DebraSY

An Open Letter to Weight-Management Scientists

In Weight-Loss Maintenance on June 15, 2011 at 1:22 pm

Dear Scientist Friends:

Consider this a personal invitation to test a theory, especially if your area of expertise is endocrine and/or you have a personal interest in exercise physiology and weight management.  (Er, and if you’re just one of my regular blog readers, please eaves drop on this letter.)

For several years, I have been synthesizing scientific information and personal experience as a radical weight-loss maintainer, and I would appreciate an experiment designed to better test the relationship between exercise and endocrine, especially those dicey signals that I believe cause most people to regain lost weight – the imbalance of leptin and ghrelin, PYY3-36 and aghouti related protein.  If you know of an experiment that has already explored this relationship, then please provide me a link.  (Disclaimer, as a lay person, my knowledge is embarrassingly limited.  I have not yet read Katarina Borer’s book on Exercise Endocrinology, or any other scholarly text, so maybe I’m naive, but if we do know all that we could know on this topic, it sure hasn’t made it into the mainstream marketplace of ideas.) 

It has occurred to me that there are different kinds of “hunger.”  Those of us who maintain radical weight losses have pretty much mastered how to quell insulin-triggered hunger and vacuous (empty stomach) hunger using macronutrient management.  In short, we use carbs (such as bananas or dark chocolate) to quell immediate, sharp (vacuous) hunger, and we use proteins and fats to keep sneaky insulin-triggered hunger at bay.  But this is not the full story.  If it were, more than 3% of people would be successful at maintaining radical weight loss for five years, the depressing figure that empirical research suggests.

According to the National Weight Control Registry (which could also be called the 3% Club), where I am listed as a participant, 90% of us exercise on average one hour per day.  This finding is one of the most dramatic commonalities among us, more so than eating breakfast (78%), regular weighing (75%) or limiting our TV viewing (62%).  In fact, the only two characteristics that are more common than the hour of exercise are that we have restricted our food (98%) and increased our exercise from our fat days (94%).  (It should hardly come as a surprise that one hour daily represents an increase for most people!) 

Learned people debate the value of exercise compared to food restriction in losing or maintaining weight, assuming that  exercise is a function of energy balance – calories expended v. calories consumed.  Energy balance, however, is not a simple equation, and I think exercise serves an additional, more important, function beyond expending energy.  I think we need to know more about its effect on endocrine. 

I have tried to wrap words around internal experiences that I call “eat impulses.”  Examples of this wordplay may be found here, here and here, among other places on this blog.  Perhaps I am disordered, but, clearly, my brain functions differently now, as a weight-reduced person.  I am sensitive to these “eat impulses,” which are real and compelling but don’t feel like vacuous hunger or insulin-triggered hunger. 

Culturally, this discrepancy between recognized hunger and endocrine impulses has created a significant problem.  I believe that because “eat impulses” do not qualify as “hunger,” people feel guilty when they respond to them, and they feel enormously defeated when they regain weight as a result of responding to them.  They don’t know why they can’t control their eating, so they blame themselves.  They are unconsoled by the fact that 97% of people who lose weight will regain, just as they have.  In fact, when they see others regain weight, they jump on the blame bandwagon because they know the dirty little secret:  that people who regain weight eat when they aren’t “hungry.”   A sad culture of fat humiliation has emerged in the developed world based on this misunderstanding.  Regainers may NOT be “hungry,” technically, but they are impelled, powerfully, by endocrine.

People who maintain radical weight loss have quite a burden.  They must defy a cultural mythology that suggests that “maintenance” after weight loss is more relaxed than loss itself and equivalent to what other people do who have never been fat.  In fact, weight-reduced people must practice a much more challenging and restrictive regimen than people who have never been fat because they are metabolically compromised.  Moreover, they must somehow quell the effects of elevated ghrelin, suppressed leptin and peptide YY3-36.  Since no one has ever told them that taming endocrine is a requirement for weight-loss management, then whatever they are doing is something that they commonly do for other reasons.  I put my money on that hour of exercise.  

Before I close this letter, I would like to share what may be my only “inspirational” discovery during my weight-management saga.  Prior to 2002, the year I began losing weight, I suffered frequent insomnia, probably 150 to 200 nights per year.  My weight loss began when I added brisk walking (45 minutes) to my day and regular weight-lifting to my week.   With that exercise, my insomnia also retreated.  Walking was to become jogging and other intense aerobic exercise.   I came to recognize that exercise was a gift I gave to my body.

One night my insomnia returned with a vengeance.  I spent the whole night tossing, turning, sweating and tip-toeing at the edge of sleep.  When the alarm went off, rather than remaing in bed, “Gawd, I need to rest,” I spoke a different script to myself.  “Okay, body, just because I’ve deprived you a good night’s rest, I will not further punish you by denying you your exercise.” I dragged my weary carcass to the YMCA, punched my program into the treadmill and started to go. Within ten minutes, the woozy fog that engulfs sleep-deprived people had lifted. I felt normal. I completed my regular (vigorous) exercise. That day at work, I felt normal and I accomplished as much as I would on any other well-slept day. I also didn’t eat any more than I normally would. That night, I slept like a brick.  It was glorious.

The relationship between sleep deprivation (A), ghrelin (B) and overeating (C) has been well documented.   A + B leads to C.  I would ask whether exercise deprivation (D) isn’t also a part of that equation and more important than A.  Many people when they are sleep deprived may also be voluntarily exercise deprived.

I missed my calling to become a scientist, but I would cheerfully help in fundraising for a credentialed scientist who would set up and execute a study.  Sadly, I’m not a millionaire myself and cannot fund this project, but I worked in nonprofit development for 15 years, and I can write grants.  This would be one that would motivate me.  Send inquiries to sappyarwood (at) att (dot) net.   

Now, as for my regular blog readers, what’s your take on the relationship between exercise and weight management?  Am I off base?  Is it only a function of energy balance or is there something more?  Do you have anecdotes?

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  1. Here’s my sense of it.

    In 1999, I weighed 227. In summer 2001, I had lost some weight just by change of habits, but I started working consciously to lose a lot. What I did: added about an hour of brisk walking in the morning before breakfast every single day, to the other exercise I was regularly doing (dance classes or a weight workout at night).

    I eventually got down to 167 (2003) and relaxed, and gained some weight back. At the time I decided to “do something about it” I’d gotten back up to about 180. Added the walking back in, lost a few pounds, but lost my job, got a new job…got stressed and distracted, and in 2006 or so was back up to 186. Added the walking back in. Dropped to 171 by winter 2007.

    Started dating a guy who basically ate all meals out on expense account. Got back up to 181 in fall ’08. We broke up, I added the morning walks back in, and by summer 2009 I was down to 160.

    Relaxed, got out of the morning walk habit, and am back up to 171 now. Added the walking back in, and have started losing weight.

    One thing we notice about me is that I cycle, but each peak is lower than the last, and my “bottom” has gradually gotten lower.

    What’s the common factor in all those weight loss success phases? A.M. walking and keeping a light rein on food intake. If I exercise twice daily for close to an hour, I can eat my RDA of calories and not feel restricted and still lose weight. In BodyBugg calorie balance terms, if I walk in the morning, I start the day off (after a breakfast that is satisfying) with a net deficit of about -500 calories. If I don’t walk in the morning, after breakfast I’m “calorie neutral” — I’ve eaten as much as I’ve burned since midnight. It is much easier for me to start the day with the deficit and stay sort of net negative all day, without getting hungry, than to start the day with no deficit and try to make it up later. If I do that I get hungrier and I eat more.

    I don’t know if that helps at all but that’s my observation of me.

  2. Love what Cynthia reports, regarding early morning walks. I should be able to start walking again in about a month. Been almost 6 months of sedentary behavior, which feels like 6 months too much. Hasn’t effected my weight at all, actually down 3 lbs (weighed first time today in a month.) My outlook however is dismal, hard to tell if that is from lack of daily walks, insomnia, or whether life is just *weighing* heavy with so much insecurity and uncertainty related to moneylessness, health problems, family sickness, etc and so forth. Ugh.

    I can’t even muster up an attempt to frame any of this in terms of weight management, which seems to have become a non issue for me…maybe you just have to look into the abyss up close and personal and you kind of get shocked into endocrine refurbishment. Hey. It happens the other direction when people go through trauma (and suddenly get diabetes, for instance), so maybe the reverse is possible too. Lovely thought, yes? They say that people in their 70s often start to lose weight without effort (due to endocrine changes). Perhaps I’m just ahead
    of the curve by a couple decades. LOL. In any case, I don’t like this insomnia or the lack of exercise because I don’t think it is health promoting in ways having nothing to do with weight.

  3. Hopeful, I think there’s a period post-operatively that suppresses appetite, in which your body steps in and moderates for you — so that you may devote your resources to healing instead of digesting, I suppose. (I recall, but cannot site the source, that diabetes symptoms are often moderated after surgery, regardless of the type of surgery, simply in response to the trauma of the surgery.) Also, the process of healing, in itself, requires energy, possibly on the level of your former exercise. If I were you, I’d listen to my body, first and foremost, if only for the education that it will provide you during this time. Be aware that at some point, the healing mode may kick over into rebuilding, and then you may find your body deciding to take on some of its lost weight. I know for you that does not create the mental panic that it does for me. Maybe you’ll be able to write on it cogently (and/or poetically) and give us some insight.

    Cynthia, what I find of interest in your comments is that your added exercise is walking. I suspect that walking is, for you, the perfect intensity to add. It revs your energy burning, ever so slightly, without instigating hunger, and, if my theory is correct, it helps suppress the endocrine impulses. I’m really curious as to whether I’m in left field on my distinctions of hunger. Do you experience and can you separate times when you have had vacuous hunger, insulin-triggered hunger, and various compelling “impulses” to eat, which I would attribute to endocrine? Do they ebb and fall in response to your exercise? Hmmmm.

    With regard to exercise suppressing endocrine impulses, I would think that is part of our ancient wiring. If the body thinks we’re in hunting or gathering mode, maybe it gives us a break from annoying endocrine signals. Perhaps the endocrine signals are the ancient body’s early warning system that tells us it’s time to get busy and go hunt and gather. In ancient times, hunting and gathering would be a challenge, and our bodies would have had powerful motivation to (with endocrine) kick our butts into action. It would want to do this before we were legitimately “hungry” and potentially too weak to hunt or gather. In modern culture, however, hunting and gathering is as easy as walking into the next room and opening the refrigerator door.

    I’m making this up as I type. But it’s resonating. Am I just a stinking loon?

    • OK, pardon the epic but here’s some more loony ideas.

      I’m not sure I’ve thought about my hunger distinctions in the way that you’ve laid out, but I know that my body chemistry feels different when I habitually go “net negative” early in the day. It changes how I feel hunger, but there’s also what I am going to mystically call sort of a hum underneath my skin. Like I can feel my metabolism working differently, in a pleasurable way. Like my blood isn’t as sluggish. And once I’m entrained into walking daily and into this “mode”, then I crave the morning walk with something that almost feels like “hunger” (maybe what you’re calling endocrine hunger?).

      I don’t think I ever let myself get to insulin-triggered hunger in the mode. Or maybe only one day a week, Saturdays, when both my Zumba session and my walk come before lunch. I’m usually 800+ calories down by the time Zumba’s over and then I can feel myself getting a bit woo-woo. On normal days I never get that far back on calories and I feel pretty even all day. As for belly hunger, I’ve played around a lot with the concept of a slow-burning breakfast to reduce hunger in the morning and finally found something that really works. I read a lot this winter about resistant starch (yes I’ve been reading that crazy dude Matt Stone) and so I live on things like black bean and egg burritos on whole wheat, slightly green bananas, super brown whole grain bread, bean and meat stews for lunch, etc. I tend to eat about 2x my RDA of fiber and I almost never feel physically empty.

      As an aside, weird digestive issues and hunger-management habits run in the family. When I was a kid, I remember my dad being hungry in weird and particular ways, craving “bulk” and he’d end up eating potatoes, or miso on wheat bread, so I think he had learned by experience to quell particular types of hunger feelings with different foods.

      Part of what put me into deeper analysis of what exercise works and when, is that I was going to Zumba (which is high intensity cardio plus you “dance into the floor” in a way that is not high-impact but creates resistance) last year 5-6 days a week and slowly gaining weight. Zumba was always in the evening. After I got down to 160, I had dropped my morning walk and thought I could maintain with an intense evening exercise schedule. Wrong-o. I just wasn’t getting into the mode, regardless of how I watched my calorie intake.

      So the thing is, in “the mode” I lose weight, even if I overshoot my calorie allowance occasionally, not in the mode (even if exercising regularly), I slowly gain. What I want to figure out is where’s the balance point? It’s like one of those state diagrams in chemistry where you’re trying to find the exact temperature and pressure where ice converts instantly to vapor.

      • What you say, Cynthia, is interesting, and I “get” it. Among other internally meaningful words, you talk of “net negative,” the “mode” and “the hum” under your skin. That’s your mind work. I find it comforting to read about it. I have mind work of my own I do. As I sit here typing, I can tell you I’m at “1950, 1.3, 10.” That means I’ve eaten 1,950 calories, I’ve had 1.3 “units” of exercise (as I understand them — a unit is comparable to 4.25 miles of running) and I’ve eaten 10 servings of fruit and vegetables (like the V8 commercials).

        You also talk about the timing of exercise, and I understand that too. I used to begin my exercise religiously before 6 am, and that “set” my body for the day — my psyche, my physical well being. On occasion I would exercise later, and it didn’t affect things much. When I got a more flexible schedule, however, I routinely exercised later, and it upset the whole system. Depression set in, even. Not good. Future scientific experiments need to look at timing of exercise and how it affects endocrine.

        What you and I do, our mind work, is so much more complex than the “tips and tricks” that comprise the “lifestyle” proscribed by women’s magazines. I’ve wondered whether this is “normal” or “disordered.” I only know that it is, and it isn’t portrayed honestly anywhere, to my knowledge. Your words comfort me. I’m not alone.

      • It seems to me the common aspect of all of our stories (mine included) is first and foremost the need to be very mindful of calories, food composition and exercise regimes to quell hunger and maintain weight loss. The research question of how does this relate to our endocrine and metabolic profiles is not a simple one and is fraught with some challenges that make me question the value of the research.

        First problem is the metrics of a concept like hunger, etc. Yes there are survey tools to help measure this and yes there are many metrics of our endocrine and metabolic systems (I actually built my research career in this domain), but when you put these two together and average across many people you tend to lose the dynamic and heterogeneous nature of the relationships between how we feel and what our blood levels look like. In the real world these associations will lend credibility to how we struggle, but still do not give us help beyond maybe a little less weight based discrimination. While we can track our blood sugar in addition to calories and exercise and fiber and fruits and vegetables and…. I already can’t cope for very long periods tracking calories so one more measurement will not help me (and I am a scientist!).

        My preference would be for research which recognized our heterogeneity and helped us with the complex challenge of daily living with hunger and other forces which lead us to eat more than our bodies need and move less than is good for our many systems including our endocrine and metabolic systems.

    • I’m having a hard time with thinking that my body kicks into a healing mode after surgery (a physical trauma), in the way of suppressing appetite (via endocrine?), and then later (after healing mode) reissues a response that leads to additional trauma (a mass greater than my poor feet can tolerate.) And yet–are you also willing to believe that the body responds to other forms of trauma and oppression with endocrine changes (including those related to eating impulses?) Not trying to argue or change topic (can do that without effort), but this goes to some of my other LONG comments.

      What regular exercise may help with, physiologically, is to condition the body to tolerate, over time, an increasing load of stress, so to speak (which might include stress from various sources, including oppression) and thus function as a mediator of (endocrine related) stress response, provided that the stress level is not TOO extreme. In that case, exercise could help various ways, but is a bandage on a gaping wound when stress is too much for mediation.

      Okay. I’ll take the response off the air. 🙂

  4. Debra: Thanks for the call to action to the scientists out there, but it causes me to ask why are you so interested in mapping out the endocrine and metabolic pathways? Why do you think this will help? I think it would be better to frame research questions in terms of solutions or at least towards causes of the solutions.

    Reading the blog and the replies make me think that our shared solution is an ability to problem solve, an idea I was just chatting about with a colleague I had lunch with yesterday. I suspect what we all do is find ways to make some of our new habits mindless (reduce complexity) and we find strategies to handle the stuff we need to be mindful of, e.g. fighting hunger with complex strategies around eating.

    I suspect if we do the endocrine studies you suggest we will find some commonalities in peoples endocrine and metabolic profiles, and IF the researchers look for them lots of differences….but how does this help?

    I’d rather we studied if learning to problem solve would help us change food and physical activity behaviours, and then we spent time and money developing effective methods to do this.

    Sadly, in our current research funding schemes, it is harder to get money to do studies like I describe.

    • I’m a bioinformatician/genomicist by day, WL maintainer by night (yes my second job) and I totally think we have to understand the biology behind weight gain/maintenance/etc to create successful interventions. It’s clear that obesity is a complex system that we haven’t fully modeled yet and so we don’t know how to control the inputs and outputs when the pieces of the system are different in different individuals. Maybe if the science was done more systematically, a doctor could just tell me — look, with your biology, you need to walk before breakfast in the morning every day to maintain or lose. I know you’re working on the societal “complex system” and not the molecular/physiological one, so I think efficient and accurate dissemination of current obesity research and its complexity to doctors, perhaps in a digested BUT SCIENTIFICALLY ACCURATE form, might help them understand the solution is not one size fits all. Which would be your “everyone is multifaceted” lens. Everyone’s biology is different! Personal genomics! Those buzzwords ought to have been around long enough (and proven out in the studies of, for instance, different classes of molecular response to cancer in the tumor microenvironment leading to different survival outcomes) that doctors won’t be completely resistant to the notion.

      Being told “eat less/move more” isn’t specific enough but doctors fall back on that because probably a lot of GPs don’t read the day’s big headlines in Genome Biology or whatever. As I posted a tome about above, I am figuring out what my specific diet and exercise regimen has to be by experimentation on myself, but it’s not a double-blind controlled study.

      • Although I currently work more at the level of societal complexity, my career was built as a physiologist studying the pathogenesis of diabetes so I understand a fair amount about complexity below the skin as well as above. I am not convinced that the way biological research has mostly been approached through a reductionist lens will help because complexity goes up as the scale goes down to the level of physiology and then molecular biology and genetics. This means the number of possible combinations goes up (our heterogeneity is even greater) and it is not likely we will find a single pattern or patterns that will help the doc in his office, at least not in this way. I agree 100% that telling people to eat more and move less is not specific enough, but giving people their DNA profile is also not helpful (and is currently a ripoff).

        Yes we each have to do our own personal experiments so getting help with a useful process here would be good. But as you point out a double blind controlled trial is not the way to go. Our whole paradigm of research needs to shift from reductionist to integrative and we need credible approaches that focus on the best processes to help us improve our capacity to deal with the complexity we each face is needed.

    • “why are you so interested in mapping out the endocrine and metabolic pathways? Why do you think this will help? I think it would be better to frame research questions in terms of solutions or at least towards causes of the solutions.

      I suspect if we do the endocrine studies you suggest we will find some commonalities in peoples endocrine and metabolic profiles, and IF the researchers look for them lots of differences….but how does this help?”
      Jane Plain has a particular interest in endocrine modifications to control hunger in the weight reduced (in her case, a loss of 160lbs which she has maintained within a normal weight range for 11 years). She writes frequently about her experience as a participant in a clinical trial that normalised her leptin levels`: Leptin is an effective treatment for hypothalamic amenorrhea.

      She distinguishes varieties of hunger as a maintainer and frequently remarks that she regularly experiences what she describes as “starvation hunger” but, for the brief time during the trial that she had normal leptin levels, she experienced normal hunger and felt more in control of her insulin and blood sugar levels in so far as they contribute to hunger (and fat storage). Jane Plain describes the effect on her as conferring the metabolism of a ‘never been obese’ person rather than a weight reduced metabolism.

      It’s an interesting trial as a fair number of the group who received the active therapeutic agent (leptin) lost some of their fat mass as well improving other endocrine functions. However, it seems as if there is little support for the notion of normalising leptin levels to allow those affected weight-reduced people to maintain their crafted bodies more readily. (Jane Plain suspects that her repeated kcal cutting during her weight loss contributed to the suppression of her leptin levels to the point where she manifested adaptive leptin insufficiency.)

      Which is a long way to say that DebraSY might find some points of agreements on experiencing a variety of endocrine-moderated cues for hunger and impulses to eat. In Jane Plain’s case, she experienced what it was like to have her clinically verified hypoleptinemia reversed for the period of the trial. I’ve no idea if Jane Plain is a clinical outlier in the nature of her response or if a number of weight reduced people might similarly benefit.

      In the interim, it seems as if a number of people are enduring serial yo-yo weight fluctuations and are increasingly concerned that they have altered their metabolisms in ways that make them resistant to voluntary weight management and subject to endocrine disorders. However, in the absence of research into endocrine and metabolic activity as it plays into food and exercise, it seems as if many weight-reduced people will only have recourse to personal experiments which will lead to criticism if the strategy fails.

      • Oops! My bad. If you got my earlier “reply,” ignore it. When I hit the reply button it revealed your comment in my blog’s back pages and I could see that you provided the link and Jane Plain IS my old bud, Wooo. I haven’t visited her in an age! I gotta go peak in. Thanks.

        As time has past, sans blog, my take-away has been that by timing my (moderately intense) exercise in the mornings I can nudge down my ghrelin ever so slightly, and that helps some to keep my “eat impulses” (which are likely tied to my brain reward center) in line throughout the day, when I need the help. Exercising at night, therefore, makes little sense. I also take comfort from studies that continue to emerge that show that multiple hormones in weight-reduced people are out of whack. It just reassures me that I’m not insane. I wish the NWCR would ask about how we maintainers define hunger. Imagine trusting us to know our own experiences?! No, we’re just mindless ninnies practicing our zippy lifestyles that ANYONE can imitate!

      • DebraSY wrote: “I also take comfort from studies that continue to emerge that show that multiple hormones in weight-reduced people are out of whack. It just reassures me that I’m not insane. I wish the NWCR would ask about how we maintainers define hunger. Imagine trusting us to know our own experiences?! No, we’re just mindless ninnies practicing our zippy lifestyles that ANYONE can imitate!”
        Yes, you bear true witness to your own experience and it is an experience that other long-term radical weight-reduced people share and report. I fail to understand how that can not be of interest to researchers and data-gatherers in this arena.

        I find the notion of allostasis to be interesting (I don’t wish to clutter up your comments so I’ve linked to a write-up elsewhere on the topic – if that’s impolite, do let me know and I’ll attempt to edit it to comment length).

        Essentially, there are limits to personal responsibility as the environments in which we live and participate can have profound effects on our endocrine responses. A favourite example is from the observations of Salvador Minuchin whose clinical studies of children with brittle diabetes led him to remark that “behavioral events among family members can be measured in the bloodstream of other family members”.

        Nonetheless, endocrine profiles of free-living autonomous adults should still yield interesting material that goes far beyond recording ‘zippy’ practices that are all that can be encapsulated/formulised for others to emulate if one is promoting mimicry as the most plausible path to weight-reduced maintenance.

      • Links are fine by me, as long as they aren’t to the latest “weight-loss breakthrough.” Allostasis is, indeed, the first hurdle. Relatively peaceful home and work environments are essential. Many weight-loss maintainers create cooperative work environs by changing their livelihoods to complement their maintenance. I briefly entertained the idea of becoming an RD, others become part- or full-time trainers or aerobics instructors. And all of us have to have pretty stable personal lives. There is NO WAY I could do what I do if I had the life my brother-in-law has, and he is embarking again on another radical weight-loss attempt and everyone else in the family is beginning the great “hurrah” for him, while I remain quiet and concerned. He is enormously disciplined and, once again, will make it to a trim body, but there is a 97% chance that his stressful, irregular-houred job as a management trainer for a large restaurant chain (with food vetted by focus group) will, once again get the better of him and he will go through the painful, humiliating process of regain.

        I have only one bone to pick with the article you linked to. The following sentence: “I sometimes wonder if the raging controversies about the relative contributions of various hormones to obesity somewhat skimps over the issues of the environmental/allostasis stressors to which those hormone shifts (and overweight->obesity) may be one response.”

        We have to stop pitting one area of research against another. Systems research is good. Allostasis research is good. Endocrine research is good. Even behavioral research has a place, though it’s better when it’s empirical (Katarina Borer) and not survey-driven (NWCR). We all must pursue what resonates with us. Since I was able to clear the allostasis hurdle and I have absented myself from many of the systems that contribute to obesity, I get to move on to explore how hormones affect me. It doesn’t mean that I disrespect or “skimp over” anything. It means, simply, I’m in a different, not superior, place.

      • “The following sentence:…We all must pursue what resonates with us.”
        Agreed, however I think the sentence may work in its context because it is in a nutritional ketosis sub-forum with regular discussion threads that rehash whether the carbohydrate-insulin hypothesis is the sole and sufficient explanation for fat storage (and that nutritional ketosis is the generally sufficient approach). (Oddly, altho’ her post came after it, Jane Plain’s discussion linked above addresses a recurrent thread topic there and elsewhere, which is the claim that it’s not feasible to add to a body’s fat mass from an exclusive intake of dietary fat because of insulin etc..)

        I belatedly saw your contributions to Weight Maven’s discussion of <a href="http://weightmaven.org/2014/03/28/obesity-physiology-psychology-sociology/"Obesity: physiology, psychology, & sociology. It’s disappointing that Bruce Alexander’s work on rat parks (with useful sidelights on the notion of allostasis and addressing the life of the individual within wider environments) does not yet have the degree of influence that it should merit.

        The striking homogeneity of members of the NWCR (female, white, higher education etc.) might eventually be something that has to be emphasised by those who are data mining the survey data for nuggets to be copied by other weight reduced maintainers.

  5. Ah, Diane, keep on doing your work. It is vitally important. You navigate deep territories of systems, where most people are lost. What I would hope that endocrine studies would do is:

    A. Assure me that I’m not imagining this. (And this is about ME, right?)

    B. Clearly take the blame off of the backs of weight regainers for what endocrine is doing, so that when you come up with your complex systems solution, people won’t say dumb stuff like “Well, that’s just too complicated. All those fat people really need to do is “push aways” — as in push away from the table. Har Har.” (Some medical doctors will say the same thing, but with multisyllabic words).

    C. With regard to A, knowing that I’m really experiencing endocrine cues (and maybe even knowing specifically what to expect) gives me the power to know when to disobey my body in order to continue this maintenance experiment. At some point, I may apply biofeedback, as well, if I know clearly what is happening inside me. Body wisdom, now, takes supremacy over much of the “advice” coming from “experts,” because those experts are subject to cultural mythology and bias. But truly, I feel I’m navigating unexplored territory. My body doesn’t always give me the right cues either, and endocrine knowledge for me would help with the clarity I need. Endocrine just resonates for me. Wish I’d figured that out 25 years ago.

    • Oh, and PS to everyone else: the conversation should continue for Diane. We haven’t really helped as much as we could. She’s opened the question to look at the subcategories in the systems — goals, etc. Revisit the “Help Diane” post when you have time. I’ll try to cogitate some more too.

  6. For me personally, if I work out too hard then I do not want to eat. But if I only work out moderately, I tend to want to eat more.

  7. You know, it may be the other way round – Gary Taubes (whose work I’m a bit iffy about) has suggested that the reason some people are into exercise is because that’s what their body wants. As a person’s metabolism gets sluggish, the body shuts down the desire for exercise. That seems to be true of me – I am not doing much formal exercise at the moment, in terms of going to the gym or working out, but I know that I have FAR more energy than I used to and I tend to do housework or clean cupboards or go for walks, where once I would have sat in front of the computer. (So I’m getting a lot of ambient exercise in.) I attribute this to not being weighed down by so much fat any more. Not having to carry so much extra weight has given me a huge burst of energy. Then again, maybe I was always this energetic, but the available energy was all being diverted to lifting and carrying all the excess, if you get what I mean.

    For me, I get hunger for three reasons: 1. I’m hungry because I haven’t eaten for a while. 2. I’m bored. 3. I’ve just eaten certain types of carbohydrates. The other week, I had some cake and I got monstrously hungry afterwards. It was insane. I was climbing the walls with hunger, even though I’d easily eaten enough that day. Funnily enough, I don’t deprive myself of cake now and then, but usually I only eat home made cakes. This cake was a commercial product and I can’t believe the effect it had on me.

    In any case, as per someone above, if I can go and do some physical exercise – which in my case means going for a brisk walk – the hunger goes away. Maybe it’s not a metabolic process – maybe it’s just that I was distracted for a bit. It would be interesting to know.

    The people who probably have the best data on exercise and fat are the body building community. I’m not a body builder and I don’t personally know any, but I’m incredibly impressed with what they write among themselves about manipulating body fat. Because the ability to do this is so vital to them, they have explored every nook and cranny and swap lots of theories and experiences among themselves. It’s not all scientifically verified, but they seem interested in hard data and things that work.

    • I think your doubt about whether exercise provides an endocrine adjustment or is just a distraction is the beginning of a great research question. Scientists?! Annabelle (and I) await your good work!

  8. I’m not sure how helpful it would be to know about endocrine because, as Diane points out, that offers no solution that people would accept as helpful, given the cultural need to blame fat people. If they don’t get it now–in terms of compassion–with outcomes such as they are and with research already indicating complexity, they ain’t gonna get it with additional endocrine study. (She says with typical optimism.) I know when it’s pure endocrine with me–my brain stops working properly–and I also know I have a choice at that point in time (because I’m not an air traffic controller or active mommy, etc) about eating for immediate relief or upping my fat intake and riding it out for a few days. Most people don’t have that option. The rest of the time, the urges are (for me) something else that may be endocrine related but everything related mental processing and emotions are endocrine related (different from simple endocrine cause and effect) more akin to a paradigm SIMILAR to PTSD. Something very very unpleasant to consider, a kind of emotional/mental issue that used to get numbed by overeating, but which I now have the privilege of facing head on in an extremely DIFFICULT and PAINFUL struggle that has nothing to do with NEEDING to eat but instead desperately and understandably WANTING to diminish the psychic pain. This is something I now have the means to do for many complicated reasons. It isn’t something I suspect others go through similarly to me unless they discuss it in similar language, so I don’t make assumptions about other people’s reasons for eating or not eating. I can only speak for myself.

    The urges I have (when not more directly endocrine w/out complications) are not eating impulses–they are escape impulses. This admission does not diminish their power or diminish my need to go through them. When people try to translate this kind of experience into a desire for situational eating or emotional eating I know that is ignorant bullsh*t coming from people who have no clue about the human condition. Thus, I ignore it.

    • I meant to say “…but everything related TO mental processing and emotions is endocrine related…”

      It’s difficult to be clear when discussing “endocrine” because when people have experiences like PTSD, for example (a horribly limiting and minimizing little effed-up paradigm in my view, by the way), the endocrine system’s hormones are all over the place. If I’ve learned anything about physiology in nursing studies it is this: the hormones and other communication/information transmitting systems in human bodies are inextricably intertwined, complex, and uniquely HUMAN. Thus, unlike anything we find in animals who do not have same cognitive functions, or human memory, or human awareness of death to the extent they write poetry about it. OF COURSE this sh*t is endocrine. For me, too. But it is endocrine AND/WITH/ON ACCOUNT OF (etc) my humanity, the essence of what makes me a human being. We can’t tease all that out, even if we have a billion dollar budget and a hundred years for people who respond in the way I am responding internally because we can’t erase our vulnerability to oppressive conditions once those have occurred, especially when the entire culture goes on pretending that we are all created equal and we all have the same chances to protect and safeguard our lives. We don’t. Some of us have to learn, if we are very lucky and are able, to live with a CONSTANT sense of impending doom. Try explaining that to some pea brain who says “just eat less and move more”. Does not translate to that poor limited soul.

      • Hopeful, you are especially agitated today, methinks. I respect your interest in systems. And Diane’s. Endocrine resonates with me. I think it would be helpful. That is all.

        Constant sense of impending doom? Ouch. How about eternal sense of peace (sans naivete), regardless of living state, regardless of humanity’s injustices? Are you okay?

    • Interesting. Today I’m am the one who is more hopeful than Hopefulandfree. The cultural NEED to blame fat people? Really? Culture does find its scapegoats but. . . . Knowledge of endocrine would not be helpful? People won’t arrive at compassion with additional study of endocrine? Perhaps not. Why is there an either/or happening here? Both, AND. Both/And, my friend.

      • I’m suggesting there is no need to pathologize fatness. Or to pathalogize overeating. (This term is in need of more qualification beyond the scope of this comment.) Or to pathologize endocrine functions which drive urges. These are evidence of body’s beautiful workings to provide harmony and equilibrium. What i’m suggesting is that we eat and/or overeat as a form of self care, like a form of art if life is art as experience (Dewey), and we cannot be judged for what is our most appropriate form of self care as an individual at any one time. By cultural NEED, I mean that our culture creates groups to attack and to hate and to blame (yes, scapegoat) because it cannot now justify the oppressive status quo–and keep it maintained–in any other way with the current paradigm of understanding and interrelationships. It is founded on domination and control.

        As for “agitated”…interesting form of judgement, a way to pathologize, perhaps, for speaking truth to power. I believe that I, like others, are responding in completely normal and understandable ways to oppressive conditions about which you are either much less impacted by and/or not aware of… Life, for some of us, is a
        very different kind of consciousness. Both, AND. Both/And. As you say. I am quite passionate about some theoretical connections (again, via honneth and fraser’s discourse cited in diane thread). Passion and agitation are perhaps physiologically similar but worlds apart mentally. I’ll pursue these lines of discussion in my own blog and elsewhere because i see it doesn’t make sense here, a different paradigm which isn’t comprehensible. The problem with language and recognition of systemic domination…much love, hopeful

  9. Hopeful, I’m NOT pathologizing endocrine. I think it’s perfectly normal.

    And I think we don’t understand it.

    And I want to understand it.

    And there is nothing wrong with wanting to understand something. Curiosity is good.

    And YOU are the one who has decided this is an either/or situation. That if I take an interest in endocrine I am somehow marginalizing systems research. That’s a false choice.

    Truth speaks. If you’re feeling powerful today, then truth speaks to power. 😉

    Much love back atcha.

  10. Personally, I would love a better understanding of processes because it would help me figure out what to do — to me it’s not about society or blame but I simply enjoy my body being at a particular size conditional on being able to maintain that size without going crazy. More information is a tool to help me maintain the body that I like. (It may make me a bit of a narcissist, but I *really* like my body.)

    • By processes, Amy, do you mean endocrine processes in our bodies or systems processes as they work in society? Or both? In my mind, they aren’t in conflict.

  11. What I am taking for the discussion particularly between hopefulandfree and DebraSY is a great display of our heterogeneity, one of the many many characteristics that make weight loss maintenance a challenge. There are many other characteristics that make this a complex challenge, so the more we can do to reduce this complexity, the better including challenging the social paradigm as well as providing credible information that helps us identify and manage our own endocrine and metabolic signals. This latter focus on helping individuals with self management is necessary given our heterogeneity…..no one size will ever fit all of us, yet most epidemiology and even endocrine and metabolic research tries to give us the “one truth” rather than trying to understand the relevance of our diversity to solving our individual problems. In addition to helping individuals increase their capacity for the challenges they face, we also as a society need to decrease the complexity faced by individuals by addressing the social determinants of health.

  12. As a science outsider/consumer, it makes me sad to think of my scientist friends wearing blinders and pursuing the “one truth.” It probably does happen a great deal. I would doubt, however, that it is exclusive to the epidemiology, endocrine and metabolic research areas. In fact, I think the NWCR is definitely subject to that rut — as in, “We will identify the behavior combination (one truth) that results in long-term maintenance, then we will disseminate the information and replicate the results.” Ack!

    I have two philosophies that I try to keep at the heart of this blog. One of the philosophies is “tell a truth; advance compassion.” I settle for one truth at a time. I have great hope for your research, Diane. (Have you visited your personal “Let’s Help Diane” thread recently, by the way? I had a little “eureka” to contribute regarding goals/structure.) I also have great hope for the likes of Rudy Leibel, Robert Lustig, Katarina Borer and others who look at the internal mechanisms.

    On a personal level, in conversation with Dr. Berkeley, I have gotten the idea that my struggle with endocrine impulses is atypical among successful maintainers: that other people get a handle on the insulin and they’re truckin’ along fine for years. Actually, I was truckin’ along fine for years on a Mediterranean influenced, health-nut “foodie” diet plus running for exercise. When my body then said ix-nay to the unning-ray, I was in it-shay creek. Everything changed. That’s when the impulses started haunting me or, at least, I became aware of them, labeled them, didn’t blame myself when I found myself responding, but instead accepted them and tried to understand them better. At any rate, my experiment got MUCH more challenging. I also became much more sympathetic to regainers. I stopped being “inspirational” entirely, spent some time in depression, but then found a more authentic voice for myself, and started on this quest/blog.

    What I want (and as Amy would attest, it may be narcissistic) is the ability to work with an endocrinologist who could look at my personal chemical cotillion, taken from a blood sample, and maybe reveal for me a truth (one at a time is okay) that might help me better manage the struggle. That is all. It’s selfish, personal, my own deal. You, Diane, are likely serving a greater good. If your work exposes and ultimately breaks apart the system of weight bias, then I will be able to meet with my endocrinologist and he or she will not assume I’m lying when an intervention fails. The conversation will happen on much better terms.

  13. I’ve been reading and re-reading the comments here and reflecting on what they mean to me.

    Allow me to meander:

    I spend a lot of time musing and worrying about how much I eat and what I eat. In fact, waaaaay too much time. I try to understand the various signals I get and whether they are true hunger signals telling me that my stomach’s empty or almost OR something more subtle (“I just haven’t had the taste that I’m longing for. I must find that taste, no matter what I’ve eaten already.” Is this my endocrine system talking? Someone, help!!).

    The funny thing is, no matter how much I worry, my weight stays more or less the same–I think I do have a set-point that I gravitate to quite effectively. This being said, as I age and as my physical limitations pose an increasingly higher barrier to calorie burning exercise (yoga stretches are a life-saver for me, but in terms of calorie burning, I might as well be lying in bed reading a book!) , this set point is creeping slowly upward.

    I also think that there is an insidious psychological aspect to the weight I carry. To wit, in the past 18 years since my first son was born, I have only lost weight due to illness with the exception of a few months starving on Herbalife shakes. In fact, I feel downright panicky when I see the scale move down since I fear that my thyroid is once again out of whack. Needless to say, within a week of noticing weight loss, I have gained that “scary” loss back.

    The only conclusion that I have come to for myself is that I must always be hungry both to lose and to maintain weight loss. It’s not a pleasant way to live, so I don’t.

    • And you shouldn’t live that way, NewMe. Live joyfully.

      As for your time spent musing, I don’t think it is wasted. I think that we are pushing, challenging the conventional wisdom, and contributing to the marketplace of ideas. At least, that’s what I tell myself, and I feel less guilty.

  14. Eat impulses. You’ve given a name to something I’ve been struggling with a lot. Yes, I definitely have eat impulses. Usually in the evening. Am I really bored? Or tired? Or angry? Who knows? I think exercise is critical because when I’m exercising regularly, my weight is more stable and I tend to eat less. But I also think that most people who have never been overweight don’t really get what exercise is about for a weight maintainer. I read something recently that said adults needed at least 150 minutes of moderately vigorous exercise every week (I’m sorry, don’t remember where I read it or what study it was from) and my reaction was, “Really? Is that all?” When I am exercising regularly, I do way more than that and it’s only when I’m getting in at least an hour a day that my weight really stabilizes. And that makes me mad because these beliefs work their way into the culture and those of us struggling with weight have to deal with them in addition to the struggle of weight maintenance, which is enough all by itself, thank you. So, yes, I’m all for more research.

  15. I have an odd anecdotal twist to add. For me, there are certain foods that absolutely suppress the eat impulses and others that trigger them. Taking your “science experiment” approach, Debra, I’ve looked at this a lot over the last 20 months. My 100-lb weight loss started when I made a couple of batches of the internettily popular “kale chips” and suddenly all overeating impulses disappeared like. It was like a lot of noise had been going on and >click< it. just. stopped. Kale works every time – raw, or roasted or quick-sauteed in olive oil or in a green smoothie with some fruit – if I eat 2 – 3 cups of kale, I simply do not feel anything like the typical eat impulses. Less predictable but also effective: collards, mustard greens. Much less effective but still sometimes so: spinach. I suspect that there is some mineral or combination of minerals in the kale – not magnesium, because I've taken that as a supplement to no effect – that interacts with my system to shut down eat impulses. Conversely, foods that flip the switch the opposite way for me – and pronto. – are those with that salt-sugar-fat combination that David Kessler has written about. For me, exercise affects weight loss but not the impulse to eat. It seems that my impulses are much more steered by what I eat.

    • I have yet to get on the Kale bandwagon. It just looks too much like the weeds I yank out of my garden with all kinds of bad karma. Perhaps if I cut it into chip sized peices, toss it with a little EVOO and herbs du provence and roast it in a 425-degree oven, it’ll turn into something mouth worthy. Your words have inspired me.

  16. If you haven’t read this study yet, I think you’d really enjoy it:
    http://ajpregu.physiology.org/content/297/3/R793.full
    Basically, obesity-prone rats were fed a high-fat diet, led sedentary lives, and were obese. Then they were put on a weight loss diet for 2 weeks, then the weight loss was maintained for 8 weeks. Then they were again given access to as much food as they wanted (this time it was low-fat food).

    Half of the rats remained sedentary throughout the study, and half of them exercised on a treadmill during the weight maintenance (but not weight loss) and regain periods. (They exercised in the early part of the dark cycle/night, which I think in humans would be comparable to the early morning.) The ones that exercised regained less weight/had a lower defended body weight (=set point?), and they also stored less of the food they took in as fat and more as carbs.

    This part struck me as kind of funny, talking about techniques used to get the rats to complete their exercise: “The type and combination of motivation used varied within the same rat and between rats, depending on the response to the motivation. One rat that did not respond to any motivational tool refused to perform any treadmill exercise.” I like to imagine him saying, “There is nothing wrong with the body of Poirot!”

    It seems to me that the reason they stored more food as carbs was so that their bodies could access that fuel more easily when exercising–their bodies expected to need quick fuel for exercising and adapted to that requirement. The researchers believe (and it seems plausible to me, too) that having more fuel stored as carbs also increased the rats’ satiety. It also says that it takes more energy to store food as carbs than as fat. (Take that, calories in-calories out people!)

    In my personal experience, FWIW, I think exercise does have an effect on weight regain. The last time I was living with my parents, about 5 years ago, and before I’d heard of Fat Acceptance, I weighed 185. I moved out, and I think through what the Fat Nutritionist calls “spiteful eating”, as well as probably some nervous eating and stress, gained weight until I was at my peak weight of 199 (based on doctor’s scales, as my scale was/is not very accurate). I became worried about the weight creep and changed eating habits with the goal of weight stabilization, although it was pretty much the same eating behavior as HAES. I had seen my mom lose and regain weight without ever becoming “not fat” throughout my childhood, so I thought it was unlikely that I would lose any significant amount of weight. I also thought that at that point I’d better try to counteract the risks of my higher weight and went from irregular exercise to regular exercise. I was surprised to see my weight actually came down quite a bit with the change in habits. It’s been within two or three pounds of 180 the last couple years or so. I’ve also increased my activity and done more challenging things since learning about FA and HAES; instead of mostly doing brisk walking, I’ve done some running and some yoga. I got up to 3.5 miles and then got peroneal tendonitis and have just recently started up again; my weight has not changed during my break from running, surprisingly (178 last doctor’s appointment), but I have been doing a decent amount of other activity, even if it’s not as much as when I was running. The yoga is something I only started doing after my break from running, and at the very least I have to take my dog for a ~30 min walk every day if I want him to be reasonably well behaved.

    • Thank you, Closetpuritan, both for the study (gotta love the recalcitrant rat!) and your personal experiences. I haven’t read the study yet, but will put it in my pile. You are right that it’s up my alley: the complex interplay of endocrine, exercise and eating.

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