A Call for a Low-Carb Diet

SLLRunner

I'm just going to leave this here:

http://examine.com/blog/is-low-carb-really-the-best-weight-loss-diet

Thank you. This is a good article with a thorough analysis.

Catter_05

I suspect the likely result of eating a high carb diet when you have obesity-induced insulin resistance is simply cravings, which can be resisted with sufficient willpower. If you're at a calorie deficit, you're still going to be burning more body fat than you're storing, so it's not really an issue of insulin resistance defying CICO. It's just that life can be more difficult due to the way you feel on such a diet and it may take a stronger will to stick with your calorie deficit, given your body's inability to properly respond to insulin.

But that said, it's pretty common advice for people that are feeling hungry to consume more protein and fat (and thus less carbs) and of course people are free to play with their own macros. And there are other steps you can take to address feelings of hunger. For instance, while I don't do it every day, but I find occasionally fasting for 16+ hours and essentially eating 1 meal for the day really helps you distinguish true hunger from other impulses to eat. Personally I find it's a bit easier to do this when acclimated to a low carb diet since I'm not really dependent on carbohydrates for energy, but that's just personal preference. In short, it's hardly insurmountable and, at least in my opinion, doesn't belong in the same category as people with a thyroid condition, diabetes, and so on.

How do you differentiate between obesity-induced insulin resistance and non-obesity-induced insulin resistance? I've never seen anyone make the differentiation before, other than speaking about possible origins of how some end up with it. Is there a difference in the insulin resistance one gets from a long untreated thyroid disorder, PCOS or otherwise than those that get it from weight gain?

Not that I know of. I only know that mine is not obesity induced because I wasn't obese. I don't think there is really any difference in the mechanism. Personally, I think that the underlying problems are the cause of the obesity. But it is a catch-22 in so many ways because the more insulin resistant you are, the more fat you produce. And the more insulin resistant you are the more exhausted you become. Diet and exercise are the best way to fight it, but your body is crying out for energy (there were times when I would be shaky and ravenous from hunger) and you are just exhausted. That's where medical intervention comes in. Once the medical conditions are treated it becomes a heck of a lot easier to eat better and exercise.

parkscs

How do you differentiate between obesity-induced insulin resistance and non-obesity-induced insulin resistance? I've never seen anyone make the differentiation before, other than speaking about possible origins of how some end up with it. Is there a difference in the insulin resistance one gets from a long untreated thyroid disorder, PCOS or otherwise than those that get it from weight gain?

Hypothyroidism comes with all sorts of other complications that can make weight loss more difficult and requires special treatment. PCOS is the same. Being overfat and sedentary and perhaps developing some degree of insulin resistance as a result may change how you respond to certain foods, but I don't see it as the same sort of obstacle. That sort of insulin resistance can also largely be reversed if you drop the weight and up your activity level. I'm no expert, but I don't believe that hypothyroidism simply goes away if you lose some fat and pick up heavy barbells on a weekly basis.

In short, it's not a lifelong medical condition that's going to require continued treatment. And while I'd agree it can make things more challenging for some people, it's also reversible through effort and willpower. So, I keep coming back to the majority of people just people need to get off the couch and do what they have to do to lose the fat (which may include tweaking their macros/following a structured diet). For the minority of people with a debilitating condition, they need to see a doctor to figure out how best to handle it.

What basis do you make these claims? That it's will power enough. I've personally experienced it and know how difficult it was for me -- and there were times I was so exhausted that I was sleeping more than 14 hours-16 a day. Catter seems to have had a similar experience. Is this the sort of will power you're talking about?

It just seems incredibly presumptuous to make such statements, and frankly downright dangerous. Like telling people with deep depression that if they just tried harder to be happier, it would fix their problems. There are chemical imbalances and will power doesn't work alone for all people with the affliction (though it may for some).

I don't know what claim you're talking about exactly. I'm not discounting the fact that a minority of people have a medical condition which makes it significantly more difficult for them to lose weight, but I do not think your personal experiences apply to the majority of people. I'd go so far as to say the vast majority of people are not sleeping 14-16 hours per day or feeling that exhausted all the time (I wish I had the time to pull that off); they're just eating too much and moving too little. It sucks that you were the exception to the rule, but we're stuck with the cards we're dealt and it sounds to me like most people have a better hand when it comes to weight management than you. And I'm not against people doing a low carb diet if they find that helps them - pretty sure I've said that multiple times and, if you know my posting history at all, you'd know I'm not anti-low carb.

I am a bit anti-excuses though. It's one thing to acknowledge obstacles you're facing and attempting to find intelligent ways to overcome them; it's another to sit around making no progress and just talking about how hard it is for you, particularly for people without a debilitating medical condition. So if high carb causes cravings due to your insulin resistance and your blood sugar going all over the place, then change your diet. Again, it comes down to finding what works for you and having the willpower to push through the un-fun parts.

likitisplit

The need to draw on will-power is argument enough for the diet - for god's sake, food shouldn't be that all-consuming. But, aside from that...

You're saying that obesity-induced insulin resistance doesn't cause fat to be stored while the muscles starve?

Fat storage can occur in the very short term regardless, but I'm saying that you will not see net fat storage over time if your calories are in check. Yes, IR as a result of being overweight can mess with your blood sugar levels and might cause cravings in some people, and yes there are certain types of food that will affect you in this way more than others. But all I'm saying is that with sufficient willpower, you can overcome cravings and sustain a caloric deficit, which will result in fat loss over time. Now if you choose to eat ice cream, rich coffee drinks and the like as part of your caloric deficit and you're to some degree insulin resistant, you may need a lot more willpower than someone else who is eating a lower carb diet. But either way, it's doable, and by dropping the weight, you will also improve your body's ability to respond to insulin. Now if you add in some exercise on top of all that, you'll further improve your body's insulin sensitivity.

I do hear what lindsey's saying though. I'll admit it bugs me a bit when people go around telling obese newbies to still eat ice cream and donuts, sometimes even daily, but to just use a bit of moderation. Personally I don't see that as very good advice, especially for someone just starting out and likely to have some degree of insulin resistance as a result of their weight. One meal per week, sure, but much more than that and I think you're pushing it for someone just starting out (just my opinion). Ultimately it's all about finding that balance and what works for you, and at the end of the day, people can and do overcome obesity-induced IR. It's just a matter of bolstering your willpower, get more active, and knowing that it gets easier as you go forward.

What basis do you make these claims? That it's will power enough. I've personally experienced it and know how difficult it was for me -- and there were times I was so exhausted that I was sleeping more than 14 hours-16 a day. Catter seems to have had a similar experience. Is this the sort of will power you're talking about? Make it so you can't function like a normal human being to maintain weight?

And having had higher levels of insulin resistant and now lower levels (not totally free of it yet, though I hope I might be one day), that there was a WORLD of difference in the "will power" I needed before treatment and after treatment. Literally night and day. And, for me, my exercise was the EXACT same. If you haven't experienced this, I don't think you have any idea what you're talking about. Eating is rather easy for me now. But there were times when it was extremely difficult and despite having a calculated deficit of over 700+ calories a day, I still wasn't really losing. Cutting more was not the solution. More exercise was not the solution (I also ran and trained for a half marathon prior to this). Medical intervention was. Now, when I cut like that, I get the expected weight loss numbers.

It just seems incredibly presumptuous to make such statements, and frankly downright dangerous. Like telling people with deep depression that if they just tried harder to be happier, it would fix their problems. There are chemical imbalances and will power doesn't work alone for all people with the affliction (though it may for some).

Actually, exercise and continuing to make an effort to maintain relationships does help people with deep depression. The drugs can be hit or miss.

Catter_05

The need to draw on will-power is argument enough for the diet - for god's sake, food shouldn't be that all-consuming. But, aside from that...

You're saying that obesity-induced insulin resistance doesn't cause fat to be stored while the muscles starve?

Fat storage can occur in the very short term regardless, but I'm saying that you will not see net fat storage over time if your calories are in check. Yes, IR as a result of being overweight can mess with your blood sugar levels and might cause cravings in some people, and yes there are certain types of food that will affect you in this way more than others. But all I'm saying is that with sufficient willpower, you can overcome cravings and sustain a caloric deficit, which will result in fat loss over time. Now if you choose to eat ice cream, rich coffee drinks and the like as part of your caloric deficit and you're to some degree insulin resistant, you may need a lot more willpower than someone else who is eating a lower carb diet. But either way, it's doable, and by dropping the weight, you will also improve your body's ability to respond to insulin. Now if you add in some exercise on top of all that, you'll further improve your body's insulin sensitivity.

I do hear what lindsey's saying though. I'll admit it bugs me a bit when people go around telling obese newbies to still eat ice cream and donuts, sometimes even daily, but to just use a bit of moderation. Personally I don't see that as very good advice, especially for someone just starting out and likely to have some degree of insulin resistance as a result of their weight. One meal per week, sure, but much more than that and I think you're pushing it for someone just starting out (just my opinion). Ultimately it's all about finding that balance and what works for you, and at the end of the day, people can and do overcome obesity-induced IR. It's just a matter of bolstering your willpower, get more active, and knowing that it gets easier as you go forward.

What basis do you make these claims? That it's will power enough. I've personally experienced it and know how difficult it was for me -- and there were times I was so exhausted that I was sleeping more than 14 hours-16 a day. Catter seems to have had a similar experience. Is this the sort of will power you're talking about? Make it so you can't function like a normal human being to maintain weight?

And having had higher levels of insulin resistant and now lower levels (not totally free of it yet, though I hope I might be one day), that there was a WORLD of difference in the "will power" I needed before treatment and after treatment. Literally night and day. And, for me, my exercise was the EXACT same. If you haven't experienced this, I don't think you have any idea what you're talking about. Eating is rather easy for me now. But there were times when it was extremely difficult and despite having a calculated deficit of over 700+ calories a day, I still wasn't really losing. Cutting more was not the solution. More exercise was not the solution (I also ran and trained for a half marathon prior to this). Medical intervention was. Now, when I cut like that, I get the expected weight loss numbers.

It just seems incredibly presumptuous to make such statements, and frankly downright dangerous. Like telling people with deep depression that if they just tried harder to be happier, it would fix their problems. There are chemical imbalances and will power doesn't work alone for all people with the affliction (though it may for some).

Yes, I think this is true. And some people do believe that about depression too. I think it can be very difficult for people to understand if they haven't experienced it first hand. That's the problem. At some point lowering your calories far enough will work, but how far? And if you lower them far enough to lose weight do you have enough to live and still get the nutrients your body needs? That's why it is dangerous. With the pressure to be thin (and not just healthy but thin) there is already so much self loathing and so many eating disorders. I want to make sure people understand that sometimes will-power just isn't enough. (If only) It's important to get medical intervention when you need it and it's important to stand up for yourself.

Catter_05

How do you differentiate between obesity-induced insulin resistance and non-obesity-induced insulin resistance? I've never seen anyone make the differentiation before, other than speaking about possible origins of how some end up with it. Is there a difference in the insulin resistance one gets from a long untreated thyroid disorder, PCOS or otherwise than those that get it from weight gain?

Hypothyroidism comes with all sorts of other complications that can make weight loss more difficult and requires special treatment. PCOS is the same. Being overfat and sedentary and perhaps developing some degree of insulin resistance as a result may change how you respond to certain foods, but I don't see it as the same sort of obstacle. That sort of insulin resistance can also largely be reversed if you drop the weight and up your activity level. I'm no expert, but I don't believe that hypothyroidism simply goes away if you lose some fat and pick up heavy barbells on a weekly basis.

In short, it's not a lifelong medical condition that's going to require continued treatment. And while I'd agree it can make things more challenging for some people, it's also reversible through effort and willpower. So, I keep coming back to the majority of people just people need to get off the couch and do what they have to do to lose the fat (which may include tweaking their macros/following a structured diet). For the minority of people with a debilitating condition, they need to see a doctor to figure out how best to handle it.

What basis do you make these claims? That it's will power enough. I've personally experienced it and know how difficult it was for me -- and there were times I was so exhausted that I was sleeping more than 14 hours-16 a day. Catter seems to have had a similar experience. Is this the sort of will power you're talking about?

It just seems incredibly presumptuous to make such statements, and frankly downright dangerous. Like telling people with deep depression that if they just tried harder to be happier, it would fix their problems. There are chemical imbalances and will power doesn't work alone for all people with the affliction (though it may for some).

I don't know what claim you're talking about exactly. I'm not discounting the fact that a minority of people have a medical condition which makes it significantly more difficult for them to lose weight, but I do not think your personal experiences apply to the majority of people. I'd go so far as to say the vast majority of people are not sleeping 14-16 hours per day or feeling that exhausted all the time (I wish I had the time to pull that off); they're just eating too much and moving too little. It sucks that you were the exception to the rule, but we're stuck with the cards we're dealt and it sounds to me like most people have a better hand when it comes to weight management than you. And I'm not against people doing a low carb diet if they find that helps them - pretty sure I've said that multiple times and, if you know my posting history at all, you'd know I'm not anti-low carb.

I am a bit anti-excuses though. It's one thing to acknowledge obstacles you're facing and attempting to find intelligent ways to overcome them; it's another to sit around making no progress and just talking about how hard it is for you, particularly for people without a debilitating medical condition. So if high carb causes cravings due to your insulin resistance and your blood sugar going all over the place, then change your diet. Again, it comes down to finding what works for you and having the willpower to push through the un-fun parts.

I agree. And I know that you are not anti low carb. And I also don't like excuses. I personally think the only people left in this conversation are those without extreme beliefs and we are sort of arguing the fine points. I think both Lindsey and I are advocating because we have had a rough time. Like I've said before, if I can save other people from the heart ache I've suffered then I will have accomplished a goal that I feel is important.

I also agree that diet and exercise can improve depression, but so can medicine and so can therapy. Just like losing weight, one size doesn't fit all.

parkscs

Yes, I think this is true. And some people do believe that about depression too. I think it can be very difficult for people to understand if they haven't experienced it first hand. That's the problem. At some point lowering your calories far enough will work, but how far? And if you lower them far enough to lose weight do you have enough to live and still get the nutrients your body needs? That's why it is dangerous. With the pressure to be thin (and not just healthy but thin) there is already so much self loathing and so many eating disorders. I want to make sure people understand that sometimes will-power just isn't enough. (If only) It's important to get medical intervention when you need it and it's important to stand up for yourself.

So what is the medical treatment for a mild degree of insulin resistance induced by obesity? What is the doctor going to do, other than tell you you need to lose weight and possibly recommend you try reducing carbs and/or your consumption of certain types of carbs? Surely you guys aren't saying that every obese person who has some degree of insulin resistance needs to be put on Metformin or a similar drug, so what's the take home here? I'm not saying it's easy, but I'm also not seeing how it's not treatable through calorie restriction, macronutrient composition and regular exercise.

I agree. And I know that you are not anti low carb. And I also don't like excuses. I personally think the only people left in this conversation are those without extreme beliefs and we are sort of arguing the fine points. I think both Lindsey and I are advocating because we have had a rough time. Like I've said before, if I can save other people from the heart ache I've suffered then I will have accomplished a goal that I feel is important.

I also agree that diet and exercise can improve depression, but so can medicine and so can therapy. Just like losing weight, one size doesn't fit all.

I agree. The reason I don't really push low carb diets is because they have their drawbacks as well. Even people with a mild degree of insulin resistance may prefer the flexibility of a balanced macronutrient intake and may struggle on a low carb diet. Yes, the low carb diet may do a better job of regulating their blood sugar levels given their resistance to insulin, but it also may eliminate some of their favorite foods and some people tend to do poorly with restrictive diets. As you said, it's not one size fits all.

Now, with more severe issues like PCOS or even worse diabetes, I have no doubt that you may need to make a more dramatic shift to your diet and you might have to give up that morning donut. But I think the vast majority of people are somewhere in the middle and need to make their own choices about what diet is optimal/sustainable for them.

Catter_05

Yes, I think this is true. And some people do believe that about depression too. I think it can be very difficult for people to understand if they haven't experienced it first hand. That's the problem. At some point lowering your calories far enough will work, but how far? And if you lower them far enough to lose weight do you have enough to live and still get the nutrients your body needs? That's why it is dangerous. With the pressure to be thin (and not just healthy but thin) there is already so much self loathing and so many eating disorders. I want to make sure people understand that sometimes will-power just isn't enough. (If only) It's important to get medical intervention when you need it and it's important to stand up for yourself.

So what is the medical treatment for a mild degree of insulin resistance induced by obesity? What is the doctor going to do, other than tell you you need to lose weight and possibly recommend you try reducing carbs and/or your consumption of certain types of carbs? Surely you guys aren't saying that every obese person who has some degree of insulin resistance needs to be put on Metformin or a similar drug, so what's the take home here? I'm not saying it's easy, but I'm also not seeing how it's not treatable through calorie restriction, macronutrient composition and regular exercise.

Probably, put the patient on a lower carb diet like south beach and tell them to exercise. And then have them come in for a check up to see if it is working. If it doesn't work, maybe a low dose of metformin with the diet and exercise.
Remember, this all started because of comments that were made about obesity being within your control and the poster (I'm sorry I don't remember who it was) saying that being scrawny could be out of your control but he was unaware of any reason obesity would be. I was only offering a counter view point to his, which I felt was harsh and damaging.

parkscs

Probably, put the patient on a lower carb diet like south beach and tell them to exercise. And then have them come in for a check up to see if it is working. If it doesn't work, maybe a low dose of metformin with the diet and exercise.
Remember, this all started because of comments that were made about obesity being within your control and the poster (I'm sorry I don't remember who it was) saying that being scrawny could be out of your control by he was unaware of any reason obesity would be. I was only offering a counter view point to his, which I felt was harsh and damaging.

Well, it's all in how you look at it. I would actually go so far as to say it's still in the person's control - but I would expect that person to educate himself and look for ways to overcome his own obstacles, which may include seeking advice from doctors and other experts. I have no clue what that poster intended, but I would guess he didn't mean that it's always easy for everyone to manage their own body weight/composition, but rather it's still your responsibility and within your power to control. Just because it's difficult (sometimes incredibly difficult) doesn't mean it's insurmountable and outside of your ability to control, and in fact you can essentially reverse the condition through your own actions. To me that's an empowering thought, rather than a harsh/damaging one, but just different viewpoints I suppose.

Catter_05

Probably, put the patient on a lower carb diet like south beach and tell them to exercise. And then have them come in for a check up to see if it is working. If it doesn't work, maybe a low dose of metformin with the diet and exercise.
Remember, this all started because of comments that were made about obesity being within your control and the poster (I'm sorry I don't remember who it was) saying that being scrawny could be out of your control by he was unaware of any reason obesity would be. I was only offering a counter view point to his, which I felt was harsh and damaging.

Well, it's all in how you look at it. I would actually go so far as to say it's still in the person's control - but I would expect that person to educate himself and look for ways to overcome his own obstacles, which may include seeking advice from doctors and other experts. I have no clue what that poster intended, but I would guess he didn't mean that it's always easy for everyone to manage their own body weight/composition, but rather it's still your responsibility and within your power to control. Just because it's difficult (sometimes incredibly difficult) doesn't mean it's insurmountable and outside of your ability to control, and in fact you can essentially reverse the condition through your own actions. To me that's an empowering thought, rather than a harsh/damaging one, but just different viewpoints I suppose.

Good point. That makes sense .
But, I would argue that you could gain muscle/weight too if you are naturally "scrawny". Even if you are fighting genetics, it isn't impossible with exercise and diet. A scrawny person may never look like Arnold Schwarzenegger, but you can increase muscle. A lot of us may never look like super models, but that's not the point.
He made the comparison. I was just offering an alternative viewpoint.

yarwell

Wow - someone seems sensitive to low carbs.

Well done - gif overachiever! boom, high five!

please don't requote them, circumvents my blocking of that sort of rubbish

colors_fade

I'm just going to leave this here:

http://examine.com/blog/is-low-carb-really-the-best-weight-loss-diet

Thank you. This is a good article with a thorough analysis.

Actually, really bad analysis and conclusions.

Here's a better one: http://www.huffingtonpost.com/david-katz-md/post_8304_b_5752160.html?utm_hp_ref=healthy-living

And finally, the low-carb diet, since it was actually low-carb, obviously was much more restrictive than the low-fat diet, which wasn't actually low-fat. That had the predictable result: those on the low-carb assignment took in many fewer calories (this information in summarized in Table 2 in the article). Over the first several months of the study, when everyone was probably on their best behavior, the low-carb group took in about 200 fewer calories per day. All the way out at the 12-month mark, when folks were falling off the wagon, the low-carb assignees were still taking in nearly 100 fewer calories per day.

And so, the results were a foregone conclusion. Over the span of a year, obese people who ate less, lost more weight. And those who lost more weight had more improvement in their cardiac risk measures -- which were mostly a mess in the first place due to obesity. Ta-da!

All the information is readily available in the study, and it comes down to one simple thing: those in the "low-carb" group ate fewer calories, so they lost more weight.

Low-carb may be an effective diet for some people because, for whatever reasons, they find it easier to follow and maintain a calorie deficit than they would eating a normal, balanced macro diet. But the reason people lose weight on a low-carb diet is the same reason everyone loses weight: they are eating at a deficit[\b].

One group ate at a slightly larger deficit than the other, and the results were predictable.

lindsey1979

Probably, put the patient on a lower carb diet like south beach and tell them to exercise. And then have them come in for a check up to see if it is working. If it doesn't work, maybe a low dose of metformin with the diet and exercise.
Remember, this all started because of comments that were made about obesity being within your control and the poster (I'm sorry I don't remember who it was) saying that being scrawny could be out of your control by he was unaware of any reason obesity would be. I was only offering a counter view point to his, which I felt was harsh and damaging.

Well, it's all in how you look at it. I would actually go so far as to say it's still in the person's control - but I would expect that person to educate himself and look for ways to overcome his own obstacles, which may include seeking advice from doctors and other experts. I have no clue what that poster intended, but I would guess he didn't mean that it's always easy for everyone to manage their own body weight/composition, but rather it's still your responsibility and within your power to control. Just because it's difficult (sometimes incredibly difficult) doesn't mean it's insurmountable and outside of your ability to control, and in fact you can essentially reverse the condition through your own actions. To me that's an empowering thought, rather than a harsh/damaging one, but just different viewpoints I suppose.

I understand what you're saying and I agree to some extent. Though I don't agree that everything is within your control. There are certain things within your control (diet, exercise, etc.), but if your body doesn't respond to certain things or you're incapable of certain types of exercise, that is not within your control.

The big issue I have is that some on this site insist that if people are struggling with losing weight, it's because they're whiners, making excuses, can't face reality, lazy, liars, etc. All they really need is to get some will power and eat less.

Although I don't doubt that is true for some people, it's also true that different methods are important and valuable to exercising that will power. So, if someone is struggling, just telling them to stop being so lazy isn't really effective. Especially if something like restricting carbs may help more -- yield better results with their will power -- especially if they have something like insulin resistance which is incredibly common. Sometimes, it's not a deficit of will power but simply the wrong method of applying it. That's what I've been trying to get at more than anything.

parkscs

I'm just going to leave this here:

http://examine.com/blog/is-low-carb-really-the-best-weight-loss-diet

Thank you. This is a good article with a thorough analysis.

Actually, really bad analysis and conclusions.

Here's a better one: http://www.huffingtonpost.com/david-katz-md/post_8304_b_5752160.html?utm_hp_ref=healthy-living

And finally, the low-carb diet, since it was actually low-carb, obviously was much more restrictive than the low-fat diet, which wasn't actually low-fat. That had the predictable result: those on the low-carb assignment took in many fewer calories (this information in summarized in Table 2 in the article). Over the first several months of the study, when everyone was probably on their best behavior, the low-carb group took in about 200 fewer calories per day. All the way out at the 12-month mark, when folks were falling off the wagon, the low-carb assignees were still taking in nearly 100 fewer calories per day.

And so, the results were a foregone conclusion. Over the span of a year, obese people who ate less, lost more weight. And those who lost more weight had more improvement in their cardiac risk measures -- which were mostly a mess in the first place due to obesity. Ta-da!

All the information is readily available in the study, and it comes down to one simple thing: those in the "low-carb" group ate fewer calories, so they lost more weight.

Low-carb may be an effective diet for some people because, for whatever reasons, they find it easier to follow and maintain a calorie deficit than they would eating a normal, balanced macro diet. But the reason people lose weight on a low-carb diet is the same reason everyone loses weight: they are eating at a deficit[\b].

One group ate at a slightly larger deficit than the other, and the results were predictable.

Actually the Examine article was one of the better reviews I've seen. If you stopped reading at "calorie deficit," you probably should stop reading studies as you aren't going to glean much from them. The first question you might ask is why did the low carb group end up eating a greater calorie deficit, even though they were not assigned a caloric target. The next question would be how might such information be used to help other people with their weight loss. As a practical matter, there's a bit more to body composition and weight management than just "calorie deficit!"

likitisplit

Probably, put the patient on a lower carb diet like south beach and tell them to exercise. And then have them come in for a check up to see if it is working. If it doesn't work, maybe a low dose of metformin with the diet and exercise.
Remember, this all started because of comments that were made about obesity being within your control and the poster (I'm sorry I don't remember who it was) saying that being scrawny could be out of your control by he was unaware of any reason obesity would be. I was only offering a counter view point to his, which I felt was harsh and damaging.

Well, it's all in how you look at it. I would actually go so far as to say it's still in the person's control - but I would expect that person to educate himself and look for ways to overcome his own obstacles, which may include seeking advice from doctors and other experts. I have no clue what that poster intended, but I would guess he didn't mean that it's always easy for everyone to manage their own body weight/composition, but rather it's still your responsibility and within your power to control. Just because it's difficult (sometimes incredibly difficult) doesn't mean it's insurmountable and outside of your ability to control, and in fact you can essentially reverse the condition through your own actions. To me that's an empowering thought, rather than a harsh/damaging one, but just different viewpoints I suppose.

I understand what you're saying and I agree to some extent. Though I don't agree that everything is within your control. There are certain things within your control (diet, exercise, etc.), but if your body doesn't respond to certain things or you're incapable of certain types of exercise, that is not within your control.

The big issue I have is that some on this site insist that if people are struggling with losing weight, it's because they're whiners, making excuses, can't face reality, lazy, liars, etc. All they really need is to get some will power and eat less.

Although I don't doubt that is true for some people, it's also true that different methods are important and valuable to exercising that will power. So, if someone is struggling, just telling them to stop being so lazy isn't really effective. Especially if something like restricting carbs may help more -- yield better results with their will power -- especially if they have something like insulin resistance which is incredibly common. Sometimes, it's not a deficit of will power but simply the wrong method of applying it. That's what I've been trying to get at more than anything.

I totally agree with this. I struggled for a year before I got an iphone and started C25k and then got on MFP. My willpower did not change at all. My tools did.

tennisdude2004

Wow - someone seems sensitive to low carbs.

Well done - gif overachiever! boom, high five!

please don't requote them, circumvents my blocking of that sort of rubbish

My apologies - ????

lemurcat12

Well, it's all in how you look at it. I would actually go so far as to say it's still in the person's control - but I would expect that person to educate himself and look for ways to overcome his own obstacles, which may include seeking advice from doctors and other experts. I have no clue what that poster intended, but I would guess he didn't mean that it's always easy for everyone to manage their own body weight/composition, but rather it's still your responsibility and within your power to control. Just because it's difficult (sometimes incredibly difficult) doesn't mean it's insurmountable and outside of your ability to control, and in fact you can essentially reverse the condition through your own actions. To me that's an empowering thought, rather than a harsh/damaging one, but just different viewpoints I suppose.

I strongly agree with this. It's not uncommon for someone (with or without issues like insulin resistance which may pose additional challenges) to believe that weight loss is impossible for them. I think it's actually incredibly common, as is the idea that it takes some kind of special formula, something outside of just reducing calories. For many people, believing that something is possible is essential for it to actually be practically possible for them. So I think stressing the control aspect can for many be empowering.

That doesn't mean it isn't hard or that it doesn't require more. For example, if you are always hungry, changing your diet is important to experiment with, and there are for many psychological issues, and other issues too (like feeling comfortable cooking or changing your way of eating). But underneath it all--and the ability to see and use the tools made available--is the need to believe that it's actually possible, that it's not just a matter of being someone who IS obese and doomed to remain that way vs. someone who was lucky enough not to be.

That's what I think a lot of these discussions end up being about. There are people I've seen posting who seem to want to be told that, yes, they can't help it, they just were fated to be fat, and they can't do anything. IMO, that just means they aren't ready (and that's okay), but I get why some find that very frustrating. I would not include an effort to get to the bottom of medical issues a claim of helplessness, though, and I don't usually read others to be doing so.

lemurcat12

I should add, however, that I'm not really sure how the thread got off on the "how much control do people have over being overweight" from the "study says low carb can be helpful" topic. Some people seemed to take offense because others said that low carb doesn't overrule CICO, although it might work great in helping individuals lose, and I am still confused about how that reasonably could lead to any offense at all, let alone how anyone was supposed to anticipate that it would cause offense.

parkscs

I should add, however, that I'm not really sure how the thread got off on the "how much control do people have over being overweight" from the "study says low carb can be helpful" topic. Some people seemed to take offense because others said that low carb doesn't overrule CICO, although it might work great in helping individuals lose, and I am still confused about how that reasonably could lead to any offense at all, let alone how anyone was supposed to anticipate that it would cause offense.

When doesn't a low carb thread get off track though? "It isn't necessary but might help some people" just isn't very interesting enough.

SLLRunner

I'm just going to leave this here:

http://examine.com/blog/is-low-carb-really-the-best-weight-loss-diet

Thank you. This is a good article with a thorough analysis.

Actually, really bad analysis and conclusions.

Here's a better one: http://www.huffingtonpost.com/david-katz-md/post_8304_b_5752160.html?utm_hp_ref=healthy-living

And finally, the low-carb diet, since it was actually low-carb, obviously was much more restrictive than the low-fat diet, which wasn't actually low-fat. That had the predictable result: those on the low-carb assignment took in many fewer calories (this information in summarized in Table 2 in the article). Over the first several months of the study, when everyone was probably on their best behavior, the low-carb group took in about 200 fewer calories per day. All the way out at the 12-month mark, when folks were falling off the wagon, the low-carb assignees were still taking in nearly 100 fewer calories per day.

And so, the results were a foregone conclusion. Over the span of a year, obese people who ate less, lost more weight. And those who lost more weight had more improvement in their cardiac risk measures -- which were mostly a mess in the first place due to obesity. Ta-da!

All the information is readily available in the study, and it comes down to one simple thing: those in the "low-carb" group ate fewer calories, so they lost more weight.

Low-carb may be an effective diet for some people because, for whatever reasons, they find it easier to follow and maintain a calorie deficit than they would eating a normal, balanced macro diet. But the reason people lose weight on a low-carb diet is the same reason everyone loses weight: they are eating at a deficit[\b].

One group ate at a slightly larger deficit than the other, and the results were predictable.

All the information is readily available in the study, and it comes down to one simple thing: those in the "low-carb" group ate fewer calories, so they lost more weight.

Yes. Exactly. That's what weight loss always comes down to.