Fat people should really be called survivors. At least in Paleolithic times, that would be so. In the face of food shortage, the human body turned calories into fat—a sort of on-the-body emergency food storage system. Our bodies still respond to food shortage (dieting) the same way—which may result in weight loss, but fat gain. Dr. G. says: If you want to be healthy and strong, eat. And exercise. Gain muscle; lose fat.
by Paul Gahlinger, MD
Summer is more than half over and the outdoor pool still beckons. That new tube of sun block is untouched. And the bathing suit… uh oh, it’s a little tight with that chub you picked up over last winter. You feel like a walrus that has waddled onto shore. The dinner roll over your hips is complemented by puffy pockets on your neck, your arms, your chest, thighs, knees—even your ankles.
Congratulations. We humans bow before you. You are a survivor.
To explain this, let’s back up a little—say, to about 24,000 years ago. This era was called the Paleolithic. Paleo, meaning “old,” and lithic, “stone.” In other words, the Old Stone Age. People at that time were fully modern humans. With a haircut and some new clothes, they could pass unnoticed today. Pictured here is a figurine from that period. It is often referred to as the Venus of Willendorf, after the Austrian town near where it was found (it is now in the Natural History Museum in Vienna). Art historian Christopher Witcombe describes it as a “remarkably realistic representation of a fat woman.” She has seven concentric rows of neatly plaited hair, with braids falling down her face and neck. Small markings on her wrists seem to indicate the presence of bracelets. Particular attention was given to her genital area, with the labia of the vulva carefully etched and made clearly visible. There are two things I am sure of about this figurine. The first is that it was carved by a man. And the second, that he was in love.
Life in the stone age had some nice features. You could wake up to a sparkling sunrise in pristine skies. Beachside property was readily available. No telemarketers. On the downside, you often risked getting eaten by a big cat, clubbed by your neighbor, or—far more often—starving to death when the winter lasted too long or the summer drought was too intense. Starvation was then, and still is now in many parts of the world, the greatest threat to life.
Humans, and indeed most animals, are hard-wired to avoid this. The chubby ones manage to save up a few calories to last through the lean times. The skinny ones die. There is a physiological rule of thumb: Without oxygen, you can live for four minutes; without water, for four days; and without food, for 40 days. That’s if you are at normal weight. A truly fat person, given water and chewing some roots for vitamins and minerals, can live without food for as long as a year. That is the person who survived. If you are a man, that is the woman you want, who will give birth to a healthy baby and have full breasts to feed it, and still be around in a few years to take care of the child. To the guy who carved the Venus, she was the angelic ideal of beauty, of health and survival. This is what fat people really should be called: survivors.
Of course, things have changed over the last few millennia. Now we have a supermarket in every neighborhood with 7-Elevens between them. If we don’t want to walk that far, we can order pizza or Chinese or whatever right to the house. And that’s if we somehow run out of food in our 19-cubic-foot side-by-side Subzero refrigerator. Evidently, starvation is the one thing we don’t have to worry about.
Today, our picture of beauty has also changed. Let’s consider Brazilian model Ana Carolina Reston. She is on dozens of magazine covers. She is also dead. In 2006, at age 21, she died of anorexia. Never mind other preposterous icons of beauty such as Calista Flockhart, who would evoke sympathy from the starving villagers in the Sudan. The fact is that for most people throughout history, our look of beauty would be the look of someone who is sick.
OK. Let’s get back to your chub. Now you know why it’s there—because you are the best! I understand this is not much reassurance when you want to look trim and slim in your lycra swimsuit. The question I hear so often is, “I’ve tried so many diets! How can I lose weight?” The first thing to realize is that you do not want to lose weight. You want to lose fat.
There is no secret to shedding body weight. You can lose more than 10 pounds in one day by sweating it off, by taking cathartics to induce diarrhea, or by taking diuretics to urinate out your body water. But all of these forms of weight loss are accomplished by losing body water, which is unhealthy, and you gain the weight right back when you rehydrate.
Diets are the worst way to lose body fat. Any type of food shortage signals your brain: “Hey, we’ve got a possible starvation threat here—so conserve energy and pack on the pounds!”
Let’s look at the science. The authoritative International Journal of Clinical Practice recently evaluated weight loss programs in a report with the rather daunting title, “Neuroendocrine Regulation of Energy Homeostasis.” Basically, here is what it says: The body tries to regulate its weight, balancing its energy needs with food intake. If food intake is unreliable (as when dieting!), the body stores extra energy to carry it through the dips. At the same time, the dieting body slows down metabolism to burn as few calories as possible. The desire to eat is largely influenced by a number of hormones that carry signals from the stomach and intestine to the hypothalamus of the brain. At least a dozen fat-regulating hormones have been identified—including leptin, insulin, ghrelin, oxyntomodulin, neuropeptide Y (NPY), proopiomelanocortin (POMC) and others. New drugs that block these hormones have shown some promise in causing weight loss. For example, Orlistat (marketed as Xenical) blocks pancreatic lipase so that you cannot digest dietary fat. Rimonabant (Acomplia, and other brands) blocks the brain’s cannabinoid receptors (the receptors which give marijuana users the munchies), and therefore takes away appetite. Sibutramine (Meridia), originally developed as anti-depressant, also takes away appetite. Remember the Fen-phen fiasco of the 1990s? It was by far the most popular weight loss drug—until users started showing up with damaged heart valves. The resulting lawsuits from 50,000 users cost the manufacturer $14 billion. The fen is now gone but the phen is still available. Phentermine can wreak havoc on your heart, not to mention causing insomnia and impotence.
The word diet really means two very different things that are endlessly confused with each other. The first meaning is the sort of food you eat. As in, “the diet of koala bears is eucalyptus leaves,” or “you should eat a healthy diet.” The second meaning is to limit food, as in being on the Atkins diet, Slimfast diet, grapefruit diet, or Oprah’s latest diet.
These two meanings of the word are constantly mixed up.
The truth about diet is incredibly simple and well-known and just plain common sense. All you need to do is eat well, which you can accomplish by the following:
• Don’t eat packaged foods.
• Don’t add salt to anything—your taste buds will adapt.
• Lay off the sugar and fats (including hydrogenated oils, which have trans-fats—about the worst stuff you can put in your body).
The difference between fat and oil is that fat is generally solid at room temperature, and oil is liquid. Oils are fine, and fish oil, olive oil, and canola oil are especially great. (Not that you’d want to cook with fish oil. But a daily dose, straight-up, is a very good thing.)
It is that simple. You don’t have to spend a fortune. Look at your food bill. How much of the money goes to packaged foods? And if you really want to economize, get a 100-pound sack of rice and a 50-pound sack of beans. For about $100, you will have enough food for a year that is more nutritious than your previous, garbage-heavy (in more ways than one) diet.
Why buy an expensive box of sugary cereal when you can get rolled oats (which you can eat uncooked if you like) with fresh fruit—at half the cost with 100 times more nutrition? Become a label reader. Don’t believe cereals with names like “Swiss muesli.” I’ve lived in Switzerland and believe me, real muesli is nothing like the crap they sell in the store. (Here is my 500-year-old family recipe: rolled oats, shredded apple, raisins, cinnamon, raw sheep’s milk—OK, you may have to substitute that last one.) You like soup? Get a crock pot and a pressure cooker. You like meat? Don’t read “The Omnivore’s Dilemma.”
So much for diet and nutrition.
The real way to lose fat
Let’s start with a metaphor every American understands. Cars. Imagine you have a Corvette. Fast, slim, but it gets as little as seven miles to the gallon. Now imagine you have a Prius; you can go a long way between fill-ups. Now imagine you have a Prius with a 500-gallon auxiliary fuel tank in the back, because maybe you want to drive across the country without stopping to fill up. That’s like a fat person—stored energy for the long haul. 
How in the world are you going to empty that extra fuel tank? The answer is to drive like the Corvette. Pedal to the metal. When you drive the extra-tank Prius, you first have to burn up the gas in your regular tank. Once that is gone, you dip into the reserve tank.
Your body is pretty much the same. You need energy to live. Just sleeping or lounging around uses maybe 1,500 calories or so per day (there are formulas for your exact number). A full 20% of that is used by your brain. When you need more during exercise, you first use the glycogen in your muscles and liver. It takes about 20 minutes of exercise to deplete those supplies—and then you open the door to your fat store. Each pound of fat holds about 3,500 calories. Each pound also contains about a mile of fine blood vessels. Think about that. Every minute, for every additional pound of fat, your heart has to push blood through an extra mile of capillaries. No wonder blood pressure goes up!
You may be thinking—“If my car has an extra gas tank in the back, why not just take it out?” A lot of people do this, usually by liposuction. But it actually doesn’t work that way. This is because there are two stores of body fat: the fat under your skin (subcutaneous fat), and the fat around your organs (visceral fat). Subcutaneous fat is good. It gives women their beautiful rounded curves. It is the difference between men who look like Michelangelo’s statue of David and men who are steroid-pumped body-building freaks. Every woman I know prefers the former. Subcutaneous fat makes skin glow and feel nice; when you lose it, skin becomes wrinkly and leathery. Visceral fat, on the other hand, is not so good. You need some to cushion the organs, but obesity packs most of its fat inside the body cavity and around the intestines. It is a set-up for diabetes, heart failure, and it’s associated with a higher risk of cancer and many other diseases.
The problem with liposuction is that it can only take away subcutaneous fat, not visceral fat. It is the visceral fat that you want to reduce.
At last, as promised, here is how you burn off that fat
The first thing that I recommend to everyone is to get a heart rate monitor. You can spend a lot on fancy ones that download data to your computer and even have a GPS built into them. A $50 basic one will do just fine. (At my MediCruiser clinic, we’ll give you a 20% discount on one.) You don’t really need a heart rate monitor—it is basically just to keep you honest—but it can make your fat loss program far more effective (and interesting).
The exercise program is simple: You set your heart rate monitor to your target level (easily found online or in the monitor instructions). Then you can do whatever you like, as long as your heart rate is in the target zone. It doesn’t matter. Run, bike, swim, hike, rowing machine, power walk, have sex…if your heart rate is on target, you are using oxygen—oxygen to burn fat. To lose weight, you should be in the target zone for an hour a day, six days a week. It is a lot, but you can watch TV, listen to music, chat on the phone, even read the paper while you are doing it. Take a few minutes to warm up, and leave 10-15 minutes to cool down and do some stretching. I recommend 60 minutes at target because the first 20 minutes are needed just to use up your glycogen, and only after that do you tap into the fat reserves.
I also suggest doing this in the morning for a couple of reasons. First, it takes some discipline. By doing it in the morning, perhaps after a cup of coffee to get going, you have it out of the way for the day. Otherwise, daily tasks tend to build up and edge out other activities, and after a long day, you might not be up for an hour’s exercise. Second, this exercise will make you stronger, fitter, give you more energy, and rev up your metabolism—all day long. In fact, you’ll find that you are sleeping warmer because you will be burning more calories even at night.
Make the discipline easier on yourself. With a regular schedule, preferably exercising with others who will reinforce your practice, you will be more consistent.
Muscle weighs more than fat. Many who begin a new fitness program are surprised to find they don’t lose weight—some even gain weight! But it is fat loss that is important. If you follow this program, you will lose fat—I guarantee it—probably about a quarter pound a day. Not body weight, but body fat. When you lose fat this way, it will stay off. It is a positive trend that gets stronger, not a negative trend like diets or drugs that inevitably fail.
Fat loss can be measured several ways: hydrostatic weighing, in which you are submerged in water; calipers, commonly used at fitness clubs; and the new scales with electrical impedance. None of these is 100% reliable or accurate. The new scales are pretty good in my opinion. (The Taylor bodyfat scale is highly rated by Good Housekeeping and sells for around $50.) I especially like the ones with four electrodes (rather than just feet), which can show visceral fat as well as total fat.
Do you need a fancy scale? Probably not. You’ll know when that fat turns to muscle. Your clothes will fit better. You’ll have more energy and strength.
And—don’t worry. You’ll still survive.
Paul Gahlinger is the president & CEO of MediCruiser, an urgent care clinic and house call service that he calls “21st century health care.” www.medicruiser.com. He is a regular contributor to CATALYST.