Your Fat is Not Your Fault

By Dr. Matthew Weiner, MD, FACS

May 14, 2013

Our initial understanding on weight loss – the idea perpetuated by the media – has always been that you lose weight by making the decision to diet and exercise and then sticking to it. It requires a strong willpower and extreme motivation and your lack of both is why you’re fat. So they tell us. But, as we learn more about the neurotransmitter and hormones that drive our appetite and our metabolic rate, we are beginning to recognize that weight gain and weight loss is driven by forces much more complicated than our behaviors.

Starting a vigorous exercise program and going on a starvation diet has a long-term success rate of less than 5%. And, in fact, more than 25% of people who embark on such behavior changes will end up – in 5 years – weighing significantly more than they did when they started. Anybody who’s ever been on a diet knows that that’s the truth.

What’s worse is that most “diet” plans are constructed in a way that almost guarantees failure, all the while implying that your failure is your fault. That’s because diet plans are BIG business and generate billions upon billions of dollars for their creator. Once you fail, you’re pressured to buy more and work harder.

So, as a society, we have to recognize that the initial beliefs of why we lose and gain weight are completely flawed.

What we have now found out is that your nervous system controls your weight the same way it controls your blood pressure, your blood glucose, your cholesterol, and hundreds of other measurable parameters that determine the way your body functions. It works through very complicated neural and hormonal processes that are originated in your blood stream, in your organs, and most significantly in your brain. Your brain acts as the central command and is constantly trying to regulate your body to a healthy weight in order to respond to the signals it’s receiving from your digestive tract. I call this entire system your Metabolic Thermostat.

When you put your body – and ultimately your brain – through a period of starvation, your brain tells your body to slow down your metabolism and increase your desire for food. When your body is overfed, your brain tells your body to speed up your metabolism and decrease your desire for food.

Figure 1 – Your Metabolic Thermostat

This is why so many people are strongly motivated to “go on a diet” for their New Year’s resolution. They are overfed from the holidays and their metabolism is ready to burn off the excess weight. However, as we all know, very few people actually successfully complete a New Year’s resolution. And, that’s because once you start to starve yourself, your brains says, “slow down – you’re not getting enough to eat.”

In my practice, the most common thing I hear people say to me is, “Dr. Weiner I hardly eat anything, I can’t understand why I am so overweight.” That’s the most common scenario. The misconception that people who are overweight are eating breakfast, lunch, and dinner at McDonald’s is just not true. That is not what’s happening out there. Most people are in the midst of some form of a starvation diet and their body is adjusting accordingly – by slowing their metabolism and increasing their desire for food.

The idea that people who are overweight become so because of a failure to control their eating habits is a fallacy and an unfair discrimination. While there are exceptions to this statement, they are relatively few, compared to the millions of Americans who are overweight. The truth is, our entire country eats way too much of the wrong foods, yet we only condemn those whose metabolism favors excessive fat storage from the American diet. Let he who is without fault cast the first stone…

The idea that you are in complete control of whether you gain or lose weight is a misconception. It’s simply not true. It’s also not true that eating fewer calories is the way to lose the weight and keep it off. The key to weight loss is eating an ENORMOUS amount of the right foods and very little of the wrong foods. This dietary change will prevent your metabolic thermostat from fighting your initial weight loss with neurotransmitters and hormones that slow down your metabolism and increase your hunger. The obesity epidemic is a grave problem and blaming the victims is not the answer. Once we recognize this, our country stands a chance at digging into the science and coming up with some useful solutions.