The Fitness Industry is the Fatness Industry

Susan, a 42 year old successful lawyer, had been slim as a child and young adult. For the past decade she’d found that the scale was creeping up. She tried a variety of diets and took up jogging. She even competed in a marathon. But still the pounds crept up.

The previous year Susan had turned to the fitness industry for help. She thought her problem was a lack of motivation and the solution was to join a gym (again) and hire a personal trainer. A personal trainer isn’t a personality trainer. He or she is there to help you reach your fitness goals. Inspired by The Biggest Loser, Susan hit the gym with determination. She measured and recorded her food intake, dutifully plugging the numbers into her blackberry.

In the first month or so she was ecstatic. Her tight clothing fit better and the scale was ticking downward. After 2 months she hit a plateau. She increased her time on the treadmill and cut back even further on her calories. Despite checking the scale 10 or 15 times a day she made no progress for weeks. Discouraged and hungry she decided to take the weekend off. Much to her horror and shame when she stepped on the scale she was up almost 10 pounds, nearly her starting weight.

She signed up for a new series of personal training sessions and went back to her diet. She lost weight, gained weight and lost again. When she came to see me it wasn’t for weight loss advice, it was for her painful knee. When I first laid eyes on Susan I could see she was upset. My first question, “How can I help you?” was answered with a flood of rushed statements punctuated with frequent with emphatic, “I have to” and “I need to” lose weight, get back to the gym as fast as possible, stop being such a crybaby, stop being such a pig and please help me now, now, NOW.

As a final gesture she shoved a packet of papers at me and said “My MRI says I have a torn meniscus and my doctor says I might need surgery. I came to see you because a colleague told me you helped with his knee. I don’t have time for surgery, I have to get back to the gym as soon as possible.”

I asked her a few questions about her daily routine and the history of her knee pain. She told me that originally it hurt only when she used the stair machine, but then started to hurt on the treadmill too. But there was no way she was going to stop—she was afraid of “exploding into fatdom.” Susan told me point blank, “I’m in a war with my fat and I’m going to win if it kills me.”

“Well, that’s an interesting perspective,” I replied. “Because you are talking about a living integrated part of your body. Your fat isn’t fingernails or fur. When you are at war with your fat you are at war with yourself. Fat cells are like brain cells or heart cells or liver cells that communicate with other cells all over the body every moment of the day and night.”

I explained to her that it might be time to consider a “peace treaty.”

It turned out that it wasn’t time yet. On that day Susan was only interested in making her knee pain go away so she could get back to the gym. She thought what I was suggesting was that she should just give up her attempts to control her weight. That’s not the case. I was actually trying to get her to ask a better question. Replace “Why can’t I lose?” with “Why am I gaining?”

Susan complained to me that she couldn’t figure out why her one big failure was her inability to lose weight. I pointed out to her that far from failure, she had successfully lost weight many times. The goal of her constant diets was to “lose weight,” and that’s exactly what she did over and over. The reason Susan was carrying around those extra pounds is that she didn’t know how to stop accumulating. She was looking for a solution when what she needed was strategy.

As a lawyer Susan should have realized that she was putting a lot of faith in “hearsay,” and that if she did her research she would find a lot evidence that her defend-to-the death combo of cardio and calorie counting was getting her exactly where the treadmill takes you—nowhere.

Traditional diet and exercise programs work well for the fitness industry model. They are there to help people lose weight. Unfortunately, most of them use a model that has been honed over centuries to disrupt your weight regulating mechanism and turn your body into a fat hoarder with a monstrous appetite. The fitness industry wins because its goal is to get your money. Health clubs rake in about 25 billion dollars annually because you gain more than you lose.

If you take a look at an obesity prevalence chart you will see that there is a nice flat line until about 1980—then it starts climbing like a roller coaster ride, and we still haven’t reached the top. In 1978 there were 3000 private fitness clubs; now there are more than 10 times that number. Membership has skyrocketed from 1.7 million in 1972 to over 50 million in 2010. During that time our weight has gone up and up and up.

Most people think that a fit healthy body requires a tremendous amount of willpower to work out, and “won’t power” in response to their hunger pangs. But the reality is that obesity was quite rare until just a few decades ago. In fact, most languages don’t even have a word for it.

I gave Susan a few exercises to increase her foot and spine mobility. Her problem wasn’t really with her knee as much as it was her posture and technique on the treadmill. Much to her surprise and pleasure she noticed a difference immediately. I reminded her that pain is just a way for our body to communicate. If she didn’t make some changes the pain might come back or show up in a different place. I didn’t really expect to see her again.

“You can’t always get what you want, but if you try sometimes you just might find you get what you need.”

A couple months later Susan scheduled another appointment. When I walked in to greet her the first words out of her mouth were “I’ve been thinking about what we talked about and I’m ready for a truce.”

“Who—with me?” I asked.

“No,” she laughed, “with my body.”

“What made you change your mind?” I asked.

Susan pondered this and replied, “I guess the point that really hit home with me was when you talked about if you only got one car and it had to last a lifetime. It also helped that my knee pain went away—that was like magic!”

I explained to her that it really was like magic, but more like Houdini than Harry Potter. The magician knows what’s happening. The secret to releasing weight, and more importantly how to stop accumulating, is managing insulin and Leptin. And just like Penn and Teller, I am more than happy to reveal how it’s done.

There are a hundred trillion cells in the human body—that’s more than 10,000 times the entire population on the planet earth. Although much of the earth could probably function without communication, this isn’t true for our bodies. Cells are constantly reacting to chemical messages sent by other cells and responding with messages of their own. Fat cells are especially abundant in the human species; along with whales and hedgehogs we have roughly 10 times the number of fat cells of other animals. We are actually much “fatter” than pigs!

Having more fat cells isn’t what makes us LOOK fat. When we become overweight or obese that is because our fat cells are hoarding fat; literally, they are actively collecting fat and won’t let it go. It’s important to stop thinking of fat tissue as an inert blob like cream cheese on a bagel that you can simple scrape off with a knife. Our fat tissue is part of our body; in fact, it is the single largest tissue in our bodies.

This is a diagram of a fat cell, or adipocyte, holding on to its storage pot of fat or fat globule. A receptor is the way a cell can receive information or instructions. For a cell like this to decide to give up some of it precious cargo, the incoming message must persuade the adipocyte to RELEASE fat so that it can be used as fuel in another cell. Fat cells don’t have to work very hard so they don’t need all this fat for themselves but they can be quite stingy about letting it go.

You could say the typical human fat cell is like Ebenezer Scrooge. It is very interested in increasing supply and very reluctant to let any go. If you try to demand or steal from Scrooge, it makes him even worse. This is exactly how your adipocytes respond when you start an intensive diet and exercise program. The point of the Dickensonian tale is useful for us. Scrooge can be persuaded to want to get along with everyone and share the wealth. The same can be done with fat cells.

Like all hoarders, adipocytes have not one but two big problems: they keep collecting, and they are reluctant to let anything go. In order to release weight and have the body you want for the rest of your life, both of these situations must be addressed.

When the body is in a normal healthy homeostatic balance, insulin distributes the fuel obtained from our food so that all the cells get only what they need to function optimally. What is left over is stored for later. After a meal is digested and absorbed we have a lot of free fuel floating around in the blood, like a big load of dollar bills dropped down from the sky. This is the signal for insulin to come out and distribute the money. When the money is gone the insulin goes away, too. When we eat frequently there are a lot of money drops. When we eat carbohydrates like sugar and starch a very large load of money is dropped at one time. That means that insulin is going to be around a lot more often.

What makes us get fat is when insulin starts hanging around all the time. When insulin levels stay high for long periods of time the cells become resistant. Insulin is needed to unlock the door to the cell and deliver the fuel. When cells become resistant to insulin they can’t get delivery of fuel. There might be plenty of dollars floating around, but they aren’t getting any.

Some people tend to put on weight much more easily than other people. That’s because some cells become insulin resistant faster than others. When muscle cells become resistant to insulin much sooner than the fat cells most of the fuel or dollars ends up in the fat cells, no matter how much the muscle cells might need the money. Insulin resistance means the rich (the fat cells) get richer and the poor (the muscle cells) get poorer. Insulin compels the fat cells to act as hoarders, stuffing more fat into their fat globule store and refusing to let it go to be used. Those fat cells tell the brain they really need all that fat and that the other body cells just need to get their own fuel.

Fat cells communicate to the brain with Leptin. Our fat is supposed to be our stored energy. Fat is required to send a report to the brain about their current value. Leptin is secreted by the adipocytes in proportion to the amount a stored fat. When you have lots of fat you should have lots of Leptin. Greedy bloated fat stores can behave just like greedy bloated fuel corporations. They lie to the brain and plead poverty through fraud and misrepresentation just like the 100 billion dollar energy corporation Enron lied.

The brain makes decisions about eating behavior based on information from the Leptin report. If the Leptin report is inaccurate because of Leptin resistance, or confusion in the brain, or because the fat is under reporting its fat stores, the brain will become worried that fuel storage is inadequate. The brain will start to send out signals like hunger or cravings to encourage you to eat. Although eating will produce momentary relief and reward, because the underlying situation isn’t corrected the food preoccupation will not go away.

Unfortunately, your fat stores will not just dissolve like Enron. Short term solutions like diet and exercise can help you “lose” weight. Scrooge doesn’t stop being stingy because you take away his money by force. He will just become more paranoid and crafty. Because storing fat has played a central role in the survival of the human species we have least 10x more fat storing options than we have fat releasing options. In other words we have a lot more scrooges than Bob Cratchits.

When we get too fat because our weight regulating mechanism is malfunctioning we need to change our behavior to get it working right again. The fitness industry promotes a mindset that you can’t control your weight; you need them to do it. They get Scrooge’s money by cheating and stealing and they justify it because they think he deserves it. That’s one of the reasons there is such a strong fat hatred in this country—it’s good for business.

A much better strategy is to optimize insulin. Most of this is accomplished with diet. The modern world is full of food temptation, and very little eating skill. Resisting temptation isn’t a skill; it’s a recipe for failure. For long term success, you need focus on USE weight, not lose weight.

If all the different types of cells developed resistance to insulin at the same rate, we wouldn’t have as much of a problem. But they don’t. Different cells develop insulin resistance at different rates. Typically the first cells to become insulin resistant are the liver cells. The liver cells are continuously producing sugar and dumping it into the blood. Insulin shuts this process down. If the insulin level drops to zero, as it does in type I diabetes, the liver dumps a huge load of sugar in the blood, causing all the blood sugar problems associated with this disease. Under normal circumstances, just a little insulin stops the liver cells in their tracks. But if these cells are resistant to insulin, much more is required to get them the message to turn off the sugar spigot.

The above scenario explains a lot. Why can some people eat like crazy and not get fat? Perhaps because they develop insulin resistance in their fat cells just as they do in their liver cells. They don’t get fat, but they typically have all the other insulin-driven problems of the obese: high blood pressure, elevated triglycerides, increased risk for heart disease, etc. And all while staying skinny.

How about morbid obesity? Easy. Those people don’t develop insulin resistance in their fat cells until late in the game, if ever. They continue to push fat into the fat cells and become more and more obese until they weight 400-500 pounds or even more. The average person will finally develop fat cell insulin resistance before the morbid obesity stage. When this happens, weight and level of obesity stabilize and stay the same, almost irrespective of how much is eaten.

Some people, with a little learning, may be quick to point out that protein drives insulin up as well. This is true, but with a catch. Protein drives both insulin and glucagon up, so you don’t have the pure insulin effect. Only carbs will give you that. With carbs, insulin goes up while glucagon goes down. With meat and other proteins, the effects of the elevated insulin are muted by the concomitant rise in glucagon. (Glucagon isn’t called insulin’s counter-regulatory hormone for nothing.)

In obese people it’s different. They eat, they use the food for immediate energy needs, and they store the rest away. In other words, they store excess energy away in their fat cells just like non-obese people do. It’s the second part of the formula that is different. In obese people, insulin is almost always elevated, even when they haven’t just finished a meal. These chronically elevated insulin levels trap the fat in the fat cells, and, in fact, turn the fat pathway into the fat cell into a one-way street. Fat can get in, but it can’t get out. If the fat does get out, the excess insulin tells the mitochondria not to burn it anyway, so it just gets sent back to the fat cells.

The more technical term for carbohydrate withdrawal is “keto-adaptation,” because the body is adapting to the state of ketosis that results from eating fewer than sixty or so grams of carbohydrates a day. This reaction is why some who try carbohydrate restriction give it up quickly. (“Carbohydrate withdrawal is often interpreted as a ‘need for carbohydrate,’” says Westman. “It’s like telling smokers who are trying to quit that their withdrawal symptoms are caused by a ‘need for cigarettes’ and then suggesting they go back to smoking to solve the problem.”)

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