White Coat Underground


Note: I’ve been informed by one or two experts whom I trust that my plan sucks. My basic plan is based on a Weight Watchers model, but I take experts with evidence very seriously, so there may be some serious modifications to this post. –PalMD

Obesity is a bad thing. This isn’t a moral judgment. If one of your values is long life and good health, then obesity is a bad thing. In general, I think it’s a bad idea for me to write about my personal health issues, but I’d like to try an experiment. I suffer from one of the most common and fasting-growing (!) health problems in the U.S.—obesity. No, I’m no Jabba the Hut or anything, but over the last several months my body mass index (BMI) has crept above 30, a somewhat arbitrary dividing line between overweight and obesity.

Like other illnesses, obesity isn’t always evident. We all know people who are huge, but there are a lot of us out there who aren’t but who still fall into a weight category that puts us at higher risk for disease and death. That’s me. I don’t care so much about the aesthetics—I can live with how I look. But I’m a dad and a husband, and I can’t afford to let preventable medical problems harm my family. But how did I get this way? And what symptoms of obesity am I experiencing, if any?

When I was a kid, my Toughskins jeans were always “husky” (if you don’t get either reference, google ’em, youngster!) . But most of my young adult life, I was very physically active, and in decent shape. Medical school and residency (especially the latter) gave me about forty extra pounds, which I managed to shed afterward. But I’ve been terrible about exercise over the last few years, and when I injured my back this winter, I put on another fifteen pounds that I didn’t need—that’s what pushed my BMI over the magic “30” mark.

Climbing stairs hurts my knees. Snoring hurts my wife. Reflux just hurts. My cholesterol sucks without medication. I feel older than I should.

So, it’s time once again. I’ve lost weight before, and it’s no mystery. Usually I join Weight Watchers online, and evidence suggests that that’s a good plan. But I have another idea.

I’m not looking to get down to what the charts say I should (about 175) as that wouldn’t fit my build, but I would like to go down fifteen or twenty pounds. So today, in front of all of you, I’m weighing in.

My morning, clothed weight is 96kg (!). As of today, I’m on the wagon. I’m dieting, and I’m using the evidence. Evidence shows that any diet that restricts calories, independent of content, will make you lose weight, so that’s what I’m doing. I tell my patients that if they don’t feel miserably hungry, they’re probably doing something wrong—so far, I’m doing it right.

So as you as my witnesses, I’m doing it. I actually started dieting yesterday, but we’ll call today Day #1, Week #1. I’ll be weighing in in front of all of you weekly. So what did I eat so far today?

In the morning, I had a small bowl of shredded wheat, with a touch of sugar, and skim milk. Later in the morning I had a 120 calorie granola bar. My lunch will depend on what’s in the cafeteria, but will probably be a hard boiled egg and some salad. Yum.

This may not interest many of you, but for those of you who have had similar struggles, welcome to mine.


  1. #1 Don in Rochester MN
    August 5, 2009

    Diets don’t work; Weight Watchers does. But your plan will too, if you want it to — I just don’t like “going on a diet” ’cause that implies that after I’ve lost the weight, I can go off the “diet” and that lead me to yo-yo weight . . . . I hope this works for you!

  2. #2 Ranson
    August 5, 2009

    I’m at my peak weight now. I’ve gotten down from here before, by about sixty pounds. Of course, that puts me around 265, where I feel really good. Of course, by any other measure, I’m about 70 pounds overweight at that stage. Given that I’d probably have to cut off a limb to drop any weight past the 265, it’s where I tend to maintain. I’m starting to work it back off now.

    With my build, I’ve always hated BMI as a measure of health. Yeah, I know I’m not doing great now, but even at my peak of youth and fitness, I registered “obese”. I, too lived in those “husky” jeans, but I consistently outpaced my peers in height and size throughout school; I was just big. My brother was the same way, though he was even worse off. He was an athlete; football, powerlifting, shotput, etc. Though he ended up about an inch shorter than me overall, his torso is about four or five inches longer; side-by-side, his waist starts at my mid-thigh, so he carries a lot more mass.

    Another friend has the opposite problem — her entire family is built like fireplugs — little five-foot-nothing balls of raw muscle. I watched this girl train for three hours a day for a year to try and lose weight because her doc called her “obese” based on BMI. Her weight and size didn’t change much, but she could probably have bodyslammed and strangled an ox by the end. Still “obese”, though.

    There are better measures, like % body fat, etc. None of them are as quick to assess as BMI, but they’re infinitely more useful.

  3. #3 JScarry
    August 5, 2009

    Over at the Neurological blog Steven Novella wrote an article about ‘calorie density’. It would be an interesting data point if you would read the article and adjust your diet to eat foods that have a low calorie density and see if it is easy for you to lose weight.

    It makes sense to me that you would automatically consume fewer calories if you ate the same amount of food but substitute low-caloric-density things like fruits, vegetables, and water for high-density items like chips, cookies, and beer.

    Start off by buying your fruits and veggies at a local farmers market. This is a good time of year for fresh stuff and the variety and taste are much better than at the mega-mart. You might even look forward to eating the stuff!

  4. #4 JohnV
    August 5, 2009

    Without attempting to ask for medical advice, since you can’t dispense that here, how does one deal with the symptoms that correlate with feeling “miserably hungry.”

    I mean, I have a friend (aren’t I the clever one) who could take tylenol every 6 hours he’s awake to at least keep the headache at bay, but recent news reports about acetaminophen making peoples livers turn to dust and fall out make that less than appealing to him.

  5. #5 Kathy
    August 5, 2009

    Good luck!

  6. #6 Russell
    August 5, 2009

    Perhaps my story will encourage you. Three years ago, I decide to change my eating habits, because my cholesterol had snuck up to above 200 as the years had crept up on me, and I wanted to avoid medication for it. I also was approaching that 30 BMI figure, but didn’t think I would lose appreciable weight in any eating fashion I could maintain. What I did want to do was eat a healthier kind of food. At the same time, my partner was making a similar shift in diet, because she had suffered a reaction to ACE inhibitors, taken for her blood pressure.

    What I don’t eat: sweets, chips, cookies, crackers, commercial baked goods, commercial dips or sauces, deli meats, ice cream, or dairy products generally, ground meat, sugared drinks. Nothing that contains high-fructose corn syrup. Almost nothing sold at most convenience stores.

    On the good side is real food: plants and animals. I eat as much as I want of every legume, vegetable, fruit, spice and pepper, in any combination and preparation. It helps to get interested in food, and to learn to cook. For dinner, we’ll prepare something from fish, shellfish, or chicken. Beef, rarely. Olive oil for sauteeing and savor, vinegar for flavor. And a little drinking wine, for our pleasure. Breakfast is a whole grain cereal without added sugar or salt, which unfortunately eliminates most of them. Almost always with some fruit. Bread is rare, mostly when my partner fixes a homemade pizza, making her own dough without salt.

    Since making that change, I’ve slowly lost quite a bit of weight, moving from a BMI of 30 to 24. Total cholesterol dropped from 215 to 161, LDL from 144 to 95, and HDL perked up a bit, to 55. My bottom line recommendation is to cut out junk food, and to learn how to make tasty meals from the kinds of real foods we evolved to eat. Good luck!

  7. #7 BB
    August 5, 2009

    You gotta exercise, dude. You know that. Did you go for PT after hurting your back, and if so, did the PT recommend exercises you can do on a regular basis (restorative yoga, swimming, something)? Broke my ankle (bimalleolar fracture with dislocation0 around when you hurt your back; the PT I’ve been doing for the past 7 months (no, not a typo) has helped me drop a few. I do an hour of yoga most days when I’m not doing PT or hiking again.

  8. #8 anonymous
    August 5, 2009

    Good for you, Pal! I’ve recently lost my appetite and about 17 kg along with it. Losing another 17 or so would be great. It looks like I’ll need to start exercising more because although I am eating 1,000 or less a day, my weight loss seems to be at a standstill. I don’t feel as happy about my weight loss as I thought I would. (Maybe because I’m secretly convinced I have cancer.)

    Although eating a healthy diet and maintaining an active lifestyle seems like good advice for just about everyone, I have an armchair hunch that there could be more to the story (of obesity). Perhaps there is some kind of interplay between overeating/the endocrine system/brain chemistry. (Maybe some people are predisposed to do some permanent damage to their brain chemistry/endocrine system just as many alcoholics do permanent damage to their livers.) Perhaps obesity is itself a disease process not unlike depression or addiction. My opinion is that medical science should look beyond “will power” for solutions. I see no difference, morally speaking, in taking a pill to lower cholesterol and taking a pill that will help a person maintain a healthy weight. I have seen too many people try so, so hard to lose weight and fail.

    My 182 cm 57 kg husband can eat absolutely anything (and everything) and never gain a gram. I smell food and put on a kilo. Life just isn’t fair.

  9. #9 rob
    August 5, 2009

    have you tried Dr. Fitzkee’s Lucky Astrology Diet?

  10. #10 PalMD
    August 5, 2009

    I wanted to but it wasn’t in the stars

  11. #11 Maria
    August 5, 2009

    Good luck, Pal! I hope your appetite adjusts to make the dieting less miserable for you.

    I’ve been trying to make small, sustainable lifestyle changes in the same direction; I’m still “overweight” rather than “obese”, but I know that my body felt much better 20 pounds ago. Since moving, I’ve been getting more exercise: biking for errands, vigorously tussling with the blackberry brambles and locust tree sprouts in the yard, and walking up a nice 100′ hill on the way to work. But I want to do as much as I can without feeling deprived or denied, so I’ve made basically zero effort on the diet front. I have been eating more fruits and vegetables, but I’ve also been making some mayo/sour cream dressings so that might actually be a net minus.

    @Don: I thought Weight Watchers was a diet (albeit with a built-in support group).

  12. #12 D. C. Sessions
    August 5, 2009

    It’s amazing how much you can cut out of your diet if you garden and are stubborn about eating what you grow. There just ain’t that many calories in fresh veggies — but damn are they both tasty and filling.

  13. #13 Cootamundra W
    August 5, 2009

    I hope you get to where you want to be!

    My experience thus far:
    I treat all fruits and veggies as freebies and consume as much of them as I want to and at any time. Yes, it means having a stash of them even away from home and yes, I enjoy them.
    I refuse to eliminate foods (unless they disagree with me or unless I am allergic to them) – for me that is creating temptation. Instead, I try to ask myself each time if I want that food or want to feel better.
    Six months of this and I have eliminated more than 25 pounds.
    Because words have alot of impact for me, I don’t call it dieting, but rather, eating differently/better.

    Is your back well enough that you can incorporate movement/exercise that you enjoy?
    Best wishes in this endeavor!

  14. #14 Harry
    August 5, 2009

    I’m 5’8″ and 205, for a BMI of 31.2

    I’m also a 2nd year medical student and the amount of crap food I eat is scary. I wish you luck.

  15. #15 Harry
    August 5, 2009

    I have BMI question.

    What is the confidence range/interval for BMI measuring obesity as compared to percent body fat? We all know that people claim that body builders with low body fat can have a high BMI, but how often does that really happen?

  16. #16 daedalus2u
    August 5, 2009

    What you really need is more nitric oxide and the rest of the stuff will take care of itself. The perfect time to try starting it is when you are on vacation away from civilization; where not bathing is not seen as aberrant behavior.

    What more NO does is increase mitochondrial number so that less glucose is needed (due to less glycolysis and more oxidative phosphorylation) and reduce capillary spacing which improves glucose delivery. NO also reduces the chronic inflammation by inhibiting NFkB and reducing the hypersensitivity of mast cells.

    What makes you feel hungry is not enough glucose where you need it most, in the extravascular space far from the vasculature (where you can’t measure the glucose level).

    If you are not brave enough to raise your NO level via my technique, then eat a lot of lettuce (few hundred grams) several times a day. It has a few tenths of a percent nitrate and that does make some nitrite via commensal nitrate reducing bacteria on the tongue. It isn’t the same as NO/NOx on the skin, but it is better than nothing. The lifetime of nitrate in plasma is fairly short, so you need it several times a day. The salivary glands concentrate it 10x over plasma to ~2 mM/L in saliva where the commensal bacteria on the tongue reduce it.

  17. #17 jon
    August 5, 2009

    You will certainly fail, based on your current attitude. You may lose some weight, but you’ll gain it back again. You don’t need a quick fix diet, you need to stop overeating and start burning more calories.

    I’m 57 and have always been in shape. In order to stay in shape, I’ve had to continually adjust my diet and workouts. At 25 I was eating everything I wanted and working out about 3 hours a week. Now, I eat fewer calories, lots more veggies, and rarely eat pork, beef, or chicken; and I work out 5 – 6 hours a week. This sort of lifestyle adjustment is true for virtually everyone in my cohort who manages to stay fit.

    And don’t be so sure that 175 doesn’t fit your frame. Just because you’ve always been a chub, doesn’t mean that there’s anything natural about your physique. I know the rule of thumb is weigh within 10 pounds of what you weighed in high school, but it sounds like you were fat in high school too.

    Get off your ass and get to work.

  18. #18 Manduca
    August 5, 2009

    If you are walking around starving hungry, this isn’t going to work. (Or, rather, *I* can’t go to sleep if I’m hungry. And *I* am subject to compulsive eating when I’m very hungry.)

    Rather than go on a diet, try to figure out what changes in your diet and exercise you could make, for good, forever.

    For example, do you drink anything with calories in it at meals, and could you stand to switch to water?

    Do you put sugar in your coffee, and could you learn not to?

    Could you make a hard-boiled egg and a bag of cut up vegetables your routine lunch?

    Do you keep any food in your desk, and could you stop doing that?

    Do you have economy size packages of cookies and chips at home, and could you not stock those?

    Can you park farther from your office?

    Can you weigh yourself daily instead of weekly, and make an Excel spreadsheet that plots weight, 30-day average, 30-day high, and 30-day low? Mine really keeps me honest, shows me the long reach of a single cookie gorge episode, and lets me distinguish signal from noise. (But then, I *love* data and data analysis!)

    I lost 15 pounds (and 2 pants sizes!) almost effortlessly by making changes like these routine. I started out just hoping to stop the creeping gain.

    P.S. Good luck. As we know, from the data, this is not an easy path.

  19. #19 Rita
    August 5, 2009

    It’s interesting that there are very few fat vegans, probably because we don’t eat animal fats or any of the sweet products which include animal products – this we all know, but what I find especially significant is the counter-intuitive finding that it’s easier to stop eating these unnecessary foods for ethical reasons – e.g., when people are convinced that exploiting other species is wrong in itself.
    Perhaps if the obese dedicated the money they save on not eating whatever foods to those in need (if they can’t get their heads round veganism), they might find it a bit easier to curb unwanted and destructive eating habits – your conscience can save your hide! (As well as other peoples’/species’).

  20. #20 PalMD
    August 5, 2009

    My conscience allows me to eat any damn thing i want. Also, I know fat vegans, and my anecdote is more powerful than your anecdote.

    @Manduca—a diet by any other name : )

  21. #21 Russell
    August 5, 2009

    Let me add my voice to those who have said that any diet that requires you to suffer through it will bring only temporary results. Permanent result requires figuring out permanent changes in habit, changes that leave you satisfied. I enjoy food more now than I did when I was eating a lot of junk food. It took some effort to figure out how to do that, though. Junk food succeeds because the food industry has figured out how to make immediate gratification available at almost every turn.

  22. #22 JohnV
    August 5, 2009

    Hah, didn’t think the evangelical vegan shtick could have been more irritating.

  23. #23 Donna B.
    August 5, 2009

    Good luck, Pal. May you achieve your goal without too much pain and hunger.

  24. #24 Denice Walter
    August 5, 2009

    Good luck.My mother was a *fashionista* who worked in the “rag” trade: in middle age, she developed severe arthritis and gained weight – which she really hated- it also led to other problems, including diabetes. She always encouraged me to exercise -she paid for dance lessons,skates, skis, tennis racquets… and clothes.Thus,I am motivated by both vanity and fear.One of my sure-fire solutions is to keep a pair of really old Calvin Klein jeans and periodically try them on;I schedule exercise regulary (FIT TV dance “class”; tennis).Still. it’s not easy.Hey, maybe you can buy the canoe-equivalent of a “rower” machine and “paddle” all year at home.You have to *like* an activity and have it easily accessible to keep it up for long periods of time.

  25. #25 Mary
    August 5, 2009

    Pal, as a former personal trainer, aerobics and yoga instructor, I can tell you that you need to move more (and eat less). Weight loss was the hardest goal to accomplish among my clients. Those who were looking to gain strength, flexibility, recover from injury, etc. were much more successful.

    I used to move about probably 6-8 hrs. a day and consumed whatever I wanted. Now that I’ve changed lifestyles, I’ve put on 15 lbs., because I’m not as mobile.

    Get motivated, get a friend, loved one or personal trainer to help, and get moving. Find something you enjoy that you will happily do for an hour or so a day. If you hate jogging, it won’t work. If you love walking your dog or dancing, it will. But you have to incorporate the change into your lifestyle knowing it will be permanent. Diets rarely are. You CAN do it, but YOU have to do it.

    Yes, I was wildly successful in that former career.

  26. #26 Katie
    August 5, 2009


    It’s a free site that is a huge help in implementing life-long eating/exercise/weight loss changes (as opposed to dieting). I lost 18 lbs to hit a BMI of 21 in a few months while rarely feeling hungry.

  27. #27 Barn Owl
    August 5, 2009

    I’m still coming to grips with the fact that, for most people, maintaining fitness and a healthy weight in middle-age requires more exercise and less food than in young adulthood. Good luck with your weight-loss program PalMD; I’m working on my own program, since I tipped into the overweight BMI category this year, after surgery-induced early menopause. Probably correlation, not causation, but nevertheless, Ugh!

    I’ve cut calorie intake, but for me, nothing works as well as increasing exercise levels. I walk my dog every night, but that’s not nearly enough. Certain types of yoga (Iyengar, in my case) don’t work as weight-loss activities either. I have to swim, cycle, ride/play polocrosse, or run, for the workouts to have an effect on my weight, and I try to get in a mix of all four each week. Even then, weight loss is depressingly gradual. However, I’m lucky in that my cholesterol, blood chemistry, and blood pressure levels have all remained within very healthy limits.

    I think you find out who your real friends are when you’re trying to lose weight and/or increase fitness, whether you’re changing an obese and inactive lifestyle, or a somewhat overweight and relatively fit one. Some people will do nothing but criticize and project their own fears and prejudices, while others will support and facilitate your efforts, without getting in your face. One of my friends in grad school, who was a competitive middle-distance runner, used to swing by my house during her workout, and run three to five miles with me. She encouraged me to push myself with pace and distance. Another friend here offers to split the cost of bulk packages of organic fruits and vegetables, and other healthy foods, at Costco. We also compare experiences with the relative merits of the different exercise equipment available at the gym … like the “dragon chase” game on the stationary bicycle, which keeps obsessive-compulsive types (like us) peddling away in pursuit of just a few more points.

  28. #28 PalMD
    August 5, 2009

    OK, I’ve been informed by a noncrackpot that my plan blows. We’ll see what she has to see and if it makes sense, the plans gonna change.

  29. #29 Casz
    August 5, 2009

    I’m in the same boat as Barn Owl, I don’t loose weight unless I exercise. But I found activities I enjoy and people to do it with.

    Good luck with your effort. You’ll get less hungry after awhile:)

  30. #30 D. C. Sessions
    August 5, 2009

    OK, I’ve been informed by a noncrackpot that my plan blows. We’ll see what she has to see and if it makes sense, the plans gonna change.

    The knees strongly suggest low-impact (I can identify, in spades.)

    What works for me is that I have a room set up with a 42″ monitor, PC driving it, wireless remote to control the PC, a stair machine and a weight machine. Lots and lots of music, video, and e-books on the PC so I can go for hours without getting bored.

    No writing, but if you’ve got stuff to read it’s awesome.

    45 minutes a day on the stair machine first thing in the morning, no exceptions, with weight work somewhat less consistently. Main limiter is the collection of orthopedic issues I have with my lower legs. Your mileage may vary, but since you’re another morning person you might consider it.

  31. #31 Donna B.
    August 5, 2009

    No one in their right mind would listen to diet or exercise advice from me, but my son tells me that the elliptical machine is great for him because of his orthopedic problems.

  32. #32 palmom
    August 5, 2009

    Keep moving- seems to work. Good luck!

  33. #33 PalMD
    August 5, 2009

    Maybe they’ll be less of me when you get back, mom

  34. #34 Zuska
    August 5, 2009

    A friend of mine has been following the guidelines laid down in a book called Fight Fat After Forty over the past 6 months and has dropped twenty pounds. She says she’s done it while eating more food than she ever did on any other diet. She says she never feels hungry, and indeed, some days wonders how she can get in all the food the diet calls for eating. As I understand it, it’s a three meals, three snacks kind of plan. She looks great and feels healthy and it was not a rapid wild weight lost but rather a steady sustained one.

  35. #35 Laura
    August 5, 2009

    Good luck Pal
    My 2 cents is try to eat low GI foods and eat small meals frequently and try to keep a food diary which is a pain I know but its the best way to keep yourself honest with how much you are consuming its so easy to forget about the calories in say a handful of chipw. I am trying to start doing that myself. Other than that exercise and try to make small changes you can stick with long term. Best of luck.

  36. #36 Chris
    August 6, 2009

    How is this for silly motivation for exercise: Our shower is out of commission. I could use the basement shower, but I have decided to just go to the pool, swim for 30 to 60 minutes (anywhere from 800 to 1500 yards), and then use the shower.

    I am not losing any weight, but my back and legs are stronger, and I sleep better at night.

  37. #37 Michael Simpson
    August 6, 2009

    I’ve probably lost and gained 2000 lbs over the past 20 years. OK, I might be exaggerating a touch. Anyways, I’ve lost 55 lbs over the past 6 months. What did I do? Nothing special. I counted calories using some high tech program on my Mac and iPhone. I have an obsessive mathematical personality, so it’s fun. And I bought an elliptical machine, and do 90 minutes of exercise every day of the week. I now catch up on my TiVo during the exercise. It’s all a balanced equation. My basal metabolic rate plus exercise must exceed my food intake by 1000 calories a day.

    My BP dropped from 135/85 to 122/80. My cholesterol has always been good, now it’s really low. And I don’t feel like I’m going to die tomorrow. And I’m at the smallest waist size in years.

    My point is I don’t think there’s a magical way to lose weight. I wish there were, because I know I could get rich on writing the book. Maybe I’ll write it anyways. 🙂

    The best advice I know is to keep a diary. There are some cool programs where you can put in the two slices of wheat toast and 1 boiled egg, and get exactly what you consumed.

  38. #38 Woronov
    August 6, 2009

    Sorry about your back, I hope it improves.

  39. #39 Kim
    August 6, 2009

    It’s not rocket science from a metabolic perspective: Eat enough protein and high-quality fat to meet the body’s maintenance needs and adjust carbohydrates to suit activity demands. Unfortunately it’s a lot harder with human psychology and social pressures thrown in. Best of luck with it.

  40. #40 Woronov
    August 6, 2009

    Anyway, I maintain my weight and fitness with an hour of cardio, either running or elliptical, most days of the week, burning at least 1000 calories during those sessions, which for people without back problems is pretty easy. It equates to running at 8-8.5 mph which for the beginner might seem daunting, but the beginner can easily achieve that level of energy expenditure on the elliptical. I have a herniated disc too (I believe you mentioned yours is herniated?), but so far I’ve been lucky in that running does not usually trigger sciatica. If I was not able to run I would probably be 15 lbs. heavier because I weighed that much more before I started working out. If you can manage the elliptical without it triggering back and leg pain, you would not need to restrict your diet as much as you’re planning and you would find it easier to stick with your weight loss program. Obvious advice I know, but none of the commenters have taken into account how important the disc problem is.

  41. #41 Dianne
    August 6, 2009

    I’ve only skimmed the comments so maybe someone’s addressed this already and I missed it, but just in case: Snoring and weight gain. Have you been tested for sleep apnea? Especially if you’re having any other symptoms like unrestful sleep, etc. And get your thyroid checked while you’re at it. It’s probably fine but couldn’t hurt to make sure. (Yes, I know you know everything I just said. But have you applied it to yourself?)

  42. #42 PalMD
    August 6, 2009

    Had a sleep study a long time ago, when I was fatter, and it was more or less OK. I’m fairly certain there’s a sleep apnea component, which improved after my tonsils came out, but worsened when i gained weight. Whenever I lose weight, my sleep and wakefulness improves, so I’m hoping to avoid further intervention.

  43. #43 daedalus2u
    August 6, 2009

    A correlation with sleep apnea, insomnia and wakefullness could be mediated through NO.

  44. #44 PalMD
    August 6, 2009

    Of course it could : )

  45. #45 Tsu Dho Nimh
    August 6, 2009

    I tell my patients that if they don’t feel miserably hungry, they’re probably doing something wrong

    You’re doing it wrong! People who get to the point where they feel miserably hungry are the MOST likely to pig out, then beat themselves up, then give up.

  46. #46 soma
    August 6, 2009

    This all sounds like discussing religion or politics, doesn’t it. I got here from a link on Science-Based Medicine, so how about some science?

    There is no substantial disagreement among anthropologists that when humans were primarily hunter/gatherers they were healthier, hardier, larger, stronger, and they bought NO food from the inner aisles of the supermarket.

    But after a few hundred thousand years of adaptation they had killed and eaten most of the large game, so some ingenious folks began to engage in agriculture. If the few hundred thousand years of adaptation is like your lifespan up to now, agriculture began about yesterday, and you’ve had about five minutes to adapt to all of the crap food and drink that occupies the vast acreage of the supermarket’s interior, having been assembled from the materials produced by factory farming.

    And all that refined carbohydrate intake: it’s all just saccharides, isn’t it. And our digestive system is very efficient at snipping those bonds to convert the polys into monos, assembling the triglycerides, then storing it as fat. All the while cranking out the insulin. Back in the stone age, when I was a kid, everybody knew, and my mom used to remind me; Don’t eat so many sweets – they’ll make you fat and give you sugar diabetes! (Yeah, they called it SUGAR diabetes back then) And don’t climb that tree: you’ll fall and break your neck!

  47. #47 PalMD
    August 6, 2009

    @Tsu Doh Nimh
    Yeah, you’re probably right. The biggest problem with my patients is they are looking for ways to eat whatever they want, feel un-hungry and lose weight. Generally, if you’re gonna lose weight, you’re gonna be hungry.

    Yeah, soma, that whole paleo diet thing is a load of hooey. Evidence about weight loss shows that diets of any composition, as long as they are calorie-restricted, work equally well. Long term support type programs like weight watchers have the best long term results. Quick fix diets fare the worst.

  48. #48 Dianne
    August 6, 2009

    ARe you getting enough sleep? Not to mention calcium? Not to harp excessively on the sleep issue, but it may be a factor.

  49. #49 daedalus2u
    August 6, 2009

    Dianne, not enough sleep is mostly an effect and not a cause.

  50. #50 catgirl
    August 6, 2009

    After about a week, you will hopefully get used to the new amount of food and not feel hungry anymore. If that doesn’t happen, maybe you should try a different diet because it’s really hard to stick with it if you feel miserable.

    I’ve tried Weight Watchers, and there are some great things about it. I did the Points thing, which meant I could have anything I want, just not everything I want. I think Weight Watchers is the only diet that has been studied and shown to be actually effective, so there’s that.

    I’ve also used Nutrisystem, which worked really well for me. I rarely felt hungry and I fell into the habit so fast that it just became routine. I imagine that it would be much harder with a family around eating different things though. Opinions vary on the food, but I thought most of it was OK, some of it was really good, and a few things were just terrible. But that wasn’t a problem because you can pick which foods you want.

    Like you said, any diet that reduces caloric intake below the level of what you burn will be effective. The real measure of a good diet is how long you can stick to it, and that varies by person. Find the one that makes you feel least miserable.

    Also, ignore all “common sense” and go with the evidence. I’ve heard a ton of well-meaning “advice” that is nothing more than a bunch of old wive’s tales. Weight loss is the one area where it’s very easy for people to forget about evidence.

  51. #51 JohnV
    August 6, 2009

    A week is all it should take to not feel like crap because you’re not eating “enough”?

  52. #52 katie
    August 6, 2009

    I’ve been using the Hacker’s Diet: http://www.fourmilab.ch/hackdiet/online/hdo.html

    Mostly because it’s more or less a calorie-counting approach (just like Weight Watchers) without the expense. And it’s written for and by mathy people like me, so I enjoy the approach.

    I’ve lost 15 pounds in the last few months on it…And as much as I know exercise is good for you, I’ve actually dropped a lot of my normal exercise because I find it makes me really overly hungry (I still bike 30 mins to/from work a day). I’m slowly easing back into the exercise now that I’m used to smaller portions and less carb.

    The only weird thing is that my bp is now really weirdly low: 100/55.

  53. #53 Charlotte
    August 6, 2009

    soma, the ~6000 years since the advent of farming in Europe has been long enough for mutant freaks (like me) to evolve lactase persistence – probably several times, independently. So don’t worry too much about the lack of mammoth steak in your local supermarket.

    Sanctimony aside, I found that adding up the amount I was spending on junk food, and giving the same to charity, was a reasonably effective way of controlling my weight. I reasoned that if I could afford that much chocolate, I couldn’t be too broke to donate. My hypothesis is that the success of this method depends on (i) a person’s dietary vices and (ii) their excess money:excess weight ratio.

  54. #54 Rogue Epidemiologist
    August 6, 2009

    Good luck, PalMD. I’m also trying desperately to lose weight. I’m not huge, but my BMI is up to 26, and I’m trying to bring it down to 21. My weight has been gaining in the last few months. I think it’s because I’ve hit that age where my metabolism is slowing down.

    Exercise is not a problem for me. I’m an avid recreational athlete. I play a lot of soccer and I hit the gym 8 or 9 times a week (at lunch and after work most days).

    But it’s FOOD. I have the worst time trying to figure out my nutritional needs. Too much or too little, I never get it right. I’m playing in a tournament, do I need 1900 Calories today? I’m chilling out at home and I’m not hungry. Rats, I didn’t clear 900 Calories ’cause I was too lazy to eat lunch (yes, there is a point where you are so slothful that you can’t be arsed to get up and feed yourself).

    Anyway, I’m taking a multidisciplinary approach here, so if you want some off-blog weight management support, feel free to drop me a line. Otherwise, you have my support in solidarity.

  55. #55 Patient
    August 6, 2009

    Good Luck PAL, on your quest for weight loss. I realize you are not a fan of anectdotal reports, but I do have to agree with soma (#46)and tell you that I lost 100 lbs on the paleo diet and it wasn’t due to lack of calories—I was eating and exercising the same as usual, and the pounds just flew off and I wasn’t hungry at all.

    I have no scientific explanation for the way it worked, but the arguments in favor are quite interesting given that finely pulverized grain flour did not become a part of the human diet until after 1850, and additional food additives, and trans fats continued to be developed along with the waistlines of Americans all through the 20th century. There IS something about the Western diet that must be at the root of obesity; the question is WHAT, and my personal experience (after struggling for many years with this issue) gives me a certain respect for the paleo viewpoint even though I certainly remain a skeptic about many of the assertions of the diets’ proponents.

    I suspect that one day we will find out the answer to this diet riddle; in the meantime I would urge you to keep an open mind about the perils of processed foods. As Michael Pollan in his recent book “In Defense of Food” states:

    “Eat food. Not too much. Mostly plants”

    Keep this in mind, and you should do well.

  56. #56 Kim
    August 6, 2009

    Apparently UCSF is a hotbed of cranks messing with hooey lately. Here’s what some of them have been up to:

    (Granted the study size is small and controlling to prevent weight loss makes it not completely relevant to your efforts…but given the choice I’d rather go for improved metabolic markers and hope the weight loss follows.)

    Here’s another UCSF faculty crank, giving a talk: http://www.youtube.com/watch?v=dBnniua6-oM

    (Not paleo, but definitely veering from the “calorie is a calorie” path in a paleo-friendly direction with pretty clear explanation of why that might be so.)

  57. #57 Arturo S
    August 7, 2009

    No! Hunger is no the best way to lose weight! Exercise is also not the best way to lose weight (you don’t burn that many calories working out, though the other benefits make it worth the effort).

    When you are hungry, your body switches wants to save energy, so your basal metabolic rate will go down. The point is to keep the basal rate up, by eating small portions all day long. 5 meals a day (the 3 ‘big’ ones, plus 2 snacks). The other benefit with not being hungry is that it reduces the probability you will overeat when you do.

    As has been mentioned before, switching to low-calorie density foods is also a big part of it. We shouldn’t mix two types of animal foods together (since it’s easier to make it calorie dense with all the fat).

    We should also keep in mind that switching to calorie free sweeteners can help but they are not innocuous. It is better to drink a diet coke than a normal one, but all those artificial sweeteners still trick our bodies. It will think that it is getting glucose and release insulin, making it diabetogenic.

  58. #58 k
    August 7, 2009

    For the person above eating 1000 calories a day but not losing much, there is a lot of “anecdata” showing that women in particular who eat too few calories just stop losing weight. Once a physically active woman ups her calories to 1800 from 1200 (for instance) weight loss often becomes easier. It’s true for me — seriously, I tried last summer at 1200 a day and I was a b**** and unhappy and did not lose weight. This summer I’m making a conscious effort eat ~1800 a day, mostly greens and some meat regularly, and I now weigh less. (I have also exercised less, as last summer I biked 50 miles a week and this summer I was bike-less for seven weeks.) I don’t understand, but the data in my life show that a calorie is not just a calorie (I tracked activity and food intake faithfully in Fitday, and can compare the two summers).

    Cutting down on the flour-based products has really helped, I must say. While I get fewer bread/pastry-sourced calories, I’ve made up for it in meat consumption (grass-fed local blah blah) and I’m still slimming down! Why?!

  59. #59 drcharles
    August 7, 2009

    Some very good discussion on this post, and I wish you success. I just wrote a post today that might be of interest, highlighting how overrated exercise is as a means to weight loss, but that exercise is still very important for overall health:


    I’m also a fan of Michael Pollan’s book “In Defense of Food.”
    Take care!

  60. #60 anon
    August 7, 2009

    The one really bad thing about going on a diet in public is having to hear everyone else’s usually negative opinion about it.

    Either they’re criticizing you for doing it wrong or they’re criticizing you for doing it all. Even if you do it and get the results you want, they’ll tell you you did it wrong and that you’ll gain it all back anyway.

    What’s the psychology behind that, I wonder? Is it envy?

  61. #61 PalMD
    August 7, 2009

    I’ve used the Pollan quote in several posts about woo diets…it’s a good one.

  62. #62 Kalieris
    August 7, 2009

    Sending supportive encouragement your way. I definitely relate to the husky jeans (although girls’ jeans had some other unencouraging moniker besides “husky” – can’t remember it now). Was diagnosed with diabetes and high cholesterol a few months ago, so am also in full-on calorie restriction / increased exercise mode.

    Not hungry or miserable though – I’m pretty much doing the “eat food, not too much, mostly plants” approach mentioned above, and making sure I eat every 2-3 hours. Packing food to take to work has also been essential for me, because I can invariably make tastier and more low cal things than I can buy. I record everything I eat, and have a plan for the week that details exactly what each meal will consist of.

    It’s actually a lot of food (had some left over today as a matter of fact, which was a really weird feeling – usually food hasn’t got a chance if it’s within 2 feet of me) but I’ve lost 6 pounds in the last 2 weeks and my fasting sugars are in the 100-110 range (albeit with meds, but they were in the 120-130 range two weeks ago on the same meds). They were over 275 three months ago at diagnosis.

    What’s been key is not torturing myself, and looking at everything I eat as an opportunity to be kind to myself. It’s definitely made a difference to view a cheeseburger as something that will undo all my hard work versus a yummy treat that I am depriving myself of.

    Sorry to be so long-winded, and hope that you find an approach that works for you.

  63. #63 Candid Engineer
    August 8, 2009

    Pal, good luck on your mission to lose weight. I, too, know how frustrating it is. And I agree with the others that if you’re hungry, it’s not going to work. You need a lifestyle change, not a quick fix, and even small changes, over time, are quite effective. All the best, CE

  64. #64 khan
    August 8, 2009

    Always ‘serve’ meals: food on a plate, you sitting at a table, don’t multi-task

    Use smaller plates and bowls.

    Lots of low carb fruit and veggies; whole grains
    google: volumetrics

    And I believe a previous poster was correct about not eating too little.

    #62 – girls’ designation was ‘chubbete (sp?)’

  65. #65 julie
    August 9, 2009

    I’ve lost 43 pounds in the last year or so, and I avoid going hungry. if I get too hungry, I’ll eventually snap and eat the first thing I find, and a lot of it. I just got fatter doing that, not effective at all. I deal with this by eating fruits and veggies, lots of them. When I eat bread, I eat hippie crunch 12-grain kind, brown rice instead of white, beans, high bulk. I also eat less overall, and better. I don’t do low-fat (except for 1% milk), don’t like meat (except bacon and a very occasional hamburger) love fish, fruit, raw veggies (trying to like them more cooked) and cheese (what can I say). Tolerate most other stuff, to some degree. I eat everything that I can, because I’m picky enough that if I can only eat diet food, I really would starve. I just eat less if it’s heavy. I exercise an hour or two most days, and I mix it up. I do strength training, kickboxing, step, hiking, bike riding, zumba. I think this allows me to be more lenient with food than most [traditional] dieters, but I won’t lose weight unless I mind my food intake. Forever.

  66. #66 Adela
    August 11, 2009

    Chronic health problems killed my activity levels and I did not adjust my diet down to deal with it so I ballooned up making the underlying problems worse and placing me at high risk of complications. I have now dropped 30 pounds over 4 years and thus entered a lower risk group. Just basic 4 food group pyramid and walking. Slow gentle long term and lasting. If I give up my remaining 3 vices the next 30 pounds will also happen and then I will be back to normal weight but alas my sanity comes first for the time being but I know it can be done when the time comes.
    I have learned that we do not objectively and accurately assess our calorie exercise ratio and that was made clear when I documented everything and crunched the numbers.

  67. #67 kismet
    August 13, 2009

    So…I’ve lost about 20 pounds in the last four months and I have not been miserably hungry but for a few isolated occasions. Keeping a constant, manageable deficit is where it’s at, you won’t be able to stick to it if you’re feeling pain. I have one of these and the trainer says that what most people can comfortably stick to is a 500 calorie/day deficit, enough to lose a pound a week. I went on one of those extreme lowfat diets back when Dr. Ornish was all the rage in the 90s and ended up fatter than ever because the fatlessness and proteinlessness of it all left me ravenous all the time. The protein for breakfast thing really works. Make sure you get a good mix of protein/fat/carbs and not just lowfat carbs.

  68. #68 Katkinkate
    September 4, 2009

    Good luck mate. Show us how it’s done.

  69. #69 kiwis can fly
    November 1, 2009

    “I tell my patients that if they don’t feel miserably hungry, they’re probably doing something wrong—so far, I’m doing it right.”
    You couldn’t be more wrong, and you’re doing it completely wrong. Google Mark Sisson, Michael Eades, etc., get on a low-carb/primal diet and eat as much as you want while getting very lean + healthy.

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