The Daily Progress
Charlottesville, VA
By Zachary M. Bush | Revolution Health Center
Published: January 16, 2011
This New Year, many of us are worried about our weight; in fact, never in the history of humankind have so many been so overweight. If there is an upside to this, perhaps it is the economic stimulus that this epidemic of fat provides for the multi-billion dollar American weight loss/diet industry. But, before you start that next diet, consider this:
From the first patient histories that I took in medical school something startling was revealed: the most obese patients were eating far less than I. When I would report this, my attending physicians would chuckle and quote studies that suggest that obese patients underestimate the amount of food they eat.
Ten years later, as I sat in case conference with endocrinology and metabolism experts, I would hear comments like, “I suppose the laws of thermodynamics just don’t apply to this patient,” which would be followed by guffawing from the academic ranks. And so it is that doctors are taught that patients are not just fat, but stupid.
In recent years I have decided to believe my patients, and they have taught me a lot.
Let’s take a typical 250-pound, 42-year-old female patient. She started gaining weight in her late teens as college studies, part-time jobs and social activities removed her from the family table. The convenience offered by the American food industry created an ever-growing dependence on increasingly unhealthy food choices.
Her first diet was at age 19, when she weighed 160 lbs. She went from a 2,500-calorie diet to a 1,200-calorie diet and was pleased to lose 18 pounds in four weeks. However, after eight more weeks, she had only lost 2 additional pounds. She was now weight stable on a 1,200-calorie diet. She had turned herself from a 2,500-calorie machine to a 1,200-calorie machine.
What did the body do to slow metabolism to half its previous burn in just six weeks?
By dropping core body temperature and decreasing muscle activity, the brain reduces energy expenditure. As muscles stop moving, they lose mass. When she “gives up her diet,” she eats only 2,000 calories per day, but since her body is now only burning 1,200 calories per day, she gains weight quickly, and within six months she’s 10 pounds heavier than she was when she started the diet, and she has a slower metabolism than when she started.
After two more decades of dieting, you have a 42-year-old woman who weighs 250 pounds and only eats 1,100 calories per day when she is not dieting. When she diets, she eats 600 calories per day. This patient comes to my clinic not for obesity, but for chronic fatigue, depression, insomnia and diffuse pain symptoms. She cries most days; when at work, she feels that she is on the verge of collapse.
