Wonderfully Made

Obesity: The Ineffectiveness Of Low-calorie Diets, Pt 1

Three Angels Broadcasting Network

Program transcript

Participants: N. David Emerson

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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!


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Revised 2014-12-17