Much of the weight-loss and maintenance information available to us is both inaccurate and unhelpful. Like Dorothy of Oz and Alice of Wonderland, during my lifetime of research on those issues, I've seen some "weird shit".

Here in my DietHobby online scrapbook I work to sort out and save reasonably accurate information that might prove helpful to me and perhaps to others.

The article below deals with the issue of Energy In and Energy Out, which is not as simple as most people believe.

People have different body weights because each of them has an individual physiology and psychology which ultimately determines their own individual levels of "energy in" and "energy out" AND which also determines how their own individual bodies respond to it. 

A snapshot of the unaveraged data contained in scientific research of Individual BMR or RMR (metabolism rates) bears a strong resemblance to a blood spatter pattern at a violent crime scene. Metabolism rates are all over the place, but these widely varying numbers are then averaged out to create the calculations we see formulas like Harris-Benedict, Mifflin, etc.  An Average is a Statistical number for mathematical convenience. It is not an accurate number for Everyone, and sometimes is not even accurate for Anyone ... similar to the following joke: 

A biologist, a chemist, and a statistician are out hunting.  The biologist shoots at a deer and misses fifteen feet to the left, the chemist takes a shot and misses fifteen feet to the right, and the statistician yells "We got 'em!"

People the same sex, age, and size can take in the same amount of "energy" and do their best to engage in the same amount of activity, but wind up with very different weight results. 

In tightly controlled feeding studies, the same absolute amount of extra calories can result in very different amounts of weight gain. Also, the exact same amount of caloric deficit will result in widely different amounts of weight loss. 

In general, this basic fact of human nature is overlooked, or ignored. 

Here is a recent article by obesity specialist, Dr. Sharma addressing this problem. 

Why The Energy Balance Equation Results In Flawed Approaches To Obesity Prevention And Management

    by Dr. Arya Sharma, MD 
         @ Dr Sharma's Obesity Notes 

Allow me to start not with the first law of thermodynamics (energy cannot be created or destroyed) but rather, the second law of thermodynamics, according to which entropy (best thought off as a measure of disorder), in any closed system, increases till it ultimately reaches thermodynamic equilibrium (or a state of complete disorder).

As some of us may recall from basic biology, the very definition of “life”, which tends to move from a state of lesser organization to a state of higher organization, is that it appears to defy the second law of thermodynamics (this is often referred to as “Schroedinger’s Paradox”).

In actual fact, we can easily argue that the second law does not apply to living organisms at all because living organisms are not closed systems and life’s complex processes continuously feed on its interactions with the environment.

Yet, when we consider the first law of thermodynamics and how it applies to obesity, we seem to forget the fact that we are again dealing with a complex living organism.

Thus, in what has been referred to as the “Folk Theory of Obesity”, we simply consider weight to be a variable that is entirely dependent on the difference between energy input and energy output (or “calories in” and “calories out”). And in our arithmetical thinking, we consider “energy in” and “energy out” as simple “modifiable” or “independent” variables, which if we can change, will result in any desired body weight.

In fact, our entire “eat-less-move-more” approach to obesity is based on this concept – the central idea being, that if I can effectively move “energy in” and “energy out” in the desired directions, I can achieve whatever weight I want.

This notion is fundamentally flawed, for one simple reason: it assumes that weight is the “dependent” variable in this equation.

However, as pointed out in a delightful essay by Shamil Chandaria in my new book "Controversies in Obesity", there is absolutely no reason to assume that weight is indeed the “dependent” or “passive” player in this equation.

Indeed, everything we know about human physiology points to the fact that it is as much (if not more) body weight itself that determines energy intake and output as vice versa.

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

Similarly, losing weight tends to increase hunger and reduce energy expenditure – or in other words, changes in body weight can very much determine changes in energy intake and expenditure (and not just the other way around).

Thus, the idea that we can control our body weight by simply controlling our energy intake and output, flies in the face of the ample evidence that it is ultimately our physiology (in turn largely dependent on our body weight) that controls our energy intake and output.

Thus, to paraphrase Chandaria’s key argument, it is not so much about what “energy in” and “energy out” does to our body weight – it is more about what our body weight does to “energy in” and “energy out”.

Once we at least accept that this equation is a two-way street, rather strongly biased towards body weight (or rather “preservation of body weight”) as the key determinant of “energy in” and “energy out”, we need to ask a whole different set of questions to find solutions to the problem.

No longer do we restrict our focus to the exogenous factors that determine “calories in” or “calories out” (e.g. our food or build environments) or see these as the primary targets for decreasing caloric intake or increasing caloric output.

Rather we shift our focus to the physiological (and psychological) factors (often dependent on our body weights) that ultimately dictate how much we “choose” to eat or expend in physical activity.

Chandaria’s essay goes on to discuss the many “derangements” of physiology that we know exist in obese individuals (and probably already exist in those at risk for obesity), including leptin resistance, impaired secretion of incretins like GLP-1, insulin resistance, alterations in the hypothalamic-pituitary-adrenal (HPA axis), and sympathetic activity. (Any keen student of human physiology or psychology should have no problem further extending this list.)

In Chandaria’s view, it is these physiological (and psychological) processes that ultimately determine whether or not someone is prone to weight gain or ultimately gains weight.

In fact, the only factor that determines why two individuals living in the same (obesogenic) environment will differ in body weights (even when every known social determinant of health is exactly equal), is because of their individual physiologies (and psychologies) which ultimately determine their very own individual levels of “energy in” and “energy out” (and how their bodies respond to it).

Readers may be well aware that in tightly controlled feeding studies, the same absolute amount of extra calories can result in very different amounts of weight gain.

Similarly, the exact same amount of caloric deficit will result in widely different amounts of weight loss.

Ignoring this basic fact of human nature distracts or, at the very least, severely limits us from finding effective solutions to the problem.

This “physiological” view of the first law of thermodynamics should lead us away from simply focusing on the supposedly “exogenous” variables (“energy-in” and “energy-out”) but rather draw our attention to better understanding and addressing the biological (and psychological) factors that promote weight gain.

This would substantially change the aims and goals of our recommendations.

Thus, for e.g., rather than aiming exercise recommendations primarily at burning more calories, these should perhaps be better aimed at improving insulin sensitivity and combating stress. Thus, rather than counting how many calories were burnt on the treadmill, the focus should be on what that dose of exercise actually did to lower my insulin or stress levels.

Indeed, we may discover that there is a rather poor relationship between the amount of calories burnt with exercise and the physiological or psychological goal we are trying to achieve. While more exercise may well help burn more calories (which I can eat back in a bite or two), it may do little to further improve insulin resistance or combat stress thus leaving my weight exactly where it is.

Similarly, rather than trying to restrict caloric intake, dietary recommendations would be based on how they affect human physiology (e.g. gut hormones, reward circuitry or even gut bugs) or mood (e.g. dopamine or serotonin levels).

In other words, fix the physiology (or psychology) and “calories in” and “calories out” will hopefully fix themselves.

Given that our past efforts primarily focusing on the “energy in” and “energy out” part of the equation have led nowhere, it is perhaps time to focus our attention and efforts elsewhere.

Or, as I often say in my talks, “We’re not talking physics here – we're talking physiology – that’s biology messing with physics”.

We cannot mess with the physics but we sure can mess with the biology.

Shamil A. Chandaria: The Emerging Paradigm Shift in Understanding the Causes of Obesity. In Controversies in Obesity.  Eds: Haslam DW, Sharma AM, Le Roux CW. Springer 201

My observation is that the fat people who become "normal" size and maintain that size for more than just a few years, manage to do this through doing the hard work it takes to continually and consistently oppose the natural physiological desires of their "reduced obese" bodies.

Rather than allow their bodies to tell them how to eat, they use their minds to overrule those bodies and consciously choose to eat food containing far less calories than their individual body desires.  Forever … one-day-at-a-time. 
It is possible, but it isn't easy.  
See Running Down the Up Escalator.

First, let me clarify that my definition of a "fat" or "obese" or "reduced obese" person is not someone who merely hangs somewhere around their BMI Obesity border. Meeting that criteria requires a person to put in more than two or three years at a weight of … at least …. 20 to 50 pounds above their BMI Obesity border. To me, those who fail to meet that requirement are merely "overweight", a condition that is often temporary for them. Although many of these people term themselves as "fat" or previously obese, in general, they appear to have a very limited understanding of true obesity or the fat condition.

An overweight person tends to think that because they went on their first diet and easily lost and kept off 10 or 20 lbs, then an obese person, on their 50th diet can do the same thing for a longer time and lose and keep off 100+ lbs. This attitude is easily seen within the numerous online diet forums that are full of overweight or formerly overweight people who are eager to offer copious advice and personal judgments along these lines to people who are obese or reduced obese.
This unequal comparison … apples to oranges … often confuses people who are truly obese or "reduced" obese and frequently results in negative self-judgments which are just wrong.

So, applying this clarification, There are psychological desires (of the mind), and physiological desires (of the body). What does it take to continually and consistently use one's mind to oppose the natural physiological desires of one's body? Is the ongoing difficulty of opposing those desires worth the effort that it takes to be "normal" weight?

This is a Judgment call that depends   
on the severity of the individual's mental pain which is caused by the culture's fat-bias, and the severity of the individual's physical pain which is caused by denying to one's own obese, or reduced obese body, the food substances which that body believes it needs for survival. 

We must each decide this for ourselves. Thus far, for me personally, the balance tilts toward accepting the physical pain to avoid the mental pain. However, my personal dieting history, including the past 8+ years of experiencing the difficulty of maintenance …. even though I've consistently continued my positive dieting behaviors …. have changed my perspectives on the feasibility of dieting and maintenance, especially for the "morbidly" obese.

Here's an excellent article by a healthy, "morbidly" obese person who discusses her own relationship with her physical body.

Me, My Body, and Relationship Counseling
           by Ragen Chastain www. danceswithfat

My body and I used to have a seriously bad relationship, and looking back it’s not that surprising. I grew up the daughter of a Marine and a multi-sport athlete. If I fell and ran to my father, I could expect to hear “Are you hurt or are you injured?” Hurt meant that it was time to suck it up; injured meant you were going to the doctor. He, along with coaches and dance teachers told me to “walk it off”, “play through the pain” and that “pain is fear leaving the body.”

I was told over and over again that my body was just a limitation to be overcome through mental toughness  – blocking out or working through the pain. It didn’t come naturally at first – I seemed to have an innate sense that my body deserved better than that, but at some point I turned a corner and got really good at thinking of my body as something separate, and something to be ignored.

I worked through stress fractures, and an IT band so tight it felt like it was going to rip in half, pulled muscles, sprains, strains, jammed fingers, knee injuries and a host of other issues. I ignored my body when it asked for food and hydration, and I scoffed at it when it asked for rest.

I became a compulsive exerciser and I started to look down on my body even more. I refused to give it what it needed and pushed it beyond reasonable, and then unreasonable, limits.  When my body would finally bend or break under the strain, I treated it with utter contempt. I believed that my body was just a “meat sack,”  a collection of muscles and bones that were trying to limit what I could do. I believed that my mind had to be stronger than my body and I felt triumphant when I ignored my body’s signals and “pushed through.”

If I ever had an acquaintance who treated me the way that I treated my body for all those years, I would never speak to them again. In fact, I would never have let it go on that long. But through all of this my body stuck with me (even though I wasn’t giving it the food, hydration, or rest it needed), my body continued to support me. It never gave up on me. If my body could talk, all it would have said for years would have probably be something like “&$*#(*@ *$*&*#(*$  and for the love of pete can we please take a nap?!” but I wouldn’t have listened.

We live in a culture that preaches that our bodies are limitations. I still think of my body as something separate (and I know and honor those for whom that doesn’t work.)  But it’s different now -  I consider my body as a cherished friend.  Think of everything your body does for you without you even asking: breathing, blinking, heart beating… every cell in your body is getting blood right now and you’re not even thinking about it.

I don’t know about you, but there are days when I am too distracted to focus on a game of solitaire. I’m pretty sure that  if I was consciously in charge of breathing and blinking and heart beat I would have been dead in middle school when I got my first Walkman and regularly walked into stuff because I was so into the soundtrack of A Chorus Line.

I’m not saying that pushing your body is always wrong, you have to decide what works for you. I know I’ve danced through plenty of injuries. What I’m suggesting is that you consider treating your body like you would treat a friend.  I can’t even count the things that my best friend has done for me, even though he might rather have been doing something else (hello marathon!) because he’s my best friend and he loves me and I asked. It’s the same with my body.

I’m privileged to be temporarily able-bodied and I learned more about that when I had a neck injury last year and lost the use of my right arm for almost three months.  I learned that even if my body has limitations, that doesn’t make my body a limitation and that I worked best when it was me and my body against a problem, and not me against my body. I don’t know what is in the future for me and my body and like any relationship, my body and I have to keep up the communication and we have breakdowns, but we’ve come a long way since our days of giving each other the silent treatment, and I’m feel like our relationship is healthier than it’s ever been.

My online Scrapbook, which I call DietHobby, contains articles about the diet subjects on my mind, which are organized in its ARCHIVES to provide me with future reference. Recently I've been reading, and referring to, books and articles about Fat Acceptance. The article above is one of those which I find valuable enough to scrapbook here.  

Looking for Progress,
because there's NO Perfection

Who Cares if 3,500 Calories Don't Make a Real Life Pound?
                      by Dr. Yoni Fredhoff, M.D. 12/12/13 @weightymatters

If there's a more painful discussion in nutrition and obesity these days beyond the one that circles the question, "Do 3,500 calories really make up a pound?", I don't know what it is.

So here are some truths.

• People are not walking math formulas whereby if they have 3,500 more or less calories than they burn they'll gain or lose a pound.
  
• 3,500 calories of one food or type of food will likely have a different impact on health, hunger, thermic effect, and weight than 3,500 calories of another food or type of food.
  
• Different people have different caloric efficiencies whereby they are seemingly able to extract more calories from food or reserves than others and lose weight with more difficulty (and gain with greater ease).
  
• And yet here's the only truth that matters.

From a weight management perspective, the currency of weight is calories. While exchange rates undoubtedly do vary between foods and between individuals, you'll always need your own personal deficit to lose, and surplus to gain.

All other discussion, while certainly academically interesting, given that there are No Other Alternate Measures Available to track, or tests to determine individual responses to different calorie sources, serves to foment confusion.

If weight's your concern, more important than anything else is finding a life that you enjoy that contains fewer calories than before. Getting stuck in the minutia of what type of calories may lead to an every so slightly faster or greater loss, rather than truly crafting a life that's enjoyable (and hence sustainable), might help in the short run, but will almost certainly defeat you in the long.

I agree with the following illustration used by Dr. Sharma, M.D. a medical specialist who deals with obesity issues.

Weight Management is like a rubber band.

Weight Loss is pulling on the rubber band.

Weight Maintenance is KEEP pulling on the rubber band.

The individual question regarding our own Weight Management is: 

“HOW MUCH CAN WE PULL ... AND KEEP PULLING?"

This is analogy describes my own lifetime experience. That Truth is especially applicable to my past 7 years of maintenance within the “normal” BMI range, after years of yo-yo dieting up to a high of 271 lbs at 5’0” tall”, with a subsequent total weight loss of 156 lbs. To better visualize this amount, this number was 58% of my TOTAL body weight, which is a similar total amount lost by many of the winners of the “Biggest Loser” television show.

Rubber bands come in different sizes and strength. So do the bodies of people. It naturally follows that the more weight a person loses, the more the "tension of the rubber band".  This is why it usually takes far less effort for someone who loses 10 lbs to maintain that weight-loss, than someone who loses 100 lbs. 

Bodies appear to have a Set Point, which is like a rubber band in it's natural state .. unstretched.  However, it is clear that weight-gain will drive the body's natural Set Point higher. Although most people hope and pray that weight-loss will re-set that altered Set Point back to a lower number, all available evidence indicates that this is a one-way--upward-only--survival path.  Click link for more information about Set Point.

   I’ve been reading a great many things written by Dr. Sharma. At this point, I have a lot of respect for his expertise and point of view.

I like the fact that Dr. Sharma believes that people need to stop beating themselves up for a lack of motivation, and understand that there are very good reasons why they struggle with their weight. He says:

”Everyone talks about eating right and exercising, which is so simplistic. I talk about things like time management and the links between mental health, depression and overeating. And I tell everyone to never trust a diet book that has recipes.”

His advice to other physicians is:

“Telling obese people to ‘eat less and move more’ is like telling someone with depression to cheer up. It’s not that easy. And telling someone that it is demonstrates your lack of understanding.”

Below is a recent video clip of Dr. Sharma.