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  #1   ^
Old Wed, Aug-30-17, 02:47
Rosebud's Avatar
Rosebud Rosebud is offline
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Default The obesity myth: experts tackle a big problem to deliver new solutions

https://www.brisbanetimes.com.au/li...829-gy6bhf.html

The obesity myth: experts tackle a big problem to deliver new solutions

By Sarah Berry

One quarter of Australian adults are obese. It is a sad stereotype that it is because they are weak-willed, over-indulgent and lazy.

In a new three-part documentary, The Obesity Myth, experts attempt to dispel such myths and the many stigmas weighing on the overweight.

"The obesity myth is that it's all due to lifestyle," says international obesity expert Professor Joe Proietto, the head of Austin Health's Weight Control Clinic in Melbourne. "In fact, obesity is predominantly genetic."

In fact, genes that evolved to help us are now contributing to a growing epidemic.

How? During times of inevitable famine, our body's hormones changed to slow down our metabolism and help us store what weight we had for survival.

"All these genes were selected for evolution because they're protective when you don't have enough food, it's only lately that we've had plenty of food," Proietto says.

So simply eat less, right? Exercise some discipline and discipline yourself to exercise?

Not exactly. Eating less, eating better quality foods and exercise are important for everyone's health, overweight or not. But, this is also where the obesity issue gets complicated.

About 90 per cent of the population is predisposed genetically to being overweight and obese and those with the "obesity" gene are about 70 per cent more likely to be obese.

Some epigenetic triggers (a high-energy, poor diet early on and malnutrition or over-nutrition in the mother while she's pregnant) also make obesity more likely in certain people.

Despite this, experts agree that improving your diet and incorporating exercise will result in weight-loss.

"No matter what your gene is, if you don't eat, your body will keep burning energy and you will lose weight," Proietto says. "The problem is your genes make you hungry.

"Back then it made sense to do energy reduced diets – we didn't know about these [hormonal] changes, we didn't know a lot of what we know today."

Two studies have influenced the two-part process he now uses to treat his patients.

The first study found that obese people could lose weight rapidly on a very low energy diet, using meal replacements for two of their three daily meals (the third carb-free meal consisted of protein, non-starchy vegetables and "a bit of oil or a bit of fat each day to empty the gall bladder").

"We were testing whether it's true that the quicker you lose it, the quicker you put it on and the answer is 'no, it's not' it's a myth," he says.

Those on the very low energy diet had greater weight-loss "success" Proietto says, which he attributes to the motivation of seeing the weight fall away and that the plan was carb-free.

"Back then it made sense to do energy reduced diets – we didn't know about these [hormonal] changes, we didn't know a lot of what we know today."

Two studies have influenced the two-part process he now uses to treat his patients.

The first study found that obese people could lose weight rapidly on a very low energy diet, using meal replacements for two of their three daily meals (the third carb-free meal consisted of protein, non-starchy vegetables and "a bit of oil or a bit of fat each day to empty the gall bladder").

"We were testing whether it's true that the quicker you lose it, the quicker you put it on and the answer is 'no, it's not' it's a myth," he says.

Those on the very low energy diet had greater weight-loss "success" Proietto says, which he attributes to the motivation of seeing the weight fall away and that the plan was carb-free.

"Our diet is ketogenic – ketones are breakdown products of burning fat, they're made by the liver and they take away hunger very nicely by acting on the brain," he says.

Once the person has lost the desired weight and returns to whole foods (including carbohydrates), the hormonal changes make maintaining that weight near impossible.

"Our other paper, which we published in 2011, showed that the hormone changes you get with weight-loss are long-lasting," Proietto says. "So following weight-loss you get an increase in the hunger hormone ghrelin and you get a decrease in several of the hunger-suppressing hormones. They don't go back until you regain all the weight."

For this reason, Proietto now puts his patients on life-long medicines to maintain the weight-loss.

"While we don't need medication to lose weight, we think that maintaining weight really does require medication," he says. "This is what makes obesity a chronic condition."

Dr Nick Fuller, an obesity researcher from the Charles Perkins Centre at the University of Sydney, says the way the weight is lost determines its sustainability.

In his new book, Interval Weight Loss, he states that losing weight very slowly (no more than two kilograms in a month eating whole foods, focusing on sleep and exercise and then maintaining that weight-loss for a month before the next cycle) gives the body time to adjust and redefines the body's set-point, meaning we do not trigger the hormonal cascade effect and decrease in metabolism.

"[Experts] acknowledge the weight keeps coming back and they say 'OK, well the long-term solution is that we put them on medication or give them surgery' but this is not suitable for all," says Fuller, who is not involved in the documentary.

"You've got to do it slow and steady. Not everyone is going to get back to a normal weight some will go from obese to overweight, but it's a better result than losing 20 and putting 22 back on."

While the methodology for dealing with the issue differs among experts and researchers, they all agree obesity is a big problem and that suggesting people just need to be more disciplined shows how largely it is misunderstood.

"I would like people to stop abusing people who are obese," Proietto says. "It's very difficult. People say even if they're hungry they could choose not to eat, it's bunkum, I would really like it if people weren't abused for being overweight."


I might mention that this is a three part doco I shan't bother wasting my time on. I might also mention that the air around here turned a tiny bit blue as I read this.
He thinks that once we lose the weight we need to take medication for the rest of our lives? Really? How about just not go back to the carbs that made us fat in the first place!
Idiot.
And I'd be interested to know just what this medication is that he so mysteriously doesn't mention.
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  #2   ^
Old Wed, Aug-30-17, 04:30
Jools16 Jools16 is offline
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Hi Roz, Great footnote. My daughter lost 30 lbs in 2000 and has kept it off by not overeating the carbs she used to consume, but, unfortunately, her mother hasn't followed her example, so has put on the lbs I had lost. However, I am now low carbing again and will lose them and keep them off!! Jools 😊
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  #3   ^
Old Wed, Aug-30-17, 04:47
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cotonpal cotonpal is online now
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And to think people make a living promoting this kind of stuff. Sometimes it feels like so many people simply live in some alternative reality, a through the looking glass world where up is down and profit rules. Gotta buy that pill to stay healthy.

Jean
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  #4   ^
Old Wed, Aug-30-17, 06:39
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doreen T doreen T is offline
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Quote:
Originally Posted by Rosebud
I might mention that this is a three part doco I shan't bother wasting my time on. I might also mention that the air around here turned a tiny bit blue as I read this.
He thinks that once we lose the weight we need to take medication for the rest of our lives? Really? How about just not go back to the carbs that made us fat in the first place!
Idiot.
And I'd be interested to know just what this medication is that he so mysteriously doesn't mention.

I did a little sleuthing ....

In June 2017, Dr. Proietto published a "study" (more of a report, really) Obesity and weight management at menopause.

Here are the interesting bits ...
Quote:
Discussion

Weight gain during menopause is predominantly due to a reduction in spontaneous activity. For women who are lean, advice about controlling energy intake and increasing physical activity may be all that is required to prevent weight gain. For women who are overweight and obese rapid weight loss is best achieved with the help of a very low energy diet. This must be followed by lifelong behaviour modification with or without the help of hunger-suppressing pharmacotherapy.

< snip >

Thus, the best way to lose weight is as follows. Assess if the patient is ready for a period of changed lifestyle to achieve a large weight loss. If so, ask the patient to select a day when she is going to start. Before starting, she needs to purchase a very low energy diet (VLED). There are many of these products on the market, but not all are suitable. Suitability can be assessed by a qualified dietitian who can check that all required micronutrients are included at the appropriate levels. These VLEDs serve two purposes. These provide the micronutrients needed, such as vitamins (eg vitamins A, B, C) and minerals (eg iron, calcium, selenium, zinc). This is very important because during this diet, the patient will not be consuming enough food to obtain all of these nutrients. Secondly, VLEDs replace two meals, usually breakfast and lunch. VLEDs come as powders that are mixed with water to make a shake, or as preformed bars for convenience. In addition, advise the patient to have available a roasted chicken or similar protein source, such as tofu, in her refrigerator.

On Day one, the patient takes the first shake or bar and has her usual morning sugarless drink. Nothing else must be eaten. At morning tea, she can have another drink, but again, nothing else must be eaten. However, on this day, if the patient is very hungry, she can nibble the roast chicken or other protein source that was prepared before starting. Lunch consists of a second shake or bar, and another sugarless drink. An afternoon sugarless drink is allowed, but nothing else must be eaten (with the exception of the chicken or other protein source in the fridge). In the evening, the patient has a large dinner, but this must not include any carbohydrates. Dinner is made up of proteins (eg meat, fish, eggs, tofu), three non-starchy vegetables (only those chosen from Appendix 1 of reference 6)6 and a salad. Advise the patient to dress the salad or vegetables with oil, preferably olive oil, as it is essential to have a small amount of fat daily to empty the gall bladder. This will reduce the risk of developing gallstones.

The routine for day two is the same as day one. Day three is the same as for day one, but the patient will notice fewer tendencies to go to the fridge to top up with roast chicken or other protein because she is less hungry than she was on the first two days. From day four, the patient continues with the regime of replacing two meals a day with a VLED and having a carbohydrate-free dinner until she has achieved her weight-loss goals.

In terms of quantities, the protein is the size of the patient’s hand and the vegetables and the salad need to fit comfortably in a normal-sized dinner plate.


Why does hunger disappear after two days?

The reason this diet stresses the avoidance of carbohydrate is that if adhered to, hunger is suppressed after two days. Why?

On the first day of this diet, the patient takes in only 3200 kJ (800 kcal), but her body must burn about 9430 kJ (2300 kcal), so it searches for the missing calories in stored energy. The body burns glucose in preference to fat, so it looks for stored glucose (glycogen). The same happens on day two. On day three, however, there is no glycogen left, as humans can only store two days of glycogen. Thus, on day three, the body moves to burn its next favourite fuel, fat.

When the body burns a lot of fat, the liver releases some of the partly burned fat molecules containing the last four carbon atoms into the blood; we call these ‘ketones’, which suppress hunger. It has been demonstrated that ketosis prevents the rise in ghrelin7 that occurs after weight loss, and also increases the secretion of the hunger-suppressing hormone cholecystokinin.8 There are additional nutrient changes that contribute to hunger suppression.7 The heart and brain are the only two organs that can burn ketones, so the other possibility, not yet proven, is that ketones, like other nutrients such as glucose and fatty acids, suppress hunger directly by working on the brain. The point is that during the weight-loss phase, the patient can manufacture her own appetite suppressant. The downside to being mildly ketotic is that the ketones are volatile and, thus, can be breathed out, so the patient may develop ketotic breath. Chewing sugarless gum may help.

If the patient has diabetes and is taking insulin or a sulphonylurea, the dose of these medications must be reduced on starting the diet to avoid hypoglycaemia. Individuals taking warfarin or who have heart, liver or kidney diseases also need more medical supervision when commencing VLEDs.


What if the patient cannot tolerate VLEDs?

Some people cannot tolerate VLEDs because of their taste or texture, or because they may develop symptoms such as diarrhoea. What should they do? Weight will be lost provided energy intake is lower than expenditure. However, if VLEDs cannot be used, the minimum energy intake cannot be less than 4920 kJ (1200 kcal). It takes at least that amount of ‘ordinary’ food to have enough variety to ensure an adequate intake of the large range of micronutrients. Other options to reduce energy intake are noted below.


The balanced, reduced energy diet

The balanced, reduced energy diet is the typical diet long used to lose weight, and best undertaken with the help and supervision of a dietitian. The strategy is to calculate the subject’s energy expenditure and then to prescribe a diet that is reduced by about 2500 kJ (600 kcal). This will result in 0.5 kg weight loss per week. The help of a dietitian is needed to ensure the reduced diet is balanced so that the patient has all of the required micronutrients. The problem with the balanced, reduced energy diet is that hunger develops as weight starts to reduce. To control hunger, there are two options available. Start an appetite-suppressing drug when hunger starts or weight loss stalls, or instead of using a balanced energy reduced diet, induce ketosis by avoiding carbohydrates.


Maintaining weight loss

Weight loss is only the first step of the treatment and, in many ways, the easier of the two phases. The next phase is maintenance of the weight loss. Maintenance will remain a lifelong effort as powerful physiological mechanisms are triggered following weight loss that result in increased hunger because of changes in hunger-controlling hormones9,10 and a reduction in energy expenditure.11,12 It has now been confirmed that these changes are long-lasting.13,14 The patient may need pharmacological assistance and advice to make a conscious effort to restrict calorie intake and increase energy expenditure by regular exercise.

In Australia, two drugs, phentermine (15, 30 and 40 mg) and liraglutide (3 mg),15 have been approved for hunger suppression. In addition, topiramate can be used off-label, either on its own or in combination either with phentermine or liraglutide. As increased hunger persists for a long time, obesity must be considered a chronic disease, which means that as with other chronic illnesses, medication must be lifelong.

In summary, most women experience modest weight gain during menopause, predominantly because of a reduction in spontaneous activity. Women who are lean and transitioning through menopause can prevent weight gain by paying attention to lifestyle. Women who are overweight and obese may require more vigorous energy restriction, and some may also require long-term pharmacotherapy to suppress hunger.



Author

Joe Proietto AM, MBBS, FRACP, PhD, Professor Emeritus, Department of Medicine (AH), University of Melbourne, Parkville Vic. J.proietto~unimelb.edu.au

Competing interests: JP is the chair of the Medical Advisory Board for Saxenda for Novo Nordisk in Australia and has given lectures on the management of obesity for iNova marketers of duromine.



So there you have it folks. Follow the yellow brick money ....




added note: ... I'm willing to bet that the manufacturer(s) of those VLED shakes, powders and bars are heavily invested in this project too


.
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  #5   ^
Old Wed, Aug-30-17, 06:41
teaser's Avatar
teaser teaser is offline
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Plan: ketosis/IF
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Quote:
In his new book, Interval Weight Loss, he states that losing weight very slowly (no more than two kilograms in a month eating whole foods, focusing on sleep and exercise and then maintaining that weight-loss for a month before the next cycle)


I'm not sure what he bases this on, I tried checking out his research on pubmed, I couldn't find much to suggest that such a slow process was better for maintenance. The idea that if you lose weight and then hold it for a month, your body weight setpoint will readjust, needs testing. He's more or less saying that the common claim that trying to lose weight too fast will put a person in "starvation mode," is backed up by science, if that were true, you'd think we'd have heard about it by now.
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  #6   ^
Old Wed, Aug-30-17, 07:13
teaser's Avatar
teaser teaser is offline
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Plan: ketosis/IF
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Quote:
Phentermine (contracted from phenyl-tertiary-butylamine), also known as α,α-dimethylphenethylamine, is a psychostimulant drug of the substituted amphetamine chemical class, with pharmacology similar to amphetamine. It is used medically as an appetite suppressant for short term use, as an adjunct to exercise and reducing calorie intake.


Duramine is a brand of phentermine. Which put the "phen" in fen-phen. We're back to amphetamines for obesity.

Quote:
powerful physiological mechanisms are triggered following weight loss


My bias here, largely because it fits my personal experience, but also based on what I've read, filtered through my own prejudice, is that this is a truer representation of "starvation mode." The lobster-trap of weight loss.

The insulin hypothesis isn't refuted by my own experience, my "setpoint" seems to be lower depending on how insulinogenic my diet is.

One problem with a hypocaloric diet is that it substantially decreases insulin. So you lose weight. If you lose all of the weight on the hypocaloric diet--if it's such a restricted diet that it would lead to actual starvation if a person didn't go off of it once they'd lost their excess weight--there's a problem there. If "maintenance" is 1500 calories, and weight loss occurred on 500 calories, and 500 calories resulted in loss of appetite due to low insulin--you can see the problem, the maintenance diet is going to result in much higher insulin levels than the weight loss diet did. Volek and Phinney sort of address this same problem with a ketogenic diet, when they suggest that as you approach maintenance, the increased calories that now have to come from food instead of from your body should come from dietary fat, keeping the metabolic state a person's in during maintenance more like the metabolic state they were in during successful dieting.
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  #7   ^
Old Wed, Aug-30-17, 08:09
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Rosebud Rosebud is offline
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I am just in from a very pleasant evening out and looky here... Pretty much just as I was assuming.

Well done, Detective Doreen!

I hope the good, er, appalling really, doctor doesn't mind if we carry on enjoying our lives and our much more than 800 calorie days' worth of delicious meals while maintaining our weight loss or even as we are achieving said loss, with or without his permission! 1 am still stunned at his assumption that one could only achieve maintenance by taking ******** phentermine for the rest of one's life!

PS: Rotten beggar has almost sobered me up! How dare he!
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  #8   ^
Old Wed, Aug-30-17, 08:20
Sniggle Sniggle is offline
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'About 90 per cent of the population is predisposed genetically to being overweight and obese and those with the "obesity" gene are about 70 per cent more likely to be obese.'

Another article providing ammunition for the 'its not my fault I am obese' crowd. Reading these articles you would think that fat is just absorbed from the atmosphere, and is totally out of the control of the individual.

Being fat is a choice, just as being fit is a choice. On path is much easier to follow but leads nowhere...the other path is harder to consistently follow but puts you in a better position to enjoy life.

I like sitting on the couch, eating corn chips and salsa and drinking beer. I did not like the man belly that grew as a result, and decided my dislike for the man belly outweighed my love of corn chips and beer.
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  #9   ^
Old Wed, Aug-30-17, 08:21
cotonpal's Avatar
cotonpal cotonpal is online now
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Avarice masquerading as science and a dangerous drug posing as treatment. It's really horrifying!

Jean
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  #10   ^
Old Wed, Aug-30-17, 11:48
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Seejay Seejay is offline
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Quote:
Being fat is a choice, just as being fit is a choice. On path is much easier to follow but leads nowhere...the other path is harder to consistently follow but puts you in a better position to enjoy life.

I like sitting on the couch, eating corn chips and salsa and drinking beer. I did not like the man belly that grew as a result, and decided my dislike for the man belly outweighed my love of corn chips and beer.
Are you a believer in the sloth and gluttony causes, then? and calories in/calories out also?
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  #11   ^
Old Wed, Aug-30-17, 12:04
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GRB5111 GRB5111 is offline
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Plan: Ketogenic (LCHFKD)
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Quote:
Originally Posted by Sniggle
'About 90 per cent of the population is predisposed genetically to being overweight and obese and those with the "obesity" gene are about 70 per cent more likely to be obese.'

Another article providing ammunition for the 'its not my fault I am obese' crowd. Reading these articles you would think that fat is just absorbed from the atmosphere, and is totally out of the control of the individual.

Being fat is a choice, just as being fit is a choice. On path is much easier to follow but leads nowhere...the other path is harder to consistently follow but puts you in a better position to enjoy life.

I like sitting on the couch, eating corn chips and salsa and drinking beer. I did not like the man belly that grew as a result, and decided my dislike for the man belly outweighed my love of corn chips and beer.

So, after dutifully following the Dietary Guidelines for Americans over the past 30+ years, and trying to make the Food Pyramid and MyPlate work, the majority of people who are obese simply lack willpower??? So, they need to move more and eat less??? So, insulin resistance and carbohydrate addiction has nothing to do with the constant hunger they are experiencing due to hormones out of control, that it's just a matter of doing the right thing???

Here's a link I provided in another post:
http://nymag.com/news/sports/38001/

Here's another video that may shine a light on reality:
https://www.youtube.com/watch?v=da1vvigy5tQ

Edited to add:
And here's another article with the same theme:
http://www.postbulletin.com/magazin...f08879d10.html?

There's a lot to learn regarding nutrition that doesn't normally agree with the recommendations we've been brainwashed with over the past 30+ years. Learning is good!

Last edited by GRB5111 : Wed, Aug-30-17 at 12:17.
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  #12   ^
Old Wed, Aug-30-17, 12:31
PaCarolSue PaCarolSue is offline
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Quote:
Originally Posted by Rosebud
https://www.brisbanetimes.com.au/li...829-gy6bhf.html

The obesity myth: experts tackle a big problem to deliver new solutions

By Sarah Berry


"No matter what your gene is, if you don't eat, your body will keep burning energy and you will lose weight," Proietto says. "The problem is your genes make you hungry.


[/I]



I cannot usually relate to any of these studies, because of this...my eating has nothing to do with hunger, but things like everyone else is eating, the food looks/smells good, it's mealtime. If I only ate when I experienced true hunger I would never have become obese in the first place. It's only since I started practicing IF that I learned what hunger feels like rather than just appetite. And many of the obese people I know would say the same thing if they were being honest.
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  #13   ^
Old Wed, Aug-30-17, 12:43
teaser's Avatar
teaser teaser is offline
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If you've ever been manic or depressed, I think it's hard from that vantage point to see activity levels as something that somebody just decides on. You really can't decide just how hard it is for somebody to get going from the outside. You could say the same about food. How can somebody tell me how hungry I am, or if it's not "stomach" hunger, but some other drive to eat, sometimes called "false" hunger, or "head" hunger--but which increases with starvation, which suggests to me that it's as legitimately a drive for survival as "real" hunger is--how can you say just what it is another person is fighting? You can't feel another person's hunger, or their cravings.

There's also a problem of definition. How do you know that somebody ate too much, and exercised too little? They gained weight. At some point starvation and forced marching will work for weightloss, for anybody. Will it be worth it? I'm happy if eating less and exercising more works for anybody, that's solved the problem for one person. But you have to understand that there's a strong bias to assume that what works for you will work for other people.
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Old Wed, Aug-30-17, 12:48
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Mama Sebo Mama Sebo is offline
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Thank you Teaser. I didn't have the words.
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Old Wed, Aug-30-17, 13:52
cotonpal's Avatar
cotonpal cotonpal is online now
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At the very least in order to take responsibility for our own health we need to be given reliable information. The information given to people trying to lose weight has been, over many decades, simply wrong and people who try to follow that advice and get on the lose gain roller coaster are made to feel that they are to blame when all they have been doing is following the advice they have been given. When I weighed 245 pounds I was ravenously hungry all the time. I was also tired, sick with various ailments and in constant physical pain. I was also seriously depressed and frequently suicidal. I am also independent minded and a good researcher, not likely to blindly follow experts like doctors, perhaps because my father was a doctor and I knew him to be, on occasion, fallible. So I finally did take responsibility for my own health because I was lucky enough to have the skills and personality that made this kind of self direction possible.

I try to be grateful for what I have been able to achieve without getting judgmental about what other people seem unable to accomplish. As Teaser said, we can't really know what goes on inside another person's mind and body. It is impossible to know what exactly drives them. Before my dietary changes I was hungry all the time and didn't have the energy to exercise plus my body was in too much pain. To others I probably just looked like a glutton. It is hard sometimes for me to remain non-judgmental when I see people acting in ways that go against their self-interest but kindness towards all others and humility about one's own circumstances goes a lot farther than arrogance and criticism. This is something I try to keep working on.

Jean
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