The Obesity Code: Unlocking the Secrets of Weight Loss (by Jason Fung)

[Dominique]

I know several community members (for instance, @divedragon and @OCDOC) swear by Dr. Jason Fung. According to his website, he has just published a book called "The Obesity Code: Unlocking the Secrets of Weight Loss". Has anyone bought it/read it?

[Dominique]

I listened to the Ted Talk, but I’m not convinced. I guess it’s a case of confirmation bias for both of us: Attia says what you want to hear, and what I believe not to be true.

First of all, I found Attia’s personal anectodal experience not convincing: here is a young man claiming to exercise 3-4 hours a day and to follow the "food pyramid" to the letter, only to find himself becoming insulin resistant, somehow, and gaining 40 pounds. Really? He’s implicitly blaming his infortune on the bad carbs (prescribed by the inept food pyramid, of course) that elevated his blood sugar. I would have diagnosed excess calories, but there are no talk of energy balance here (it’s conventional wisdom, so has to be challenged, right?). He also implicitly dismisses the role of physical activity: see, no matter how active I was, I still managed to become insulin resistant and gain weight as a result (his hypothesis is that insulin resistance is the cause of obesity, not the other way round). Fortunately for him, he was able to get rid of his insuline resistance and drop his 40 pounds. He (implicitly) attributes his success to his diet (dumping the food pyramid, going no carb), insisting he did that while exercising far less than when he gained all the weight. Again, I would have diagnosed energy balance: he was able to find a way of eating that put him in a caloric deficit (in spite of exercising less), which caused him to lose weight, which caused his insulin sensitivity to improve.

Attia then went on to mention there are 6 million lean people in the US who are insulin resistant and 35 million people who are obese, but not insulin resistant. I don’t know where he got these numbers (he specifically said "insulin resistant", not "pre-diabetic"), but I don’t understand what point he’s trying to make with them. If insulin resistance causes obesity (as he hypothesizes), how come these 6 million people didn’t become obese? And if obesity is caused by insulin resistance, how did these 35 million people manage to become obese? Maybe there’s some truth in the "conventional wisdom": eating calories in excess results in becoming fatter and increasing insulin resistance (because insulin resistance is determined by body fatness).

I note that the grand scheme of Gary Taubes and Peter Attia (NuSi) has all but collapsed.

[Dominique]

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@Daves_Not_Here wrote:

Here is an Healthline article that provides 6 arguments as to why different kinds of calories cause different effects, and result in different weight loss  outcomes.

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Let’s take 4 persons all eating 1500 calories and expending 2000 calories. The first one is eating a McDougall diet (mostly plants, no animal products, hardly any fats). The second one is eating an Atkins diet (loads of fats, moderate protein, very low carb). The third one is eating Fung-style (carefully choosing when to eat, picking foods that trigger minimal insulin response). The fourth one is eating mostly pizza, ice-cream and other "junk" foods. Will they see different weight loss outcomes? For the most part, I don’t think so. Health outcomes will likely differ, same with body composition outcomes. Some will likely feel more hungry than others, but if they can all stick to their diet, they will lose the same amount of weight. Bottom line: if the goal is to lose weight, pick up whatever diet / eating style that will let you achieve the caloric deficit required for the weight loss to happen. 

[Baltoscott]

@Dominique  I think CICO matters, but it is hard to nail down how many calories go in, what percentage is actually used by the body, and there also seems to be an involuntary adaptive calorie burn response to the calorie input.  

There might, for example, be a difference in weight loss if the 1500 calories came from whole foods (better) vs. processed foods as this precision nutrition article suggests.  Some calories just seem to take more energy to use than others, 100 calories from an apple, say, vs. 100 calories from honey.  I guess technically that would mean that if the Whole Foods (spell check keeps capitalizing WF) individual expends 20% more energy to use his 1500 calories, the experiment would have him move a little less so that calories out are the same for both the Whole Foods and processed food subjects, but in real life I would just take advantage of the extra work involved in digesting whole foods in my weight loss strategy.

I think one of reasons CICO as determined by Fitbit and on-line calculators doesn’t seem to work for many people is because an individual’s BMR slows a bit on calorie reduction diets, and ramps up a bit with excess calories, and the calculators cannot take this change into account. As a daily calorie counter for over a year and a half now, I was surprised when I got down to 160 lbs last year and gradually ramped my calories up from 2500 to 3000 without gaining any weight.  It was over a five-month period and clearly my energy expenditure amped up to use the extra calories rather than add weight, but I could not tell you where that extra burn was coming from.  Not extra bike miles or gym work or walking.  Maybe because more calories were available my body temperature went up a bit, or blood pressure increased or I fidgeted more, all are possible calorie burn adaptations that I probably would not have noticed.

[Daves_Not_Here]

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@Dominique wrote:

I listened to the Ted Talk, but I’m not convinced. I guess it’s a case of confirmation bias for both of us: Attia says what you want to hear, and what I believe not to be true.

..... 

I note that the grand scheme of Gary Taubes and Peter Attia (NuSi) has all but collapsed.

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Hey @Dominique -- I appreciate how you take the trouble to follow the links I post even though we may interpret them differently.  And thanks for the Wired article on NuSI -- I've been looking for their status for months.

I had suspected NuSI was running off the rails after Attia left and I saw no updates over the last couple of years.  I think NuSI was a great idea, but having Taubes as its public face was problematic given that he is such a partisan and lightning rod for criticism.

In the next post, you asked:  Let’s take 4 persons all eating 1500 calories and expending 2000 calories. ...(description of 4 different diets) ... Will they see different weight loss outcomes? For the most part, I don’t think so.

My response is I agree with you .. and ... I may disagree with you.  I agree that, if they all maintain a 500 calorie deficit, they will lose the same amount of weight.  However, my question is if their 2,000 calorie expenditures (which have large BMR components) will remain the same for all 4 people. 

Here is the discussion / debate / dialectic I'd like to have with you:  we both agree that energy balance (calories in versus calories out) determines if our weight changes and how fast.  The question I want to answer is what determines energy balance?  What affects calories in?  Easy, whatever you put into your face.  But what affects calories out?  Unless you run marathons, the largest daily component of energy expenditure is BMR.  So what affects BMR?

I am coming to the view that BMR can vary significantly from what the Harris-Benedict equations would estimate, and that these variations can happen quickly for an individual (as @Baltoscott described happening to him in his post following yours).  I'm curious as to the mechanisms behind these variations (hormones?) and how inputs such as Calories In, Calorie Deficit, Meal Timing, exercise type / intensity / frequency / duration, etc. affect these variations.  I'm starting to see weight maintenance as a fairly complex control system with feedback loops.  Once I finish the book, I'll start a thread on the topic "If your weight stall is hitting a set-point, how do we lower it?", and invite you to "weigh"in.