How the world's heaviest man lost it all (2017)
gq.com
gq.com
(Apologies for the highly opinionated source, but as you might guess most of the news coverage is from UK tabloids.)
https://www.youtube.com/watch?v=-pgOX0hT1G0
How he lost his fiancee:
https://www.mirror.co.uk/news/uk-news/how-loaf-bread-helped-...
Ah yes, the proper diet of carbs and sugar, little protein and even less fat. PB&J for lunch for a diabetic, seriously? We're still a few decades away before the common populace and your GPs learns that sugar, especially fructose, is one of the biggest causes of the obesity epidemic.
A reasonable diet isn't even that complicated. Control the sugar and choose foods lower on the insulin index and it will be surprisingly difficult to not control your weight. You won't necessarily get ripped on that alone, but it would be really unlikely to get anywhere near as large as this guy or for him to stay that way.
For instance, even though oatmeal is pretty overrated to start with, it's by no means the worst thing one can be eating, so he would just need to not eat it with sugar. Oatmeal is a somewhat higher glycemic food if I remember correctly, but it's a good source of fiber. Bananas are pretty high on the glycemic and insulin indexes so they should only be eaten occasionally and as an alternative to something worse like ice cream. Salad is of course mostly fine if it has minimal dressing and no added sugar (and hopefully a good fat like olive oil). Peanuts are, surprisingly enough, very low on the insulin index and are fairly low on the glycemic index, and they're high in satiation. A peanut butter sandwich with natural peanut butter (no added sugar) and whole grain bread would be far better to a PB&J, though eating some peanut butter without bread would be optimal. Pasta probably isn't the best thing to be eating if you're 600+ lbs, but at lower weights it's not necessarily that bad relative to other things. Better to replace it with something closer to a low carb Mediterranean dish if you want a substantial dinner.
If you (the reader in general) read those two paragraphs then I just saved you countless hours in reading research papers and fad diet books/sites.
Metabolism is complicated, but the insulin response is the most important thing to understand for body fat control. If you don't have an insulin response, you can't gain adipose fat. The most successful diet plans usually select for foods that have a lower glycemic effect and a lower insulin response.
The leptin/ghrelin balance is also important, but even that is less important in the long term than insulin. Both diet and fasting help with those, the latter being of greater help in the short term.
> especially fructose
I would generally agree, although I think the fructose thing is a little overstated and misleads some people to lumping food into the same category is Coca Cola. Different fruits have different insulin index values, different amounts of sugar, and usually come with fiber which helps with blood sugar spikes among other things. With some exceptions (bananas and obviously fruit juices), if you're consuming whole fruit but you're not eating refined sugars then you'll probably be fine. Even mangos, which are super tasty IMO, aren't particularly high in calories relative to many other foods people normally consume, and if your source of sugar is a mango a day then most of that sugar will be processed by your liver and it's little enough that you can burn it off with some low intensity exercise.
Mai, Brandon H, and Liang-Jun Yan. “The Negative and Detrimental Effects of High Fructose on the Liver, with Special Reference to Metabolic Disorders.” Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 12 (May 27, 2019): 821–26. https://doi.org/10.2147/DMSO.S198968.
Jensen, Thomas, Manal F. Abdelmalek, Shelby Sullivan, Kristen J. Nadeau, Melanie Green, Carlos Roncal, Takahiko Nakagawa, et al. “Fructose and Sugar: A Major Mediator of Nonalcoholic Fatty Liver Disease.” Journal of Hepatology 68, no. 5 (May 2018): 1063–75. https://doi.org/10.1016/j.jhep.2018.01.019.
And some interesting evolutionary speculation on why effects of fructose might be so powerfully conserved:
Johnson, Richard J., Peter Stenvinkel, Peter Andrews, Laura G. Sánchez-Lozada, Takahiko Nakagawa, Eric Gaucher, Ana Andres-Hernando, et al. “Fructose Metabolism as a Common Evolutionary Pathway of Survival Associated with Climate Change, Food Shortage and Droughts.” Journal of Internal Medicine, October 17, 2019. https://doi.org/10.1111/joim.12993.
BTW, beyond mechanistic research, I think one of the most interesting recent trials was this elegant study done recently in obese children (n=41) where it was shown that over 10 days of isocaloric (calorie-matched) swapping of sugar for starchy carbs resulted in a halving (!) of liver fat, a 68% decrease in DNL (de novo lipogensis = fat produced by the liver), and improved insulin kinetics across the board, showing that fructose was not only uniquely bad from a metabolic perspective even vs glucose, but that the response to removing the fructose was a dramatic and immediate improvement in health markers:
Schwarz, Jean-Marc, Susan M Noworolski, Ayca Erkin-Cakmak, Natalie J Korn, Michael J Wen, Viva W Tai, Grace M Jones, et al. “Effects of Dietary Fructose Restriction on Liver Fat, De Novo Lipogenesis, and Insulin Kinetics in Children with Obesity.” Gastroenterology 153, no. 3 (September 2017): 743–52. https://doi.org/10.1053/j.gastro.2017.05.043.
- You must think about the insulin index of your whole meal, not individual components. It's fine to eat a banana if you mix with high fiber stuff. That's also why you should eat greens in your meals. They're high in fiber and will lower the insulin index of your dishes.
- If you're exercising before or after eating, that changes everything.
- Study the insulin index of the foods you generally eat.
- Exercise like there is no tomorrow =)
* Not sure if that's the correct term. My understanding is insulin resistance is a life long condition and even with great care it might progress to type 2 diabetes. All we can do is lower the probability of that happening.
Here's a bit of the more recent research suggests that full "reversal," which includes normalization of beta cell function and normal glucose tolerances/insulin sensitivity is totally possible:
Taylor, Roy, Ahmad Al-Mrabeh, Sviatlana Zhyzhneuskaya, Carl Peters, Alison C. Barnes, Benjamin S. Aribisala, Kieren G. Hollingsworth, John C. Mathers, Naveed Sattar, and Michael E. J. Lean. “Remission of Human Type 2 Diabetes Requires Decrease in Liver and Pancreas Fat Content but Is Dependent upon Capacity for β Cell Recovery.” Cell Metabolism 28, no. 4 (October 2, 2018): 547-556.e3. https://doi.org/10.1016/j.cmet.2018.07.003.
Lim, E. L., K. G. Hollingsworth, B. S. Aribisala, M. J. Chen, J. C. Mathers, and R. Taylor. “Reversal of Type 2 Diabetes: Normalisation of Beta Cell Function in Association with Decreased Pancreas and Liver Triacylglycerol.” Diabetologia 54, no. 10 (October 2011): 2506–14. https://doi.org/10.1007/s00125-011-2204-7.
BTW, exercise without a doubt increases your insulin sensitivity and is a good glucose sink, and meal mix is a good thing to point out too (there's actually plenty of fascinating research on how now just what you eat, but food consumption order actually affects your incretin/insulin response too!) and if what you're doings works best for you, by all means, keep doing it, but I'll just mention that there are many ways to go about improving your metabolic health and I think for most people, sorting out their diet first (basically, cutting out sugar, reducing processed foods) is going to be the more important thing, as exercise also tends to increase appetite, and takes more time/energy to do. Personally, I also found TRE/IF (16:8) to be one of the more initially daunting, but ultimately most effective methods when I was getting started. The way I tend to frame it is that you have a ~100g glycogen fuel tank that's your liver. How you empty/fill it is up to you, but you just want to keep it from overflowing (since when you go above that, you're going to get DNL and all the nastiness that ensues).
People have been saying this for the past 15-20 years, yet it keeps not being true. The difference is pretty obvious with just a little thought. Sugars are part of a balanced diet, it's perfectly healthy to consume some amount of sugars during a normal day. Cigarettes have NO health benefits, they only serve to kill you. Cutting out all cigarettes is a pretty minimal sacrifice compared to avoiding large swaths of foodstuffs.
Comparing the two only makes normal people rolls their eyes at you and ignore anything you have to say from your ivory tower.
If people feel this is a ridiculous comparison, they need to be corrected. The lowest common denominator does not dictate how I communicate.
I agree that obesity is terrible. I even agree that the "oversugaring" is probably a large portion of the cause side of the obesity problem. I'm just pointing out that when you compare it to smoking, you sound full of yourself. I'm of normal weight but consume way too much sugar (I'm working on it). When you tell me that I'm as bad as smokers I don't hear someone telling me the hard truths. I hear someone erecting a pedestal they can put themselves on.
You're making this weirdly personal. No one is saying you're a bad person for eating sugar or "as bad as" a smoker. There's no pedestal.
I don't have to answer your questions and it's not like you'd care about my answers anyway. The guy I'm responding to said "over-sugaring" which implies there's an amount of sugar that's not too much. I would expect something like eating an apple would fall under his definition of "not too much" but I wouldn't know.
What's the point of the rhetorical questions? I feel like you're trying to "own" me in order to put me into some Ben Shapiro youtube clip. If you want to make an argument, just make it.
> No one is saying
That's an odd point to make for someone just entering the discussion. I'm telling you what impression it leaves on me. Just saying "well your impression is wrong" is not really an interesting observation. Communication is a two-way street where we collaboratively create the impression we want. If you want to leave a different impression, then communicate differently.
There's no doubt that too much sugar is a really bad thing, and that the average diet in USA (and other parts of the world) is way too heavy on sugars, but it's not something to be puritanical about. A little sugar in your diet is non-harmful for most people; it is a valuable nutrient.
Right, but you don't need to eat sugar. Your body is capable of manufacturing glucose as-is from fat or protein. If you have 0 grams of sugar in your diet it's not like your brain will starve.
> it is a valuable nutrient.
No it isn't. Your body does not require that you eat sugar and it does not benefit from it either.
I made no such claim, agreed. It is definitely possible to survive and thrive without eating sugar.
> No it isn't
But it _is_ valuable, nutritionally speaking. Sugars have great value to our bodies, which is why we seek them. Sugars are an abundant source of calories and our ancestors who are honey, fruits, vegetables, roots and so on had a survival advantage over those who didn't access these foods.
Nowadays the game has changed, but sugars are still highly valuable to our bodies. It's why athletes still carb load and take gels etc when they're performing. You don't see Olympians taking olive oil or meat mid race.
There's absolutely NO health benefit to having any added sugar in food products.
Manufacturers know that it is harmful, they know that they are encouraging addiction, and they know that consumers are suffering as a result. And then there's the advertising, especially to children. Ninety percent of the breakfast aisles in most grocery stores should absolutely be illegal and people should be ashamed to be poisoning their children with products like these[1].
It's this combination of addiction, harmfulness, and advertising that are so similar to the cigarette industry.
[1]: https://www.metroparent.com/parenting/advice/kids-cereals-su...
That's a better take, to be sure. I haven't done the research, but I feel confident in agreeing that there are no health benefits to added sugar. Much like there are no health benefits to smoking.
At that point it becomes too nuanced of a subject for the "our generations smoking" argument though. It makes no difference to my body if the fructose in my juice came from the apple that was juiced, or if it was added later on. It doesn't matter if the fructose I added to my chocolate cake came from orange juice or HFCS. So it becomes an argument of quantity, with the argument being that there's too must sugar in processed foodstuffs. And hey, I agree.
I think that's a fine argument to make, but it's miles away from the "any amount is bad, and if you do it, it says something bad about your character" that we've used against smoking.
Citation needed. Only two things are necessary to live: protein and fat. Carbohydrates are decent fuel. Literal sugar (as added fructose/glucose to regular food for taste) isn't required for a diet to be called balanced or healthy any more than alcohol is (both are considered fuel for the metabolic system).
Thankfully the body is quite resilient and can work with reasonable amounts of sugar or alcohol in the diet, but to say it's part of a balanced diet is a bit of a stretch.
Now that sounds like a gross simplification, and it is, but it's missing a key insight: sugars don't really keep you full for long, and limiting calorie intake with such a diet requires a lot more willpower than eating fats and proteins that actually curb your feeling of hunger for a long period of time.
I'm not an expert on the topic, but that's how it works in my limited experience.
Yes, absolutely. My point is that obese people shouldn't worry about what specific diet is the best diet. I see people make this mistake all the time. It doesn't matter as much as many people assume. The only way to lose weight is to eat less calories.
This article is about how a formerly fat guy managed to lose weight. This is a big accomplishment. Many obese people try to lose weight and fail. Criticizing the minor details of his new diet is foolish. There are so many armchair diet experts who don't understand this.
I am nearly speechless. Suicide is no joke, but assuming the story here is true, it's kind of remarkable that a person's morbid obesity saved them from death in such an ironic way. If he was at a lower end of obesity he might not be alive today.
Does anyone here have background knowledge to know whether this story is plausible? I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it.
> To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).[1]
It strikes me as at least plausible that codeine could be behave in a similar way.
[1] https://bnf.nice.org.uk/treatment-summary/poisoning-emergenc...
Adults are usually about the same size, so it's less of a problem there. Usually. https://www.nytimes.com/2018/06/08/well/drug-dose-weight-siz...
[1] https://www.msdmanuals.com/professional/pediatrics/principle....
I thought it was the opposite. The effect of medication, drugs and alcohol all seem to depend at least partly on body mass.
It definitely affects it: This is part of the reason they ask you for your weight before you get an MRI with contrast (The amount of contrast changes on your weight) and IIRC, they change the dose of IV morphine depending on your weight. Realistically, this is also the case for some drugs - a small person generally gets drunk faster than a large one.
But it doesn't matter as much for some drugs than others: Two adults can generally take the same amount of ibuprofen because the differences aren't really all that large. Extremes are going to change this, though.