I have had a couple of patients recently who described their intense emotional pain after hearing people make derogatory comments at them while they were shopping for food or in other public places. I think its obscene how it seems OK in our society to bash fat people for being fat. You’re not supposed to bash people because of their gender, race, sexual orientation or whatever (which is good), but if someone is fat then its OK (which is just wrong).

I want to explain why making people feel guilty about being fat just makes things worse, This has nothing to do with being politically correct, and everything to do with neuroendocrinology. Along the way I hope to give you some insights into the way the body deals with weight and fat that may help you understand how we can attain and maintain a healthy weight. Here we go.

There is a myth that your body needs a certain number of calories per day and if you eat more than that number of calories then your body will store all of them as fat. This is a myth. It is not true.  However, this myth seems to have a deep hold on our collective psyche even though it is utter nonsense. The truth is that once your body gets above what it needs, it can choose whether to spend or save the extra calories.

Think of the economics of your household. There is a certain amount of money per month that you need to pay all of your essentials. If you make more than that amount then do you save every extra penny?? Probably not. You will use the extra to do things like purchase better food, get some new clothing, decorate your house, etc. In short, you will not save every extra penny, but rather you will use at least some of the extra money to improve your quality of life. What determines how much you save vs how much you spend? Well, the level of financial stress will have a large impact on your decision. The greater the financial uncertainty the more likely you are to save the extra money.

Its similar with the body. If you eat more calories in a day than your body needs, then your body gets to either store those extra calories or spend them on keeping the body running better. The more stress your body is under the more likely it is to store the extra calories instead of spend them. The more at ease you are, the more likely your body is to spend the calories instead of store them as fat.

As humans we tend to be sensitive to our social environment. So if you are fat and some person makes obnoxious comments about your weight, then you will experience that as stressful. Your body will then generate chemicals that will tend to cause it to store calories as fat. The person making the comment is contributing to your being fat. Fortunately there are some things you can do to change this which are socially appropriate.

Let’s look at this more closely. Fat is not just a place that the body stores calories. Fat cells come in different types and produce a variety of chemicals that affect the nervous system and endocrine system. Some fat cells, especially abdominal fat cells seen to have a protective effect against stress. To explain that I need to take a brief detour and distinguish stress from strain.

Stress is what is putting pressure on you. Its all the demands that you have to deal with, including those you put on yourself. Strain is how your body responds to the stress. Stress causes strain in the body. So when you are under a lot of stress and feel your muscles tense up, what you are feeling is a particular type of strain. The same stress might cause someone else to get a different type of strain, say a stomach ache, or a headache, or … ?get fat? Yes. In fact, it seems that fat may well be a kind of response to chronic stress that, from the body’s perspective, is better than other kinds of strain.

The implications of this are profound. First of all, it means that if you are trying to lose weight and the processes you are using to lose weight are increasing your stress in a chronic manner, then you are fighting yourself. Your body will be working as hard as it can to keep those fat cells that are helping you deal with stress because you are creating more stress. And the more pressure you put on yourself to lose weight, the more strain and the more the tendency to increase fat.

The second implication is a little more complex. It goes back to our body being able to decide whether to spend or save extra calories. In fact, the body doesn’t just take in calories and let them diffuse around to the different cells in a random manner. Instead it is directing the various nutrients in a rather precise manner.

Think of a large company with several departments. There are the workers, the IT staff, the billing and collection people, etc. There is also an administrative department. The company allocates its resources to each of the departments according to some kind of budget. Let’s say that the workers and IT staff are not getting enough resources and they put in a request for more. The billing and collection people get busy and bring in more revenue. But an odd thing happens. The extra money goes to the administrative department and they hire more administrators! Of course, the workers and IT staff are still overworked so they send out another request for more resources. So the billing and collection people dutifully bring in more revenue, and it goes to … the administrative department which gets even bigger! Not helpful.

This seems to be what is going on with obesity. The muscles, nerves, and other cells need nutrition, so they send out a message to the brain and you feel hungry. So you eat and your digestive organs break the food down into nutrients, which get sucked up by the fat cells, and those get bigger. But that means that the other cells are still lacking nutrition and they complain. So you feel hungry, and eat, and again the nutrients go to the fat cells which get even bigger.

The problem here is that you are hungry. Its not about will power or self-sabotage. A lot of the cells in your body are simply not getting enough nutrition. Just because the fat cells are getting more than their share, doesn’t mean the other cells are getting enough. Dieting doesn’t change this situation, and exercise can put more of a load on the muscle and other cells that are already starving. This causes them to break down and our body will stop us from exercising to avoid injury.

The conclusions that come from this are that to attain and maintain a healthy weight we need to do two things.

1. We need to change how our body handles stress so that it does need as much fat to protect us from it.
2. We need to avoid making the processes we use to lose weight cause long-term increases in stress.

Note that I did not say we need to eliminate stress. That is often not possible. Stress is not going to go away. We can change the strain our body experiences when we are under stress, and we can stop adding to the stress by pressuring ourselves to lose weight.

Some examples. I have had patients lose weight by going to Weight Watchers. Then Weight Watchers did not work for them. Then it started working again. What seemed to be consistent is that when they liked the group, felt that it was low pressure and supportive, and got ideas that they could fit into their routine, then they lost weight. When they went to a different group or the group changed so that it was not as supportive, generally more punitive or shame based, then it did not work and they gained weight. It was the same program. The difference was in how it was implemented. A low-stress implementation reduced weight more than a high-stress implementation.

Let’s look at exercise. From the perspective of burning calories, exercise does little to help with weight loss. Part of that is because our body is extremely efficient when it moves. Ten pounds of fat will provide enough energy for you to walk about 350 miles! Furthermore, exercise is stressful. And the more sedentary you are the more stressful the exercise. If you are dieting and exercising it is even more stressful. So the stress of exercise can cause the body to want to store more fat. We may get fitter and we definitely get fatter.

So if exercise is stressful and stress causes the body to tend to increase fat, then why exercise? Remember that one of the problems is that the nutrition is not getting to the muscle cells. Exercise tends to change that. By exercising the body seems to get the message that the muscles need more nutrition and it will gradually start sending those nutrients to the muscles instead of the fat cells.

Furthermore, if we are patient and focus on finding physical activity we enjoy, increasing the intensity at a pace our body can adapt to, then the exercise becomes a way of reducing stress. Now the body has another way of handling stress rather than needing the fat cells. This is why people may lose more weight over the long-term with a moderate and sustainable activity program which is not stressful then with an intense exercise program which in stressful.

I will expand on these points in later posts. For now, if you are working on losing weight yourself, realize that there are lots of methods that work. The key is that you must implement whatever method you use in as natural and easy-going a manner as possible, while making the changes.

If you are supporting someone who is trying to lose weight, look for ways to make their process less stressful, especially less emotionally stressful. Avoid criticism and give advice only if you have their permission first.