Participants: N. David Emerson
Series Code: WM
Program Code: WM000431
00:36 Hello, I'm Dr. Emerson, Medical Director at
00:39 Eden Valley Lifestyle Center 00:41 I wanted to talk to you today about obesity, weight control 00:44 as it's part of the insulin resistance syndrome. 00:48 We want to ask ourselves... 00:49 "What causes people to be too heavy?" 00:53 Most of us have been brought up with the idea that it's 00:57 too many calories in - too few calories out - 01:01 and that will cause weight gain. 01:03 But we want to look at a group later on that actually 01:07 is no more active than the average American 01:11 eats 30% MORE calories than the average American 01:15 and yet weighs 20% LESS 01:18 We want to show you how you too can actually eat MORE 01:21 and weigh LESS 01:23 How is obesity defined? 01:26 Well, it's defined as a body mass index... 01:29 that's your weight in kilograms divided by your 01:32 height in meter squared, and that's called the 01:34 body mass index... BMI for short 01:36 A normal BMI is 20 to 25 01:39 Overweight is 25 to 30 01:43 Obese is 30 to 40 01:46 Morbidly obese is over 40 01:50 Morbid means disease or sickness, 01:54 and we find that obesity can indeed cause 01:57 disease and sickness. 02:00 Now, you don't actually have to calculate your body mass index 02:04 There are charts that are available where you 02:07 look across the top, and you find your weight 02:11 and then you move down to your height to find 02:15 your body mass index... 02:16 And as you move down looking for your height, you may find that 02:19 you're too short for your weight. 02:21 How big a problem is obesity? 02:26 Well, an American, as of 2002, 02:29 1 in 4 American adults have it. 02:31 It costs 17 billion dollars a year to treat the diseases 02:37 that are made worse by obesity... 02:39 And it killed about 300,000 Americans each year. 02:45 It contributes to medical problems such as 02:47 diabetes, heart disease, hypertension, sleep apnea 02:52 gallstones and osteoarthritis... 02:55 making these problems worse, more difficult to control. 02:58 It actually also increases your risk of sudden death 03:05 The risk increases dramatically when your body mass index 03:09 goes over 29. 03:13 Your risk of premature death, if you're in the obese range, 03:18 increases by 50 to 100%, but even mild degrees of 03:23 being overweight 10-20 pounds can confer an increased 03:27 risk of death, especially in 30 to 64-year-old age group. 03:32 Now apart from the health risks, there's also a social stigma... 03:39 People don't like to be overweight. 03:41 In fact, if I want to talk to a group of nurses about a 03:45 health topic, on making rounds, 03:47 all I have to do is start talking to one of the nurses 03:50 about weight control, and VOOM... 03:53 the whole nursing floor is there and they want to hear about it 03:56 It's a hot topic usually on the floors. 04:03 How does obesity rank in terms of prevalence? 04:10 Is it growing in problem, or is it being alleviated? 04:13 And actually, we're finding that it is increasing at alarming 04:17 rates in terms of prevalence. 04:19 On the West Coast... the West Coast tends to lag 04:23 behind the East Coast in terms of the prevalence of obesity, 04:27 were usually 5% less in prevalence on the West Coast 04:32 But we're finding that every 10 years, 04:36 the prevalence has been increasing since about 1991 04:40 by about 10% every 10 years or so. 04:42 On the West, it used to be anywhere from 10% or less 04:51 as of 1991, but as of 2008, it has increased to 04:58 somewhere around 20 to 25% on the West... 05:02 And on the East Coast, in the 1990s, it was 10 to 14% 05:05 and now it has increased to 25 to 30%. 05:09 The problem is getting to be so bad 05:11 that actually one of the airlines made a rule that 05:15 if you are too large to fit in one space, 05:19 you were required to buy 2 spaces. 05:21 And I remember seeing a little cartoon that showed this 05:23 beanpole of a guy going up to the airline ticket agent, 05:28 and she is responding and saying... 05:30 "No sir, we cannot sell you half a ticket. " 05:33 So, he wasn't able to get a discount being thin. 05:38 How do we treat obesity? 05:42 How do we solve the problem? 05:46 First of all, does a low-calorie diet work? 05:52 News stands carry a new diet every month. 05:57 These are usually low calorie diets. 05:59 Presumably, they have a low calorie diet every month 06:03 because the last one didn't work. 06:06 The issue of McCall's, January 1992, ran a story 06:12 about Oprah... 06:14 She had lost 67 pounds 2 years previously 06:20 and all the world rejoiced. 06:22 However, the world was very saddened at the time of this 06:28 article, because she had regained all the weight 06:31 that she had lost. 06:33 Dr. Callaway, in an interview on the next page, 06:37 actually reviewed the low calorie diets, 06:41 and showed that her failure was predictable... 06:46 that it was expected... 06:47 and then he goes on to explain why it's predictable... 06:51 why a low-calorie diet is actually doomed to failure 06:54 and will actually cause INCREASED weight gain 06:57 in the long run. 06:59 The page, describing the interview, had a picture 07:03 of her, and the caption showed "slender or starved" 07:08 And the question is, "Do we have to be starved 07:11 in order to be slender? 07:13 We want to actually show, and give evidence today, 07:17 that... no, you don't have to be starved to be slender. 07:21 Well, where did our understanding that low-calorie 07:24 diets were not helpful actually begin? 07:26 It started around 1959... 07:29 Stunkard and McLaren-Hume reviewed the low-calorie diets 07:33 over the previous 30 years, and they found that 07:35 7 of them were very good, and were considered 07:40 well-conducted. 07:42 So they looked at those 7, and they found that 07:43 all but one of them had a maximum weight loss 07:46 of only 20 pounds or more for less than 30% of the patients. 07:54 Less than 8% of the patients lost 40 pounds or more. 07:58 And they asked themselves, "Why the failure? 08:00 Why doesn't a low-calorie diet work long-term to help 08:05 patients lose weight?" 08:06 So to investigate, they did their own study. 08:08 They looked at the next 100 patients that were 08:11 coming to their clinic, and they put them on an 800 to 1500 08:14 calorie per day diet. 08:16 Now to give you perspective, a normal adult male 08:18 usually take about 2500 to 3000 calories per day... 08:23 So they were getting less than half the normal 08:25 amount of calories per day. 08:27 At the end of the treatment program, 08:30 only 12 out of 100 patients lost 20 pounds. 08:33 After 1 year, only 6 were able to maintain this weight loss 08:39 and after 2 years, only 2 out of the initial 100, 08:42 were able to maintain their weight loss. 08:45 And they asked themselves... "Why? Why the dismal failure?" 08:48 Well, they interviewed the patients, 08:50 and they found that nervousness was one of the problems. 08:54 Weakness... of course they had no calories, 08:56 so, of course, they were weak. 08:58 Irritability was another symptom fatigue, nausea 09:02 One patient actually had increased nervousness, 09:06 developed a schizophrenic reaction; 09:09 he was admitted to the hospital, and he gradually 09:11 regained most of the weight he had lost. 09:15 So, the question then is... "Why doesn't a low calorie 09:19 diet work?" 09:21 Well to look at this, we want to find out actually how 09:24 God designed our bodies. 09:26 God actually designed our bodies to adapt to whatever 09:30 stress we put it under. 09:31 Do our bodies adapt to exercise? 09:35 Well, we all know that it does. 09:37 If we exercise, lift weights, run... our musculature 09:42 gets stronger to adapt to the stress we're putting it under 09:47 But many of us don't consider the fact that possibly our 09:52 bodies can adapt to starvation ALSO to protect yourself 09:56 from dying from too few calories. 10:00 So we want to look at how our bodies adapt to starvation 10:03 Two studies give light on this interesting concept. 10:08 In 1919, the Carnegie Nutrition Experiment was done 10:11 Patients were put on a 1400 calorie per day diet. 10:16 Now the body immediately compensated. 10:20 What happened was the metabolism slowed down, 10:23 and this would be reasonable if you lose your job, 10:27 and you don't have money to pay the power bill, 10:29 you turn your thermostat down. 10:31 If the body is not taking in the calories it desires, 10:34 it turns its thermostat down too. 10:36 The metabolism dropped... 10:38 Body temperature dropped... 10:39 Blood pressure dropped... 10:41 Heart rate dropped... 10:42 Oxygen consumption dropped... 10:44 CO2 production dropped... 10:45 They were burning less calories. 10:47 They were radiating less heat. 10:49 They were conserving calories. 10:51 AND they became much less active. 10:54 If you've ever been on a water fast, 10:57 cutting back the calories dramatically, after a day or 2, 11:02 your energy level is at a low point. 11:05 You might be looking out the window, and say.. 11:07 "Ah, that's an interesting bird, I'd like to get a closer 11:09 look at it" and you're about to get up 11:11 and you think... "Nah, maybe I'll just sit here, 11:14 and not look at the bird" 11:15 because the energy level is so low. 11:17 This is what they noticed in that Carnegie Experiment 11:21 When they came OFF the diet, the fast, the low calorie regime 11:27 ...they found that they actually gained MORE weight 11:31 than they had initially lost during the starvation period. 11:34 Well, later, after World War II, they did another study 11:40 They were going to go in to free starvation victims 11:44 and they found that if they fed these starvation victims 11:48 too fast, they died... suddenly the heart would stop 11:52 And so, they needed to study starvation, 11:55 and how to re-feed starvation victims. 11:58 So they took 32 conscientious objectors, 12:01 and they put them on a semi-starvation diet 12:03 for 6 months. 12:05 The normal things that you expected would happen happened 12:09 Of course, the metabolism slowed down. 12:11 They were starting to conserve calories again 12:15 and they became much less active 12:17 What they then found was that the weight dropped as well 12:23 ...and this wasn't surprising 12:25 The muscle mass dropped to about 60% of normal 12:30 The body fat also dropped to about 33% of the 12:34 original body fat weight, and the metabolism was much lower 12:40 This was at the end of 6 months. 12:42 Then, they re-fed them. 12:44 They gave them their normal calorie intake, 12:46 and what surprised them was the response the body had 12:49 to this re-feeding. 12:51 As they re-fed them, the muscle mass slowly increased 12:55 At the end of the year, it was still a couple of pounds 12:58 below what it was before the fast. 13:00 The metabolism also slowly increased, 13:04 but at the end of the year, it was still several notches 13:07 below what it was before they started the fast. 13:12 But body fat, jumped up and at 33 weeks, 13:16 it was about 10 pounds MORE than the body fat weight 13:21 before their fast. 13:22 It jumped and peaked at about 32 weeks, slowly came down, 13:26 but at the end of 1 year, the body fat was still 2 to 3 pounds 13:30 ABOVE what it was before the fast. 13:33 The question is... "Why did the body do this?" 13:35 Why did the metabolism come up only slowly, 13:38 and stay below what it was before the fast? 13:40 Why did the muscle mass not come back up to normal, 13:43 but stayed below normal... 13:44 and why did the body fat go VERY high... 13:47 ABOVE what it was before the fast, 13:49 and only slowly come down toward normal still remaining 13:52 a couple of pounds above what it was before the fast? 13:56 Well, the body was again adapting to starvation. 14:00 At the end of the starvation period at 6 months, 14:03 the body now was re-fed, and the body said... 14:06 "You know, we've just come through 6 months of starvation, 14:09 we now have calories... we'd better prepare 14:13 for the next starvation. " 14:15 So, to prepare for the next starvation, 14:18 we're going to keep the muscle mass low, so we have less 14:21 muscle to feed... 14:22 We're going to keep the metabolism low, so that 14:24 we're burning fewer calories, so that we can 14:27 save more calories in terms of fat, 14:29 and we're going to keep the body fat HIGH 14:32 Higher than it was so that when the next starvation comes, 14:35 we'll have more fat to feed less muscle with" 14:39 ...And this is what the body does. 14:40 In countries where there are annual famines, 14:43 they find that the people, when the crops come in, 14:48 will become obese... 14:50 When the crops are eaten up, and they go into starvation, 14:53 they become very thin, low muscle mass, low metabolism 14:56 And when the crops come in again they become obese... 15:00 And they go through this cycle, 15:01 and this is what protects them from starvation. 15:06 We have found that this concept of the body 15:11 adapting to starvation also works with dieters and wrestlers 15:16 In high school, we used to do something which is not advisable 15:21 but we would stop eating for a day or 2 to try to 15:27 lower our weight, so that we would make weigh-ins 15:29 to wrestle at a lower weight class. 15:32 Then, once we made weigh-ins, we would eat and eat to try to get 15:37 our calorie intake up, so we would have energy to wrestle. 15:40 This is called, "weight-cycling" 15:43 The body, however, adapts to this weight-cycling as well 15:47 and they found that in a study with wrestlers, 15:50 the ones that weight-cycled, that would cut their calories 15:53 ...eat, cut their calories and eat, 15:55 had a lower resting metabolic rate, than wrestlers 15:59 that did not weight-cycle... 16:01 And, of course, with wrestling, you want all the metabolism 16:04 you can... you DON'T want a low metabolic rate. 16:07 They've also looked at obese, or actually non-obese patients 16:13 They took a thousand of these and they looked at them to see 16:17 if weight-cycling affected them as well. 16:20 And they found that if these weight-cyclers had been on a 16:24 low-calorie diet for a week or more, 16:26 4 times or more, over the previous year, 16:30 that their metabolism was lower than the women that 16:36 had not done the weight-cycling. 16:39 They then looked at patients who were put in a hospital, 16:48 or at home, and placed on a low-calorie diet 16:52 And they wanted to find out if the body remembers 16:56 its experience with a low-calorie diet. 17:00 So the first group was in an outpatient program 17:05 They put them on a restricted calorie diet 17:08 It was actually a low-carb diet, 800-1500 calories a day 17:13 And they found that as outpatients, the first time 17:16 they did it, they lost 0.19 kilograms per day 17:20 They then took them OFF the diet, 17:23 and the patients regained not just the weight they lost, 17:27 but 120% of the weight they'd lost. 17:30 They actually gained more weight than they lost which was not 17:33 too unexpected. 17:34 They then said, "Well okay, we'll put them on a diet AGAIN" 17:38 The second time they put them on the low-calorie diet, 17:40 this time they only lost not 0.19 kilograms per day, 17:45 but 0.15 kilograms per day. 17:48 They were losing weight at a SLOWER rate 17:51 And they thought, "Well, what's going on here? 17:53 It's not working as well as it did the first time 17:56 So let's go and try to correct the problem... 18:01 Maybe they're cheating? 18:03 Maybe they're eating more than they're supposed to. 18:07 Because after all, they're doing this at home... 18:08 we can't really monitor them. 18:09 So let's put them in the hospital"... 18:12 And sure enough, they put them in the hospital... 18:14 put them on the same low-calorie diet, 18:16 and, yes, they did lose weight at a faster rate 18:20 the first time they did this. 18:21 They found that they lost 0.47 kilograms per day 18:26 which was losing weight at a faster rate than 18:30 as an outpatient. 18:31 When they came off the diet... again, they regained 18:35 115% of the weight they had lost. 18:38 They actually gained more weight than they had lost. 18:41 So they put them BACK in the hospital, monitored very closely 18:45 how many calories they were taking 18:46 They were on the same program, but THIS time, 18:48 they didn't lose 0.48 kilograms per day, 18:51 they lost 0.37 kilograms per day. 18:55 And the question is... "Why were they losing 18:57 weight at a slower rate?" 19:00 Well, what was happening was the body was now REMEMBERING 19:06 what had happened before. 19:08 The first time they went on the low-calorie diet, 19:10 the body said, "I think she's going on a low-calorie diet, 19:13 we'd better turn down the metabolism" 19:17 And it did it more slowly, more gently, 19:20 and there was a slowing down of the metabolism 19:23 but there was still some significant weight loss. 19:27 She had calories... the body said, "We'd better get ready 19:30 for the next starvation" 19:31 So they regained more weight than they lost. 19:33 The second time, she went through the low-calorie diet, 19:37 the body says, "She's doing it AGAIN." 19:39 "We recognize this, we'd better shut down the metabolism 19:42 FASTER, SOONER, protect her more quickly" 19:45 The metabolism shuts down faster, 19:48 and the weight loss DROPS... in other words 19:51 the rate of weight loss decreases, and they lose 19:54 weight more slowly because the body is now conserving calories 19:59 more aggressively, and starting sooner. 20:07 So, why do these low-calorie diets not work? 20:16 Well again, to review... 20:18 a low-calorie diet causes 20:20 weight gain in the long run because the body is 20:23 trying to conserve calories for the next starvation 20:28 It stores them as fat, keeps the muscle mass low, 20:31 and keeps the metabolism low. 20:34 This is how the body responds to starvation. 20:39 In the long run, starvation diets are tolerated poorly 20:44 We just don't tolerate being starved, 20:49 and we tend to go OFF of those starvation diets 20:51 And when we do, that's when the weight-rebound occurs. 20:59 We have a problem with repeated starvations, or diets 21:07 because the more times we repeat the process, 21:10 the more the body responds by increasing the weight. 21:16 Well, the next question then comes is... 21:20 "What about the Atkins Diet?" 21:23 I've had friends that go on the Atkins Diet and they lose 21:26 weight... at least initially. 21:28 When was the Atkins Diet actually introduced? 21:31 Well, it was actually introduced around 1860 by William Banting 21:35 This is not a new program. 21:38 The Atkins Diet is essentially a low-carbohydrate diet 21:43 and a high protein and high fat diet. 21:48 Now, the reason it's high protein, high fat 21:50 is because we only get calories from 3 sources... 21:53 Most generally speaking, we have carbohydrates, proteins, 21:58 and fats. 22:00 Some people include alcohol, but that's not one we want to use. 22:05 Many risks involved with alcohol intake. 22:07 If you decrease one of those, generally, you then have to 22:12 concentrate on the other 2. 22:13 So a low-carb diet pushes you to a high protein, high fat diet 22:18 Well, this Atkins Diet really became a craze around 2004 22:26 in America. 22:28 Many low-carb alternatives were being put out and promoted 22:33 to people, and the market was buying them avidly. 22:39 It was similar to the 1980s low-fat options that were 22:47 being offered at that time. 22:49 What is a low-carb diet? 22:51 Well, in general, the central nervous system 22:54 needs about 130 grams of carbohydrates per day. 22:58 This is because the brain... the central nervous system 23:01 can only burn carbohydrates, it can't burn fats. 23:07 There's also a need in the nutritional status of our system 23:14 to get nutrients, vitamins and minerals... 23:19 And these vitamins and minerals are basically found mainly 23:23 in the plant products. 23:24 And, in order to get enough nutrients, 23:27 they recommend not just 135 grams a day, 23:31 but 225 to 325 grams of carbohydrates per day 23:36 to guarantee enough of the vitamins and minerals 23:40 to be taken in. 23:42 Because the Atkins Diet avoids the carbohydrates, 23:45 it has to avoid the plant foods and so there are some 23:48 nutrient deficiencies and the Atkins Diet requires 23:51 you to take the supplements in order to compensate for this. 23:56 Does the Atkins Diet meet either of these requirements? 23:59 Actually... No. 24:00 It starts at about 20 grams per day, and then slowly 24:05 increases to 60 grams a day... 24:07 Nowhere near the 135 grams needed for the 24:10 central nervous system, or the 200 to 300 grams needed 24:14 for your nutrition. 24:15 Well does the Atkins Diet work? 24:19 Well, it does cause weight loss initially... 24:22 And the question is... Why? 24:25 Well, when they observed the people on the Atkins Diet, 24:29 what they found was that there was no 24:33 official calorie restriction, but the people were 24:36 only eating about 66% of their normal calorie intake. 24:42 Well, why were they only getting 66% of their normal calories? 24:45 Because they weren't telling them to restrict their calories 24:48 What they found was that their appetite was suppressed 24:51 They had no desire for anymore of the foods that were available 24:56 because there was just protein and fat mainly, 24:59 very little carbohydrates, and it was the carbohydrates 25:02 that were replenishing, or satisfying the appetite, 25:06 and without those, they had a suppressed appetite. 25:09 So they hypothesized... 25:11 Is it possible that the reason people on the Atkins Diet 25:14 lose weight... is because of calorie-restriction? 25:17 Well they did a test to find out 25:20 They took 25 people, paired them up... 25:22 And they had a test group, and a control group. 25:25 The test group was, of course, the Atkins group, 25:28 and they were on the Atkins Diet, the low carbohydrate diet 25:34 And each of them was paired with another person on a 25:37 low-calorie diet. 25:39 A regular diet, lots of carbohydrates, 25:42 but they restricted their calories to match 25:45 the Atkins calorie intake. 25:47 So the Atkins calorie intake were spontaneously eating only 25:51 about 66% of their normal calorie intake 25:54 The low-calorie diet was forced to be restricted 25:59 to match the Atkins group... 26:01 And when they went out, after about 6 weeks, 26:05 they found that both groups lost weight 26:08 at exactly the same rate. 26:11 They found that neither of these diets was tolerated well 26:16 and the Atkins Diet had a lot of other complications 26:20 ...vitamin and mineral deficiencies that raised 26:23 the low-density lipoprotein levels which is hazardous 26:29 So that the Adkins group, and the low-calorie group 26:32 were both causing weight loss from low-calorie intake 26:36 and, of course, when you have a low-calorie intake 26:39 and you stop and come off it, you get a weak rebound. 26:42 Side effects for the Atkins group were constipation 26:45 because there's no fiber in the diet 26:46 Weakness... because there are no calories 26:47 Headache, bad breath, muscle cramps, diarrhea and rash... 26:50 And you needed to compensate with lots of vitamins, minerals 26:54 vitamin A, C, and E 26:56 So in review, the low-calorie diets are actually 27:02 doomed to failure because of calorie restriction... 27:06 And the body then compensating for a low-calorie diet by 27:12 putting on more weight after the diet is stopped 27:16 and the metabolism lowering... 27:18 body fat increasing... 27:20 muscle mass decreasing to compensate for this 27:24 starvation that you put it through. 27:26 We're going to look, next time, at exercise... 27:31 Is this the solution to a weight problem... 27:37 or are there other solutions that we need to look at? 27:42 So for now, we hope that you can follow through 27:49 on the next program where we can look at these other 27:53 possible sources of the obesity problem in America. 27:59 We look forward to seeing you again next time... 28:03 And for now, may God bless! |
Revised 2014-12-17