory is the idea that reducedphysicalactivityplaysa keyrole
intheobesityepidemic.This ideais thatwe Do you want to loss your weight without any exercise than click here
used to walk everywhere, but now wedrive. With the increase in laborsavingdevices such as cars, our exercise hasdecreased, leading to obesity. Theproliferation of video games, televisionand computers is also believed tocontributetoasedentarylifestyle.Likean ygooddeception,thisonesoundspretty reasonable at first. There is asmall problem,though.Itisjustnottrue. Researcher Dr. Herman Pontzerstudied a hunter-gatherer society living aprimitivelifestyleinthemodernday. TheHadzainTanzaniaoftentravel15to20mil esperdaytogatherfood.Youmight assume that their daily energyexpenditureismuchhigherthanatypic
alofficeworker.Pontzerdiscussesthe
surprising results in a New York Timesarticle: “We found that despite all thisphysical activity, the number of caloriesthat the Hadza burned per day wasindistinguishable from that of typicaladultsinEuropeandtheUnitedStates. ”6 Even if we compare relatively recentactivity rates to those of the 1980s,before the obesity epidemic came intofull swing, rates have not decreasedappreciably.7In a Northern Europeanpopulation, physical-activity energyexpenditure was calculated from the1980s to the mid 2000s. The surprisingfinding was that if anything, physicalactivity has actually increased since
the1980s.Butthisstudy’sauthorswentone stepfurther.Theycalculatedthe
predicted energy expenditure for a wildmammal, which is predominantlydetermined by body mass and ambienttemperature. Compared to its wild- mammalcousinssuchastheseeminglyvigo rous cougar, fox and caribou, Homoobesus2015 isnotlessphysicallyactive. Exercise has not decreased sincehunter- gatherertimes,orevensincethe1980s,whil eobesityhasgallopedaheadfullsteam.Itish ighlyimprobablethatdecreased exercise played any role incausingobesityinthefirstplace. Iflackofexercisewasnotthe causeof obesity epidemic, exercise
isprobablynotgoingtoreverseit.
CALORIESOUT THE AMOUNT OFcalories used in a day(Calories Out)is moreaccuratelytermedtotalenergyexpen diture.Totalenergy expenditure is the sum of basalmetabolic rate (defined below),thermogeniceffectoffood,non- exerciseactivity thermogenesis, excess post-exercise oxygen consumption and, ofcourse,exercise. Totalenergyexpenditure=Basalmetaboli crate+Thermogeniceffectoffood + Nonexercise activitythermogenesis + Excess post- exerciseoxygenconsumption+ Exercise. The key point here is that total energyexpenditure is not the same as exercise.Theoverwhelmingmajorityoftot al
energyexpenditureisnotexercisebutthe basal metabolic rate: metabolichousekeeping tasks such as breathing,maintaining body temperature, keepingtheheartpumping,maintainingthe vitalorgans,brainfunction,liverfunction,k idneyfunction,etc. Let’stakeanexample.Basalmetabolic rate for a lightly activeaverage male is roughly 2500 caloriesperday.Walkingatamoderatepac e(2miles per hour) for forty-five minutesevery day, would burn roughly 104calories.Inotherwords,thatwillnotev enconsume5 percentofthetotalenergy expenditure. The vast majority(95 percent) of calories are used forbasalmetabolism.
Basalmetabolicratedependsonmanyfact ors,including genetics, gender(basalmetabolicrateisge nerallyhigherinmen), age(basalmetabolicrategenerallydr opswithage), weight (basal metabolic rategenerallyincreaseswithmusclem ass), height (basal metabolic rategenerally increases with height),diet (overfeeding or underfeeding),bodytemperature, externaltemperature(heatingorco olingthebody)and organfunction.
Nonexercise activity thermogenesis isthe energy used in activity other thansleeping, eating or exercise; for instance,inwalking,gardening,cooking,cl eaningand shopping. The thermogenic effect offood is the energy used in digestion andabsorptionoffoodenergy.Certainfood s, such as dietary fat, are easilyabsorbed and take very little energy tometabolize. Proteins are harder toprocessandusemoreenergy. Thermogenic effect of food variesaccordingtomealsize,mealfrequen cyand macronutrient composition. Excesspost-exercise oxygen consumption (alsocalled after-burn) is the energy used incellular repair, replenishment of
fuelstoresandotherrecoveryactivitiesafte r
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss
The Obesity Code_ Unlocking the Secrets of Weight Loss

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The Obesity Code_ Unlocking the Secrets of Weight Loss

  • 1.
  • 3. Thisbookisdedi cated to mybeautifulwife ,Mina. Thank you for yourloveand thestrengthyougive me.Icouldnotdoitwi thoutyou,norwould Ieverwantto.
  • 6. PART 4: The Social Phenomenon of ObesityCHAPTER 11: Big Food, More Food and theNewScienceofDiabesity CHAPTER12:PovertyandObesity CHAPTER13:ChildhoodObesity PART 5: What’s Wrong with Our Diet?CHAPTER14:TheDeadlyEffectsofFructose CHAPTER 15: The Diet Soda DelusionCHAPTER16:CarbohydratesandProtect iveFiber CHAPTER17:ProteinCHAPTE R18:FatPhobia PART 6: The SolutionCHAPTER19:Whatto EatCHAPTER20:WhentoEat APPENDIXA:SampleMealPlans(withFastingProto cols) APPENDIXB:Fasting:APracticalGuide APPENDIXC:MeditationandSleepHygieneto
  • 8. FOREWORD DR. JASON FUNG IS a Torontophysician specializing in the care ofpatients with kidney diseases. His keyresponsibility is to oversee the complexmanagement of patients with end-stagekidney disease requiring renal (kidney)dialysis. His credentials do not obviouslyexplain why he should author a booktitledTheObesityCodeorwhyheblog son the intensive dietary management ofobesityandtype2diabetesmellitus.Toun derstand this apparent anomaly, weneed first to appreciate who this man isandwhatmakeshimsounusual. Intreatingpatientswithend-stage
  • 9. kidney disease, Dr. Fung learned twokey lessons. First, that type 2 diabetes isthe single commonest cause of kidneyfailure. Second, that renal dialysis,however sophisticated and even lifeprolonging,treatsonlythefinalsympto ms of an underlying disease thathasbeenpresentfortwenty,thirty,forty or perhaps even fifty years. Gradually, itdawned on Dr. Fung that he waspracticing medicine exactly as he hadbeen taught: by reactively treating thesymptoms of complex diseases withoutfirst trying to understand or correct theirrootcauses. He realized that to make a differencetohispatients,hewouldhavetos tartbyacknowledgingabittertruth:thatour
  • 10. venerated profession is no longerinterested in addressing the causes ofdisease. Instead,itwastesmuchofitstime and many of its resourcesattemptingtotreatsymptoms. He resolved to make a real differenceto his patients (and his profession) bystrivingtounderstandthetruecausesthatu nderliedisease. Before December 2014, I wasunaware of Dr. Jason Fung’s existence.Then one day I chanced upon his twolectures— “TheTwoBigLiesofType2Diabetes” and “How to Reverse Type 2DiabetesNaturally”— onYouTube.Assomeone
  • 11. withaspecialinterestintype 2diabetes, not least because I have theconditionmyself,Iwasnaturally
  • 12. intrigued. Who, I thought, is this brightyoung man? What gives him the certaintythat type 2 diabetes can be reversed“naturally”?And howcanhebebraveenough to accuse his noble profession oflying? He will need to present a goodargument,Ithought. It took only a few minutes to realizethat Dr. Fung is not only legitimate, butalso more than able to look after himselfin any medical scrap. The argument hepresented was one that had beenbouncingaround,unresolved,inmyo wnmind for at least three years. But I hadnever been able to see it with the sameclarity or to explain it with the sameemphaticsimplicityashadDr.Fung.B ytheendofhistwolectures,IknewthatI
  • 13. had observed a young master at work.Finally,IunderstoodwhatIhadmissed . What Dr. Fung achieved in those twolectures was to utterly destroy thecurrentlypopularmodelforthemedical management of type 2 diabetes— themodelmandatedbyallthedifferentdiab etes associations around the world.Worse,heexplainedwhythiserrone ousmodel of treatment must inevitably harmthehealthofallpatientsunfortunateen oughtoreceive it. According to Dr. Fung, the first big liein the management of type 2 diabetes isthe claim that it is a chronicallyprogressive disease that simply getsworse with time, even in those
  • 15. medicineoffers.But,Dr.Fungargues,this is simply not true. Fifty percent ofthepatientsonDr.Fung’sIntensiveDiet ary Management (IDM) program,which combines dietary carbohydraterestriction and fasting, are able to stopusinginsulinafterafewmonths. Sowhyareweunabletoacknowledge the truth? Dr. Fung’sanswerissimple:wedoctorslietoou rselves. If type 2 diabetes is a curabledisease but all our patients are gettingworse on the treatments we prescribe,then we must be bad doctors. And sincewedidnotstudyforsolongatsuchgreat cost to become bad doctors, this failurecannot be our fault. Instead, we
  • 17. patients, who must unfortunately besuffering from a chronically progressiveand incurable disease. It is not adeliberate lie, Dr. Fung concludes, butone of cognitive dissonance— theinabilityto acceptablatanttruthbecauseaccepting it would be too emotionallydevastating. Thesecondlie,accordingtoDr.Fung,is our belief that type 2 diabetes is adiseaseofabnormalbloodglucoselevels for which the only correcttreatment is progressively increasinginsulin dosages. He argues, instead, thattype 2 diabetes is a disease of insulinresistance with excessive insulinsecretion— incontrasttotype 1diabetes,aconditionoftrueinsulinlack. To treat
  • 18. How Jones loss his weight without any exercise you want to learn this special method than click here
  • 19. bothconditionsthesameway— byinjectinginsulin— makesnosense.Whytreat a condition of insulin excess withyet more insulin, he asks? That is theequivalentofprescribingalcoholforthet reatmentofalcoholism. Dr.Fung’snovelcontributionishisinsight that treatment in type 2 diabetesfocusesonthesymptomofthediseas e—anelevatedblood glucoseconcentration —rather than its root cause, insulinresistance. And the initial treatment forinsulin resistance is to limitcarbohydrate intake. Understanding thissimple biology explains why thisdiseasemaybereversibleinsomecases —and, conversely, why the
  • 21. notlimitcarbohydrateintake,worsensth eoutcome. But how did Dr. Fung arrive at theseoutrageous conclusions? And how didtheyleadtohisauthorshipofthisbook? In addition to his realization,described above, of the long- term natureof disease and the illogic of treating adisease’ssymptomsratherthanremovingit s cause, he also, almost by chance, inthe early 2000s, became aware of thegrowingliteratureonthebenefitsof low-carbohydrate diets in those withobesity and other conditions of insulinresistance. Taught to believe that acarbohydrate-restricted, high-fat dietkills, he was shocked to discover theopposite:thisdietarychoiceproduces
  • 22. a
  • 23. range of highly beneficial metabolicoutcomes, especiallyinthosewiththeworstinsulinresi stance. Andfinallycamethecherryonthetop —a legion of hidden studies showingthat for the reduction of body weight inthose with obesity (and insulinresistance), this high-fat diet is at leastas effective, and usually much more so,thanothermoreconventionaldiets. Eventually, he could bear it no longer.Ifeveryoneknows(butwon’tadmit) thatthe low-fat calorie-restricted diet isutterly ineffective in controlling bodyweight or in treating obesity, surely it istime to tell the truth: the best hope fortreating andpreventing
  • 25. excessiveinsulinproduction,mustsurely be the same low-carbohydrate,high-fat diet used for the management ofthe ultimate disease of insulin resistance,type 2 diabetes. And so this book wasborn. In The Obesity Code, Dr. Fung hasproduced perhaps the most importantpopularbookyetpublishedonthis topicofobesity. Its strengths are that it is based on anirrefutable biology, the evidence forwhich is carefully presented; and it iswrittenwiththeeaseandconfidenceofam aster communicator in an accessible,well-reasoned sequence so that itsconsecutive chapters systematicallydevelop,layerbylayer,ane vidence-
  • 26. based biological model of obesity thatmakes complete sense in its logicalsimplicity. It includes just enoughscience to convince the skepticalscientist,butnotsomuchthatitcon fusesthosewithoutabackgroundinbiology. This feat in itself is a stunningachievementthatfewscience writerseveraccomplish. Bytheendofthebook,thecarefulreader will understand exactly thecausesoftheobesityepidemic, whyourattempts to prevent both the obesity anddiabetes epidemics were bound to fail,and what, more importantly, are thesimple steps that those with a weightproblem need to take to reverse theirobesity.
  • 27. The solution needed is that which Dr.Fung has now provided: “Obesity is... amultifactorial disease. What we need isa framework, a structure, a coherenttheorytounderstandhowallitsfact orsfit together. Too often, our current modelof obesity assumes that there is only onesingle true cause, and that all others arepretenderstothethrone.Endlessdebate sensue...Theyare allpartiallycorrect.” In providing one such coherentframework that can account for most ofwhat we currently know about the realcauses of obesity, Dr. Fung has providedmuch,muchmore. Hehasprovidedablueprintfortherev ersal of the greatest medicalepidemicsfacingmodernsocie
  • 28. ty—
  • 29. epidemics that he shows are entirelypreventableandpotentiallyrever sible,but only if we truly understand theirbiological causes—not just theirsymptoms. The truth he expresses will one day beacknowledgedas self-evident. Thesoonerthatdaydawns,thebetterforus all. TIMOTHYNOAKESOMS,MBChB,MD,DSc,PhD (hc), FACSM, (hon) FFSEM (UK), (hon)FSEM(Ire) EMERITUSPROFESSOR UNIVERSITYOFCAPETOWN,CapeTown, SouthAfrica
  • 30. INTRODUCTION THE ART OF medicine is quite peculiar.Onceinawhile,medicaltreatm entsbecome established that don’t reallywork.Throughsheerinertia,theset reatments get handed down from onegeneration of doctors to the next andsurvive for a surprisingly long time,despitetheirlackofeffectiveness. Consider the medicinal use of leeches(bleeding)or,say,routinetonsillec tomy. Unfortunately, the treatment of obesityis also one such example. Obesity isdefinedintermsofaperson’sbodymassind ex,calculatedasaperson’sweightinkilogra ms divided by the square of theirheightinmeters.Abodymassindex
  • 31. greater than 30 is defined as obese. Formore than thirty years, doctors haverecommendedalow-fat,calorie- reduceddiet as the treatment of choice forobesity. Yet the obesity epidemicaccelerates. From 1985 to 2011, theprevalence of obesity in Canada tripled,from 6 percent to 18 percent.1Thisphenomenonisnotuniqueto NorthAmerica, but involves most of thenationsofthe world. Virtually every person who has usedcaloric reduction for weight loss hasfailed.And,really,whohasn’ttriedit? By every objective measure, thistreatment is completely and utterlyineffective.Yetitremainsthetreat mentofchoice,defendedvigorouslyby
  • 32. nutritionalauthorities. As a nephrologist, I specialize inkidney disease, the most common causeof which is type 2 diabetes with itsassociated obesity. I’ve often watchedpatients start insulin treatment for theirdiabetes, knowing that most will gainweight. Patients are rightly concerned.“Doctor,”theysay,“you’vealw aystoldmetoloseweight.Buttheinsulinyou gavememakesmegainsomuchweight.How isthishelpful?”Foralongtime,Ididn’thave agoodanswerforthem. Thatnagginguneasegrew.Likemanydoc tors, I believed that weight gain wasa caloric imbalance—eating too muchand movingtoo little. Butifthatwereso,whydidthemedicationIp rescribed—
  • 33. insulin—cause such relentless weightgain? Everybody, health professionals andpatients alike, understood that the rootcause of type 2 diabetes lay in weightgain. There were rare cases of highlymotivated patients who had lostsignificantamountsofweight.Theirtyp e2 diabeteswouldalsoreversecourse. Logically, since weight was theunderlying problem, it deservedsignificant attention. Still, it seemed thatthe health profession was not even theleast bit interested in treating it. I wasguiltyascharged.Despitehavingworke d for more than twenty years inmedicine,Ifoundthatmyownnutritionalk nowledgewasrudimentary,atbest.
  • 34. Do you want to loss your weight without any exercise than click here
  • 35. Treatment of this terrible disease— obesity—was left to large corporationslikeWeightWatchers,aswell asvarioushucksters and charlatans mostlyinterested in peddling the latest weight-loss “miracle.” Doctors were not evenremotely interested in nutrition. Instead,the medical profession seemed obsessedwith finding and prescribing the nextnewdrug: Youhavetype2diabetes?Here,letme giveyoua pill. You have high blood pressure?Here,letmegiveyoua pill. You have high cholesterol? Here,letme give youa pill.
  • 37. megiveyoua pill. But all along, we needed to treatobesity. We were trying to treat theproblems caused by obesity rather thanobesity itself. In trying to understand theunderlying cause of obesity, I eventuallyestablished the Intensive DietaryManagementClinicinToronto,Ca nada. The conventional view of obesity as acaloricimbalancedidnotmakesense. Caloric reduction had been prescribedfor the last fifty years with startlingineffectiveness. Reading books on nutrition was nohelp. That was mostly a game of
  • 38. “hesaid, she said,” with many quoting“authoritative”doctors.Forex ample,
  • 39. Dr. Dean Ornish says that dietary fat isbadandcarbohydratesaregood.Heisares pected doctor, so we should listen tohim. But Dr. Robert Atkins said dietaryfatisgoodandcarbohydratesarebad. Hewasalso arespecteddoctor, so weshouldlistentohim.Whoisright?Whois wrong? In the science of nutrition,there is rarely any consensus aboutanything: Dietaryfatisbad.No,dietaryfatisgood . There are good fats and badfats. Carbohydrates are bad. No,carbohydratesaregood.Therea regoodcarbsandbadcarbs. Youshouldeatmoremealsaday.
  • 40. No, you should eat fewer meals aday. Countyourcalories.No,caloriesd on’tcount. Milk is good for you. No, milk isbadforyou. Meatisgoodforyou.No,meatisbad foryou. Todiscovertheanswers,weneedtotur n to evidence-based medicine ratherthanvagueopinion. Literally thousands of books aredevoted to dieting and weight loss,usually written by doctors, nutritionists,personal trainers and other “healthexperts.” However, with a fewexceptions,rarelyismore thana
  • 42. thoughtsparedfortheactualcausesofobe sity.Whatmakesusgainweight? Whydowegetfat? Themajorproblemisthecompletelack of a theoretical framework forunderstanding obesity. Current theoriesare ridiculouslysimplistic,oftentakingonlyo nefactorintoaccount: Excesscaloriescauseobesity.E xcess carbohydrates causeobesity. Excess meat consumption causesobesity. Excess dietary fat causes obesity.Toolittleexercisecausesobe sity.
  • 44. multifactorial, and these factors are notmutually exclusive. They may allcontribute to varying degrees. Forexample, heart disease has numerouscontributing factors—family history,gender, smoking, diabetes, highcholesterol, high blood pressure and alack of physical activity, to name only afew— andthatfactiswellaccepted.Butsuchisnott hecase inobesityresearch. Theothermajorbarriertounderstanding is the focus on short-termstudies. Obesity usually takes decades tofully develop. Yet we often rely oninformation about it from studies that areonly of several weeks’ duration. If westudyhowrustdevelops,wewouldneedt oobservemetaloveraperiodofweeks
  • 45. tomonths,nothours.Obesity,similarly,is a long-term disease. Short- termstudiesmaynotbeinformative. While I understand that the research isnot always conclusive, I hope this book,which draws on what I’ve learned overtwenty years of helping patients withtype 2 diabetes lose weight permanentlyto manage their disease, will provide astructuretobuildupon. Evidence-based medicine does notmean taking every piece of low- qualityevidence at face value. I often readstatements such as “low-fat diets provento completely reverse heart disease.”The reference will be a study of fiverats. That hardly qualifies as evidence. Iwillreferenceonlystudiesdoneon
  • 46. humans, and mostly only those that havebeen published in high-quality, peer-reviewed journals. No animal studieswill be discussed in this book. Thereason for this decision can beillustratedin“TheParableoftheCow”: Two cows were discussing the latestnutritional research, which had beendoneonlions.Onecowsaystotheother, “Did you hear that we’ve been wrongthese last 200 years? The latest researchshows that eating grass is bad for youandeatingmeatisgood.”Sothetwocow s began eating meat. Shortlyafterward,theygotsickandtheydie d. One year later, two lions werediscussing the latest nutritional
  • 48. to the other that the latest researchshowed that eating meat kills you andeating grass is good. So, the two lionsstartedeatinggrass,andtheydied. What’s the moral of the story? We arenot mice. We are not rats. We are notchimpanzeesorspidermonkeys.Wear ehumanbeings,andthereforeweshouldco nsider only human studies. I aminterested in obesity in humans, notobesity in mice. As much as possible, Itrytofocusoncausalfactorsratherthanass ociation studies. It is dangerous toassume that because two factors areassociated,oneisthecauseoftheother. Witness the hormone replacementtherapy disaster in post-
  • 49. menopausalwomen.Hormonereplaceme nttherapy How Jones loss his weight without any exercise you want to learn this special method than click here
  • 50. wasassociatedwithlowerheartdisease,bu tthatdidnotmeanthatitwasthecauseoflow erheartdisease. However, in nutritional research, it isnotalwayspossibletoavoidassociationst udies, as they are often the bestavailableevidence. Part 1 of this book, “The Epidemic,”explores the timeline of the obesityepidemic and the contribution of thepatient’sfamilyhistory,andshowshowbo thshedlightontheunderlyingcauses. Part 2, “The Calorie Deception,”reviews the current caloric theory indepth, including exercise andoverfeedingstudies.Theshortcomin gsof the current understanding of obesityarehighlighted.
  • 51. Part 3, “A New Model of Obesity,”introducesthehormonaltheoryo fobesity, a robust explanation of obesityas a medical problem. These chaptersexplain the central role of insulin inregulatingbodyweightanddescribethev itally important role of insulinresistance. Part 4, “The Social Phenomenon ofObesity,” considers how hormonalobesity theory explains some of theassociationsofobesity.Whyisobesity associated with poverty? What can wedoaboutchildhoodobesity? Part 5, “What’s Wrong with OurDiet?,”explorestheroleoffat,protein and carbohydrates, the
  • 53. addition, we examine one of the mainculprits in weight gain— fructose— andtheeffectsofartificialsweeteners. Part 6, “The Solution,” providesguidelines for lasting treatment ofobesity by addressing the hormonalimbalance of high blood insulin. Dietaryguidelines for reducing insulin levelsinclude reducing added sugar andrefined grains, keeping proteinconsumption moderate, and addinghealthy fat and fiber. Intermittent fastingis an effective way to treat insulinresistance without incurring the negativeeffects of calorie reduction diets. Stressmanagement and sleep improvement canreducecortisollevelsandcontrolinsuli
  • 54. n.
  • 55. The Obesity Code will set forth aframework for understanding thecondition of human obesity. Whileobesity shares many importantsimilarities and differences with type 2diabetes,this is primarilyabookaboutobesity. The process of challenging currentnutritional dogma is, at times, unsettling,butthehealthconsequencesaret ooimportant to ignore. What actuallycauses weight gain and what can we doabout it? This question is the overalltheme of this book. A fresh frameworkfortheunderstandingandtreatm entofobesity represents a new hope for ahealthierfuture.
  • 58. (1)
  • 59. HOWOBESITY BECAMEANEPIDEMIC Ofalltheparasitesthataf fecthumanity,Idonotkn owof,norcanIimagine, anymoredistressingtha nthatofObesity. WILLIAMBANTING HERE’S THE QUESTIONthat has alwaysbotheredme:Whyaretheredoctors whoare fat? Accepted as authorities inhumanphysiology,doctorsshouldbetrue expertsonthecausesandtreatmentsof obesity. Most doctors are also veryhardworking and self-disciplined. Sincenobodywantstobefat,doctorsin
  • 60. particular should have both theknowledge and the dedication to staythinandhealthy. Sowhyaretherefatdoctors? The standard prescription for weightlossis“EatLess,MoveMore.”Itsou nds perfectly reasonable. But whydoesn’titwork?Perhapspeoplewanti ngto lose weight are not following thisadvice.Themindiswilling,buttheflesh is weak. Yet consider the self- disciplineand dedication needed to complete anundergraduate degree, medical school,internship,residencyandfellowshi p.Itis hardly conceivable that overweightdoctors simply lack the willpower tofollowtheirownadvice. Thisleavesthepossibilitythatthe
  • 61. conventional advice is simply wrong.And if it is, then our entire understandingofobesityisfundamentallyf lawed. Given the current epidemic of obesity, Isuspect that such is the most likelyscenario. So we need to start at the verybeginning, with a thorough understandingofthediseasethatishumanob esity. Wemuststartwiththesinglemostimport antquestionregardingobesityoranydisea se:“Whatcausesit?”Wespend no time considering this crucialquestion because we think we alreadyknow the answer. It seems so obvious:it’s a matter of Calories In versusCaloriesOut. Acalorieisaunitoffood
  • 63. breathing,buildingnewmuscleandbone, pumping blood and othermetabolic tasks. Some food energy isstored as fat. Calories In is the foodenergy that we eat. Calories Out is theenergyexpendedforallofthesevarious metabolicfunctions. Whenthenumberofcalorieswetakein exceeds the number of calories weburn, weight gain results, we say. Eatingtoo much and exercising too little causesweight gain, we say. Eating too manycaloriescausesweightgain,wesay. These “truths” seem so self-evident thatwe do not question whether they areactuallytrue.Butarethey?
  • 64. PROXIMATEVERSUSULTIMATECA USE EXCESS CALORIES MAY certainly be theproximatecauseofweightgain,butnot itsultimatecause. What’s the difference betweenproximateandultimate?Theprox imatecauseisimmediatelyresponsible,w hereas the ultimate cause is whatstartedthechainofevents. Consider alcoholism. What causesalcoholism? The proximate cause is“drinkingtoomuchalcohol”— whichisundeniably true, but not particularlyuseful.Thequestionandthecau sehereareoneandthesame,sincealcoholis mmeans “drinking too much alcohol.”Treatmentadvicedirectedagain
  • 65. stthe
  • 66. proximate cause—“Stop drinking somuchalcohol”—isnotuseful. Thecrucialquestion,theonethatweare really interested in, is: What is theultimate cause of why alcoholismoccurs.Theultimatecauseincl udes the addictive nature of alcohol,anyfamilyhistoryofalcoh olism,excessive stress in the homesituationand/or anaddictive personality. There we have the real disease, andtreatment must be directed against theultimate,ratherthantheproximatecause. Understandingtheultimatecauseleadstoeff
  • 67. ectivetreatmentssuchas(inthis Do you want to loss your weight without any exercise than click here
  • 68. case) rehabilitation and social supportnetworks. Let’stakeanotherexample.Whydoesa plane crash? The proximate cause is,“there was not enough lift to overcomegravity”—again, absolutely true, but notin any way useful. The ultimate causemightbe human error,mechanical fault and/orinclementweathe r. Understandingtheultimatecauseleads to effective solutions such asbetter pilot training or tightermaintenance schedules. Advice
  • 70. wings,morepowerfulengines)willnotre duce plane crashes. This understanding applies toeverything. For instance, why is it so hotinthisroom? PROXIMATE CAUSE: Heat energycominginisgreaterthanheatener gyleaving. SOLUTION: Turn on the fans to increasetheamountofheatleaving. ULTIMATECAUSE:Thethermostatissettoo high. SOLUTION: Turn down the thermostat.Whyistheboatsinking? PROXIMATE CAUSE: Gravity is strongerthanbuoyancy. SOLUTION:Reducegravitybylig hteningtheboat.
  • 71. ULTIMATECAUSE:Theboathasalargeholei nthehull. SOLUTION:Patchthehole. In each case, the solution to theproximate cause of the problem isneitherlastingnormeaningful.Bycontras t,treatmentoftheultimatecauseisfarmore successful. Thesameappliestoobesity:Whatca usesweightgain? Proximatecause:Consumingmorecalori es thanyouexpend. If more calories in than out is theproximatecause,theunspokenanswerto that last question is that the ultimatecause is “personal choice.” We chooseto eat chips instead of broccoli. WechoosetowatchTVinsteadofexercise.
  • 72. Through this reasoning, obesity istransformed from a disease that needs tobe investigated and understood into apersonal failing,acharacter defect. Insteadofsearchingfortheultimatecau se of obesity, we transform theprobleminto eating too much (gluttony) and/orexercisingtoolittle(sloth). Gluttony and sloth are two of theseven deadly sins. So we say of theobese that they “brought it onthemselves.” They “let themselves go.”It gives us the comforting illusion thatwe understand ultimate cause of theproblem.Ina2012onlinepoll,161
  • 73. percent of U.S. adults believed that“personal choices about eating andexercise” were responsible fortheobesity epidemic. So we discriminateagainstpeoplewhoareobese .Webothpityandloathethem. However, on simple reflection, thisidea simply cannot be true. Prior topuberty,boysandgirlsaveragethesame body-fat percentage. After puberty,women on average carry close to 50percent more body fat than men. Thischange occurs despite the fact that menconsume more calories on average thanwomen.Butwhyis thistrue? What is the ultimate cause? It hasnothingtodowithpersonalchoices.Itisn otacharacterdefect.Womenarenot
  • 74. moregluttonousorlazierthanmen.Thehorm onal cocktail that differentiates menand women must make it more likely thatwomen will accumulate excess caloriesasfatasopposedtoburningthemoff. Pregnancy also induces significantweightgain.Whatistheultimatec ause?Again, it is obviously the hormonalchangesresultingfromthepregnan cy —not personal choice—that encouragesweightgain. Having erred in understanding theproximate and ultimate causes, webelievethesolutiontoobesityis toeatfewercalories. The“authorities”allagree.TheU.S.Dep artment of Agriculture’s DietaryGuidelinesforAmericans,updated
  • 75. in
  • 76. 2010, forcefully proclaims its keyrecommendation:“Controltotalcalo rieintaketomanagebodyweight.”TheCen ters for Disease Control2exhortpatients to balance their calories. TheadvicefromtheNationalInstitutesof Health’s pamphlet “Aim for a HealthyWeight”is“tocutdownonthenum berof calories... they get from food andbeverages and increase their physicalactivity.”3 Allthisadviceformsthefamous“EatLe ss, Move More” strategy so belovedby obesity “experts.” But here’s apeculiar thought: If we alreadyunderstand what causes obesity, how totreat it, and we’ve spent millions
  • 79. ANATOMYOFANEPIDEMIC WEWEREN’TALWAYSsoobsessedwithcalorie s. Throughout most of humanhistory,obesityhasbeenrare. Individuals in traditional societies eatingtraditional diets seldom became obese,even in times of abundant food. Ascivilizationsdeveloped,obesityfollow ed. Speculating on the cause,many identified the refinedcarbohydratesofsugarandstarches . Sometimes considered the father of thelow- carbohydrate diet, Jean AnthelmeBrillat-Savarin (1755–1826) wrote theinfluential textbook The Physiology ofTaste in 1825. There he wrote: “Thesecond of the chief causes of obesity
  • 81. manmakestheprimeingredientsofhisdaily nourishment. As we have saidalready, all animals that live onfarinaceous food grow fat willy- nilly;andmanisnoexceptiontotheuniversa llaw.”4 All foods can be divided into threedifferent macronutrient groups: fat,protein and carbohydrates. The “macro”in“macronutrients”referstothefa ctthatthebulkofthefoodweeatismadeupoft hese three groups. Micronutrients,which make up a very small proportionof the food, include vitamins andmineralssuchasvitaminsA,B,C,D,Ean d K, as well as minerals such as ironandcalcium.Starchyfoodsandsugarsa
  • 83. Severaldecadeslater,WilliamBanting (1796–1878), an Englishundertaker, rediscovered the fatteningpropertiesoftherefinedcarbohyd rate.In1863,hepublishedthepamphletLett eron Corpulence, Addressed to thePublic, which is often considered theworld’s first diet book. His story israther unremarkable. He was not anobese child, nor did he have a familyhistory of obesity. In his mid- thirties,however, he started to gain weight. Notmuch; perhaps a pound or two per year.By age sixty-two, he stood five foot fiveandweighed202pounds(92kilograms ).Perhaps unremarkable by modernstandards, he was considered quiteportlyatthetime.Distressed,hesought
  • 84. How Jones loss his weight without any exercise you want to learn this special method than click here
  • 85. adviceonweightlossfromhisph ysicians. First,hetriedtoeatless,butthatonlyleft him hungry. Worse, he failed to loseweight. Next, he increased his exerciseby rowing along the River Thames, nearhishomeinLondon.Whilehisphysicalf itness improved, he developed a“prodigious appetite, which I wascompelled to indulge.”5Still, he failedtolose weight. Finally,ontheadviceofhissurgeon,Banti ngtriedanewapproach.Withtheideathatsug aryand starchyfoodswerefattening, he strenuously avoided allbreads,milk,beer,sweetsandpotatoesth at had previously made up a largeportionofhis diet.(Todaywewould
  • 86. call this diet low in refinedcarbohydrates.) William Banting notonly lost the weight and kept it off, buthe also felt so well that he wascompelledtowritehisfamouspamphle t.Weight gain, he believed, resulted fromeating too many “fatteningcarbohydrates.” Formostofthenextcentury,diets lowin refined carbohydrates were acceptedas the standard treatment for obesity. Bythe 1950s, it was fairly standard advice.If you were to ask your grandparentswhat caused obesity, they would not talkabout calories. Instead, they would tellyou to stop eating sugary and starchyfoods. Common sense and empiricobservationservedtoconfirmthetr uth.
  • 87. Nutritional“experts”andgovernmento pinionwere notneeded. Caloriecountinghadbegunintheearly 1900s with the book Eat Your Wayto Health, written by Dr. Robert HughRose as a “scientific system of weightcontrol.” That book was followed up in1918 with the bestseller Diet andHealth,withKeytotheCalories,writte n by Dr. Lulu Hunt Peters, anAmerican doctor and newspapercolumnist. Herbert Hoover, then the headof the U.S. Food Administration,convertedtocaloriecount ing.Dr.Petersadvised patients to start with a fast, oneto two days abstaining from all foods,and then stick strictly to 1200 caloriesperday.Whiletheadvicetofastwas
  • 88. quicklyforgotten,moderncalorie- counting schedules are not verydifferent. By the 1950s, a perceived “greatepidemic” of heart disease wasbecominganincreasingpublicconcer n.Seemingly healthy Americans weredeveloping heart attacks with growingregularity. In hindsight, it should havebeen obvious that there was really nosuchepidemic. The discovery of vaccines andantibiotics, combined with increasedpublic sanitation, had reshaped themedical landscape. Formerly lethalinfections, such as pneumonia,tuberculosis and gastrointestinalinfections,becamecu rable.Heart
  • 89. disease and cancer now caused arelatively greater percentage of deaths,giving rise to some of the publicmisperception of an epidemic. (SeeFigure 1.1.6) Figure1.1.CausesofdeathintheUnitedS tates1900vs.1960. The increase in life expectancy from1900to1950reinforcedthepercepti
  • 90. on
  • 91. of a coronary-disease epidemic. For awhite male, the life expectancy in 1900was fifty years.7By 1950, it hadreached sixty-six years, and by 1970,almost sixty-eight years. If people werenot dying of tuberculosis, then theywould live long enough to develop theirheart attack. Currently, the average ageat first heart attack is sixty-six years.8The risk of a heart attack in a fifty-year-old man is substantially lower than in asixty-eight-year-old man. So the naturalconsequence of a longer life expectancyisanincreasedrateofcoronary disease. Butallgreatstories needavillain, and dietary fat was cast into that
  • 92. role.Dietary fat was thought to increase theamountofcholesterol,afattysubstance
  • 93. that is thought to contribute to heartdisease, in the blood. Soon, physiciansbegantoadvocate lower- fatdiets.Withgreat enthusiasm and shaky science, thedemonization of dietary fat began inearnest. There was a problem, though wedidn’t see it at the time. The threemacronutrients are fat, protein andcarbohydrates: lowering dietary fatmeantreplacingitwitheitherproteinorc arbohydrates. Since many high- proteinfoods like meat and dairy are also highin fat, it is difficult to lower fat in thedietwithoutloweringproteinaswell. So,ifone were torestrictdietaryfats,then one must increase dietarycarbohydrates
  • 95. developed world, these carbohydratesalltendtobehighlyrefine d. Low Fat = High CarbohydrateThisdilemmacreate dsignificant cognitive dissonance. Refinedcarbohydrates could not simultaneouslybe both good (because they are low infat)andbad(becausetheyarefattening).T he solution adopted by most nutritionexperts was to suggest thatcarbohydrateswerenolongerfattenin g.Instead,calorieswerefattening.Without evidence or historical precedent, it wasarbitrarily decided that excess caloriescausedweightgain,notspecificfo ods.
  • 97. In/Calories-Out model began to displacethe prevailing “fattening carbohydrates”model. But not everybody bought in. One ofthe most famous dissidents was theprominent British nutritionist JohnYudkin (1910–1995). Studying diet andheart disease, he found no relationshipbetween dietary fat and heart disease.Hebelievedthatthemainculpritof bothobesity and heart disease was sugar.9,10His 1972 book, Pure, White andDeadly:HowSugarIsKilling Us,iseerily prescient (and should certainlywin the award for Best Book TitleEver). Scientific debate raged back andforth about whether the culprit
  • 99. THEDIETARYGUIDELINES THE ISSUEWASfinallysettledin1977,notby scientific debate and discovery, butby governmental decree. GeorgeMcGovern, then chairman of the UnitedStates Senate Select Committee onNutrition and Human Needs, convened atribunal, and after several days ofdeliberation, it was decided thathenceforth, dietary fat was guilty ascharged. Not only was dietary fat guiltyof causing heart disease, but it alsocaused obesity,sincefatiscaloricallydense. The resulting declaration became theDietaryGoalsfortheUnitedStates.Ane ntire nation, and soon the entire world,wouldnowfollownutritionaladvice
  • 100. from a politician. This was a remarkablebreak from tradition. For the first time, agovernment institution intruded into thekitchens of America. Mom used to tell uswhat we should and should not eat. Butfrom now on, Big Brother would betelling us. And he said, “Eat less fat andmorecarbohydrates.” Severalspecificdietarygoalsweresetf orth.Theseincluded raiseconsumptionofcarbohydratesu ntiltheyconstituted55percentto60pe rcent ofcalories,anddecrease fat consumption fromapproximately 40 percent ofcalories to 30 percent, of which nomorethanone- thirdshouldcome
  • 101. Do you want to loss your weight without any exercise than click here
  • 102. fromsaturatedfat. With no scientific evidence, theformerly “fattening”carbohydratemadeastunningtra nsformation.Whiletheguidelines still recognized the evils ofsugar, refined grain was as innocent as anuninaconvent.Itsnutritionalsinswereex onerated, and it was henceforth rebornandbaptizedasthehealthywholegrai n. Was there any evidence? It hardlymattered. The goals were now thenutritionalorthodoxy.Everythingelse was heathen. If you didn’t toe the line,you were ridiculed. The DietaryGuidelinesforAmericans,
  • 104. recommendations of the McGovernreportclosely.Thenutritionalla ndscapeoftheworldwas foreverchanged. TheDietaryGuidelinesforAmericans, now updated every fiveyears, spawned the infamous foodpyramidinallitscounterfactualglory. The foods that formed the base of thepyramid— thefoodsweshouldeateverysingleday— werebreads,pastasand potatoes. These were the precisefoods that we had previously avoided tostaythin.Forexample,theAmericanHear tAssociation’s1995pamphlet,TheAmeri can Heart Association Diet: AnEatingPlan forHealthyAmericans,declared we should eat six or
  • 106. starchy vegetables (that) are low in fatand cholesterol.” To drink, “Choose...fruit punches, carbonated soft drinks.”Ahhh. White bread and carbonated softdrinks—the dinner of champions. Thankyou,AmericanHeartAssociation(AH A). Entering this brave new world,Americans tried to comply with thenutritionalauthoritiesofthedayandmad e a conscious effort to eat less fat,less red meat, fewer eggs and morecarbohydrates. When doctors advisedpeople to stop smoking, rates droppedfrom33percentin1979to25perce ntby1994. When doctors said to controlblood pressure and cholesterol, therewas a 40 percent decline in high
  • 108. cholesterol. When the AHA told us to eatmore bread and drink more juice, we atemorebreadanddrankmorejuice. Inevitably, sugar consumptionincreased. From 1820 to 1920, newsugar plantations in the Caribbean andAmerican South increased theavailability of sugar in the U.S. Sugarintakeplateauedfrom1920to1977 . Eventhough“avoidtoomuchsugar”was anexplicitgoalofthe1977DietaryGuideli nes for Americans, consumptionincreasedanywayuntiltheye ar2000. With all our attention focused on fat, wetookoureyesofftheball.Everythingwas “lowfat”or“lowcholesterol,”andnobody
  • 110. increasedtheaddedsugarsinprocessedfood forflavor. Refined grain consumption increasedby almost 45 percent. Sincecarbohydrates in North America tendedto be refined, we ate more and morelow- fatbreadandpasta,notcauliflowerandkal e.11 Success! From 1976 to 1996, theaverage fat intake decreased from 45percentofcaloriesto35percent.Butterco nsumptiondecreased 38 percent. Animal protein decreased 13 percent.Egg consumption decreased 18 percent.Grains andsugarsincreased.
  • 111. Figure1.2.Increaseinobeseandextre melyobeseUnitedStatesadultsaged2 0–74. Until that point, the widespreadadoption of the low-fat diet wascompletelyuntested.Wehadnoideawh at effect it would have on humanhealth. But we had the fatal conceit thatwe were somehow smarter than 200,000yearsofMotherNature.So,turnin
  • 112. g
  • 113. away from the natural fats, we embracedrefined low-fat carbohydrates such asbread and pasta. Ironically, theAmerican Heart Association, even aslate as the year 2000, felt that low- carbohydratedietsweredangerousfads,de spitethefactthatthesedietshadbeeninusea lmostcontinuouslysince1863. Whatwastheresult?Theincidenceofhea rt disease certainly did not decreaseas expected. But there was definitely aconsequencetothisdietarymanipulation — anunintentionalone.Ratesofobesity,define d as having a body mass indexgreater than 30, dramatically increased,starting almost exactly in 1977, asillustratedbyFigure 1.2.12 Theabruptincreaseinobesitybegan
  • 114. exactly with the officially sanctionedmove toward a low-fat, high- carbohydrate diet. Was it merecoincidence?Perhapsthefaultlayinou rgeneticmakeupinstead.
  • 115. (2)
  • 116. INHERITING OBESITY IT IS FAIRLYobvious that obesity runs infamilies.1Obese children often haveobese siblings. Obese children becomeobese adults.2Obese adults go on tohaveobesechildren.Childhoodobesityi s associated with a 200 percent to 400percent increased risk of adult obesity.This is an undeniable fact. Thecontroversy revolves around whetherthis trend is a genetic or anenvironmental problem—the classicnatureversusnurturedebate. Familiessharegeneticcharacteristics that may lead to obesity.
  • 118. the1970s.Ourgenescouldnothavecha ngedwithinsuchashorttime. Geneticscanexplainmuchoftheinter- individual risk of obesity, but not whyentirepopulationsbecomeobese. Nonetheless, families live in the sameenvironment,eatsimilarfoodsatsimi lartimesandhavesimilar attitudes. Families often share cars, live in thesamephysicalspaceandwillbeexpose dtothesamechemicalsthatmaycause obesity—so-called chemicalobesogens. For these reasons, manyconsider the current environment themajorcauseofobesity. Conventional calorie-based theoriesof obesity place the blame squarely onthis“toxic”environmentthatencourages
  • 119. How Jones loss his weight without any exercise you want to learn this special method than click here Do you want to loss your weight without any exercise than click here
  • 120. eating and discourages physicalexertion. Dietary and lifestyle habitshavechangedconsiderablysincet he1970sincluding adoption of a low-fat, high- carbohydrate diet,increased number of eatingopportunitiesperday, moremealseatingout,more fast-food restaurants,more time spent in cars andvehicles, increased popularityofvideosgames, increased use of computers,increasein dietary sugar,increaseduseofhigh-
  • 122. syrupand increased portionsizes. Anyorallofthesefactorsmaycontribute to the obesogenicenvironment. Therefore, most moderntheories of obesity discount theimportanceofgeneticfactors,believin ginstead that consumption of excesscalories leads to obesity. Eating andmoving are voluntary behaviors, afterall,withlittlegeneticinput. So— exactlyhowmuchofaroledoesgeneticsplayi nhumanobesity?
  • 123. NATUREVERSUSNURTURE THE CLASSIC METHODfor determining therelative impact of genetic versusenvironmental factors is to studyadoptive families, thereby removinggeneticsfromtheequation.Byco mparing adoptees to their biologicaland adoptive parents, the relativecontribution of environmental influencescan be isolated. Dr. Albert J. Stunkardperformed some of the classic geneticstudies of obesity.3Data aboutbiological parents is often incomplete,confidential and not easily accessible byresearchers. Fortunately, Denmark hasmaintained a relatively complete registryof adoptions, with information on bothsetsofparents.
  • 124. Studyingasampleof540Danishadultado ptees, Dr. Stunkard compared themto both their adoptive and biologicalparents. If environmental factors weremost important, then adoptees shouldresemble their adoptive parents. Ifgenetic factors were most important, theadoptees should resemble theirbiologicalparents. Norelationshipwhatsoeverwasdiscover ed betweentheweightoftheadoptiveparentsa ndtheadoptees. Whetheradoptiveparentswerethinorfat made no difference to the eventualweight of the adopted child. Theenvironment provided by the adoptiveparentswaslargelyirrelevant. Thisfindingwasaconsiderable
  • 125. shock. Standard calorie-based theoriesblame environmental factors and humanbehaviors for obesity. Environmentalcues such as dietary habits, fast food,junkfood,candyintake,lackofexerci se,number of cars, and lack of playgroundsandorganizedsportsarebelie vedcrucialinthedevelopmentofobesity. Buttheyplayvirtuallyno role. Infact,the fattest adoptees had the thinnestadoptive parents. Comparing adoptees to theirbiologicalparentsyieldedaconsider ablydifferentresult.Heretherewas a strong, consistent correlationbetween their weights. The biologicalparents had very little or nothing to dowithraisingthesechildren,orteaching
  • 126. themnutritionalvaluesorattitudestoward exercise. Yet the tendencytoward obesity followed them likeducklings. When you took a child awayfromobeseparentsandplacedthemint oa “thin” household, the child stillbecame obese. Whatwasgoingon? Studying identical twins raised apartis another classic strategy to distinguishenvironmentalandgeneticfac tors. Identicaltwinsshareidenticalgeneticm aterial, and fraternal twins share 25percentoftheirgenes. In1991, Dr. Stunkard examined sets of fraternal andidentical twins in both conditions ofbeing reared apart and reared together.4Comparisonoftheirweightswo
  • 127. uld
  • 128. determine the effect of the differentenvironments. The results sent ashockwave through the obesity- researchcommunity. Approximately 70 percent ofthevariance inobesityisfamilial. Seventypercent. Seventypercentofyourtendencytogai n weight is determined by yourparentage. Obesity is overwhelminglyinherited. However, it is immediately clear thatinheritance cannot be the sole factorleading to the obesity epidemic. Theincidenceofobesityhasbeenrelativel ystable through the decades. Most of theobesityepidemicmaterializedwithina single generation. Our genes have notchangedinthattimespan.Howcanwe
  • 130. THETHRIFTY- GENEHYPOTHESIS THE FIRST ATTEMPTto explain the geneticbasis of obesity was the thrifty- genehypothesis, which became popular in the1970s. This hypothesis assumes that allhumans are evolutionarily predisposedtogainweightasasurvivalmec hanism. Theargumentgoessomethinglikethis: In Paleolithic times, food wasscarceanddifficulttoobtain.Hungeri sone of the most powerful and basic ofhuman instincts. The thrifty genecompels us to eat as much as possible,and this genetic predisposition to gainweighthadasurvivaladvantage. Increasingthebody’sfoodstores(fat)permitt
  • 132. scarce or no food. Those who tended toburnthecaloriesinsteadofstoringthem were selectively wiped out. However,thethriftygeneisilladaptedtothe modern all-you-can-eat world, as itcauses weight gain and obesity. But weare simply following our genetic urge togainfat. Likeadecomposingwatermelon,thishyp othesisseemsquitereasonableonthesurfac e. Cut a little deeper, and you findthe rotten core. This theory has longceasedtobetaken seriously.However,it is still mentioned in the media, and soits flaws bear some examination. Themost obvious problem is that survival inthe wild depends on not being eitherunderweightoroverweight.Afatani
  • 133. mal
  • 134. is slower and less agile than its leanerbrethren.Predatorswouldpreferenti allyeat the fatter prey over the harder-to- catch, lean prey. By the same token, fatpredators would find it much moredifficulttocatchleanandswiftprey. Body fatness does not always provide asurvival advantage, but instead can be asignificant disadvantage. How manytimes have you seen a fat zebra orgazelle on the National Geographicchannel?Whataboutfatlionsa ndtigers? Theassumptionthathumansaregenetica lly predisposed to overeat isincorrect. Just as there are hormonalsignals of hunger, there are multiplehormonesthattelluswhenwe’refu llandstopusfromovereating.Consider
  • 135. the all-you-can-eat buffet. It isimpossibletosimplyeatandeatwithoutst opping because we get “full.”Continuing to eat may make us becomesickandthrowup.Thereisnogeneti cpredisposition to overeating. There is,instead, powerful built-in protectionagainstit. The thrifty-gene hypothesis assumeschronic food shortages preventedobesity. However, many traditionalsocieties had plentiful food year round.Forexample,theTokelau,aremotet ribein the South Pacific, lived on coconut,breadfruit and fish, which wereavailableyearround.Regardless,obe sity was unknown among them untiltheonsetofindustrializationandthe
  • 136. Do you want to loss your weight without any exercise than click here
  • 137. Westernization of their traditional diet.Even in modern-day North America,widespreadfaminehasbeenunco mmonsince the Great Depression. Yet thegrowth of obesity has happened onlysince the 1970s. In wild animals, morbid obesity israre, even with an abundance of food,exceptwhenitispartofthenormallife cycle,aswithhibernatinganimals. Abundant food leads to a rise in thenumbers of animals, not an enormousincrease intheirsize.Thinkaboutratsorcockroaches. When food is scarce, ratpopulations are low. When food isplentiful, rat populations explode. Therearemanymorenormal- sizedrats,notthesamenumberofmorbidlyo
  • 139. There is no survival advantage tocarryingaveryhighbody- fatpercentage.A male marathon runner may have 5percent to 11 percent bodyfat. Thisamount provides enough energy tosurviveformorethanamonthwithouteatin g.Certainanimalsfattenregularly. For instance, bears routinely gain weightbefore hibernation—and they do sowithout illness. Humans, though, do nothibernate. There is an importantdifference between being fat and beingobese. Obesity is the state of being fat tothe point of having detrimental healthconsequences.Bears,alongwithwh ales,walruses and other fat animals are fat,but not obese, since they suffer no
  • 141. genetically programmed to become fat.We aren’t. In humans, evolution did notfavorobesity,butrather,leanness. The thrifty-gene hypothesis doesn’texplain obesity, but what does? As wewill see in Part 3, “A New Model ofObesity,” the root cause of obesity is acomplex hormonal imbalance with highblood insulinasitscentralfeature.Thehormonal profile of a baby is influencedby the environment in the mother’s bodybefore birth, setting up a tendency forhigh insulin levels and associatedobesity later in life. The explanation ofobesity as a caloric imbalance simplycannot account for this predominantlygenetic effect, since eating and exercisearevoluntarybehaviors.Obesitya
  • 142. s a
  • 143. hormonalimbalancemoreeffectivelye xplainsthisgeneticeffect. But inherited factors account for only70percentofthetendencytoobesitythat we observe. The other 30 percent offactors are under our control, but whatshouldwedotomakethemostofthis? Aredietandexercisetheanswer?
  • 145. (3)
  • 146. THECALORIE- REDUCTIONERRO R TRADITIONALLY,OBESITYHASbeenseen as a result of how people processcalories, that is, that a person’s weightcouldbe predictedbya simpleequation: Calories In–Calories Out=BodyFatThiskeyequationperpetra teswhatI call the calorie deception. It isdangerous preciselybecauseitappearsso simple and intuitive. But what youneedtounderstandisthatmanyfalseass
  • 148. and CaloriesOutareindepende ntofeachother THISASSUMPTIONISacrucialmistake. As we’ll see later on in this chapter,experimentsandexperiencehave proventhisassumptionfalse.Caloricintake andexpenditure are intimately dependentvariables. Decreasing Calories IntriggersadecreaseinCaloriesOut.A30 percent reduction in caloric intakeresults in a 30 percent decrease incaloric expenditure. The end result isminimalweightloss. Assumption2:Basalmet
  • 150. barely a thought for caloric expenditure,except for exercise. Measuring caloricintake is simple, but measuring thebody’stotalenergyexpenditureiscomp licated. Therefore, the simple butcompletely erroneous assumption ismade that energy expenditure remainsconstant except for exercise. Totalenergy expenditure is the sum of basalmetabolic rate, thermogenic effect offood, nonexercise activitythermogenesis, excess post- exerciseoxygen consumption and exercise. Thetotal energy expenditure can go up ordown by as much as 50 percentdepending upon the caloric intake aswellasotherfactors.
  • 151. Assumption 3: We exertconsciouscontrolov erCaloriesIn EATINGISAdeliberateact,soweassume that eating is a conscious decision andthathungerplaysonlyaminorroleinit.B ut numerous overlapping hormonalsystems influence the decision of whento eat and when to stop. We consciouslydecide to eat in response to hungersignals that are largely hormonallymediated. We consciously stop eatingwhen the body sends signals of satiety(fullness) that are largely hormonallymediated. Forexample,thesmelloffryingfoodmake syouhungryatlunchtime.
  • 152. However, if you have just finished alarge buffet, those same smells maymake you slightly queasy. The smells arethe same. The decision to eat or not isprincipallyhormonal. Ourbodiespossessanintricatesystem guiding us to eat or not. Body- fatregulationisunderautomaticcontrol,lik e breathing. We do not consciouslyremind ourselves to breathe, nor do weremindourheartstobeat.Theonlywayto achieve such control is to havehomeostatic mechanisms. Sincehormones control both Calories In andCaloriesOut, obesityisahormonal, notacaloric,disorder. Assumption4:Fatstoresare
  • 153. How Jones loss his weight without any exercise you want to learn this special method than click here
  • 154. essentiallyunregulated EVERY SINGLE SYSTEM in the body isregulated.Growthinheightisregulatedb y growth hormone. Blood sugars areregulated by the hormones insulin andglucagon, among others. Sexualmaturation is regulated by testosteroneand estrogen. Body temperature isregulated by a thyroid- stimulatinghormone and free thyroxine. The list isendless. We are asked to believe, however,that growth of fat cells is essentiallyunregulated.Thesimpleact ofeating,without any interference from anyhormones,willresultinfatgrowth. Extracaloriesaredumpedintofatcellsliked
  • 156. This assumption has already beenprovenfalse.Newhormonalpathway sin the regulation of fat growth are beingdiscovered all the time. Leptin is thebest-known hormone regulating fatgrowth, but adiponectin, hormone- sensitivelipase,lipoproteinlipaseandadi pose triglyceride lipase may all playimportantroles.Ifhormonesregulatef atgrowth,then obesityisahormonal, notacaloricdisorder. Assumption5:Acalorieisacal orie THISASSUMPTION ISthemostdangerous ofall.It’sobviouslytrue.Justlike adogis a dog or a desk is a desk. There aremanydifferentkindsofdogsanddesks,
  • 157. but the simple statement that a dog is adog is true. However, the real issue isthis: Are all calories equally likely tocausefatgain? “A calorie is a calorie” implies thatthe only important variable in weightgainisthetotalcaloricintake,andth us,all foods can be reduced to their caloricenergy. But does a calorie of olive oilcause the same metabolic response as acalorie of sugar? The answer is,obviously, no. These two foods havemanyeasilymeasurabledifferences. Sugar will increase the blood glucoselevel and provoke an insulin responsefrom the pancreas. Olive oil will not.Whenoliveoilisabsorbedbythe smallintestineandtransportedtotheliver,
  • 158. thereisnosignificantincreaseinbloodgluco se or insulin. The two differentfoods evoke vastly different metabolicandhormonalresponses. These five assumptions—the keyassumptions in the caloric reductiontheory of weight loss—have all beenprovedfalse. Allcaloriesarenotequally likely to cause weight gain. Theentirecaloricobsessionwas afifty- yeardeadend. So we must begin again. What causesweightgain?
  • 159. HOWDOWEPROCESSFOOD? WHAT IS Acalorie? A calorie is simply aunit of energy. Different foods areburnedinalaboratory,andtheamountofh eatreleasedismeasuredtodetermineacalor icvalue forthatfood. All the foods we eat contain calories.Foodfirstentersthestomach,wher eitismixed with stomach acid and slowlyreleasedintothesmallintestine. Nutrients are extracted throughout thejourney through the small and largeintestines.Whatremainsisexcretedass tool. Proteins are broken down into theirbuilding blocks, amino acids. These areused to build and repair the body’stissues,andtheexcessisstored.Fatsa re
  • 160. directly absorbed into the body.Carbohydrates are broken down intotheir building blocks, sugars. Proteins,fats and carbohydrates all providecaloricenergyforthebody,butdi ffergreatly in their metabolic processing.This results in different hormonalstimuli.
  • 161. CALORICREDUCTIONISNOTT HE PRIMARY FACTOR INWEIGHTLOSS WHY DO WE gain weight? The mostcommon answer is that excess caloricintakecausesobesity.Butalthoug htheincrease in obesity rates in the UnitedStates from 1971 to 2000 wasassociated with an increase in dailycalorie consumption of roughly 200 to300 calories,1it’s important toremember that correlation is notcausation. Furthermore, the correlation betweenweight gain and the increase in calorieconsumptionhasrecentlybrokendo wn.2Data from the National Health andNutritionExaminationSurvey(NHANES)
  • 162. in the United States from 1990 to 2010finds noassociationbetweenincreasedcalorie consumptionandweightgain. While obesity increased at a rate of 0.37percentperyear,caloricintakeremaine dvirtually stable. Women slightlyincreased their average daily intake from1761calories to 1781, but men slightlydecreased theirs from 2616 calories to2511. The British obesity epidemic largelyran parallel to North America’s. Butonce again, the association of weightgainwithincreased calorieconsumptiondoes not hold true.3In the Britishexperience, neither increased caloricintake nor dietary fat
  • 164. relationship.Infact,thenumberofcalories ingested slightly decreased,evenasobesityratesincreased. Otherfactors, including the nature of thosecalories,hadchanged. Wemayimagineourselvestobeacalo rie-weighingscaleand maythinkthat imbalance of calories over timeleadstotheaccumulationoffat. Calories In–Calories Out=BodyFatIfCaloriesOutremainssta bleover time, then reducing Calories In shouldproduce weight loss. The First Law ofThermodynamicsstatesthatenergycann either be created nor destroyed in anisolated system. This law is ofteninvoked to support the
  • 166. obesity researcher Dr. Jules Hirsch,quotedina2012NewYorkTim esarticle,4explains: Thereisaninflexiblelawofphysics— energy taken in must exactly equal thenumberofcaloriesleavingthesystemwh enfatstorageisunchanged.Caloriesleaveth esystem whenfoodisusedtofuelthebody.Tolowerfa tcontent—reduceobesity— onemustreducecaloriestakenin,orincrease theoutputbyincreasingactivity,orboth.Thi sistruewhethercaloriescomefrompumpkin sorpeanutsorpâtédefoiegras. But thermodynamics, a law ofphysics,hasminimalrelevancetohuman biology for the simple reason that thehumanbodyisnotanisolatedsystem.
  • 167. Energy is constantly entering andleaving. Infact, theveryactwearemostconcerned about— eating—puts energyintothesystem.Foodenergyisalsoe xcreted from the system in the form ofstool. Having studied a full year ofthermodynamics in university, I canassure you that neither calories norweight gain were mentioned even asingle time. If we eat an extra 200 calories today,nothing prevents the body from burningthat excess for heat. Or perhaps thatextra 200caloriesisexcretedasstool.Or perhaps the liver uses the extra 200.We obsess about caloric input into thesystem,butoutputisfarmoreimportant.
  • 168. Whatdeterminestheenergyoutputof How Jones loss his weight without any exercise you want to learn this special method than click here
  • 169. thesystem?Supposeweconsume2000ca lories of chemical energy (food) inone day. What is the metabolic fate ofthose2000calories?Possibilitiesforth eiruse include heatproduction, new protein production,new bone production,new muscle production,cognition (brain),increasedheartra te, increased stroke volume (heart),exercise/physicalexertion ,detoxification (liver),detoxification(kidney),di gestion (pancreas and
  • 171. excretion(intestinesandcolon)andfat production. We certainly don’t mind if energy isburned as heat or used to build newprotein,butwedomindifitisdeposited as fat. There are an almost infinitenumberofwaysthatthebodycandiss ipate excess energy instead ofstoringitasbodyfat. Withthemodelofthecalorie-balancing scale, we assume that fat gainor loss is essentially unregulated, andthat weight gain and loss is underconscious control. But no system in thebody is unregulated like that. Hormonestightlyregulateeverysinglesyst eminthebody.Thethyroid,parathyroid,
  • 172. sympathetic, parasympathetic,respiratory, circulatory, hepatic, renal,gastrointestinalandadrenalsystemsa reall under hormonal control. So is bodyfat. The body actually has multiplesystemstocontrolbodyweight. The problem of fat accumulation isreally a problem of distribution ofenergy. Too much energy is diverted tofat production as opposed to, say,increasing, body-heat production. Thevast majority of this energy expenditureis controlled automatically, withexercise being the only factor that isunder our conscious control. Forexample, we cannot decide how muchenergy to expend on fat accumulationversusnewboneformation.
  • 174. metabolicprocessesarevirtuallyimpossib le to measure, they are assumedto remain relatively stable. In particular,CaloriesOutisassumednottoch angeinresponsetoCaloriesIn.Wepresume thatthetwo areindependentvariables. Let’stakeananalogy.Considerthemoney thatyouearninayear(MoneyIn)and the money that you spend (MoneyOut). Suppose you normally earn andalso spend $100,000 per year. If MoneyInisnowreducedto$25,000 peryear,whatwouldhappentoMoneyOut? Wouldyoucontinuetospend$100,000pery ear? Probablyyou’re notsostupid,asyou’dquicklybecomebank rupt. Instead,youwouldreduceyourMoneyOutto $25,000peryeartobalancethe
  • 175. budget. Money In and Money Out aredependent variables, since reduction ofone willdirectlycause areductionoftheother. Let’sapplythisreasoningtoobesity. Reducing Calories In works only ifCalories Out remains stable. What wefind instead is that a sudden reduction ofCalories IncausesasimilarreductioninCalories Out, and no weight is lost asthebodybalancesitsenergybudget. Some historic experiments in caloriereductionhaveshownexactlyth is.
  • 176. CALORIC REDUCTION:EXTREME EXPERIMENTS,UNEXPECTE D RESULTSEXPERIMENTALLY,IT’SEAS Ytostudy caloric reduction. We take some people,give them less to eat, watch them loseweight and live happily ever after. Bam.Case closed. Call the Nobel committee:Eat Less, Move More is the cure forobesity,andcaloricreductiontrulyisthe bestwaytoloseweight. Luckily for us, such studies havealreadybeendone. A detailed study of total energyexpenditure under conditions of
  • 177. reducedcaloric intake was done in 1919 at theCarnegie Institute of Washington.5Volunteersconsumed“sem i-starvation”
  • 178. diets of 1400 to 2100 calories per day,an amount calculated to beapproximately 30 percent lower thantheirusualintake.(Manycurrentweigh t-loss diets target very similar levels ofcaloric intake.) The question waswhethertotalenergyexpenditure(Calo ries Out) decreases in response tocaloric reduction (Calories In). Whathappened? The participants experienced awhopping 30 percent decrease in totalenergy expenditure, from an initialcaloric expenditure of roughly 3000calories to approximately 1950 calories.Even nearly 100 years ago, it was clearthat Calories Out is highly dependent onCaloriesIn. A30 percentreductionin
  • 179. caloric intake resulted in a nearlyidentical30percentreductionincalor icexpenditure. The energy budget isbalanced. The First Law ofThermodynamicsisnotbroken. Several decades later, in 1944 and1945, Dr. Ancel Keys performed themostcompleteexperimentofstarvatio never done—the Minnesota StarvationExperiment, the details of which werepublished in 1950 in a two- volumepublication entitled The Biology ofHuman Starvation.6In the aftermath ofWorld War II, millions of people wereon the verge of starvation. Yet thephysiologic effects of starvation werevirtually unknown, having never beenscientificallystudied. TheMinnesota
  • 180. study was an attempt to understand boththe caloric-reduction and recoveryphases of starvation. Improvedknowledge would help guide Europe’srecovery from the brink. Indeed, as aresult of this study, a relief-worker’sfield manual was written detailingpsychologicalaspectsofstarvat ion.7 Thirty-sixyoung,healthy,normalmen were selected with an average height offive foot ten inches (1.78 meters) and anaverage weight of 153 pounds (69.3kilograms). For the first three months,subjects received a standard diet of3200caloriesperday.Overthenextsixm onths of semi-starvation, only
  • 181. 1570calories were given to them. However,caloricintake wascontinuallyadjusted
  • 182. to reach a target total weight loss of 24percent (compared to baseline),averaging 2.5pounds(1.1kilograms)perweek.Some meneventuallyreceivedlessthan1000calo riesperday. The foods given were high incarbohydrates,similartothoseavailable in war-torn Europe at the time— potatoes,turnips,breadandmacaroni. Meat and dairy products were rarelygiven.Inaddition,theywalked 22 milesper week as exercise. Following thiscaloric-reduction phase, their calorieswere gradually increased over threemonths of rehabilitation. Expectedcaloricexpenditurewas3009 caloriesperday.8 EvenDr.Keyshimselfwasshocked
  • 183. by the difficulty of the experiment. Themenexperiencedprofoundphysicalan dpsychologicalchanges.Amongthemostc onsistent findings was the constantfeeling of cold experienced by theparticipants. As one explained, “I’mcold. In July I walk downtown on asunny day with a shirt and sweater tokeepmewarm.Atnightmywellfedroom mate, who isn’t in the experiment,sleeps on top of his sheets but I crawlundertwoblankets.”9 Restingmetabolicratedroppedby40 percent. Interestingly, thisphenomenon is very similar to that of theprevious study, which showed a drop of30percent.Measurementofthesubjects’ strengthshoweda21percentdecrease.
  • 184. Do you want to loss your weight without any exercise than click here
  • 185. Heartrateslowed considerably, fromanaverage of fifty-five beats per minute toonly thirty-five. Heart stroke volumedecreased by 20 percent. Bodytemperature dropped to an average of95.8°F.10Physical endurance droppedby half. Blood pressure dropped. Menbecameextremelytiredanddizzy.The ylosthairandtheirnails grewbrittle. Psychologically, there were equallydevastating effects. The menexperienced a complete lack of interestin everything except for food, whichbecame an object of intense fascinationto them. Some hoarded cookbooks andutensils. They were plagued withconstant,unyieldinghunger.Somewe
  • 187. withdrew from their university studies.There were several cases of franklyneuroticbehavior. Let’s reflect on what was happeninghere.Priortothestudy,thesubj ectsateand also burned approximately 3000calories per day. Then, suddenly, theircaloric intake was reduced toapproximately 1500 per day. All bodyfunctions that require energyexperienced an immediate, across-the-board 30 percent to 40 percentreduction, which wrought completehavoc.Consider thefollowing: Caloriesareneededtoheatthebod y.
  • 189. reduced. Result: constant feeling ofcold. Caloriesareneededforthehearttopu mp blood. Fewercalorieswereavailable, so the pump sloweddown. Result: heart rate and strokevolume decreases. Calories are needed to maintainbloodpressure.Fewercalor ieswereavailable,sothebodyturnedt he pressure down. Result: bloodpressuredecreased. Caloriesareneeded forbrainfunction, as the brain is verymetabolically active. Fewercalorieswereavailable,s ocognition was reduced. Result:lethargyandinabilityto
  • 190. concentrate. Calories are needed to move thebody.Fewercalorieswereavail able, so movement wasreduced.Result:weaknessduri ngphysicalactivity. Caloriesareneededto replacehairandnails.Fewercalories wereavailable, so hairandnailswerenot replaced. Result: brittle nailsandhairloss. The body reacts in this way— byreducing energy expenditure— becausethe body is smart and doesn’t want todie. What would happen if the bodycontinuedtoexpend3000caloriesdai lywhiletakinginonly1500?Soonfat
  • 191. stores would be burned, then proteinstores would be burned, and then youwoulddie.Nice.Thesmartcourseofacti on for the body is to immediatelyreduce caloric expenditure to 1500caloriesperdayto restorebalance. Caloric expenditure may even beadjusted a little lower (say, to 1400caloriesperday),tocreateamarginof safety.This isexactlywhatthebodydoes. In other words, the body shuts down.In order to preserve itself, it implementsacross-the-board reductions in energyoutput. The crucial point to remember isthatdoingsoensuressurvivaloftheindivi dualinatimeofextremestress. Yeah,youmightfeellousy,butyou’ll
  • 192. live to tell the tale. Reducing output isthesmartthingforthebodytodo. Burning energy it does not have wouldquickly lead to death. The energy budgetmustbebalanced. CaloriesInandCalories Outarehighlydependentvariables. With reflection, it should immediatelybeobviousthatcaloricexpen dituremustdecrease. If we reduce daily calorieintake by 500 calories, we assume that 1pound (0.45 kilograms) of fat per weekis lost. Does that mean that in 200weeks, we would lose 200 pounds (91kilograms)andweighzeropounds?Ofc oursenot.Thebodymust,atsomepoint, reduce its caloric expenditure tomeetthelowercaloricintake.Itjustso
  • 193. happens that this adaptation occursalmost immediately and persists longterm. The men in the MinnesotaStarvation Experiment should have lost78 pounds (35.3 kilograms), but theactual weight lost was only 37 pounds(16.8kilograms)— lessthanhalfofwhatwas expected. More and more severecaloric restriction was required tocontinuelosingweight.Soundfamiliar? Whathappenedtotheirweightafterthes emi-starvationperiod? During the semi-starvation phase,body fat dropped much quicker thanoverall body weight as fat stores arepreferentially used to power the body.Once the participants started therecoveryperiod,theyregainedthe
  • 194. weight rather quickly, in about twelveweeks. But it didn’t stop there. Bodyweightcontinuedtoincreaseuntilitwa sactually higher than it was prior to theexperiment. The body quickly responds to caloricreduction by reducing metabolism (totalenergy expenditure), but how long doesthis adaptation persist? Given enoughtime, does the body increase its energyexpenditurebacktoitsprevioushigh erlevel if caloric reduction is maintained?The short answer is no.11In a 2008study, participants initially lost 10percent of body weight, and their totalenergy expenditure decreased asexpected.Buthowlongdidthissituationla st?Itremainedreducedover the
  • 195. course of the entire study—a full year.Evenafteroneyearatthenew,lowerbo dyweight,theirtotalenergyexpenditure was still reduced by anaverageofalmost500caloriesper day.In response to caloric reduction,metabolism decreases almostimmediately, and that decrease persistsmoreorless indefinitely. The applicability of these findings tocaloric-reductiondietsisobvious. Assume that prior to dieting, a womaneats and burns 2000 calories per day.Following doctor’s orders, she adopts acalorie-restricted,portion- controlled,low-fat diet, reducing her intake by 500calories per day. Quickly, her totalenergyexpenditure alsodropsby500
  • 196. caloriesperday,ifnotalittlemore.Shefeel s lousy, tired, cold, hungry, irritableand depressed, but sticks with it,thinking that things must eventuallyimprove. Initially, she loses weight, butas her body’s caloric expendituredecreases to match her lowered intake,her weight plateaus. Her dietarycompliance is good, but one year later,things have not improved. Her weightslowly creeps back up, even though sheeats the same number of calories. Tiredof feeling so lousy, she abandons thefailed diet and resumes eating 2000calories per day. Since her metabolismhas slowed to an output of only 1500calories per day, all her weight comesrushingback— asfat.Thosearoundher
  • 197. How Jones loss his weight without any exercise you want to learn this special method than click here
  • 198. silentlyaccuseheroflackingwillpower.Sou nd familiar? But her weight regain isnot her failure. Instead, it’s to beexpected. Everything described here hasbeen well documented over the last 100years!
  • 199. ANERRONEOUSASSUMPTION LET’S CONSIDER Alast analogy here.Supposewemanageacoal- firedpowerplant. Every day to generate energy, wereceive and burn 2000 tons of coal. Wealso keep some coal stored in a shed,justincasewerunlow. Now,allofasudden,wereceiveonly150 0 tons of coal a day. Should wecontinuetoburn2000tonsofcoaldaily? We would quickly burn through ourstores of coal, and then our power plantwould be shut down. Massive blackoutsdevelop over the entire city. Anarchyandlootingcommence.Ourbosste llsushow utterly stupid we are and yells,“YourassisFIRED!”Unfortunatelyfor us,he’sentirelyright.
  • 200. In reality, we’d handle this situationanotherway.Assoonaswerealiz ethatwe’ve received only 1500 tons of coal,we’d immediately reduce our powergeneration to burn only 1500 tons. Infact, we might burn only 1400 tons, justincasetherewerefurtherreductionsin shipments.Inthecity,afewlightsgodim, but there are no widespreadblackouts. Anarchy and looting areavoided. Boss says, “Great job. You’renot as stupid as you look. Raises allaround.”Wemaintaintheloweroutputo f1500tonsaslongasnecessary. Thekeyassumptionofthetheorythatreduc ing caloric intake leads to weightlossisfalse,sincedecreasedcalorici ntakeinevitablyleads todecreased
  • 201. caloric expenditure. This sequence hasbeenproventimeandagain.Wejustkeep hoping that this strategy willsomehow,thistime,work.Itwon’t.Fac eit. In our heart of hearts, we alreadyknow it to be true. Caloric reduction andportion- controlstrategiesonlymakeyoutired and hungry. Worst of all... youregain alltheweightyouhavelost.Iknowit.Youkn owit. We forget this inconvenient factbecauseourdoctors,ourdieticians,ou rgovernment, our scientists, ourpoliticiansandourmediahaveallbeens creamingatusfordecadesthatweightloss is all about Calories In versusCalories Out. “Caloric reduction isprimary.”“EatLess,MoveMore.”We
  • 202. haveheard itso oftenthatwedo notquestionwhetherit’sthetruth. Instead,webelievethatthefaultliesino urselves.We feelwe havefailed. Some silently criticize us for notadhering to the diet. Others silently thinkwe have no willpower and offer usmeaningless platitudes. Soundfamiliar? The failing isn’t ours. The portion- control caloric-reduction diet isvirtually guaranteed to fail. Eating lessdoes notresultinlastingweightloss.
  • 203. EATING IS NOT UNDERCONSCIOUSCONTR OL BY THE EARLY 1990s, the Battle of theBulge was not going well. The obesityepidemicwasgatheringmomentum ,withtype 2 diabetes following closelybehind. The low-fat campaign wasstartingtofizzleasthepromisedbenefits had failed to materialize. Even as wewere choking down our dry skinlesschicken breast and rice cakes, we weregetting fatter and sicker. Looking foranswers, the National Institutes ofHealth recruited almost 50,000 post- menopausalwomenforthemostmassive, expensive, ambitious
  • 205. controlledtrialwascalledtheWomen’sHea lth Initiative Dietary ModificationTrial.12This trial is arguably the mostimportantdietarystudyeverdone. Approximately one-third of thesewomen received a series of eighteeneducation sessions, group activities,targeted message campaigns andpersonalized feedback over one year.Their dietary intervention was to reducedietary fat, which was cut down to 20percent of daily calories. They alsoincreasedtheirvegetableandfruitintak eto five servings per day and grains to sixservings. They were encouraged toincrease exercise.Thecontrolgroupwas instructed to eat as they normallydid.Thoseinthis
  • 207. with a copy of the Dietary Guidelinesfor Americans, but otherwise receivedlittlehelp.Thetrialaimedtoconfir mthecardiovascular health and weight- reductionbenefitsofthe low-fatdiet. Theaverageweightofparticipantsatth e beginning of the study was 169pounds (76.8 kilograms). The startingaverage body mass index was 29.1,putting participants in the overweightcategory (body mass index of 25 to29.9), but bordering on obese (bodymass index greater than 30). They werefollowed for 7.5 years to see if thedoctor- recommended diet reducedobesity, heart disease and cancer asmuchasexpected. Thegroupthatreceiveddietary
  • 208. counseling succeeded. Daily caloriesdropped from 1788 to 1446 a day—areduction of 342 calories per day foroversevenyears.Fatas apercentageofcaloriesdecreasedfrom38. 8percentto 29.8 percent, and carbohydratesincreased from 44.5 percent to 52.7percent. The women increased theirdaily physical activity by 14 percent.The control group continued to eat thesamehigher-calorieandhigher- fatdiettowhichtheywere accustomed. The results were telling. The “EatLess, Move More” group started outterrifically, averaging more than 4pounds (1.8 kilograms) of weight lossoverthefirstyear.Bythesecondyear,th eweightstartedtoberegained,andby
  • 209. the end of the study, there was nosignificant difference between the twogroups. Did these women perhaps replacesome oftheirfatwithmuscle? Unfortunately, the average waistcircumferenceincreasedapproximate ly 0.39 inches (0.6 centimeters), and theaverage waist-to-hip ratio increasedfrom 0.82 to 0.83 inches (2.1centimeters), which indicates thesewomen were actually fatter than before.Weightlossover7.5yearsofthe EatLess,MoveMorestrategywasnoteven onesinglekilogram(2.2pounds). This study was only the latest in anunbroken string of failed experiments.Caloricreductionastheprimar
  • 210. ymeans
  • 211. of weight loss has disappointedrepeatedly. Reviews of the literature bythe U.S. Department of Agriculture13highlight this failure. All these studies,ofcourse, serveonlyto confirmwhatwealready knew. Caloric reduction doesn’tcause lasting weight loss. Anybody whohasevertrieditcantellyou. Manypeopletellme,“Idon’t understand. I eat less. I exercise more.But I can’t seem to lose any weight.” Iunderstand perfectly— because thisadvice has been proven to fail. Docaloric-reduction diets work? No. TheWomen’sHealthInitiativeDietaryMo dification Trial was the biggest,baddest, most kick-ass study of
  • 212. the EatLess,MoveMorestrategythathaseven Do you want to loss your weight without any exercise than click here
  • 213. beenoreverwillbedone— anditwasaresoundingrepudiationofthatstra tegy. What is happening when we try toreduce calories and fail to lose weight?Part of the problem is the reducedmetabolism that accompanies weightloss.Butthat’sonlythebeginning.
  • 214. HUNGERGAMES THECALORIESIN,CaloriesOutplanforweig ht loss assumes that we haveconsciouscontroloverwhatweeat.B utthis belief ignores the extremelypowerful effect of the body’s hormonalstate. The defining characteristic of thehuman body is homeostasis, oradaptation to change. Our body dealswith an ever-changing environment. Inresponse,thebodymakesadjustmentsto minimizetheeffectsofsuchchangesandretu rn to its original condition. And so itis,whenthe bodystartstolose weight. There are two major adaptations tocaloric reduction. The first change, aswe have seen, is a dramatic reduction intotalenergyexpenditure.Thesecondkey
  • 215. change is that the hormonal signals thatstimulate hunger increase. The body ispleadingwithus toeatinorderforittoregainthe lostweight. This effect was demonstrated in 2011,in an elegant study of hormonaladaptation to weight loss.14Subjectswere given a diet of 500 calories perday, which produced an average weightlossof29.7pounds(13.5kilograms ). Next, they were prescribed a low- glycemic-index,low- fatdietforweightmaintenance and were encouraged toexercisethirtyminutesperday.Despitet
  • 216. heir best intentions, almost half of theweightwasregained. Varioushormonallevels,includingg hrelin—ahormonethat,essentially,
  • 217. makes us hungry—were analyzed.Weight loss significantly increasedghrelin levels in the study’s subjects,even after more than one year, comparedtothesubjects’usualbaseline. Whatdoesthatmean?Itmeansthatthesubj ects felt hungrier and continued tofeelso,rightuptoendofthestudy. The study also measured severalsatiety hormones, including peptide YY,amylin and cholecystokinin, all of whichare released in response to proteins andfatsinourdietandservetomakeusfeelful l.Thisresponse,inturn,producesthedesired effect of keeping us fromovereating.Morethanayearafterinitia lweightloss,thelevelsofallthreesatietyhor monesweresignificantlylowerthan
  • 218. before. Whatdoesthatmean?Itmeansthatthesubj ectsfeltlessfull. Withincreasedhungeranddecreasedsati ety,thedesiretoeatrises.Moreover,these hormonal changes occur almostimmediately and persist almostindefinitely. People on a diet tend to feelhungrier, and that effect isn’t some kindof psychological voodoo, nor is it a lossof willpower. Increased hunger is anormal and expected hormonal responsetoweightloss. Dr. Keys’s Minnesota StarvationExperimentfirstdocumentedth eeffectof “semi-starvation neurosis.” Peoplewholoseweightdreamaboutfood. Theyobsessaboutfood.Alltheycanthink
  • 219. about is food. Interest in all elsediminishes. This behavior is not somestrange affliction of the obese. In fact,it’s entirely hormonally driven andnormal.Thebody,throughhungerands atiety signaling, is compelling us to getmore food. Losing weight triggers two importantresponses. First, totalenergyexpenditure is immediately andindefinitely reduced in order to conservethe available energy. Second, hormonalhunger signaling is immediately andindefinitely amplified in an effort toacquiremorefood.Weightlossresultsini ncreased hunger and decreasedmetabolism. This evolutionary survivalstrategyhasasinglepurpose:to
  • 220. makeus
  • 221. regainthelostweight. Functional magnetic resonanceimagingstudiesshowthatareasoft hebraincontrollingemotionandcognitionli ghtup inresponseto food stimuli. Areas of the prefrontal cortex involvedwith restraint show decreased activity.In other words, it is harder for peoplewho have lost weight to resist food.15Thishasnothingwhatsoevertodo with a lack of willpower or any kind ofmoral failure. It’s a normal hormonalfact of life. We feel hungry, cold, tiredanddepressed. Theseareallreal,measurable physical effects of calorierestriction. Reduced metabolism and theincreased hunger are not the cause ofobesity— theyaretheresult.Losing
  • 222. weight causes the reduced metabolismand increased hunger, not the other wayaround.Wedonotsimplymakeaperson al choice to eat more. One of thegreat pillars of the caloric-reductiontheory of obesity—that we eat too muchbecause we choose to—is simply nottrue.Wedonoteattoomuchbecausewec hoose to, or because food is toodelicious, or because of salt, sugar andfat.Weeattoomuchbecauseourownbra incompelsusto.
  • 223. THEVICIOUSCYCLEOFUNDER- EATING ANDSOWEhavetheviciouscycleofunder- eating. We start by eating less andlose some weight. As a result, ourmetabolism slows and hunger increases.Westarttoregainweight.Wedou bleourefforts by eating even less. A bit moreweight comes off, but again, total energyexpenditure decreases and hungerincreases. We start regaining weight. Sowe redouble our efforts by eating evenless. This cycle continues until it isintolerable. We are cold, tired, hungryand obsessing about calories. Worst ofall,theweightalwayscomesbackon. At some point, we go back to our
  • 225. slowed so much, even resuming the oldwayofeatingcausesquickweightgain, up to and even a little past the originalpoint. We are doing exactly what ourhormonesareinfluencingustodo.Butfri ends, family and medicalprofessionals silently blame the victim,thinkingthatitis“ourfault.”Andwe ourselvesfeelthatweare afailure. Soundfamiliar? All dieters share this same sad storyof weight loss and regain. It’s a virtualguarantee. The cycle has beenscientifically established, and its truthhas been forged in the tears of millionsof dieters. Yet nutritional authoritiescontinue to preach that caloric
  • 228. THE CRUELHOAX CALORICREDUCTIONISaharshandbitterdisa ppointment. Yet all the “experts”still agree that caloric reduction is thekey to lasting weight loss. When youdon’tloseweight,theysay,“It’syourfau lt. You were gluttons. You weresloths. You didn’t try hard enough. Youdidn’t want it badly enough.” There’s adirty little secret that nobody is willingto admit: The low-fat, low-calorie diethas already been proven to fail. This isthecruelhoax.Eatinglessdoesnotresulti nlastingweightloss.It.Just. Does.Not.Work. It is cruel because so many of us havebelieved it. It is cruel because all of our“trusted healthsources”tellusitistrue.
  • 229. How Jones loss his weight without any exercise you want to learn this special method than click here
  • 230. It is cruel because when it fails, weblame ourselves. Let me state it asplainlyasIcan:“EatLess” doesnotwork.That’safact.Acceptit. Pharmaceutical methods of caloricreduction only emphasize the spectacularfailure of this paradigm. Orlistat(marketed in the U.S. as Alli) wasdesigned to block the absorption ofdietary fat. Orlistat is the drugequivalent of the low-fat, low- caloriediet. Amongitsnumeroussideeffects,themo st bothersome was euphemisticallycalled fecal leakage and oily spotting.The unabsorbed dietary fat came out theother end, where it often stainedunderwear.Weight-
  • 232. in with useful advice about the “orangepoopoil.” Neverwearwhite pants. Never assume it’s just a fart. In 2007,Alli won the “Bitter Pill Award” forworst drug from the U.S. consumergroup Prescription Access Litigation.Thereweremoreseriousconce rnssuchas liver toxicity, vitamin deficiency andgallstones. However, orlistat’sinsurmountable problem was that it didnotreallywork.16 In a randomized, double- blindcontrolled study,17four years of takingthe medication three times daily resultedin an extra 6 pounds (2.8 kilograms) ofweight loss. But 91 percent of thepatients complained of
  • 234. of the drug peaked in 2001 at $600million. Despite being sold over thecounter,by2013,saleshadplummetedt o$100million. The fake fat olestra was a similarlyill-conceived notion, born out ofcaloric-reduction theory. Released togreat fanfare several years ago, olestrawas not absorbed by the body and thushad no caloric impact. Its sales began tosink within two years of release.18Theproblem? It led to no significant weightloss. By 2010, it landed on Timemagazine’s list of the fifty worstinventions,justbehindasbestos.19
  • 235. (4)
  • 236. THEEXERCISE MYTH DR. PETER ATTIAisthe cofounder ofNutrition Science Initiative (NuSi), anorganization dedicated to improving thequality of science in nutrition andobesity research. A few years ago, hewas an elite long-distance swimmer, oneof only a dozen or so people to haveswum from Los Angeles to CatalinaIsland. A physician himself, he followedthe standard prescribed diet high incarbohydrates and trained religiously forthree to four hours daily. He was also,by his own estimation, about fortypounds (18 kilograms) overweight
  • 238. bodyfat. Butisn’tincreasingexercisethekeytow eightloss? Caloricimbalance— increasedcaloricintake combined with decreased caloricexpenditure—is considered the recipefor obesity. Up until now, we’veassumed that exercise was vitallyimportant to weight loss— that byincreasing exercise, we can burn off theexcesscaloriesthatweeat.
  • 239. THE LIMITS OF EXERCISE: AHARSHREALITY CERTAINLY, EXERCISE HAS great healthbenefits. The early Greek physicianHippocrates, considered the father ofmedicine, said, “If we could give everyindividual the right amount ofnourishment and exercise, not too littleand not too much, we would have foundthe safest way to health.” In the 1950s,along with increasing concern aboutheartdisease,interestinphysicalacti vity and exercise began to grow. In1955, President Eisenhower establishedthePresident’sCouncilonYout hFitness.By 1966, the U.S. Public Health Servicebegan to advocate that increasingphysicalactivitywasoneoftheb
  • 240. est
  • 241. ways to lose weight. Aerobics studiosbegan to sprout like mushrooms after arainstorm. The CompleteBook ofRunningbyJimFixxbecamearunawayb estsellerin1977. The fact that he died at age fifty-two of a massive heart attack was only aminorsetbacktothecause.Dr.KennethCo oper’s book The New Aerobics wasrequired reading in the 1980s where Iwent to high school. More and morepeople began incorporating physicalactivityintotheirleisuretime. It seemed reasonable to expectobesity rates to fall as exercise ratesincreased.Afterall,governmentsaro undthe world have poured millions ofdollarsintopromotingexercisefor
  • 242. weight loss, and they succeeded ingettingtheircitizensmoving.IntheU nitedKingdomfrom1997to2008,regu lar exercise increased from 32percent to 39 percent in men and 21percentto29percentinwomen.1 There’s a problem, though. All thisactivity had no effect on obesity at all.Obesityincreasedrelentlessly,evenas we sweated to the oldies. Just take alookatFigure 4.1,2.
  • 243. Figure4.1. Theincreasingworldwideprevalenceof obesity. The phenomenon is global. A recenteight-country survey revealed thatAmericans exercised the most— 135days per year compared to a globalaverage of 112 days. The Dutch
  • 245. main motivation for exercise in allcountries. Did all this activity translateintolowerratesofobesity? Glad you asked. The Dutch andItalians, with their low exercise rates,experienced less than one-third theobesity of those iron- pumpingAmericans. The problem was apparent in theAmerican NHANESdata as well. From2001 to 2011, there was a generalincrease in physical activity.4Certainareas (Kentucky, Virginia, Florida andthe Carolinas) increased exercise atHerculean rates. But here’s the dismaltruth:whetherphysicalactivityinc reasesordecreases,ithasvirtuallynorelat ionshiptotheprevalenceof
  • 246. obesity. Increasing exercise did notreduceobesity.Itwasirrelevant.Certain states exercised more. Other statesexercised less. Obesity increased by thesameamountregardless. Is exercise important in reducingchildhood obesity? The short answer isno.A2013paper5comparedthephysical activity (measured usingaccelerometry) of children aged three tofive years to their weight. The authorsconcludedthereisno associationbetween activityand obesity. Whatwentwrong? Inherent to the Calories In, CaloriesOut theory is the idea that reducedphysicalactivityplaysa keyrole
  • 247. intheobesityepidemic.This ideais thatwe Do you want to loss your weight without any exercise than click here
  • 248. used to walk everywhere, but now wedrive. With the increase in laborsavingdevices such as cars, our exercise hasdecreased, leading to obesity. Theproliferation of video games, televisionand computers is also believed tocontributetoasedentarylifestyle.Likean ygooddeception,thisonesoundspretty reasonable at first. There is asmall problem,though.Itisjustnottrue. Researcher Dr. Herman Pontzerstudied a hunter-gatherer society living aprimitivelifestyleinthemodernday. TheHadzainTanzaniaoftentravel15to20mil esperdaytogatherfood.Youmight assume that their daily energyexpenditureismuchhigherthanatypic
  • 250. surprising results in a New York Timesarticle: “We found that despite all thisphysical activity, the number of caloriesthat the Hadza burned per day wasindistinguishable from that of typicaladultsinEuropeandtheUnitedStates. ”6 Even if we compare relatively recentactivity rates to those of the 1980s,before the obesity epidemic came intofull swing, rates have not decreasedappreciably.7In a Northern Europeanpopulation, physical-activity energyexpenditure was calculated from the1980s to the mid 2000s. The surprisingfinding was that if anything, physicalactivity has actually increased since
  • 252. predicted energy expenditure for a wildmammal, which is predominantlydetermined by body mass and ambienttemperature. Compared to its wild- mammalcousinssuchastheseeminglyvigo rous cougar, fox and caribou, Homoobesus2015 isnotlessphysicallyactive. Exercise has not decreased sincehunter- gatherertimes,orevensincethe1980s,whil eobesityhasgallopedaheadfullsteam.Itish ighlyimprobablethatdecreased exercise played any role incausingobesityinthefirstplace. Iflackofexercisewasnotthe causeof obesity epidemic, exercise
  • 254. CALORIESOUT THE AMOUNT OFcalories used in a day(Calories Out)is moreaccuratelytermedtotalenergyexpen diture.Totalenergy expenditure is the sum of basalmetabolic rate (defined below),thermogeniceffectoffood,non- exerciseactivity thermogenesis, excess post-exercise oxygen consumption and, ofcourse,exercise. Totalenergyexpenditure=Basalmetaboli crate+Thermogeniceffectoffood + Nonexercise activitythermogenesis + Excess post- exerciseoxygenconsumption+ Exercise. The key point here is that total energyexpenditure is not the same as exercise.Theoverwhelmingmajorityoftot al
  • 255. energyexpenditureisnotexercisebutthe basal metabolic rate: metabolichousekeeping tasks such as breathing,maintaining body temperature, keepingtheheartpumping,maintainingthe vitalorgans,brainfunction,liverfunction,k idneyfunction,etc. Let’stakeanexample.Basalmetabolic rate for a lightly activeaverage male is roughly 2500 caloriesperday.Walkingatamoderatepac e(2miles per hour) for forty-five minutesevery day, would burn roughly 104calories.Inotherwords,thatwillnotev enconsume5 percentofthetotalenergy expenditure. The vast majority(95 percent) of calories are used forbasalmetabolism.
  • 256. Basalmetabolicratedependsonmanyfact ors,including genetics, gender(basalmetabolicrateisge nerallyhigherinmen), age(basalmetabolicrategenerallydr opswithage), weight (basal metabolic rategenerallyincreaseswithmusclem ass), height (basal metabolic rategenerally increases with height),diet (overfeeding or underfeeding),bodytemperature, externaltemperature(heatingorco olingthebody)and organfunction.
  • 257. Nonexercise activity thermogenesis isthe energy used in activity other thansleeping, eating or exercise; for instance,inwalking,gardening,cooking,cl eaningand shopping. The thermogenic effect offood is the energy used in digestion andabsorptionoffoodenergy.Certainfood s, such as dietary fat, are easilyabsorbed and take very little energy tometabolize. Proteins are harder toprocessandusemoreenergy. Thermogenic effect of food variesaccordingtomealsize,mealfrequen cyand macronutrient composition. Excesspost-exercise oxygen consumption (alsocalled after-burn) is the energy used incellular repair, replenishment of