Obesity – You’re Still in Charge
Let's be clear, obesity is "today's" disease. It's hot, and it dominates the news when it comes to stories about health. Years ago it was heart disease and then cancer. Sure they're still the one and two killers in the developed world, but how old news they seem now! Cigarette smoking had its day in the sun too, but a couple of good law suits chased big tobacco overseas. Yes, billions of dollars of profits are still being earned -- but it's a third world problem now, if you don't count the domestic rise in the consumption of small cigars and pipe tobacco. AIDS was hot for awhile too, but once anti-retro-viral drugs came into common use, that also slipped from the front pages of the news…and from our terror radar. Diabetes had its moment in the sun -- and will again as the full scope of the epidemic hits home. But make no mistake, the disease of our time, at least today, is obesity! And everyone has an opinion on it.
On August 2nd, the New England Journal of Medicine (NEJM) published a lead "perspective" article on it entitled, "Are Americans Ready to Solve the Weight of the Nation?1" This article touched on some absolutely crucial points, but missed some even more important ones. And as it represents the evolving mainstream medical point of view, I think it's worth examining point by point, with my commentary following each quote.
The NEJM Article on Obesity in America
"The dramatic increase in obesity among Americans over the past three decades has taken a major toll on our society, and progress toward curbing the epidemic has been minimal. Two thirds of adults and nearly one third of children in the United States are overweight or obese, and many public health experts are worried that we are not solving the problem quickly enough."
We all agree on the problem, and the numbers stare us in the face every day -- both in statistical reports and in the body shapes we see on the streets. Where there is great disagreement is in what can be done about it. What is the responsibility of the individual? What is the role of government and the community? What can be legislated? When have we crossed over into being a "nanny state?" And what is the role of the medical community and "pharmaceutical solutions" in helping resolve the problem?
"This concern prompted the recent Institute of Medicine (IOM) report, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.2" The groundbreaking report and accompanying HBO documentary, "The Weight of the Nation,3" present a forceful case that the obesity epidemic has been driven by structural changes in our environment, rather than embrace the reductionist view that the cause is poor decision making by individuals."
First, let me say that both the report and the documentary are worth viewing. (You can use the links listed in the references to do so.) But as you view this material, I recommend that you keep at least one eyebrow slightly arched. The facts presented are pretty solid; the conclusions, however, not so much. I have always said that society plays a role in solving the obesity epidemic -- the city of Somerville proved how important that role can be some years ago (and is cited in the IOM report) -- but never to the point of absolving people of their own personal responsibility. I will talk more about this later, but this is actually a curious consistency in the medical community -- absolving people of personal responsibility for anything to do with health, that is. Yes, doctors pay lip service in the sense that they tell patients to clean up their acts, but when it comes down to it, they are more comfortable offering a medication or surgical procedure that allows a person to keep living their bad health choices than in actually "working" with a patient to change their lifestyle choices. In fact, in mainstream medicine, "health" is determined not so much by how fundamentally fit you are or how healthy your lifestyle is, but rather by whether or not your test numbers fall within "normal" guidelines -- with or without medication. I don't know how many times I've met people who announce to me they are in perfect health even as they take daily doses of statin drugs, diabetes medication, blood pressure pharmaceuticals, and erection pills. And as long as their numbers stay within normal, their doctors tell them they are in perfect health. Thus, their confidant avowal. I would disagree. I say that these people are merely managing the symptoms associated with their fundamentally, very unhealthy state. And if you truly understand this statement, then you understand how vast the divide is between the world of alternative health and the world of "organized" medicine.
"How do the IOM's expansive recommendations square with the American public's current views?...The report details accumulating evidence that the obesity epidemic has been driven by a complex interaction of changing factors in several critical environments -- our schools, workplaces, communities, media, and food and beverage systems -- rather than by individual choices."
Notice, and notice well, the article doesn't state that the obesity epidemic has been driven by external factors "in combination" with individual choices, but by external factors "rather" than by individual choices. Wow! In the religious world, you at least have to confess your sins before they can be forgiven. Here, with a single stroke of the pen (or cursor, more likely), the medical community, in the person of the Institute of Medicine, is granting blanket absolution pre factum. Personally, I think that's pretty stunning.
"However, public opinion studies consistently find that this view is not widely embraced. Only 18% of Americans identify external factors (exposure to junk food, lack of safe places for children to play, and limited availability of healthy foods in some neighborhoods) as the biggest causes of childhood obesity, whereas 64% identify personal factors (overeating, lack of exercise, and watching too much television) as the biggest causes."4
Amazingly, the public doesn't buy it. According to public opinion studies, the American public, despite the pronouncements of the medical community, believes that people are primarily (not exclusively, but primarily) accountable for their own obesity. They may not have been able to do much about it so far, but hats off to the public for at least manning up -- or womaning up, as the case may be. On the other hand, one thing the IOM doesn't mention is that despite accepting responsibility, the public is living in delusion in the sense that although they recognize there is an "obesity problem," they don't think it applies to them -- even if they are morbidly obese. And for at least some of that, we can thank clothing manufacturers, who have been steadily modifying clothing sizes to fit larger people into smaller sizes, thus convincing people they're smaller than they actually are.
"These views varied according to respondents' political ideology, with conservatives offering the lowest ratings for joint responsibility. Respondents attributed even less responsibility to federal, state, and local governments. All respondents, regardless of their political worldview, believed that parents bear the primary responsibility for addressing childhood obesity. "
Obviously, this kind of contrarian thinking cannot be allowed to stand.
"Unfortunately, such public beliefs about obesity render prevention messages vulnerable to counter-messaging about personal responsibility, such as the recent charge by the Center for Consumer Freedom that the IOM has joined the ranks of "food nannies."5
Let me be absolutely clear here. Although I disagree with the medical community's complete removal of personal responsibility from the weight equation, I find the "nanny state" charge by the Center for Consumer Freedom to be equally silly. It's not a question of personal freedom. It's a question of what actually works. Living with other people has always meant some loss of personal freedom to accommodate society as a whole. It's all a question of what are you willing to give up to reap the benefits of living in a larger society. If you're looking for total personal freedom, then you have to go totally off the grid and become totally self sustaining -- and that's a tough row to hoe. If I really thought society as a whole could play a stronger role in "regulating" obesity, I'd say go for it. But as I've consistently stated over the years, when it comes to health and nutrition, authority figures almost always get it wrong. And even when they get it right, they usually implement it wrong because the lifetime bureaucrats down the line who are actually in charge of implementation are usually clueless, petty dictators getting off on wielding power. And most significantly of all, once you let state or medical authorities get their nose in your tent, they become uncontrollable, like the proverbial camel pushing its master out of the tent and into the sandstorm. It takes the effort of a Hercules cleaning out the Augean stables,6 to get rid of them at a later date. For example, Homeland Security was instituted as the result of 9/11. Does anyone think it's ever going away, even if every terrorist in the world was killed or had an epiphany and renounced all forms of violence? Not likely!
Incidentally, the Center for Consumer Freedom (CCF) (formerly called the "Guest Choice Network (GCN)")7 actually represents restaurant chains, alcohol, and big tobacco, along with other related industries. It has no concern for consumers or their freedoms. It was founded by a grant from Philip Morris. Other contributors have included Coca-Cola, Cargill, Monsanto, Tyson Foods, Outback Steakhouse, Wendy's, Brinker International, and Dean Foods. It runs media campaigns railing against "the Nanny Culture," "food cops," "anti-meat activists," and "meddling bureaucrats" -- all of whom, so the CCF says, "know what's best for you." Even on those occasions when the CCF is on the correct side of an issue -- and this is not one of those occasions -- they are not to be taken seriously.
"Rigorous evaluation research has been conducted in the past decade to identify effective interventions and policies for combating obesity. A similar research-driven effort is needed to identify effective communication strategies that encourage the public to accept the evidence base regarding the environmental determinants of obesity and the necessity of a collective response. The IOM report may help hasten this process with its broad recognition of the critical importance of "messaging environments" in preventing obesity and its call for a sustained, robust social marketing program that balances individually and environmentally focused messages."
Or in other words: "The public doesn't believe us, so we need to develop strategies to convince them we know what's best for them." Unfortunately, considering the track record of the medical establishment over the years -- at one time advertising cigarettes and recommending them for weight loss, 100 years of radical mastectomies, promoting the consumption of high trans fat margarines over butter, hormone replacement therapy, Vioxx, etc., etc. -- perhaps the public is not necessarily wrong in taking assured pronouncements from the medical community as something less than gospel.
"The report also recognizes, as a guiding principle, that obesity-prevention strategies and messages should avoid unintentionally increasing weight-based stigma, stating that "the case for addressing the obesity epidemic cannot be made at the expense of obese people. … Seemingly innocuous obesity-prevention efforts could lead to increased stigma if they reinforce the strongly held notion of personal or parental responsibility for tackling obesity."
Obviously, no one should be stigmatized or "blamed" for having a weight problem. But pretending that a person's own actions and decisions have nothing to do with their condition is utter nonsense and ultimately counter-productive to the nth degree. In fact, the stigma is even worse because now personal responsibility becomes the elephant in the room that everyone knows is there but no one dares talk about.
"Workplace wellness-incentive programs, for example, might increase stigma by labeling or penalizing overweight and obese employees or by emphasizing behavioral change without also acknowledging the environmental factors that are outside a person's control. Similarly, media campaigns with individualized depictions of overweight people could have unintended effects. Obesity-prevention ads that aired in Georgia in 2011 featuring stark images of obese children were pulled after critics argued that the portrayals could increase the stigma attached to obesity and the shame felt by obese children. Although such campaigns are intended to raise public awareness and concern about childhood obesity, they may risk increasing blame and stigma, a possibility that demands more empirical research."
And now an admission that although assigning personal responsibility is no longer an option (at least according to this new thinking), no one actually knows what to do. Or to put it in scientific terms, "More study is required."
"The IOM report concludes with the hope that "heightened awareness of the potential catastrophic consequences of the high rates of obesity in the United States" on the part of the public and leaders in many sectors of society will serve as a primary catalyst for implementation of its recommendations. Yet social science research contradicts the notion that instilling a sense of crisis in the public will automatically lead to policy action. "
Well that won't work, then, will it?
"In a classic 1972 article, public-policy scholar Anthony Downs described an "issue-attention cycle" in which societal problems leap into public prominence, captivate public attention for some time, then gradually recede from the public's view, often before the problem has been resolved.8 This pattern occurs when initial public alarm over the discovery of a problem and optimism about its quick resolution are replaced by the realization that solving the problem will require some public sacrifice and will displace powerful societal interests."
And this takes us back to the very first paragraph in this newsletter in which we talked about obesity as the "disease of the day" -- have replaced previous diseases of the day that are no longer in the public's "issue-attention cycle." But that means, at some point, the public will lose interest in combating obesity, and a new disease of the day will take its place. Better act now while the issue is hot.
"Sustained policy attention to a societal problem can also lead to the politicization of that issue, prompting the public to consider it in polarized terms that may inhibit action or even prompt backlash. The IOM has laid out a clear and compelling vision for accelerating change on obesity prevention, and its recommendations are too important to rely on the hope that public awareness of the obesity crisis alone will catalyze change. Comprehensive, evidence-based communication campaigns, along with grassroots community mobilization, cross-sector advocacy, political champions, and a favorable political environment, are needed to accelerate the transition from vision to action."
In the end, as could easily be predicted once personal responsibility was taken off the table, nothing is on offer here but platitudes, generalities, and a call to think about taking some unspecified action in the future. And of course, that also means more research -- not to mention the development of new and exciting weight-loss drugs by the eager pharmaceutical industry. And this time, may they be less deadly than fen-phen.
In summary, this NEJM perspective article on solving the "weight problem" is, to paraphrase Macbeth, "Full of sound and fury, signifying nothing." But surprisingly, the comments left onsite by the doctors who read the article are decidedly more on point. Here is a sampling.
Certainly, there are some who support the basic premise of the NEJM article. Here are a couple of examples. (Note: in this section, my comments come first with the quotes from the commenters being indented.)
"We must alleviate the guilt. Obesity is a complex problem that requires a multifaceted health, educational, and policy strategy to address. It is dismaying to think that individuals have taken on this burden themselves without considering the societal influences that drive the promulgation of our toxic environment. One would think there would be a collective sigh of relief at the idea that it is not necessarily our fault that obesity is so widespread."
And there were some who thought the article didn't go far enough -- that what we really need to do is unleash the drug companies. After all, the only real solution to obesity lies in more and better drugs, doesn't it? What could possibly go wrong with that strategy?
"Obesity is a disease and requires treatment. The medical community has had its hands tied for over 13 years due to the heart valve issue with the Fen Phen scare. .. Fortunately, as society and political leaders realized that obesity is a disease and that food pyramids, counting calories, endless diets, and exercising weren't getting the job done, and the BMI kept growing year by year, the Senate Republicans sponsored a bill to get the ball rolling -- and the FDA was part of the problem being overly restrictive and cumbersome in advancing novel ideas and stifling growth."
And those who thought corporate America was at fault.
"The obesity epidemic appears to have shown the first evidence after the large influence of fast food choices to the population at large twenty years ago. The people are the same people; the difference is the high calories food choices introduced by the big corporations that have taken control of what we eat. Same for exercising - it is becoming an industry controlled by money corporations that offer high pay membership to go to exercise in private controlled gyms."
But in truth, the overwhelming majority of comments denied the article's basic premise and refocused on personal accountability. How refreshing!
"There is no question that structural changes in our society are largely responsible for the obesity epidemic. There is no question that a systemic approach to changing those barriers is needed. But it is also true that poor choices also play a huge role, and should not be denied. One only has to spend some time observing food choices on the plates of people in a hospital cafeteria or in the checkout line at Wal-Mart to confirm this hypothesis."
"Americans need to hold themselves to the right amount ... which is 32 ounces of daily food, thereby stopping the overeating without harmful undernourishment. There really is no other **healthy** way to stop the overeating. An alternative is being surgically forced to eat less. However, the invasive alternative has disabled and killed patients while leaving others dissatisfied with their outcomes because they are still overeating."
And some people went even further -- sounding like long term readers of this newsletter.
"Reduce the federal deficit and improve population health by stopping federal subsidies for agricultural products known to foster disease."
"Address subsidies for farm commodities first. I can't help but think much of the debate about who is responsible for obesity could be avoided if tax money wasn't being used to subsidize the worst processed foods. If consumers had to pay the true cost of a supersized soda, the food nanny wouldn't be necessary."
All in all, the NEJM article wasn't that useful as it offered no solutions other than more study. Then again, it wasn't really written to be a solution -- merely a perspective. In any case, it offers no help in the here and now. So what can you do to combat obesity while waiting for America's medical community to complete their next round of studies?
An Alternative Point of View on How to Solve the Obesity Problem
I'm not saying that government, schools, and the medical community have no role to play in helping reverse the obesity epidemic, just not the primary role -- let alone, as the NEJM article implies, the only role. The reasons this must be so are many. First, as I mentioned earlier, when it comes to health and nutrition, the people in positions of authority almost always get it wrong. Examples from the medical community include:
- Cigarettes. Back in the days when the Journal of the American Medical Association carried ads for cigarettes, they also published position papers promoting the virtues of cigarette smoking for weight loss -- even while publishing studies that linked tobacco to lung cancer.9
- Fats. For years, the medical community denied the connection between saturated fats and heart disease, despite decades of concern raised by the alternative health community. Then, finally when they acknowledged it, they promoted high trans fat margarines as a "safe" alternative -- again despite the warnings coming from the complementary medicine camp. And then, only in the last ten years did the medical community turn on trans fats. And never once did they acknowledge their previous errors, or the fact that the alternative community knew the truth long before they did, or the hundreds of thousands of people they effectively killed by ignoring the alternative voices for decades.
- Hormone replacement therapy. For many years, those of us in the natural health community screamed about the dangers of HRT based on pharmaceutical synthetic hormones -- only to be mocked by OB/GYN's en masse. Amazingly, even now that the dangers have been acknowledged, as many as 36 million HRT prescriptions are still written each and every year by members of the medical community. Hardly credible.
- Constipation and diverticulitis. For decades the medical community mocked the idea of diverticulitis (called herniations of the colon and bowel pockets by natural healers). "We've performed thousands of autopsies and never seen one of these mythical pockets." Now, according to the Merck Manual, the physician's bible, every person living in the developed world will have many such herniations…if they live long enough. And yet again, no recognition of the years of denial or of the healers who told them what to look for.
- High sugar diets. How many of you can remember back to 1975 when William Duffy's book, Sugar Blues, was first published. Mainstream health experts tore the book apart and dismissed all of its concerns about excessive consumption of refined sugars and the problems it would cause over time. How's that derisive attitude looking a quarter of a century later as we see that we are in the midst of a diabetes epidemic? And how much better off are the people who listened to William Duffy way back when? The bottom line question, though, is: who knew best?
Worst of all, though, is the fact that when they finally realize they got it wrong, the medical community never acknowledges the switch or the people in the alternative health community who got it right years before they did. Is that a problem? Absolutely!
The problem, as I've discussed in previous newsletters, is that the medical community gets to look smarter than it is by never admitting they got it wrong -- whereas alternative voices are made to look dumber than they are since they are continually denied credit for ever being right. This allows mainstream medicine, backed by its supporters, to assume the position that they are the "only" authority worth listening to when it comes to health and nutrition and that everyone else is not only wrong, but quite probably dangerous. The net result is that the public as a whole is denied access to potentially lifesaving information -- often for decades -- until the medical community decides to "take over" the issue -- usually wrongly and incompletely. And truth be told, when it comes to health and nutrition, doctors (and politicians by extension) are woefully ignorant. At one time, doctors took a total of 6-8 hours of nutrition classes in medical school -- not per semester or year, but 6-8 hours total throughout their entire time in medical school. If you read two good books on health and nutrition (Lessons from the Miracle Doctors being one of them, of course), you know more than most doctors. And while it's true that in recent years class time may have increased in some medical schools to 12-16 hours total, you don't have to look very far to see how little the extra few hours have mattered. Just look at the meals served to recovering patients in hospitals. We're talking overcooked, dead food with tiny iceberg lettuce salads and packets of unhealthy dressings, served with sugar water fruit juices, and a high glycemic dessert. And make no mistake, although hospitals employ dieticians to create these menus, they answer to the doctors. The food you see in hospitals represents what doctors define as healthy. Enough said.
But there's another problem when it comes to doctors, and that's schizophrenia. As I've pointed out on numerous occasions, the vast majority of doctors are dedicated, extremely competent, and often even heroic. But that's doctors as individuals. When they get together as a group, they are transformed like locusts into an unreasoning swarm. What you end up with is schizophrenia. Take supplements as an example. For years doctors denied their value, referring to them as expensive urine. Now, after numerous studies have proven their value, most doctors acknowledge the value of taking supplements -- at least when they speak as individuals. But when they speak with their collective voice, they are still locked in the past and express nothing but contempt.
And that's the doctors. Politicians and bureaucrats are worse. They know even less about health and nutrition than doctors, but are even more motivated to take action -- any action -- for political reasons. It is why I have always spoken out against legislative influence over what we eat, whether that's FDA regulations or plans to force behavior by taxing certain foods. For example, even though I am not a fan of most sodas, I have spoken out against the "soda tax." I'd have more belief in the purity of Mayor Bloomberg's motives if he didn't actively promote high trans fat junk food and its purveyors in New York City when campaigning. But it's not just Mayor Bloomberg. It's all politicians. Even as Michelle Obama campaigns for better eating habits across the country, political needs require photo ops of the President and his wife eating burgers, fries, and sodas to show their connection to the American people. Whether they believe in these things or not, the message is clear: politics trumps health.
Given that fundamental problem, do you want politicians telling you what to eat or not eat? And while we're on the topic, let's consider the classic example of why government is not to be trusted when it comes to nutrition. I'm talking about the total redesign and distortion of the USDA's food pyramid10 to reflect the lobbying interests of the National Dairy Council, the Soft Drink Association, the American Meat Institute, the National Cattlemen's Beef Association, and the Wheat Foods Council. And make no mistake; this is not a Democrat thing. When it comes to letting political considerations trump health, Republican politicians are equal opportunity whores.
And yet, there is a role for government. As several commenters suggested, government needs to stop subsidizing bad behavior such as the growing and manufacturing of unhealthy food items -- just because they're backed by strong lobbies. Let the farmers grow what the markets want, but why subsidize disease? Subsidizing merely lowers the price of junk foods, which makes unhealthy options cheaper than healthy ones, which encourages people to buy them -- thus driving the market to grow the subsidized junk food in the first place. Kill the subsidy and you kill the cycle. And government -- especially local government, such as a school board -- has the right and responsibility to regulate the promotion and availability of unhealthy products to people unable to make rational decisions on their own -- i.e. children. Whether or not children bring unhealthy snack foods and sodas to school is up to the children's parents. But schools certainly have the ability and the moral authority to not make those foods available as part of school lunches or easily accessible in vending machines. And in fact, a study due to be published in the September issue of Pediatrics found that consistent and strongly-worded competitive food laws may indeed reduce weight gain among grade school students.11
And then there's the question of what role business should play in helping control obesity. The IOM report cited earlier states, "Businesses that provide catering or venues where the public eats -- such as movie theaters, sporting event venues, and shopping malls -- have a role to play in changing the availability of food and norms about food consumption."12
I don't necessarily disagree with the broad principle here, that business has a role to play. I just don't think that strong-arming businesses works. Nor is it necessary. The key is that businesses don't lead; they follow. Or more precisely, as Deep Throat would say, they follow the money. They have no vested interest in selling you junk food. They sell it because you buy it. It makes them money. Years ago, when no major grocery store carried organic produce, I said that if enough people demanded it and enough people bought it, they would absolutely carry it. And now they do. Virtually every supermarket now has an organic foods section -- even if small. Show the stores the money and they will come. In fact, Wal-Mart and Costco are now the largest retailers of organic foods in the country -- much larger than Whole Foods.13 And for several years, McDonald's has been the biggest seller of salads in the world.14 Once again, there is no need to strong arm or "encourage" businesses to sell healthy food. They are in the business of making money. If you show them the money, they will sell it! Or more precisely, if the public starts rejecting junk food and starts buying healthy food in any volume, stores will instantly diminish their junk food inventory and increase their health food inventory. But people have to put their money where their mouths are. Too often, people who say they intend to buy healthy, buy junk when given the chance. Stores stock what people buy!
Conclusion: How to Lose Weight
We've talked many times about weight-loss and weight management on this site. There's no need, nor is it possible, to repeat all of that information at this time. Instead, what I'd like to do is leave you with some simple lifestyle tips that if followed will allow you to lose weight fairly easily.
- Give up all high glycemic carbs for your basic meals. Or to put it in simple terms, give up all flour, potato, corn, and rice dishes. And what better time to start than with prices starting to rise for many of these items because of the drought. Note: I did not say give up all carbs, just the high glycemic ones. Instead, eat moderate amounts of protein (4-6 ounces of meat, fish, chicken, or a vegetarian source per day) with large salads or lightly cooked vegetables. Stir fry is an option. On the other hand, if you go out to dinner or have dinner at a friend's house, you can indulge -- moderately -- on those occasions. But day in day out, avoid high glycemic foods -- including anything with high fructose corn syrup.
- Eat tossed salads, not naked salads with bottles of dressing. You end up using about 1/3 the dressing when you toss it. That saves you about 240 calories per salad.
- Buy smaller (10 inch) plates. A few years ago, dinner plates were 10" in diameter. Now, they average 12." It doesn't sound like much of a difference, but a 12" plate is 44% larger -- 113 VS 78.5 square inches. Visually then, a 12" plate encourages you to pack a whole lot more extra food onto your plate. In fact, if you go back 1,000 years, plates are now 69% bigger. The net result is that the average person is now consuming 523 more calories on a daily basis than did the average person in 1970. Is it any wonder that we're getting fatter and fatter? Buy and use smaller plates.
- Do one or two protein-shake-days per week. Depending on your schedule, the best days are Monday and Friday. Monday is great because it gets rid of any weight you might have put on by over-indulging over the weekend -- not to mention breaking any bad habits you might have got yourself into during those days. Friday, on the other hand, is useful as a set up day for the weekend -- allowing you to drop some weight just before the weekend and enter Saturday with a reduced appetite. How much weight are we talking about here? You can easily save yourself 1,700-2,000 calories on a shake day. For dinner on shake days, you can have a high protein yogurt or something comparable. With two shake days a week, we're talking about dropping a pound a week (3,500 calories) -- on top of what you're already losing by giving up the high glycemic carbs. For a protein source, my preference is for a rice/pea protein blend. A 70% hemp protein source or green super foods are also fine, but have a much stronger taste. Whey is also a possibility, but tends to leave you hungry sooner. (I'm not a big fan of soy as a primary protein source.)
And do what you can in terms of adding some exercise. It makes a huge difference. But even without exercise, the above changes should allow you to lose weight. Keep in mind that weight loss tends to be irregular. You may find that you quickly drop 5-7 pounds on the above program, but then plateau. Stick with it. After several weeks, you will suddenly drop another 4-5 pounds before hitting a plateau again. Again, if you stick with it, in several weeks you will have another surge. And so on for as long as you choose.
Once you've lost all the weight you want, I recommend you pretty much stick with the program. Just adjust your shake days to stabilize your weight. Why bring back the bad habits that got you into trouble in the first place?
- 1. Colleen L. Barry, Sarah E. Gollust, and Jeff Niederdeppe, "Are Americans Ready to Solve the Weight of the Nation?" N Engl J Med 2012; 367:389-391. http://www.nejm.org/doi/full/10.1056/NEJMp1206519?query=TOC
- 2. Commitee on Accelerating Progress in Obesity Prevention, Food and Nutrition Board. "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation." The National Academies Press. 2012. http://www.nap.edu/openbook.php?record_id=13275&page=1
- 3. PART 1: Consequences http://www.youtube.com/embed/-pEkCbqN4uo.
PART 2: Choices http://www.youtube.com/embed/hLv0Vsegmoo.
PART 3: Children in Crisis http://www.youtube.com/embed/T24B6T-hp0E.
PART 4: Challenges http://www.youtube.com/embed/BmcZRgWBdwQ.
- 4. Bleich SN, Blendon RJ, "Public opinion and obesity," in Robert J. Blendon, Drew E. Altman, Mollyann Brodie, and John M. Benson eds., American Public Opinion and Health Care Policy (Washington: CQ Press, September 2010), Chapter 17.
- 5. "Institute of Medicine's new obesity-prevention strategies miss the mark." Center for Consumer Freedom. 8 May 2012. (Accessed 11 August 2012.) http://www.consumerfreedom.com/2012/05/institute-of-medicines-new-obesity-prevention-strategies-miss-the-mark/
- 6. http://en.wikipedia.org/wiki/Augeas
- 7. http://www.consumerfreedom.com/
- 8. Downs, Anthony. "Up and Down with Ecology-the Issue-Attention Cycle." Public Interest, 28 (1972:Summer) p.38.
- 9. "American Medical Association promoted tobacco." Tobacco Campaign. 25 July 2009. (Accessed 12 August 2012.) http://www.tobaccocampaign.com/american-medical-association-promoted-tobacco
- 10. http://www.nal.usda.gov/fnic/Fpyr/pmap.htm
- 11. Taber DR, et al "Weight status among adolescents in states that govern competitive food nutrition content." Pediatrics 2012; 130: 437-444. http://www.rwjf.org/files/research/74599.5977.influenceofcompetitivefoods.reveiw.2012.june.pdf
- 12. IOM page 91
- 13. Jennifer Chait. "6 Largest Organic Retailers in North America 2011." About.com. (Accessed 12 August 2012.) http://organic.about.com/od/marketingpromotion/tp/6-Largest-Organic-Retailers-In-North-America-2011.htm
- 14. "Big Mac's Makeover." The Economist. 14 Oct 2004. (Accessed 12 August 2012.) http://www.economist.com/node/3285898