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1 a. The development of agriculture meant that we could now have foods we wanted, not needed. And that’s what provided the foundation for indulgence.

2 a. Most diets don’t reprogram you to think and eat automatically, so that eventually you’ll go off the diet just as surely as you went on it.

3 c. Eating a handful of nuts has been shown to help you stay full, while skipping meals can be detrimental because your body will go into a fat-storing, starvation mode when it doesn’t have enough calories.

4 b. Of these risks, blood pressure is the greatest indicator of health risks associated with being overweight.

5 b. Ghrelin makes you want to eat more.

6 d. Leptin keeps you full.

7 a. Cinnamon increases insulin sensitivity, which helps enhance the satiety center in your brain (and also reduces blood sugar levels as well as cholesterol levels).

8 b. Fructose, as in high-fructose corn syrup, doesn’t appear to turn off your hunger chemicals, so you do not feel full; thus you eat more.

9 a. Extreme stress (as in the case of a car accident, or even exercise) turns off your hunger. Chronic stress (like a long line of looming deadlines or family problems) can make you crave feel-good carbohydrates.

10 a. Whole-grain foods are loaded with filling fiber.

11 d. Playing video games works because it keeps your hands busy, so you can’t eat. (Training for a marathon is actually destructive to your body because of the risk to your joints, and for most people, 1,000 calories is a dangerously low daily caloric intake. Do we really need to explain colonics?)

12 c. Your liver is responsible for most metabolic functions.

13 c. PCOS is responsible for weight gain in at least 10 percent of women under age fifty. It’s now clinically called androgen excess; androgen refers to the male hormone.

14 b. Fiber fills you. A cup of oatmeal in the morning has been shown to prevent you from afternoon gorging.

15 a. Walk at least thirty minutes-at once or in intervals-every day.

16 b. Liposuction should be used to sculpt problem areas, not to remove a lot of fat.

17 d. Located next to your stomach, your omentum is fat that can cause damage to surrounding organs.

18 b. While 32½ inches or less is ideal, 37 inches is when women start seeing a greatly increased risk of weight-related disorders.

19 c. Your small intestine-with 100 million neurons-has anatomy similar to your brain.

20 d. CCK is a chemical that directly and indirectly sends a message to your brain from your guts that you’re full.

21 c. Chronic stress makes your body store more fat.

22 a. A duodenal switch is one of several surgical options for people with morbid obesity.

23 d. Bupropion, an antidepressant, has been shown to help control cravings and lead to about a 7 percent weight loss. Other antidepressants, such as tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs), can often be associated with weight gain.

24 c. Adding a little muscle through resistance training helps your body burn more fat throughout the day.

25 c. Yo-yo dieting not only has physiological effects, because you end up gaining more weight after you’ve lost it, but it also has psychological effects.

Scoring

You get one point for each correct answer.

20 and above: Congratulations, doc. You’re an anatomical expert.

11–19: You’re average, but then again, the average person is overweight, so maybe this isn’t so good. Maybe you’d better read on.

10 and below: Don’t worry, you’re about to enroll in the ultimate course in the biology, history, and anatomy of fat-which is the best way to change your body.

Chapter 1
The Ideal Body
What Your Body Is Supposed to Look Like

Diet Myths

 Your body doesn’t need any fat.

 Fast food is responsible for most of our fat problems.

 Dieting has to be hard.

The most common question heard among overweight people isn’t “Can I have more sour cream?” It’s “Why can’t I lose weight?” While you may think you know the answer (severe pancake addiction), the real reason is biological: We’re actually hardwired to store some fat.

Our bodies have more systems that allow us to gain weight than to lose it. Historically, as we’ll see in a moment, that served us well. Today, though, we’ve poisoned the systems that help us lose weight and empowered the ones that allow us to gain it—botching up our anatomy and turning our bodies into fat-storing machines. One of your goals will be to reprogram your body so that your internal systems can work the way they did when the greatest enemy we faced was a charging wildebeest, not a cheese-drowned pork roll.

Our ancestors survived by gaining and storing weight to survive periodic famines. That has left our bodies prone to storing fat and gaining weight, tendencies that willpower alone can rarely overcome. To see how our bodies have morphed from rock-hard to sponge-soft, let’s look inside the bodies of early man and woman. They looked like stereotypical super-heroes: strong, lean, muscular, able to jump snorting mammals in a single bound.

As we evolved, we created systems and behaviors to survive when droughts and poor eyesight made picking and hunting less than successful. We learned to thrive, and we learned to eat. In early times, our diets consisted of fruits, nuts, vegetables, tubers, and wild meat—foods that were, for the most part, low in calories. That’s not to say our ancestors didn’t enjoy their foods. They consumed their sugars through fruit, and they even splurged when they came across the Paleolithic Cinnabon—a honeycomb. The difference between their splurges and ours? They came across the sweet treats only rarely; it’s not as if they popped in for a 900-calorie sugar bomb every time they went shopping for a new buffalo hide. Add that to the fact that their definition of “searching for food” included walking, stalking, and chasing, not sliding the milk carton out of the way to find the pudding pack. It was a lot of work to get food, so they naturally burned many of the calories they consumed through the physical activity of hunting and gathering.

The Heavyweight Fight: Genetics Versus Environment

It’s easy to argue that lifestyle choices and lack of willpower are responsible for weight problems (it’s the argument that lean people tend to make). But it doesn’t explain the 95 percent failure rate after two years of people who have lost fifty pounds or more; they had plenty of willpower to lose but regained the weight nonetheless. Researchers argue that obesity is more genetically linked than any other trait except height-and at least 50 percent of obesity cases clearly have genetic components. Our take: The waist control game requires two players-environment and genetics. Even if your genes have made you predestined for a life of taking up two seats, that doesn’t mean you should abdicate control over your body. When you make the right behavioral and biological changes that we outline, you’ll be able to stay healthy and avoid the bad side effects of excess weight, like diabetes, high blood pressure (hypertension), and arterial inflammation. While 10 percent of the obese population has genetic challenges that may make a supermodel contract impossible, the bigger risk with these genes is not in the weight itself but in the predispositions for risks associated with obesity. For example, one genetic problem associated with being overweight is called leptin deficiency (leptin is a hormone associated with satiety, which we’ll discuss in the next chapter). Folks who either don’t produce leptin or block its signals usually become morbidly obese, and the problem is surely genetic.

While some people have these abnormalities, they tend to be the minority of the population. If you need to worry about losing twenty-five, thirty-five, even fifty pounds, your problem is not likely to be genetic. Only when your excess weight exceeds one hundred pounds would most doctors consider testing for genetic abnormalities. Still, the example of leptin is only the tip of the scientific iceberg as far as genetics and obesity are concerned. As the fight against obesity continues, we’ll see more and more drug companies target genetic reasons for weight gain-that is, drugs that attack the genetic biochemical problems that may be contributing to your weight problem. That said, the onus of waist management still falls on you, to improve your environment and your behaviors so that your genetics can work for you, not against you.

Because salt and sugar were scarce, our ancestors mostly feasted on grains, vegetables, and meats—for good reason. The meat provided the protein, vitamins, minerals, and fatty acids that helped them grow taller and develop larger brains, while the other foods gave them nutrients such as glucose, a simple sugar found in fruit and the complex carbohydrates of plants, that they needed to grow and develop, and for energy to move. And, of course, food was always fresh, as there was no canning or refrigeration to store up food for Super Bowl parties, or to sneak in an 11 p.m. bowl of sugar-coated oats.

FACTOID

The difference between obese people and thin people isn’t the number of fat cells, it’s the size of these cells. You don’t make more fat cells the fatter you get; you have the same number of fat cells you had as an adolescent. The only difference is that the fat globules within each cell increase as you store more fat. By the way, muscles work the same way: you don’t make more muscle cells; the muscle cells get larger.

Another difference was that the meat our ancestors ate wasn’t like the meat we know today. Theirs was low in fat and high in protein; ours often comes in the form of corn-fed cows pumped up to make fattier, tastier cuts. Even today’s buffalo burger is corn-fed. Truly wild game has about 4 percent fat, while now most commercially available beef has nine times that amount. (The theory behind protein-heavy diets like Atkins is that protein reduces overall food intake and could reduce calories as well. The flaw is that eating proteins dripping in saturated fat, like bacon, isn’t exactly the same as eating the leaner, healthier forms of protein like chicken and fish.)

The result: Your tribal forefathers and foremothers could eat anytime they could harvest or catch something, and still not put on excess weight.

The lesson: Our ancestors never thought about a diet in the way we do—and their bodies had the approximate density of granite. Us? We obsess about diet more than red-carpet reporters obsess about designer dresses, and our bodies have the consistency of yogurt.

Still, we can’t blame the advent of fast food and waffle cones for all of our weight issues. The downfall started in the pre-GA. (pre-Golden Arches) era—over 10,000 years or so ago, when agriculture first appeared. Agriculture allowed us to make more advances than a seventeen-year-old boy in a movie theater, but we paid a price for them. Besides Myth Buster sparing the lives of countless mammoths, the rise of agriculture ensured that we’d always have a steady supply of food—an advantage during times of famine, a disadvantage at the $6.99 Mama’s Kitchen Eat-Everything Buffet. With a constant source of food, people became less nomadic, and communities grew closer together. While the average life span increased (thanks to the elimination of the extreme sport of tiger chasing, with, perhaps, some help from sanitation and immunization), agriculture also brought its share of downsides: more bacterial infections, shorter stature, and rotting teeth that comes from eating refined sugar and less nutritious farm-raised food (overused soil depletes food of its nutrients). Our ancestors’ diets shifted from vegetables and meat to grains from the farms, essentially hindering them from getting the diverse mix of protein and micronutrients needed for brain development.

FACTOID

During the Muslim holiday of Ramadan, people eat only after sunset so they consume all their calories at night. Should they lose weight? Anecdotal evidence, gathered by doctors watching residents working all-night shifts, indicates that people who eat all their 2,000 daily calories in one meal gain more weight than those who space those calories over three meals. Why? Because the one-timers are kicking in their starvation mode, making their bodies want to store fat rather than burn it.

The advent of agriculture essentially started the sociological shift that altered the way we lived—and the way we eat—up until this day. We could now produce food, so we could now produce what we wanted, not necessarily what we needed. Instead of making foods that could both complement our bodies and appeal to our taste buds, we started making ones that were kinder to our tongues and pocketbooks than they were to our waists.

We’re not in the business of trying to make you live like cavemen, or help you score a blue-jeans billboard, or help you become thin enough to escape between two jail bars. What we should acknowledge is that we live in a world with free will, with temptations, and with more eating options than the Mall of America. Biologically, our bodies want us to eat right. But in today’s society (cavemen didn’t have bad bosses or deadlines for annual reports), our biological drive to be the right weight and to eat right can be overcome by stress or temptation. And that has shifted many dietary decisions from biological necessities to psychological reactions. What we’re going to do is teach you how to reprogram your body to work the way it’s supposed to work—so that you eat to satisfy and to fuel rather than to console or excite. Controlling your fat isn’t about being banished with a life sentence of broccoli florets. It’s about teaching your body a little bit about the way our ancestors ate. Naturally and automatically.

YOU TIPS!

Automate Your Eating. If your waist management plan is going to work-as in, really work, for your whole life-then eating right has to become as automatic as it was for our ancestors. That’s not as insurmountable as it seems. Just look at one study from the Journal of the American Medical Association. Two groups were assigned two different diets. One went on a diet rich with good-for-you foods like whole grains, fruits, vegetables, nuts, and olive oil, foods found in the typical Mediterranean diet. The other group was not given any specific direction in terms of foods to eat but was instructed to consume specific percentages of fat, carbohydrates, and protein daily. In short, they had to think a lot about preparing foods and dividing amounts, while the first group only had general guidelines about foods to eat.

The groups weren’t given guidelines about how much to eat; they let their hunger levels dictate their hunger patterns. And when they did that, what happened? Without trying, the first group ate fewer calories, lost inches, and dropped pounds.

YOU-reka! The point: The people in the good-foods group ate the foods that naturally kept them satiated so their bodies could seek their playing weights.

 The “good-for-YOU-foods group” ate significantly more fiber than the control group (32 grams versus 17 grams).

 The “good-for-YOU-foods group” ate higher amounts of good-for-you omega-3 fats in the form of olives, fish, and nuts (especially walnuts). Those fats help increase the level of chemicals that make you feel satiated.

 The “good-for-YOU-foods group” more than doubled their consumption of fruits and vegetables.

The “good-for-YOU-foods-group” ate the foods we recommend in the YOU Diet, didn’t obsess about calories, and enabled their bodies to do what they’re supposed to do: regulate the chemicals that are responsible for hunger and for satiety (more on this in Chapter 2).

Don’t Undereat. When our ancestors couldn’t find food and went for long periods of time without it, their bodies acted like a life preserver, storing fat in anticipation of the inevitable periods of famine. The same system works today. YOU-reka! When you try to “diet” by going for long periods of time without eating or by eating way too few calories, your brain senses the starvation and sends an SOS signal through your body to store fat because famine is on its way. That’s why people who go on extreme fasts and extremely low-calorie diets don’t lose the expected weight. They store fat as a natural protective mechanism. To lose weight you have to keep your body from switching into starvation mode. The only way to do it: Eat often, in the form of frequent healthy meals, and snacks.

Plan Your Meals. Start every day knowing when and what you’re going to eat. That way, you’ll avert the 180-degree shift between starving and gorging that occurs when you skip meals. Our fourteen-day diet (in Chapter 12) will show you how to plan your meals so that you feed your body regularly to avoid extreme periods of overeating and undereating that can lead to a gain in weight and inches.

YOU Test

Remember Your Ancestry

Some people say their family has big bones or big cells. Some say their family has big appetites. Some say their family just has big beer coolers. If you gained weight as an adult you can get a relatively accurate picture of what your ideal size should be by thinking about what you looked like when you were eighteen (for women) or twenty-one (for men); a time when you were at your metabolically most efficient and when you weren’t stapled to an office chair for sixty hours a week. Most people gain their weight between the ages of twenty-one and sixty, so by looking at your size at eighteen or twenty-one, you’ll have a good, though not quite scientific, idea of your factory settings. It’s not perfect, but it’s a thumbnail sketch of where you want to be. You can record your waist size (or closest guess) from when you were eighteen, but, more important, think about your shape. Ask your parents about their body sizes-or find pictures of them-when they were eighteen, to help give you a good idea of what you’re supposed to look like.

YOU Test

Stand in Front of the Mirror.

Naked. Without Sucking in Your Belly.

For some of you, this assignment may feel natural, but for most the exercise is as uncomfortable as a coach-class airline seat. We’re having you do this not to benefit the neighborhood peepers, but for two other reasons. First, we want you to realize that we’re emphasizing healthy weight. Not fashion-magazine weight, not featherweight, but healthy weight. And we think that means you have to start getting comfortable with the fact that every woman isn’t as light as a kite, and every man won’t have the body of Matthew McCanoughey. Where you want to be may not be exactly where your body wants you to be. We’re not saying you need to accept a belly that looks like four gallons of melted ice cream, but we want you to get closer to your ideal health-and that means physically and emotionally.

Second, we want you to look at your body. Now draw an outline of your body shape (both from the side and front views). Ask a partner or close friend to look at the shape you drew and tell you-honestly-if that’s approximately what your body looks like. (Your clothes can be back on at this point.) This is just a quality-control check to make sure you have an accurate self body image. (Those with eating disorders have very distorted body images, making it an obstacle for getting back to a healthy weight.) This might be the first time you’ve ever had to articulate things about what your body looks like-and that’s good.

Part 2

Chapter 2
Can’t Get No Satisfaction
The Science of Appetite

Diet Myths

 Hunger is primarily dictated by what’s happening in your stomach.

 The biggest battle in dieting involves willpower.

 As long as a food is low-fat it’s not going to make you fat.

As much as an iPod bud in the ear, fat has become a regular part of our landscape. We see it everywhere. We see it tethered to a hunk of prime rib. We see it masquerading as a Nutter Butter. We see it crammed into evening gowns or cascading over belt buckles. We’ve seen paparazzi-haunted celebrities gain it and lose it, lose it and gain it. And, if we can bear a confidence-crushing six seconds of nudity in front of a mirror, most of us have seen our own share of flesh that droops, sags, or jiggles. So, reason would tell you that we should know as much about fat as we know about Angelina Jolie’s private life. But we don’t.

Sure, we know what it looks like, what it feels like, and that it can be as bad for our health as a steak knife lodged in our hand. But few of us really know how fat works biologically—how the Twinkie morphs from a wonderfully yellow spongy cake to the flab that conjoins our inner thighs, or how our skinny-as-a-straw friend can wolf down a meat-lover’s supreme while we feel bloated if we as much as sniff four carrots.

Starting in this chapter and continuing throughout the rest of part 2, we’ll show you the way that food travels—from the time your body wants you to eat it, to the time it exercises squatter’s rights on your hips, to the time you fry it into oblivion. The best place to start? With your appetite. Appetite really comes in two forms: physiological signals that make you hungry and emotional coaxes that lure you to food.

In this chapter, we’ll explore those physiological signals, because understanding and controlling your hunger and satiety signals will help you adopt a healthy eating plan. (We’ll explore the psychological and emotional aspects in part 3.) Once you know that those mechanisms have much more powerful control over how you eat than do your taste buds, then you can make the behavioral, attitudinal, and biological adjustments you need to live at your healthy weight.

Above all, there’s one sign that will clue you in to whether you’ve become an effective processor of food. It’s the sign that you, not a bag of gummy bears, are in control of your weight. It’s the sign that you, without having to work at it, have been promoted to captain of your waist management vessel. And it’s the sign that you’ve ultimately reprogrammed your biology so that your body uses food as a medicine to make you stay healthier so that you live long enough to see how Lost ends.

Fat’s Bad Rap

Sure, nobody likes body fat especially when it beats you through the door by five or six seconds. But despite potentially serious consequences, fat, by nature, is good. (That’s not a typo.) Besides helping Santa hopefuls land December jobs, it also helps your cells function and provides insulation. Most of your fat is stored in a reservoir throughout your body. You have drums and drums of it sitting passively, just waiting to be burned. But you have another kind of fat, too. It’s called brown fat and is usually found on the back of your neck and around your arteries (and has absolutely nothing to do with how much chocolate you eat). This increases in outdoor workers during cold spells to protect them from the weather; it insulates our vital organs. Though you have a fairly small percentage of brown fat as an adult about one-third of fat in babies is brown fat and it’s used primarily to keep them warm. What makes brown fat different? YOU-reka! Brown fat is alive. It has nerve fibers, like any organ, and it also has leptin receptors. When the level of this hormone goes up, it turns on energy consumption in the brown fat and burns it. This is important because it shows that the right leptin levels can signal you to immediately get rid of this fat. And it’s also symbolic of the inherent goodness of body fat-when it’s found in the right amounts.

That sign? Satisfaction.

As you change from always thinking about diet to never thinking about it, you will be reprogramming your body so that it’s not your eyes, tongue, or overzealous utensils that will guide you.

YOU-reka! Instead, it will be the chemicals in your brain and body.

By tuning in to your body’s signals, you’ll allow your anatomy to work the way it’s supposed to: so that you’ll never be famished, you’ll never pop a button at the table, and you’ll never bounce between hunger extremes. Instead, you’ll get a little hungry, you’ll eat, you’ll stop. Satisfied.

The Anatomy of Appetite

You’d think that the first place we’d start to talk about how appetite influences fat would be the spot that’s covered by an XXXXL shirt. But to understand appetite, you have to navigate farther north—to the place that may hold the least fat. In your brain, you’ll find the hypothalamus, a key command center for your body. Among the biological functions it controls are your temperature, your metabolism, and your sex drive. Located in the center of your brain, the hypothalamus (see Figure 2.1) also coordinates your behaviors that involve appetite—not just for food but also for thirst and even for sex. So while it may appear that call-to-duty signals come from your stomach growling or your loins tingling like a static shock, it’s actually your brain that’s sending out the signals that you crave either a quiche or a quickie. (At least one person we know helped curb an eating problem by having regular, monogamous, healthy sex. When the appetite function for sex was satisfied, the appetite function for food was diverted.)

FACTOID

As you get older, you have fewer leptin receptors in your hypothalamus-meaning that you have fewer satiety signals, which makes you more prone to gaining weight.

Hidden in your hypothalamus, you have a satiety center that regulates your appetite. It is controlled by two counterbalancing chemicals that are located side by side (see Figure 2.2).

 The satiety chemicals led by CART (the C stands for cocaine and the A for amphetamine, since these drugs put this chemical into overdrive). CART stimulates the surrounding hypothalamus to increase metabolism, reduce appetite, and increase insulin to deliver energy to muscle cells rather than be stored as fat.

 The eating chemicals driven by NPY (a protein called neuropeptide Y). NPY has the opposite effect on the hypothalamus; it decreases metabolism and increases appetite.

Think of these two command chemicals as any game or sport that involves offense and defense, like soccer, checkers, or even dating. The offense is always trying to make advances, trying to score points, and trying to attack, while the defense protects its territory.

Your eating chemicals play offense. They want as many points as possible, so they fire off those signals for your body to score: eat, eat, eat, calories, calories, calories, chimichanga, chimichanga, chimichanga. The biological message: Prevent starvation by eating. Meanwhile, your satiety chemicals play defense, like a goalkeeper, the back row of checkers, or a protective parent. They send the messages to your brain that you’re full, to shield you from steadily pumping bacon-wrapped scallops down your gullet. How do we know these centers work this way? For one, by looking at extremes and seeing what happens when the feeding system is turned completely on or off. When we study animal models, we see that if a rat’s eating center is destroyed, for instance, it forever forgets to eat. The resulting severe anorexia starves the body of all energy and nutrients so that it withers away to the approximate width of an envelope. In rats whose eating center is overstimulated, though, food is always on the radar screen. And those rats eat themselves to death—literally—by increasing their fat-induced diseases like diabetes, hypertension, and arthritis.

Figure 2.1 Food Fight In your hypothalamus, you have hunger and satiety chemicals. The hormone leptin goes to the satiety center to make you feel full and satisfied, while the signal from the hormone ghrelin makes you want to eat gorge, and slobber over your every feast.

Figure 2.2 Chemical Reaction If we look closely at the hypothalamus, we see that a small nucleus at the bottom houses NPY and CART, which fight the yin-yang battle to control the brain biochemistry of hunger. Each chemical readily travels to other nuclei in the hypothalamus. NPY causes our temperature to drop and our metabolism to decrease as we feel hungry. CART stimulates the opposite influence. The nearby mammillary body (literally shaped like a nipple) is part of our limbic system, where we store memories and emotions—just the right combination to create a craving for a favorite food. The thalamus is the body’s relay station and rapidly transmits orders throughout the brain based on the desires of the eating center.

FACTOID

CART (cocaine-amphetamine-regulatory transcript for those scoring at home) is the reason why cocaine addicts don’t gain weight. Cocaine and amphetamine stimulate this chemical, giving you a double brain bat to help you control appetite and increase metabolism. It’s unclear whether CART will be the basis for effective weight-loss treatments, but researchers are studying the neurological effects these drugs have on appetite to see if they could lead to long-term pharmaceutical solutions to weight loss (without of course, the dangerous side effects of illicit drugs). Marijuana, by the way, has its own receptors that overwhelm leptin, which is one big reason why pot smokers get the munchies. It’s also an area that’s a promising new approach to weight-loss drugs. By figuring out how the drug turns off the gene that produces leptin, we’ll be able to figure out how to flick it on-to keep leptin (and thus satiety levels) high. The prototype drug has done great in trials and symbolizes a new generation of smart weight-loss medications that work hormonally.