Sunday, February 10, 2013

The FAT In Me

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I’m fat.  F A T.  It’s sad really.  I give advice to people every day about weight loss, exercise, and diet.  Yet I’m fat.  I am not always a follower of my own advice.  This is also not a new development.  I weigh 203 pounds.  I am 70” tall.  That works out to a BMI of 29.1.  As a physician, I know that means I am overweight (BMI of 25-30).  Just for reference, the ideal weight of a 5’10” average framed male is 165lbs or so.   I have struggled most of my adult life with weight control.  I like to cook, like to eat, and definitely like to enjoy my wine.   I have always felt my problem is that I “like” too much.  I overeat.  In fact I have always looked at weight gain as being either an issue of overeating or lack of activity.  Overeater's generally come in two varieties:  1) people with relatively healthy diets but who consume to much of it (too much of anything is bad);  2) people who only eat 2-3 times per day but choose to eat fast foods, fried foods, and packaged meals (garbage in = garbage out).
My Data:


That is my actual life data.  Since finishing puberty (I was a late bloomer) I have had but one very short period of my life when I would not have been considered by medicine to be overweight.  A visual inspection however would likely have not agreed.

Sadly, most of patients wouldn't say that I am fat.  Some may say I am “little” overweight.  In actuality though, most of us are fat.   In fact the average American is 25lbs heavier today than they were 30 years ago.   And it’s not just the very obese that are skewing the data.  Even thin Americans are fatter than they use to be.  A Gallup poll done over the last 20 years shows that our weight has gone up by roughly 20lbs during that period but more alarming is that our perception of whom is fat (or rather what we think is ideal) has also gone up by over 10!  It appears that much like beauty, FAT may be in the eye of the beholder.

Obesity has been present throughout history but on a whole the average weight of Americans has been going up since the 1940’s but the rate at which we are getting fat has rapidly increased since 1980.  Most medical literature, including the conclusions of this study, noted this to likely be due to a general shift to a more sedentary lifestyle (a shift away from the farm and to the city).   However that doesn't quite make sense does it?  Suburbs have existed as far back as the 30’s and 40’s.  America did not see a massive decline in the farming population in the 70’s.   In fact that move occurred much earlier (30’s).  USDA states on their site that Urban Americans have outnumbered rural Americans since the 1920s!  Also, it is important to point out that not all farmers are heavy workers.  It doesn't take a great deal of physical effort to grow crops since the advent of the tractor and harvesters. 

Energy use by people has declined and that most likely has been part of the problem but is it all?  Ask yourself this question:  Did my grandparents ever go to the gym or for a run?  Fast food has also been listed as a cause and no doubt contributes as well but remember than most fast food chains have been around since the 1960’s and there are plenty of fat Americans that almost never eat fast food.

The weight gain mantra is that increased weight is due to either a lack of exercise or an overabundance of intake.  In fact that is what I and most doctors are taught in school.  For years we have thought of weight gain by this equation:

Change in weight = Calories In – Calories Out

The national institute on health even preaches this mantra on their webpage here.  This is so ingrained in medical teaching that until very recently one would be laughed out of the building to suggest otherwise.  But what if that isn't true? 

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What if how much you eat and how much you exercise is much less important than WHAT you eat?  What if what nutritionist and dietitians (and thus the doctors they teach) have been wrong for the last 25 years is wrong?   Everything they have taught you would also be wrong!

Over the last few weeks I have spent an incredible amount of my free time reading about that very question.  I learned that the Paleo diet may just be better than I thought.  I learned that not all calories are created equal.  And I learned that obesity is much more than a problem of abundance.  Later this week I will share my findings and hopefully be able to offer up some decent medical advice as well.  
The research seems to say that weight isn't a simple mathematical equation.  What type of calories you consume may be more important long term than how much your consume or how much you burn off.

For the scholars among my readers I highly recommend you check out the following which will be the basis of my next post:

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On to Part 2:  The FAT In Sugar

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