Chapter 2

So You Want to Lose Weight

You're not alone. Most Americans feel the same way and most Americans need it. Yet the numbers are not good.

Despite wanting to be thinner, Americans are getting fatter and their extra weight is making them sick from weight-related illness. This is most true for children and adolescents in our country.

The cause of obesity is long-term energy surplus. The body is like a magical car with an almost infinitely expandable balloon-like gas tank. If you fill-up with ten gallons every week but you only use nine, pretty soon you are hauling around a lot of extra fuel.

The simplicity of this idea is misleading. While body weight is indeed ultimately controlled by energy balance (calories IN and calories OUT), energy balance itself is controlled in very complex ways that have almost nothing to do with free will or choice. One can DECIDE to reduce caloric intake and increase caloric output, but, as any dieter knows, that's far easier said than done. The typical result of such a decision is hunger (which people can feel) and reduced metabolism (which people cannot feel).

To borrow the automobile analogy again, it's about like this: After expanding the gas-tank until it's huge and full of fuel, you decide that every week instead of putting ten gallons in the tank and only burning nine, you'll put eight gallons in and burn ten. Sounds like a plan. But if your car were like an overweight human, it wouldn't work so well. You'd find that suddenly the car would start "feeding" on its own, pulling into gas stations in the middle of the night and secretly gulping down fuel. Worse yet, the car would grow more fuel efficient, morphing from say, a Chevy Tahoe into a Toyota Prius. It's a silly analogy, but you get the point.

Back to the real world of overweight humans, the result of simple and direct caloric deficit is far slower and more painful weight loss than seems fair. Most people quickly give up.

So the history of most overweight people, indeed of most of the patients I see for the first time in my office, is one of long-term gradual weight-gain punctuated by occasional failed attempts at weight loss. Needless to say, such a history is discouraging and leads many people to feel quite frustrated and perhaps hopeless about their body weight.

To make matters worse, there is a common misconception that body weight is the result of a simple choice, much like a hairstyle.

But long-term and life-changing weight loss isn't impossible. In fact, people accomplish it all the time and they do it without living a life of misery and self-deprivation. It isn't easy to do, but neither is it "hard"; it is a "sea-change", a new outlook on oneself, one's responsibility to oneself and to loved ones, and above all, long-term weight loss results from believing that a new life is possible. It's not blind-faith either. It's faith based upon reality, upon the knowledge that if he or she can do, then by God, so can YOU.

And you really can.

That's what THIS is all about.

Take-Home Lesson: Just counting calories doesn't work because it makes you hungry


Long-Term Weight Loss Is Possible: The Evidence and the Explanations

Cultural Evidence for Long-Term Healthy Weight:

The whole world is not overweight. The obesity epidemic of the late twentieth century has primarily affected the most affluent "Western" cultures, especially the United States. Many other countries and cultures have been unaffected and people have remained thin and healthy.


There are a few possibilities that come to mind.

One possibility is that people are thin in some other cultures because those people are genetically different. This possibility can be easily refuted by a few simple observations: first, immigrants to the US FROM "thin" cultures don't stay thin. Within a generation as those immigrants adopted an "American" lifestyle, most of them begin to gain weight and in this regard, resemble the rest of American society.

Another possible explanation for the relatively low weights of people in other societies is starvation. Tragically, this is indeed the case for too many of the nations that we label as "third world", but it is not the case for all "third-world" nations nor is it the case in decidedly "first world" nations like Japan and Singapore, yet their citizens are still thin.

So we arrive at the truth. People remain happily thin without starvation and without some unique genetic difference in other cultures because the lifestyles and particularly the diets that are customary within those cultures promote thinness. The corollary of this is thus: if Americans started eating differently by adopting the habits of these other "thinner" cultures, then they too would become and remain thin.

Again, real people in the real world can and do live happily thin forever.

The Dramatic Effect of Long-Term Small Change

Another way to illustrate the possibility of real and long-term success at weight loss is to appeal to what I call "the rule of small change over long time". All we have to do to understand this rule is apply some very simple mathematics to body weight.

Let's start with some facts:

1.     A pound of fat contains about 3,500 calories (on your body or on a plate)

2.     Therefore, to lose one pound of body fat over a certain period of time, one must consume 3,500 fewer calories than one burns.

3.     3,500 calories happens to be somewhat more than most people's average TOTAL daily calorie intake.

4.     Therefore, to lose a pound of body fat, one would have to

a.     absolutely starve for more than day (actually even longer because starvation slows metabolism), or

b.    Eat dramatically less food every day for a week

c.     Eat slightly less food every day for a month or

d.    Eat 10 calories less (half a potato-chip's worth of calories) every day for a year.

This illustrates how "diluting" calorie deficit over time makes weight loss and maintenance vastly less painful. So again, you really CAN do this. You don't have torture yourself into thinness. You just need to focus on making reasonable lifestyle changes over a long period of time.

Take-Home Lesson: There is abundant evidence that long-term weight loss is possible.

Chapter 3: It Starts With Knowledge

To lose weight, people need to change the way they eat and exercise. There are healthy ways and dangerous ways. There are ways that work long-term  and there are ways that fail long-term. The only way to tell the difference is to understand the basic principles of human health and nutrition as they relate to body weight.

The subjects are complicated. But I think that the best place to start is by exploring the causes of obesity, specifically the causes of obesity in the United States over the last forty years.

Why is contemporary American obesity such an interesting and illustrative subject? The very simple answer is because Americans used to be fairly thin and now they are very fat.