Saturday, January 15, 2011

Blog 25- The Real Reason Some People Cannot Lose Weight (Blog 23 continued)

Danika was of a young woman of African American descent who had been adopted by a Caucasian couple shortly after birth. She was a happy, bright child who was healthy overall except when it came to eating. "We are concerned about her appetite," her mother reported obviously uncomfortable. "We don't want to make a big deal out of it, but we are worried she might be getting rather too large," she tentatively concluded. She was going for tact but Danika was having none of it.

"I'm huge," she stated matter of factly.

I generally appreciate when people are blunt because it saves a lot of time and trouble figuring out how to approach a situation. So I liked Danika immediately. She was a big girl heightwise, too, making her look more like a fourteen year old. I would have to remind myself not to expect behavior beyond her actual years especially because she was so articulate.

"Don't say that about yourself," her mother protested, cutting her off and fidgeting in her seat. I stopped for a second and took in the situation. Here sat two thin Caucasian parents raising a non-thin child of African decent. They were trying so hard not to let any cultural preconceived notions prejudice them that they were practically sweating from the stress of not being judgmental. This could get dicey.

"What do you think is going on?" I inquired.

"I try to eat healthy," she explained, "but I am hungry a lot."

Looking at her food diary it was clear she had a good appetite but was not eating the quantity of food I would have expected given her size. Her thyroid had been checked and she was in otherwise perfect health. She was partial to pasta and bread so I suggested a gluten free diet for 6 weeks to see if that helped her feel less hungry. If a reaction to a food is causing excessive hunger, that food usually contains gluten or sugar. It is almost impossible to help someone lose weight if they feel hungry all the time so I thought it was a good place to start. Danika groaned. Her parents groaned but the deal was struck. Six weeks: no gluten.

What does this all have to do with genetics? I could pretend I am trying to build up some suspense, but in truth, it is just complicated so the answer will take a little while. The six weeks passed and Danika’s parents checked in. They were pleased to report her appetite had calmed down and she was eating less. Nonetheless, they were very unhappy because despite her food reduction she had gained of three pounds. It was that old medical joke where the doctor announces the treatment was successful but the patient died.

The laws of physics states this is not possible. In my profession, this phenomenon has only one accepted explanation: the client is fibbing. Nobody wants to blame the client because of course, they do not mean to fib but if there is weight gain, there must be a cookie somewhere nobody is copping to. But after much poking around and having run into this situation before, I concluded Danika was not eating in secret but is likely suffering the results of unfavorable epigenetics.

Recall that epigenetics is how the genes change in response to the environment. When big adaptations occur during pregnancy, the child’s gene expression changes and that child passes that adjustment on to their child and so on for many generations. What may have been useful and adaptive given your grandmother’s environment when she was pregnant, may not be so useful for you now. One of the strongest epigenetic trends has been high rates of obesity in the offspring of pregnant women suffering from starvation. This tendency has been documented to continue through four generations.

Danika’s birth mother’s history was murky. In adoption where the health history is not clear, there is a good chance it involves poverty or other social issues where food is not plentiful or eating is restricted (to hide weight gain, for example). I have also noticed through the years that Africian American women can have a particularly hard time losing weight even on severely restricted diets. I ran into this situation so many times that I developed a theory about it.

From an epigenetic perspective, the best body type for surviving in Africa would be one that conserves calories well. The growing conditions are harsh in many areas and there can be long periods of drought when food is scarce. While in the womb, the smart, adaptive baby would naturally shift its metabolism so it could survive on very little food. And as long as the person lived in Africa, all would be well. But transplant that same metabolism here where most people can get all the food they want, drought or no drought and that same baby will put on weight.

A full figured woman once consulted with me because she had been on a 1,200 calorie diet and had not lost an ounce. She was understandably very discouraged. She insisted that calorie restriction never helped her lose weight and wanted some new ideas. We tried a low carbohydrate version of the low calorie diet with no success. On the plus side, she was an amazingly vibrant woman. She was strong and healthy and probably could survive well on a few turnips a week but her epigenetics was not geared for a plentiful food environment. I could not bring myself to reduce her calories further so I asked her to make a difficult decision. I explained epigenetics. Then I told her she would either have to accept the fact that she needed very little food compared to others to maintain weight or she would have to accept herself as a bigger woman. She chose the later.

I often wonder if this is the situation Oprah faces. Even with a trainer, a chef and 42 personal assistants, does she have an epigenetic situation where she can only lose weight eating ridiculously few calories? It is hard to live in this country on a severely calorie restricted diet and it would make sense that she would hang in there for awhile but periodically eat an extra cracker and gain 3 pounds. That sounds like an exaggeration but the small amount of food people with this epigenetic profile can eat is no joke.

Danika was another strong individual who needed very little food to maintain weight. In fact, when she reduced her calories by going on a gluten free diet, her body immediately interpreted this as starvation. Applying epigenetic theory, Danika’s body was highly adaptive for dealing with starvation and so it went immediately into conservation mode. She was not going to need much food to maintain weight. A tough reality at any age but I thought it might be a good thing for her and her parents to know.

“So, what are we suppose to do?” her mother asked.

“Well, here is the situation…….” I started.

1 comment:

  1. Hi, Kelly!II

    I can't comment on the theory behind your post but based on my own experience I wonder about the role of exercise in a case like Danika's. I had a lot of troublelosing extra pounds until I added exercise. - both strength and cardio - to the program. What's your. View?