Nutrition and Weight Loss

A Free Medical Weight Loss Book Online


Welcome to the "Holland Diet" website. Currently this website is the home for my new weight loss book. The preliminary if boring title of the book is Scientific Weight Loss: Beyond the Cult of Calories. As I hope you'll see when you read on, the title's theme is reflected in the subject matter. The central thesis of the book and, in many ways, of my life's work, is that "calories count but you can't count calories". To put this cheeky statement another way, weight loss only occurs through caloric deficit but that deficit must be achieved by paying attention to what you eat and not how much you eat. 

The book is unfinished and I am modifying it nearly daily. Some chapters end rather abruptly and, sad to say, at the moment the work has a number of typographical errors. I will attempt to correct these over time and hope not to make many new ones.

It is a fair question to ask why I would want to put an unfinished work out here on the web. The simple answer is that it is a necessary consequence of a busy bariatric practice. The printed material that I prepared for my patients ten years ago won't do. Too much science has passed since then and I needed a new work. Furthermore it won't do to tell people that "one of these days" I'll finish my new book. Finally, doing it this way saves trees and gives me an incentive to redouble my efforts and get this thing finished. 

To you, the reader, good luck. I encourage lots of constructive feedback which you may send to me through the form below. If you are a patient (and ONLY if you are a patient) I am delighted to respond by Dr. Holland's email. If you aren't a patient, please understand the time constraints I face.

Mark J. Holland MD
January 22, 2012

Part 1: The Fat Plague

Americans are growing alarmingly fat and no matter how much we try to blame it on lifestyle, we can't fully explain it in those terms. Hidden forces are working to cause us all to gain weight.

I am going to show you how to lose weight by identifying and eliminating substances in your diet that are making you fat. These are substances that are produced and sold by some of the largest agricultural conglomerates in the world; powerful multinational corporations who today have a deeply vested interest in hiding the truth from the public. These corporations are already engaged in vigorous marketing to convince you that what they sell and what you are eating is perfectly safe and perfectly natural. Unfortunately, nothing could be farther from the truth.

I have spent twenty years as a physician helping Americans lose weight. I have an MD from a respected American medical school and I live an ordinary upper middle class American lifestyle. I am not a conspiracist or a radical by nature. But what I have come to learn and to understand about the modern food industry in this country and around the world is truly terrifying. I now believe that much of the American obesity epidemic is caused by unsafe and untested chemically altered food that is marketed and sold by unscrupulous companies to unsuspecting consumers. Because obesity leads to so many other illnesses, these foods and these companies are literally killing us.

What I am going to tell you in this book is not my theory or anyone else's. It is fact backed by abundant well-controlled scientific studies that I will cite. What I am going to tell you is that you and your children are being fed metabolic poisons hidden in the foods you eat every day. What I am going to tell you is how to avoid these poisons, how to lose weight permanently and how to live a better and happier life. What I am going to tell you is the truth about the American diet in the new millennium.

 

The Obesity Epidemic in the United States

Obesity rates in the US have increased dramatically every year since 1985. Consider the images below which are produced by the United States Centers for Disease Control (CDC):


Here is the link to the original animation... it's shocking.

The numbers are downright shocking.

Since 2009, the last year for which these maps were prepared, obesity rates have begun to level-off some but today, in 2011, the CDC estimates that 34% OF Americans are obese and two-thirds of us are "overweight" (Body Mass Index greater than 25). If the rates of "overweight" and obesity are grouped together and graphed, we have the image below:


Image 4: Rate of Overweight and Obesity in America for People Between 20 and 74 Years Old From 1960 through 2003

Notice that the numbers used for this image are for the years 1960 through 2003 so that the most recent and severe weight increases are not shown.

Think for a moment about what these images and numbers really mean: There is a disease running rampant in our society that is destroying the quality of people's lives, causing them get sick from related diseases and that is killing them. There is a killer epidemic running rampant in America. This is the Fat Plague.

But WHAT is causing this epidemic?

The conventional answer is "the modern American lifestyle". The argument is that over the last four decades, Americans have become less active because of things like television, video games and more stressful and less-physical jobs. At the same time, we are told, American diets have deteriorated because of fast food and "junk-food". While this set of explanations makes sense, it only partially explains the problem. While it's fairly easy to understand how reduced exercise could lead to weight gain, it's not clear HOW reduced people's activities actually are. And while junk and fast food may BE part of the cause, the question remains why and how these foods play a role. In order to sort matters out, we need to look more deeply at some basic and unchallenged assumptions about obesity.

Part 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.

Why?

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.


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