Fuck Your Weight
Disclaimer: This blog provides general information and discussions about health and related subjects. The content provided in this blog is not intended as and should not be considered medical advice. Always seek the guidance of your doctor or other qualified health professional with any questions or concerns you may have regarding your health or a medical condition.
Also, I have no affiliation and receive no benefits from the companies, people, or apps mentioned in this post.
As an American, the probability you are overweight is incredibly high. Over 70% of Americans are “overweight” and over 40% are “obese.” How does that compare to the 1970s, the decade when those of us now turning 50 were born? In the mid-70s, 15% of adults were overweight, slowly increasing at 0.5% a year. Then, something happened. Obesity rose to 23% in the period from 1988 to 1994, and 31% by 2000. American obesity isn’t sexist or racist, it doesn’t care if you are a man, woman, transgender, black, white, Latino, or anything else — all types of Americans have dramatically changed their shapes and increased their size over the last 50 years.
What the fuck happened?
There is a lot of data and even more theories — too many calories, not enough movement, too many carbs, too much meat, too little protein, too much fat, too much sugar, too much oil, too little fiber, dangerous food additives, the rise of fast food, expanding portions, etc. All have a kernel of truth with a legion of “experts” proclaiming their supremacy on Instagram, but one thing is clear — American culture is killing us.
The culture we’ve created, with highly palatable food designed to drive our cravings and eat more than we need (without the need to move to get it), while being marketed everywhere we look and ubiquitously available on every street corner, is way overmatched for how our brains and bodies evolved. As recent as a few hundred years ago, the history of human evolution was one of scarcity. Food was actively sought out, required miles of walking with bursts of speed, and then carried home. There was an evolutionary advantage for our brains to develop in a way that motivated us to go out and seek food, especially calorie-dense food. Those capable of storing excess eaten food as fat during times of abundance also had an advantage as they drew on that fat energy to ride out lean times. Those who were not motivated to seek out food and or lacked fat stores eventually faced a food shortage and died of starvation, while our motivated ancestors hunted, gathered, migrated, and eventually domesticated plants and animals to stay alive. We are designed to be food-motivated - that is what has kept us alive for 99.95% of human existence. The issue is that in the last 0.05% of human existence, we’ve transitioned from an environment of food scarcity to an environment and culture of food abundance.
Our brains are coded to seek out and eat like assholes whenever possible and our culture is designed to make sure you can eat like an asshole any time you want. Food companies spend $5.7B on advertising (2022) on all our screens (phones, tablets, computers, TVs, etc.) and across all our social and community spaces. These ads are designed to trigger our unconscious motivation to eat and to act on this motivation, we just pick up our phone and make a DoorDash order, or hop in the car and drive to the convenience stores, fast food restaurants, or supermarkets that surround our homes. We are not ordering the highly fibrous tubers and free-range game our ancestors ate, nor putting in the physical effort to acquire it. Our food is born in a lab, designed by food scientists to hit “the bliss point” — the perfect combination of sugar, salt, and fat that optimizes the release of dopamine in the brain to keep you eating more. So when Lays Potato Chips hires celebrities and athletes to quip, “Betcha can’t eat just one,” they are playing a game of three-card monte that you are guaranteed to lose. The result? You quickly blow past the calories needed to live and begin storing the excess calories as fat.
Weight is an important health marker and predictor of the non-communicable diseases (NCDs) that are killing us at an increasing rate. If you are obese, the risk of developing Type 2 Diabetes goes from 7% to 70% in men and 12% to 74% in women. Obesity is estimated to be the cause of 20% of cancer cases, and increases the risks of heart attack, stroke or other cardiac events 2.5 times for women and almost 3 times for men. Studies are also finding that overweight and obese individuals are more likely to develop dementia later in life.
So with all the evidence for how we gain weight and why it is bad for us, why is weight a poor metric for improving our health?
Because focusing only on weight loss leads to behaviors that can be harmful to our health. Peter Druker said, “You can’t manage what you don’t measure,” and the inverse is also true — you manage what you measure. If your only metric is your weight, anything goes to lose weight. Including, dramatic calorie restriction. Yes, you need to reduce the amount of fuel (calories) you put into your body so that you are pulling fuel (calories) from fat stores to make up the difference (resulting in fat loss). But radically reducing your calories only triggers your body’s starvation response. You can fight it for days, weeks, maybe a few months, but over time, your brain, hard-wired for survival, will wear you down and force you to eat. You will not only be discouraged as the weight comes back but realize that your body has adjusted and now eating what you ate before results in weight gain because your metabolism slowed as part of the starvation response.
Worse, you likely reduced your protein intake when you dramatically cut your calories. Without enough protein to maintain and repair muscles, your muscles begin to waste away (known as sarcopenia). When your metric is weight, you see muscle loss as a win! But maintaining muscle mass as you age is critical to your health. Muscles are the main drivers of your metabolism (it is where the majority of your mitochondria live), and muscles provide the strength and stability you need to live a healthy, active life. By the time you are 50, you are losing 1–2% of muscle mass a year (unless you are doing resistance training), and dramatic calorie and protein restriction accelerates the muscle-wasting process. Not convinced about muscle’s importance? One in three people over 50 who break a hip are dead within 12 months. Weight loss that comes at the cost of muscle loss is a poor choice.
This brings us to the decision by some non-diabetics to take semaglutide (Wegovy and Ozempic), originally a drug to assist diabetics with weight loss. If you are morbidly obese, semaglutide can dramatically change your life. But for people who have the health and means to achieve better health through lifestyle change, research increasingly shows semaglutide as a very poor, and potentially dangerous option. An Atlantic article summarizes Dr. Ropebrt Kuschner from Northwestern University as saying “The more these patients lose, the more likely their body is breaking down muscle… The impacts of losing muscle may go beyond losing just strength. Muscle cells are major consumers of energy; they influence insulin sensitivity and absorb some 80 percent of the glucose.” Another study showed that people who stopped using semaglutide regained two‐thirds of their prior weight loss. The recommendation is to take semaglutide forever. Good luck getting your insurance company to pay for that, and some recommend only taking semaglutide for 2 years. As usual, the silver bullet solutions promised to us don’t deliver because they only address symptoms and don’t solve the underlying problem(s).
So if weight is not the metric to manage, what is?
Einstein may or may not have said, “We can’t solve problems by using the same kind of thinking we used when we created them.” Even if he never said it, someone did and they were right.
If we want a different, healthier result, let’s shift our mindset and change the metrics. The new mindset shifts from “weight loss” to “better health.”
What the hell is “better health?” Better health is living in a way that aligns with how our bodies were designed to function, thus reducing the probability of injury, disease, and premature death. This broad definition allows us to choose a few metrics to focus on given our current situation, and then add additional metrics as our lifestyle and health improve.
Three stater metrics are “Insulin Sensitivity,” “VO2max,” and “Muscle Mass.” If you improve those three metrics, the probability your health improves goes up, and your weight will most likely go down. Yes, measuring these new metrics is harder than stepping on a scale every morning (which you can still do, just don’t put too much faith in it), but Egyptians invented the scale 3,300 years ago. It’s time for an upgrade.
Why these three metrics? Collectively, they measure the quality of the food you eat (insulin sensitivity), how well you move (VO2max), and how strong and powerful you are (Muscle Mass). There are no devices to measure these metrics daily, but you don’t need to measure them daily to manage them. There are proxies to gauge your daily progress in between your quarterly or annual measurements. Let’s dive into each one.
Insulin Sensitivity is how well your cells respond to insulin and take up glucose from the blood. Why is this important? Your body turns the carbohydrates and sugar you eat into glucose, the fuel your cells use to produce energy. Glucose is critical to survival, but too much glucose in the blood is toxic, so your body closely regulates it. Insulin is the hormone that shuttles glucose from the blood into your cells, including muscle cells. (Your muscles take the glucose and store it as glycogen, a short-term energy source muscles use when you move and exercise.) If there is extra glucose in the blood, insulin shuttles it to your adipose (fat) tissue for storage. The more you eat and the less you move, the more your adipose tissue stores fat for lean times, which rarely occurs in our culture. The more glucose and insulin that flood your bloodstream, the less sensitive your cells are to insulin, so the pancreas pushes more insulin into the blood to get the job done. This is called insulin resistance and is the first step towards Type 2 diabetes.
Insulin sensitivity is a reflection of the quality of our diet. When we are insulin sensitive, there is a high probability that the food we are eating is healthy / aligns with how our bodies evolved to work best.
The challenge is that the only way to measure insulin sensitivity is via a blood draw, which you can have done 1–2 times a year. Insulin is not always included in a standard blood test, so make sure you tell your doctor to include it. If your doctor says it is not needed because they are measuring glucose, say great, but please include insulin, too.
What do you do between blood tests? Track the food you eat. I know I just lost 90% of you but stay with me for another paragraph. Remember, what isn’t measured isn’t managed. So why are we not managing what we eat? One excuse is that humans never had to track what they ate before. True, but humans have never lived in an environment and culture where the food was so abundant and toxic it could kill them. Our goal is to track our food until we recreate our personal and familial eating culture in a way that promotes our health. (Future posts coming on this.) If tracking food is too much for you, think about what your overweight, diabetic self and your loved ones would say after getting a cancer diagnosis. Sounds grim but future casting works.
For tracking, apps like MyFitnessPal and Carbon are helpful. Track your diet for a week to set your carbohydrate and sugar baseline and then remove sugary drinks (colas, sports drinks, juices) for a month. Then reduce the amount of sweets, candies, and desserts; then fried foods; then things in bags (chips) and boxes (cereals). It sounds ominous so start slow and give yourself early wins. As your sugar and carb numbers drop, so will your calories. You can replace some of the calories with healthier carbs, proteins, and healthy fats. A small reduction in calories will lead to a little weight loss. Remember, radically dropping your carbs and calories will lead to a starvation response and lower your likelihood of long-term weight loss. This is not a temporary diet but a lifestyle change. Highly refined carbohydrates and foods with a lot of added sugar should not return to your daily eating, except for planned cheat days. Replace these foods with healthier options. Fried chicken with grilled chicken breasts. Potato chips with carrots and hummus. Sweets with berries and watermelon. When your ancient brain says, “fuck this!” train your rational brain to step in, pause and reply, “The alternative is a slow painful death.” That works 80% of the time and that is good enough. To greatly increase your chance of success, clear the shitty food from your fridge and pantry— cookies, chips, candy, etc. Designing a food environment without highly palatable, calorie-dense food that you will binge on is key (future post coming on this, too). There is another way to increase your insulin sensitivity — move! That brings us to VO2max.
VO2max is how well your body processes oxygen. You can get it measured in a physical therapy lab. They put a mask on you and have you run on a treadmill, slowly increasing the incline and speed until you surrender. It’s not the most fun test, and thankfully, your digital watch has a pretty good estimate (I’ve measured my VO2max in the lab twice and it matched my Apple Watch estimate both times). You improve your VO2max through exercise. The most effective way is through High-Intensity Interval Training (HIIT) — Short bursts (1–5 mins) of intense exercise followed by rest (1–5 mins) repeated several times. (3–5 reps). If you’re not ready for that, Zone 2 training is a great place to start. What is Zone 2 training? Cardio workouts are performed at a relatively low intensity for an extended period. If you’re not as fit, this may be a brisk walk, slow jog, or bike ride. If you're breathing heavily and struggling to speak, you're working way too hard. Do this for 45 minutes, three times a week and you will see pretty quick results. Once you’re ready, add one HIIT workout a week. What are we measuring? The time you spend on Zone 2 and HIIT workouts. If you have an Apple Watch, turn on the heart monitor and it will estimate your VO2max in between your annual/bi-annual VO2max test at the lab. A great app to track your workouts is Strava. Finally, muscle.
Muscle Mass is the total amount of muscle you have. Why is muscle important? Your muscles are the largest organ in your body. Why muscle wasn’t taught as an organ when we were in school in the 70s and 80s is a signal of how little we knew about health. Muscle is important for many reasons but it comes down to mitochondria. Mitochondria are the organelles in our cells that use glucose and fatty acids as fuel to produce energy. The healthier your mitochondria and the more you have, the better you are at producing energy — which is another way of saying, “living.” The more muscle mass you have, the more mitochondria you have. The more active you are, the healthier your mitochondria. The more intense your activity, the higher the mitochondria turnover you have. More muscle is better and increases the probability you are healthy.
You increase muscle through resistance exercises. You can do bodyweight workouts (pushups, pull-ups, etc.), resistance bands, and lift weights. Start with what you will do, get stronger, and then keep going. One critical element here is protein. You have to eat enough protein to give your body the protein and amino acids it needs to maintain and repair muscle. A great workout coupled with a low-protein diet will not build the muscle you need (future post coming).
Muscle mass is something you can measure every day, however, my smart scale is woefully inaccurate. Track your workouts and the improvements in the number of reps and amount of weight you can do. Then 1–2 times a year you can get a DEXA scan to measure your body composition, including bone density, adipose (fat) tissue, and muscle. (Make sure you ask for the fat and muscle measurements before the scan, most insurance companies don’t include them, and therefore hospitals may exclude them.) The good news is you can see your progress! Sneak into the bathroom, take off your shirt, and take a photo to track your progress (no, this doesn’t make you vain), and go old school - measure your chest, arms, legs, and waist. As you create all this new muscle, you may gain weight because muscle is more dense than fat. But your DEXA scan will show you your true progress. This is another reason why your weight is not an ideal measure of your health.
In summary, we live in a culture that is mismatched to how our bodies and brains evolved over millions of years to survive. So instead of battling, work with it. Start by re-creating your food environment, removing all the highly palatable, calorie-dense food we overeat. Then track what you eat and your Zone 2, HIIT, and resistance training workouts, and measure your insulin sensitivity, VO2max, and muscle mass 1–2 times a year. If you’re tracking these activities and these three metrics are improving, your health is improving, and your weight is likely falling. If it is not, you are still healthier.
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