For most, being healthy or losing weight has often translated into a focus on two things: calories and exercise. Either you are eating too much, in which case you're a glutton, or you are not exercising enough, in which case you're a sloth.
This way of thinking is unfortunate, because it describes your health, or lack thereof, as almost entirely a behavioral issue. It says that your lack of willpower is the reason you are overweight or have metabolic disease. Hence the rise of apps like Noom and others that deal with behavior modification. Approaching health and wellness from this perspective can lead to counterproductive self-judgment and “fat shaming.”
Still, it is common to hear, “if only he or she would eat less or exercise more they would be healthy.” If only life were that simple!
We were told for decades to eat less fat, more carbs
Anyone, say, over the age of 25 will no doubt will remember this:
For decades (up until 2011), this was the U.S. government's official recommended diet. Notice anything about the bottom? The recommendation was for 6-11 servings of bread, pasta, rice, and cereal per day! Now, there is nothing wrong per se with eating bread, pasta, rice, and cereal. But the reality is that this recommendation helped contribute to decades of poor eating decisions.
In the years since, studies have shown that a person following this pyramid would create a very unhealthy imbalance.
There is an exceptional book by investigative journalist Gary Taubes called Why We Get Fat: And What to Do About It. In it, Taubes discusses the history of that imbalance in the most scientific and elegant way I have seen. His premise, backed by a large amount of research, is that it's not that we are gluttons or sloths. The problem isn't that we have failed to follow advice for the past 40 years. The real problem is that the advice is wrong!
Health effects of a low fat, high carb diet
The end result of a low fat and high carbohydrate diet is a rise in insulin resistance.
This means that your body, via the pancreas, has to produce more and more insulin to maintain a stable blood sugar. That means trying to maintain a fasting blood sugar of under 100 mg/dL. The increasing amount of carbohydrates through consumption of refined grains like bread, pizza, pasta, white rice, potatoes and instant oatmeal as well as sugar laden treats is the real cause. Think about the last three to four meals you’ve had; did any of those kinds of foods make it onto your plate and into your mouth? If they did then we have the first step: awareness.
In the midst of an obesity epidemic, we are used to demonizing any food with fat as part of the structured nutritional base. That is a shame, because there is a clear reason why you feel less hunger with a meal made up of healthy fats like eggs, avocado or wild caught fish vs that based on carbohydrates. Fats have a tendency to cause less rise in insulin and less swings in the level of glucose or sugar in your blood:
These large swings are what cause the feelings of fatigue after a large, carbohydrate-packed meal versus that which is primarily made up of fat. I am not saying we should all be on a ketogenic diet (though there is pretty good evidence for that diet based on the health benefits of lower triglycerides, higher HDL (commonly called good cholesterol) and lower blood pressure). What I am saying is that the amount of carbohydrates, specifically refined carbohydrates, should be dramatically reduced for almost everyone.
There are certainly people, through a gift of genetics, who seem to be less sensitive to weight gain and insulin resistance. That comprises a small minority of the population. It is also easy to make judgments (eat less, exercise more) when you were able to sit on a pedestal created by your genetics.
Why does long-term weight gain happen?
So how does a person gain weight over a long time period?
Let’s take your typical person and look at them over a 20 year period, say from age 20 to age 40. If that person eats 20 more calories per day (<1% more of a 2,500 calorie a day diet) that would result in about 7000 extra calories per year stored as fat – the equivalent of about 2 pounds of fat. Over 20 years that person will have gained 41.7 pounds, mostly of fat.
Yet that 20 calories daily is the equivalent of just four almonds a day or three potato chips. Does it make any sense that the difference between being fat and thin over 20 years is 3 potato chips a day? No, it does not. So, what is the explanation?
In short: insulin resistance. The more insulin someone puts out to maintain a stable blood sugar, the more fat one accumulates, because insulin signals to the liver to convert calories into fat for storage.
This is a critical point: carbohydrates trigger insulin release. Insulin drives sugar (glucose) into cells and tells your liver to store calories as fat. It does both simultaneously.
Some people are more sensitive to carbohydrates and therefore produce more insulin. So, the key for those people (according to the CDC as of 2018 nearly 40% of Americans have diabetes or pre-diabetes and over 50% for those above age 65), is to pay particular attention to those foods which trigger insulin release. In other words, carbohydrates, and especially refined carbohydrates.
We don’t completely understand why some people can tolerate higher amounts of carbohydrates in their diet and not put on weight. There are different theories around changes in:
The types of food we consume
How that food is grown including herbicide load and impact on microbiome
Genetic variation between slim and obese people
Research into the last one has shown some interesting results. So, does that mean it is all about your genes? Of course not. Actually, the widespread rise in obesity rates over the last few decades argues for an environmental cause, since there is no way all of our genes could change in the span of 40 to 50 years in any significant way.
What you eat matters
What you eat matters, but as Taubes said, we've been given the wrong advice.
You should focus on the types of nutrients you consume. Minimize carbohydrates, especially refined ones like white bread, white pasta, white rice (you're seeing a pattern here?), potatoes, and any sweet treats. Reduce extra sugar in all forms: added sugar in drinks, sodas, and unhealthy snack bars. Instead, switch to more healthy fats like pastured eggs, wild caught fish, avocados, olive and avocado oil, nuts and seeds as well as grass fed beef.
Here is a picture from Martin Luther King’s March on Selma. What do you notice about the crowd?
In about 50 years we have gone from the above picture to more than 40% of our country being obese.
It's clear the conversation needs to change. We need to stop thinking of ourselves as either gluttons or sloths, and instead think about our health as a combination of genetics, environment, and hormones.