Arguing in Circles

There is so much debate today about the process of weight loss. Some people claim it’s all about calories and others claim it has nothing to do with calories altogether. The fact that not all health professionals have the same opinion means that we don’t have it all figured out yet. It probably doesn’t surprise anyone that knows me that I have an opinion on the subject. Like most doctors that are passionate about their field of medicine, I tend to have pretty strong opinions about things that directly impact my patients.

We know that calorie restriction causes weight loss. We’ve seen it in multiple instances. I’ve written about it here before. We also know that once forced restriction ends, almost without fail, people regain the weight they lost. The body does everything in it’s power to balance out the loss. The question of whether or not calorie restriction works isn’t the issue – it’s whether or not simple calorie restriction is an effective method of treatment in today’s calorie-rich environment.

Starving people and then telling them to resist their body’s physiologic drive to regain the weight is like asking them to resist the desire to breathe deeply when they are exercising. It’s simply almost impossible to do. No amount of willpower can overcome the body’s innate nature very long.

This is why we need to employ other methods. When we change the composition of our diet to one comprised of whole foods (rather than highly processed ones – as in the Standard American Diet), whether that’s a high-protein, low-fat diet or a high-fat, moderate protein, or a moderate-fat vegan diet, we change the way the body responds hormonally to food. When done properly (and there is no one-size-fits-all way to do this), we improve satiety (the feeling of fullness). Satiety, combined with cognitive-behavioral therapy, helps reduce cravings and emotional eating and distracted eating, and all kinds of other patterns that contribute to weight gain. By doing these things, we inevitably decrease calories. However, what’s important is that those physiologic changes (if done correctly) allow us to adapt to calorie restriction and decrease the body’s drive to regain the lost weight.

Calorie restriction is a RESULT of the changes in diet composition. Calorie restriction is the RESULT of the changes in behaviors (behavioral changes that are effective because the biochemistry of the body is improved). Simply restricting calories is the same as opening a window to let the smoke out of the kitchen. It improves the obvious problem, but unless you actually put out the fire, the smoke is going to keep accumulating.

When you turn the levers of behavioral change and diet composition, you inevitably change the lever of calorie consumption. The smoke clears out because the fire has been put out.

Science isn’t math and human beings are not calculators. What happens on a spreadsheet doesn’t happen in the human body – whether you want it to or not. Science doesn’t let you dig in your heels and ignore the data because the other side of the argument makes sense to you. We keep trying to polarize this issue (calories vs physiology) and we need to stop. Science is supposed to be better than politics. Just because every other issue has gotten polarized, we shouldn’t feel left out.

If you need more help, you know where to find me!

Courtney Younglove, M.D.