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To save itself, Homeland had to get over the loss of its leading man – The A.V. Club

Posted: April 15, 2020 at 7:44 pm

Peak SeasonIn Peak Season, The A.V. Club dives deep into the year when a long-running show reached its high point.

Previously on Homeland

Carrie Mathison (Claire Danes) ranks among the CIAs most talented intelligence analysts, dedicating most waking moments to thwarting the next major terrorist attack on American soil. But a pair of secrets threatens to derail her hopelessly tangled personal and professional lives.

The first is that Carrie suffers from bipolar depression, a potentially career-ending condition she conceals from her Langley superiors, including pragmatic-to-a-fault Saul Berenson (Mandy Patinkin). She manages her condition with clandestine meds from her M.D. sister Maggie (Amy Hargreaves), but also thinks it can be a gift when appropriately harnessed, and wonders if her next manic flight could yield a game-changing counter-terrorism insight.

The second and more pressing secret is her dogged suspicion that Nicholas Brody (Damian Lewis), an Army sergeant discovered alive after eight years under al-Qaeda captivity, is turncoat. The series begins with Carrie creating a diplomatic incident by bribing her way into an Afghan prison to talk to a local asset about to be executed. His final words, whispered into her ear as the guards yank her away, will change the course of her life: An American prisoner of war has been turned. Naturally, Carrie is suspicious when a rescue team extracts Brody long after he could have produced valuable information for the enemy.

Saul, Carries closest ally within the agency, is unsettled by her nascent theory, but wont sign off on the invasive surveillance she wants, especially as Brody is greeted with a heros welcome. Ever the maverick, Carrie installs cameras in Brodys home and monitors them on her off-hours, peering into private moments as Brody integrates himself back into a family that had assumed he was dead. Carries off-the-books operation runs out of funding, but shes more obsessed with Brody than ever, the consequence of a one-sided intimacy formed through hours of watching him.

Carries fixation on Brody accelerates from passive surveillance to contrived in-person interactions, and finally, to a perilous sexual affair. Despite her deepening feelings for Brody, Carrie continues to search for evidence that he remains under the sway of the charismatic terrorist Abu Nazir (Navid Negahban). A near-death experience triggers her mania, which leads to a breakthrough about Brodys true motivations, but also exposes her condition to the agency. An unemployed and discredited Carrie still manages to thwart Brodys terrorist attackwhich would have killed most of the presidential succession linebut is unable to expose him as the culprit.

Few shows in the past decade have debuted with the kind of instant critical acclaim and cultural resonance that greeted Homeland in October 2011. The brisk and thrilling first season won four Emmys: an Outstanding Actress In A Drama statue for Danes (whos been camping in the category ever since); Outstanding Actor for Lewis; and for the show, Outstanding Writing and Outstanding Drama Series. Homeland also took the top drama award at the Golden Globes, won a Peabody, and was talked up by President Obama as his newest cultural obsession.

By the end of the tortured third season, Homeland had mostly dropped off the Emmy radar, with only Danes and Patinkin nominated. More than that, Homeland was being talked about as a show that was doomed by the instant success of a story that felt self-contained and self-limiting. The less charitable explanation was that the show had become too reliant on unearned plot twists and had mired itself in Carrie and Brodys romantic quagmire. Troubleshooting the show became a new national pastime for television critics.

Understanding why Homeland followed its parabolic trajectory requires a closer look at its source material. Homeland was based on Hatufim, an Israeli drama that ran for two seasons comprising 24 episodes. While Hatufim has thriller elements, its primarily a domestic ensemble drama. Nimrod (Yoram Toledano) and Uri (Ishai Golan) are two Israeli military prisoners freed by their government with a prisoner swap. How would they ever relate to their loved ones, some of whom had been preparing for a life without them? How would they navigate the guilt, anxiety, and survivors remorse?

Homeland would become a distinctly different narrative as a result of who adapted it. 20th Century Fox bought the Hatufim pilot and hired Howard Gordon and Alex Gansa, whod previously worked together on the whiplash-inducing terrorism thriller 24. They localized the story by rooting it in post-9/11 paranoid and fears around how Osama bin Ladens ideology could metastasize in the wake of his assassination.

But the biggest change they made was supercharging Haimthe psychiatrist with suspicions about Nimrod and Uriby turning him into Carrie Mathison, a more cerebral and nuanced version of Jack Bauer character Gordon and Gansa wrote for so many years. Like Jack before her, Carrie would be instinctual, resolute, and constantly coloring outside the lines. The Homeland pilot is a potent character study of Carrie, the vigilant intelligence officer fraying at the seams and single-minded about preventing the next domestic terror attack. Much of what comes to define the character is proffered up front: Carries mental illness and her attempts to hide it; her love of hard bop and stiff drinks; and her habit of seducing her way out of trouble.

Brody is richly drawn too, with good reason, given that the character absorbs elements of both the Nimrod and Uri characters. But whereas Hatufim was all about the former prisoners emotional states, in Homeland, Carrie is the one with all the interiority. Brody remains opaque for much of the first season while the mystery of his reappearance unfurls. As a result, the audience is forced to empathize with Carrie, the only person savvy enough to keep a gimlet eye on Brody even as a cheerful propaganda campaign springs up around him. Factor in Danes muscular, intense performance, and its no surprise the show skews in Carries direction. Brody would soon be identified as the shows dead weightthe foolish choice made repeatedly by an otherwise smart woman.

For all its nuanced characterization, Homeland quickly becomes a story about a good girl trying to take down a bad guy. Rebalancing the show in favor of Carrie supercharged the shows storytelling, putting her and Brody on a collision course that could only end with one of them dead or in jail. But the strategy also made Brody expendable. That wasnt an unanticipated consequence for Howard and Gansa, who reportedly planned to have Brody complete his suicide mission, only for Showtime brass to intervene and insist Lewis was too valuable to lose.

Season two resumes six months later, with Carrie in professional exile, only to be dragged back into the intelligence world when Saul corroborates her theory about Brody. Despite Brodys current hero status, Saul and Carrie launch a task force to take him down, enlisting stoic company man Peter Quinn (Rupert Friend) to run point on a sting built around Carrie and Brodys fraught emotional bond. Whats intended as a disciplined, methodical operation hits terminal velocity when Carrie confronts Brody about his terroristic intentions and turns him against his handlers.

Most storylines in Homeland accelerate wildly, the result of a deliberate strategy by Howard and Gansa to jolt the audience. They spoke in season one postmortems about their theory that contemporary television viewers had become too savvy, and would probably see the plot twists coming. The only way to surprise, they concluded, was to do what the audience expected to happen eventually, but at a much faster pace.

But by the back half of season two, Homelands thrilling pace began to feel like the result of the narrative equivalent of deficit spending. The seasons fifth episode, Q&A, remains among the shows finest episodes. Danes and Lewis are invariably excellent together, and the scenes in which Carrie compassionately interrogates Brody are nearly perfect. (Executive producer Henry Bromell won a posthumous Emmy for writing the teleplay.) But as soon as Carrie and Brody are fighting on the same side and openly dating, their story hits the same patch of inertia as does the will-they-wont-they romance in an office sitcom. The relationship pulls the most focus at the exact moment it becomes dramatically inert.

Fears about the shows direction solidified early in season three. Brody is flapping in the wind and Abu Nazir is dead after the latter masterminded one final attack on the CIA, killing much of the agencys leadership structure and leaving Brody to take the fall. The uncertainty around Brodys future made his story feel at once beyond its usefulness, and in serious need of resolution.

Without Brody in custody, the heat for the cataclysmic attack falls on Carrie, who gets publicly outed for her illicit relationship with the main suspect. Neither one of the shows leads is effectively present, between Brodys scofflaw status and Carrie in a darker place than shed ever been. She suffers a breakdown after being backed over by the agency, including Saul, who callously implicates Carrie at a televised congressional hearing. But what looks to the audience like Carries abandonment and descent into madness turns out to be a ruse cooked up with Saul to convince a hostile foreign power that Carrie could be compromised.

That arc sparked a targeted backlash from critics, who accused the show of crossing the boundaries of good faith with its narrative sleight-of-hand. In addition to being poorly conceived, the storyline was ill-timed, absorbing the first four episodes of the season. For anyone already put off by season twos antics, it seemed as if Homeland might never overcome its worst instincts. The season improbably builds to a thrilling and poignant end, with Brody receiving a martyrs death after pulling off one final mission for his country. Carrie will keep a part of Brody with her after his death, as their final dalliance resulted in a pregnancy she intends to take to term.

Homeland was in desperate need of a rebuilding season when it returned in October 2014. Of course its painful and it hurts, said Gansa to the Los Angeles Times of the critical drubbing season three took. Hopefully we can get back to the mountaintop again. To do that, Gansa and his team had to stop telling the audience Carrie Mathison was an international terrorist hunter and actually show her doing it. The Carrie of current Homeland seasons is more comfortable skulking around internecine hot zones than living a placid domestic life. But prior to season four, there was woefully little of that character on display.

The season premiere, The Drone Queen, finds Carrie heading up the field office in Kabul, Afghanistan and running point on the long-distance strikes that earned her the half-admiring, half-snide nickname of the title. Shes using Skype to stay connected to family, but the physical distance allows her to avoid the maternal responsibilities she feels ill-equipped to handle. Carrie receives tantalizing intelligence from Islamabad station chief Sandy Bachman (Corey Stoll) on the location of infamous Taliban leader Haissam Haqqani (Numan Acar). She authorizes a drone attack at the coordinates Sandy specifies, only to find out the location is the venue for a large wedding. Haqqani isnt there, but plenty of his family members are, and 40 civilians are killed in the strike.

The errant drone strike reverberates when one of its survivors, a young medical student named Aayan Ibrahim (Suraj Sharma), allows an incendiary video clip to fall into the wrong hands. Aayan was a wedding guest, recording with his cell phone seconds before the missile hit. He unwittingly captures the exact moment the joyous wedding becomes a funeral pyre, and a rabble-rousing friend uploads the footage to YouTube, setting in motion a crescendo of events that ends with Sandy beaten to death by an angry mob. Carrie strong-arms her way into the newly vacant role as Islamabad bureau chief, then enlists Quinn to help her trace Sandys tip back to its source and determine Pakistani intelligences role in the purportedly spontaneous riot that killed him.

The plot is knottier and more complex than anything Homeland had done before. Carrie is still American foreign policy made flesh, but the show changes from a meditation on how the war on terror changed America into an exploration of the global consequences of fighting it. Carries unorthodox methods are now in service of a mission that puts innocents in harms way as often as it makes them safer. This compromised version of Carrie is often called to account for the wreckage left in the wake of her well-intentioned choices. In the premiere, Carrie is confronted in a bar by the soldier who piloted the drone, whos just learned the payload he released incinerated a wedding. Monsters, all of you, says the guilt-wracked soldier to his superior. She gives him a steely response, but shes shaken by the exchange, and her reckoning is just beginning.

Carrie is forced to make a gaggle of wrenching, no-win decisions, several of which have lasting ramifications for Homelands foundational relationship. While Carrie and Brodys torrid affair blazed in the foreground, Carrie and Sauls quasi-paternal mentorship was simmering in the background. In season four, their unique partnership is pulled into focus and tested like never before. Shes conflicted when he shows up at her Islamabad post unannounced, even though its mostly a social call. Saul has since departed the agency for a cushy gig as a private security contractor, but Carrie is still worried her new team will think shes called in a powerful ally for help. He finally takes the hint and goes to depart Islamabad, only to be intercepted by Haqqanis men and held captive for the bulk of the season.

The story of Sauls kidnapping and eventual rescue is key to the success of season four. Homeland, at its best, takes complex geopolitical issues and turns them into deftly written and acted conversations between two characters. The zenith of season one is The Weekend, the episode most known for Carrie and Brodys fateful cabin trip. But the secondary plot is all about Saul, who advances an investigation by conducting a patient, empathetic interrogation with an American suspected in a terror plot, played by Marin Ireland. Those scenes became something of a template for Homeland, and Sauls kidnapping replicates that template with the dynamic reversed. Now its Saul as the captive, trying to find the right combination of words that will keep him alive under extreme duress. But Sauls captivity only ends if he dies, or the U.S. pays his freight by freeing Taliban prisoners who could go on to carry out deadly attacks. Saul makes clear he doesnt want to be rescued at the cost of freeing dangerous detainees and wont allow Haqqani to turn his capture into propaganda.

Sauls prideful stance puts him at odds with Carrie, whos determined to bring him home at all costs. But the road to Sauls safe return is riddled with obstacles. In From A To B And Back Again, Carrie manipulates Aayan to get him to lead to Haqqani, Aayans uncle. Carrie is initially fine with using a drone to take out Haqqani even if it means killing Aayan, whose innocence Carrie has already compromised with an on-the-job seduction. She holds back when Haqqani reveals Saul as his captive, but is ignited again when Haqqani casually murders Aayan. Carrie demands the drone take the shotSauls life be damnedbut is talked back from the ledge by Quinn. (Executive producer Lesli Linka Glatter took home an Emmy for Outstanding Direction for her work on the episode.)

Two episodes later, Saul manages a short-lived escape. After slipping his captors, he reaches Carrie with a satellite phone and presents her with a wrenching decision: either lead him out of harms way, or allow him to avoid further embarrassment by taking his own life. Just as Saul has concluded death is the only way out, Carrie convinces him shes found a path to safety. But its all a ruse, like the many Carrie and Saul had sprung on so many others. Her turn-by-turn directions lead Saul back into the hands of his captors, an imperfect solution that leaves him in harms way, but still alive. Saul screams and curses at Carrie upon realizing she lied to him in a gut-wrenching scene.

The season should feel skeletal with Brody dead and Saul missing in action, but Homeland restocked its cast by adding excellent recurring characters and breathing new life into familiar faces on the periphery. Acar is brilliantly sinister as Haqqani, and hes well matched by Sharma, whose delicate performance as Aayan made an impression that long outlasted the characters life. Nazanin Boniadi was promoted to the regular cast as thoughtful yet timid CIA analyst Fara Sherazi. Though her character doesnt make it through the season, Faras memory is carried forward by Max Piotrowski (Maury Sterling), a tech wizard who starts Homeland with barely any dialogue and slowly turns into the shows beating, broken heart.

But the best new character is Tasneem Qureishi (Nimrat Kaur), a Pakistani intelligence officer who schemes to get Carrie ejected from her post before she can finish tracing Sandys calamitous tip back to its source. To carry out the plan, she recruits Dennis Boyd (Mark Moses), the intelligence source Sandy Bachman had been keeping under wraps. Tasneem blackmails Dennis into compromising the medication keeping Carries mania at bay while working covertly to influence the prisoner trade. Homeland has long excelled at folding nighttime soap-style plots into its batter, and with the Tasneem and Dennis subplot, the show takes on the contours of a show like Dallas, complete with poisonings and professional sabotage. Kaurs shrewd performance left such an impression that she was brought back as a regular for the shows final season seven.

Homeland season four still has its missteps, including an early scene in which Carrie submerges her daughter in bathwater before changing her mind about drowning her child. (Gansa dubiously explained that the scene was edited to leave room for a less literal interpretation.) A slight blowback greeted the seventh episode, Redux, in which Carrie suffers a mental break (due to Tasneems skullduggery) and appears to wind up in Brodys comforting arms. Turns out its not actually Brody, but Aasar Kham (Raza Jaffrey), Carries Pakistani counterpart and her unlikely ally. Even though Homeland didnt actually resurrect Brody, the brief appearance was an uncomfortable jolt for anyone relieved to be rid of him.

But for all its faults, the fourth season of Homeland represents the peak of the shows strengths, achieved as a direct result of expanding it beyond The Carrie And Brody Show. Homeland became riskier, tenser, and more potent when it finally abandoned Brody, and the shows insights about the global war on terror only got sharper once it left American soil.

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‘I kept thinking I was having a heart attack but it was the perimenopause’ – iNews

Posted: August 1, 2022 at 2:14 am

Becky Maynard has spent 10 years working in many international humanitarian crises, dealing with everything from earthquakes to refugees, and then did a Masters in Disaster Management. Consequently, you might expect her to be more resilient than most in dealing with the perils of the perimenopause, but like so many women, she was knocked sideways by mystery symptoms.

Her problems began when she was 44, driving home to Cornwall, and pulled her car over three times. I kept thinking I was having a stroke or a heart attack, says Maynard, now 48. I drew into a lay-by, realising there was no way I could drive any further because I was going to die.

She asked a lorry driver parked nearby to help, saying, I dont know whats happening. I cant be alone. He tried some breathing exercises with her and called a friend. Three hours later, she managed to drive herself home.

She wondered if she was suffering from PTSD from her work, was diagnosed with panic attacks and offered cognitive behavioural therapy, which didnt help much. Then she was given antidepressants: [They] made no difference. I continue to have constant anxiety, gain weight and feel utterly miserable. When she began to suspect her problems might be linked to hormones, she asked about hormone replacement therapy [HRT], but her GP told her to come back two years after your periods have stopped.

But Maynard had been on a pill that meant she was not having periods. So she started researching her symptoms and discovered they are common in the years leading up to menopause. Its been a revelation finding out about perimenopause, and Ive decided to see a different GP to discuss HRT, she said.

Perimenopause is menopauses dastardly little sister. On no account should it be underestimated, as it moves by stealth. Women in their forties find themselves flummoxed by a raft of mental and physical symptoms, and blame themselves instead of their changing hormones, because they usually still have their periods.

Until recently, there was silence and ignorance around perimenopause among women and even doctors, and only now is it beginning to get the attention it needs. If you looked on the NHS website three months ago, there was only one vague mention of the word perimenopause, but now (in a slight improvement) the site describes symptoms of perimenopause and menopause as one item.

But the emotional and physical rollercoaster of perimenopause needs far more explanation than that: it is a time of anxiety, sleeplessness and physical change for most. Suicide peaks among women, and divorce rises. In midlife, usually when women are in their mid-to-late forties, oestrogen and progesterone unpredictably drain and refill like rip tides, and then decline along with testosterone, which is also a female hormone. Every day can be different.

It is not merely the onlookers, families and friends that dont realise whats going on. Women themselves (along with some non-binary people and trans men who go through this process) often have no idea. Perimenopause can seriously affect mental health.

I am the producer of two recent Davina McCall menopause documentaries for Channel 4, and it was the perimenopause rather than the menopause that caused havoc in the TV presenters life. McCall was 44 when she started getting hot flushes, anxiety and brain fog that stopped her reading the autocue: I thought I had early onset dementia, she said.

For me, the perimenopause brought peculiar symptoms: terrifying heart palpitations in the early hours and overwhelming anxiety, as well as sudden gaps in my memory bank. The heart palpitations led to an electrocardiogram, which was just fine Im a regular runner. The doctor concluded the cause was too much coffee. Menopause was never mentioned, but the palpitations disappeared and my memory rebooted as soon as I sought out HRT.

I was so astonished at the lack of reliable information that I wrote a book, Everything You Need to Know About the Menopause (but were too afraid to ask) and discovered there were huge gaps in research, particularly around perimenopause. I only found out how common some of my own symptoms were after we commissioned a Channel 4/Fawcett Society poll of 4,000 women aged 45-55 for the second programme, Davina McCall: Sex, Mind and the Menopause. It turned out that 41 per cent had experienced difficulties with heart palpitations, and 73 per cent had brain fog and memory problems.

With menopause coming on average at 51 (though it can be younger, particularly for Black and Asian women) it was important to include women in their late forties in the poll, and what resonated was that 69 per cent suffered anxiety and depression, and 84 per cent sleeplessness. There was one other key finding 44 per cent said they had uncomfortably heavy periods in perimenopause. These flooding, tsunami-style periods stop some women leaving the house, and others need more access to the bathroom at work.

Theres no one-size-fits-all set of symptoms that define perimenopause, say nutritionist Emma Bardwell and menopause specialist Dr Shahzadi Harper in their book, The Perimenopause Solution. Hot flushes are not always the signifier. NHS guidelines say that women under 45 can be given a blood test to see if their hormones are low. But if your blood test comes back normal, you might think you cant possibly be in perimenopause. What you need to know is this: its not about the numbers, its about how you feel.

Bardwell and Harper say: Many GPs are still reluctant to prescribe hormone replacement therapy to women in perimenopause who still have their periods, even when symptoms are signalling hormonal change and a call for help.

As Becky Maynard found, perimenopause is often not identified as a possible cause of mental-health symptoms. That means women may miss out on effective treatment for their anxiety or depression.

Menopausal depression is different from clinical depression, and usually responds to hormones. Patients who have never previously been depressed describe low mood, a grey, flat kind of feeling, a loss of joy, said Dr Rebecca Lewis, a GP turned menopause specialist at the Newson Heath Menopause and Wellbeing Centre in Stratford-Upon-Avon. The reason women come to see me most in the clinic is not the hot flushes, not the muscle pains, but the psychological changes. As eggs begin to run out in perimenopause, that starts fluctuations in hormones which affect the brains limbic system, which governs anxiety, mood, libido and concentration.

So what can women do if they suspect they are perimenopausal? Obviously paying attention to lifestyle choices really matters and Bardwell points out that changing hormones can cause bloating and even alcohol intolerance. A diet overhaul is a good idea, looking after your gut microbiome and making sure you get enough vegetables, vitamin D, fish oils and even magnesium, which can help with sleep.

Exercise has also been shown to reduce hot flushes, but nothing can replace lost hormones except hormones themselves, and the new body-identical HRT available on the NHS is safer than the older preparations. A body-identical progesterone pill and transdermal oestrogen in a patch, gel or spray showed no increased risk of breast cancer in a 2022 study of almost half a million womens records in the UK databank.

One of the best resources, with more detailed information than the NHS website, is the balance-menopause.com website, and the free Balance app. Balances chief executive Gaele Lalahy explains: The app allows users to track their symptoms and print an individualised health report which they can take to their doctor. More than 250,000 health reports have been downloaded, and more than half of women who had been using the app for more than five months said it had helped them to access treatment faster.

We need to empower women with accurate information, and in turn improve their physical and mental health, as well as their quality of life.

Weve had period power. Now we need to talk about the perimenopause power and take control of our hormones.

Everything You Need to Know About the Menopause (but were too afraid to ask) by Kate Muir (Gallery Books, 16.99) is out now

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Division 1 female athletes are among those plagued by eating disorders, missing periods, and broken bones – INSIDER

Posted: November 30, 2019 at 9:44 pm

Elite runner Mary Cain said in the New York Times this month that her experience with the coaching system at the now-shuttered Nike Oregon Project encouraged unhealthy levels of weight loss, leading to five broken bones, mental health problems.

The ordeal also derailed her career, according to Cain.

Her experience eating too few calories, having dangerously low bone density, and missing her periods is illustrative of what seems to be a disturbingly common condition among female athletes: Relative energy deficiency in sports, or RED-S. It's also been called female athlete triad, but most professionals now refer to it as RED-S, in part to include male athletes, and to recognize that undereating isn't always related to an eating disorder.

While the condition or symptoms of it can affect anyone from the weekend warrior to the Olympian, it seems to be an especially pervasive, though still under-the-radar, problem among higher-level athletes, including Division 1 female runners.

When Delaney White, now a Division 1 cross-country and track runner and senior at Portland State University, entered the collegiate running scene, she had already begun to have irregular menstrual periods, she told Insider. She thought it was normal for competitive athletes at her level.

That mentality seems to be pervasive.Cate Barrett, a former Division 1 track athlete, wrote on Instagram that "college programs today are still preaching thinner is fast, and telling women to lose weight, or that low weight and lost periods aren't a problem."

For so long, I thought I was the problem. To me, the silence of others meant that pushing my body past its healthy limits was the only way. But I know we were all scared, and fear keeps us silent. @runmarycain Mary Cain's expos of abuse she suffered while training as a young pro runner is shocking and upsetting. A decorated coach at Nike, Alberto Salazar, pressured her to lose weight to run faster. This is an inexcusable abuse of power. Salazar had nearly every resource available to boost Marys performance, yet chose to emphasize a strategy that risked her health. And it didn't even fucking work. It drove her to slow races, self-harm and quitting the sport. Marys story resonates with the amateur and collegiate running community all too well. We've experienced the same thing. Being shamed for our size. Told that our poor performances were because of weight. And that we were lucky to be here, so we shouldnt complain. That this is part of the sport. I competed for a D1 NCAA track team for all four years of college. While this was a great experience, it did leave me with a disordered view of my body and food. 11 years after I entered the NCCA, I still feel the strain that Im not small enough. I know this is not factual and rational, but my mindset is a work in progress. I do not know any teammates who emerged from the NCAA system unaffected by the pressure to be thinner. It may seem like the entire running community is already woke to this issue, but please listen: IT IS WILD how deep this goes. It is still happening. Girls still need help. College programs today are still preaching thinner is faster, and telling women to lose weight, or that low weight and lost periods arent a problem. College sports are not the only offenders here, but they have to do better. They, along with the whole running world, have the opportunity and obligation to make a positive impact in young peoples lives. I am thankful that Mary Cain and many others have faced their fear and brought their stories to light. This is how we change.

A post shared by Cate Barrett (@beingcate) on Nov 8, 2019 at 12:39pm PSTNov 8, 2019 at 12:39pm PST

And, Andrea Toppin, a former runner at Iowa State, wrote on Twitter that her teammate and boyfriend at the time told her she needed to lose 20 pounds in order to contribute to the team. "All I cared about was the number on the scale and pleasing my boyfriend until I got my first awful stress fracture after 2 muscular injuries and 2 years of not having a period," she wrote.

Research backs up these women's experiences.

While estimates of the ubiquity of RED-S vary widely, but some research has shown women at higher levels of sport may be at greater risk because of the high competitive pressure and specific demands of certain sports, such as running. Research also suggests as many as 54% of female collegiate athletes being unhappy with their weight.

What's more,studies suggest disordered eating is especially common in sports that emphasize aesthetics or leanness, like running and gymnastics, with as many as 69% of female athletes in those types of sports missing their periods.

Eating disorders "have continued to increase for girls ages 15 to 22, which directly overlaps with the peak of adolescence, commonly spent in high school and college sports," professional runner Lauren Fleshman wrote in the New York Times. "Over one-third of N.C.A.A. Division I female athletes exhibit risk factors for anorexia nervosa."

She was one of them, writing that her final year of her collegiate career she restricted her diet to look more like the professional, older runners she hoped to become. "I may have looked the part, but I lost my energy. I lost my period, and injuries set in, derailing the first half of my professional running career."

"Running is an interesting microcosm of our culture," Delaney White told Insider. Flickr/josiahmackenzie

No matter how common, a disrupted menstrual cycle can be a dangerous sign that low calorie intake is messing with the body's hormone levels, which can cause long-term health issues like permanent bone loss and potential fertility problems.

But awareness lags among athletes and professionals alike. A small study found 44% of high-school female athletes reported that they thought losing their period was a normal response to a high level of athletic training, Dr. Aubrey Armento, a sports medicine physician in Colorado, reported on Twitter.

And one 2018 study found that less than half of clinicians, physiotherapists, and coaches could correctly define RED-S.

Women also get cues from the environment that "thin is better," Mary Jane De Souza, a professor of kinesiology and physiology at Penn State who specializes in the syndrome, told Insider. "It's a huge problem," she said. "We need a lot more widespread knowledge to be disseminated that you get to be a great, high-performing female athlete but coaches and other people without dietary expertise don't get to tell you what to weigh."

White's first college team didn't talk about missing periods, body image, eating, and weight. But when she transferred to Portland, she found her new teammates were open about discussing their experiences and checking in with each other.

There, she was told that irregular periods were an important sign that something was going on with her body, and she was encouraged to talk to a female trainer about it. Her performance, and health, immediately improved as a result.

"I was running 74 miles a week, and I didn't realize I needed to be eating more. As soon as I did that, I started getting faster," White said. "It's turned around how I feel about running, my performance is better than ever, and I'm healthier than I've ever been."

As White's experience demonstrates,when caught early, many of the damaging effects of RED-S can be reversed. With enough calories, athletes can begin to recover from energy deficit within days or weeks, according to the most recent guidelines from theFemale and Male Athlete Triad Coalition.

White said having female trainers, and strong female athletes as role models in her life, have made a world of difference. As more women become high-profile coaches, including record-breaking marathon runner Shalane Flanagan, she hopes that more young athletes will have the support, encouragement, and resources they need to pursue elite levels of the sports without risking their mental and physical health.

Ultimately, real progress also means looking at the broader culture that links women's value to their weight, White said.

"Running is a really interesting microcosm of our culture, that you expect women to be strong but if they get above a certain weight, they're no good any more," she said. "Until we change the culture of comparison, our sport isn't going to change."

Read more:

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Division 1 female athletes are among those plagued by eating disorders, missing periods, and broken bones – Business Insider

Posted: November 28, 2019 at 12:44 am

captionWhen Delaney White entered the collegiate running scene, she thought missing her period was normal. Now at Portland State University, she feels supported.sourceCourtesy of Delaney White

Elite runner Mary Cain said in the New York Times this month that her experience with the coaching system at the now-shuttered Nike Oregon Project encouraged unhealthy levels of weight loss, leading to five broken bones, mental health problems.

The ordeal also derailed her career, according to Cain.

Her experience eating too few calories, having dangerously low bone density, and missing her periods is illustrative of what seems to be a disturbingly common condition among female athletes: Relative energy deficiency in sports, or RED-S. Its also been called female athlete triad, but most professionals now refer to it as RED-S, in part to include male athletes, and to recognize that undereating isnt always related to an eating disorder.

While the condition or symptoms of it can affect anyone from the weekend warrior to the Olympian, it seems to be an especially pervasive, though still under-the-radar, problem among higher-level athletes, including Division 1 female runners.

When Delaney White, now a Division 1 cross-country and track runner and senior at Portland State University, entered the collegiate running scene, she had already begun to have irregular menstrual periods, she told Insider. She thought it was normal for competitive athletes at her level.

That mentality seems to be pervasive. Cate Barrett, a former Division 1 track athlete, wrote on Instagram that college programs today are still preaching thinner is fast, and telling women to lose weight, or that low weight and lost periods arent a problem.

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For so long, I thought I was the problem. To me, the silence of others meant that pushing my body past its healthy limits was the only way. But I know we were all scared, and fear keeps us silent. @runmarycain Mary Cain's expos of abuse she suffered while training as a young pro runner is shocking and upsetting. A decorated coach at Nike, Alberto Salazar, pressured her to lose weight to run faster. This is an inexcusable abuse of power. Salazar had nearly every resource available to boost Marys performance, yet chose to emphasize a strategy that risked her health. And it didn't even fucking work. It drove her to slow races, self-harm and quitting the sport. Marys story resonates with the amateur and collegiate running community all too well. We've experienced the same thing. Being shamed for our size. Told that our poor performances were because of weight. And that we were lucky to be here, so we shouldnt complain. That this is part of the sport. I competed for a D1 NCAA track team for all four years of college. While this was a great experience, it did leave me with a disordered view of my body and food. 11 years after I entered the NCCA, I still feel the strain that Im not small enough. I know this is not factual and rational, but my mindset is a work in progress. I do not know any teammates who emerged from the NCAA system unaffected by the pressure to be thinner. It may seem like the entire running community is already woke to this issue, but please listen: IT IS WILD how deep this goes. It is still happening. Girls still need help. College programs today are still preaching thinner is faster, and telling women to lose weight, or that low weight and lost periods arent a problem. College sports are not the only offenders here, but they have to do better. They, along with the whole running world, have the opportunity and obligation to make a positive impact in young peoples lives. I am thankful that Mary Cain and many others have faced their fear and brought their stories to light. This is how we change.

A post shared by Cate Barrett (@beingcate) on Nov 8, 2019 at 12:39pm PST

And, Andrea Toppin, a former runner at Iowa State, wrote on Twitter that her teammate and boyfriend at the time told her she needed to lose 20 pounds in order to contribute to the team. All I cared about was the number on the scale and pleasing my boyfriend until I got my first awful stress fracture after 2 muscular injuries and 2 years of not having a period, she wrote.

Research backs up these womens experiences.

While estimates of the ubiquity of RED-S vary widely, but some research has shown women at higher levels of sport may be at greater risk because of the high competitive pressure and specific demands of certain sports, such as running. Research also suggests as many as 54% of female collegiate athletes being unhappy with their weight.

Whats more, studies suggest disordered eating is especially common in sports that emphasize aesthetics or leanness, like running and gymnastics, with as many as 69% of female athletes in those types of sports missing their periods.

Eating disorders have continued to increase for girls ages 15 to 22, which directly overlaps with the peak of adolescence, commonly spent in high school and college sports, professional runner Lauren Fleshman wrote in the New York Times. Over one-third of N.C.A.A. Division I female athletes exhibit risk factors for anorexia nervosa.

She was one of them, writing that her final year of her collegiate career she restricted her diet to look more like the professional, older runners she hoped to become. I may have looked the part, but I lost my energy. I lost my period, and injuries set in, derailing the first half of my professional running career.

No matter how common, a disrupted menstrual cycle can be a dangerous sign that low calorie intake is messing with the bodys hormone levels, which can cause long-term health issues like permanent bone loss and potential fertility problems.

But awareness lags among athletes and professionals alike. A small study found 44% of high-school female athletes reported that they thought losing their period was a normal response to a high level of athletic training, Dr. Aubrey Armento, a sports medicine physician in Colorado, reported on Twitter.

And one 2018 study found that less than half of clinicians, physiotherapists, and coaches could correctly define RED-S.

Women also get cues from the environment that thin is better, Mary Jane De Souza, a professor of kinesiology and physiology at Penn State who specializes in the syndrome, told Insider. Its a huge problem, she said. We need a lot more widespread knowledge to be disseminated that you get to be a great, high-performing female athlete but coaches and other people without dietary expertise dont get to tell you what to weigh.

Whites first college team didnt talk about missing periods, body image, eating, and weight. But when she transferred to Portland, she found her new teammates were open about discussing their experiences and checking in with each other.

There, she was told that irregular periods were an important sign that something was going on with her body, and she was encouraged to talk to a female trainer about it. Her performance, and health, immediately improved as a result.

I was running 74 miles a week, and I didnt realize I needed to be eating more. As soon as I did that, I started getting faster, White said. Its turned around how I feel about running, my performance is better than ever, and Im healthier than Ive ever been.

As Whites experience demonstrates, when caught early, many of the damaging effects of RED-S can be reversed. With enough calories, athletes can begin to recover from energy deficit within days or weeks, according to the most recent guidelines from the Female and Male Athlete Triad Coalition.

White said having female trainers, and strong female athletes as role models in her life, have made a world of difference. As more women become high-profile coaches, including record-breaking marathon runner Shalane Flanagan, she hopes that more young athletes will have the support, encouragement, and resources they need to pursue elite levels of the sports without risking their mental and physical health.

Ultimately, real progress also means looking at the broader culture that links womens value to their weight, White said.

Running is a really interesting microcosm of our culture, that you expect women to be strong but if they get above a certain weight, theyre no good any more, she said. Until we change the culture of comparison, our sport isnt going to change.

Read more:

I had the condition that broke down Nike runner Mary Cains body, and I wasnt even an elite athlete

3 marathoners who are breaking stereotypes about what runners look like

An athlete who spoke out against Nikes running program in 2015 says Mary Cains allegations could change the future of the sport

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Division 1 female athletes are among those plagued by eating disorders, missing periods, and broken bones - Business Insider

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Tired of the Paleo Diet? Maybe It’s Time to Try ‘Moon Eating’ – Bloomberg

Posted: April 27, 2017 at 6:44 pm

For those who believe that the key to good health is a return to more primitive forms of eating, its a great time to be alive. The cultish Paleo method of diningwhich encourages ingesting mostly meats, fruits, vegetables, and good fats, only when you are hungryhas been the most-searched weight loss method on Google for the past four years. Many fast-casual restaurants have sprung up around the trend, and fancier spots have incorporated the ethos into their menus.

But theres a way to get even closer to ancient ways of eating: moon eating. A nascent trend that started in Hawaii, moon eating has yet to be co-opted by a profit-making enterprise like the South Beach Diet or Atkins. You can just start doing it on your own. If you want to, heres everything you need to know.

First of all, moon eating is not the same as the whack-a-doodle Lunar Diet (also known as the more frightfully named Werewolf Diet) that has graced the gossip rags, wherein aging celebs engage in strange fasting practices looking for their fountain of youth.

Crops planted and picked properly, according to ancient lunar calendar-based traditions, are better according to moon eating advocates.

Source: Grand Wailea

Basically, moon eating takes many of the tenets of clean living that are already trending around the world (eating organic, unprocessed foods that are locally grown or foraged, reviving ancient grains, etc) and adds a layer of timing based on the phases of the moon. The idea is, you eat certain foods at certain timesacknowledging something that the centuries-old civilizations recognized, which is that the human body and our behavior operate on roughly monthly loops like the menstrual cycle.

If you are able to grow your own food, even better. According to the chefs behind the movement, specific cycles of planting and harvesting will provide the best, most nutritious produce. The goal is to be healthier, feel better, and be able to prepare physically for regular changes in the environment around you.

Ultimatelyyou may lose weight by moon eating, but thats merely a welcome side effect; the primary goal of mindful consumption is truer connection to our planet and thus a heightened sense of well beingboth emotionally and physically. Its a lifestyle.

The modern-day moon eating craze is taking shape in Hawaii, where Michael Lofaro, chef at the iconic Grand Wailea, is trying to cast a culinary spotlight on Kaulana Mahina, the ancient Hawaiian lunar calendar.

Chef Mike Lofaro, an early proponent of moon eating.

Source: Grand Wailea

Although treated as mythology today, the Kaulana Mahina was grounded in scientific observation and was once a covenant of the land. The Hawaiians tracked the moons waxing and waning energies and perceived an incredible impact on two types of water: the big water (such as the tides bringing fish to shore) and small water (which encompasses everything from tree sap, to aquifers, to your testosterone levels). The influence of the calendar increasedto dictate practically every element of the quotidian, from fishing larger marine life (when the highest tides would roll in) to signing contracts among chieftains (during the waxing energies of lunar cycle.)

For the past two years, Chef Lofaro has been working with Kainoa Horcajo, the Grand Waileas cultural ambassador, to create special Ka Malama dinners during different phases of the moon throughout the year. The word malama is a double entendre meaning both "month" in Hawaiian and care for the world around us. A fully immersive experience, the intimate luaus celebrate the lunar cycles bounty while introducing participants to the moon eating lifestyle. And with the reopening of the hotels signature restaurant, Humuhumunukunukuapuaa, at the beginning of this year, Lofaro is now bringing the moon eating ethos to the masses with a series of ever-revolving menu items that adhere to the hunter-gather principles.

Last week, for example, while teaching a workshop on the Kaulana Mahina at the Pebble Beach Food & Wine Festival, he prepared a dish made of akule and ulu. Akule, bigeye scad, and ulu, breadfruit, are both downmarket items rarely seen on the gourmands plate. But the ulu was planted and picked on the full moon for maximum flavor and was paired with the akule, which are fished at the same time because thats when their population comes in close to the Maui coast.

The restauarant Humuhumunukunukuapua'a at the Grand Wailea.

Source: Grand Wailea

Dozens of other farms and seaside fish shacks in Maui are also pulling inspiration from the Kaulana Mahina. A look at the hundreds of images tagged #moonphaseproject on Instagram will reveal the neonatal stages of the food fad throughout the island. Here, moon eating affects not only how vendors serve fresh fare, but also how they grow it, when they procure it, and how they harvest it to ensure the highest, most robust quality possible.Fruits are once again a great entry point into purposeful planting by the local farmers, as many itemssuch asavocado, mango, and breadfruitnaturally mature throughout a lunar month. By starting and ending the cycle on the eve of the full moon, the produce is noticeably more plump and much more delicious and vitamin-rich when harvested in the correct season (breadfruit during Aprils lunar month, mango throughout the summer). Fishing practices are also much more methodical than simply dropping a linein addition to big fish moving closer inland at high tide, small mollusks and shellfish are most easily captured during the lowest tides of the lunar month. Believers in moon eating think that there's a reason why these foods become more available to human at these times, and that, essentially, we should be better about taking the earth's suggestions.

Kai Momona, prepared by Chef Mike Lofaro of Humunumunukunukuapua`a at Grand Wailea.

Source: Grand Wailea

Further extending their influence, Lofaro and Horcajo reach a wide audience of Hawaiian viewers with their local television program, Search Hawaii, which encourages viewers to plan their meals based on holistic place-based sourcing. They call this practice Mauka-Makaiessentially Land and Seaa local tradition of pairing proteins from the ocean with seasonal fruits on the land, such as limpets and mountain apple, and sea urchin and breadfruit. But they arent the only two champions of the movement. Off-island bloggerHank Shaw really drills down to the core of a similar culling methodologyadjusting your needs to your place, not trying to change the environment to suit your desires, and how to maximize the earths naturally occurring bounty.

You dont have to be in Hawaiior necessarily surrounded by natureto get in on moon eating.

Kealopiko's lunar journal.

Source: Kealopiko

Horcajo recommends starting with keeping a lunar journal (like the one from Kealopiko) to recognize the cyclical behaviors of our environment, from tracking the weather outside and the quality of our daily commute, to monitoring our moods and even the temperament of our bosses and friends.

Our survival depends on our ability to analyze patterns. Without understanding patterns, we would simply die, he said, pointing out historic needs (agricultural cycles; how to hunt prey) and their modern counterparts (data analysis; avoiding heavy traffic).

Horcajo adds that after keeping a diary for some time, youll start to notice uncanny patterns in nature, essentially being able to overlay events from past years on top of one anothera phenomenon long blurred by the arbitrary mathematics of the January-December calendar. When youre first starting out, Horcajo recommends documenting the days when its particularly hard to get out of bed (hangovers notwithstanding). He maintains that the bodys energies are weaker around the first and third moon quarters, which the Hawaiians call the ole phases, meaning "without."You can conceive of it as the moon eating version of Mercury being retrograde. Police officers and medical staff can corroborate the tangible upswing in erratic behavior as the moon becomes full. Planning around the moons impactextra sleep during ole, or leaving early for the office during full-moon traffic jamsis just as important as planning what to eat when.

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Then work on your green thumb by planting as much as you can, wherever you can, be it in a garden, window box, or rooftop plot. Root cropsthink sweet potatoes, carrots, beetsshould be planted around the new moon, and above-ground producesuch aslettuce, kale, and strawberriesgo in around the full moon.According to ancient Hawaiian beliefs about small water, this is the perfect system to get the fullest, most nutrient-rich harvest.

The full moon rises from behind the hills among the silhouette of palm trees in Lahaina on the island of Maui, HI.

Photographer: shootthebreeze/Getty Images/iStockphoto

For those without the time or interest in gardening, its best to start at a farmers market. While the "organic" branding is well and good, youre looking to create a base layer of knowledge aboutwhat grows when, and, according to Horcajo, it may sound like something out of a Portlandia episode, but you can quite literally feel the fullness of produce when its planted and harvested during the energetic parts of the lunar cycle. Just ask the farmer what day that week the fruits and vegetables were pickedonce youre in the swing of moon mindfulness, youll know what to make of the answer.

Ultimately, you might be surprised to find that moon eating works into your life more easily than any diet youve ever tried before. Whether it is the stock market or the farmers market, when you begin to pay attention, not just once in a while but all the time, you begin to spot the patterns, the ebb and flow. Its just the hubris of modern man to think that one is more important than the other. continues Horcajo. Most people involved in the various food industries around the worldmodern foragers, organic farmers, back-to-the-earth advocates are all already basing their lives around the moon calendar. They just dont know it.

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Tired of the Paleo Diet? Maybe It's Time to Try 'Moon Eating' - Bloomberg

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Is Fat Killing You, or Is Sugar? – The New Yorker

Posted: March 27, 2017 at 5:45 am

Nutritional science is too complex to furnish easy answers about what to eat.CreditIllustration by Ben Wiseman

In the early nineteen-sixties, when cholesterol was declared an enemy of health, my parents quickly enlisted in the war on fat. Onion rolls slathered with butter, herring in thick cream sauce, brisket of beef with a side of stuffed derma, and other staples of our family cuisine disappeared from our table. Margarine dethroned butter, vinegar replaced cream sauce, poached fish substituted for brisket. I recall experiencing something like withdrawal, daydreaming about past feasts as my stomach grumbled. My fathers blood-cholesterol levelnot to mention that of his siblings and friendsbecame a regular topic of conversation at the dinner table. Yet, despite the restrictive diet, his number scarcely budged, and a few years later, in his mid-fifties, he had a heart attack and died.

The dangers of fat haunted me after his death. When, in my forties, my cholesterol level rose to 242200 is considered the upper limit of whats healthyI embarked on a regimen that restricted fatty foods (and also cut down on carbohydrates). Six months later, having shed ten pounds, I rechecked my level. It was unchanged; genes have a way of signalling their power. But as soon as my doctor put me on just a tiny dose of a statin medication my cholesterol plummeted more than eighty points.

In recent decades, fat has been making a comeback. Researchers have questioned whether dietary fat is necessarily dangerous, and have shown that not all fats are created equal. People now look for ways of boosting the good cholesterol in their blood and extol the benefits of Mediterranean diets, with their emphasis on olive oil and fatty nuts. In some quarters, blame for obesity and heart disease has shifted from fat to carbohydrates. The Atkins diet and, more recently, the paleo diet have popularized the idea that you can get slim eating high-protein, high-cholesterol foods.

Still, I remained wary of the delicacies of my childhood. Surely it was wiser simply to avoid fats altogether? I wavered, though, in 2013, when The New England Journal of Medicine published an article endorsing the salubrious effects of Mediterranean eating habits. The article detailed the results of a study, the most rigorously scientific one yet conducted on the issue, which showed that following a Mediterranean diet rich in either olive oil or nuts could reduce the risk of heart attack, stroke, or death from cardiovascular causes by thirty per cent. I was elated until my wife, an endocrinologist who is an expert on metabolism, pointed out that the headline number of thirty per cent emerged from the complex statistical way that the studys results were projected over time. If you looked at what happened to the people in the study, the picture was less encouraging: 3.8 per cent of the people consuming olive oil and 3.4 per cent of the people eating nuts suffered cardiovascular misfortune, compared with 4.4 per cent of the group on a regular diet. The true difference in outcome between the two diets was, at best, one per cent.

Its one of many cautionary tales about assessing dietary data. Everyone wants to be healthy, and most of us like eating, so were easily swayed by any new finding, no matter how dubious. Publishers know this all too well and continually ply us with diet and health books of varying degrees of respectability and uplift. The most prominent on the current menu are Sylvia Taras The Secret Life of Fat (Norton) and The Case Against Sugar, by Gary Taubes (Knopf). Both present a range of cutting-edge dietary research, both say that fat is unfairly maligned, and both inadvertently end up revealing that the science behind their claims is complex and its findings hard to translate into usable advice.

Sylvia Tara is a freelance writer who holds a doctorate in biochemistry and an M.B.A.; she has worked at McKinsey and on the management side of various biotech companies. Drawing on insights from both science and consulting, she has produced a book that is part physiology and part marketing pitch. Tara wants us to view lipids positively. Once we stop treating fat like a vicious enemy, she argues, it could become beloved once again.

But Taras attitude to fat is more ambiguous than this statement suggests. She claims to be obsessed with her figure, measuring her worth by how well she fits into skinny jeans. In her telling, the spur to her investigations comes from her envy of a friend who stays svelte despite gorging on beer and burritos, drinking sugary lattes, and never exercising. Tara, who writes that she gains weight easily, is interested in the question of why some people eat like hogs and stay thin, while others expand no matter how abstemious they try to be.

The book is a useful primer on the biology of fat. Fat comes in different forms, categorized by color. White fat, the type that we seek to lose when overweight, stores energy. Brown fat, normally found in the neck, back, and around the heart, is filled with tiny structures called mitochondria, and serves as a furnace to burn energy for body heat. A third type, beige fat, was identified some five years ago; during exercise, it receives messages from our muscles to morph into brown fat. Moreover, fat should not be characterized simply as inert blubber. It is the vehicle by which our cells receive certain essential nutrients, like Vitamins A, D, E, and K. The myelin sheaths around our nerves are eighty per cent lipids, which means fat is actually required to think, Tara writes. Studies by Jeffrey Friedman, at the Rockefeller University, have shown that the hormone leptin travels from fat cells to the hypothalamus, a part of the brain which is involved in regulating appetite. Friedmans discovery redefined fat, Tara writes. It was a verifiable endocrine organ with wide influence to our bodies. Through leptin, fat could talk. It could tell the brain to stop eating.

All this will be illuminating for many readers, but Tara is a less reliable guide when she uncritically embraces various new theories about the causes and effects of obesity. She trumpets the findings of a Turkish physician, Gkhan Hotamisligil, whose work suggests that a molecule known as TNF-alpha, which has potent inflammatory properties, may be the link between obesity and Type 2 diabetesa condition arising when the body becomes resistant to insulin, a hormone that we need in order to process sugar. (Though theres a clear correlation between diabetes and obesity, no one has yet discovered a causal link.) Hotamisligils experiments showed that not only is TNF-alpha produced by fat; it also can cause resistance to insulin. This discovery was big news, Tara writes. However, she fails to specify that the finding was in rodents, and that subsequent studies in humans, including some by Hotamisligil, did not show the same results.

Tara also speculates that viruses may cause obesity. The research she draws on here is obscure and unconvincing. It concerns a virus called Ad-36, which infects fowl and can make chickens fat. In the studies Tara cites, more overweight people appeared to have antibodies to Ad-36suggesting that they had been infected in the pastthan slim people did. There are many reasons to be skeptical: theres no evidence that fowl can pass Ad-36 to humans, and there are many viruses that could easily be mistaken for Ad-36.

As with many books on diet, The Secret Life of Fat alternates exposition with prescription. But the idea that understanding lipids at a molecular level will help you stay trim seems far-fetched. Its telling that Taras final triumphmanaging to fit back into her skinny jeanshas little to do with her sophisticated understanding of fat. Rather, she follows the advice of Mark Sisson, a fitness educator who fasts eighteen hours a day, and who, at sixty-two, she writes, is muscular and fit and looks every bit like the Malibu surfer he is. Tara lost weight by restricting her daily intake to at most a thousand calories and by intermittent total fasts.

This is hardly a healthy note to end on, yet elsewhere Tara seems to take aim at our destructive cultural fixation on body image. Fat was prized in the past, she notes, with big bellies signalling access to plentiful food and, thus, prosperity. The Buddhas belly is a major part of his brand, she writes. (Such consultant-speak seems odd in the context of religion.) The porcine aristocrats one sees in eighteenth-century portraits are frequently shown near tables overflowing with delicacies. The womens bodies depicted in canvasses by Peter Paul Rubens have long since made Rubenesque a euphemism for plus-size. And, if one goes far enough back, the huge bellies and buttocks of the Paleolithic Steatopygian Venus figures that have been found across much of Europe suggest that fat can connote fertility and desirability.

Tara digs up examples of Americans celebrating fat as late as the latter half of the nineteenth century. Ladies Home Journal gave tips on gaining weight, as did an 1878 book titled How to Be Plump. Still, the nineteenth century in general was more notable for a growing concern with being slim, as has been shown by previous writers, such as Gina Kolata, whose Rethinking Thin (2007) itself draws heavily on Hillel Schwartzs remarkable history Never Satisfied (1986). Lord Byron, who struggled with his weight, swore by vinegar; at other times, he ingested just a single raisin a day, supplemented by a glass of brandy. Women in the nineteenth century stuffed themselves into near-suffocating corsets to achieve an hourglass figure with an unnaturally tiny waist. Weight-loss regimens included consuming soap, chalk, pickles, digitalis, camphor tea, grapefruit (which was thought to contain fat-dissolving enzymes), potassium acetate (a diuretic), and ipecac (which induces vomiting). People tried sweating their fat away in rubber suits, or squeezing it away in a pressurized reducing machine.

Indeed, the weight-loss fads of past centuries include precedents for all the main contemporary diets, from low-fat, low-calorie ones to high-fat, low-carbohydrate ones, like the Atkins diet. In 1825, a French lawyer, Jean Anthelme Brillat-Savarin, wrote a famous treatise, The Physiology of Taste, in which he contended that true carnivores and herbivores did not get fat; it was only when one ingested grainread: breadthat the trouble started. Around the same time, an American Presbyterian minister, Sylvester Graham, reasoned that, as gluttony was the greatest sin, abstinence must lead to virtue; he advised eating vegetables and drinking water, eschewing meat, coffee, spices, and alcohol. For a while, students and faculty at Oberlin College were made to follow Grahams diet; graham crackers were so named in order to appeal to his acolytes. Several years later, Horace Fletcher, known as the great masticator, touted very slow chewing as the remedy for obesity; adherents included normally skeptical people like Upton Sinclair and John D. Rockefeller.

A genuine advance, which put nutrition on a solid scientific footing for the first time, was the work of the chemist Wilbur Atwater. In the eighteen-nineties, he began studying how the body converted food to energy, by placing subjects in a closed chamber and measuring the amount of carbon dioxide they produced and oxygen they consumed after eating various foods. Atwater came up with the idea of the food calorie, adapting a measurement previously used for heat energy. In 1917, Herbert Hoover, then the head of the U.S. Food Administration, worked to publicize Atwaters findings. I eat as little as I can to get going, he said. Low-calorie foods and skipping meals became popular. The importance of caloriesif energy gained exceeds output, the excess becomes fatremains one of the few unchallengeable facts in the field of dietary science. Still, further research has shown that calories eaten are only part of what determines weight. Our metabolism reflects an interplay of things like genes, hormones, and the bacteria that populate the gut, so how much energy we absorb from what we eat varies from person to person.

In the nineteen-fifties, the American Medical Association identified obesity as the countrys No. 1 health problem, and the diet industry exploded. The end of that decade brought the idea of the liquid dietskimmed milk, supplemented with bananas or other fruitwhich, in turn, eventually gave rise to products like Metrecal, Carnation Slender, and SlimFast. Self-help groups modelled on Alcoholics Anonymous began proliferating with the establishment, in 1948, of a movement called TOPS (the acronym stood for take off pounds sensibly). Overeaters Anonymous followed, in 1960; Weight Watchers, in 1963; and Jenny Craig, in 1983.

The immediate postwar years also brought the first sustained scientific assault on dietary fat. Ancel Keys, a physiologist at the University of Minnesota, who had spent the war developing nutritionally optimal Army rations and studying the effects of starvation, became interested in the high rates of heart attack among a seemingly well-fed sector of the populationAmerican businessmen. He soon became convinced that the saturated fats found in meat and dairy products were the cause, and thus began the war on fat that galvanized my parents. Keys became, with his wife, Margaret, an advocate for the Mediterranean diet of unsaturated fats. Their books promoting the diet were best-sellers, and Keys, who spent his latter years in Italy, lived to the age of a hundred. (Margaret lived to ninety-seven.)

The author of The Case Against Sugar, Gary Taubes, gained prominence as a science writer in 2002, with a cover story in the Times MagazineWhat If Its All Been a Big Fat Lie?which challenged the orthodoxy of restricting dietary fat. Carbohydrates were the real danger, he wrotenot just processed foods containing refined sugars like sucrose and fructose but also easily digestible starches from grains and vegetables. He expanded these arguments in a book, Good Calories, Bad Calories (2007), and, in his new book, he goes much further. Though he now allows that people can eat some carbohydrates and still live a relatively healthy life, he sees sugar as the devil incarnate, doing harm independent of its known role in causing obesity. Taubes believes that a wide range of seemingly unrelated diseasesdiabetes, heart disease, cancer, stroke, and Alzheimers, which account for five of the top ten causes of death in the U.S.are in fact linked, and that dietary sugar is the cause of them all, as well as of other disorders that associate with these illnesses, among them polycystic ovary syndrome (PCOS), rheumatoid arthritis, gout, varicose veins, asthma, and inflammatory bowel disease. In addition, he aims at showing that the food industry has systematically tried to obstruct scientific research that exposes the dangers of sugar, just as tobacco companies tried to hide the risks of smoking.

The latter claim is the more persuasive. Taubes, a pugnacious writer who clearly relishes the role of muckraker, digs up a long history of attempts to discredit charges against sugar and to point the finger at fat as the primary dietary cause of disease. In 1943, when sugar, dismissed by the government and medical organizations as empty calories, was being rationed as part of the war effort, sugar companies formed a trade association to set the record straight. It devised a two-pronged strategy: support scientists who endorsed the notion that sugar was a valuable source of dietary energy without any specific health risks; and then mobilize these experts in a public-relations campaign. A prominent Madison Avenue firm was hired to design a public-health campaign that would establish with the broadest possible audiencevirtually everyone is a consumerthe safety of sugar as a food. Among the scientists they supported was Ancel Keys, the Mediterranean-diet pioneer; his work influenced the dietary guidelines of the American Heart Association and the American Diabetes Association. Fred Stare, an influential nutritionist at Harvard, received not only research funding but a donation of more than a million dollars, from the General Foods Corporation (whose products included Kool-Aid and Tang), to build a new department. He proclaimed that it was not even remotely true that modern sugar consumption contributes to poor health. Taubes recounts that Stare appeared on talk shows on more than two hundred radio stations as a front man to dismiss anti-sugar sentiments publicly.

The spread of diet crazes and of obesity anxiety in the fifties alerted the sugar industry to the fact that its product was at risk. Diet sodas with artificial sweeteners were gaining market share. The sugar industry responded in two ways: by stressing how important sugar was as an energy source for children (neither a weight reducing nor fattening food); and by discrediting artificial sweeteners such as saccharin and cyclamates as health dangers. It funded research at the Wisconsin Alumni Research Foundation and at the Worcester Foundation for Experimental Biology, which managed to find various adverse effects from consumption of cyclamates in rats. The latter achieved this by giving rats an absurd dosethe equivalent, in human terms, of five hundred and thirty cans of Fresca. Nonetheless, the F.D.A. eventually banned cyclamates as a health risk.

Though Taubess account of these little-known manipulations is useful, he overreaches in blaming sugar for such a wide range of diseases. In attempting to lump them together, he cherry-picks from a variety of recent research. For instance, some epidemiological surveys have shown that when people move from the developing world to the West they change diet and often become obese, leading to an increased incidence of diseases, including diabetes and cancer. And other diseases, such as Alzheimers, appear on Taubess list, because researchers have studied whether they are linked to insulin resistance.

Synthesizing these conjectures, Taubes sees insulin resistance as the bedrock disturbance in the body which unleashes a cascade of other hormonal and inflammatory molecules that attack the brain (causing dementia), degrade the heart and the blood vessels (causing heart attack and stroke), disturb the metabolism of uric acid (causing gout), and so on. He then attempts to build his case as a prosecuting attorney by means of a chain of if/then statements, such as If sugar and high-fructose corn syrup are the cause of obesity, diabetes, and insulin resistance, then theyre also the most likely dietary trigger of these other diseases. He invokes Occams razor, a concept adopted by medieval philosophers and theologians, which holds that explanations should rely on the smallest possible number of causes. If this were a criminal investigation, the detectives assigned to the case would start from the assumption that there was one prime suspect, Taubes writes.

Occams razor is hardly a fundamental law of the universe, however. No credible scientist would ever think of using it to prove or disprove anything. And Taubes neglects findings that contradict his idea that diabetesand, by extension, sugaris at the root of all our troubles. A study of the diabetes drug metformin, published two years ago in The Lancet, failed to show any impact on the treatment of pancreatic cancer. A placebo-controlled trial in which insulin was given to dementia patients did not find a meaningful improvement in cognition. Indeed, there is no conclusive evidence that excess dietary sugar per se causes diabetes. Most important, Taubess assertion that all these diseases are closely related is not scientifically supported. The biological behavior of cancerDNA mutations, aberrant growth, metastatic spreadis nothing like that of diabetes. Inflammatory-bowel disease, a complex disorder that appears to have a variety of genetic underpinnings, does not seem to be caused by any particular diet or substance, and there is no evidence that restricting sugar ameliorates it. The attempt to characterize Alzheimers as type-III diabetes, linking it to insulin resistance and inflammation, is likewise speculative.

The temptation to draw facile connections is ever-present in medical research, and the most valuable current work on these conditions is a matter not of grand unified theories but of a multiplicity of very fine-grained observations. Taubes is critical of scientists tendency to see disorders as multifactorial and multidimensionalthat is, as arising from a complex interplay of factors. Lung cancer, he argues, is also multifactorial (most smokers dont get it and many non-smokers do), yet no one disputes that smoking is the primary cause. But cigarette smoke contains carcinogens, molecules that have been shown to directly transform normal cells into malignant ones by disrupting their DNA. Theres no equivalent when it comes to sugar. Taubes surmises a causal link by citing findings that cancer cells need glucose to thrive, and absorb more of it than other cells. But this proves nothing: malignant cells consume in abundance not only carbohydrates like glucose and fructose but other nutrients, like vitamins. To imagine that, just because cancer cells like glucose, elevated levels of it might prompt healthy cells to become cancerous is to take a vast, unsubstantiated leap.

Ultimately, Taubess indictment of sugar as the leading culprit in virtually all modern Western maladies doesnt provide enough evidence for us to convict. That doesnt mean sugar is without dangers: it certainly plays a role in the development of obesity, to say nothing of dental cavities. But these are lesser charges, and they make for a less dramatic headline.

Taubess big claims get our attention, of course, but for people suffering from these diseases theyre not just a harmless rhetorical strategy. A woman I know who recently emerged from chemotherapy treatment for ovarian cancer and is now in remission told me that she was terrified after reading Taubess book. She asked if eating chocolate would make her tumor start growing again.

The problem with most diet books, and with popular-science books about diet, is that their impact relies on giving us simple answers, shorn of attendant complexities: its all about fat, or carbs, or how many meals you eat (the Warrior diet), or combinations of food groups, or intervalic fasting (the 5:2 diet), or nutritional genomics (sticking to the foods your distant ancestors may have eaten, assuming you even know where your folks were during the Paleolithic era). They hold out the hope that, if you just fix one thing, your whole life will be better.

In laboratories, its a different story, and it sometimes seems that the more sophisticated nutritional science becomes the less any single factor predominates, and the less sure we are of anything. Todays findings regularly overturn yesterdays promising hypotheses. A trial in 2003, led by researchers at the University of Pennsylvania, compared an Atkins diet, high in fat and low in carbohydrates, with a low-fat, high-carbohydrate, low-calorie one. After a year, there were no significant differences in how much weight the people in each group had lost, or in their levels of blood lipidsincluding their LDL cholesterol, the primary concern for heart attack and stroke. In a follow-up study in 2010, participants who followed either a low-carbohydrate or a low-fat diet ended up losing about the same amount of weight (seven kilograms) after two years. It was impossible to predict which diet would lead to significant weight loss in any given individual, and, as most dieters well know, sustaining weight loss often fails after initial success.

Other research seems to undermine the whole idea of dieting: extreme regimens pose dangers, such as the risk of damaged kidneys from a buildup of excess uric acid during high-protein diets; and population studies have shown that being a tad overweight may actually be fine. Even studying these issues in the first place can be problematic. Although the study of the Mediterranean diet, for example, reflects randomized controlled experiments, most nutritional studies are observational; they rely on so-called food diaries, in which subjects record what they remember about their daily intake. Such diaries are notoriously inexact. No one likes admitting to having indulged in foods that they knowor think they knoware bad for them.

Science is an accretion of provisional certainties. Current research includes much that is genuinely promisingseveral groups have identified genes that predispose some people to obesity, and are studying how targeted diets and exercise can attenuate these effectsbut the more one pays attention to the latest news from the labs the harder it becomes to separate signal from noise. Amid the constant back-and-forth of various hypotheses, orthodoxies, and fads, its more important to pay attention to the gradual advances, such as our understanding of calories and vitamins or the consensus among studies showing that trans fats exacerbate cardiovascular disease. What this means for most of us is that common sense should prevail. Eat and exercise in moderation; maintain a diet consisting of balanced amounts of protein, fat, and carbohydrates; make sure you get plenty of fruit and vegetables. And enjoy an occasional slice of chocolate cake.

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Is Fat Killing You, or Is Sugar? - The New Yorker

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Why Diets Dont Work – The Fat Nutritionist

Posted: September 25, 2015 at 9:44 am

Most diets seem to succeed in the short-term, and fail in the long-term. This is not a new, or even particularly controversial, observation among researchers:

There are two indisputable facts regarding dietary treatment of obesity. The first is that virtually all programs appear to be able to demonstrate moderate success in promoting at least some short-term weight loss. The second is that there is virtually no evidence that clinically significant weight loss can be maintained over the long-term by the vast majority of people.

Confronting the failure of behavioral and dietary treatments for obesity, Garner & Wooley, 1991

Although weight loss can usually be achieved through dietary restriction and/or increased physical activity, the overwhelming majority of people regain the weight that they have lost over the long-term.

The Defence of Body Weight: A physiological basis for weight regain after weight loss, Sumithran & Proietto, 2013

Of course, we can all endorse the call for a healthier lifestyle, but we must be realistic about what it can and cannot accomplish including that it is not by itself an effective approach to long-term obesity treatment.

An Inconvenient Truth about Obesity, Schwartz, 2012

More in-depth analysis of the failure rate of dieting can wait for another post. The question Im asking here is, if diets fail for some proportion of people, which they indisputably do, why is that? What is the reason? What are the specific mechanisms at work?

The usual assumption among non-researchers about why diets fail is that when a dieter regains weight, it must be because they stopped dieting, which is in turn attributed to things like not having enough willpower, personal and moral failure, gluttony and laziness, or being too ignorant to know better.

These are assumptions which reflect the mythology of our culture: that anyone, if they try hard enough, can be anything they want and therefore that weight is entirely a choice, a product of effort and moral character. This story centres the individual, their behaviour, their character traits, and their moral attributes as the cause of fatness in the first place, and the reason why weight is regained following a diet.

But these explanations are not satisfactory to me, nor, as you will see, are they reflected in the scientific literature.

To explore other answers, I haphazardly gathered peer-reviewed articles, spanning a range of more than 30 years, that investigated or discussed the various reasons why weight loss produced by dieting is not maintained long-term.

Here is what they theorize about why diets fail.

1. Behavioural relapse, a.k.a. going off the diet

The earlier papers on the failure of dieting focused on behavioural factors, since dieting was, at the time, a relatively new and exciting behavioural intervention for obesity. (By the mid-20th century, dieting as a popular pastime was not new, but as a subject of medical research, it was still fairly novel.) Researchers assumed that when someone could not sustain weight loss, it mustve been due to a breakdown in their new behaviours people must have gone back to eating more and moving less, just as is popularly assumed.

However, the researchers tended not to lean so heavily on moral explanations for this relapse. One study suggested that the fault lay with lack of scholarly attention to the maintenance phase of behavioural change in designing weight loss plans. This was further complicated by the fact that no one can avoid eating entirely, which makes dieting quite different from other behavioural interventions like smoking cessation programs and abstinence from alcohol.

Alongside this were proposed cultural and commercial pressures to eat, especially calorie-rich and highly palatable foods. There also appeared to be few natural rewards provided by dieting once the intervention phase ended apparently nothing, not even thinness, feels as good as food tastes.

The researchers were not very optimistic about the usefulness of dieting if it only resulted in regaining weight. An illuminating quote from the conclusion of one paper:

Research on humans suggests that the deleterious effects of obesity are exerted primarily during periods of weight gainIts medical consequences may be unfortunate enough that if people cannot maintain weight loss, they would be better off not trying to lose weight!

Behavior Modification in the Treatment of Obesity: The problem of maintaining weight loss, Stunkard & Penick, 1979

Another paper suggested that culprits for the breakdown of dieting behaviours were negative moods, emotional stress, social pressures to eat more, as well feelings of intense hunger that prompted overeating. But an interesting quote from this same article hints of more than purely behavioural factors:

The obvious reason for weight regain after weight loss treatment is that participants return to inappropriate eating and exercise habits. These habits need not be as bad as pretreatment habits to cause regain, because metabolic factors may make it easier to regain after a period of dietary restrictionThe pattern of relapse and regain appears to be the result of a war between the will and physiologic demands over which self-control appears relatively powerless.

Why Treatments for Obesity Dont Last, Goodrick & Foreyt, 1991

So even in cases where behavioural relapse were implicated, researchers seemed to acknowledge that other factors contributed to that relapse (like stress, biological and cultural pressures to eat, and increased hunger), or to the weight regain itself (metabolic changes.)

2. Lowered energy expenditure

Reduced calorie intake and weight loss, it turns out, cause some interesting changes to the body that result in expending fewer calories. In animal studies, changes include decreased body temperature, less spontaneous activity, and lowered resting metabolic rate (the amount of energy the body uses while at rest.)

Reduced total energy expenditure and, possibly, lowered resting metabolic rate after diet-induced weight loss have also been observed in humans. (Conversely, humans who gain weight above their baseline weight through eating have been observed to have an increased resting metabolic rate.)

A person who gains weight would be expected to expend more energy just due to their increased body mass, thus requiring more energy to physically move and biologically maintain it. The same, but in reverse, is true for someone who loses weight less energy is required to maintain a smaller body.

But the changes in energy expenditure resulting from dieting have been described as disproportionate, meaning that they were greater than the changes expected for the amount of weight gain or loss, indicating that some compensatory mechanism meant to restore preferred weight may exist.

In other words, a person who lost weight to reach 150 lbs. may expend fewer calories just existing than someone who has always weighed 150 lbs. And someone who purposely gained weight to reach 150 lbs. may use more calories to maintain their weight than the person who has always weighed 150 lbs.

However, other studies of weight loss in humans have not demonstrated the effect of lowered resting metabolic rate, which leaves the question open.

A nod to weight diversity from the last study linked:

Body weight in adults is remarkably stable for long periods of time. In the Framingham Study the body weight of the average adult increased by only 10 percent over a 20-year period. Such a fine balance is evidence of the presence of regulatory systems for body weight. Whatever the mechanism (or mechanisms), the weight at which regulation occurs differs from one person to another, and these differences are almost certainly due in part to genetic and developmental influences.

Changes in Energy Expenditure Resulting from Altered Body Weight, Leibel, Rosenbaum, and Hirsch, 1995

3. Fat storage and insulin sensitivity

Another physiological change produced by weight loss is increased insulin sensitivity. This is generally considered a good thing, but it may also leave people vulnerable to weight regain. We may need to go back to a little high school biology to cover this one adequately.

Insulin is a hormone that the pancreas releases into your bloodstream. Insulins main life goal is to act like a key that allows glucose, also flowing through your bloodstream, into your cells, which then use the glucose for energy.

When a persons cells become resistant to insulin, the glucose cant get into the cells it then builds up in the blood, eventually causing high blood sugar. Meanwhile, the cells switch to using fat for fuel.

With weight loss, cells become more sensitive to insulin, which allows glucose to enter the cell once more. Those cells use that glucose, and the fat that would otherwise be used for energy is directed back into storage, which may spell weight gain.

Experimental research in humans has indeed demonstrated that increased insulin sensitivity following weight loss from dieting predicts the amount of weight the person will eventually regain. The researchers are careful to point out that increased insulin sensitivity, alone, is not enough to cause weight regain, but in combination with lowered energy expenditure (see above) and increased food intake (see below), it certainly helps.

From this same paper:

Following weight reduction, there is a 95% failure rate for obese individuals to stay weight-reduced more than 4 years (5). After obese subjects undergo weight reduction, metabolism shifts to favor weight regainThese metabolic phenomena result in the shunting of lipid fuels away from oxidation in muscle to storage in adipose tissue, and in the setting of positive energy balance, increases in body weight and percent body fat occur.

Weight Regain Following Sustained Weight Reduction is Predicted by Relative Insulin Sensitivity, Yost, Jensen, and Eckel, 1995

4. Increased appetite

During and after weight loss, levels of several hormones involved in appetite regulation change significantly.

Hormones that promote feelings of fullness and inhibit food intake (including leptin, peptide YY, GLP-1, cholecystokinin, and amylin) are decreased with weight loss. Meanwhile, ghrelin, a hormone that stimulates hunger, is increased, along with reported food preoccupation and appetite.

Again, these responses may indicate the existence of a regulatory mechanism intended to restore preferred body weight:

Taken together, these findings indicate that in obese persons who have lost weight, multiple compensatory mechanisms [encourage] weight gainFurthermore, the activation of this coordinated response in people who remain obese after weight loss supports the view that there is an elevated body-weight set point in obese persons and that efforts to reduce weight below this point are vigorously resisted.

Long-Term Persistence of Hormonal Adaptations to Weight Loss, Sumithran et al., 2011

In addition to feeling hungrier, weight-reduced people show a stronger preference for high-calorie (high sugar and high fat) foods. There are also changes in brain activity patterns indicating that weight-reduced people are more responsive to food rewards, while brain areas associated with controlling ones food intake are less active.

The hypothalamus, a part of the brain that may act as a brake on the homeostatic tendency toward weight gain, shows decreased activity in people who have lost weight, which affects both food foraging behaviour and metabolism to favour eating more and regaining weight.

5. Genetic predisposition to gain weight

It has long been understood that body weight has a significant genetic component.

Research in pairs of identical twins shows that there is also a significant genetic component to weight loss, including how much and what type of fat is lost, and the rate of fat burning relative to use of glucose for energy.

On the other side of the coin, population studies of twins have shown an association between dieting attempts and subsequent weight gain, which probably reflects a pre-existing tendency to gain weight that is powerful enough to counteract weight loss attempts.

From that study:

The poor success in weight maintenance after dieting predisposes individuals to the vicious cycle of frequent dieting attempts and weight regain. The relation between weight cycling and subsequent weight gain is well described in the literature. Part of the weight gain occurring in young adults may be regarded as physiologic, and is likely to occur independently of attempts to lose weight.

Weight-loss attempts and risk of major weight gain: a prospective study in Finnish adults, Korkeila et al., 1999

Another study using twin data indicates that some of the weight gain may also be due to dieting itself, independent of genetics.

As you can see, moral explanations for weight regain leave a lot to be desired. They reflect lazy thinking. A persons drive to eat, combined with their tendency to regain lost weight, is clearly more dependent on physiology than on moral corruption, or even simple ignorance.

Biology drives behaviour. It also primes the body to most efficiently exploit that behaviour. What is often interpreted as weakness of will and greediness by our culture is actually the result of a complex orchestration of genetic, homeostatic, metabolic, hormonal, and neurological processes influencing us to eat, restore lost weight, and ultimately survive.

And a final quote:

metabolic conditions after weight loss may not be the same as they were prior to gaining the weight in the first place. Instead of working in our favor to prevent weight gain, biology becomes one of the driving pressures that underlie weight regain.

Biologys response to dieting: the impetus for weight regain, MacLean et al., 2011

If youve ever regained weight after a diet, you are in very good company. Most dieters regain the weight. You are not lazy, stupid, or greedy. You did not fail on the contrary, your body worked hard to save you.

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Why Diets Dont Work - The Fat Nutritionist

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