Until a few years ago, obesity and being overweight have always been considered the result of excessive food intake.
The most recent pieces of research, which began to describe the existence of “diets signal”, are showing that the issue is much more complex than we thought and that eating a lot and excessively is not the cause of obesity, but in a sense it is the result of a metabolic condition coming from external stimuli acting on the organism.
This is a real revolution shifting the focus from calories (so far considered the only responsible for weight gain) to either food quality, or the dish composition or the times and ways in which it is consumed.
In an article published a few days ago on JAMA, Dr. D Ludwig, an extremely experienced physician and investigator when coming to talk about problems related to obesity and metabolism (he is member of the Obesity Prevention Centre at Boston Children’s Hospital and professor at Harvard Medical School), stated what already described years ago by researchers studying and discussing about diets signal, in regards to the relationship with insulin, zone diet, for the anti-inflammatory diet, glycaemic index and food-related inflammation.
The interesting paragraph “Viewpoint” published by JAMA delivers some useful concepts worth to be highlighted.
An excessive and prolonged food intake is a manifestation rather than the cause of the growing global epidemic of obesity (Ludwig DS et al, JAMA. 4 Jun 2014, 311 (21): 2167-8).
Unfortunately, it is well known that the use of low-calorie diets to regulate the body weight does not maintain its effects over time. Only a small percentage of people who change their weight is able to keep a 10% drop for at least a year’s time.
The evolutionary meaning of the relationship with the food, the feeling of hunger and the way in which food is metabolized all depend on whether you have access to a quantity of “fuel-rich” plasma between 4 and 6 kcal/litre (glucose, lipids or other).
When there is a decrease in the concentration of these substances, an intense hunger and the search for food are triggered. In that, insulin plays a crucial role.
Today we know that changes in food quality and diet composition can induce obesity, as demonstrated in genetically normal animal models, in a completely independent fashion if compared to the increase in energy/calories taken.
A study published in Lancet in 2004 showed that rats fed with food of high glycaemic index developed hyperinsulinemia, which leads to the accumulation of fat in the adipose cells and an increased storage of glucose into body fat (Pawlak DB et al, Lancet. 2004 28-Aug Sep 3, 364 (9436): 778-85)
When those mice given highly glycaemic diets were fed with low amounts of calories (the exact equivalent of the current low-calorie diets that use refined food) to try reducing their weight gain, contrary to expectations they continued to gain weight (70% more) when compared to the animals fed with low glycaemic index aliments.
All this explains (as indicated by Ludwig in his JAMA article) how an increase in fat accumulation in conditions of reduced calorie intake cannot be explained by a calorie-centric vision of obesity, instead it should be viewed according to alternative models.
In such a new model of interpretation an environmental role is played by various factors such as the quality of the diet, the intake of food, low or high in glycaemic index, the right amount of protein, the limitation in refined sugar intake such as low-calorie sweeteners, the relationship between saturated and poly-unsaturated fatty acids and the introduction of hydrogenated vegetable lipids.
In addition, huge importance is gained by the micronutrients present in the diet, the content in polyphenol and the presence of probiotics and prebiotics in the same way in which the physical activity, sleep and stress may directly or indirectly influence the use of calories and their accumulation in adipose tissue.
The JAMA article concludes by saying, as we have been saying for years, that the urge to eat excessively is not necessarily the cause of obesity, but it may instead be secondary to metabolic dysfunctions induced by the diet itself, at least with regard to certain forms of obesity and over-weight.
For this reason, for years our clinic in Milan has been following overweight people with supportive therapeutic paths, which refer to the presence of inflammatory cytokines in the body, the values of BAFF and PAF, to food-related inflammation and, in particular, to the way physical activity is done.
As we have been saying a lot in the past, “a calorie is not always equal to a calorie”. The way in which the body turns the calories consumed depends on many factors that are not only related to the calories present in food, but on the way the dish has been prepared, the time in which it has been eaten, the way in which is chewed, the context in which it is used, and so on.
Therefore, we are talking of setting a change in lifestyle that can help achieving one’s own shape and well-being long-term, not just by counting the number of calories described on the product label, instead by understanding how food becomes part of us in full connection with energy and well-being.