Weight Loss Science: Dr Louis J. Aronne Talks Science Behind His Book 'The Change Your Biology Diet' [SCIENCE WORLD REPORT EXCLUSIVE INTERVIEW]
Weight loss and successfully managing a sustained, healthy weight aren't easy. These days, it's not just about eating fewer calories, following fad diets or trendy exercise routines; it's about the kinds of food you're consuming and addressing the genetic and environmental factors that influence weight gain. That's the contention of Dr Louis J. Aronne as well as the theme of his new book, "The Change Your Biology Diet: The Proven Program for Lifelong Weight Loss," which is available beginning January 5.
Aronne is the director of the Comprehensive Weight Control Center at Weill-Cornell Medical College and his theory about weight loss is founded on cutting edge research that focuses on biological factors and food-body interactions. For example: consuming a diet rich in processed foods damages neurons in the brain's appetite control center, resulting in weight gain.The book also includes adaptable diets that readers can personalize, easy exercise routines, and the most recent developments in weight loss medications and bariatric procedures.
Science World Report (SWR) met with Aronne to discuss the hard science behind his sensible weight loss approach.
SWR: What inspired you to write the book?
Aronne: I wanted everyone with a weight problem to be able to benefit from the type of treatment we offer at the Weill Cornell Comprehensive Weight Control Center. We are at the forefront of a movement known as Obesity Medicine, treating patients in a way that is not entirely behavioral, not entirely medical, but a combination of the two. We are getting better results than ever because we have an increasing number of treatment options so that if one approach doesn't work, we find another. The purpose of the book is to try to bring that information to people struggling to lose weight and maintain their weight loss. There's a lot more to losing weight than meets the eye.
I know the book talks about the ridiculousness of fad diets. Can you touch on how we've come a long way?
For years, people have been trying to lose weight using a variety of methods, many of which make no sense. Diets impact body weight for a very short time and you can lose weight, but the goal is to have a durable loss of weight. Why do people do these diets? For example, someone who's fasting with a week-long juice fast; one reason they may lose weight is that they're not consuming enough protein. It gives the appearance of terrific weight loss but when they start eating normally their weight bounces right back up. People not losing weight may also try using juices. We see this all the time. But the next thing you know, they're gaining weight. They're consuming hundreds of calories of juice a day and that can make it difficult to lose weight – or even cause weight gain, which is something many people are not aware of. There is a tremendous amount of misinformation out there as far as dieting is concerned. One goal of my book is to correct that and to provide people with accurate information to use and to maintain weight loss in the long run.
Can you talk about the common misconception that obese individuals are lazy vs. what the science shows – that genetic components play a factor in over eating and keeping weight off?
This is critical. What people don't realize is that when you gain weight, signaling pathways in the brain are damaged and that makes it hard to lose weight. Scientific evidence is showing that when you gain weight by eating fattening food, something physical changes in your brain. The critical nerves in the brain that carry signals from the fat cells, stomach and intestine to the rest of the brain are injured and inflamed and don't function as well. As a result, the fidelity of the signaling getting to the rest of your brain is degraded, so your brain can't tell how much you've eaten and how much fat is stored. That's really what makes it so hard to lose weight. So you might say, "Why don't those people just eat less?" It's not that easy. It's like trying to breathe less. You don't think about breathing, you just do it. If you tried to breath less, you would feel uncomfortable, give up and start breathing more. This is similar to what happens when you try to eat less. Eating is a lot more complicated than people think. If you don't eat enough, your body tells you to eat more. If you eat certain foods, like vegetables and proteins, you can get by eating fewer calories. If you eat carbs and fats together, your body wants you to eat more calories for many physical reasons.
Given the science of all that, what are the factors that drive obesity?
There are many more causes than people think. It's not just eating too much and not exercising enough. A very important common cause of weight gain is medication. For example, over-the-counter sleep medications and antihistamines, which contain diphenhydramine, can cause weight gain. Prescription medications including those for the treatment of blood pressure, mood disorders, and depression can cause weight gain as well. Some other factors that are contributors to the obesity epidemic aren't going to change – for example, the fact that room temperature is pretty much controlled these days. The temperature in the room used to be hot in the summer and cold in the winter and your body would have to burn calories in order to regulate temperature. We don't have to do this now because we have air conditioning in the summer and heating in the winter. These things all add up to more and more weight gain. And many of these trends happen at the same time so it's difficult to tell you which one is the cause of weight gain in any given case.
Why might meal plans, recipes, exercises, etc. be a better nutritional lifestyle plan to follow?
The program that we outline is based on the latest research, as well as my experience treating patients for 30 years. It's not just based on an idea that some approach causes weight loss. A good example is the recognition that when people go on a lower carbohydrate diet they do great, but then they go off the diet, and – all of a sudden – the weight comes flying back on. Then they're demoralized and they give up. Telling people not to eat carbs, ever, doesn't work in the long run. The question is this: how can you integrate a more flexible diet to minimize its effect on appetite and metabolism? In looking into this problem we believe we've figured out what is probably the best time to reintroduce carbohydrates. And that is towards the end of the meal. We studied people with diabetes and found that if we gave them protein and vegetables followed by bread at a meal, rather than the other way around, their blood sugar rose gradually rather than spiking, and was 60 points lower at maximum. In addition, they produced just one half the insulin to get that better result. So they ate the same meal in a different order but had a lower blood sugar and produced less insulin, which translates into less appetite and a better metabolic outcome. Our patients find this advice very easy to follow.
Do you think that this would be a good way for people to start off the new year?
Yes. An important point is that for people who are having trouble with their weight, this book is not just about going on a really great, healthy diet; there is advice for the person who can't seem to lose weight, which is one of our specialties. We see people who are frustrated by their inability to lose weight, referred by their physician, nutritionist or trainer. We look for barriers to weight loss like medications they're taking, sleep apnea, and others. We come up with a treatment plan and often, they start to lose weight. Most times, they don't have to count calories. In some cases it's the medications, in others it's that when you eat calories with less starch and sugar, you tend to eat less food; that's one of the things people should understand.
Why does the body crave some foods more than others?
There are several reasons why. The simplest study I've ever seen explaining this phenomenon was performed by Dr. David Ludwig and colleagues, who gave young men instant oatmeal on one day and eggs another day. On the day they had instant oatmeal, they ate 80 percent more later in the day! They were hungrier and they weren't as full. The young men in this study had carbohydrate processing problems and higher levels of insulin when they ate the oatmeal than the eggs. We think that anybody gaining weight probably has higher levels of insulin than they should have. This study (published in the journal Pediatrics) illustrates that phenomenon. Is it because of addiction? That's just one day-one meal. I wouldn't call that addiction, but it is something physical. Nonetheless, there is evidence that sweet, fattening foods may indeed be addicting.
What might you say to reader looking to change their nutritional habits but who have a slip up?
It's ok. Just do the best you can. There's evidence that even intermittent dieting can help. Some people can't stick with a diet every day and that's fine. Second thing is – depending upon how serious your weight problem is – if you're having health problems from your weight, seek medical help. Who should you see? We now have The American Board of Obesity Medicine, of which I am the chairman. More than 1500 doctors nationwide are now credentialed in Obesity Medicine, a discipline in which practitioners are trained to deal with patients who can't lose weight. They use more advanced diagnostic techniques, medications, and are familiar with weight loss procedures and surgery.
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