When discussing the innovations designed to help people lose weight  – everything from devices  without surgery, like the gastric pacemaker, or surgery without devices (which significantly lowers the risk of complication/rejection), like the gastric pleat – I have heard many variations on the theme: how any solution that focuses on  the result of the problem (e.g. the weight that results from overeating) instead of further upstream at the cause (the diet and exercise patterns of the overweight) can offer short-term hope but  by its very definition will be ineffective in the long term.

After all the common wisdom is so clear –  if people would just exert more discipline in their daily lives, ensuring  their calories in do not exceed calories expended, their weight would remain stable. In other words, if people would just eat right and exercise, then we’d have no obesity or, by extension, obesity-related chronic illnesses such as the Type 2 Diabetes pandemic predicted to shorten the lifespans of today’s children to such an extent that, for the first time in history, doctors are predicting a generation of children who will have shorter lives than their parents.

The problem is, the common wisdom isn’t.  If it were, then we would probably have a different reality than 66%  of Americans being overweight or obese (according to the federal Centers for Disease Control and Prevention).

Let’s look at the common wisdom in terms of the simple math it is often presented in, a 3-step syllogism:

  1. There are 3,500 calories in a pound.
  2. If you subtract 100 calories per day by walking for 20 minutes,
  3. Then you ought to lose a pound every 35 days.

According to obesity researcher Dr. Jeffrey Friedman, it is more difficult to to maintain this calories in-calories out balance than people realize, for several reasons:

  • imprecise calorie accounting is unavoidable, given  the wide variability of meal size and composition that most people face on a weekly if not daily basis, with little in the way of nutritional informational labeling/accounting for the food we actually consume
  • the brain has a genetically determined weight of about +/- 30 pounds that it ‘defends’; drop below that natural set point and your brain will signal you to eat more and return to homeostasis, or, for uncooperative dieters, slow your metabolism to conserve energy and regain to the set point in *that* way

As Dr. Matthew W. Gillman, obesity prevention program at Harvard Medical School/Pilgrim Health Care said in this NY Times article,  “There are physiological mechanisms that keep us from losing weight.”

You read that right: The brain has mechanisms to prevent us from losing weight.  Your  body’s ability to maintain a set point is why a person can skip a meal, or even fast for short periods, without losing weight.   It’s also why burning 100 calories in a 75 minute walk every day won’t lead to the slow, steady weight loss that the common wisdom math implies.

Dictated to by the brain’s set-point meter monitoring, most dieters will unknowingly make up for deprivation with extra bites here and there without even realizing it, a system that operates with ” 99.6 percent precision, according to Dr. Friedman.

If that weren’t enough, there is more deconstructing of the common wisdom: while we often blame the  lack of exercise and bad food choices dictated by a  time-pressed, convenience-oriented environment for obesity, the latest obesity research suggests that the environment that most strongly influences body composition may actually be in utero.

Animal studies have shown conclusively that the mother’s diet may have far more to do with the genetic set-point determined for a child’s weight, a seeming correlate to the studies among humans  that have demonstrated a link between mom’s gestational habits and the adult weight of her children, for example, women who eat little and/or smoke during  pregnancy are more likely to have fatter adult children

In short, the body, due to many factors,  establishes its optimal set-point weight early- possibly even in the womb.  As a result, weight control is difficult for most people, and obesity may be almost impossible to cure.