Friday, January 18, 2008

What if Willpower Matters Little in the Long-Term for Weight?

In my last post I noted that the idea of counting calories to maintain a balance between calories in and calories out is an unnatural state of being. Yet is it exactly what is promoted, has been promoted for decades, and increasingly is being promoted in what could be considered a 'cradle to grave' approach, where even children are being subjected to messages designed to make them ever aware of calories in, calories out - if they gain weight, it's obviously their fault that they didn't get it right.

As I said in my previous post, "For some reason we are stuck in this thinking that the problem isn't the concept, but the execution."

Some lively discussion in the comments followed, as well as a good number of emails - with most boiling down to four main themes - any type of restriction is difficult, counting carbohydrates is as unnatural as counting calories, most people won't eat just whole, natural foods and most people won't do what it takes anyway.

How depressing!

But I definitely understand the points made, and think at least opening a discussion on the issue has value for the future.

Afterall, we can safely say, based on the evidence available, almost every weight loss diet dreamed up in the last century works - data clearly shows that calorie restriction, dietary fat reduction, carbohydrate restriction, increasing protein, manipulating glycemic index or glycemic load, using shakes and meal replacements, fasting approaches, and even weight loss surgery all enable an individual to lose weight.

The diet or medical intervention one utilizes does not matter all that much - they all work for weight loss - so to say one approach is better than the other for weight loss truly has little value for long-term success to maintain weight loss.

Weight loss isn't the problem - keeping the weight off afterward is the really critical issue that we continue to fail to address in a meaningful way to actually see long-term results.

Oh, don't get me wrong, the diet industry, along with the medical and research communities talk a good story, point to data from those few who manage to maintain their weight loss in a national registry, and repeat again and again that failure comes down to lack of willpower in the individual. If only a person would continue, for the long-term, the dietary principles they utilized to lose the weight, they would not gain back the weight lost.

As Sandy Szwarc said in a Junkfood Science post early last year, "Only long-term results, after weights have stabilized, are relevant when evaluating any diet and, more importantly, any actual impact on health outcomes."

While I don't always agree with Sandy's take on things, or her conclusions, she is well known for taking an evidence-based approach in her writing and on this issue I agree 100% - not because everything she wrote in the above linked article was spot-on, but because she stated something so obviously ignored in the current urgency to do something about the "obesity epidemic" that seems to have no workable long-term solution.

The rising incidence of obesity in the United States is not new - for decades now we've watched as each year more and more of our population is classified as overweight or obese; and it does not appear to be reversing, despite the continuous messages to eat less and move more, be aware of calories in and calories out, just do it and stick to it.

Oddly it seems, the louder the messages get, the fatter the population grows.

Yet, while it's acknowledged that in the long-term dieting doesn't seem to result in long-term weight stabilization and maintenance, few are asking why.

Instead we're left with the idea that all these tens of millions of people who lose weight on a diet lack the willpower and resolve to maintain a healthy-balanced diet in the long-term.

It's the failure of the individual not the dietary principles they're told work - as I said before, the failure is not the concept, but the execution.

Every single year, tens of millions of people set out to lose weight and the vast majority do lose weight - they celebrate, buy new clothes, enjoy high self-esteem, are empowered by their success and feel great.....and then are just too damn weak, so they eat themselves back to where they started?

Is this not where the idea that it's a lack of willpower takes us?

If it's not willpower, then what does enable successful weight loss followed my maintenance and improved health outcomes in the long-term?

Before embarking on an exploration of this issue next week, I'd like to hear from readers about their experiences - success and failure - and what ultimately you've learned over the years? If you had to give advice on how to maintain weight loss for the long-term, what would you suggest based on your experiences?


  1. I lost 70 pounds on low carb. I didn't follow any particular program or count carbs, just avoided carby foods. I ate whenever I was hungry; conversely I ate only when hungry (I now have a hard time stuffing in much more than one meal a day). I found it much easier to treat it as a lifestyle change rather than a temporary fix just to shed some pounds. That way it just becomes part of the routine of shopping, cooking, and eating.

    My own experience after three years of low carb is that I just can't tolerate refined carbohydrates at all anymore. The bad reaction I have (racing heart, followed by sugar crash, followed by nasty acne breakout) serves as a pretty good deterrent. But I don't think most people have as severe a reaction.

    Calorie restriction is doomed, because you're fighting against survival mechanisms that have existed since life began. Any diet that allows a significant amount of carbohydrate cannot succeed, for similar reasons: the exaggerated hormonal response not only produces a temporary "high", but also triggers stress hormones. Not surprisingly, part of the stress recovery response is a strong craving for quick calories. The only way to succeed in the long term is to avoid triggering these internal survival mechanisms.

    I think people have trouble sticking to "diets" because they're forced into deciding between some disease that may occur in the future, or signals from their body that they're going to die NOW if they don't get some food. Widespread failure should be no surprise, and the whole "willpower" thing is idiotic. In any other context, having the willpower to cause your own death would be considered mental illness.

    Finally, we really need to educate the public that obesity itself is not a disease, nor does it cause any disease. It's like saying smoker's cough causes lung cancer. Obesity is a symptom of an underlying serious hormonal disorder, brought about at least partly by eating the wrong kinds of food. Maybe if we move the focus away from appearance, and more towards internal health, people will have more success. There was at least some success using this approach to reduce cigarette smoking.

  2. Regina,

    I first started watching my weight in my teens 40-some years ago. Because of undiagnosed blood sugar abnormalities, I have always been able to gain weight very quickly. We dieted back then by cutting out bread, potatoes, etc, and that would always get me back to goal.

    At menopause weight control became much, much tougher. I managed to lose 30 lbs at age 55 and keep it off for almost 5 years mostly with the help of metformin, which really keeps me from gaining, and an attitude that if I gained more than 3 lbs, I better cut back on the food until I was back to goal. Losing three pounds is doable. More than that is tough.

    A change in my insulin regimen packed a bunch of weight on me last month extremely quickly so now I have 7 lbs to lose after 3 weeks of stringent very low carb/low cal dieting. It's going to take a couple months.

    But taking off 10 lbs is easier than taking off 30.

    I think the key for me has always been treating a relatively small weight gain as an emergency. My female relatives would wait until they had 20 lbs to lose and never get it off, because losing 20 lbs at middle age can take a year of stringent dieting.

    And the other thing that has helped me is I've had to accept that even when I'm not dieting, I can't eat all that much anymore.

    I'm only 5'3" and my body doesn't need much to keep it going. All the calculators tell me maintenance for my size and age is 1600 calories. That's not a lot of food!

  3. First off, I think that not enough attention has been given to the psychological reasons people eat, emotional eating, comfort eating, etc., and putting an end to those patterns in people.

    Secondly, the whole idea of "maintenance"is flawed. I think that the only way to successfully "maintain" is to continue to have fitness goals, striving to constantly improve. Once you settle into "maintenance", it's only a matter of time before old habits and pounds creep back in. People need to realize that fitness is a journey, not a destination.

    Finally, I think that people need to learn new behaviors that are sustainable for them. They need to learn how to buy and prepare healthy food that they actually enjoy. They need to find a way to exercise that is fulfilling to them. Nobody is going to stick to a plan of miserable exercise and self-denial for very long.

    Self-discipline plays a part in it, and unfortunately so does the omnipresence of extremely unhealthy food. It's about getting your head in a place where you can rise above all that noise and choose your own path.

  4. Anonymous11:20 AM

    Obviously antecdotal: When I started low carbing and losing weight I decided my long term goal was to come up with a diet I liked. Comfort food, acceptable sweets, safety foods if I really am hungry. I look forward to what I plan and cook for dinner each night. After about two years of dieting I noticed that my appetite had really come under control. Life has got more complicated as my 'impaired glucose function' converted to insulin (not much) dependent diabetes. RobLL

  5. I'm 6 pounds away from an initial weight loss goal of 35 pounds, and I don't think I'm going to have much trouble keeping this off. I don't count calories or carbs, I just do my best to limit processed, sugary and starchy foods. I don't feel bad about one cheat meal per week. I exercise, but my only goal is to keep my activity level the same as it was before. The huge change I've noticed is that I'm just not that hungry any more. My appetite directly scales with my activity level.

    There have been a few other things that surprised me. Walking into a grocery store and realizing how little of what they have on the shelf is of any interest to me any more. Tasting spaghetti sauce over meatballs and being able to clearly taste the sugar in the tomato sauce.

    This feels like a lifestyle change, not just a weight-loss diet. The key word is sustainable, and this feels sustainable. There's little need to wonder if I'll gain back the weight after I've completed the weight loss because I don't intend to change my diet once the initial goal is met. The specific weight-loss goal was actually just a way to measure progress against the BMI. The longer-term goal stretches for the rest of my life and I'll find more short-term goals to work towards so that it's an interesting trip.

  6. Anonymous12:33 PM

    Billy wrote: "First off, I think that not enough attention has been given to the psychological reasons people eat, emotional eating, comfort eating, etc., and putting an end to those patterns in people."

    I respectfully disagree with Billy and agree with Regina. Psychology seems to be all we hear about! It's our fallback position when people fail on diets - it must be some weakness on the part of the dieter. And then the guy running the nutrition program at the USDA made his name by telling us how psychology influences food choices.

    I wish the guy running the USDA had made his name by knowing what people should eat.

    I don't mean to suggest that psychology is unimportant, just that it is not the primary determinant of what we eat.

    My story: tried to eat low-fat, low-calorie from around 1992 through 2002, never succeeded for more than a few days at a time because at best I was always hungry, at worst I would get the shakes, gained nearly 60 lbs in that decade on my 5' 3" frame, blamed it all on lack of willpower. Went LC in 2002, lost 24 lbs in the course of 6 months easily, without hunger, without symptoms of low blood sugar. Foolishly allowed myself to stray over the course of the next few years. Finally went back to LC last August, have lost all 18 of the pounds I regained.

    Psychology is somewhat important - why did I let myself stray from something I knew was working? But the reason I don't think it was the most important thing is that all the willpower in the world couldn't help me stick to a low-fat, low-calorie diet for even a week, but it hardly took any work at all to stick with it for six months.

    (Still have about 10 lbs to go - I learned from a recent body mass composition test that some of the 60 lbs I gained in that decade was much needed lean body mass - probably muscle and bone developed as a consequence of carrying around extra fat.)

  7. How many diet books out there are focused on changing the way we think and feel about our relationships with food? How many focus on the psychological aspects of behavioral change?

    A scant few, in comparison with the countless books that simply tell us what, when, and how much to eat and exercise.

    You can only do what you're told for so long. Until you learn how to really want to do it for yourself, you won't succeed long-term.

    One of the interesting things I've learned in my weight loss quest is how powerful a psychological aversion (or in contrast, an attachment) to a food can be. Fish, for instance, used to make me literally gag. Until I learned to open my mind and free myself of these barriers, I could never accept healthy food. (I just had sushi for lunch).

    Now that I have, I find that I'm starting to develop new, healthy aversions to previously coveted foods, like chips and soda.

    By addressing these psychological issues within myself, I have eliminated much of what I struggled with before.

    Once you clear the path ahead of you, the journey becomes much easier.

  8. I’m two years into a 75 pound weight loss, stable for the last 6 months.

    I gained the weight over the years as an undiagnosed, low fat, high carb vegetarian diabetic.

    Once the diagnosis was made, I switched to a lower-carb, paleo-type diet along with about 1 hour of walking 5X/week (ditched my vehicle and now walk the ½ hour to and from work) and 3X/week resistance training.

    I don’t know that willpower has had anything to do with it. At the outset, fear certainly helped. But my blood-sugar is now stable, without meds, and has been since about 3 months into the change in lifestyle, and the fear has subsided but the weight-loss has remained.

    The change in eating habits is easy to maintain, mostly because with lower carb paleo approach I’m not hungry. And I think that’s the key. Keeping blood sugar stable means, for me, I no longer have ravenous hunger a few hours after eating – I no longer snack in the evening after dinner; I seldom think about food and often have to remind myself to eat. I often stop eating in the middle of a meal because I feel full and that feeling stays for a long time. So many benefits, beyond weight loss and blood sugar control, have come from this change that I can’t imagine every going back to my former ways. I don’t even want to ‘cheat’ by eating processed/high carb foods – at this point, the thought is revolting. When donuts and cookies are passed around at morning meetings, I feel no deprivation as I pass them along to the next person – the thought of eating them (which would have been irresistible to me in the past) is actually distasteful. Two times in the past year when carb/processed food eating was unavoidable the results, 12 or so hours later, were so painfully uncomfortable that I would choose to fast at this point rather than eat.

    I can’t speak for anyone else – the key for me has been experimentation and education. Lots of both. Skepticism has also been important – where is the evidence for 5/6 small meals a day? I tried, found it harder to control my blood sugar and I just couldn’t force myself to eat that many times during the day. So much of the expert advice that I’ve read has turned out to be dead wrong – for me. Multiple servings of whole grains a day as an absolute necessity for good health? I don’t think so! When I cut out the grain, I stopped craving it. Stopped feeling hungry all the time. Started feeling much healthier. My blood pressure and triglycerides dropped.

    My advice – read everything you can get your hands on; don’t rely on a one-size-fits all approach. Be skeptical of everything you read – is there really any science at all behind it? Be open to new ideas (I realize the contradiction) – just because they aren’t mainstream doesn’t mean they aren’t worth pursuing for you – Intermittent fasting is definitely not mainstream, and the very idea seems to appall many people, but I’ve found much success with that approach. Listen to your body, it really is sending messages worth hearing.

  9. First off, I think that not enough attention has been given to the psychological reasons people eat, emotional eating, comfort eating, etc., and putting an end to those patterns in people.

    Interesting perspective....can you elaborate some on what you think drives this emotional eating and what may help alleviate this emotional drive to eat?

    Secondly, the whole idea of "maintenance"is flawed. I think that the only way to successfully "maintain" is to continue to have fitness goals, striving to constantly improve. Once you settle into "maintenance", it's only a matter of time before old habits and pounds creep back in. People need to realize that fitness is a journey, not a destination.

    So, if I understand what you're saying correctly, the only effective long-term solution is to engage in a highly structured fitness program for the long-term? That old habits are going to creep back and exercise can over-ride the calorie creep concurrent with that retreat back to one's old habits?

    Finally, I think that people need to learn new behaviors that are sustainable for them. They need to learn how to buy and prepare healthy food that they actually enjoy. They need to find a way to exercise that is fulfilling to them. Nobody is going to stick to a plan of miserable exercise and self-denial for very long.

    Again, so I understand what you're saying - dieting sucks and leaves a person miserable from all the exercise and denial of foods they like to eat wherever whenever they want?

    Can you define what is healthy food versus not healthy food?

    How much exercise do you think one must include and do? How often?

  10. Anonymous2:15 PM

    It took years of trying different diets to realize none worked for the long term.

    After losing and gaining the same 50-60 pounds over a ten year period, I finally took a long hard look at what I was eating and eliminated anything in a box, jar, can or bag. Crap food = crap health.

    Not only did the weight come off without counting calories, fat or carbs, I've now maintained my weight for five years eating simply meats, eggs, cheese, nuts, berries, leafy green vegetables and some other fruits and vegetables. I don't eat much starchy carbs, don't eat grains and don't drink milk.

    I think you're on to something each time you talk about nutrients and nutrient density in diet being important. When I think about my old diet and how I eat today, the two are night and day, with my current 'all natural real food' diet being nutrient dense and satisfying unlike years ago, where no matter what I ate, I was left feeling hungry and tired.

  11. Anonymous2:16 PM

    Three keys to long term success:

    1. Good food
    2. Good sleep
    3. Relief from stress

  12. can you elaborate some on what you think drives this emotional eating and what may help alleviate this emotional drive to eat?

    I am by no means an expert on the psychological reasons people have for seeking out food in order to comfort them or distract them from emotional pain, discomfort, boredom, or loneliness. But the fact is that eating can give pleasure and comfort, and just like with any drug, food, as a means of pleasure or comfort seeking, can be abused. I know I've done it. I'm sure many of us have. I think the key to resolving that issue may be different for everyone. For some, recognizing it and being vigilant may be enough. Others may need counseling.

    the only effective long-term solution is to engage in a highly structured fitness program for the long-term? That old habits are going to creep back and exercise can over-ride the calorie creep concurrent with that retreat back to one's old habits?

    There may not be a need for a highly structured fitness program, and no, exercise can not make up for poor nutrition. What I am saying is that when most people think "maintenance", they think of it in terms of "going off their diet", or in some way no longer focusing on health and fitness. What I meant was that it may be more helpful to adopt a lifelong commitment to health and fitness, rather than a weight loss/maintenance mentality.

    dieting sucks and leaves a person miserable from all the exercise and denial of foods they like to eat wherever whenever they want?

    Some people have this mentality, absolutely. The more successful people I have encountered have found ways to learn to enjoy new, healthier habits.

    Can you define what is healthy food versus not healthy food?

    For the most part, I would define healthy food as whole, natural, organic foods that have been minimally processed and have not been subjected to pesticides, hormones, or cruel conditions.

    Unhealthy foods are highly processed, unnatural food products that are stripped of nutrients and contain unnatural compounds and ingredients.

    How much exercise do you think one must include and do? How often?

    This is different for everyone, and it depends on your body and your goals. For fat loss, I have found resistance training and interval training particularly effective.

  13. I am by no means an expert on the psychological reasons people have for seeking out food in order to comfort them or distract them from emotional pain, discomfort, boredom, or loneliness. But the fact is that eating can give pleasure and comfort, and just like with any drug, food, as a means of pleasure or comfort seeking, can be abused. I know I've done it. I'm sure many of us have. I think the key to resolving that issue may be different for everyone. For some, recognizing it and being vigilant may be enough. Others may need counseling.

    Not to be argumentative or contrarian - and in no way dismissing the fact that some people truly do have disorders related to eating - but shouldn't eating be pleasurable and comforting in the long-term?

    Shouldn't we enjoy our food, share the experience with others, and get real satisfaction when we have something good to eat?

    Maybe...just maybe...the problem isn't that food provides comfort, but that the type of food many rely on for comfort doesn't actually satisfy!

    Good comments so far - keep them coming!

  14. Food absolutely should provide pleasure and comfort. The point of what I was saying is that it can also be abused.

    I can tell you from personal experience, there is a big difference between experiencing pleasure and comfort while enjoying good, healthy food in a controlled, healthy way, and trying to use food to alleviate pain, discomfort, boredom, loneliness, etc.

    I would wager that almost everyone who has significant weight problems has done this to some extent.

  15. Low calorie, low fat eating never worked for me. At the end of the day, after I had consumed my daily allotment, I was looking for something else to eat, hungry, unsatisfied. As I do low carb, even though my weight losses are slow, I don't have the overpowering hunger, the need to graze at night, the need to get up and eat something first thing in the morning because I'm starving.

    My overall health has improved tremendously. I suffer from osteoarthritis, especially in my knees. I used to wake up in the middle of the night, my knees throbbing from pain, I couldn't walk much at all. Lived on pain killers. Now I seldom take anything for pain, the knees still hurt, but just a twinge, not the agony I used to suffer. Yes, some of it is from the weight loss, but I think more of it is from eating good, healthful foods, getting adequate fat and protein.

    I can stick with low carb, have for about 6 years, with only a rare, occasional lapse, perhaps once or twice a year. I never feel deprived, my hunger is controlled, if my meal is delayed a bit, I can wait, because I'm not ravenous due to my last meal being satisfying.

    There is no way I could have done low calorie, low fat for the long term. I have done low carb for the long term, will continue with it because it is keeping me healthier than I've been in many years.

  16. Anonymous2:54 PM

    For me, discovering the hunger/insulin/blood sugar connection was key to my success in dieting and maintenance of my weight loss.

    When I'm eating refined carbs, my hunger is insatiable. My willpower is not strong enough to fight it and win the fight forever.

    My willpower got me through the first little while of low-carbing, until my hunger abated and I was able to lose weight relatively easily and without counting calories as long as I kept it low carb. That didn't last forever though. I hit an equillibrium point somewhere around 200 lbs where satisfying my natural hunger with a lower carb diet no longer produced weight loss. From that point on, I had to combine calorie restriction with low-carb in order lose more weight, which I did to lose another 25 lbs.

    Now, three years after losing the bulk of my weight, I find that as long as I'm eating a low or even moderate carb diet (under 100g per day), my hunger is appropriate and I can eat until I'm satisfied and maintain my weight.

    My advice for long term maintenance of weight loss is to eat a low to moderate carb diet. In my experience, it's the only way I can eat enough to satisfy my hunger and body's needs and not gain weight. Adding refined carbohydrates on a regular basis (and I've tried it for limited periods) always adds pounds and increases my hunger greatly.


  17. I never know whether to pipe up or not, because I started low carb before I had gained much weight and so I never was very overweight. I started to support my husband, and felt so much better that I kept it up. I only dropped maybe ten pounds.

    But I have maintained my weight for several years, the last few in peri-menopause (when all around me women are gaining), so perhaps I should contribute.

    Anyway, I haven't counted carbs for years except once in a while when I gained a few pounds or I just wanted to check in. I think I eat about 40 grams a day or so. I know at this point what I eat and what I don't eat. I eat some frankenfoods (mostly sweets) but mostly meat, fish, dairy, fruit, veggies. If I am at someone's house or a restaurant and a baked potato or attractive looking bread shows up on my plate I eat a few bites. If my kids make cookies I eat one. I like what I eat and don't feel it requires much willpower or sacrifice.

    As for exercise - I am very spotty. It doesn't make any difference to my weight, but I do like being a little more toned. But I get busy and lazy a lot.

    So my advice (which no one will take) would be to start eating fairly low carb *before* you trash your metabolism. It is so much easier if you don't have to eat 20 grams of carb a day to stay at a healthy weight.

  18. there is a big difference between experiencing pleasure and comfort while enjoying good, healthy food in a controlled, healthy way, and trying to use food to alleviate pain, discomfort, boredom, loneliness, etc.

    Setting aside those with eating disorders for whom therapy is a necessary part of the process....can you elaborate on why eating would need to be in a "controlled" way? How does that work?

    Also, if food is good and is OK to be comforting in one sense, why is it (I'm assuming) bad to eat the same foods for comfort if you're lonely or sad?

    I'm asking since I find the perspective you're presenting very interesting and am trying to understand your view realize I'm not "arguing" but seeking to understand what you're saying better, OK?

  19. Anonymous3:04 PM

    I did all the diets out there and the only one that worked and I can maintain on is low-carb. Seven years ago I lost one hundred pounds and today still maintain my weight and haven't "dieted" since.

    I don't count calories and for the last few years haven't bothered to count carbs. I know what I can eat and what I can't. Simple as that.

  20. OK good, I was starting to think you were picking on me ;)

    Let me first ask you a few questions:

    Most people know what they need to do in order to lose or maintain a healthy weight. Why do you think it is so difficult for them to do it?

    Why do you think that people have a tendency to overeat foods like sugar and refined carbs and highly caloric, very fatty foods? Why don't people seem to overeat whole, natural foods as much?

    What do you think would happen to a depressed person if they ate to help overcome feelings of depression?

    What I'm trying to point out with these questions is that in my opinion, most of the problem of obesity boils down to the why, not the what. If a person knows what to do, and yet still finds themselves unable to do it, to me, that sounds like something of an addiction.

    I don't really know when "healthy" patterns of eating become addictive patterns, but I suspect it has something to do with a) using food in an attempt to manipulate feelings or emotions, and also b) inability to control ones behavior regarding food despite a desire to do so.

  21. Anonymous3:30 PM

    I followed the low fat/high carb diet for the last 20 years and my weight would constantly ping-pong between 170-190 lbs. Granted, at 5'11" I've never been more than slightly overweight, but the constant 20 lb fluctuation every year was getting tiring.

    A few years ago I tried low carb and have maintained my weight at the 170 mark ever since. I've always had an insatiable sweet-tooth, but on low-carb, I've had to permanently banish that part of my personality. I've found that without eating white food (sugar, flour, potatoes, rice, etc.) that it is impossible for me to gain weight. Some days I gorge on 5000 calories. Others maybe only 2000. I don't really count, but my weight never budges either.

    Gary Taubes answered a question recently from a reader who asked how he had the will-power to stay on low carb for life. His answer was to equate high carbs to smoking. Millions of Americans have successfuly quit smoking on the premiss that it will kill you. His analogy was that a high carb diet is just as deadly as smoking, and his cravings for cigarettes were always more than those for sugar. I've succesfuly used that analogy to quite high carbs forever myself.

  22. Most people know what they need to do in order to lose or maintain a healthy weight. Why do you think it is so difficult for them to do it?

    Do they?

    I think they know what they're told works and what they're told is healthy long-term, but I also maintain that the dietary recommendations are deeply they don't really offer much for long-term health and weight management.

    Do you think people know how to maintain a healthy weight? If they do, why do they fail to do so long-term after losing the weight in your view?

    Why do you think that people have a tendency to overeat foods like sugar and refined carbs and highly caloric, very fatty foods? Why don't people seem to overeat whole, natural foods as much?

    Hormonal responses primarily, chronic malnutrition contributing, and mass marketing of flawed dietary advice that keeps perpetuating the cycle.

    What do you think would happen to a depressed person if they ate to help overcome feelings of depression?

    They're likely to gain weight, but I'd ask this question instead - is their daily diet contributing to depression and can modification of their diet reverse the depression?

    What I'm trying to point out with these questions is that in my opinion, most of the problem of obesity boils down to the why, not the what. If a person knows what to do, and yet still finds themselves unable to do it, to me, that sounds like something of an addiction.

    So you're firmly in the camp holding the sloth-gluttony-lack-of-willpower is the problem view?

    What if it is the "what" and not the "why"...simply put, what if it's the "what" driving the "why"?

    I don't really know when "healthy" patterns of eating become addictive patterns, but I suspect it has something to do with a) using food in an attempt to manipulate feelings or emotions, and also b) inability to control ones behavior regarding food despite a desire to do so.

    One more possibility - the "what" disrupting things internally (like hormones and metabolic processes) to interrupt satiety signals, thus inhibiting proper energy utilization, causing intake of more food and calories than needed to overcome the breakdown of homeostatis because the "what" causes problems?

    .....and no, I'm not picking on ya....just interesting discussion here - a way to challenge me and you to think outside the box on this issue and look beyond everything we're told.

  23. Anonymous3:47 PM

    Wow, this is a great comment discussion here! I just found your blog from an email a friend sent saying I should read your blog.

    I have been doing low-carb for 25 years now. Yes, 25 years! My weight has never fluctuated more than three pounds in all that time.

    When I started low-carb it was because I was huge and seriously needed to lose weight. Low-carb was simple and easy back then. You just didn't eat some of the foods everyone else did and made sure you ate your vegetables.

    Today, it seems a lot harder because there are thousands of foods marketed that are nothing more than rubbish, but we're always told they're good for us. It's a hard message to ignore. But ignore it I do because my weight is stable and my health is great!

  24. Anonymous3:58 PM

    For years and years I dieted up and down on the scale until I'd finally had it. I was never obese, but constantly finding my weight up 15-20 pounds in a year and then dieting to lose the weight the next, only to find the weight back again the year after that.

    I certainly did not lack willpower! I gained weight back, each and every time I attempted to eat what should have been "normal" again! I didn't know back then that I have PCOS and that a "normal" diet with 55-60% carbs just makes it worse and that weight gain is expected on that type of diet when you have insulin resistance.

    What worked for me to finally lose weight was not doing calorie counting. It was just eliminating starches and sugar. The speed that all my symptoms got better was amazing. I no longer gained weight, stopped getting stray hairs on my face and chest, my period was normal again, and my cholesterol got into the normal range. I don't have to count calories or anything. I just have to eat what is good for me and my condition and not even consider just one bite of something that makes my condition worse.

  25. Yes, I do think that the majority of people know that if they eat less and exercise on a consistent basis, they will lose weight. Most people know that drinking soda all day and eating fast food is making them fat. Some may not, but most do. Especially unsuccessful dieters or people who fail to maintain.

    I wouldn't say it's all "sloth-gluttony-lack-of-willpower", but also psychological conditioning, effects of society, and failure to take responsibility.

    Let's talk about that last one for a second.

    As much as I agree with most of your low-carb beliefs, I still think that the bulk of the problem is behavioral. And the bottom line is that people need to stop blaming hormones and metabolic processes and genetics and all of that and take a serious look at their behavior.

    Sure, hormones and metabolic processes may be at play here, but they are the hammer and chisel as far as their impact in comparison to the sledgehammer that is behavior.

    People need to take responsibility for their behavior and take steps to change it, whatever that means.

  26. Anonymous4:20 PM

    Hey Regina, I am a person who had an actual eating disorder (40 years bulimia, gone now with lc) and in my experience you are right on.

    It's not what's eating you, it's what you are eating.

    The "emotional" school of thought says...

    how you feel leads to > how you eat

    but really it's longer and inter-dependent....

    how you eat > affects CNS/hormones which changes > how you feel which changes > how you eat

    Very similar to the interdependent loop of energy intake/outgo that Taubes talks about - no arrow of causality.

  27. Anonymous4:21 PM

    From what I can see of your blog Billy, you've only recently hit your weight goal and haven't maintained your results long term, so you're where every other person doing the same was before they gained it back!

    I look at those like Regina who have not just lost a lot of weight, but actually kept it off for the long term. She practices what she recommends and studies. She actually eats a diet I am awed by in its simplicity. And she isn't preachy about it.

    When you've kept the weight off and maintained the fitness level in one, two, three or more years from now, then you have something to say. Right now, you're just a sitting time-bomb waiting to regain.

    But I do wish you luck. You'll need it with your attitude.

    For the record, it was Regina's writing about the research that made me seriously examine my own eating habits and give a low-carb diet a try. And yes, it worked.

  28. It's not what's eating you, it's what you are eating.

    Thank you.

    I haven't read enough on the subject, but continue to look for and read about data that suggests that what you feed your body can influence a huge variety of responses, including "physchological" responses.

    To me it's odd that over the years we've come to accept the idea that the reason people don't keep the weight off is that they're lazy or lack willpower, when physiology and basic biology point to metabolism of macronutrients and micronutrients contributing to this "inability" to stick with a diet rich with carbohydrates, especially those that are refined or processed.

    I'm glad you stopped by and shared your experience!

  29. Anonymous4:28 PM

    I first went LC for gestational diabetes in 1998, recognized that it was a very healthy way to eat, but I missed my carbs and I found it unnatural and annoying to count and weigh my food (and there were few LC cookbook resources in that Low Fat time) so went back to eating sugar and starchy foods after my son was born. Then I started gaining about 5 lbs a year until I hit a weight above any prior non-pregnant weight levels. Going to the gym didn't budge my weight but did increase my appetite. Starving myself didn't seem like a viable option, either. Wasn't sure what to do, but it didn't occur to me to reduce carbs to lose weight.

    On a whim I bought a Dana Carpender 15 minute LC cookbook because of the fast nature of the recipes (I was into fast and easy then, and had been buying too much processed food from Trader Joe's - somehow it seemed better than processed food from the conventional grocery store - not!). This cookbook looked good to me because it used foods I liked, like avocados, cheese, cream, and nuts. Just using this cookbook for the delicious recipes at dinner started some weight loss. When I noticed that, I purposely reduced more carbs, learned more about LC and got more LC cookbooks, and the weight came off even faster. By then my husband started LC during the day, too (he had to eat LC at dinner because I do the cooking) and he lost weight. Neither of us added extra exercise, in fact I stopped going to the gym.

    We have maintained healthy weights (just under 25 BMI for him and about 21-22 BMI or me) since 2004 and plan to eat this way forever. We don't count carbs anymore or even make many calculations, we just avoid sugary and starchy foods for the most part, at home, and away if at all possible (long plane rides are hardest). I do make a note to be sure to eat enough fat, though I don't count or measure it. I couldn't begin to say how many calories I eat, though I have a sense that it is much higher than when I was gaining weigh. Fat helps keep my energy level up (I'm hypothyroid and now realize I would be diabetic by now if I still baked bread and pizza and made pasta several times a week). For the most part, we just eat when and how much of what we like, avoiding sugar and starch (super dark chocolate - 70-88% is one of our exceptions). Willpower only comes into play if we decide (or are forced) to stray into high sugar and starch foods away from home because that sets off cravings for more.

    Mostly I have to exercise willpower to not be seduced by convenience foods in the stores, things like pre-marinated meat, out of season imported veggies, bagged RTE produce, etc. Once I was able to make the break from sugar and starch, I found it much easier to make a break from prepared RTE foods. If I want ice cream, no problem, but assemble the ingredients and make it myself (so easy, fairly fast, and I can reduce the sugar quite a bit and not use additives) instead of buying it. Same for cheesecake, but I even often make the ricotta cheese (takes about 1 hour) with local fresh milk prior to making the cake instead of buying the cream cheese or ricotta. That really limits dessert consumption so that it is special, and dessert becomes less of a daily habit. I now constantly strive to have higher standards for my family's food (real food, as non-industrial as I can, as local as I can and in season); even with LC foods, I am raising my standards. If I want mayo, fine, but I have to make it (takes about 5 minutes to make a week's worth). Most of these foods don't take too much time, but they do take forethought and cleaning up, and that is often enough "willpower" to prevent having too much food around that we don't really need. And despite the increased cost of individual items, my overall food expenditures probably went down or stayed the same; they certainly didn't go up because there is a lot I am no longer buying. If I want to cook meat, fine, but it is usually grass fed and humanely raised in my local area or as close as possible. Same for poultry or eggs. Cheap industrial food, LC or HC, is very easy to overconsume because it is so cheap. But if I am thinking ahead to how much meat does my family need for a quarterly order at the local farm or reviewing the season's crops for our farm veggie box order so they can plan their production schedules, then I have a much different relationship with our food than if I just toss it mindlessly in my cart at the store.

    I haven't reached the Little House on the Prairie mode yet :-), but my 9 yo son has noticed some parallels in our eating habits and no longer is annoyed if I won't buy out of season imported fruit, avocados, yogurt tubes, etc. Yes, perhaps I spend a bit more time in the kitchen than before, but it isn't as much time as some would suspect (very little standing in front of a hot stove). And I also spend a lot less time in the grocery store.

  30. But I do wish you luck. You'll need it with your attitude.

    For those commenting, let's not sink to personal attacks - let's discuss the ideas, issues and such without making it personal!

  31. Susan, I never claimed to have all the answers, I'm only stating my opinions.

    But I do plan on keeping the weight off, thanks.

  32. Anonymous4:32 PM

    As Regina said in this post, any diet can work for losing weight. I've lost a total of around 1000 lbs in my lifetime and up 'til a few years ago, always gained it all back. In 2002 I started low carb and over that time have lost 100 lbs without gaining much back, and any time I have gained any back,it has been relatively easy to lose it again. I still have more to lose, but I approach it slowly, losing some and then pausing for long periods of time. Only low carb has allowed me to do this.
    It is the "diet" that I have been able to make a lifestyle.

  33. Yes, I do think that the majority of people know that if they eat less and exercise on a consistent basis, they will lose weight. Most people know that drinking soda all day and eating fast food is making them fat. Some may not, but most do.

    OK...I have no arguement on this and did include in my post above that the evidence even shows that diets and excercise lead to weight loss. It's the long-term that gets people. Why?

    Especially unsuccessful dieters or people who fail to maintain.

    I wouldn't say it's all "sloth-gluttony-lack-of-willpower", but also psychological conditioning, effects of society, and failure to take responsibility.

    So, if they followed a diet, lost weight and did everything right - what happened to make them gain it back? Do they just give up? What exactly are they doing that makes them irresponsible in their weight management?

    As much as I agree with most of your low-carb beliefs, I still think that the bulk of the problem is behavioral. And the bottom line is that people need to stop blaming hormones and metabolic processes and genetics and all of that and take a serious look at their behavior.

    We've blamed behavior for 30-odd-years now....blamed the person for just not doing what it takes to keep the weight off when they lose or if they gain.

    Is it that people are too stupid to get it?

    Is it that they're simply too lazy to do what it takes?

    Or could it be that there are very real physiological consequences when one eats foods that disrupt normal metabolic processes and hormone levels?

    Sure, hormones and metabolic processes may be at play here, but they are the hammer and chisel as far as their impact in comparison to the sledgehammer that is behavior.

    So what you eat doesn't matter much as long as your head is in the right place?

    The effects of insulin don't drive hunger when it pushes blood sugar downward?

    Insulin resistance doesn't contribute to blood glucose being converted to fat for storage to protect the body from excess glucose freely circulating?

    The effects of alpha-glycerol phosphate don't inhibit release of fatty acids for energy from stored fat?

    People need to take responsibility for their behavior and take steps to change it, whatever that means.

    Can dietary choices drive behaviors?

  34. Anonymous4:49 PM

    But I do plan on keeping the weight off, thanks.

    Dude. That's what they all say.

  35. Anonymous4:53 PM

    My experience is very different. I have never had a weight problem, but come from a country where our dietary style is very much like controlled carbing is here.

    Lots of fresh vegetables, in season fruits, nuts, beans, preserves, and a huge variety of whatever is in season for the kill. Goat, cows, lamb, quail, doves, pigeon, pig, elk, deer. You name it, we eat it. And rendered fats are used to cook and so is butter. Definitely not much in the way of grains or cereals though.

    When I come to America I was shocked by how you eat here. It is all in a box or out of a bag. Something you won't ever see where I come from.

  36. You can't separate behavior from biology. Behavior is a consequence of hormones, metabolic processes, and genetics. People think they have absolute voluntary control over their behavior, but that's clearly not true.

    Drinking alcohol to excess will change behavior. Why should food be any different? We know that the brain directly senses things like fatty acids, as well as hormones like insulin and amylin. This sets up communication to other parts of the body, controlling rate of gastric emptying, sensations of hunger, etc. Certainly if internal behavior is so tightly influenced by diet, external behavior will be as well (no doubt precisely the case for a rat).

    The problem of diet is no different than any other "behavioral" problem caused by external chemical influence. Diet influences behavior. The only way to get the whole thing under control is to remove those aspects of your diet which encourage undesirable behavior.

  37. Anonymous5:14 PM

    Been there done that with the whole thinking that once the weight is off it'll stay off. NOT

    If you eat a diet with lots of carbs after you work so hard to lose the weight, it comes back.

    It can only come back. You start to eat normal again after the diet and up goes your carbs, up goes your insulin, up goes your fat being stored, up goes your weight.

    Two choices then, keep your calories below starvation levels forever, or just cut the carbs down a lot like getting rid of potatoes and rice, or eliminating bread and pasta. You don't need it and those foods actually promote weight gain if they're eaten like we're told to eat them!

    If you want to lose weight and keep it off you have to either commit to starving forever or just cut the carbs.

  38. Outstanding topic, Regina! As someone who has lost 170 pounds and gained it back in four months and several years later lost 180 pounds and kept it off for three years plus, I'm happy to weigh in on this issue. And I certainly agree that weight loss is NOT the problem with obesity in the United States. Instead, it's weight maintenance and how to help people better manage their weight once it comes off that should be the focus.

    For me, the process of figuring out this thing for myself began back in 1999 when I lost 170 pounds on a low-fat (nearly ZERO fat), high-carb diet. Sure, I lost a ton of weight in about 9 months and looked fabulous. There was only one problem--I was HUNGRY, IRRITABLE and DOWNRIGHT NASTY to be around. It should have come as no surprise to anyone that I rebelled against feeling that way and started eating like gangbusters again--and the weight poured back on.

    So when I was ready to give weight loss another try in 2004, I knew ahead of time that I needed to implore a different strategy for dealing with my morbid obesity which had me at 410 pounds. If I was going to successfully lose weight, then I needed to find a plan that would work for me once the weight loss ended. Low-fat diets had already proven they were not sustainable long-term for me, so those were off the table right away. After searching and searching for what to do, I decided to read Dr. Atkins' New Diet Revolution.

    Reading the book from cover to cover, I embarked on what I would hope to be a permanent and healthy lifestyle change beginning on January 1, 2004. It was scary at first since the nutritional advice shared by Dr. Atkins went against everything I ever knew about diet and health, but I trusted this cardiologist knew what he was talking about.

    It didn't take long for me to experience phenomenal results--30 pounds lost in month one, 40 more in month two, and 100 pounds lost in the first ten weeks! WOW! Screw what anyone says about this diet--IT WORKS and VERY VERY WELL!

    And the rest is history...I went on to lose 180 pounds that year, dropped over 20 inches from my waist, went from 5XL shirts to XL, and came completely off my prescriptions for high cholesterol, high blood pressure, and breathing problems. I was thin and healthy for the first time in my life, but I knew the REAL test had only just begun. Could I KEEP the weight off now by continuing to eat this way?

    Well, here it is 2008--four years since I began this journey to better health and the weight has STAYED OFF! WOO HOO! People always automatically assume that I have some great willpower or something and I just have to laugh at this. My mantra back to them is this--weight loss doesn't take willpower, but a steadfast resolve to make better choices.

    That's the bottom line for me when it comes to long-term success. If you had enough willpower to resist food during your weight loss, then how the heck did you get to become overweight or obese to begin with? Where was your willpower then, hmmm? No, it doesn't take willpower to resist temptation, but rather a constant, conscious effort to always try to choose wisely for the sake of your health. Doing that will put you in a better position to maintain weight loss for many years to come. Or at least it has for me.

    I recently did an entire podcast show on this topic about why diets fail most people and what can be done to make you more likely to be successful than not. I think this is a topic well worth pursuing further and I'm happy to see the great Regina Wilshire being the one to bring it up. FANTASTIC WORK as always, Regina! KEEP IT UP!!!

  39. Anonymous5:30 PM

    Congratulations to all here who lost so much weight and have been able to keep it off. You are all inspirational.

    I am still losing weight and hope that when I hit goal, I'll be as successful as all of you!

  40. Anonymous5:31 PM

    I think people are just lazy and don't want to bother with eating less and moving more because that means they can't have their slurpees, burgers and fatty butter.

    It's not rocket science people.

    Calories in calories out

    Nothing else needed for keeping your weight steady.

  41. Oooops....I think I deleted a couple of comments in error. If you commented and don't see your comment, please resubmit!

    My apologies!

  42. Anonymous5:37 PM

    There is no magic in the idea that if you go back to eating as you did before a diet you gain the weight back.

    If you want to maintain you weight after losing weight you have to maintain a calorie level to keep the weight off.


  43. Anonymous5:39 PM

    It seems like you think it's not just calories in calories out?

    Are you now eating less than you did before? Why can't people like you understand that you're maintaining your weight because you're not eating excess calories everyday?

    It has nothing to do with carbs and everything to do with calories.

    Anthony Colpo is right, you're all MAD.

  44. Anonymous5:42 PM

    Holy beefaroni batman!

    Why did AC and his whole ranting and ravings about metabolic advantage get dragged into this?

  45. Anonymous5:50 PM

    I lost so much weight in my life, I could be queen of weight loss. Keeping it off is another story.

    I have to tell Billy that each time I gained weight back it wasn't because I suddenly lost my will or had some eating disorder.

    I bought the lies that eating a lot of grains was how to eat and that grains should be where I get most calories every day. Bullshit.

    Only after doing Atkins, then going back to that normal healthy diet and gaining it all back did I try Atkins again. And finally got why it worked. And kept the weight off now for six years. Without counting calories or having to obsess over the portion size or anything. I just eat. I stay thin. I don't stress about food.

    Atkins works because it's how we're supposed to eat.

  46. Anonymous5:54 PM

    I've maintained my weight for over ten years by just keeping carbohydrates at about 20% of my calories a day.

    I'm never ravenously hungry.

    I eat really good food.

    It just works really well to keep weight within normal and all the risk markers within normal too.

  47. Anonymous5:59 PM

    In my experience, many things come into play in the long run.

    First when you begin to change your diet to lose weight, you have to realize that you can't go back to how you were eating before you started. That is a recipe for disaster.

    You have to find a way of eating that you can live with in the long run too. If you can't live without bread, low carb isn't going to work for you because you'll want bread later and can't have it. That's torture long term.

    You have to decide what you will tolerate for restrictions in the long run.

    You have to increase your exercise.

    And you have to just wake up each day and recommit yourself to keep at it.

    No more needed.

  48. It's not just calories in/calories out. The basic molecular and cellular mechanisms of fat storage have been known for over 30 years. Your doctor learned about it in med school. Fat storage requires increased insulin and available glucose.

    We could go over this in excruciating scientific detail, but it is well-documented elsewhere. If you really think it is only calories that matter (as opposed to the form of those calories and their effect on hormones, enzymes, etc.), then please direct us to a detailed account explaining how dietary fat gets stored in adipose tissue WITHOUT dietary carbohydrate.

  49. Lets start with one over riding issue that hasn't been broached, you can't save people who don't want to be saved. No matter how scientifically superior the program or diet, if people won't do it, its worthless. Just being better isn't enough.

    Second, contrary to low carb mythology, most people did not get fat by eating in accordance with the USDA pyramid, flawed as it is. They got fat by eating super sized extra value meals, double stuffed crust pizza, 64oz big gulp soda's, Oreo's and banana splits, often all in the same day. I have never met a fat person who got fat by eating too many fruits and vegetables. You'd have to have lived in a cave in Siberia for the last 40 years to not know that eating like that is not good for you, its called junk food for a reason. However, this is the easiest, and often cheapest way to eat. People have made the Faustian bargain of trading health for convenience.

    Additionally, it always takes willpower to stay on plan. I've witnessed committed vegetarians wilt at the smell of frying bacon, committed low carbers fade at the sight of "mom's famous" dessert, and so forth. Sooner or later you will be faced with temptation. It may come when you are strong, or it may come when you are weak, but it will come. The world in general doesn't care about your plan and will often put obstacles in your way. How well you negotiate those obstacles, will often determine how well, and how long you remain on plan.

    Lastly, the benefits of eating well, and the repurcussion of eating poorly, are for most people, delayed. Without immediate feed back its very difficult for most people to know if the changes they are making are having any effect or not. The people I've met, both online and in the real world, who manage to stay on plan the most, have some sort of immediate negative feedback that lets them know that deviating from plan is not a happy thing.

  50. Anonymous6:17 PM

    On the topic of comfort food--in the past I suffered from major depression. For whatever reason, eating carbs, and particularly ice cream, seemed to alleviate the symptoms in the short term.

  51. Lost 30 lbs on a mid-low carb diet; gained 15 of it back when I went off the diet.

    Went back on, lost down to a net of 58lbs. That was 3+ years ago. Have gradually put back on 5-10lbs (it fluctuates) but I've been working out at the Y; much of that gain is muscle.

    I eat maybe 40g of carb daily. Lots of fish, meat, seafood, poultry, green veggies, salads, spinach, nuts, avacados.

    In addition to the diet, the most helpful thing has been my glucometer. I've got type II diabetes. Any time my bg > 140 mg/dl, then I *immediately* know that I've messed up and I need to get back on the straight and narrow. I eat to keep my meter happy, rather than to keep the pounds off. I've kept my A1c between 4.9 and 5.3%, with few postprandial spikes.

    I was influenced in getting on low-carb by several folks over at Several of them had been schooled in works of Dr Bernstein. I'd been eating very low carb for almost a year before I read his book. I found I'd been pretty much following his program, just from the things I'd read on a.s.d.

    Adam Becker Sr

  52. I genuinely don't believe that people know what to do and know how to lose and keep weight off. I don't think they have a clue. There are mixed messages and misinformation coming at them from every side and it's totally confusing.

    For years I ate low fat. I bought the message that this was the only healthy way to eat and I did it. I am not saying low calorie but definitely low fat. I ate my veg, ate lots of wholewheat bread and pasta and rice and potatoes. I obsessively sought out ways to cook them with minimal or no fat. Cut out red meat, trimmed fat from chops, threw chicken skins away and recoiled from butter.

    I didn't eat much junk food, a pizza might be a once a year thing or less, burgers or other stuff from fast food places even less frequent. I was appalled at the thought of those foods and avoided them.

    Yes, I had cookies, and sweets and cake - but, y'know, I was picky, they were low fat ones, and that was ok, wasn't it? Bread. Oh gosh did I eat bread, but it was GOOD bread, home made, high fibre, low fat. You couldn't get enough of that and dammit I was hungry!

    Over those years my husband, who ate like me, got diabetes and I got fat. Occasional attempts to diet by eating even less fat as well as fewer calories resulting in intense cravings and inevitable break down - usually with slice after slice after slice of bread, with a VERY thin scraping of VERY low fat spread, of course.

    I'd heard of low carb, but it was a fad, for cranks, in total opposition to the nutritional advice from the experts. I had the food pyramid poster proudly displayed in my kitchen - and I sure as heck was not going to eat much from those dangerous top shelves.

    Then my (thin and fit) doctor told me - "Do Atkins, it's the only thing that'll work for you".

    I resisted. I fought. What would she know - she was thin (yeah, logical, I know)! I hugged my beloved bread maker and assured it I would remain faithful.

    But in the end, having topped out at 200 pounds I did.

    My tiredness vanished. I could get through the day without a nap or that horrible afternoon slump. I was in control of my appetite. Miracle of miracles I ceased to care about bread, didn't give a fig for pasta and lived contentedly without potato.

    SHOCK!! The cranks were right!!

    I lost 60lbs. My husband no longer takes any medication for his diabetes. I read and read and read and realised that there was another and better way. For us at least. I've been four years now at this weight, or thereabouts.

    Keeping the weight off has NOT required ANY willpower - I don't have much of that. I diligently followed the Atkins plan though all it's stages and learned how to satisfy my hunger, eat food I love, enjoy cooking for my family and friends, eat out happily and without guilt. Without guilt - that's important. I ENJOY food, I don't worry about it.

    But NONE of this makes me hopeful about the general problem of obesity. Why?

    Mainly because so many people consider that life without junk food or sugary treats or high carb starchy food is life without pleasure.

    This message is backed by vast advertising budgets and top notch marketing, paid for by companies with countless billions riding on its success. They affect the thinking of everyone - from kids to adults, from policy makers to medics.

    When my husband's doctor learned he was eating low carb he went nuts. It wasn't the recommended diet - eat potato, eat bread, eat rice he siad, that's what you need to fill you up. So, had he never heard of low carb? Or had he heard of it, but just believed it didn't work?

    Neither. He'd heard of it. He knew it would work. He just didn't believe anyone could deprive themselves of all that is good to eat and live like that - so there was no point in advising them to try as it was just setting them up for failure.

    With attitudes like that, where do you go?

  53. The problem with calories is that they do matter, sort of. If you look at most studies that compare this diet to that diet, you will find that for about 50% of the people, calories in vs calories out will explain the difference in their weight. You will however also find that ABOUT 1/4 will do better than can be explained by the calorie equation, and another 1/4 will respond the opposite of what is expected. This is why the "average" results often hide some valuable information. You also have to consider the population being studied. If you are obese and or diabetic studies on athletes may not provide much insight and vice-versa.

  54. When I went to parties when I was younger, I would drink and smoke dope. I could never drink two days in a row, rarely more than twice a week. But I did develop an addiction to pot and hash. Same young idiot, presumably same psychology, same lack of willpower. I have to assume something physiological made the difference.
    I used to eat french toast. I could go through any amount of egg, in the form of french toast. Now I eat as many eggs as I made french toast with, and I'm stuffed. Again, not willpower. I never developed the ability to control my consumption of bread, I simply have to avoid bread altogether.
    I don't think you can separate mind from body here. People addicted to cigarettes will rationalize, and sometimes refuse to believe that smoking is as unhealthy as it is. The body makes demands, and the brain runs behind.
    Potato chips--you can't have just one.
    Steak--if you can finish this (how many ounce?) steak it's free.

  55. Anonymous11:03 PM

    Skipping much of the discussion - wow, over 50 comments! - but I wanted to respond to Billy saying that most people know what to do.

    I didn't. I thought I did. I thought that a low-fat, low-calorie diet was the key to a healthy weight, and the fact that I kept gaining weight meant that I was a moral failure, a gluttonous sloth with no willpower.

    It wasn't until someone told me how insulin works that I learned why I continued to gain weight and that it had virtually nothing to do with moral failure. From there, willpower played only a minor role. Truthfully, I was fighting a wicked sweet craving just today, and willpower got me through it. But once I knew the truth about how the body stores fat, it has been quite easy to follow my low-carb habits most of the time.

  56. Anonymous3:55 AM

    What Katherine said.

  57. Anonymous7:51 AM

    I lost 35 pounds on low carb (down from 230 to 195). I lost all of it in the first few months and kept it off easily for five plus years. I agree that willpower had very little to do with it. I had lost the same amount of weight before, several times, using various low fat methods, and like everyone else, I always relapsed and gained it all back.

    I started out trying to follow Atkins by the book, but I soon realized I didnt need to bother counting carbs, or worrying about what my mythical upper carb count was, or to go through the phases desribed in that plan-I find all that rather contrived and silly. I just eat the low carb foods I like- all types of meat and seafood, low starch/sugar vegetables and fruit,cheese, butter, etc. And that's it, I never counted anything.

    Of course, what that got me, along with most other Atkins dieters, was a plateau at about 20 pounds above my ideal. Which is ok, 195 pounds is a much better place to be than 230 and climbing (who knows where I might be if I hadn't stumbled over low carb-270?, 280? 300 even??)

    Lately I've turbocharged my low carb plan with something called fast-5. I only eat between 5 and 10 pm, most days anyway. Usually some snacks in the afternoon, and then a bigish dinner. Using that plan, my weight has dropped to 185. Still overweight, but still, much better than 195 and way way better than 230 and climbing. This plan does take a bit more willpower, but it is suprisingly easier than you would expect. I get hunger pangs on and off throughout the day, but they are pretty superficial and easy to deal with. I just remind myself of the glorious feast to come later in the day. And it is a glorious feast, each and every day. Every meal feels like a gift from the gods, I tell ya!

  58. Anonymous8:19 AM

    let me add that I do think calories count-my weight is usually directly related to how much I've been eating and drinking lately. To get rid of this last bit of flab around my midsection, it seems that I would need to eat a suprisingly small amount of food-I probably eat about 1800 calories a day (plus some scotch, beer, wine...) and I can't get under 185ish.

    Exercise doesn't make much difference. I used to do loads of cardio every day. When I quit that in favor of slow burn style strength training, my weight stayed the same.

    Moral of the story, for me at least: Lift weights, eat once a day, eat low carb, and get over trying to get ultra slim!

  59. Anonymous8:26 AM

    How do you keep it off?

    1. The same way you took it off. It's a live-it, not a diet. If you go back to eating like you did before, you will soon look like you did before. Sad but true.

    2. Weigh every day. As soon as you're up more than three pounds, it's not water weight or potty problems. Go back to being strict with what you eat.

    3. Keep yourself encouraged. Talk to other low-carbers every day. The internet works fine for this.

    4. Read Gary Taubes' book. Those who have lost weight by low carbing know that it works. But the mainstream media and most of the mainstream medical community still believes in low-fat-low-calories. Gary Taubes explains why we are right and they are wrong. You will begin to think twice and even three times before you put a refined carbohydrate into your mouth.

    5. Realize that it's never over. We happen to be handicapped in the area of weight maintenance. Most handicapped people get to live with their handicaps all of their lives. They figure out coping strategies, they use their sense of humor and with that in place, they get on with life. Once we realize that we are simply not like other people in the area of weight maintenance, we can do the same.

    Hope all of that helps. For me, anyway, it's what works.

  60. Anonymous8:56 AM

    After a lifetime of yo-yoing on different diets I tried Atkins and lost the weight like always. Started to eat normal again and gained some back, but then got back to Atkins and lost it and have no strayed again because it is a way to eat that is satisfying and easy. I don't have to count anything like calories every day or worry too much about carbohydrate as long as I stick to the foods I know are allowed. I don't know how many carbs I eat a day but would guess it's under 100g. I like eating like this and don't find it hard.

  61. Well I must say I'm a little perturbed by the people on here who seem a bit full of themselves, assuming that I will gain the weight back with my "attitude". That type of negativity isn't helping anyone. Howabout a little support for someone who obviously shares many of the weight issues you all do?

    Take a minute to read my blog you would see that I am committed to a low-carb lifestyle.

    So, why am I going to gain the weight back exactly? Because I believe in behavior control? Well, the decision to eat low-carb in the first place is behavior control.

    Nobody ever got fat eating a diet of whole grains and low calories / fat. Sure, maybe it's hard to sustain. My point was only that people need to find a way of eating in the long term that works for them. An extreme low carb approach might not work for everyone.

    It seems like a lot of people on here have an extremely low carb-tolerance, and that's fine. Just don't assume that everyone is the same.

    What about the traditional Japanese diet? People eating that aren't fat, and that's not a low-carb diet. Open your eyes and you might see that there may be more than one problem, and more than one solution.

  62. Anonymous9:12 AM

    In my experience, "...almost every weight loss diet dreamed up in the last century works..." is true but has limitations based on a number of factors.

    I was an obese teen male, 5'11", topping out at 255 lbs at age 17 during 1971. My approach to weight loss was to become the food pyramid poster boy and use calorie restriction to get to 165 lbs in about 2 years.

    The weight stayed off until about age 35. I found I had to reduce calories even more to maintain my weight. It was tough. I felt hungry and snacked quite a bit.

    Then at age 50 I developed frozen shoulder. During my research, the fact that diabetics got this condition 30% more than the rest of the population led me to get an oral glucose tolerance test. Low and behold, I was 180mg/dl at 2 hrs, a diagnosis of impaired glucose tolerance. That's when I started looking at dietary solutions and hit upon low carb as a possibility.

    Ever the skeptic, I began slowly and found myself going from 170 lbs to 150 lbs in less than a year. All medical biomarkers improved -- fasting glucose, A1c, lipids, etc. My doc was amazed. Not a single diabetes-related drug was prescribed, and no supplements were used except a standard daily vitamin.

    My impression is that a particular nutrition plan for a given point in time in one's life needs to take into consideration a number of variables most people either don't take time to examine, or have no objective way to evaluate: aging, genetics, hormones, neurotransmitters, metabolic processes, system signaling, exercise and satiety are all key players in determining what nutrition plan will work.

    For me, it was switching to a low carb way of eating. I'm also the kind of guy that doesn't need a great deal of variation in meal composition. I pick ingredients and assemble a few meals that are appropriate for a given season and rotate between them. It's so much easier from a planning and shopping perspective. Since I eat smaller meals 5 - 6 times a day, I don't have to count calories and I'm rarely hungry between meals.

    Until something interferes with my current level of success, I'm sticking with this plan because it is working for *me*. Depending on the complex variables I described above, a different plan may have equal efficacy for someone else. I think there's enough room for everyone at the table as long as the method achieves results.

  63. "Nobody ever got fat eating a diet of whole grains and low calories / fat."

    Nobody ever got fat eating a diet of rocks and sticks, either. That doesn't make it a good idea. Absence of overt symptoms of illness does not imply an optimal diet. It should be remembered that obesity is not a "disease", but a symptom of an underlying metabolic/hormonal disorder. That you can eat carbohydrates and not get fat does not mean you aren't doing damage; it doesn't necessarily mean you are, either.

    But I think that once you get down to the basic chemical level, things are a lot more common amongst individuals than we often think. For example, it doesn't matter who you are, sugar will react with protein to ultimately for advanced glycation endproducts (AGEs). AGEs are bad, for several reasons. I know of no individual trait that protects one from AGEs (though again, just because I don't know about it doesn't mean it doesn't exist).

    BTW, what exactly is the traditional Japanese diet? And is that how the Japanese eat today?

  64. You've got 62 comments to this post, so I'll keep it simple:

    Eat (at least, the majority of the time) foods that are suited to our physiology - foods that have a proven evolutionary basis for good nutrition and health. Foods that keep our systems functioning optimally - keep our insulin and leptin signalling working properly. Ultimately, that means keeping carbs low.

  65. Billy - you commented that "Nobody ever got fat eating a diet of whole grains and low calories / fat."

    I did. Vegetarian, whole grains, low fat (I was meticulous about low-fat) and low calories (meaning at my prescribed maintenence level of calories based on my height/weight etc, or below)

    I also had addictive eating patterns, accompanied by intense cravings for starchy foods. Emotionally, it was horrible. I had to make a huge effort to control my eating, and I would occasionally eat in secret out of sheer humiliation.

    Once I was diagnosed with celiac/gluten intolerance, and stopped eating all grains, my symptoms (both emotional and physical) disappeared did my low-level depression, anxiety, and other mood disturbances I didn't even realize were "abnormal."

    The "what" can, and does in many cases, drive the "why".

    Not saying there aren't other factors - I still, on occasion, turn to certain foods for comfort much like I would turn to cigarettes, even though I know they're bad for me. But I would wager that in most cases, the problem can be addressed through dietary changes, at least at the outset. Any remaining patterns are then much easier to deal with and/or rectify.

    (As a side note, I would love to test OA members for celiac/GI)

  66. Anonymous11:33 AM

    "Nobody ever got fat eating a diet of whole grains and low calories / fat."

    No? My husband and I did. Katherine's description sounds very similar to our experience. We thought we were following good advice on eating lots of whole grains and avoiding fat. But we both gained weight.

    After LCing for just about a year now, my husband has lost 50 lbs and I've lost 25. We each have a few more pounds we want to shed, but we'll get there. We do not eat ANY grains, sugar, potatoes or milk and we don't miss them any more.

    For the long term:
    We've also been feeling so good physically and mentally that there's no way we'd consider reverting to the foods we used to eat. WHY would we? Life feels a lot better when you feel good.

    I really like the term "Live-it" above. I heartily agree! LC is going to be our lifetime way of eating.

    Actually, we've just started Intermittent Fasting (Dr. Eades' method so that we have a 24-hour fast every 2nd day) and are finding this pretty easy and quite exhilarating. Surprise! Maybe none of us needs as much food as we think.

    Regina, thank you for your excellent blog!

  67. Anonymous11:53 AM

    I want to add that what helped us make such a drastic change in our lifestyle was understanding how our bodies deal with protein, fat and carbohydrates. The Eades' Protein Power book got us started on learning about this.

    Once we got the concept, there was no turning back. I think the hardest part was going through the first couple of months of adjustment, and that was psychological as well as physical.

  68. Anonymous2:58 PM

    Nobody ever got fat eating a diet of whole grains and low calories / fat.

    Its statements like this that are getting people mad at you, Billy. How dare you make pronouncements for other people? That is EXACTLY how I ate for 20 years and gained 50 pounds. I DID not drink big gulps, biggie fries or any other junk. I rarely ate any sweets or candy. Just supposedly wholesome low fat, low sugar food. But it was still full of carbs. I ate what the low fat dogmatists said I should, cooking low fat meals at home that consisted of mostly vegies, no fat, very little meat, with a starch (usually rice or pasta). And I got fat!
    But reacting to your comments (reminds me of a newly smug ex-smoker) is not the main thing I wanted to comment on.

    Regina commented in her answers to you about the role of hormones. She is very much on to something there. I wanted to mention what has happened to me since I started eating low carb but I've not seen much comment about in the varoius readings I've done about peoples experience with low carb.

    During my time of low fat/low calorie eating, I struggled with depression and developed a drinking problem. Well guess what. Since almost completely cutting out carbs, I no longer have the desire to drink, at all! And the one time I did treat myself, over the holidays, to eating sweet treats, the desire to drink came roaring back.

    I used to drink diet pop every day (have for years) but had seen some comments that even fake sugar would effect your hormones so I decided to give it up for a while. I didn't notice a change in weight but I certainly did notice a difference in cravings. One day, I wanted something more flavourful than water so had one can of diet pop. Back came that desire to drink!

    Regina I hope you will post on this aspect for low carb eating and perhaps show some research that has been done in this area.

  69. "Nobody ever got fat eating a diet of whole grains and low calories / fat."

    Sorry, let me rephrase:

    "Most people with normal glucose tolerance won't get fat eating a diet of whole grains and low calories / fat."

    The traditional japanese diet is based around fish, rice, tofu, and vegetables. It is not as dominant in japan as it once was as western ways of eating are spreading.

  70. I have to say "yes, yes, yes" to so many comments.

    I too was told "you must be an emotional eater - what are you hiding". Like I was CHEATING - well, frankly they did accuse me of cheating on Weight Watchers. Why?? Because my very carb intolerant body could not take all of those "healthy carbs". I ate by the book and didn't lose weight.

    I'm so sick of being told I have an emotional eating problem. Bull Pucky is what I say. In fact, when I'm sad, happy and stressed out I DON'T eat. Go figure.

    I have a 16 year old daughter that was being taught in school to eat less and move more - she was being told that the reason people are fat is because they eat too much and are lazy. This all in her HEALTH CLASS!! "How dare them" she says to me. She went on an information quest and "educated" her teachers. She lost 50lbs on a LC LIFESTYLE - cause that's what it is in our home. She got her insulin resistance & SUPER HIGH insulin levels treated with the meds that she needed and eats WHOLE foods. Yep, I said it, a TEENAGER that loves to eat REAL food, not crap.

    And you want to know something. She'll NEVER gain her weight back because this is "just the way we live" (as she says to her friends that come over for dinner and LOVE the homecooked REAL food).

    Thanks for opening up such great topic of conversation. As always, it warms the cockles of my heart to read such a bold woman, plainly state the TRUTH.

  71. Atkins was the answer for me. I was raised on the dreadful "Mediterranean diet" (pea-sized portions of protein - high percentage of carbohydrates), and it meant constant hunger, fatigue, and feeling generally unwell. With avoiding starchy food, and being able to take in sufficient protein and fat not to be constantly hungry, I have lost over 70 pounds and had no problem with gaining at all. I have no reason to think about such matters as 'relationships with food' - presumably, if 'food were love' (one may use any tag line popular with those trying to sell books or counselling... no one needs 'help' with Atkins, though their site would make one think it essential), reducing carbohydrates would not reduce one's need for love!

    I have utter contempt for Weight Watchers' false dependence and mind games (equating their programme with 'self esteem,' 'life goals' and so forth) - or for programmes where one is constantly hungry but made to feel guilty if one does not 'obey.' Hunger is completely ignored, or treated as a weakness! (It seems to boil down to - get used to being ravenous - if you eat more than your tiny allotment, you either are subconsciously trying to sabotage yourself, or only eating more than 2 ounces of anything because you weren't taught 'portion control' measurements - or are a pathetic neurotic turning to 'comfort foods.') And one would not dare 'cheat' - knowing one must face a monstrous doctor, or a weekly weigh in, or even the abuse some people hand out on an Internet forum.

    However, with that said - I've had no problem with gaining, but have had very extended, highly frustrating plateaus in weight loss. I am not 'on maintenance' - I am trying to lose another fifty pounds, but, after the first year or so, weight loss slowed to a crawl.

    I think the reason Atkins works for me, and for others, is that it eliminates hunger, fatigue, and cravings at the source. With no excessive carbs to stimulate appetite, and no need for 2 or three ounce protein portions that don't reduce hunger, the control of appetite is natural. It is based on one's own needs, not on what is on a 'diet sheet.' That is a far cry from being constantly hungry and refraining from eating what would ease it through fear or having to account to anyone.

  72. I think a major reason is that our brain function is very strongly influenced by our diet and our body weight. Not just with food intake, but how we perceive ourselves, our goals, our priorities, motivations. Food controls mood.

    Some people have chemical disorders which are self-treated by high insulin diets. These individuals find it impossible to stick with any diet that actually works to lose body fat becuase this automatically reduces insulin and ultimately adversely affects their mood or functioning.

    Then there are other people, like me, who feel good only when on a low insulin diet. If I start gaining weight or eating carbs I become a wreck in more ways than one. It's a very quick change. I get motivation. I can set goals. I am much more balanced, and much less depressed. I think this has played a strong role in my ability to maintain this weight loss.

    Even if a person doesn't happen to have a susceptability to medicating with insulin, it's at least true that the effects of excess insulin are antagonistic to change. I am as good of an example as any of the power of an insulin-balancing diet on mood/behavior but even I can succumb to the awful effects of high insulin. You start gaining, then you become more apathetic and there are emotional changes (because of the effects of high insulin), and this encourages behaviors which only make the high insulin state worse. It's a cycle. I think insulin has this paralyzing and sedating effect on all people, and this is a major reason weight regain occurs.

    Once you're in the trap, you're trapped, and it takes something powerful to get you out of it.

    Again it is my good fortune that I respond so well to weight loss/restriction and other low insulin states. Even when I get in that trap all it takes usually is a day or two of food restriction to get me back to a place where the apathy and emotional affects melt away. I'm back to feeling motivated, energetic, balanced and capable.

    So basically, weight regain occurs as a much understated cause: insulin is a tranquilizer, and it's hard to stay awake and make changes when you've got an infusion of hypnotics going on. By the time you can muster sufficient motivation, you've been lulled into regain of significant weight.

  73. I also wanted to mention, all food will raise insulin, directly or indirectly. Carb is just the most powerful, most direct, most imbalancing source.

    Eating excess protein contributes glucose and insulin, and in someone with a broken ability to metabolize glucose properly this is going to cause higher insulin and excess eating/storing very similar to that of carb.

    Eating excess fat reduces glucose tolerance, because fatty acids hog up mitochondria making them less able to burn glucose. Insulin resistance results in response, indirectly increasing insulin levels and blood nutrients from carbs and protein. Fat alone cannot cause weight gain but it powerfully affects the metabolism of foods that can (protein/carb).

    So you see, all food, if in excess, is going to cause weight gain, the only question is at which level of intake does it occur.

    I'm generally against calorie restriction because I think if we eat the right things, and are careful to eat properly (regular meals, when truly hungry) calories take care of themselves. The obesity epidemic correlates with increased consumption of large meals with fat and simple carbs. It's not because people stopped counting calories. It's because we're eating large portions of food types that profoundly break our bodies. If portions were smaller (less energy) or if it were lower in carbs, there wouldn't be an exaggerated insulin response.

  74. Billy,

    Echoing some of Regina's questions, just who is this "I" that is in control of one's eating behaviors?

    It is some abstract, disembodied spiritual entity, unaffected by the hormones, neurotransmitters, and other biochemical and neurochemical processes that are affected by the food we eat and our genetics?

    There is no doubt that taking responsibility for our own health and our own food choices is important.

    But to say that it's just a matter of willpower, as if that "willpower" (of undefined origins) is somehow disconnected from the long- and short-term effects of what we are eating is to look at human behavior in a very narrow and, in my experience, unrealistic way.

    Over and over, it's been demonstrated that large amounts of carbohydrates affect the human body in very dramatic ways, and in ways that would affect one's ability to make informed, rational choices about what our next meal will look like.

    And it's also been demonstrated that getting people off high-carbohydrate, low-fat diets, onto diets that more closely mirror what our bodies have been evolved to eat over the past couple of million years, significant reduces the need to somehow "will" one's self to eat better, however you define better.

    Also in my experience over the past 20-30 years, getting people off of high-carb diets also tends to make them less and less obsessive about their weight and their diets. they just seem to gradually gravitate toward healthier food choices and healthier weights. Willpower just isn't much of an issue. It almost becomes harder to make the wrong choices, because your body can now communicate the right messages to your brain.

    Or rather the brain now resides in a mix of nutrients and hormones that it is equipped to deal with.

  75. Hi Billy. Here's some interesting info on the health effects of the traditional Japanese diet.

    I have a feeling that your definition of "normal glucose tolerance" is circular. Is there a way to specify glucose tolerance other than in relation to carbohydrate consumption?

  76. Again, the decision to go (and stay) low carb is a behavioral change.

    I find it interesting that no one has mentioned the legions of people who have gone on low carb diets, lost weight, and then gained it all back. Probably a comparable amount to those who do the same on low fat and or low calorie diets.

    The fact that you may be extremely carb intolerant and gain weight on normal, traditional diets like the Mediterranean diet simply means you have a different metabolism from many people.

    The fact is that many people have much more difficulty following a low carb diet than those of you who fare extremely well on them due to carb sensitivity.

  77. Is this not where the idea that it's a lack of willpower takes us?

    No, it has nothing to do with willpower and that's the lie that fat folks have been fed for many years. It's all part of the diet industry's marketing strategy to make us feel guilty if we do not maintain the weight loss. Just think about it, all of these "diet" programs you see on TV clearly tell you that the transformations you see from their "paid" personalities are not typical! They do this to give their program a safety hatch so when you regain the weight you lost, they can simply say: "Well, I guess you just don't have the willpower." Hell, I was once told something similar to this at a Weight Watcher's meeting--you can imagine how pissed and embarrassed I was!

    Look, when your body signals that it needs food, it's not just your stomach asking for food, but every single cell in your body is asking for energy! Very few people can stave off this type of prodding from you body to eat.

    Eating LC has a very satiating effect for most folks who go on it, I've read it's like 60%. Fortunately, I'm one who falls into that camp because my appetite is pretty much an after thought when I'm eating LC, so that's why I advocate combining LC with counting calories, which is a killer combination IMO.

    I know there is a big debate about whether it is natural to count calories or there's no need to count calories when doing LC, and I've participated in this fiery debate. Well, as someone who thinks that a controlled-carb, paleo-style diet is our natural diet, I think we need more communicating, personal experimentation, and less debating in the LC community.

    So, I now encourage anyone who has reached a weight loss plateau doing LC to simply start being more mindful of you daily caloric intake and play around with your numbers while keeping your carb intake the same.

    Finally, when you educate yourself about the process(es) of how the body gains and loses weight, then you'll realize that folks who say that it takes willpower to lose and keep the weight off are pretty ignorant (not informed) about basic human biochemistry and physiology.

  78. Anonymous4:17 AM

    I lost 55 pounds using Protein Power Life Plan as my guide, over a one year period. Age 49, now at my college weight of 193 (6'2"). Never thought I'd see the day before low-carb. Blood parameters from cholesterol to CRP to homocysteine are perfect. I no longer fear cardiovascular disease.

    I find the concept of insulin stealing the fuel from the blood to make fat (and the insulin thereby indirectly CAUSING hunger to increase due to the lack of fuel in the bloodstream) very useful in understanding how low carb works and in motivating me to keep the carbs low. I'm convinced it's impossible for me to gain weight without the insulin caused by carbs. I've always eaten volume, and I still eat quite a bit at each meal, just not carbs. People marvel at the size of steaks or the amount of chicken I eat at a meal and the huge plate FULL of broccoli. I can't succeed hungry.

    I count myself among the converted now, and can't see myself ever going back. I buy the evolutionary explanation, digestive tract arguments, etc. for low carb as the healthiest long term eating pattern. I think that's key to my motivation, after the hunger control. Now I join those angry at the FDA for their high carb recommendations that perpetuate the obesity epidemic affecting MILLIONS, along with the American Diabetic Association (that one just boggles the mind; although I was never diabetic, my interest in low-carb has lead me to do a lot of reading).

    I only had the time to add in limited exercise late in my program. I believe, based on my experience, that exercise is strictly optional for weight loss, and it certainly accelerated mine (weight lifting program to build calorie-burning muscle, not aerobics). Diet has to be the mainstay, and I've demonstrated (as have numerous others, of course) that it's very possible to lose significant weight with no exercise at all. This is an important point for all the time-pressed who are discouraged to even start a program because they know they have no time to exercise, and the powers that be are telling them that they can't lose weight without it.

    I've come to believe that, for the vast majority of people, absent severe emotional eating, weight loss is guaranteed if carbs are truly kept below about 40-50 g/day. The key here is being truthful about the carb count.

    Isn't it interesting that if you want to do low-carb, there's virtually nowhere you can go for in-person help. It's a do-it-yourself plan only. Jenny Craig, Lindora, Weight Watchers, FDA, etc. are all "balanced diet" promoters. There are some doctors out there who have seen the light, but too few. Most people will find themselves fighting against their doctor if they have picked up a low-carb book and try to follow it.

    I know I'm preaching to the choir here, so I won't take up too much more space. Thanks for your wonderful blog and for the opportunity to vent.

  79. Anonymous10:25 AM

    When I was in my early 30s, I developed insulin resistance and gained 30 pounds in a year, after a lifetime of being underweight (sometimes dangerously so).

    I consulted with a nutritionist, who put me on a low-fat, minimal animal products, counting-calories routine for the first time in my life. Rather than lose weight, I gained another 20 pounds.

    After seeing about a half-dozen doctors, finally one dx'd me with IR and told me to follow Atkins (at the time, I had no idea what a carbohydrate even *was*). This was in early 2003 - I stayed on induction levels of carbs for about 6 months and lost the 50 lbs with no trouble at all.

    Fast forward to the present. I have loosened up on the carb restriction a little bit (I consider my diet controlled carb, but sometimes deviate from low carb for the sake of variety). I'm 10 pounds heavier than when I first lost the weight, which is fine - it's right in the middle of the recommended weight for my height, and my endo basically says "just keep doing what you're doing."

    True, if I *counted* every single carbohydrate, I'd probably be about 10 pounds thinner. But, as has been discussed in previous comments, I did not find that approach sustainable for the long term.

    By eliminating *all* junk food, never setting foot in a fast food restaurant, making protein the center of every meal, and continually keeping myself informed and educated about my food choices, I have arrived on something that works that does not involve counting calories or carbs, does not leave me feeling deprived, and allows me to maintain healthy A1C, blood sugar, and cholesterol levels.

  80. Anonymous10:47 AM

    I think one of the craziest things about counting anything is that counting calories means you have to know the calorie count in any given food; counting carbs means you have to know the carb count; counting fat grams means you have to know the fat grams.

    What happened to eating FOODS? The way things are today, we're expected to become rocket scientists, all knowing about every last calories, carb and fat gram within food, and ignore the FOOD itself. If that isn't a recipe for disaster, I don't know what is.

    Eating is supposed to be simple. We NEVER before in our history knew, much less counted, calories, fat or carbs before a hundred years ago, and now we're told that is the only way to health?



  81. Anonymous1:45 PM

    Chelly Bean,

    I agree that people should eat Real Food and that counting anything is inherently "unnatural". But the food that is currently available, even the "Real Food", is available in unnatural proportions, plus human intervention in the past 10-12,000 years has changed many Real Foods (sweeter, larger, more available, etc.).

    Plenty of people do eat Real Food, never eat packaged food or step into a fast food restaurant and yet still they gain weight and develop diabetes and other health problems. I know a very obese person who eats little beyond fruit and vegetables, and never any packaged or fast food. I know another chef in Europe who is very, very active, makes everything from scratch with Real Food (in the modern sense of from scratch - she doesn't mill the grains, for example) yet she has always been heavy. Eating Real Food doesn't solve the problem if the foods still mess with human biochemistry, i.e., keep insulin production chronically high.

    Also, many people who eat Real Food don't develop weight problems, yet they do develop health problems that can have nutritional origins, such as such as dental problems, heart disease, cancer, GI troubles, etc.

    So I think "Just Eat Real Food" is very oversimplified. Yes, counting nutrients over- complicates things and is "unnatural", but sticking to Real Foods that are *most like the foods available to early humans* seems to be a "more natural" way to eat, which in modern times, doesn't come naturally. That means greatly reducing amounts of tubers, little or no grains or dairy, and more fat and organ meats. Exact proportions probably vary somewhat, but for someone who doesn't want to count anything or think too hard about it, that is surely the most "natural" approach.

  82. Anonymous11:26 PM

    We really don't need to make up reasons for why we eat too much. We don't need to eat for emotional reasons are because we are horrible human beings. Eating is a natural and strong drive.

    One way to think about it is:

    Food is different for a reason that should be obvious, but is still surprising: food is the most important thing in your life, because food is essential to survival.

    Get lost in the woods for a few weeks and you won’t worry about sex, your stock portfolio, or how you look. You’ll worry about food and how to get more of it. Food is almost all you’ll think about.

    Tasty food reaches deep into your brain and makes you want to eat with a real and true hunger. Food has power. The unlimited quantities of fatty high-calorie and sugary foods available in our modern world are a constant threat to make us slip up and gain weight. If you are prone to obesity, you will often find yourself eating more than you want and exercising less than you think you should.

    Eating isn’t something you decide to do. Eating is a powerful drive. Eating is raw survival and your brain wants you to survive above all else.

    Dismissing that drive is like trying to tell someone to stop drinking water when they are thirsty or to not go the bathroom for a few days.

  83. Chelly Bean,
    I think part of the problem might be that people have unrealistic goals about what they should weigh.

    Back when people ate "real food", there was far less emphasis on maintaining a pubescent figure.

    I can't count the number of times I've observed perfectly healthy weight women trying to lose weight, and having so much trouble with binging and gaining, trying desperate diets to get the "weight" off...

    Low carb works if you have pathological levels of fat storage. To look like a movie star, to get the waifish protruding bones look, that's plain and simple starvation, low carb with a healthy attitude toward food isn't going to take (most of us) there without that additional component.

    So, I think part of the reason food has become so complicated is because our relationships with our bodies has become complicated. Perfectly healthy, normal weight women are trying to lose weight, and if you're healthy and normal weight you really can't expect to lose body fat on a healthy diet. The extra focus on food and restriction is necessary when trying to foil the way our body is supposed to work.

    Garden variety obesity is made up of poisonous sugar and starch and largep ortions of it.

    The rest of us are brainwashed into thinking our healthy bodies need to be changed, and we resort to counting carbs fats and calories on our hands to look like nicole ritchie.

  84. And, I agree with anna;
    If I "Just ate real food" I would probably not be as morbidly obese as I WAS, but I would be on the larger side at least.

    What controls weight is insulin, and insulin is controlled by carbohydrate (and to a lesser degree, by protein and even less by dietary fat). "Real or not real" doesn't figure in. Example, I can eat a bunch of low carb cookies. If I keep eating them, I lose appetite (good cop, encouraging me to stop). If I ignore good cop's warning, then bad cop violent nausea kicks in and forces me to stop LOL.

    With carbohydrate cookies, the only thing that stops me is the availability (how many are on my plate) and my motivation to obtain more cookies (should my plate run out). The lack of appetite and strong nausea never happens, because my body simply makes more and more insulin to usher the blood nutrients into my fat cells.

    I get fatter, not fuller.

    As said before, "real food" correlates with low insulin diets, but not always. I can quite well make organic cookies with sugar in the raw and milled whole wheat flour etc. I will become huge eating these. WHereas, if I use ingredients with no / low digestible carb and low protein counts, my ability to gain weight off of this is very limited due to the metabolism of it (very little insulin is made).
    I can eat salads with walnuts and dried fruits, rice and beans and meats... I'll gain weight unless I'm careful of the food's effect on insulin.

  85. losing weight and maintaining it is about a lifestyle change. That means your diet changes, your activities change, your outlook changes.
    So for the people who have posted saying they lost a lot of weight, low carb, low fat, whatever, and then gained it back, I have a few questions.

    Did you exercise to lose weight? Did you continue to do so when you got to your "maintain" level?

    Successful weight losers do not diet. They change their lifestyle. You need to take a truthful look at the entire picture to really determine why you gained the weight back before you can go pointing fingers as to what the cause was. And I'd be willing to bet that 9 times out of 10 that reason was something within your control. You can't switch the 'lifestyle' off once you get to your goals. That's just the beginning.

  86. I have been fighting weight most of my life. I tried the low fat approach for several years. However, I didn't have the willpower to stick to it. I would get hungry an hour or two after a "healthy" low fat, high carb meal. I had intense, insatiable cravings that lead me to overeat. I tried to satisfy those cravings with "health complex carbs," but I was never satisfied and just couldn't stop.

    I always thought it was in the execution and if I could just do it better, I would be successful. I could lose weight, but the cravings would kick in and I'd regain. I eventually gave up on trying to lose weight. It took a diagnosis of type 2 diabetes to make me question my approach.

    Now that I'm on low carb, the cravings are gone for the most part and manageable. I am more satisfied with my food. The low fat approach wasn't right for me. There was no problem with execution.

  87. Clearly "willpower" is a red-herring, and always has been. Willpower, like "portion-control" was the excuse given when low-fat dieting failed from the very start in the salad-and-cottage-cheese-eating and jogging days of the 1970's. Men saw that women were getting nowhere with low-fat dieting and immediately lost faith and interest in such diets for themselves, and relegated it to a "women's" fantasy subject, because it was clearly ineffectual. Men will follow anything that they see is effective and efficient at manipulating the physical world - give them a diet that works efficiently and logically, and they will jump on it eagerly. Low-fat just never worked. "Lack of willpower" was our first justification buzz-word for this failure. To this day, when confronted with a successful low-carber, interviewers will immediately say the successful dieter "must have great will-power". It's an undead mentality from the 70's, like lettuce, low-fat cottage cheese and wheat germ.

  88. Iwould say, happy are they who are overweight - sooner or later they WILL come to LC.
    What about people who are slim, eating "healthy" oatmeal, plenty of fruits/vegetables, avoiding sat fat, exercising regularely?
    Over the years, they develope all kinds of illnesses and will never become well.
    It is sad. I know many folks like these and they are resisting to any information. They can find many explanations for their desieses and none will be the food they eat.
    (apology for my English)