Weight loss? One word

Hunger.  Period.  Full stop.

Weight loss is all about hunger. 

Although many articles and scientific studies would have us think that weight loss is a matter of mathematics, physiology, or metabolism, it really all boils down to one concept: hunger.  If we could only understand how to control hunger, weight loss would be simple.

Weight loss?  One Word - Hunger. Period. Full stop.  Not math or metabolism, not physics or physiology, just hunger.

Click to Tweet

In an insightful and entertaining essay in Aeon, Princeton neuroscience Professor Michael Graziano persuasively argues that most approaches treat weight loss as a problem in math or metabolism, physics or physiology, rather than what it really is: psychology.  

He posits that this misconception leads to our modern conundrum of endlessly conflicting diet plans that either don't work, or if they do work, work for the wrong reasons.   As the hapless purchaser of diet books and gym memberships repeatedly applies the wrong tools to the job, he is virtually condemned from day one to failure. 

Where does that leave you? At the end of that seemingly inevitable progression, you’re demoralised and depressed. You can do anything else you put your mind to but somehow you can’t manage the weight loss. And so you enter a disastrous spiral. If you’re going to be miserable anyway, you might as well indulge yourself. The food at least mitigates the misery. You slip into comfort eating, self-medication and addiction, and lose all motivation. You fall into the deepest part of the psychological quagmire and your chance of recovery is small.
-Michael Graziano, Aeon, 18 Jan, 2016

His point is hammered home by a 2015 study in the American Journal of Public Health in which more than 176,000 obese patients were followed for up to 9 years and the chances of reaching a normal weight was heart-breakingly low, less than 1 in 100.  Graziano's argument is clear, simple, and compelling, scientifically valid, well-evidenced, and appealing.  But where does that leave us?  What does Graziano's "hunger mood" mean?

Sometimes, I intentionally ruin my appetite and then I call my mother to tell her that I did. “Hello mom, I just ruined my appetite with cookies.” Because as an adult we understand that if we ruin our appetite, there is another on the way. There is no danger of running out of appetites.

Jerry Seinfeld

Two things are astonishing  about Graziano's argument :

  1. Despite the infinitesimally tiny chances, Graziano is describing a weight loss experiment (sample size = 1) in which he applies his principle and SUCCEEDS.
  2. Why don't we hear this type of logical argument more often?

Both of those astonishing facts can easily be explained.   First, in order for a diet to gain any market share, that is for anyone to actually try it, it needs a "hook" i.e. a metabolic theory for why it should work better than other diets.  For low-carb diets, this theory is ketone-induced changes in fat metabolism and lower levels of insulin leading to increased insulin sensitivity.  Sounds great, but what if all that happened and the actual reason for weight loss had nothing to do with it?  What if the cause of good outcomes was something much more basic, like if you eat more fat calories, you're not as hungry, so you eat fewer total calories and lose weight as a result.

This is exactly what Graziano alludes to  but fails to elaborate on when he cites the ​"calorie for calorie" 2015 NIH study in Cell Metabolism which compares low fat to low carb diets in the unusually well-controlled environment of a "metabolic ward".  In the study, participants in both groups ate the exact same number of calories - they were in a controlled environment so the effect of hunger was eliminated - they couldn't eat any more than the alloted calories.  Since the low fat group lost more body fat, Graziano chalks this up as a victory for low fat.  I would argue that this study actually reinforces Graziano's point.

Why? There is good evidence, espoused for years by Dr. Robert Lustig, a pediatric endocrinologist at Stanford, and summarized well by Nina Teicholz in her book, The Big Fat Surprise, that the low fat craze and more specifically replacing fat in processed foods with refined carbohydrates and sugar, is a major cause of the obesity epidemic.  ​

The fact that we all got fat eating low fat for the last 30 years, along with abundant evidence that low-carb diets work better in the real world where snacks are everywhere and appetite and hunger matter, suggest that the "calorie for calorie" NIH study outcome effectively rules out metabolic effects (ketones, insulin, whatever...) as an explanation of the real-world success of low-carb diets, bringing us right back to Graziano's "hunger mood".  Low-carb diets work for Graziano and for most people because when more of your calories come from fat and protein, you're just not as hungry.  I'd love to see an extension of the NIH study in which subjects were allowed to snack - and THEN compare who ate more calories.

The same logic explains Graziano's conclusion that counting calories makes you eat more.  The excellent NIH study notwithstanding, almost every real-world diet involves some type of calorie restriction - probably for a motivational "bump" that will encourage people to stick with it.  Graziano readily admits that once he let go of "that dubious concept of willpower", his weight loss required very little effort - so little, in fact, that he felt lazy. However, it wasn't quick, "​..it worked at a slow drip of about 2 pounds per week".  That doesn't make for a very sexy ad in the supermarket tabloids.

I simply had to trust a bizarre psychological twist: if I try to eat less, I’ll end up eating more.

The take-home message of all these academic studies is simple:

  1. Most diets that work, do so because they reduce hunger
  2. Most diets fail because of calorie restriction​

Studies show that the odds are against changing your body weight for the long-term, but that may be because we've failed to embrace an individual, psychological, non-market oriented (lose 10 pounds in 2 weeks!) approach.  This is actually good news because the best hunger-control tactics from several different diets could be combined for an individual to give them a customized diet plan that would be likely to work in the long-term.  These are steps you can take right now:

  1. Keep a satiety index or hunger journal
  2. Find a diet and eating schedule that keeps your hunger in control
  3. Don't play the calorie-restriction game
  4. Set a goal of controlling your hunger, not losing weight or consuming some magic number of calories
  5. watch the pounds melt away

The only MD-produced-beach-yoga-drone-video website in the universe

Click Here to Leave a Comment Below