How can I lose weight?

Choosing to look at this page is the first step on your weight loss journey. (The more you read this blog, though, I hope you’ll come to realize that weight loss may be a proxy for fixing the more important issues unpinning your health.)

In the fall of 2009, I was sick and tired of being overweight. I was ready to lose weight, but it wasn’t clear what the right steps to weight loss were. I’m sure my weight loss story is slightly unusual, but I think the lessons I learned about how to lose weight are universally applicable. I was overweight, despite exercising 3 to 4 hours per day – yes, 3 to 4 hours a day. I was pretty sure I was eating the “right” diet, too – a “healthy” diet low in fat and saturated fat. But, I was insulin resistant and based on my family history, I was probably heading towards a heart attack in 20 years. So I began to explore the question: How can I lose weight?

I was an athlete and I consumed what I believed was a “good” athlete’s diet – lots of complex carbs and protein, and precious little saturated fat.  I couldn’t figure out what I was doing wrong, and I was getting really frustrated.  I wanted to be, as my wife put it, “less not thin.” After fixing my diet, I lost 35 lbs of fat and reduced by body fat percentage from about 25% to 7%. See the before (2 left) and after (2 right) pictures below. By the way, the left-most picture is me after swimming 14 miles across Lake Tahoe in 2007 – fit, but fat.  (To read more about how I went through this process, you may want to read my personal journey of weight loss and nutrition discovery, where I chronicle this in much more detail.)

Before in swimsuit Before Peter Attia, with bicycle Petter Attia, MD

I can’t teach you everything in one page, but essentially, I advocate a diet low in sugar and refined carbohydrates for weight loss and for health, especially for people who are insulin resistant, like I was (which is true for about 70% of people who are overweight). If you must make a change immediately, though, here are a few of the changes you should choose from, probably in this order.  As you go down the list, the improvements get incrementally greater.

  1. Reduce (ideally, eliminate) all sugar consumption in the form of sucrose and high fructose corn syrup.  This will require getting awfully familiar with ingredient labels as, unfortunately, these substances are in many foods you’d never expect to contain sugar – most breads, pasta sauces, ketchup, “fat-free” products, breakfast cereals, and (obviously) non-diet sweetened beverages.  If you see anything that says “fat-free” or “low-fat” on the package, that’s a huge warning sign to avoid it.  “Fat-free” and “low-fat” is almost universal code for, “we took out the fat and stuffed in more sugar.”
  2. Swap “simple” carbohydrates for “complex” ones.  The more a carbohydrate food source contains insoluble fiber, for example, the less likely it is to lead to the hormonal condition in your body that promotes fat storage.  For example, if you want vegetables, eat those with less sugar and more fiber, such as broccoli over peas and carrots, or yams over white potatoes.
  3. Limit really sweet fruits (e.g., banana, mangoes) to 1-2 servings per day, avoid any dried fruits (e.g., raisins, dried mangoes, and the like), and don’t drink any fruit juice. I know this may sound crazy when it’s been hammered into your head to eat more fruit, not less, but fruits are relatively high in sugar and carbohydrates, and so consumption needs to be controlled like any other carbohydrate if you have low carbohydrate tolerance.  Berries tend to be the better choice for fruits.  As far as I can tell, there is no reason to limit non-starch vegetables.  I probably eat an average of two salads per day.
  4. Reduce overall carbohydrate intake to one serving per day.  At this point you’re just down to the so-called “good” carbs, but nevertheless you’ll want to continue to reduce even these, if you haven’t achieved your goals.
  5. With each step above, increase your intake of fat (over protein or other carbohydrates).  I know this sounds crazy.  But if you’re still hungry and your metabolic demands are high (e.g., if you exercise a lot), you’re probably better off adding more fat back into your diet, than adding more carbohydrate, or even protein. For example, eat more eggs, more cheese, more nuts, more avocados, more olive oil, more coconut oil, more high fat over low fat yogurt.  (If this sounds too crazy, don’t worry, I devoted countless hours to writing about why this is ok, provided your insulin levels are kept low.)
Remember, as you go down the list the improvements are greater, but for many folks, it’s easier to start with one change at a time.  There is no one “right” way to do this. I spent about a year making incremental changes (roughly in line with those in order, below), but I’ve worked with many people who went straight for the last step.  Choose a path you deem sustainable for you, and let your doctor know you are making a change.  They will likely disagree with some aspect of it, but they should respect your willingness to try a new approach and support you (given that the current strategy of starving yourself and drinking low-fat lattes probably isn’t working).

There is a lot more to it than this, but if you’re bent on starting immediately, this is a good place to start your journey.  Keep the following in mind, though.  We are all different and therefore we all have a different degree of response to these changes.  Some (like me) require a greater change for effect.  Others (like my wife) require only subtle changes for great effect.

Here is the great irony: Despite everything I once thought, and all of my medical training, and all my obsession, I failed to appreciate that obesity is a disorder of fat accumulation, not a disorder of eating too many calories.  What do I mean by this?  When you are overweight, it’s not because you’re eating too many calories – it’s because your fat cells are storing too much fat.  These are not the same thing.  (Check out a video of me explaining this.) I write about this extensively elsewhere on my blog, but I know what you’re thinking: What is he talking about?  Just have faith, for a moment.

If you want to lose weight and be “less not thin,” I have some good news and some bad news for you.  Let’s start with the good news:

  1. You can do this.  You can lose the weight. I’ve helped countless friends achieve their goals, plus I’ve read all of the literature applying what I now understand to thousands of people.  This approach works. It does not work for everyone, but in my experience and based on the best literature I can find, it appears to work for about 70-80% of people.
  2. Many of you may be thinking of just losing weight – which is a great goal – but that’s only the beginning.  The other health benefits are at least as powerful, if not more so.  In addition to weight loss, you will reduce your risk of heart disease, diabetes, many forms of cancer, and probably even Alzheimer’s disease.
  3. You will be so much sharper, both physically and mentally, that soon (for me it took about 6 months) you will actually forget that feeling of being exhausted around 4 pm every day.

So what’s the catch, you ask?  Well, few things worth having in life come free or without some serious effort, and this is no exception:

  1. You will need to challenge everything you think you know about nutrition.  To achieve the benefits I describe, above, you’ll need to put aside every preconceived notion of what is “good for you” and what is “bad for you.” In this blog, I will do my best to explain all of this in detail.
  2. You will need to be patient.  Low carb is not a “fad” crash diet, though some will undoubtedly try to mis-classify anything outside of mainstream USDA recommendations as such.  This is about correcting the way your body chooses to interact with food – what your body burns versus what your body puts into storage.
  3. You will need to change your approach to food and eating.  Don’t think of “dieting” or temporary changes in what you eat for short term goals.  What I’m talking about is changing the way you look at food altogether.

A lot of folks who watch me eat say things like, “Gee, Peter, you’re really disciplined when it comes to what you eat.” I actually disagree with this assertion.  I’m no more disciplined than a non-smoker is for not smoking.  Let me explain what I mean. I don’t smoke, and no matter how many smokers or cigarettes I’m surrounded by, I never feel like I’m exerting some great force of self-discipline to avoid lighting up.  Why? I guess it’s because I understand what a cigarette does to my body, both in the short term (e.g., less cardiovascular performance) and the long term (e.g., increased risk of heart disease and cancer).

I’m not picking on people who smoke.  Everyone has a reason for doing what they do.  If you smoke, I believe you do so because, in your calculation, smoking gives you more than it takes from you (or the addiction is so powerful, that you just can’t stop it anymore).  Food is the same way, with one big difference: at least the person who chooses to smoke does so with the knowledge of the trade-offs.  Unfortunately, when it comes to food choices, how to lose weight and improve health, most people are where I was up until a few years ago – they don’t even have the information to make the trade-off calculation.  They may think they do, but the information they’ve mostly been getting is the product of decades of bad science and biased thinking.

If I’ve got you interested, welcome aboard.  You’re about to embark on a journey that will change your life.

 

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