Know, patient: losing weight is not easy (2)

How do those who have lost weight live

Evgenia Kobylyatskaya, licensed nutritionist (USA)
Published in the magazine "Snob"

Continuation of the lecture summary by Dr. Arya Sharma, one of the world's leading specialists in the treatment of obesity, for professionals. The beginning is here.

You've probably heard the phrase many times: "To lose weight, you just need to eat less and move more." This is often said by doctors, friends and just random people. This is no better than telling a person with depression – "Hey, cheer up!" Or advising a person suffering from panic attacks – "Don't worry, be happy."

People who have lost weight and retained achievements for many years exist. What do you think they are doing for this? Probably eat less and move more. How do they achieve this? Do they control portions? Refuse sweets? Avoid empty calories? Do they exercise at least an hour a day? All of the above? What are they doing?

They're all doing SOMETHING.

All of them, without exception, are constantly working to keep the weight normal. Do you know why? Because obesity cannot be cured. If a person has lost weight, it does not mean that he is cured.

In 25 years of working in a specialized clinic, I have not seen a single person who would be cured of obesity. This is a chronic progressive disease.

If a patient with diabetes, hypertension or asthma stops taking medications and follows the doctor's prescriptions, his symptoms will worsen and the disease will progress. So it is with obesity. If you lose weight, and then stop controlling portions, avoid empty calories and give up sports – the weight will return.

Do you want to live like this? Can you live in this mode?

People who were able to lose 15 kilograms or more and keep this weight for more than one year are registered here – their stories motivate others and serve as an object for observations and conclusions. On average, they eat 1400 calories a day. And they do sports at least an hour a day. Can you do that? Well, then you will succeed.

But in reality, only 10% of all those who have lost weight can live like this.

These stories helped to draw the following conclusion. Do you know who achieves the greatest success in this business? Those who have made this lifestyle a profession. Became a personal trainer, video blogger, aerobics instructor or motivational speaker.

Patients usually ask: "How much can I lose weight on this regime?" or "How quickly can I lose 20 kilograms?" "Will I be able to lose up to 70 kg by the summer? «

I answer – it doesn't matter at all. What matters is the weight that you can hold, that you can live with. And if you can't, the weight will return. Why is this so? Because by losing weight, you are going against your own biological attitudes.

Let's say you used to weigh 100 kg. You began to eat less and move more, and your weight reached the 70 kg mark. You think you should weigh 70 kg. But your body believes that your weight is 100 kg, and does everything possible to get it back. It doesn't understand why you are torturing it so much. It hinders your plans.

How does it do this?

Reduces metabolism – you need fewer calories to maintain the same weight.

Increases appetite – the feeling of hunger increases so much that it prevents you from doing other things.

Reduces the energy level – you do not have the strength to move, you want to lie down.

And although the percentage of fat reserves in the body is quite high, your body behaves as if it is afraid to die of exhaustion – its distress signals are so strong. He has a 100 kg installation. And he will strive to return them by all means known to him. All this, of course, complicates the process of losing weight. The problem is that others think it's easy and think you're a lazy glutton.

Why does your body behave this way?

You've probably heard about the “set point” (set value, setting – VM) – this is your weight, genetically predetermined, which is stably maintained throughout your life under these conditions. What is your set point?

Let's say you were born with a weight of 3 kg. Your set point is 3 kg. A month later, you began to weigh 4 kg. Your set point is 4 kg. When you turned one year old, you already weighed 10 kg. This is your new set point. See? This setup has been increasing all the time. This continues to happen throughout life. “Set point” has no program for reduction.

There is a special area in the brain – the hypothalamus, which controls your weight, your appetite, metabolism, as well as hunger and satiety signals. How does he do it?

The hypothalamus receives signals from various parts of the body and organs through a complex system of neural connections. This neural connection changes the structure in the process of adaptation to excess weight. And it is impossible to return this connection to its previous state. This mechanism was not programmed to return to its previous weight. When you decide that you need to lose weight, you are one on one with this adaptive biological mechanism.

The biggest weight you have achieved is your new set point. And this is for life. We have no means to return these neural connections to their original state.

People think, "If I lose weight slowly, my set point will return to normal." Or they believe that a special diet will help to reset the set point. They also hope that if they manage to lose weight and keep a normal weight for a long time, then set point will be reinstalled.

No. Will not be reinstalled. And if you lose weight, the body will always strive for the biggest mark on the scales that you have ever reached.

Let's say I've always been skinny. And you gained forty kilograms of excess weight, and then you began to "eat less and move more" and lost weight. We are in the same weight now. But there is a significant difference between us. Suppose you and I were offered a movie role for which you need to gain 20 kg, say, in 2 months. I will have problems with this – it is extremely difficult for me to do it. As for you... (Laughter in the audience)

I repeat. We have no way to return to the starting point such a complex system of neural connections. I agree, it's sad. But people live with chronic diseases, for example, type 1 diabetes. People live with asthma or hypertension – they are never cured, they just learn to regulate their condition and slow down the development of the disease.

Hundreds of different medications exist to control depression, diabetes or hypertension. From obesity? Well... one medicine, maybe two, with serious side effects, and then – as a temporary remedy. Bariatric surgery is used only for the severe stage of obesity.

Low–calorie diets (less than 1200) - do not try it at home. Such a regime makes it impossible to obtain all the substances necessary for good health. This is done in a clinic, under supervision, and for these purposes, not food is used, but special vitamin cocktails. Low-calorie diets are used only in cases when the patient has to undergo surgery and he needs to lose weight urgently.

So the diet and sports are the only ways to treat obesity. But this is sometimes not enough to achieve the desired weight. Sometimes, no matter how hard a person tries, he does not manage to lose the desired number of kilograms.

People believe that if they lost 5 kg in the first month, they will lose 5 kg every month. That's how they deceive themselves. And then they get upset.

The desire to reach a certain mark on the scales is nonsense. That shouldn't be the goal. What should be the goal? How to measure success in the treatment of obesity?

(To be continued)

Portal "Eternal youth" http://vechnayamolodost.ru
04.07.2016