Our Weight is Regulated by Our Biological System
- POSTED ON: Jul 13, 2017

I continually read a great many books, articles, blogs, and forum posts on the subject of obesity.

No one,…. not even the most qualified medical doctor or scientist, … knows everything or holds only beliefs that are absolutely correct.

However, I am often amazed by the vast amount of existing misconceptions, myths, and wishful-thinking that gets spread and promoted by people who present themselves as obesity “experts” or “gurus”.

One thing that Scientists know for sure about obesity management, is the sad fact, that no diet, exercise, medication, not even bariatric surgery, will permanently reset the body’s tendency to defend and regain its body weight to its set point .... this generally being the highest weight that has been achieved and maintained for a notable length of time.



Thus, any effective long-term treatment MUST OFFSET the complex neurobiology which is designed to eventually doom every weight-loss attempt to ultimately "fail".

A comprehensive review recently published in Endocrine Reviews describes the complexity of  the biological system that regulates our body weight.

The 30+ page research paper, backed by about 350 scientific citations, was written by the undisputed leaders in the medical field of Endocrinology (Michael Schwartz, Randy Seeley, Eric Ravussin, Rudolph Leibel and colleagues)  and is actually a “Scientific Statement” from the Endocrine Society. 

In other words, these Scientists know that they are talking about when they speak about the Science of Energy Balance, and in this paper they outline in excruciating scientific detail just how complex the biological system that regulates, defends, and restores body weight actually is.

From the Abstract of this research paper:

We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained.

A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time.

Growing evidence suggests that
obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight.

Their position is that, despite all we have learned about this system, we are still far from fully understanding it.

Science knows about one of the pathways, but there are many pathways in a complex network of multiple interacting pathways that involve virtually every part of the brain.

They say that the medical field currently needs a great deal more information about the specifics of this issue:

The identification of neuromolecular mechanisms that integrate short-term and long-term control of feeding behavior, such that calorie intake precisely matches energy expenditure over long time intervals, will almost certainly enable better preventive and therapeutic approaches to obesity.”

To be viable, theories of obesity pathogenesis must account not only for how excess body fat is acquired, but also for how excess body fat comes to be biologically defended.

Answering this question requires an improved understanding of the neuro-molecular elements that underlie a “defended” level of body fat. What are the molecular/neuroanatomic predicates that help establish and defend a “set point” for adiposity? How do these elements regulate feeding behavior and/or energy expenditure, so as to achieve long-term energy balance?
By what mechanisms is an apparently higher set point established and defended in individuals who are obese?”

They conclude that:

Given that recovery of lost weight ... (the normal, physiological response to weight loss irrespective of one’s starting weight) ... is the largest single obstacle to effective long-term weight loss, we cannot overstate the importance of a coherent understanding of obesity-associated alterations of the energy homeostasis system.”


So, in essence, this scientific paper shows why no simple solution to obesity is in sight; details the existence of an enormous Problem; and raises Questions for which Science still needs to find answers.

To get a simple explanation of the basic concept, see: Set Point. 

Any “health & wellness” professional, medical doctor, or guru who claims that any particular Diet, Behavior, or LifeStyle can fundamentally change the part of the body’s biology which acts to protect and restore body fat in the long term is Simply Wrong. 

They are either spreading a Lie, sharing a Myth, or offering a hypothesis for which no proof or reasonable evidence exists… which means that they are simply sharing their own Wishful-Thinking.

At this point, all credible Scientific Research indicates the following:

No matter how much weight gets lost, or is maintained for the short-term, …
No matter whether that weight loss was slow or fast, ...
No matter when food intake occurs ...

No matter whether “unprocessed” or “healthy” food is eaten, ...

Ultimately NO diet or behavior
manages to “reset” the body-weight set point to a lower level,
in order to biologically “stabilize” weight loss for the long-term.






Calorie Restriction = Calorie Restriction.
- POSTED ON: Jul 12, 2017

At the end of the day:
Calorie Restriction
equals
Calorie Restriction.


See the article below from Dr. Arya Sharma, who is one of the world’s top medical obesity specialists.

Dr. Sharma is highly respected by obesity researchers, health professionals. His opinions are based on many years of extensive obesity research as well as many years of practical experience with obese patients. 


Alternate Day Fasting Is No Better Than Any Other Fad Diet
                   by Dr. Arya Sharma,  July 11, 2017

It seems that every year someone else comes up with a diet that can supposedly conquer obesity and all other health problems of civilization.

In almost every case, the diet is based on some “new” insight into how our bodies function, or how our ancestors (read – hunters gatherers (never mind that they only lived to be 35) ate, or how modern foods are killing us (never mind that the average person has never lived longer than ever before), or how (insert remote population here) lives today with no chronic disease.

Throw in some scientific terms like “ketogenic”, “guten”, “anti-oxidant”, “fructose”, or “insulin”, add some level of restriction and unusual foods, and (most importantly) get celebrity endorsement and “testimonials” and you have a best-seller (and a successful speaking career) ready to go.

The problem is that, no matter what the “scientific” (sounding) theories suggest, there is little evidence that the enthusiastic promises of any of these hold up under the cold light of scientific study.


Therefore, I am not the least surprised that the same holds true for the much hyped “alternative-day fasting diet”, which supposedly is best for us, because it mimics how our pre-historic ancestors apparently made it to the ripe age of 35 without obesity and heart attacks.

Thus, a year-long randomized controlled study by John Trepanowski and colleagues, published in JAMA Internal Medicine, shows that alternate day fasting is evidently no better in producing superior adherence, weight loss, weight maintenance, or cardioprotection compared to good old daily calorie restriction (which also produces modest long-term results at best).

In fact, the alternate day fasting group had significantly more dropouts than both the daily calorie restriction and control group (38% vs. 29% and 26% respectively). Mean weight loss was virtually identical between both intervention groups (~6 Kg).

Purists of course will instantly criticize that the study did not actually test alternative-day fasting, as more people dropped out and most of the participants who stayed in that group actually ate more than prescribed on fast days, and less than prescribed on feast days – but that is exactly the point of this kind of study – to test whether the proposed diet works in “real life”, because no one in “real life” can ever be expected to be perfectly compliant with any diet. In fact, again, as this study shows, the more “restrictive” the diet (and, yes, starving yourself every other day is “restrictive”), the greater the dropout rate.

Unfortunately, what counts in real life is not what people SHOULD be doing, but what people actually do.

The question really is
not whether or not alternate-day fasting is better for someone trying to lose weight but rather, whether or not “recommending” someone follows an alternate-day fasting plan (and them trying to follow it the best they can) is better for them. The clear answer from this study is “no”.

So why are all diets the same (in that virtually all of them provide a rather modest degree of long-term weight loss)?

My guess is that no diet (or behavior for that matter) has the capability of fundamentally changing the body’s biology that acts to protect and restore body fat in the long-term. Irrespective of whether a diet leads to weight loss in the short term and irrespective of how it does so (or how slow or fast), ultimately no diet manages to “reset” the body-weight set point to a lower level, that would biologically “stabilize” weight loss in the long-term.

Thus, the amount of long-term weight loss that can be achieved by dieting is always in the same (rather modest) ballpark and it is often only a matter of time before the biology wins out and put all the weight back on.

Clearly, I am not holding my breath for the next diet that comes along that promises to be better than everything we’ve had before.

My advice to patients is, do what works for you, but do not expect miracles – just find the diet you can happily live on and stick to it.


Dr. Arya M. Sharma, MD, PhD, FRCPC is a medical doctor and university professor of medicine and obesity research.  His research focuses on the evidence-based prevention and management of obesity and its complications.

He has authored and co-authored more than 350 scientific articles and has lectured widely throughout the world on the etiology and management of obesity and related cardiovascular disorders. Dr. Sharma is regularly featured as a medical expert in national and international TV and print media and maintains a widely read obesity blog at www.drsharma.ca.

 

I have been observing and experimenting with various forms of Intermittent Fasting since early 2006, which was BEFORE the best-selling intermittent fasting books… including… JUDDD, ADF, EatStopEat, 5/2, and EOD ... were published.  And BEFORE the concept of Intermittent Fasting as a diet became famous on the internet.

This past 12 years, I’ve closely watched many diet “experts” talk about the latest fasting research, while providing their own anecdotal evidence.   I’ve seen both of these offered as evidence to prove the "expert's"  own opinions about the subject. 

As an attorney, I’ve been trained to notice when people improperly characterize evidence, especially when they misstate evidence or misquote a witness in order to prove a point they are trying to make.

This is something that is commonly done by diet “experts”.  Unfortunately even medical doctors whose overall medical expertise and opinions I tend to respect, sometimes engage in this type of Behavior, and apply valid scientific research incorrectly in order to support “a hypothesis with zero proof, which is really no more than that expert’s own wishful thinking.”

For example, even Dr. Jason Fung, who appears to be a very dedicated, well-educated, and experienced medical expert specializing in the area of Diabetes, …(and who is extensively quoted here in the Fasting Blog Category section of DietHobby as an intermittent fasting expert) … sometimes improperly characterizes research evidence in order to prove points which appear to be merely based on his “wishful thinking” due to the lack of valid supporting evidence.

One of Dr. Fung’s hypothesis is that people cannot lose weight by using “calorie restriction”, but that they can lose weight by using “Intermittent fasting”, and he claims that there is a very big difference between these two behaviors.  As evidence for this principle, he often compares scientific Research about Biggest Loser Contestants, who he labels as “Calorie Restricting”, versus scientific Research about Gastric Bypass Participants, who he labels as “Fasting”.

Of course, the main problem with the Comparison is that BOTH of these weight-loss methods are based on Calorie Restriction in that Post-gastric bypass, participants do not “Fast”.  They do not go without eating. After weight-loss surgery they eat small amounts of food daily.  First, they ingest liquid food, then soft food, and then go on to firm food. 

During the first year after my own open RNY gastric bypass, 25 years ago, my experience was similar to what everyone else commonly reports.  I ate between 300 and 600 calories per day … which was as much food as my body would tolerate at the time.  I did not fast.  I did not consciously “restrict calories”,  but instead focused on eating only the amounts and kinds of food that would prevent me from lying on my bed with dry heaves.  I did not fast. My surgery restricted calories for me.

Since both of these forms of eating behavior leading to weight-loss were based on Calorie Restriction, Dr. Fung misstated the evidence which he provided as proof for his hypothesis.  As a result, his hypothesis lacks proof.  This reduces it back to his own personal “wishful thinking”.   Over the past several years, Dr. Fung has failed to address or provide any explanation for this error, even though I have seen it pointed out to him on several different occasions.

I find it interesting that Dr. Fung also relies heavily on Dr Krista Varady’s past scientific research on Intermittent Fasting to prove that Intermittent Fasting is superior to Calorie Restriction… although in her own words .... Dr. Varady says that Intermittent Fasting is a form of "Calorie-Restriction".

 When Dr. Varady was interviewed about this recent research study which is the subject of Dr. Sharma’s article, she said:


I really thought people would have an easier time and lose more weight on the [intermittent fasting diet] and I was shocked they lost the same amount,” says study author Dr. Krista Varady, an associate professor of nutrition the University of Illinois at Chicago and author of the book The Every-Other-Day Diet.The take-home message for me is that this diet isn’t for everyone.”

"I don't think there's anything magical to the diet at all," she said of alternate-day fasting.
"I think it's just another way of tricking people into eating less food or helping people to kind of monitor how much food intake there is or how much food they're taking in."

You can find the complete study in my previous article: “Fasting is No Better For You Than Regular Calorie Restriction - new Scientific Study”.

 


Fasting is No Better For You Than Regular Calorie Restriction - new Scientific Study
- POSTED ON: May 03, 2017

A Scientific Study was recently published concluding that an alternate-day fasting diet was NOT superior to a daily calorie restriction diet for Metabolically Healthy Obese Adults with regard to adherence, weight loss, weight maintenance, or improvement in risk indicators for cardiovascular disease (including insulin resistance).

The lead researcher in this study, Dr. Krista Varady, has previously done extensive research on Alternate Day Fasting.  Those studies are currently considered the best scientific authority on Intermittent Fasting, and her previous research findings have often been extensively quoted by the majority of Intermittent Fasting Gurus, including Dr. Jason Fung, author of The Obesity Code (2016) and The Complete Guide to Fasting (2016)

Below is a recent article from TIME

 


Fasting Isn’t Better for You Than Regular Dieting
Alexandra Sifferlin   May 01, 2017    TIME

Losing weight is hard, which is why weight loss experts have long searched for different approaches to make it easier for people. One strategy gaining steam is intermittent fasting, where people fast or lower their calories substantially for a short period of time. (This diet plan also has potential lifespan-extending benefits.)

But new research published in JAMA Internal Medicine suggests that the fasting diet may not be the weight loss key it's been hyped up to be.

In the new trial, researchers wanted to know whether people who tried a fasting diet would be more successful than those on a standard diet. They told 100 people with obesity to follow one of three diets for a year. Some were told to cut their calorie consumption by 25% per day—a typical calorie restriction diet—while others did an alternate-day fasting diet, where they ate about 500 calories on “fast” days and whatever they wanted on “feast" days. The last group, which served as the control group, ate what they normally would.

The researchers expected that the people in the fasting group would lose more weight and have an easier time sticking to the diet than regular dieters, but the results didn't reflect that. At the end of the year, people who did the fasting diet and those who just cut calories both lost an average of 13 pounds. However, people in the fasting group actually had a harder time sticking to the diet, and more people in that group dropped out of the study.

I really thought people would have an easier time and lose more weight on the [intermittent fasting diet] and I was shocked they lost the same amount,” says study author Dr. Krista Varady, an associate professor of nutrition the University of Illinois at Chicago and author of the book The Every-Other-Day Diet. “The take-home message for me is that this diet isn’t for everyone.”

The researchers also did not find significant differences in other health measures between the dieting groups, like blood pressure, heart rate or insulin resistance.

Dr. Varady says that while half of the people in the fasting group "could barely do the diet," there were several people who were very successful, losing between 20 to 50 pounds. Those findings suggest that some people do respond well to the diet.

Still, what works for one person clearly doesn’t work for everyone. “If people have failed other diets, maybe this will work,” Dr. Varady says. “People will pick what diet works best for them."


Below are Excepts from a recent CNN article about this scientific research study. 
 

The study suggests that there is no significant difference between fasting and the other popular weight loss strategy of simply restricting how many daily calories you consume.

Dr. Varady said that, before the study, she thought alternate-day fasting would be an easier diet to adhere to because it allowed for a "break" from dieting every day.

"We were a little bit shocked to see that it was actually the calorie-restriction group that seemed like they could stick better to their daily calorie goals. Whereas the alternate-day fasting group, they were kind of wavering," said Dr. Varady, who authored a book about alternate-day fasting called "The Every-Other-Day Diet."

"Instead of eating the 500 calories on the fasting days, they were eating a couple hundred calories more on those days," she said.

'Not one diet fits everyone'

All in all, the new study showed that alternate-day fasting may be difficult to follow but can be effective in reducing obesity, said Valter Longo, a professor at the University of Southern California and director of the university's Longevity Institute. He was not involved in the study.

However, "because it requires a major effort every other day, it is unlikely to be applicable to the great majority of the obese population, particularly in the absence of the close monitoring carried out in the clinical study," Longo said.

For overweight or obese adults who might be interested in alternate-day fasting as a weight loss approach, Dr. Varady advised taking the time to really determine whether it is the best option.  "I really think people just need to find what works for them," she said. "Not one diet fits everyone."

"I don't think there's anything magical to the diet at all," she said of alternate-day fasting. "
I think it's just another way of tricking people into eating less food or helping people to kind of monitor how much food intake there is or how much food they're taking in."

Below is a copy of the published research study.

This study can also be found at:
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2623528

May 1, 2017 

Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults
A Randomized Clinical Trial

John F. Trepanowski, PhD1; Cynthia M. Kroeger, PhD1,2; Adrienne Barnosky, MD1; et al Monica C. Klempel, PhD1; Surabhi Bhutani, PhD1; Kristin K. Hoddy, PhD, RD1; Kelsey Gabel, MS, RD1; Sally Freels, PhD3; Joseph Rigdon, PhD4; Jennifer Rood, PhD5; Eric Ravussin, PhD5; Krista A. Varady, PhD1

Author Affiliations Article Information
JAMA Intern Med. Published online May 1, 2017. doi:10.1001/jamainternmed.2017.0936


Key Points

Question  Is alternate-day fasting more effective for weight loss and weight maintenance compared with daily calorie restriction?

Findings  This randomized clinical trial included 100 metabolically healthy obese adults. Weight loss after 1 year in the alternate-day fasting group (6.0%) was not significantly different from that of the daily calorie restriction group (5.3%), relative to the no-intervention control group.

Meaning  Alternate-day fasting does not produce superior weight loss or weight maintenance compared with daily calorie restriction.

Abstract

Importance  Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy.

Objective  To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease.

Design, Setting, and Participants  A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois.

Interventions  Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating “feast days”), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase.

Main Outcomes and Measures  The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease.

Results  Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (–6.8% [95% CI, –9.1% to –4.5%] vs –6.8% [95% CI, –9.1% to –4.6%]) and month 12 (–6.0% [95% CI, –8.5% to –3.6%] vs –5.3% [95% CI, –7.6% to –3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, –5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group.

Conclusions and Relevance  Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction.

Trial Registration  clinicaltrials.gov Identifier: NCT00960505

Introduction

The first-line therapy prescribed to obese patients for weight loss is daily calorie restriction.1 However, many patients find it difficult to adhere to a conventional weight-loss diet because food intake must be limited every day.2 As such, adherence to daily calorie restriction decreases after 1 month and continues to decline thereafter.3- 5 In light of this limitation, another approach that requires individuals to restrict calories only every other day was developed.6 This strategy is called alternate-day fasting and involves a fast day where individuals consume 25% of their usual intake (approximately 500 kcal), alternated with a “feast day” where individuals are permitted to consume food ad libitum. Findings from short-term studies indicate that participants lose 3% to 7% of body weight after 2 to 3 months of alternate-day fasting and experience improvements in lipid profiles, blood pressure, and insulin sensitivity.7- 13

Alternate-day fasting regimens have increased in popularity during the past decade, and several best-selling diet books14,15 have promoted this approach. More than 1 million copies of these books have been sold in the United States and United Kingdom to date. Despite the growing popularity of alternate-day fasting, to our knowledge, no long-term randomized clinical trials have evaluated its efficacy or compared this regimen with a conventional weight-loss diet.

We conducted a 1-year, randomized clinical trial to compare the effects of alternate-day fasting vs daily calorie restriction on body weight and risk indicators for cardiovascular disease. We hypothesized that the participants in the alternate-day fasting group would be more adherent to their diet, achieve greater weight loss, and experience more pronounced improvements in risk indicators for cardiovascular disease during the 6-month weight-loss phase compared with those in the daily calorie restriction group. We also hypothesized that the alternate-day fasting group would better maintain their weight loss and sustain their improvements in risk indicators for cardiovascular disease during the 6-month weight-maintenance phase compared with the daily calorie restriction group.

Methods

Participants

We conducted the trial between October 1, 2011, and January 15, 2015, at the University of Illinois at Chicago. Participants were recruited from the Chicago area by means of flyers placed around the university and were screened via a questionnaire, an assessment of body mass index, and a pregnancy test. Individuals included were men and women between 18 and 65 years of age, with a body mass index between 25.0 and 39.9 (calculated as weight in kilograms divided by height in meters squared) who had previously been sedentary (<60 minutes per week of light activity for the 3 months prior to the study).

Exclusion criteria were a history of cardiovascular disease or type 1 or 2 diabetes, use of medications that could affect study outcomes, unstable weight for 3 months prior to the beginning of the study (>4-kg weight loss or gain), perimenopause or otherwise irregular menstrual cycle, pregnancy, and currently smoking. The protocol was approved by the Office for the Protection of Research Subjects at the University of Illinois at Chicago, and written informed consent was obtained from all participants. The full protocol is available in Supplement 1.

Randomization and Intervention Groups

Participants were randomized in a 1:1:1 ratio to an alternate-day fasting group, daily calorie restriction group, or no-intervention control group. Randomization was performed by a stratified random sampling procedure by sex, age (18-42 years and 43-65 years), and body mass index (25.0-32.5 and 32.6-39.9). Block size ranged from 1 to 11 participants. The active trial duration was 1 year and consisted of a baseline phase (1 month), a weight-loss phase (6 months), and a weight-maintenance phase (6 months) (eFigure 1 in Supplement 2). We chose this design because weight loss typically peaks at 6 months during a lifestyle intervention.16 During the baseline phase, all participants ate their usual diet and maintained a stable weight. Baseline total energy expenditure was measured using doubly labeled water.17 All participants were instructed not to change their physical activity habits throughout the trial (eg, not to join a gym) to avoid potential confounding.

Weight-Loss Phase

Participants in the alternate-day fasting group and those in the daily calorie restriction group were provided with all meals during the first 3 months of the trial and received dietary counseling thereafter (eFigure 1 in Supplement 2). During the 6-month weight-loss phase, the intervention groups were instructed to reduce their energy intake by a mean of 25% per day. To achieve this reduction, the alternate-day fasting group was instructed to consume 25% of baseline energy intake as a lunch (between 12 pm and 2 pm) on fast days and 125% of baseline energy intake split between 3 meals on alternating feast days. The daily calorie restriction group was instructed to consume 75% of baseline energy intake split between 3 meals every day. The provided meals were in accordance with the American Heart Association guidelines18 for macronutrient intake, with 30% of energy as fat, 55% as carbohydrate, and 15% as protein. From months 4 to 6, when food was no longer provided, intervention participants met individually with a dietician or nutritionist weekly to learn how to continue with their diets on their own.

Weight-Maintenance Phase

At the beginning of the 6-month weight-maintenance phase, total daily energy expenditure was reassessed using doubly labeled water.17 Participants were instructed to maintain their body weight during this phase. Participants in the alternate-day fasting group were instructed to consume 50% of energy needs as a lunch on fast days and 150% of energy needs split between 3 meals on alternating feast days. Participants in the daily calorie restriction group were instructed to consume 100% of energy needs split between 3 meals every day. Intervention participants met with the dietician individually each month to learn cognitive behavioral strategies to prevent weight regain19 and received personalized energy targets for weight maintenance based on results from doubly labeled water.

Control Group Protocol

Participants in the control group were instructed to maintain their weight throughout the trial and not to change their eating or physical activity habits. Controls received no food or dietary counseling but visited the research center at the same frequency as the intervention participants (to provide outcome measurements). Controls who completed the 12-month trial received 3 months of free weight-loss counseling and a 12-month gym membership at the end of the study.

Outcome Measures

The primary outcome of the study was change in body weight, which was measured monthly via a digital scale while the participant was in a hospital gown. Fat mass and lean mass were measured every 6 months in the fasted state by dual-energy x-ray absorptiometry (QDR 4500W; Hologic). Visceral fat mass was measured every 6 months by magnetic resonance imaging performed with a 1.5-T magnet (Siemens Vision), and images were analyzed using validated software.20

Mean percentage energy restriction during the weight-loss phase was retrospectively calculated by the intake balance method using doubly labeled water and changes in body composition.21 Physical activity was measured for 7 consecutive days every 6 months using an activity monitor (SenseWear Armband Mini; BodyMedia Inc).22 Dietary intake and adherence to diets was assessed every 3 months with a 7-day food record and analyzed using Nutritionist Pro software (Axxya Systems LLC). Intervention participants were considered to be adherent when their actual energy intake, determined via food records, was within 200 kcal of their prescribed daily energy goal.

Blood samples were obtained following a 12-hour fast every 6 months (collected on the morning after a feast day for the alternate-day fasting group). Secondary outcomes included blood pressure, heart rate, and total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting glucose, fasting insulin, C-reactive protein, and homocysteine concentrations (analytical methods are detailed in the full protocol in Supplement 1). The homeostasis model assessment of insulin resistance was calculated as insulin × glucose/405, where the unit of measure for insulin is in micro-international units per milliliter and the unit of measure for glucose is milligrams per deciliter.23

Statistical Analysis

For the sample size calculation, we estimated that alternate-day fasting would reduce body weight by 15% by month 69,11 and that daily calorie restriction would reduce body weight by 10% by month 6.24 We calculated that 26 participants per group would provide 80% power to detect a significant difference of 5% in body weight between the alternate-day fasting group and the daily calorie restriction group at month 6, using a 2-tailed independent-samples t test with α = .05. We anticipated a dropout rate of 12%. Thus, we initially aimed to recruit 90 participants (30 per group), assuming that 78 participants (26 per group) would complete the trial. We later decided to recruit 100 participants to increase our statistical power because our dropout rate was higher than expected.

Data are shown as mean values (with 95% CIs) unless otherwise noted. A 2-tailed P < .05 was considered statistically significant. Tests for normality were included in the model, and all data were found to be normally distributed. We conducted an intention-to-treat analysis, which included data from all 100 participants who underwent randomization. Results are reported by intention-to-treat analysis unless indicated otherwise. A linear mixed model was used to assess time, diet, and time × diet effects for each outcome. This model provides unbiased estimates of time and treatment effects under a missing-at-random assumption. Time was not assumed to be linear in the model. This strategy allowed for estimation of time and diet effects (and their interaction) without imposing a linear time trend. The analyses were performed using SAS, version 9.4 (SAS Institute, Inc), and R software, version 3.2.2 (R Foundation for Statistical Computing).

Results

Participant Characteristics and Attrition

Of the 222 participants who were screened, 100 (45.0%) were randomly assigned to the diet or control groups, and 69 (69.0% of those assigned) completed the study (Figure 1). The dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), relative to the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). More participants in the alternate-day fasting group than in the daily calorie restriction group withdrew owing to difficulties adhering with the diet. All baseline characteristics had comparable distributions between the alternate-day fasting group, the daily calorie restriction group, and the control group (Table 1). The participants were primarily metabolically healthy obese women.

Prescribed vs Actual Energy Intake Determined via Food Records

On the fast day (Figure 2A), participants in the alternate-day fasting group exceeded their prescribed energy goal at months 3 and 6. On the feast day (Figure 2B), participants in the alternate-day fasting group ate less than their prescribed goal at months 3, 6, 9, and 12. Participants in the daily calorie restriction group (Figure 2C) met their prescribed energy goals at months 3, 6, and 12 but ate less than their prescribed goal at month 9. A higher proportion of participants in the daily calorie restriction group were adherent to their energy goals at months 3, 6, 9, and 12 relative to those in the alternate-day fasting group.

Percentage Energy Restriction Determined via Doubly Labeled Water

From baseline to month 6, the alternate-day fasting group achieved a mean (SD) percentage energy restriction of 21% (16%), and the daily calorie restriction group achieved a mean (SD) percentage energy restriction of 24% (16%), with no significant difference between the intervention groups or compared with the control group (eFigure 2 in Supplement 2).

Physical Activity and Dietary Intake

Data on dietary intake are displayed in eTable 1 in Supplement 2. Percentage of energy intake from fat, carbohydrates, and protein did not differ significantly over time in any of the groups. Physical activity, measured as steps per day, did not change during the course of the trial in any group (eTable 2 in Supplement 2). This level of activity is approximately 1000 to 2000 steps per day higher than that of the average overweight or obese adult.25

Weight Loss and Weight Maintenance

Changes in body weight are displayed in Figure 3 and Table 2. Weight loss was not significantly different between the alternate-day fasting group and the daily calorie restriction group at month 6. At the end of the study, total weight loss was –6.0% (95% CI, –8.5% to –3.6%) for the alternate-day fasting group and –5.3% (95% CI, –7.6% to –3.0%) for the daily calorie restriction group, relative to controls, with no significant difference between the intervention groups. Weight regain from months 6 to 12 (–0.8%; 95% CI, –3.2% to 1.7%) was not significantly different between the alternate-day fasting group and the daily calorie restriction group. Moreover, weight regain from months 6 to 12 was not significantly different between the alternate-day fasting group and controls (0.8%; 95% CI, –1.8% to 3.3%), or the daily calorie restriction group and controls (1.5%; 95% CI, –0.8% to 3.9%). Changes in body composition are reported in Table 2. There were no statistically significant differences between the alternate-day fasting group and the daily calorie restriction group for fat mass, lean mass, or visceral fat mass at month 6 or month 12.

Blood Pressure and Heart Rate

Blood pressure was not significantly different between the intervention groups, or relative to controls, at month 6 or month 12 (Table 2). There were also no statistically significant differences in heart rate between the alternate-day fasting group and the daily calorie restriction group at month 6 or month 12 (Table 2).

Plasma Lipids

Changes in plasma lipids during the course of the trial are shown in Table 2. Total cholesterol levels were not significantly different between the intervention groups, or relative to controls, at month 6 or month 12. At month 6, high-density lipoprotein cholesterol levels were significantly elevated in the alternate-day fasting group by 6.2 mg/dL (95% CI, 0.1-12.4 mg/dL) (to convert to millimoles per liter, multiply by 0.0259) vs the daily calorie restriction group, but this effect was no longer observed by month 12. Low-density lipoprotein cholesterol concentrations did not differ significantly between the intervention groups at month 6. At month 12, low-density lipoprotein cholesterol levels significantly increased in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) (to convert to millimoles per liter, multiply by 0.0259) relative to the daily calorie restriction group. Triglyceride levels did not differ significantly between the intervention groups at month 6 or month 12.


Glucoregulatory and Inflammatory Factors

Changes in glucoregulatory and inflammatory factors are displayed in Table 2. Fasting plasma glucose did not differ significantly between the intervention groups, or relative to controls, at month 6 or month 12. There were also no significant differences in fasting insulin or the homeostasis model assessment of insulin resistance between the intervention groups at month 6 or month 12. High-sensitivity C-reactive protein and homocysteine levels did not differ significantly between the intervention groups, or relative to controls, at month 6 or month 12. We also performed a sensitivity analysis, in which sex and race/ethnicity were included as adjustment covariates in the intention-to-treat mixed model. The inclusion of sex and race/ethnicity did not affect any of the estimated treatment effects reported in Table 2.

Discussion

The results of this randomized clinical trial demonstrated that alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or improvement in risk indicators for cardiovascular disease compared with daily calorie restriction.

Alternate-day fasting has been promoted as a potentially superior alternative to daily calorie restriction under the assumption that it is easier to restrict calories every other day. However, our data from food records, doubly labeled water, and regular weigh-ins indicate that this assumption is not the case. Rather, it appears as though many participants in the alternate-day fasting group converted their diet into de facto calorie restriction as the trial progressed. Moreover, the dropout rate in the alternate-day fasting group (38%) was higher than that in the daily calorie restriction group (29%) and the control group (26%). It was also shown that more participants in the alternate-day fasting group withdrew owing to dissatisfaction with diet compared with those in the daily calorie restriction group (Figure 1).

Taken together, these findings suggest that alternate-day fasting may be less sustainable in the long term, compared with daily calorie restriction, for most obese individuals. Nevertheless, it is still possible that a certain smaller segment of obese individuals may prefer this pattern of energy restriction instead of daily restriction. It will be of interest to examine what behavioral traits (eg, ability to go for long periods without eating) make alternate-day fasting more tolerable for some individuals than others.

To our knowledge, the present study is the longest and largest trial of alternate-day fasting to date. Previous trials of alternate-day fasting reported weight loss of 3% to 7% after 2 to 3 months of diet.7- 13 Adherence was measured in several previous trials and was shown to be high (eg, participants met their calorie goals on approximately 80%-90% of fast days).7,8,10,11 Most of these past studies provided food on the fast day,7,8,10,11 so the provision of food is not a confounder when comparing past findings with present findings. Food was provided to the intervention participants during the first 3 months of the weight-loss phase to promote adherence26 and show participants the types and quantities of foods that they should be eating. Data from the food records indicated that participants frequently ate extra “nonstudy” foods that were purchased from stores or restaurants.

This finding suggests that limiting caloric intake to approximately 500 kcal every other day may have been difficult for many participants early in the intervention. Future work in this area should examine whether this lack of adherence to alternate-day fasting is due to cognitive, environmental, and/or physiological factors. For instance, measuring changes in subjective appetite (hunger and fullness) in conjunction with modulations in appetite hormones (ghrelin, peptide YY, and glucagon-like peptide-1) could offer some insight into why daily calorie restriction may allow for easier adherence compared with alternate-day fasting.

Contrary to our original hypotheses, the participants in the alternate-day fasting group did not experience more pronounced improvements in risk indicators for cardiovascular disease compared with the participants in the daily calorie restriction group. However, the trial included primarily metabolically healthy obese adults. Since many of the participants had normal cholesterol levels and normal blood pressure at baseline, it is not surprising that most risk indicators for cardiovascular disease did not change in response to diet.

Limitations

Our study has several limitations. First, the duration of the maintenance phase was short (6 months). Second, the control group was imperfect, in that they received no food, no counseling, and less attention from study personnel, relative to the intervention groups, which may have confounded our findings. We also failed to include the control group in our initial power calculation. Third, since the dropout rate was higher than anticipated, our power to detect the hypothesized difference of 5% weight loss between the intervention groups at month 6 decreased from 80% to 60%. The higher dropout rate in the alternate-day fasting group may have also introduced a possible selection bias between groups.27 Finally, we enrolled predominantly metabolically healthy obese individuals, which may have hindered the abilities of the interventions to produce greater improvements in our measured cardiovascular disease risk indicators.28,29 The generalizability of our findings is also limited by the enrollment.

Conclusions

The alternate-day fasting diet was not superior to the daily calorie restriction diet with regard to adherence, weight loss, weight maintenance, or improvement in risk indicators for cardiovascular disease.



Article Information

Corresponding Author: Krista A. Varady, PhD, Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W Taylor St, Room 532, Chicago, IL 60612 (varady@uic.edu).

Accepted for Publication: February 26, 2017.

Published Online: May 1, 2017. doi:10.1001/jamainternmed.2017.0936

Author Contributions: Dr Varady had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Trepanowski and Kroeger contributed equally to this work and should be considered co–first authors.

Study concept and design: Kroeger, Varady.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Trepanowski, Kroeger, Varady.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Freels, Rigdon.

Obtained funding: Varady.

Administrative, technical, or material support: Kroeger, Barnosky, Bhutani, Hoddy, Gabel, Rood, Varady.

Study supervision: Varady.

Conflict of Interest Disclosures: Dr Varady reported receiving an advance for the book The Every-Other-Day Diet: The Diet That Lets You Eat All You Want (Half the Time) and Keep the Weight Off, published by Hachette Book Group. No other disclosures were reported.

Funding/Support: This study was supported by grant R01HL106228 from the National Institutes of Health/National Heart, Lung, and Blood Institute and grants P30DK072476 and F32DK107157 from the National Institute of Diabetes and Digestive and Kidney Diseases.

Role of Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication

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8.Hoddy  KK, Kroeger  CM, Trepanowski  JF, Barnosky  A, Bhutani  S, Varady  KA.  Meal timing during alternate day fasting: impact on body weight and cardiovascular disease risk in obese adults.  Obesity (Silver Spring). 2014;22(12):2524-2531.PubMed

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10.  Klempel  MC, Kroeger  CM, Varady  KA.  Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet.  Metabolism. 2013;62(1):137-143.PubMedArticle

11.  Varady  KA, Bhutani  S, Church  EC, Klempel  MC.  Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults.  Am J Clin Nutr. 2009;90(5):1138-1143.PubMedArticle

12.  Catenacci  VA, Pan  Z, Ostendorf  D,  et al.  A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity.  Obesity (Silver Spring). 2016;24(9):1874-1883.PubMedArticle
 

13.  Alhamdan  BA, Garcia-Alvarez  A, Alzahrnai  AH,  et al.  Alternate-day versus daily energy restriction diets: which is more effective for weight loss? a systematic review and meta-analysis.  Obes Sci Pract. 2016;2(3):293-302.PubMedArticle

14.  Mosley  M, Spencer  M.  The Fast Diet. New York, NY: Atria Books; 2012.

15.  The 5:2 Fast Diet For Beginners. Berkeley, CA: Rockridge Press; 2013.

16.  Gardner  CD, Kiazand  A, Alhassan  S,  et al.  Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.  JAMA. 2007;297(9):969-977.PubMedArticle

17. Ravussin  E, Redman  LM, Rochon  J,  et al; CALERIE Study Group.  A 2-year randomized controlled trial of human caloric restriction: feasibility and effects on predictors of health span and longevity.  J Gerontol A Biol Sci Med Sci. 2015;70(9):1097-1104.PubMedArticle

18.  Eckel  RH, Jakicic  JM, Ard  JD,  et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  Circulation. 2014;129(25)(suppl 2):S76-S99.PubMedArticle

19.  Laliberte  M, McCabe  RE, Taylor  V.  The Cognitive Behavioral Workbook for Weight Management: A Step-by-Step Program. Oakland, CA: New Harbinger Publications; 2009.

20. Demerath  EW, Ritter  KJ, Couch  WA,  et al.  Validity of a new automated software program for visceral adipose tissue estimation.  Int J Obes (Lond). 2007;31(2):285-291.PubMedArticle

21. de Jonge  L, DeLany  JP, Nguyen  T,  et al.  Validation study of energy expenditure and intake during calorie restriction using doubly labeled water and changes in body composition.  Am J Clin Nutr. 2007;85(1):73-79.PubMed

22. Johannsen  DL, Calabro  MA, Stewart  J, Franke  W, Rood  JC, Welk  GJ.  Accuracy of armband monitors for measuring daily energy expenditure in healthy adults.  Med Sci Sports Exerc. 2010;42(11):2134-2140.PubMedArticle

23. Matthews  DR, Hosker  JP, Rudenski  AS, Naylor  BA, Treacher  DF, Turner  RC.  Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;28(7):412-419.PubMedArticle

24. Redman  LM, Rood  J, Anton  SD, Champagne  C, Smith  SR, Ravussin  E; Pennington Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE) Research Team.  Calorie restriction and bone health in young, overweight individuals.  Arch Intern Med. 2008;168(17):1859-1866.PubMedArticle

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Binge = Response to Starvation
- POSTED ON: Feb 23, 2017


No one in life gets away
with avoiding all problems.

Some problems are physical. 
Some problems are mental.
Some problems are the two combined.
If it’s my problem,
I’m the one who has to deal with it.

Defining a problem helps me understand it,
which helps give me
wisdom to know the difference
between what I can change,
and what cannot be changed.




What is a Binge?

The dictionary definition of bingeing is:

  • to be immoderately self-indulgent and unrestrained;

    to engage in excessive or uncontrolled indulgence in food or drink.

Bingeing isn’t usually because of lack of self control and weakness.  We binge because of a complex interaction of habit, brain chemistry, and external cues that signal us to eat. This interaction can be overcome, but it's harder to do and takes longer to change than most of us realize.

Current scientific research indicates that bingeing has a physical (PHYSIOLOGICAL) cause, and that mental & emotional (PSYCHOLOGICAL) problems are a RESULT of the condition, not the CAUSE of the condition.

Neuroscientists say that Bingeing is a normal response to Dieting because:  

Metabolic suppression is one of several powerful tools that the brain uses to keep the body within a certain weight range, called the set point. The range, which varies from person to person, is determined by genes and life experience. When dieters’ weight drops below it, they not only burn fewer calories but also produce more hunger-inducing hormones and find eating more rewarding.



The brain’s weight-regulation system considers your set point to be the correct weight for you, whether or not your doctor agrees. If someone starts at 120 pounds and drops to 80, her brain rightfully declares a starvation state of emergency, using every method available to get that weight back up to normal. The same thing happens to someone who starts at 300 pounds and diets down to 200.

Our brains send signals to the rest of our body that it is starving when our weight is below its Set Point range.  A person’s Set Point is determined by a person’s genes and life experience. 

Life experience involves a person’s weight history, because when a person gains and holds “excess” weight, their Set Point can rachet up, and up and up.  (A rachet is a mechanical device consisting of a toothed wheel or rack engaged with a pawl that permits it to move in only one direction.)  

However,  thus far all of the evidence shows that this is a one-way-street survival issue. While Set Points can go up with weight-gain,  they don’t go back down with weight-loss. 

Lots of body functions are naturally one-way as we grow, age, and experience life.  When our life experience changes our Set Point, it’s like our scars, stretch marks, wrinkles, grey hair etc. in that there is no “natural” way our bodies will revert back to the way they once were.

Weight-loss and maintenance have less to do with motivation and will-power than most people think. In fact it has far more to do with how the individual body adjusts to, and is capable of, resisting a calorie deficit. Putting less fuel in the tank of one's car will always cause the car to drive a shorter distance.  However, the human body adapts to less fuel .... meaning eating fewer calories .... by becoming more ‘efficient’ and running the same distance on less fuel than before. That is the big difference between simple physics and biology.


Is Dieting a form of STARVATION?


The dictionary definition of STARVATION is defined as “to suffer or die from lack of food”. 

To “SUFFER” is defined as “to experience something unpleasant”.  Although we might not be in any danger of dying from lack of food, most Dieting does involve “suffering… from lack of food”.  Therefore, the term “starvation” isn’t completely inaccurate, but, of course, there are a great many different degrees of suffering.

However, most Diet Guru’s, including medical doctors, say that a Dieter is not experiencing “starvation” as long as there is any excess fat left on that person’s body. Excess fat defined as: there is “less than an inch of fat to pinch”, and the body weight is near the bottom border of its 18 BMI “underweight” category. 

This is true for some people, but not ALL people.  Although all human bodies operate in a similar fashion,  there are differences in the ways that they function. The regulatory mechanisms which allow our cells to deal effectively with fluctuations in nutrient supply can vary from person to person, and there is a still a great deal that science has not yet discovered about the body’s inner workings.

Research studies involving lab rodents have demonstrated genetic differences. Certain genetically obese mice will fatten excessively regardless of how little or how much they eat. Some of them, … while dieting, … will consumed their own muscles and organs and die before all of their “excess” fat is gone.

Researcher Jean Mayer reported: “These mice will make fat out of their food under the most unlikely circumstances, even when half starved”.  If starved sufficiently, these animals can be reduced to the same weight as lean mice, but they’ll still be fatter.  They will consume the protein in their muscles and organs rather than surrender the fat in their fat cells. 

When these fat mice are starved, they do not become lean mice…, they become emaciated versions of fat mice.


In 1936 Francis Benedict reported this after fasting a strain of obese mice.  They lost 60 percent of their body fat before they died of starvation, but when they died, they still had five times as much body fat as lean mice that were allowed to eat as much as they desired.

In 1981, M.R.C. Greenwood reported that restricting the diet of an obese strain of rats known as Zucker rats from birth onward, caused those rats to grow fatter by adulthood than their littermates who were allowed to eat to their heart’s content.  These semi-starved Zucker rats had 50% less muscle mass than genetically lean rats, and 30% less muscle mass than the Zucker rats that ate as much as they wanted.  The calorie restricted rats were sacrificing their muscles and organs to make fat.

DietHobby’s BOLG CATEGORIES Research - Science contains additional articles relevant to Set Point and its relationship to weight-gain and maintenance.


If Bingeing is a natural response to Starvation,
why is it considered to be an Eating Disorder?


In the 1960s the medical profession began attributing psychological reasons, rather than physiological reasons to people who overeat to the point of obesity. 

Since that time, there has been a tendency on the part of health professionals to classify every kind of eating outside “moderate eating” as an “eating disorder”.

Eating Disorder Not Otherwise Specified (EDNOS) includes a wide variety of disordered eating patterns. It's often used for people who meet many of the symptoms of anorexia or bulimia but not all. For example, a woman who meets all of the symptoms for anorexia, but still menstruates regularly -- a criteria for an anorexia diagnosis -- would be diagnosed with an “eating disorder not otherwise specified”.

Binge eating disorder (B.E.D.) first appeared in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1994. Until recent times, “Binge Eating Disorder” was categorized under the umbrella term 'eating disorders not otherwise specified”, or EDNOS for short.  However, in 2013 it was added to the DSM-V as B.E.D., a specified eating disorder.

There are many reasons for this…and one of them is Financial Motivation. Unless a behavior is labeled a “disorder” or an illness, health insurance won’t pay for treatment.

You may call me cynical, but since “Binge Eating Disorder” is far more common than anorexia and bulimia, it has a much larger population base. This means MORE PATIENTS to treat with Therapy, and/or Eating Disorder programs;  MORE MONEY and more profit for that specific health industry field.

Health professionals admit that a Binge Eating Disorder is more than simply eating too much food, and that many obese patients don't have it.  However these medical “experts” still they claim that up to 5 percent of obese patients and 30 percent of patients participating in weight loss programs meet the criteria for binge eating disorder.

In May 2013 the DSM-V, added Binge Eating Disorder to its list of specified eating disorders.  All of the following must be met to meet the diagnostic criteria of B.E.D.
 

1.  Recurrent and persistent episodes of binge eating
2.  Binge eating episodes are associated with three (or more) of the following:

  •     Eating much more rapidly than normal
  •     Eating until feeling uncomfortably full
  •     Eating large amounts of food when not feeling physically hungry
  •     Eating alone because of being embarrassed by how much one is eating
  •     Feeling disgusted with oneself, depressed, or very guilty after overeating

3.   Marked distress regarding binge eating
4.    Absence of regular compensatory behaviors (such as purging).



Think about it.

Such a diagnosis would fit almost every fat person that I’ve even known.  I’ve been super fat myself, and I’ve known many, many others.  Almost every fat person … and some of those who are not fat … experiences eating occasions where they sense that they have lost control of their eating behavior, AND have strong feelings of embarrassment and guilt after eating an unusually large amount of food when they aren’t physically hungry.

Weekends come every week, vacations and holidays come frequently, other celebrations and special events happen frequently as well.  Plus, most of us experience times of sadness, anxiety, or crisis more frequently than we like.

It is common for almost any person, whether fat or thin,  to engage in excess overeating on these occasions. It is also a very common occurrence for a fat person to “binge out” at least one time a week for months at a time.

The disgust and aversion that modern Society has for fat people pretty much guarantees that fat people will feel embarrassment and guilt because they’ve “failed” to keep from engaging in behavior that contributes to their fat condition.

It is my opinion that, despite the “conditions” that psychologists attach to the “Binge Eating Disorder”, by their proposed definition, almost everyone who engages in excessive or uncontrolled indulgence in food, which is the dictionary definition of Bingeing, could easily fall into the current medical classification of having an “eating disorder”.

I find something really wrong with this reasoning.

For those who are obese, (and normal-weight-dieting-people) bingeing is normal, and not abnormal, eating behavior.

My own experience together with my observation of the dismal long-term success rate 
of “eating disorder” treatments, … especially those that include the use of “Intuitive Eating” as a tool of recovery …  supports my belief that while Therapy is helpful to gain self-understanding of one’s behaviors, and can help one learn alternative behaviors, the underlying conditions causing obesity are not cured through that process.

I see Society’s current label of “Eating Disorder”, and suggested “Treatment”, as simply another attempt to shame fat people into believing that they should eat “normally” and that their body should be a “normal” weight.  It’s one more indoctrination to misinform fat people. It's another way to reinforce the Cultural Lie that only those who are greedy, lazy, or mentally ill are fat, and that if anyone would just “eat healthy” instead of "overeating" or "dieting", they would meet our Culture’s standards of what is a “healthy”, or a  “normal”, or even a “thin” weight.

This is a misplaced effort, because an obese body wants to maintain itself.  It doesn’t want to maintain itself as a Thin body.  It wants to stay Obese.  Bingeing is a natural physiological response to our Culture’s demand that fat people become thin. It is based upon a survival instinct that will never disappear, no matter how thin one becomes, or how much therapy one has.


Happily Ever After & Neuroscience
- POSTED ON: Feb 20, 2017


Once upon a time, there was a fat woman who wanted to become thin.  She began eating less food than her body used day after day, and eventually her body became a size “normal”. 

After she crossed the “finish line” to her weight goal, she slightly relaxed her rigid eating behaviors, but in order to maintain her weight-loss, she paid close attention to the hunger signals from her body, working to eat only when she felt hungry, and to stop as soon as she stopped feeling hungry.

And she lived happily ever after…..
…........... NOT exactly .......….

I advise anyone struggling with - or interested in - maintenance issues to go to DietHobby’s
BLOG CATEGORIES, Research - Science and read the articles that have been scrapbooked there.

The following article was written by Sandra Aamodt, a neuroscientist, author of  “Why Diets Make Us Fat: The Unintended Consequences of Our Obsession With Weight Loss” (2016). It was posted in the New York Times in May 2016. 

Dr. Aamodt makes the point that the problem with Dieting is not Willpower. It’s neuroscience.  I found her book to be well researched, and I believe she accurately states the basic problem.  Dr. Aamodt’s information is extremely valuable, and I recommend her book for people working to maintain weight-loss.  However, although the “solution” to the dieting and maintenance struggle that she proposes could be effective for some people, it is not one …. for various reasons … that I find personally acceptable or one that I’m willing to adopt. 


Why You Can’t Lose Weight on a Diet
                  by Sandra Aamodt

SIX years after dropping an average of 129 pounds on the TV program “The Biggest Loser,” a new study reports, the participants were burning about 500 fewer calories a day than other people their age and size. This helps explain why they had regained 70 percent of their lost weight since the show’s finale. The diet industry reacted defensively, arguing that the participants had lost weight too fast or ate the wrong kinds of food — that diets do work, if you pick the right one.

But this study is just the latest example of research showing that in the long run dieting is rarely effective, doesn’t reliably improve health and does more harm than good. There is a better way to eat.

The root of the problem is not willpower but neuroscience. Metabolic suppression is one of several powerful tools that the brain uses to keep the body within a certain weight range, called the set point. The range, which varies from person to person, is determined by genes and life experience. When dieters’ weight drops below it, they not only burn fewer calories but also produce more hunger-inducing hormones and find eating more rewarding.

The brain’s weight-regulation system considers your set point to be the correct weight for you, whether or not your doctor agrees. If someone starts at 120 pounds and drops to 80, her brain rightfully declares a starvation state of emergency, using every method available to get that weight back up to normal. The same thing happens to someone who starts at 300 pounds and diets down to 200, as the “Biggest Loser” participants discovered.

This coordinated brain response is a major reason that dieters find weight loss so hard to achieve and maintain. For example, men with severe obesity have only one chance in 1,290 of reaching the normal weight range within a year; severely obese women have one chance in 677. A vast majority of those who beat the odds are likely to end up gaining the weight back over the next five years. In private, even the diet industry agrees that weight loss is rarely sustained. A report for members of the industry stated: “In 2002, 231 million Europeans attempted some form of diet. Of these only 1 percent will achieve permanent weight loss.”

The specific “Biggest Loser” diet plan is probably not to blame. A previous study found similar metabolic suppression in people who had lost weight and kept it off for up to six years. Whether weight is lost slowly or quickly has no effect on later regain. Likewise — despite endless debate about the relative value of different approaches — in head-to-head comparisons, diet plans that provide the same calories through different types of food lead to similar weight loss and regain.

As a neuroscientist, I’ve read hundreds of studies on the brain’s ability to fight weight loss. I also know about it from experience. For three decades, starting at age 13, I lost and regained the same 10 or 15 pounds almost every year. On my most serious diet, in my late 20s, I got down to 125 pounds, 30 pounds below my normal weight. I wanted (unwisely) to lose more, but I got stuck. After several months of eating fewer than 800 calories a day and spending an hour at the gym every morning, I hadn’t lost another ounce. When I gave up on losing and switched my goal to maintaining that weight, I started gaining instead.

I was lucky to end up back at my starting weight instead of above it. After about five years, 41 percent of dieters gain back more weight than they lost. Long-term studies show dieters are more likely than non-dieters to become obese over the next one to 15 years.

That’s true in men and women, across ethnic groups, from childhood through middle age. The effect is strongest in those who started in the normal weight range, a group that includes almost half of the female dieters in the United States.

Some experts argue that instead of dieting leading to long-term weight gain, the relationship goes in the other direction: People who are genetically prone to gain weight are more likely to diet.

To test this idea, in a 2012 study, researchers followed over 4,000 twins aged 16 to 25. Dieters were more likely to gain weight than their non-dieting identical twins, suggesting that dieting does indeed increase weight gain even after accounting for genetic background. The difference in weight gain was even larger between fraternal twins, so dieters may also have a higher genetic tendency to gain. The study found that a single diet increased the odds of becoming overweight by a factor of two in men and three in women. Women who had gone on two or more diets during the study were five times as likely to become overweight.

The causal relationship between diets and weight gain can also be tested by studying people with an external motivation to lose weight. Boxers and wrestlers who diet to qualify for their weight classes presumably have no particular genetic predisposition toward obesity. Yet a 2006 study found that elite athletes who competed for Finland in such weight-conscious sports were three times more likely to be obese by age 60 than their peers who competed in other sports.

To test this idea rigorously, researchers could randomly assign people to worry about their weight, but that is hard to do. One program took the opposite approach, though, helping teenage girls who were unhappy with their bodies to become less concerned about their weight. In a randomized trial, the eBody Project, an online program to fight eating disorders by reducing girls’ desire to be thin, led to less dieting and also prevented future weight gain. Girls who participated in the program saw their weight remain stable over the next two years, while their peers without the intervention gained a few pounds.



WHY would dieting lead to weight gain? First, dieting is stressful. Calorie restriction produces stress hormones, which act on fat cells to increase the amount of abdominal fat. Such fat is associated with medical problems like diabetes and heart disease, regardless of overall weight.

Second, weight anxiety and dieting predict later binge eating, as well as weight gain. Girls who labeled themselves as dieters in early adolescence were three times more likely to become overweight over the next four years. Another study found that adolescent girls who dieted frequently were 12 times more likely than non-dieters to binge two years later.

My repeated dieting eventually caught up with me, as this research would predict. When I was in graduate school and under a lot of stress, I started binge eating. I would finish a carton of ice cream or a box of saltines with butter, usually at 3 a.m. The urge to keep eating was intense, even after I had made myself sick. Fortunately, when the stress eased, I was able to stop. At the time, I felt terrible about being out of control, but now I know that binge eating is a common mammalian response to starvation.

Much of what we understand about weight regulation comes from studies of rodents, whose eating habits resemble ours. Mice and rats enjoy the same wide range of foods that we do. When tasty food is plentiful, individual rodents gain different amounts of weight, and the genes that influence weight in people have similar effects in mice. Under stress, rodents eat more sweet and fatty foods. Like us, both laboratory and wild rodents have become fatter over the past few decades.

In the laboratory, rodents learn to binge when deprivation alternates with tasty food — a situation familiar to many dieters. Rats develop binge eating after several weeks consisting of five days of food restriction followed by two days of free access to Oreos. Four days later, a brief stressor leads them to eat almost twice as many Oreos as animals that received the stressor but did not have their diets restricted. A small taste of Oreos can induce deprived animals to binge on regular chow, if nothing else is available. Repeated food deprivation changes dopamine and other neurotransmitters in the brain that govern how animals respond to rewards, which increases their motivation to seek out and eat food. This may explain why the animals binge, especially as these brain changes can last long after the diet is over.

In people, dieting also reduces the influence of the brain’s weight-regulation system by teaching us to rely on rules rather than hunger to control eating. People who eat this way become more vulnerable to external cues telling them what to eat. In the modern environment, many of those cues were invented by marketers to make us eat more, like advertising, supersizing and the all-you-can-eat buffet. Studies show that long-term dieters are more likely to eat for emotional reasons or simply because food is available. When dieters who have long ignored their hunger finally exhaust their willpower, they tend to overeat for all these reasons, leading to weight gain.


Even people who understand the difficulty of long-term weight loss often turn to dieting because they are worried about health problems associated with obesity like heart disease and diabetes. But our culture’s view of obesity as uniquely deadly is mistaken. Low fitness, smoking, high blood pressure, low income and loneliness are all better predictors of early death than obesity. Exercise is especially important: Data from a 2009 study showed that low fitness is responsible for 16 percent to 17 percent of deaths in the United States, while obesity accounts for only 2 percent to 3 percent, once fitness is factored out. Exercise reduces abdominal fat and improves health, even without weight loss. This suggests that overweight people should focus more on exercising than on calorie restriction.

In addition, the evidence that dieting improves people’s health is surprisingly poor. Part of the problem is that no one knows how to get more than a small fraction of people to sustain weight loss for years. The few studies that overcame that hurdle are not encouraging. In a 2013 study of obese and overweight people with diabetes, on average the dieters maintained a 6 percent weight loss for over nine years, but the dieters had a similar number of heart attacks, strokes and deaths from heart disease during that time as the control group. Earlier this year, researchers found that intentional weight loss had no effect on mortality in overweight diabetics followed for 19 years.

Diets often do improve cholesterol, blood sugar and other health markers in the short term, but these gains may result from changes in behavior like exercising and eating more vegetables. Obese people who exercise, eat enough vegetables and don’t smoke are no more likely to die young than normal-weight people with the same habits. A 2013 meta-analysis (which combines the results of multiple studies) found that health improvements in dieters have no relationship to the amount of weight they lose.

If dieting doesn’t work, what should we do instead? I recommend mindful eating — paying attention to signals of hunger and fullness, without judgment, to relearn how to eat only as much as the brain’s weight-regulation system commands.

Relative to chronic dieters, people who eat when they’re hungry and stop when they’re full are less likely to become overweight, maintain more stable weights over time and spend less time thinking about food. Mindful eating also helps people with eating disorders like binge eating learn to eat normally. Depending on the individual’s set point, mindful eating may reduce weight or it may not. Either way, it’s a powerful tool to maintain weight stability, without deprivation.

I finally gave up dieting six years ago, and I’m much happier. I redirected the energy I used to spend on dieting to establishing daily habits of exercise and meditation. I also enjoy food more while worrying about it less, now that it no longer comes with a side order of shame.

I listed Dr. Aamodt’s book in DietHobby’s RESOURCES Books & Tools section with the following comment:


"Why Diets Make Us Fat: The Unintended Consequences of Our Obsession With Weight Loss by Sandra Aamodt PhD (2016).

The author, a neuroscientist and proponent of mindful eating, discusses scientific research on weight and health.  Her central argument is that our body weight tends to settle at "set points" — that 10- to 15-pound range the brain maintains despite repeated efforts to lower it.

Once people see how the set-point theory reflects their dieting experience, they realize that although they don't have the final say on their weight (their brain does), they do have real influence — through exercise and other health-affirming activities — over their health and well-being."


Dr. Aamodt’s information is extremely valuable, and I recommend her book for people working to maintain weight-loss. 

Dr.Sandra Aamodt thinks that you can’t - and shouldn’t - fight back against your Set Point. Her solution is the Behavior of eating mindfully, while following the body’s hunger signals, and to accept whatever weight the body chooses to give you as a Result of that Behavior.

I agree with her opinion that we are stuck with our biological and historical Set Point. However, although the “solution” to the dieting and maintenance struggle that she proposes could be effective for some people, it is not one …. for various reasons … that I find personally acceptable or one that I’m willing to adopt. 

Sandra Aamodt’s personal experience is that of a person who has struggled with being overweight or slightly obese, and not of a person who deals with the struggles caused by a history of extreme, morbid, or severe obesity.  Dr. Aamodt’s personal Set Point might keep her from meeting our culture’s high standards for “thinness”, but her choice not to struggle against it won’t cause her body to become Fat Enough enough to make her a TRUE VICTIM of our fat biased culture. The majority of offensive comments and other behaviors showing open disgust, ridicule, and abuse are primarily reserved for those who are extremely fat. 

The Set Point of someone who has struggled with 10 to 50 excess pounds is very different from the Set Point of someone who has struggled with 100+ excess pounds. Also, someone who has carried 50+ excess pounds for only a year or so is going to have a lower Set Point than someone who has carried that same weight for several years and longer. 

This is the ongoing dilemma for those who are Fat.  It is a situation in which day-after-day, year-after-year, a difficult choice has to be made between two or more alternatives, all of them equally undesirable. 

Each of us must make the eating and behavior choices that will work for us personally in our own individual lives.  Everyone doesn’t value the same things the same way. Food vs. Body Size vs. Desire and everything else that is involved in those categories.  Everyone’s choice is equally valid, despite the fact that those - often difficult - choices can result in making us Thin, Overweight, or Extremely Fat.

My own personal choice is to treat Dieting as a Hobby.  For many, many years I have continually dieted; have been vigilant about what I eat; and have diligently worked against my own body’s Set Point in order to maintain my “reduced fat” body inside the BMI weight range that is labeled “normal”. 


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