Diabetes Self-Management Blog

I went to a couple of interesting lectures at UC San Francisco this week, so I thought I’d share them with you.

One was about food insecurity. That means not having enough food, or being worried about not having food. Food insecurity is known to contribute to obesity, hypertension, and diabetes. But professor Elissa Epel, PhD, asked why. How could not having enough food make you fat? Is it the stress, she wondered, or is it different eating habits caused by worrying about food, or what?

Her associate Barbara Laraia, PhD, MPH, RD, decided to research this. She studied thousands of women, asking about food insecurity and comparing their answers with their weight gain and eating habits. Sure enough, fear of hunger predicted weight gain, and actual hunger predicted even more.

But Why?
Drs. Epel and Laraia explained their results like this. Hunger, or anxiety about hunger, changes you psychologically and physically. You tend to crave food more; it starts to taste better. When it’s available, you eat more. Your body also starts putting on more fat, probably to protect against more times of hunger.

When food is short, your cortisol (the #1 stress hormone) goes up, which causes insulin resistance and makes you put on abdominal fat. Psychologically, you may find that sweets and fats make you feel even better than they usually do — your brain will be more sensitive to serotonin than usual, so your mood will be better.

What does this have to do with dieting? Think about it. When you diet, your body experiences food deprivation, just as if there were a famine or you were living in poverty. It might react the same way, by depositing fat and increasing hunger. So it could very well be that by dieting, you are setting yourself up for greater weight gain in the future.

That is what research has long found. Most people who lose weight on diets gain it back, no matter what kind of diet they put themselves on. In Dr. Laraia’s study, the people who gained the most had food insecurity plus “restrained eating,” which means a history of dieting and worrying about food.

What This Means for People with Type 2 Diabetes
As we know, almost everyone with Type 2 diabetes is told to lose weight. (If you’re one of the so-called “thin Type 2’s,” I again beg you to get checked for latent autoimmune diabetes of adults [LADA] or maturity-onset of diabetes of young [MODY].) But how does one lose weight if dieting actually promotes weight gain?

I think that dietitian Amy Campbell would agree that the best way is not to diet, but to get on a healthy eating plan you can stay with for life. A plan that doesn’t make you feel deprived, a diet that gives you some pleasure, even. Then stick with it, while gradually increasing your exercise. Then you will be less likely to regain weight.

One of the good things about not dieting is that you won’t be stressing about food so much. Stress is also a big weight promoter, so reducing stress increases your chances of getting in shape.

Of course, if you really are facing food insecurity, that’s different. Sometimes it makes sense to eat cheap, “energy-dense” (a fancy word for high-calorie) food, like a burger from the Dollar Menu or something, if you’ve only got a little money to spend. But you can try to get your vegetables at a food bank, farmers’ market, or produce stand. Vegetables help you fill up, so you feel less deprived, as well as being generally good for blood glucose control and providing vitamins.

Have you had experiences with dieting? Did it work for you? Were you able to keep the weight off? The government even keeps a weight-loss registry of people who have successfully kept weight off, and there aren’t that many people on it. Your stories would be appreciated.

End Notes
Two Web sites you might want to check out:

  • The Behavioral Diabetes Institute has great online programs (although most of their live stuff is in San Diego).
  • TuDiabetes is a social networking site and forum for people with diabetes, mostly Type 1. A lot of interesting people are on there, so check it out.
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Comments
  1. Dear David.

    Wow what a great article, we need more on this complex problem.

    I have had a smashing success with a very low calorie monotonous diet of boiled rye with lean ham (much more yummy than boiled oats) combined with a lot of exercise. I lost 80 lb at a rate of 1/3 lb per day. Unfortunately over the years I have gained most of it back about 65 lb so 15 lb still to the good. The exercise was at least 10 miles of moutain bike mostly on pavement. The food intake was about 1000 Calories per day.

    I have never been able to repeat this miracle. Moreover last year in fall I tried consienciously to write down everything I put in my mouth and tried to limit the net calories(i.e. food minus exercise to 2200 cal/day). I lost 10 lb over a period of 65 days but as accurately described above I was so stressed that no only did I regain the 10 lb but also an additional 10. I have been depressed about this outcome ever since.

    What has changed? Of course it is 11 years later. The amount of exercise I do now is a pidley amount compared to then.

    Then dying was not an option being knee deep in teen age kids. Now I feel I am ready to go anywhere my maker sends me. Could it be that dieting successfully needs super human will power?

    Insulin may be another factor that increases the stress the body undergoes when dieting. It is easy to see that the body does not enjoy the hypoglyceamic episodes that are inevitable with the use of insulin. I have not been able to go for a 24 hour period without food anymore. In my case (not true for all insulin diabetics) it would be of no harm since my liver does store and release a prodigious amount of glucose so hypo would not be a real problem. But the brain refuses this reality and refuses to participate in the experiment.

    Prodigious amounts of daily exercise like our ancestors may be the only solution. It wins by reducing stress and consuming a lot of calories. This is easier said than done.

    Posted by CalgaryDiabetic |
  2. I think a better definition of “restrained eating” is that you eat less than you want. Restrained eating is a major successful strategy for people who have lost weight and kept it off long-term. These “successful losers” also tend to eat less variety than other people, which is perhaps a manifestation of restrained eating.

    A recent article in the journal, Clinical Diabetes, summarized the effective measures for prevention of weight regain. I blogged about it here:
    http://advancedmediterraneandiet.com/blog/?p=87

    -SteveBlog post: Prevent weight regain

    Posted by Steve Parker, M.D. |
  3. This makes complete sense to me. When I have checked in with my own sense of my body and emotions, I have reached a similar conclusion. Let me explain.

    First, I am quite overweight now, but was not always overweight. I gained a lot of weight in my 30’s, during a period of several years when I was working hard to stay alive while suffering from major depression and panic attacks. Eventually, through a combination of medication, insight therapy, and meditation, I have learned to stay in better balance. But my weight has not gone down.

    I have had many years now since my last panic attack and bout of severe depression. When I try to lose weight, I find myself genuinely very hungry. I carry the genes of farming people in Central Europe who were at the crossroads of many armies, and who lived in a harsh climate. Famine was an ever-present reality.

    It seems that my body feels as if weight loss carries a threat of starvation. Food deprivation only makes it worse. However, increasing physical activity does help. To really lose weight, I need to increase to a level that is higher than current recommendations. It does not need to be strenuous, but does need to be sustained.

    Posted by Beth |
  4. Thanks for these comments. I really like Steve’s blog, which he linked to his comment, on preventing weight regain. But Steve, your list of recommendations does not include restrained eating. Less variety, yes. That makes perfect sense, as we are programmed to seek variety and will eat more when given more options.

    The idea of voluntary deprivation (”restrained eating”) intuitively sounds unsustainable. And studies like the one below do show that restrained eating does lead to weight regain in “emotional eaters.” weight regain study

    Well, since all eaters are emotional to some extent, I don’t think deprivation works for many people. I agree with all your other suggestions, especially physical activity (which you helpfully repeated three times.)
    DAvid

    Posted by David Spero RN |
  5. I fully agree with this concept. I “dieted” my way to 315 lbs. I am under 5 ft tall. I was under a lot of stress, and every diet failed. I’d start by losing a few pounds, then still on the diet, the weight would start returning! I’d give up and baloon bigger than I was before starting. This occurred no matter the diet I tried.

    Now, I’m eating low carb - but I eat as MUCH as I want within those carb limits, and NOT stressing over it. I dropped to 251. Back up to 269 during a stressful period, then I plateaued, but now they are finally starting to come off again. I really think NOT depriving myself is going to work. I’m currently at 265 (last Dr visit).

    I think my biggest problem now is lack of exercise. I have other medical problems on top of the diabetes that make it difficult: asthma and a type of arthritis that is exacerbated by repetitive movements, plus NO cartiledge left in my right knee at all. I’m getting a brace to hoprfully help that next week because I’m too young (48) to be a good candidate for knee replacement.

    Posted by Ephrenia |
  6. I just read a book by Deborah Waterhouse called
    Like Mothers Like Daughters. It said the same thing that dieting causes weight gain because of not only deprivation but the hormones. Women at different stages in life the store more fat, during post pregnancy and during menopause. When a woman stops producing estrogen she begins to store fat because fat produces some estrogen, so it helps a woman get the estrogen she needs. Also we have become so obsessed with thinness that we have tried to become much thinner than is natural.
    Women are supposed to have curves it is how we are built. She said genetics play a part to a small degree but dieting makes it worse. She said to eat well and get some exercise.

    Posted by Peggy |

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