I know it seems counter intuitive to increase fat intake to lose weight. But the fact that you have a hunger problem hints at the possibility that your body is starving for materials needed to make hormones, namely cholesterol and certain kinds of fats. Diana Schwarzbein may be able to help you understand the particulars. http://www.youtube.com/watch?v=JLZP8FkgK0U Often, when over weight people add fat to the diet they gain weight initially as the body heals. Then, as the hormone systems become fully functional the body rebuilds muscle tissue, the metabolism ramps up, and weight loss occurs.

I’m NOT going to switch back to a higher fat diet, because low fat is the only thing that has ever worked for me, and I will not risk regaining the weight I’ve kept off for over a year now. Now I am not totally strict about “no” fat as I am doing a little olive oil and the occasional handful of nuts. But I take Alli anytime I have meats or eggs or other undesirable fats, and choose nearly all lower fat meats. But I have not been able to lose any more, as I still have an appetite like a horse and I am eating as healthy as I can stand, and exercising as much as I have time for. So I’m ordering some barley bread products and will do my best to make sure that though I can’t low-carb, I can avoid consuming fructose without plenty of fiber attached to it. You may also want to watch Food, Inc. because they also highlight the role of refined corn products in fattening cattle and other livestock as well as its prevalence as a cheap carbohydrate source in our current food economy.

As far as helping patients and families with obese chidren – many people with massive sugar soda or juice intake get very ornery when you suggest giving it up for water and low-fat dairy drinks, they can’t imagine life without unlimited sweet drinks – it really does seem like an addiction.

I did see one problem with the sugar video – early on, these is a slide where BMI increase per extra sugary drink may be as little as 0.1kg/m2 and the odds ratio for obesity is well within the CI (meaning not statisticaly significant.) Also, I thought that modest alcohol intake was overall favroable for lipid profiles, especially HDLs. My LDL runs high and HDL low – even worse on statin, which I actually do not tolerate and will not be taking anyways – and the LDL is the small dense (bad) kind to boot. Any other diet suggestions for me?

Fundamentally, there are no quick fixes to what is essentially a problem of our prehistoric bodies trying to cope with mass-produced food stuffs. To be honest, I don’t think the answers are going to be unique to any individual nor surprising. It’s easy for me to say with my good BMI and my half-decent cholesterol, but the answer lies in not ever getting to the point where people are eating more than they need. Need and want are related but not the same.

An inability to control one’s appetites may have a genetic, hormonal or other cause, but basically you have to consume more calories than you burn through activities to raise your BMI. So, the converse is equally true. Yes, I know it can be hard, especially if someone has a genetic tendency to accumulate body fat or a leptin problem, but it is an issue of simple calorie calculations at the bottom line.

Topamax, AKA Dopamax to some of docs, does suppress appetite for most people, but esepcially skinny little picky-eater kids who don’t need it. I got ocular and other side effects when I tried it myself as a headache preventive that at least would not make my appetite and weight problems worse. It might have worked but I sure couldn’t stay on it.

Phentermine may be bad for the lungs. I have a friend who got a big dose of formica dust, and used phentermine for years, now has pulmonary hypertension realted to interstitial lung disease, which is not good. Her family’s obesity genes are worse than mine, apparently, and they all hit the 300-400 lb range without any appetite supressant.

I think the solutions to obesity are going to be very individualized and very suprising.

I have actually gone from BMI 34 to BMI 27 on a low fat diet and find that control of appetite is critical for me. I can’t defeat my excess appetite without a modified diet and supplements, which are expensive, especially compared to junk food. I almost gave up trying to reverse my pre-diabetes, because I could not fast and could not low-carb, and thought I was eating healthy. But in fact I was taking in a lot of excess fat…using Alli made me aware of it, and that made all the difference. NO, I was not interested in diet pills that could kill me or make me stupid or depressed. I’m glad to see rimobanant off the table, frankly. But there are some reasonably safe OTCs and dietary manipulations that can work even in the presence of bad genes.

If you have seen Food Inc. you know that the excess of corn and corn syrup, the emphasis on economics/efficiency over quality of food and of human life as well as the very limited excercise endemic to modern life is the root of the problem from a population perspective. Also, though I do not deny the exisitence of individuals who are lazy, unwilling, and emotional or binge eaters, the vast majority of people are just mismatched by a relatively small but daily amount in terms of intake and expenditure. When I calculate for patients who are gaining weight, it is usually 100-250 calories a day; they find it helpful that someone understands they are not grossly overindulging huge amounts all the time. Exercise alone may not work for most peole (it din’t for me), but it certainly helps avoid muscle loss when you are dieting.

What’s your take on the artificial sweeteners increasing food intake and obesity, at least in mice?
I found that was true for me, and avoid them entirely, or make sure I get a little bit of “real” carbs along with the fake ones. There was a sweetener called tagatose that was mismarketed that might have been a real answer, especialy for people with type 2 diabetes issues. They ate trying to revive it essentially as a pharmaceutical. You can get a litlte bit of it in a product called Therasweet, but that has way too much xylitol…frustrating. And not the first time something that could really work – or DID work- went away!

You mention Britain and N America but here in Australia I think we are doing a fine job in growing our girths. I believe we may even have overtaken the States in the “obesity epidemic”. The obvious thing I see regularly is laziness and the Australian lifestyle has encouraged this (so much for a sports mad culture!!!). We are spectators not participants. Coupled with the mind set of an affluent society that expects to have what ever it wants when ever it wants – GREED.