Lap Bands, Red Wine and Fat Cells

Dr. Paul O’Brien is right! We do get to have our glass of red wine with a Lap Band! Not that I’m much of a drinker, but I would like to live longer. Being an American with no health insurance, I get scared sometimes.

I was googling “weight loss” + genetics + fat and found this study from researchers at Oregon State University, the Massachusetts Institute of Technology and the University of Ottawa about SIRT-1 - a gene which can reduce the development of new fat cells and increase metabolism. Ooooo la la! Well, it seems this gene’s activities can be increased by resveratrol, a compound found in grape skins.

The study was done with mice as a research model, and a remaining challenge will be to see if the same results are observed in a higher vertebrate model, including humans.
The research outlined the processes of fat formation and usage at a cellular and genetic level. It also analyzed the metabolic function of resveratrol, a polyphenol and antioxidant found at high levels in grape skins.

“When cells were exposed to resveratrol, our studies showed a pretty dramatic reduction in the conversion to fat cells and a lesser but still significant increase in the mobilization of existing fat, or the rate at which the cells metabolized stored fat,” said Mark Leid, a professor of pharmacology in the OSU College of Pharmacy. “This clearly could be one of the explanations for the health benefits that some researchers believe can be linked to moderate red wine consumption.”

And…

n trying to determine the molecular basis for this genetic link to longevity, the new study found that SIRT1 increases the use of fat and reduces the formation of new fat cells – apparently it represses one or more fat-regulating proteins and other genes that drive fat storage following calorie restriction. This may have been an evolutionary adaptation for the body to sense short term famine and counter it by increasing the burning of stored body fat, researchers say.

So, there ya go - I get to have a glass of red wine while I’m blogging and you get to have a glass of red wine while you’re reading my blog.

One more in my series Why You Can’t (Or Don’t) Lose Weight and Keep It Off. I’ve got more to report comin’ up in the next few days.

Exercise, Weight Loss, and Metabolism

Here is a fascinating exchange from the New York Times’ head science writer, Gina Kolata about her book, RETHINKING THIN. Here is the book excerpt in question.

This excerpt makes that case that changing the body’s weight above (resp. below) some intrinsic value causes the body to increase (resp. decrease) its metabolism. The research seems good on this.

This doesn’t mean that people are powerless to reach their desired weight. There seem to be effective ways to increase a body’s metabolism beyond adjusting caloric intake. It seems like increasing muscle mass, doing aerobic exercise, drinking caffeine, and eating small amounts throughout the day all can increase your metabolism. Are any of these things known to be effective in counteracting the body’s use of metabolic rate to maintain some given weight?
— Posted by A. Johnson

2.
May 7th,
2007
11:49 pm
The real issue is, how realistic is the desired weight? In studies, many obese people state a dream weight but almost no one achieves it and of those who do, almost no one maintains it. It can be very difficult to become as thin as you might want to be and stay that thin. On the other hand, many people can successfully lose modest amounts of weight and keep those pounds off. But you asked about other methods to increase the metabolism. Exercise can increase the number of calories you need but it does not increase your metabolism. And the amount of calories most people burn, particularly with moderate exercise, is not very significant, 100 or 200 calories per session. Increasing muscle mass does nothing for metabolism – that’s an exercise myth. The reason is that any added muscle is minuscule compared with the total amount of skeletal muscle in the body and muscle has a very low metabolic rate when it is at rest, which is most of the time. A man who weighs 70 kilograms, or 154 pounds, for example, has about 28 kilograms of muscle. His muscles, when he is at rest, burn 22 percent of his body’s calories — the brain uses the same amount and so does the liver. If the man lifts weights and gains 2 kilograms, or 4.4 pounds of muscles, his metabolic rate would increase by 24 calories a day. The average amount of muscle that men gain after a serious 12-week course of weight lifting is 2 kilograms.

— Posted by Gina Kolata

One more in a series on why you can’t (or don’t) lose weight and keep it off or what the diet and excercise industry doesn’t want you to know. This stuff really ticks me off.

Caffeine, Insulin, Fat and Weight Loss

As I mentioned earlier today, Gwen of Gwen’s WLS Journey was stuck on a weight loss plateau for several days. She’s lost eighty pounds with her Lap Band and is now down to losing her final fifteen. She finally laid off coffee over the weekend and voila! she dropped a pound and a quarter.

Duke University did a study on caffeine and Type II diabetics and discovered that it caused blood sugar levels to spike through out the day after meals. We don’t know whether it does the same for non-diabetics or not, but we do know that Dr. Atkins found his patients didn’t lose weight as well when they were drinking coffee. In my case, I could barely register as being ketosis if I drink any caffeine whatsoever regardless of how meticulous I am about keeping my carbs below induction level.

Here’s a quick little video from the Mayo Clinic for diabetics about how blood glucose and insulin are created and function in your body.

Calories Per Hour puts what happens next very simply:

Our pancreas creates a hormone called insulin that transports blood sugar into our body’s cells where it is used for energy. When we eat refined grains that have had most of their fiber stripped away, sugar, or other carbohydrate-rich foods that are quickly processed into blood sugar, the pancreas goes into overtime to produce the insulin necessary for all this blood sugar to be used for energy. This insulin surge tells our body that plenty of energy is readily available and that it should stop burning fat and start storing it.

From the Duke study:

Participants took capsules containing caffeine equal to about four cups of coffee on one day and then identical capsules that contained a placebo on another day. Everyone had the same nutrition drink for breakfast, but were free to eat whatever they liked for lunch and dinner.

The researchers found that when the participants consumed caffeine, their average daily sugar levels went up 8 per cent. Caffeine also exaggerated the rise in glucose after meals: increasing by 9 percent after breakfast, 15 percent after lunch and 26 per cent after dinner.

“We’re not sure what it is about caffeine that drives glucose levels up, but we have a couple of theories,” says Lane, who is the lead author of the study. “It could be that caffeine interferes with the process that moves glucose from the blood and into muscle and other cells in the body where it is used for fuel. It may also be that caffeine triggers the release of adrenaline – the ‘fight or flight” hormone that we know can also boost sugar levels.”

For those of you who aren’t losing weight, try laying off the caffeine and see if it makes a difference. We all love our coffee and tea, but most of us would rather be skinny.

Successful Long Term Weight Loss With The Lap Band

Diets and exercise just don’t work - let’s face it. Fewer than 5% of people who lose weight through diet and exercise manage to keep it off. There are reasons for this, as I have written about before, that have nothing to do with self-discipline. You can’t lose weight and keep it off for some very sturdy evolutionary reasons - your body likes having all that handy-dandy energy just packed away for a rainy day. Or more precisely, a non-rainy season. So when you lose weight, after a certain amount, your body starts cranking down your metabolism. Youve been losing weight on 1200 calories a day? No more. That fifteen pounds you’ve lost that has you feeling svelte is gonna come right back, if your body has any say over the situation. And your body does have say over the situation. So, your metabolism goes down and your hunger level goes up. Your body floods you with chemicals that make you feel hungrier than you’ve ever felt. Oh, you think you’re just being undisciplined and you feel guilty for eating. But that’s not what’s happening. Your body is pushing you to eat, eat, eat, and it’s slowing your metabolism down so that you can pack the weight right back on. Good bye, little red dress. Hello, big black dress. Have you ever stood in the kitchen eating something, hating yourself for eating it because you’re actually losing weight, but you can’t stop because you’re so darn hungry? That’s normal. That’s your body functioning as it should. The curious thing is that obese people’s bodies functions normally when they’re heavy and their bodies cease to function normally when they lose weight. Factor in that we now know that around 75% of weight gain is genetic, and we’re all in a dire situation.

Look, there are lots of reasons to lose weight besides vanity - you’ll live longer. And if you’re like most people, you have family who love you and want you to live as long as possible. That right there is good reason to do it. You’ll be happier. And more physically comfortable. And you’ll probably earn more money. And have more sex. So with all those motivations, if losing weight was really possible, you would do it. Some of us master the literally Sisyphean task of weight loss and peel off 120 pounds or maybe more. But then, because of biological imperatives, we gain it back again. Over and over.

That’s where Lap Bands come in. Dr. Favretti, one of the first surgeons to work with Lap Bands, completed a 12 year study on the effectiveness of Lap Bands and the news is good - people don’t gain the weight back. The study covered over 1700 patients over twelve years both morbidly obese and super obese. The average weight of the patients started out around 260 pounds plus or minus 37 pounds with an average BMI of 42.6 - that’s our 5′3″ woman at 236 pounds or our 5′10″ guy at 292 pounds. At the end, they weighed on average 185 pounds plus or minus 60 pounds with an average BMI of 31.6 - putting our woman at 175 pounds and our man at 216.

If you want to check your BMI, you can do so here at the Centennial Treatment Center For Obesity in Nashville, Tennessee.

I know all of you reading this think, “Oh no, I want to lose a lot more weight than that!” Well, of course you do, and as far as I can tell, you can. You do have to exercise though and to make that point, I’m going to quote Dr. William Lee of Blue Earth, Minnesota in the Mankato Free Press:

Lee said his patients can be divided into two groups, those who shed 6 to 8 pounds a month and patients who lose 10 to 15 pounds a month. “The difference between these two groups,” he said, “is exercise.”

So, just keep that in mind - you’re gonna have to buy a trampoline, a pair of Nordic Walking Poles or get yourself a backyard treadmill. And if you do, and if you follow the doctor’s directions, and get yourself into a support group, you’re going to have a really good shot at getting down to the tiny little person you’d really rather be.

Why You Eat What You Eat

Since it’s a holiday in much of the western world, I thought I’d link to this fantastic Word Press Blog post on why we eat what we eat and as much as we eat. This is one more in my series of why excess weight is so insidiously difficult to get off.

From SOMETHING TO READ WHEN YOU’RE BORED by Linsey Mallory - Do You Know Why You Eat?

This morning one of my coworkers (Rich) laughed at me when I told him I was covering up the stack of cookies he brought in because seeing them made me want to eat them. I defended my actions by informing him that there have been studies documenting the phenomenon of food visibility increasing consumption, but I still didn’t get the impression he believed me. So I of course decided to do some digging and prove to him that my snickerdoodle concealing behavior was not absurd.

So, this is what I learned in this post - that food that is convenient to us gets eaten - pretty much even if we don’t like it. I’ve done that - I’ve eaten an entire meal I didn’t like. I’ve snacked on snacks I didn’t enjoy. I don’t do a lot of it, but I have done it.

Mallory goes on to quote a CDC study on the subject:

People served larger portions simply eat more food, regardless of their body weight and regardless of the food item, meal setting, or timing of other meals; and the temptation to eat food at hand is so strong that human beings eat more even if the food tastes bad.

The amount of food consumed increases as the effort to eat it decreases, even if the differences in effort are tiny (the example they gave of this was a bowl of candy within reach, rather than a few feet away)

The mere sight of food can stimulate people to eat (Take that Rich!)

The longer the meal, the more people eat. The amount of food people eat is directly and strongly related to the number of people sharing the meal, with food consumption increasing by 28% when one other person is present and increasing steadily to 71% when the number of companions is six or more.

And this is what I find most germane to the essential topic of regaining weight after it’s been lost:

In general, human self-control over automatic behaviors is limited. Self-control tires like a muscle and taxes our ability to perform other tasks. And just as refusing food depletes a person’s mental reserves, tasks requiring mental effort can reduce the ability to resist the temptation of food. (this explains why I eat like crazy when I’m stressed out)

Because people are unaware of automatic behaviors, they are also unaware that the behaviors are not under control; people tend to fabricate reasons to explain their behaviors, typically choosing the most plausible, culturally acceptable theories.

Yes, I’ve experienced being too stressed to resist food that I didn’t want to eat. Eating didn’t require any mental gymnastics at all while refusing it seemed like the most ingracious ordeal imaginable.

Happy Easter to everyone. I’m editing my interviews with Lorraine finally today. I’m doing this post in the middle of a render. I’ll have them up later this evening for your viewing pleasure.

…Works Better Than A 500 Calorie Diet!

yeah, baby, cuz I been on 500 calorie diets and they are no fun.

Alright, i don’t know how missed this study. This is good to see.

Researchers at Monash University Medical School in Melbourne, Australia, recruited 80 patients who were on average 52 pounds over a healthy weight. Half had the laparoscopic adjustable gastric band surgery.

The other half followed a medical program that included a variety of strategies such as a very-low-calorie diet (500 calories a day) with liquid meal replacements, prescription weight-loss medication and behavioral therapies.

And guess what we found out? The patients with lap band kept the weight off and the dieters didn’t.

After six months, both the surgery patients and the low-calorie dieters lost an average of 14 percent of their starting weight.

- After two years, the gastric band patients lost 22 percent of their starting weight. That was about 87 percent of their excess weight, or roughly 45 pounds. They also showed marked improvement in their health and quality of life.

- At the end of two years, the dieters had regained much of their lost weight but were still 5.5 percent below their starting weight. They had lost 22 percent of their excess weight, or about 12 pounds.

Lap bands allow you to get around the weight set point issue. After you’ve dieted a few pounds away, your body starts cranking your metabolism and it becomes harder and harder to lose weight - you’ve experienced this, no doubt. Unfortunately, it becomes easier and easier to put weight on and as soon as you stop dieting, your weight keeply rebounds to where it was before. But with weight loss surgery, the crank down in metabolism doesn’t happen and so you lose weight and you keep it off. Once you stabilize at given weight, you have the ability to stay there. That’s the key, right there.

Happy Saturday, folks. Now I’ve got a video interview to go finish cutting.

Why You Regained The Weight You Lost So Happily

I’m going to look for the original study on this but here are some numbers I’ve never seen before. From Rachel Zabrodski’s Beyond Dieting:

Set point theory also relates to issues of metabolism. If one’s metabolic rate is reduced to ensure survival, fewer calories are needed. The “set point” is lowered. Therefore, one will gain more weight when the diet stops ensuring a subsequent weight gain on fewer calories. This phenomena is often found in women who have endured a very low calorie liquid protein diet (VLCD) that consists of 500 calories per day. Weight is lost initially, stabilizes and when calories are increased to just 800 per day, weight is GAINED. It is believed that the set point is lowered and a resultant net gain occurs (College of Physicians and Surgeons of Alberta, 1994).

There has been discussion that the process of prolonged and repeated dieting puts the body at physical risk. Yo-yo dieting or weight cycling is the repeated loss and regain of weight. Brownell, Greenwood, Stellar, and Shrager (1986) suggested that repeat dieting will result in increased food efficiency that makes weight loss harder and weight regain easier. The National Task Force on the Prevention and Treatment of Obesity (1994) concluded that the long term health effects of weight cycling were largely inconclusive. It recommended that the obese should continue to be encouraged to lose weight and that there were considerable health benefits in remaining at a stable weight. This is an ironic suggestion in that most dieters do not intentionally try to regain weight once it has been lost

Nowhere in the happy “diet and exercise” mythology is there room for discussion of people gaining weight consuming 800 calories a day. All of us burn that many calories a day easily - that is, under normal metabolic conditions. But that’s the problem those of us who wrestle with obesity face, we don’t metabolize food normally.

I’ve lived on 700 calories a day for months on end. It’s horrible. You just look at piece of protein and you feel guilty because all of it is too high calorie for satisfaction. Big plates of plain vegetables, tuna in water, a bowl of shredded wheat with a little fruit (careful there) and maybe a piece of bread or two. Croutons become a luxury. Don’t get carried away with that chicken breast - you can only have four ounces of that. A piece of birthday cake becomes a crisis. If you’re hypoglycemic, you may have a headache the entire time as well. I did. And you are never, ever full. You are hungry 24 hours a day, seven days a week. That’s one of the reasons this quote from Dr. Jeff Friedman in RETHINKING THIN meant so much to me:

“Those who doubt the power of basic drives, however, might note that although one can hold one’s breath, this conscious act is soon overcome by the compulsion to breathe,” Dr. Friedman wrote. “The feeling of hunger is intense and, if not as potent as the drive to breathe, is probably no less powerful than the drive to drink when one is thirsty. This is the feeling the obese must resist after they have lost a significant amount of weight.”

I was going to close with that, but I do want to include another potent paragraph about set points:

The researchers concluded that 70 percent of the variation in peoples’ weights may be accounted for by inheritance, a figure that means that weight is more strongly inherited than nearly any other condition, including mental illness, breast cancer or heart disease.

The results did not mean that people are completely helpless to control their weight, Dr. Stunkard said. But, he said, it did mean that those who tend to be fat will have to constantly battle their genetic inheritance if they want to reach and maintain a significantly lower weight.

The findings also provided evidence for a phenomenon that scientists like Dr. Hirsch and Dr. Leibel were certain was true — each person has a comfortable weight range to which the body gravitates. The range might span 10 or 20 pounds: someone might be able to weigh 120 to 140 pounds without too much effort. Going much above or much below the natural weight range is difficult, however; the body resists by increasing or decreasing the appetite and changing the metabolism to push the weight back to the range it seeks

And those set points can be eliminated with weight loss surgery - that’s why it works so much better than diet and exercise.

More On Genetics And Obesity

“Those who doubt the power of basic drives, however, might note that although one can hold one’s breath, this conscious act is soon overcome by the compulsion to breathe,” Dr. Friedman wrote. “The feeling of hunger is intense and, if not as potent as the drive to breathe, is probably no less powerful than the drive to drink when one is thirsty. This is the feeling the obese must resist after they have lost a significant amount of weight.”

I’ve been reading Gina Kolata’s book Rethinking Thin. Ms. Kolata is the head science writer for the New York Times, and she explores the many diets and the research around weight loss and weight loss maintenence. She makes clear in this book that we have known definitively since the 1950s that it takes far more than diet and exercise to keep weight off.

The New York Times published an outstanding excerpt from her book that really contains the most essential information as it relates to those of us who are trying to understand how we got in this situation and moderate from there. This particular section talks about the initial obesity studies and how, by the early sixties, science had documented that after a dieter successfully loses weight, their metabolism drops to put it right back on. It’s infuriating to think we’ve know this this long, and it hasn’t been made part of the cultural discussion.

It was 1959. Jules Hirsch, a research physician at Rockefeller University, had gotten curious about weight loss in the obese. He was about to start a simple experiment that would change forever the way scientists think about fat.

Fred R. Conrad/The New York Times
Jules Hirsch, a research physician at Rockefeller University, conducted a simple but groundbreaking experiment on obesity nearly 50 years ago, changing the way scientists think about fat. Obese people, he knew, had huge fat cells, stuffed with glistening yellow fat. What happened to those cells when people lost weight, he wondered. Did they shrink or did they go away? He decided to find out.

It seemed straightforward. Dr. Hirsch found eight people who had been fat since childhood or adolescence and who agreed to live at the Rockefeller University Hospital for eight months while scientists would control their diets, make them lose weight and then examine their fat cells.

The study was rigorous and demanding. It began with an agonizing four weeks of a maintenance diet that assessed the subjects’ metabolism and caloric needs. Then the diet began. The only food permitted was a liquid formula providing 600 calories a day, a regimen that guaranteed they would lose weight. Finally, the subjects spent another four weeks on a diet that maintained them at their new weights, 100 pounds lower than their initial weights, on average.

Dr. Hirsch answered his original question — the subjects’ fat cells had shrunk and were now normal in size. And everyone, including Dr. Hirsch, assumed that the subjects would leave the hospital permanently thinner.

For those of you who can’t bear to read entire paragraphs, in the 1950s, Dr. Jules Hirsch put 8 people who had been obese since childhood in the Rockefeller Hospital for eight months and fed them 600 liquid calories a day - a diet that guaranteed they lost weight. They lost on average 100 pounds and then spent four weeks on a maintenence diet before they were sent home. What happened when they went home? They gained the weight back.

So, Dr. Hirsch and is partner, Dr. Rudolf Leibel, repeated the experiment again and again. Each time, the end result was the same.

“The weight, so painstakingly lost, came right back.”

Then something else was noticed.

But since this was a research study, the investigators were also measuring metabolic changes, psychiatric conditions, body temperature and pulse. And that led them to a surprising conclusion: fat people who lost large amounts of weight might look like someone who was never fat, but they were very different. In fact, by every metabolic measurement, they seemed like people who were starving.

Before the diet began, the fat subjects’ metabolism was normal — the number of calories burned per square meter of body surface was no different from that of people who had never been fat. But when they lost weight, they were burning as much as 24 percent fewer calories per square meter of their surface area than the calories consumed by those who were naturally thin.

So, when you lose weight, your body ceases to function normally. Wow. So, here you are all trim and happy - and your body thinks you’re dying of starvation. Wow. Wow. Wow.

This explains a lot, doesn’t it?

The Rockefeller subjects also had a psychiatric syndrome, called semi-starvation neurosis, which had been noticed before in people of normal weight who had been starved. They dreamed of food, they fantasized about food or about breaking their diet. They were anxious and depressed; some had thoughts of suicide. They secreted food in their rooms. And they binged.

The semi-starvation neurosis is real. You’ve experienced it, no doubt. But it’s not you being undisciplined or gluttonous - it’s how our ancient bodies have evolved to protect us.

And here is one of the money quotes in the article:

The Rockefeller researchers explained their observations in one of their papers: “It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved nonobese individuals.”

Next, Dr. Ethan Sims decided to find out what happened when thin people got fat. Did they stay that way? Because the popular belief is that fat people get that way be eating badly - so if the belief is true, these guys should put the weight on and get stuck with it. Just like you and I did, right? Wrong.

His subjects were prisoners at a nearby state prison who volunteered to gain weight. With great difficulty, they succeeded, increasing their weight by 20 percent to 25 percent. But it took them four to six months, eating as much as they could every day. Some consumed 10,000 calories a day, an amount so incredible that it would be hard to believe, were it not for the fact that there were attendants present at each meal who dutifully recorded everything the men ate.

Once the men were fat, their metabolisms increased by 50 percent. They needed more than 2,700 calories per square meter of their body surface to stay fat but needed just 1,800 calories per square meter to maintain their normal weight.

When the study ended, the prisoners had no trouble losing weight. Within months, they were back to normal and effortlessly stayed there.

So, when you lose weight beyond your set point, your metabolism drops by up to 24% per square inch. When you gain weight beyond your set point, your metabolism speeds up by 50%.

The implications were clear. There is a reason that fat people cannot stay thin after they diet and that thin people cannot stay fat when they force themselves to gain weight. The body’s metabolism speeds up or slows down to keep weight within a narrow range. Gain weight and the metabolism can as much as double; lose weight and it can slow to half its original speed.

So, that’s what you’re up against. It’s not, as a commenter below suggested, simply enough that you eat appropriately. Eating appropriately won’t keep weight off and it likely won’t prevent you from gaining it either. Your body is going to rebound to it’s set point after you lose weight.

UPDATE: I found a study which I wrote about in another post that I’m going to add in here. A study in Canada put women on a supervised 500 calorie per day liquid with exercise diet. They lost weight, of course. Then they scooted their calories up to 800 per day and all of the women gained weight. Got that? These women gained weight consuming 800 calories per day. So that’s why your diets fail as well - it’s not about eating appropriately. It’s about the fact that whenever you diet and reduce the amount of colories you consume, your body reduces your metabolism accordingly. So when you go back to a calorie level that you can actually live on, you gain weight. It doesn’t matter how balanced, or low fat, or high fat, or how many veggies you eat with that new calorie intake - it only matters that it was higher than the calorie intake you were consuming while dieting.

You have to decide what you want to do. You have three choices that I know of:
1. Accept yourself as you are and quit fretting about your weight.
2. Spend the rest of your life on an aggressive diet with an aggressive work out plan and hope for the best.
3. Get weight loss surgery and be able to lead what most bandees regard as a normal life.

If you take anything away anything from this blog, I hope it’s the awareness that guilt is not earned on your part. What I hope you will do is look in the mirror everyday and see a wonderful person who is loved and needed. Whether you’re fat or not doesn’t change who you are in your loved one’s hearts. Just put that burden down. Guilt is not yours to carry on this subject. Even if your weight is impacting your marriage. Even if you have children who need you.

I’m a big believer in the whole fat acceptance movement because no one should be beating themselves up over something this far beyond human control. I spent years of my life monitoring every single bite I put in my mouth, kept my calorie intake way under 1500 per day, worked out daily and gained weight steadily the whole time. I’ve had relationships go south because of weight. We live life with the genetics we have, not the genetics we want.

If you need to lose weight, then take a read what I’ve written above and take a good look at weight loss surgery. It’s a tool - really, the first tool we’ve ever had - that will allow you to get back to a moderate weight and stay there without complication. Studies say you’ll live longer and you’ll be happier. You’ll probably earn more money too.

Obesity Largely Determined By Genetics

Sometimes I feel like I harp on this a bit too much, but most people who are overweight suffer from so much guilt, that I think it’s incredibly important to reiterate the degree to which weight gain is beyond common sense control. I doubt that most overweight people eat that much differently from their trimmer companions. Most of us eat somewhat badly but few of us really binge.

From the University College London:

Becoming overweight as a child is more likely to be the result of your genes than your lifestyle, claims a study.

University College London researchers examined more than 5,000 pairs of identical and non-identical twins.

Their American Journal of Clinical Nutrition study found that differences in body mass index and waist size were 77% governed by genes.

Why twins?

Twin studies are a good way to test how far our genes or our environment influence our development.

Identical twins have exactly the same genes, while non-identical twins are genetically different, like brother and sister.

However, because they were born at the same time, and raised in the same household, they can be assumed to have roughly similar upbringing in terms of food.

This allows scientists to measure differences in weight and calculate how much of that difference can be blamed on environment, and how much on genes, even though it doesn’t identify individual genes which might be linked to obesity.

They worked out that the effect of a bad environment was far less marked than the effect of a child’s genes.

I think it works out like this - our modern diet is a mess. Lots of carbs and fat and salt - not a good combo. For people who are not genetically inclined to gain weight though, the diet isn’t that much of a problem. But for those of us who are - watch out!

And be very clear - carbs, fat and salt is very much the diet that was encouraged on us from the late sixties on. I’m talking about pasta and pesto here - not fast food. But once you get to fast food, then you have real problems. And how many kids, in our mom-got-home-late-and-still-needs-to-do-laundry-and-grade-papers world are eating fast food a few times a week? Grrrrrr……

Just put your burden down and decide what you want to do. If you don’t want surgery, learn to love yourself anyway. Eat right. Get some exercise. Check out the online fatosphere and make some new friends. The truth of the matter is that you’re pretty worthwhile regardless of what you do, and that’s what you should treasure about yourself. And if you do want to lose weight, then quit beating yourself up. You probably aren’t any more gluttonous than lots of your skinny friends - it’s true. Get yourself to a surgeon and check out lap band surgery. You’ll live longer, you’ll be healthier and happier. And that’ll make your mom, your spouse and your kids happy too.

Lap Bands, Weight Loss and Strength Training

This will be my last exercise post for a while, but now that I know how much of a difference it makes, I do want to provide you with some kind of pathway.

I talked to my friend Bonney (named after one William Bonney - how cool is that?) about her weight loss at the gym. In her late fifties, Bonney collapsed into a coma and was diagnosed with severe COPD. She was approximately 150 pounds overweight, and after she revived, she was pretty much trapped in her second floor apartment. Traveling up and down the stairs required a tremendous amount of energy and risk so she would only leave a few days a month. After a couple years of this, she discovered that her insurance provided her with a gym membership and access to a personal trainer for a few sessions. She wound up joining a new gym in a somewhat off-the-beaten-path location. And because they were a new gym, rather than getting just a couple sessions with a personal trainer, they assigned her a personal trainer and footed the bill for several months. Her first day, she could barely spend five minutes at the slowest speed on the treadmill. She was also introduced to a round of strength training and resistance exercises. She went four days a week and over the course of eight months, lost 110 pounds. She can now spend about 35 minutes on the treadmill.

I asked her if she had any advice for my readers who are self-conscious in gyms. She said that she’s glad she joined a new gym because the membership was lower - there were just fewer people around. Also, she went at odd times - in the early afternoon or late at night - and that also meant fewer people. They also had a separate section for women and she was far more comfortable there. She loves the treadmill now because it has handlebars that she can balance on - it makes walking easier for her than taking a stroll down the street. The interesting thing is that once she lost 40 pounds or so, the other people in the gym really began to cheer her on. There were a handful of very buff young men who were passionate about their strength training and they became her biggest cheering section. They wanted to hear about her progress and share work out tips with her. Oddly, the people that she was most uncomfortable in front of in the beginning, were the people who became her biggest assets as she continued.

The brilliant thing about weight loss surgery is that it allows you to reset your “set point” - the weight at which your body stabilizes. With a lap band, when you diet and exercise, you can actually lose weight and keep it off - something that fewer than 5% of dieters normally accomplish. Without it, you have a constant struggle for the rest of your life to maintain your weight loss. Strength training and Nordic walking both build up your muscles so that your body consumes more calories as you go through your day. Between that and the Lap Band, you can get to your goal weight or very close to your goal weight and stabilize. From there, you can lead a normal life. You can be healthy and feel beautiful and for probably the first time in many years, not feel deprived. What could be better than that?

What’s going on with this blog?

So, here I am with a blog that says it’s about life and weight loss with a lap band and there is very little about lap bands here. The truth of the matter is that I want it to be larger than that - I want it to be about the whole ugly truth of weight loss. I want to provide a really three dimensional presentation of why weight loss is so difficult and unlikely and if, in the process, I can get a few people to leave their guilt behind, hallelujah.

I’m going to begin doing my interviews this week finally. I’m looking forward to getting started on that part. They should be fairly easy and quick for me to get up, so you’ll be seeing them by next weekend. In the meantime, I’m going to continue providing information on the literally Sisyphean task which is weight loss and weight loss maintenence.

Set Points and Weight Loss Surgery

One of the things I’ve been reading a lot about is set points. Basically, your body has a set weight that it likes and it’ll do everything it can to keep you there. You can lose about 10% - 15% of your excess weight, and if you work hard enough, your body will probably go along with that. Much more than that, and your body goes to war with your diet. Judy Forman, in a Boston Globe article, says this:

If you’re talking merely 10 to 20 pounds - and nobody knows the actual figure - you probably can diet and exercise your way to a svelter self and stay there, provided you stick with your weight control program rigorously. Forever.

Depressing, but you know it’s true. Dr. Lee Kaplan, in the same article continues:

Only about 1 to 2 percent of obese people can permanently lose weight through diet and exercise alone, said Dr. Lee Kaplan , director of the weight center at Massachusetts General Hospital.

And then he sets us all free:

“Dieting is like holding your breath,” he said. “You can do it, but not for long. Your body is stronger than your willpower.”

Uh huh. Now this is what all those “diet and exercise” types never tell you. Some of ‘em don’t know and some of ‘em can’t make money off you if they tell:

One famous study conducted at the University of Minnesota during World War II illustrates the ineffectiveness of severe dieting. The researchers put 36 physically and emotionally healthy young men of normal weight on a strict diet, allowing them only half the calories they were used to. The men lost weight, but became psychological wrecks, obsessing about food, bingeing, and, even after the diet was over, eating way too much, often 8,000 to 10,000 calories a day until they regained the weight, recounted New York Times science writer Gina Kolata in her recent book, “Re-thinking Thin.”

In another classic study in the 1950s, researchers at Rockefeller University in New York City recruited obese people who were so desperate to lose weight that they agreed to live in the hospital for eight months, including a four-month period in which they subsisted on only 600 calories a day of liquid formula. They lost weight, Kolata noted. But, to the dismay of subjects and researchers, they all quickly regained the weight.

Here’s what happens:

When a very fat person loses a lot of weight by diet and exercise, the brain goes into panic mode, reading a complex array of chemical signals as proof of impending starvation. Metabolism slows. The body hangs on to every calorie it can get. The chemical signals that trigger appetite soar, creating a drive to eat so powerful you can’t resist. From the standpoint of evolution, this makes sense: Our DNA was built when we were hunter-gatherers to protect us against starvation, not obesity.

So after you go on a diet, not only is your body slowing your metabolism, it’s also flooding you with hormones and chemicals that trigger hunger. So if you were happy with a Quarter Pounder and a small order of fries before your diet, after your diet, you’re gonna need to super-size everything to feel an equivalent level of satisfaction. That isn’t you being undisciplined. It’s you responding quite normally to your body.

They don’t why it happens yet, but here’s their best current guess:

Consider one of the best-studied weight control hormones, leptin, which is made in fat cells and is designed to tell the brain: “Stop eating. I’m full.”

“Obese people usually have high levels of leptin because they have so many fat cells making it,” said Dr. Eleftheria Maratos-Flier, an obesity researcher and associate professor of medicine at Beth Israel Deaconess Medical Center. “The heavier you are, the higher the circulating leptin.” In theory, being fat should mean that the brain would be flooded with “stop eating” signals.

But when people go on severe diets, “they lose more leptin than you would expect. So the brain thinks there is less fat than there ought to be,” which makes people eat more, she said.

And now we’re back to diet and exercise and why it doesn’t work:

Put differently, some researchers believe that one reason weight loss programs ultimately fail is that diet and exercise do not change the body’s “set point,” the thermostat-like mechanism in the hypothalamus and other parts of the brain that keep weight fairly constant.

And that brings us round to weight loss surgery. The article goes on to talk about gastric bypass, but there’s no evidence that all patients need to go that far. We know that patients who have had lap band surgeries lose as much weight as patients who have had gastric bypass, and they keep off as effectively as well. Though there are reasons for some to choose other types of weight loss surgery over lap bands, for most of us, the less invasive the surgery the better.

And here’s the conclusion about long term weight loss from the Medical Journal of Australia. LAGB being Gastric Banding:

All bariatric procedures have been able to achieve loss of more than 50% of excess weight.24,27-29 The ASERNIP-S systematic review showed greater weight loss after RYGB than LAGB during the first 2 years after the procedure, but the difference in weight loss was not significant at 3 and 4 years.24 In a recent review,23 we extended the data of the ASERNIP-S review by including all studies that included at least 50 patients, reported up to March 2004 (Box 5). This showed a substantial weight loss after both procedures, with an initial greater weight loss after RYGB but similar effectiveness for both procedures at 4, 5 and 6 years.

So, there ya’ have it - the big reason why diet and exercise do not work as we have been taught to believe they do.

Life Delays And Caffeine

Isn’t this how it always goes? You get really jazzed about a project and something in your life stops you cold. Car problems put my interviews on hold. I’ve decided the thing to do is just buckle down and write about what it is I’m learning.

I read a really interesting article a couple weeks ago about caffeine and blood glucose levels. Dr. James Lane, a psychologist at Duke University (where they have been working for a very long time on obesity issues) discovered that patients with Type 2 diabetes experienced rising blood sugar levels just from consuming caffeine. Tiny little monitors were placed under the patient’s skin, and recorded the rising levels after meals.

The findings, appearing in the February issue of Diabetes Care, add more weight to a growing body of research suggesting that eliminating caffeine from the diet might be a good way to manage blood sugar levels.

Lane studied 10 patients with established type 2 diabetes and who drank at least two cups of coffee every day and who were trying to manage their disease through diet, exercise and oral medications, but no extra insulin. Each had a tiny glucose monitor embedded under their abdominal skin that continuously monitored their glucose levels over a 72-hour period.

Participants took capsules containing caffeine equal to about four cups of coffee on one day and then identical capsules that contained a placebo on another day. Everyone had the same nutrition drink for breakfast, but were free to eat whatever they liked for lunch and dinner.

The researchers found that when the participants consumed caffeine, their average daily sugar levels went up 8 per cent. Caffeine also exaggerated the rise in glucose after meals: increasing by 9 percent after breakfast, 15 percent after lunch and 26 per cent after dinner.

For those of us who have experimented with Atkins, this may answer a mystery that Dr. Atkins wrestled with. From the very beginning, he stated that you could not drink coffee on his diet. He didn’t know why, but he knew his patients didn’t lose weight unless they cut the caffeine out. His suspicion was that it triggered hunger and we’d eat more than we should. Well, I knew that wasn’t the case with me, but I didn’t lose weight until I cut the coffee out.

I wrestle with a lot of guilt (as I’m sure most of you do as well) and it’s gratifying to discover that many of the problems with weight loss really have nothing to do with self-discipline. I do a lot of work at my computer and it’s so comfy in the morning to sit here quietly, typing away, and when I pause to collect my thoughts, to have a sip of a nice, hot cup of coffee with a little cream (okay, a lot of cream - I’ve given up) and sweetner. In the summertime, for me, it’s Diet Coke in the morning. I love the bubbles and the acidic bite against my tongue.

So, now, what do I do? It will be several more months before I can afford surgery. Do I give up caffeine? Or do I wait it out?