You know you've done it — seen someone morbidly obese and thought to
yourself, "Why couldn't they just control themselves?" or stood in the
supermarket, comparing people's carts to how they look, or any other
myriad of judgments we have when we see someone who is overweight. Many
of us have this overly simplified view that it's just a matter of
exercising more and eating less, that it's the First Law of
Thermodynamics with it's "calories-in-calories-out" model. I'm here to
tell you that you couldn't be more wrong.
"But it's the fault of the fast food restaurants!" people cry out.
Soda! Larger portions! High fructose corn syrup! Yes, that's all true.
It's also because we spend more time in front of computers with less
exercise, we eat out more, and we eat more processed food, right? There
are a lot of reasons, and many of them are reasonably accurate. But
there's a bit more to the picture than you realize.
Let's start with some basics, and ones that are irreconcilable
truths. The first one is, our systems are designed for times of feasting
and times of starvation. There is no getting around that. Remove those
periods of starvation, and our systems start to break down with the
caloric overload. And once our systems are broken, it can be nearly
impossible to get them completely "fixed". The other fact is that there
are a lot of weird "things" in our environment nowadays that our system
doesn't know how to handle, and those molecules are causing changes from
the genetic level on up (that's what the study of epigenetics looks at —
the impact of "foreign" molecules on cellular processes). Bring those
two pieces together and we have a virtual tidal wave of obesity, and no
way to turn it around.
Most people know that, at some point, calories DO count. The problem is
(and Weight Watchers has finally realized this) that a calorie is not
just a calorie. A carbohydrate calorie, for example, comes with insulin
(which, when present in the blood stream, completely prevents you from
burning fat). If you eat too much protein, your body will turn it into
fat as well. And not all fats are calorie-bombs that make you fat:
coconut oil and it's medium and short-chain fatty acids gets burned in
your body as quickly as carbohydrates and won't turn into fat. So the
model of "calories-in-calories-out" isn't fully accurate because you are
not a furnace. Calories count, sort of, but not totally.
Then there's the low-carb movement, of which I am a proponent. I made
a very popular video about blood sugar and how we progress to diabetes
on YouTube (www.youtube.com/merrittwellness) but it basically comes down
to this: we were given a certain amount of "points" for carbs in our
lifetime, and most people have used those "points" up by the time
they're 30 years old. Which means that after that, carb intake starts to
cause biochemical breakdowns, insulin resistance, hormonal imbalances,
and all the problems that are associated with too much insulin and too
much glucose in the body. This is a big foundation for our practice,
and, without question, can improve a lot of symptoms that people
struggle with, as well as reverse blood sugar imbalances. And yet,
that's not the whole problem either. So what else is "broken" that is
contributing to our obesity problem?
Sometimes it's an easy change — the way most people exercise, for
example, is often not helping them lose weight. Studies have
consistently shown that the 45-60 minute cardio session people are doing
simply makes them hungrier, and they end up eating more. Spending 30
minutes walking, for example, is definitely better than nothing, but
your body gets accustomed to easy exercise like that. On the flip side,
high intensity exercise done over a longer time (think spin classes) can
increase inflammation which then contributes to weight gain (or, at
least, inhibits weight loss). Exercise, without question, is beneficial
in many, many ways, and we are large proponents of varying forms of
exercise, but if you think it's going to help you with weight loss,
well… just check out all the overweight people training for marathons.
You can't tell me they need more exercise!
Here's a crazy one you might not have heard: did you know that if you
have the wrong type of gut bacteria, those bacteria can cause weight
gain? In studies done with morbidly obese people, it was observed that
certain strains of bacteria more efficiently extracted calories and
nutrition out of food than others. , It just depends on what
combination of gut flora you have — that same handful of crackers you
eat may or may not have the same caloric impact on the next person. And
how do we have such wildly differing gut bacteria? Well, the average
child, by the time they start school, has had 20 different antibiotic
prescriptions. How many have you had over your lifetime?
Which brings us to the direct impact of antibiotics on obesity. This
research study bluntly said, "…both antibiotics and probiotics, which
modify the gut microbiota, can act as growth promoters, increasing the
size and weight of animals. The current obesity pandemic may be caused,
in part, by antibiotic treatments or colonization by probiotic
bacteria." That's right — conventionally raised animals are treated
with antibiotics AND probiotics so that they gain weight. In fact,
these researchers pointed out that conventionally-raised feed-lot
animals are treated with antibiotics and probiotics to cause weight gain
and they wanted to see if short-term antibiotic treatment to humans,
given after endocarditis, caused weight gain (it did). Another reason
to buy grass-fed beef and pasture-raised chickens.
Of course, there is always the issue of hormones. About 10% of the
population has hypothyroidism and that's always an area to check when
working with weight gain. But why is there such an epidemic of
hypothyroidism? Is it the lack of iodine in the diet? High stress (the
stress hormone cortisol inhibits T3)? High estrogen levels (often from
insulin resistance, and estrogen inhibits T3 as well)? Fat cells
actually make their own estrogen, so take a look around you and think
about how much estrogen might be in someone's system. Or what about
xenoestrogens — chemicals that act like estrogen in the body? They also
will contribute to obesity. What about adrenal disorders like Cushing's?
It's rare, but imagine if all of a sudden you started gaining weight,
and yet people told you it's because you were eating too much. And then
it took the doctors years to figure out you had a hormonal problem like
Cushing's. Yes, you'd feel hopeless too. You are probably starting to
see that these hormonal issues don't stand by themselves, but can be
interwoven with other hormonal problems or other issues altogether.
What about the metabolic damage that comes with a history of dieting?
Yo-yo dieting (which, for most people, happens over years) severely
stresses the thyroid. When caloric intake is low, the metabolism slows
down, and it ultimately starts to stay low. So if you have patients
who have a history like this, they may always struggle with weight, even
if they are doing all the right things.
Then there's stress. Muffin top is a common complaint for many
people, but what most people don't realize is that the stress hormone
cortisol is responsible for that central obesity. And stress looks very
different than most people think it does. I will talk to many of my
patients about carbs, and they will lose weight around their middle when
they change their diet, but that's because a high-carb diet is
stressful for the body. Stress isn't just your job, or how you react to
situations — it's also how much sleep you get, because not enough sleep
is an independent risk factor for obesity. , It's how much
inflammation you have, whether it's from chronic pain, unknown food
intolerances, intestinal permeability, allergies, low-level sinus
infections that you know (or don't know) you have, teeth and mouth
problems like gingivitis or untreated periodontal disease,
over-exercising… the list goes on and on. This is probably the biggest
area that people don't deal with, because many of them don't realize the
impact or the need to change.
Wait! We're not done yet! Let's look at the issues with chemicals
that are KNOWN to cause health and weight issues — polychlorinated
biphenyl (PCB's), dichlorodiphenyltrichloroethane (DDT), and Bisphenol A
(BPA). While PCB's and DDT are, thankfully, a bit more limited in
society now, the prevalence of BPA and its health risks should shock
you. BPA has been directly linked to obesity , , hormone disruptions ,
and increased risk of cancer, especially breast cancer . While it only
take about 3 days to clear from the body, the problem lies in our
continuous exposure to it, as it's found in most plastics (like those
disposable water bottles, take-out containers, plastic wrap, food
storage containers), as well as food and soda cans. When you microwave
in plastic, or put hot food in plastic containers, or drink water in
containers that were exposed to heat (think about how those cases of
water are shipped in trucks) you begin to get a sense of where you
ingest it. Even worse, it's found in credit card receipt paper and other
thermal papers. In fact, paper money also carries BPA from rubbing up
against it in your wallet. And the most vulnerable victims are children
and babies, as their immature livers cannot process this chemical to
clear the body as well as adults.
What about prescribed medications? Entire classes of drugs are known
to cause weight gain and ironically, one class of them is
anti-depressants. Tricyclic antidepressants (TCA's), selective serotonin
reuptake inhibitors (SSRI's), and monamine oxidase inhibors (MAOI's)
all have been known to increase weight in at least 25% of people taking
them. Of course birth control pills are known to cause weight gain, beta
blockers, and, of course, steroids, will also increase weight. And,
according the CDC, 22% of children are on prescription meds, 30% of
teenagers, 88% of people over 60 years old are on at least one
medication, and one-third of them are on five or more. If you are 20 to
59 and are on a medication, statistically it's probably an
anti-depressant.
Can you start to see how some of these things tie together? Like
antibiotic use damaging the gut biome, causing intestinal permeability,
resulting in the body reacting to food proteins that should have stayed
in the gut, causing inflammation around the body. Here's another
example: high-carb intake causing insulin resistance, in turn causing
high estrogen (which just by itself causes weight gain — why do you
think they inject estrogen into cattle?), which then interferes with
thyroid function. Or someone is on a prescription med, doesn't eat
ideally, and then has an injury that prevents exercise. And we look at
them and think it's that they're undisciplined and lazy.
Then, of course, there are factors like Vitamin D levels contributing
to obesity, leptin resistance causing people to never feel full, and
how diet sodas increase obesity even more than regular sodas. And
naturally, people are quick to say that obesity can be genetic, but you
want to think about that: have our genes really changed in the last 25
years? No, they have not, but a lot of other things have. Put all of
these factors together in some combination, add in the cultural pulls we
have in TV commercials, that we have the cheapest food in the world
(literally and nutritionally), a subsidized farming culture, food
marketing to children, and a plethora of other factors, and you can see
that it's simply wildly inaccurate (not to mention statistically
ineffective) to tell people to count their calories and exercise more.
So what SHOULD people do? Well, no matter what, sugar and insulin
cause huge amounts of damage so people should manage their carb intake.
People should do short, intense exercise, like intervals. All the
different elements that affect stress need to be looked at and
addressed, including finding hidden infections, coaching people on
lifestyle practices, and supporting adrenal health. Proper thyroid
panels need to be run (TSH is not enough), training people to not
automatically get antibiotics, learning how to repair gut flora… yes,
there are many avenues to work with, but hopefully this has opened your
eyes to the complexity of the situation, and you can begin to unravel
this tangle for people. Believe me, they will be beyond grateful.
The theory is relatively simple, if you think about it: Inactivity can
make your spine and back muscles tight and stiff, increasing the pain,
particularly when you bend or stretch. Prolonged inactivity can also
make you weaker, not to mention that evidence suggests the longer you
stay in bed with pain, the more likely that your pain will become
chronic / more disabling, often because you avoid moving for fear it
will exacerbate the pain. 
