I had a morbidly obese friend. I was obese at that time too. Once, when we ate lunch together, I gasped when I saw him eat a whole muffin in one swallow. I asked, “Don’t you worry about choking?” We then bonded over tales about our uncontrollable weight.
After that day, I didn’t see my friend for a while. Over the next several years, I grew lean and athletic—even trying out for the university wrestling team. My friend, though, grew bigger.
During that time, I once saw my friend at a charity buffet. One of the buffet organizers complained my friend ate most of the turkey, leaving the skeleton for the guests. So, I approached my friend. Right away, he congratulated me for my weight loss and called me his role model. I nudged him, “Just exercise and diet.” But that advice didn’t help. For most morbidly obese people, that advice doesn’t help.
And today I wonder if my friend has died.
Dr. Robert Ziltzer and Dr. Craig Primack say, “We cannot stress enough that overweight and obesity are medical diseases and not self-help problems” (location 743 of 2279, 33%). In other words, telling an obese person to just exercise and diet doesn’t stop obesity (Ziltzer, Robert & Primack, Craig, 2019).
Instead, an effective weight loss program needs to have four pillars: (1) weight-loss medication, (2) a low-calorie healthy diet, (3) exercise, and (4) education (Ziltzer, Robert & Primack, Craig, 2019). Let’s examine these four pillars of weight-loss intended for people who are (morbidly) obese:
Pillar 1: Weight Loss Medicine
Weight-loss medicine may help severely obese people: “While every medicine, including … Tylenol … has potential side effects, it is rare that the side effects of weight loss medications are more dangerous than having obesity, a disease which contributes to innumerable heart attacks, cancer, need for joint replacements from arthritis, lung disease, and other dangerous conditions” (Ziltzer, Robert & Primack, Craig, location 775 of 2279, 34%). You’ll need medication for up to a year: “Sometimes we recommend that you remain on your medication for at least six to twelve months” (Ziltzer, Robert & Primack, Craig, location 841 of 2279, 37%).
Pillar 2: Diet
Do you eat like most everyone else? If so, beware. “One-third of Americans have obesity, and one-third of Americans are in the overweight range eating regular food. Therefore, eating ‘regularly’ like everybody else will likely lead to either being overweight or having obesity” (Ziltzer, Robert & Primack, Craig, location 1259 of 2279, 55%). Young people have a buffer, but the older they get, the more weight they gain if they fail to diet and exercise.
So, what should you eat? Low carbohydrate diets serve as “the diet of choice by many obesity medicine specialists” (Ziltzer, Robert & Primack, Craig, location 1088 of 2279, 48%). I eat a low carb diet that looks like a Mediterranean Diet. The Mediterranean Diet “consists of less processed foods [with] emphasis on fish, nuts, fruits and vegetables, and little red meat” (Ziltzer, Robert & Primack, Craig, location 1135 of 2279, 50%).
My diet gives me all the RDA for most every vitamin. I chomp mostly veggies, seeds, nuts, All-Bran, fruit, sour cabbage, plain Greek yogurt, flaxseed, and canned salmon. Not much else. “A meal plan best suited to each person leading to calorie reduction while providing complete nutrition is the foundation of any weight loss plan” (Ziltzer, Robert & Primack, Craig, location 578 of 2279, 25%).
Yet, Ziltzer and Primack say, “In our experience, medical meal replacements are the fastest way to lose weight, with the exception of bariatric surgery” (location 1242 of 2279, 54%). But medical meal replacements require prescription (Ziltzer, Robert & Primack, Craig, 2019). I suggest you go off the medical meal replacements once you achieve your ideal weight. Instead, try a low carb, high-fiber Mediterranean diet. After all, you need healthy whole foods to prevent diabetes and autoimmune diseases.
Pillar 3: Education
Education for obesity management includes studies of
- emotional eating,
- body image,
- food addiction,
- healthy eating,
- shopping tactics,
- and exercise routines (Ziltzer, Robert & Primack, Craig, 2019).
For example, instead of emotional eating, you could try “journaling thoughts, taking a bath, calling a friend, engaging in a craft or hobby, and exercising” (Ziltzer, Robert & Primack, Craig, location 1473 of 2279, 65%).
Some strategies I’ve used include
- avoiding restaurants,
- ordering only water when I dine out,
- cutting out all sugar except dark chocolate,
- never skipping breakfast,
- fasting for at least twelve hours during the night,
- and eating every two or three hours during the day.
Why do I eat every two or three hours? Eating only one meal a day means your body turns the excess nutrition into fat (Ziltzer, Robert & Primack, Craig, 2019). So, eat five or six tiny but healthy meals each day.
But put me in front of a restaurant meal and my full signal fails. I gorge. And then I get cravings for junk again. So, I stay clear of restaurants.
Pillar 4: Exercise
Exercise is less important for weight loss than diet is: “In truth, 80% to 90% of weight loss relates to nutritional intake and adequate sleep, and only 10-20% of your weight loss is related to exercise” (Ziltzer, Robert & Primack, Craig, location 596 of 2279, 27%). But once you arrive at your weight goal, you must exercise to keep the weight off: “Exercise is a small part of weight loss but a critical part of weight maintenance” (Ziltzer, Robert & Primack, Craig, location 578 of 2279, 25%).
Drs. Robert Ziltzer and Craig Primack say, “We recommend starting small with exercise. Set a goal to be active for one or two minutes a day. Every one or two workouts, add a minute or two until you are at 30 continuous minutes of exercise …. Ultimately, you should work up to 20 to 60 minutes per day” (Ziltzer, Robert & Primack, Craig, location 1319 of 2279, 58%). At first, I could barely walk a block, but I walked that block daily. And after a month of walking, I hit the gym doing weights. Over the next year and eight months, I arrived at an athletic workout. According to Drs. Robert Ziltzer and Craig Primack, “In our experience, once someone has been exercising regularly for 30 to 60 days, they often find that they appreciate how they feel and want to exercise more and more” (location 1319 of 2279, 58%). And “the best exercise is the exercise you like. The more you like the exercise, the more likely you are to do it” (Ziltzer, Robert & Primack, Craig, location 1367 of 2279, 60%). Ideally, you could do cardio three or four days a week and weight train two days a week (Ziltzer, Robert & Primack, Craig, 2019).
Although not one of the four pillars, weight maintenance is the final challenge to any weight loss regime. A study on the Biggest Loser television contestants “showed that they lost an average of 128 pounds each by the end of the competition. Six years later each contestant regained an average of 90 pounds. Also, their metabolism was 500 calories per day lower than expected … In other words, they were miserable on the paltry amount of food required for weight maintenance” (Ziltzer, Robert & Primack, Craig, location 494 of 2279, 22%).
Yes, it’s hard to keep weight off. “Weight loss leads to changes in the hormones leptin and ghrelin that ensure an increase in hunger. They are continually trying to drive us back to our initial higher weight” (Ziltzer, Robert & Primack, Craig, location 825 of 2279, 36%). That’s why we need weight maintenance strategies: “a high level of exercise, close follow-up with your clinic, and frequent small meals will give you the best chances of maintaining weight loss” (Ziltzer, Robert & Primack, Craig, location 856 of 2279, 38%).
Throughout my life, I struggled to keep the weight off. I went from anorexic 110 pounds to obese 180. And then I dropped to 127 and spiked to 165. And then I plummeted to 128 pounds and soared to 150. And then I dropped to 113 pounds. But now I easily maintain a weight of 123 pounds by eating mostly whole foods and by exercising high intensity cardio six or seven hours a week
Where to Find Help
So, who can you turn for weight loss help?
To start, avoid dieticians unless they’re certified in obesity management: “Most RDs [registered dieticians] get very little training in obesity or in the emotional difficulties that lead to diet failure. If you do find dieticians with training in obesity treatment, they are quite effective …. However, dieticians know that their role is only one part of the equation” (Ziltzer, Robert & Primack, Craig, location 706 of 2279, 31%).
I once had a dietician who looked as obese as I did. She gave thumbs up to my popcorn drizzled in butter and my ice cream snacks. She called them healthy treats. But those treats led me to gain another forty pounds fast.
Instead of dieticians, seek out specialists in obesity management: “Our experience is that certified obesity medicine physicians are best able to help you lose weight and keep it off” (Ziltzer, Robert & Primack, Craig, location 743 of 2279, 33%). Weight management centers exist in Canada, housed with medical doctors and specialists trained in obesity management. Also, seek what is called a bariatric physician: in the documentary The 600 Pound Mom – Dominique Lanoise, a bariatric physician (a weight loss expert) attempts to help a morbidly obese woman control her diet enough to qualify for bariatric surgery.
But I fear for obese people who get surgery. None of the episodes of My 600 Pound Life that I’ve seen document what happens to the morbidly obese long after surgery. And I worry the outcomes may be frightening: “Even bariatric surgery is not a permanent cure, as many patients lose weight in the first year, only to begin to regain two to three years later. Surgery carries the risk of complications, including infection, chronic nausea and vomiting, and death” (Ziltzer, Robert & Primack, Craig, location 758 of 2279, 33%).
So, instead of surgery, lose weight through the four pillars: medicine, education, exercise, and diet.