Why can’t I lose weight? Here’s why.


For years I have watched my loved ones struggle with this question, even go to doctors and have blood drawn to find out why. Why can’t they lose weight like everyone else? Is it thyroid? Genetics? David, you’re a doctor – how come I can’t lose weight?

Honestly, I have dedicated the better part of my career to understanding and answering this question. So, here it is.

1) First, the question is probably flawed. Most of the people you are looking at likely did not lose weight – they have more likely been like that forever. Not that many people actually lose weight – less than 5 in 100 tries. So, the assumption that lots of people are losing weight is off. They aren’t.

2) Second, a complex biological response emerges every time you try. Every time you restrict your calories and/or start new exercise – a series of events occur:


a. Hunger hormones. The hunger hormone system coordinates a response that overwhelms you. The body is wired to survive, and when new exercise starts with or without less food a hormone assault is unleashed. Ghrelin goes up, leptin goes down, and the desire to seek food overtakes everything. Importantly, this response is not present in the already lean folks that try the same thing.

b. Thermogenesis. When you eat less your body slows down it’s calorie burning. Yep. It fights you every step of the way. You cut 500 calories from your diet and your body burns LESS calories to try and offset it. Again, the already lean person’s body just hums along at the same rate so they don’t have to deal with this.

c. Gut Microbiota. Overweight people often absorb more calories from a given piece of food than not. So, when you say, “I could eat the same little food as Skinny Sally over there, and still gain weight!” You’re right.

d. Stress. Stress hormones make you hungry. The body figures something unusual is happening here and we may need to go without food for a while, so stock up now.


There you have it. 95% of folks quit their diets because of this coordinated biological response. It cannot be overcome on your own.* It’s like holding your breath under water. At some point the body’s signals for air consumption win out and you burst to the surface for a big breath. Likewise, the longer you can stand the decreased calories and new exercise, the more likely you are to burst into a McDonald’s for relief.

Don’t worry though, scientists have figured out how to get past this. Stay tuned for the next post 😊. Love you all!


* Ok, everyone knows someone who white knuckled through a diet and lost weight. If they did, they probably gained it back – and if they didn’t they are an outlier. We are talking about most people here.


How people are actually going to lose weight in 2018.


I have written a lot lately describing why our diet failure rate is at 95%. Admittedly, I have been nearly obsessed with making the point that folks who cannot lose weight have a d#$% good reason why that is. That they face challenges many lean folks don’t feel, and that to shame or condescend them is nonsensical (let alone ethically deplorable).

That said, almost every post is followed by comments asking, “OK, so what do I do know?”, and “Is there anything at all that works to overcome this barrier to weight loss?” Indeed, there is.

First, procedures work. It is important to start here because this is how we learned all of the stuff from the other posts. There is no “willpower” implantation procedure. These new procedures work by altering the hormones and metabolism that otherwise stop folks. Bariatric surgeries, interventional obesity procedures (bariatric artery embolization, cryovagotomy) bypass the response that has stopped so many, for so long.

Second, medications work. We are a long way from phen-fen. Also, stopping medications work.  Common medications like antihistamines are often significant contributors to weight gain. Obesity medicine physicians have a long list of medications that we often stop or change at the first visit as “low hanging fruit.” *

Finally, retrograde neuroplasticity works. It specifically overcomes attrition. Plainly said, changes made to the body will modify the brain. This is the opposite of what we have been doing all along. “Change starts from within,” “mind over matter,” and “no pain, no gain,” were all misdirected sentiments. It is not surprising that we have such a high failure rate with our current approach when we come to the realization that it is literally backwards, that success follows change from the outside-in.

And what are those principles? Attention to recovery, flexibility in diet and exercise, and the C-PASS principles: Capacity, Progress (not perfection), Accountability, Self-monitoring, and Stimulus control. These are the things you can do at home to directly address the body’s response that would otherwise make you quit. It’s like taking an anti-anxiety pill so you can make it through an MRI. See you again soon!



* Do not stop medications on your own. Talk with your doctor please.




Should Fat People be Allowed to Vote?

Should fat people be allowed to vote?

Given the state of treatment of an overweight person in 2017, I would have to say no to the voting proposition. They are a minority group, we stereotype them, we discriminate against them, we shame them, and we take advantage of them economically. So really, I don’t see how their vote should count for anything important. (this is sarcasm, of course – laid out here to make the following points)

If you post on the internet that overweight and obese folks should not be blamed (or shamed) for their inability to lose weight, 10,000 people will leave comments like, “who shoved those cheeseburgers in their mouths?” and “it’s their own fault their such fat asses.”

How does such a despicable level of discrimination and hatefulness against a group of human beings still exist? What sustains it? The same things that sustain prejudice against races, sexual orientation, religion, and so on: the assigning of our own personality traits and values to someone in a different situation, and assuming that we know how it would go if we were in their shoes.

The truth is, if the fat-shamers could somehow be switched into the bodies of the people they persecute, they would not be able to cross back. They would be stuck on the other side of the expanse, realizing that the journey back is not what they thought – apologizing and begging to be switched back. *

The first step to ending this negative force is to concede that we don’t know what it is like – that it is a flawed assumption that we (or anyone) would be able to do better with the same circumstances. The second is opening our minds to new possibilities for weight loss – so we can unlock the potential of a beautiful, valuable segment of our population.

*Of course, everyone knows someone who white knuckled through a diet and lost weight. Those are the outliers. We are talking about most people here.


Diet resistance. A modern-day explanation for failed weight loss attempts.


If you post on the internet that overweight people are not to be blamed (or shamed) for their inability to lose weight, 10,000 people will post comments like, “Who shoved those cheeseburgers in their mouths?” and “it is their own fault they are such fat asses,” and so on. It is quite striking.

It does get to the center of the stereotypes that lead to fat shaming, though. The lean population believes to their cores that they are somehow members of a supreme race, and that if they switched places with their 300lb counterparts tomorrow, they would be able to lose the weight.

Here is the truth though. They would not be able to. They would end up frustrated, hopeless, and (maybe) apologetic – begging to be put back in their own bodies. And why? Because the overweight and obese population faces absolutely unique backlash from their bodies when they start to restrict calories and begin new exercise that the lean population does not feel when following the same program.

There are scientific words assigned to this backlash in 2017: adiposapthy, basal metabolism alterations, hunger hormone changes, the gut microbiome, and a few more. The bottom line is, these phenomena combine to make it impossible for overweight or obese folks to sustain calorie restriction, especially when combined with new exercise.

If we take a step back and look at the facts, it is impossible to deny this. For 50 years we have been trying different combinations of calorie restriction and exercise as prescriptions for weight loss in overweight or obese patients. It doesn’t work. Ninety five percent of these folks are back to their starting weight in six months. Ninety. Five. Percent. In what other medical condition would we continue to prescribe the same therapy with a ninety-five percent failure rate?? None.

Time for something new.


The end of dieting: how doctors are “zapping” hunger centers now for patients who want to lose weight.



I remember as a young adult hearing my mother say, “Can’t they just zap my brain or something so I won’t’ eat?” Well, mom – it looks like that time is finally here.

Zap 1. BAE. BAE stands for “bariatric artery embolization.” As it turns out, the hunger hormone is released into the blood by the stomach when it’s time to eat.  It also turns out that doctors can block the release of this hormone (called ghrelin) with a simple procedure through the blood vessels.

The procedure involves placing a small tube into the blood vessels and blocking the blood supply to that portion of the stomach. It’s an outpatient procedure that takes about an hour and you go home the same day. It’s new, but has resulted in overall weight loss for groups that have been studied.  A bit more information about BAE can be found here.

Zap 2. Cryoablation of the hunger nerve. This is also very new. Doctors use cat scan guidance to guide a needle to the nerve that carries hunger signals (also located near the stomach). The needle drops the temperature in the region and freezes the nerve, which results in less severe hunger when the stomach is empty (Figure 1). A bit more information on this procedure can be found here. The Maestro device is a similar idea. It is a small electronic device that is implanted beneath the skin and attaches to the hunger nerve to decrease its signaling. Their website is here.



Zap 3. Medications. The 21st century has revealed an entirely new axis for obesity. Brand new targets for which pharmaceutical companies can generate specific medications have been discovered. Hunger centers in the brain are now targeted specifically with medications taken by mouth. Similarly, receptors in the gut have been discovered for which medicines now exist. Even targets in the pancreas, muscles, and fat cells themselves have been successfully targeted with medications recently.

Zap 4. Stomach balloons. Balloons which are placed in the stomach either through a tube placed in the mouth and esophagus under sedation, placed through the skin into the stomach, or taken as a pill. These balloons occupy space in the stomach which may result in earlier satiety (getting full earlier) and also maintain distention of the stomach which has effects on the nerves mentioned above. They are either decompressed by the doctor in the office the way they went in, or are degradable and eventually pass on their own.

Zap 5. Surgery. Bariatric surgeries, such as gastric bypass, have evolved and changed the face of obesity medicine. In fact, it is these surgeries that unveiled the true mechanisms of obesity and led to Zaps 1-4. These techniques vary but essentially involve changing the hormones related to eating for patients, and have been shown to be crazily successful for both weight loss and disease modification (such as diabetes or heart disease) in the right patients.

The state of being overweight is complex and comparable to other chronic diseases.  Just as we don’t tell our patients to use willpower against their diabetes or cancer, so should we be moving on from the antiquated “no pain, no gain” approach to obesity. Help is available for getting over the hump so patients can lead healthy lives.







Bariatric Artery Embolization (BAE)


Ghrelin is the hunger hormone. It is primarily produced in the stomach, specifically by cells called X/A cells that live in a portion of the stomach called the fundus. (Figure 1) Once produced, ghrelin travels through the bloodstream from the stomach to the brain and signals the brain to seek food and feel hungry.


Millions of dollars have been spent by drug companies trying to block ghrelin without success. We have, however, been successful in blocking ghrelin through gastric bypass surgery by excluding the portion of the stomach that produces ghrelin. (Figure 2) In fact, recent studies have confirmed that the reason gastric bypass patients lose weight – and even cure their diabetes and other obesity related conditions – is because hunger hormone profiles change after the surgery.



Bariatric artery embolization is a new way to shut down ghrelin producing cells. Interventional radiologists use X-ray guidance to steer a catheter into the artery that supplies the portion of the stomach that contains the ghrelin producing cells. Using small particles, the artery is blocked and the tiny ghrelin factories closed. (Figure 3) The entire procedure is performed through a tiny hole in the groin (the same method used for heart catheterizations, liver cancer embolizations, and other), nonsurgically.


In the months following the procedure patients can lose significant amounts of weight. The outcomes of BAE can be markedly improved with implementation of exercise and diet modifications during the months following the procedure – such that the effect of either interventions is accelerated by the other.



References [1-8]

  1. Weiss, C.R., et al., Bariatric Embolization of the Gastric Arteries for the Treatment of Obesity. J Vasc Interv Radiol, 2015.
  2. Borer, K.T., et al., Appetite responds to changes in meal content, whereas ghrelin, leptin, and insulin track changes in energy availability. J Clin Endocrinol Metab, 2009. 94(7): p. 2290-8.
  3. Disse, E., et al., Systemic ghrelin and reward: effect of cholinergic blockade. Physiol Behav, 2011. 102(5): p. 481-4.
  4. Karra, E., A. Yousseif, and R.L. Batterham, Mechanisms facilitating weight loss and resolution of type 2 diabetes following bariatric surgery. Trends Endocrinol Metab, 2010. 21(6): p. 337-44.
  5. Moran, T.H. and M.J. Dailey, Intestinal feedback signaling and satiety. Physiol Behav, 2011. 105(1): p. 77-81.
  6. Stensel, D., Exercise, appetite and appetite-regulating hormones: implications for food intake and weight control. Ann Nutr Metab, 2010. 57 Suppl 2: p. 36-42.
  7. Dockray, G.J., Gastrointestinal hormones and the dialogue between gut and brain. J Physiol, 2014. 592(Pt 14): p. 2927-41.
  8. Barja-Fernandez, S., et al., Peripheral signals mediate the beneficial effects of gastric surgery in obesity. Gastroenterol Res Pract, 2015. 2015: p. 560938.




Participants lose 35% of their body weight in 100 days.


Here is what we found out. Obese individuals are missing two critical tools that block them from losing weight on their own: they lack capacity and they lack efficiency. If we provide those two things – then folks consistently lose 35% of their body weight in 100 days.


  • Capacity.  The idea of taking one’s body the way it is now (overweight and sedentary) and using it to burn calories for weight loss is ludicrous. It’s like saying you are going to take your 1998 Chevy Cavalier and race in the Indy 500. Sure, the drivers on the Indy 500 are cool and attractive and popular – just like the fitness models we are trying to look like – but they have high end machines that trump the Cavalier.  Likewise, the fitness folks who burn significant numbers of calories have exercise capacity that obese folks don’t have. Plain and simple – it cannot be done from scratch. An overweight person who tries to lose weight on mainstream diets without having capacity first, has a 95% chance of failing. [1-5]


  • Efficiency.  If you start lifting heavy rocks every day, your body will adjust by strengthening your hands and developing callouses. If you are fair skinned and start going into the sun every day, your body will change your skin color to tan to adjust and protect. If you are a smiley in-shape kale eating fitness person, your body will react by changing the way it digests your food. It will be efficient and take only what it needs from each meal, discharging the rest. Eating 1000 calories means the body holds on to the 200 it needs, and burns the rest. This is categorically different when compared to an obese person who eats 1000 calories. Their bodies hold on to the 200 they need, and store the rest as fat. So, when you see Sally Yogapants eating 15 cookies at the office birthday party and wonder how the heck she does it – she is efficient. Most of you are not. [6-9]


That’s it. No kidding. 95% of obese people who continue to try and lose weight starting on “day 1” with a program written by (and for) fitness people who are already in shape will fail. It’s like having a Ivanka Trump write a “how to be successful” book for poor, Spanish speaking kids from an inner-city. The obese population needs “how to” instructions written from a different perspective. And two of the things that we have shown need to be in there are roadmaps capacity and efficiency.

The good news is this. I am on your side. I am building a bridge from where you are now, to the crystal castle city where all the fitness fairies live. Because I love you 😊 Thanks for reading.





  • Desgorces, F.D., et al., Onset of exercise and diet program in obese women: metabolic and anorexigenic responses related to weight loss and physical capacities. Horm Metab Res, 2015. 47(7): p. 473-8.
  • da Silva, R.P., et al., Improvement of exercise capacity and peripheral metaboreflex after bariatric surgery. Obes Surg, 2013. 23(11): p. 1835-41.
  • Wycherley, T.P., et al., Comparison of the effects of weight loss from a high-protein versus standard-protein energy-restricted diet on strength and aerobic capacity in overweight and obese men. Eur J Nutr, 2013. 52(1): p. 317-25.
  • Banasik, J.L., et al., Low-calorie diet induced weight loss may alter regulatory hormones and contribute to rebound visceral adiposity in obese persons with a family history of type-2 diabetes. J Am Assoc Nurse Pract, 2013. 25(8): p. 440-8.
  • Katz, D.L., Pandemic obesity and the contagion of nutritional nonsense. Public Health Rev, 2003. 31(1): p. 33-44.
  • Knuth, N.D., et al., Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring), 2014. 22(12): p. 2563-9.
  • Redman, L.M., et al., Effect of calorie restriction with or without exercise on body composition and fat distribution. J Clin Endocrinol Metab, 2007. 92(3): p. 865-72.
  • Konarzewski, M. and A. Ksiazek, Determinants of intra-specific variation in basal metabolic rate. J Comp Physiol B, 2013. 183(1): p. 27-41.
  • McMurray, R.G., et al., Examining variations of resting metabolic rate of adults: a public health perspective. Med Sci Sports Exerc, 2014. 46(7): p. 1352-8.



Maybe you just don’t have the Willpower Gene?


At any given time in America, there are more than 200 million people on a diet. Each one of these people averages 4-5 formal attempts to lose weight each year, and more than 95% of them fail. (1-4) The explanations for this phenomenon? Laziness. Weakness. Lack of Willpower.


Science has shown us, though, that these perpetuated myths are not the cause of diet failures. Weight loss programs are abandoned in a predictable fashion because of known changes that occur in response to calorie restriction and new exercise, including hunger hormone reactions, basal metabolism alterations, and brain signaling modifications. (5-13)


So why does anyone think that “willpower” is the culprit? Because the lean folks do not feel what the overweight dieter feels when faced with the same stressors. As a result, a powerful misconception has been created and sustained over time: Overweight and obese individuals cannot change their positions in life because they are unable to endure exercise and calorie restriction due to the absence of willpower. Conversely, the lean population (including most authors of mainstream diet and exercise programs) have been blessed with strength, perseverance, and excellence – which is why they can follow these same schedules without quitting. False!


The physical cascade responsible for the exhaustion, discomfort, and hopelessness that overweight people feel during the early days of every new diet has been defined, and it has been clearly shown that the idea of making a change is a completely different project than maintaining one’s physique.


So no, your struggles with diet have absolutely nothing to do with “willpower,” or mental fortitude, or perseverance, or inner strength. It has to do with hormone changes, metabolism stubbornness, gut microbiota, and stress rebound – and it is all based in survival. No amount of willpower or mental fortitude can overcome these systems, which is why the failure rate remains at 95%. Your struggle is real, and those with normal or near normal body composition don’t feel it, so they paste you with negative labels.


Don’t lose hope though, the obesity medicine research community has identified ways to mitigate the response you feel. We’ll get you there. And God loves you. So in the meantime please just smile, relax, and know that the help is on the way.


Happy New Year!



  1. Staff AN. 100 Million dieters, $20 Billion: The Weight Loss Industry by the Numbers ABC News2012 [Available from: http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197.
  2. Ard JD, Miller G, Kahan S. Nutrition Interventions for Obesity. Med Clin North Am. 2016;100(6):1341-56.
  3. Dulloo AG, Montani JP. Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: an overview. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2015;16 Suppl 1:1-6.
  4. Dulloo AG, Jacquet J, Montani JP, Schutz Y. How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2015;16 Suppl 1:25-35.
  5. Weiss CR, Gunn AJ, Kim CY, Paxton BE, Kraitchman DL, Arepally A. Bariatric Embolization of the Gastric Arteries for the Treatment of Obesity. Journal of vascular and interventional radiology : JVIR. 2015.
  6. Karra E, Yousseif A, Batterham RL. Mechanisms facilitating weight loss and resolution of type 2 diabetes following bariatric surgery. Trends in endocrinology and metabolism: TEM. 2010;21(6):337-44.
  7. Chandarana K, Batterham RL. Shedding pounds after going under the knife: metabolic insights from cutting the gut. Nature medicine. 2012;18(5):668-9.
  8. Beckman LM, Beckman TR, Sibley SD, Thomas W, Ikramuddin S, Kellogg TA, et al. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass surgery. JPEN Journal of parenteral and enteral nutrition. 2011;35(2):169-80.
  9. Neff LM. Sleep Deprivation, Hunger and Satiety Hormones, and Obesity. Nutr Clin Care. 2005;8(1):2-5.
  10. Feinle-Bisset C. Modulation of hunger and satiety: hormones and diet. Curr Opin Clin Nutr Metab Care. 2014;17(5):458-64.
  11. Yamamoto H, Kaida S, Yamaguchi T, Murata S, Tani M, Tani T. Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery. Surg Today. 2016;46(3):268-74.
  12. Galanakis CG, Daskalakis M, Manios A, Xyda A, Karantanas AH, Melissas J. Computed tomography-based assessment of abdominal adiposity changes and their impact on metabolic alterations following bariatric surgery. World J Surg. 2015;39(2):417-23.
  13. Ganguly S, Tan HC, Lee PC, Tham KW. Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist’s perspective. J Biomed Res. 2015;29(2):105-11.



Magic Coins that Keep You on Your Diet

If I had a bucket of magic coins, and each time you felt liking quitting your diet all you had to do was reach in and grab one to get rid of those feelings, would you be interested? Couldn’t you then stay on your diet? Of course you good. Here is the good news, you can do it without the magic. The “coins” that keep you on your diet in real life are called recovery.

When you exercise, it’s like swallowing a stick of dynamite. Wastes build up, muscles are weakened, your nervous system is shocked, you get dehydrated, and stress hormones are produced. (1-8)  The traditional teaching then, is to push through this feeling and swallow some more dynamite on day 2. And 3, and 4, and so on (until you quit). In the 21st century though, science has shown us that this bullheaded approach is neither necessary nor effective.  The road to success is paved with changes harnessed through peaceful, individual recovery from exercise.

Golden background with natural bokeh defocused sparkling lights

These changes occur with a real time feedback loop that lets you know where you are, just like a bar in a video game that tells you how much life your character has left. That is, in many video games the main character runs around trying to beat levels but slowly runs out of energy, or ammo, or whatever. You have to find something to replenish them before you move on. If you just start the game and run your guy forward without paying attention to refuel options, you will pretty quickly die and go back to the beginning. Similarly, most folks mistakenly think that because you miss a workout, eat some cake, or feel like crap, that you should bail and start over some other time – when in fact you just need to find a mushroom or a magic coin to charge up.  These energy sources are available in life by delaying and modifying the next workout and supplementing your diet.  Likewise, if you ignore your recovery signals and hit the gym before these changes occur, you are sealing your own short term fate, and may end up worse off than when you started.

What is this timeline for recovery then? It varies. We know that muscles burn calories and synthesize protein for at least 48 hours after your workout, changes occur in your heart and blood vessels for 48-72 hours, stress hormones are up for 18-24 hours, and that inflammatory changes persist for 24-72 hours.  (6, 7, 9-12) All of these processes give you feelings of soreness, fatigue, motivational drops, or even depression. The key is to recognize this feedback, and time your workouts appropriately. Stop focusing on the undoable – and build a program around recovery.





  1. Morton JP, Kayani AC, McArdle A, Drust B. The exercise-induced stress response of skeletal muscle, with specific emphasis on humans. Sports medicine. 2009;39(8):643-62.
  2. Svendsen IS, Killer SC, Gleeson M. Influence of Hydration Status on Changes in Plasma Cortisol, Leukocytes, and Antigen-Stimulated Cytokine Production by Whole Blood Culture following Prolonged Exercise. ISRN nutrition. 2014;2014:561401.
  3. Coyle EF. Physical activity as a metabolic stressor. The American journal of clinical nutrition. 2000;72(2 Suppl):512S-20S.
  4. Godin R, Ascah A, Daussin FN. Intensity-dependent activation of intracellular signalling pathways in skeletal muscle: role of fibre type recruitment during exercise. The Journal of physiology. 2010;588(Pt 21):4073-4.
  5. Xing JQ, Zhou Y, Fang W, Huang AQ, Li SB, Li SH, et al. The effect of pre-competition training on biochemical indices and immune function of volleyball players. International journal of clinical and experimental medicine. 2013;6(8):712-5.
  6. Margaritelis NV, Kyparos A, Paschalis V, Theodorou AA, Panayiotou G, Zafeiridis A, et al. Reductive stress after exercise: The issue of redox individuality. Redox biology. 2014;2:520-8.
  7. Astorino TA, Schubert MM. Individual responses to completion of short-term and chronic interval training: a retrospective study. PloS one. 2014;9(5):e97638.
  8. Nascimento Dda C, Durigan Rde C, Tibana RA, Durigan JL, Navalta JW, Prestes J. The response of matrix metalloproteinase-9 and -2 to exercise. Sports medicine. 2015;45(2):269-78.
  9. Phillips SM. A brief review of critical processes in exercise-induced muscular hypertrophy. Sports medicine. 2014;44 Suppl 1:S71-7.
  10. Drygas W, Rebowska E, Stepien E, Golanski J, Kwasniewska M. Biochemical and hematological changes following the 120-km open-water marathon swim. Journal of sports science & medicine. 2014;13(3):632-7.
  11. Buchheit M, Laursen PB. High-intensity interval training, solutions to the programming puzzle: Part I: cardiopulmonary emphasis. Sports medicine. 2013;43(5):313-38.
  12. Neubauer O, Konig D, Wagner KH. Recovery after an Ironman triathlon: sustained inflammatory responses and muscular stress. European journal of applied physiology. 2008;104(3):417-26.



Dear Obese Woman, it is not your fault.

Middle class Caucasian housewife holding a help sign looking at the camera

How many years have we been listening to the diet gurus and fitness experts tell us, “you really gotta want it,” and “it’s all about willpower.” Too many.

Listen, each morning I wake up early before my cases begin, and I work on this blog. My friend Jon presses snooze 4-5 times every morning and can barely get to work within 30 minutes of his start time.  Jon and I are structured differently. I don’t feel like I can’t wake up. In fact, I wake up automatically before any alarm goes off because of the way I am built. I literally have no idea what Jon feels like in the morning because my brain and organs aren’t structured like his so I don’t feel what he feels. As a result, I may be tempted to say, “I wake up early because God has made me a supreme human being with will power, determination, and guts to succeed. I choose to work hard and resist the urge to sleep because I am strong.” Sure that would make me feel good, but really – I just wake up.

The same applies to all the smiley, beautiful, in-shape people that love to tell themselves (and everyone else who will listen) that they have been successful because they possess will power, endure pain, embody strength, focus, and so on. But the truth is that they don’t resist the urge to eat or be lazy any more than I resist the urge to sleep in. Honestly, are we to believe that these people who go to the gym 6 times/week, drink smoothies, tan, and carry those yoga mats everywhere are experiencing pain? They are not, because at some point in their lives they got over the hump, and now it’s fun.

The idea that an average Joe (or Jane) cannot follow “Ninja Abs in 90 Days,” and be successful, is not new. In fact, the cycle of ramping up for a new diet, buying books and DVDs and notebooks, starting said new diet, and failing shortly thereafter – only to restart this cycle a few weeks later – has been well described. (1-5) From a business standpoint there is no real motivation to interrupt this cycle because each time it starts over consumers are back online looking for new products. As a result, savvy companies rewrite the same undoable plans and “feed the machine” that way in a predictable, forward fashion. As long as the market internalizes these failures (which, we are happy to do so often because of our low self-esteem), they will continue to consume the products and blame themselves for the lack of results. Can you imagine? It’s like selling a car that doesn’t run when you turn the key, but you’ve convinced the buyer that it’s because they lack sufficient willpower and worth to turn the key correctly.

Just as in reality there is a nuts and bolts explanation for why the key in our example above does not turn, so is there a real explanation for why obese patients are unable to turn the corner so far toward healthy living. Signals sent out by the brain to regular people when they stop eating are harsh, powerful, irresistible messages to stop the madness. (6-11) Traditional diet changes and calorie cuts send an alarming message to the brain: we’re starving! The brain then, following thousands of years of evolutionary learning, rains hell down on us until we stop it (this is the source of all the misery felt on day 7 or 8 or 9 of your new diet).

These signals are real, survival based, and impossible to overcome.[1] When I say there are connections between the body and the brain that won’t allow us to restrict our calories – I mean there are known molecules that have been well described which are accountable for people quitting their diets. (11-14) They have names. Leptin, ghrelin, GLP-1, PYY, and CCK, amongst others. (8, 11, 15, 16)

So the age of “no pain, no gain” has come to a close, and it is clear that the feelings of horrible hunger pangs, desperation, anxiety, and depression are unique to those trying to make a change (vs. those who are already lean). It is further clear that these feelings are mediated by a defined set of hunger hormones that can be changed through surgery, some medicines, or through behaviorally induced retrograde neuroplasticity – changing the brain from the outside in.


[1] To be fair, you probably know someone who white knuckled it through a diet and lost weight. We are talking about the majority of people here, though – not the outliers.








  1. Staff AN. 100 Million dieters, $20 Billion: The Weight Loss Industry by the Numbers ABC News2012. Available from: http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197.
  2. Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States. Annals of internal medicine. 2005;142(1):56-66. PubMed PMID: 15630109.
  3. Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, et al. Efficacy of commercial weight-loss programs: an updated systematic review. Annals of internal medicine. 2015;162(7):501-12. doi: 10.7326/M14-2238. PubMed PMID: 25844997; PubMed Central PMCID: PMC4446719.
  4. Walter R. Worldwide Survey of Fitness Trends for 2016. American College of Sports Medicine Health and Fitness Journal. 2015;19(6):9-18.
  5. Greene GW, Rossi SR, Rossi JS, Velicer WF, Fava JL, Prochaska JO. Dietary applications of the stages of change model. Journal of the American Dietetic Association. 1999;99(6):673-8. doi: 10.1016/S0002-8223(99)00164-9. PubMed PMID: 10361528.
  6. Berthoud HR. Homeostatic and non-homeostatic pathways involved in the control of food intake and energy balance. Obesity. 2006;14 Suppl 5:197S-200S. doi: 10.1038/oby.2006.308. PubMed PMID: 17021366.
  7. Berthoud HR. Neural control of appetite: cross-talk between homeostatic and non-homeostatic systems. Appetite. 2004;43(3):315-7. doi: 10.1016/j.appet.2004.04.009. PubMed PMID: 15527935.
  8. Chandarana K, Batterham RL. Shedding pounds after going under the knife: metabolic insights from cutting the gut. Nature medicine. 2012;18(5):668-9. doi: 10.1038/nm.2748. PubMed PMID: 22561824.
  9. Howe SM, Hand TM, Manore MM. Exercise-trained men and women: role of exercise and diet on appetite and energy intake. Nutrients. 2014;6(11):4935-60. doi: 10.3390/nu6114935. PubMed PMID: 25389897; PubMed Central PMCID: PMC4245573.
  10. Gardiner JV, Jayasena CN, Bloom SR. Gut hormones: a weight off your mind. Journal of neuroendocrinology. 2008;20(6):834-41. doi: 10.1111/j.1365-2826.2008.01729.x. PubMed PMID: 18601707.
  11. Weiss CR, Gunn AJ, Kim CY, Paxton BE, Kraitchman DL, Arepally A. Bariatric Embolization of the Gastric Arteries for the Treatment of Obesity. Journal of vascular and interventional radiology : JVIR. 2015. doi: 10.1016/j.jvir.2015.01.017. PubMed PMID: 25777177.
  12. Minett GM, Duffield R. Is recovery driven by central or peripheral factors? A role for the brain in recovery following intermittent-sprint exercise. Frontiers in physiology. 2014;5:24. doi: 10.3389/fphys.2014.00024. PubMed PMID: 24550837; PubMed Central PMCID: PMC3909945.
  13. Peinado AB, Rojo JJ, Calderon FJ, Maffulli N. Responses to increasing exercise upon reaching the anaerobic threshold, and their control by the central nervous system. BMC sports science, medicine and rehabilitation. 2014;6:17. doi: 10.1186/2052-1847-6-17. PubMed PMID: 24818009; PubMed Central PMCID: PMC4016642.
  14. Kjaer M, Secher NH. Neural influence on cardiovascular and endocrine responses to static exercise in humans. Sports medicine. 1992;13(5):303-19. PubMed PMID: 1565926.
  15. Karra E, Yousseif A, Batterham RL. Mechanisms facilitating weight loss and resolution of type 2 diabetes following bariatric surgery. Trends in endocrinology and metabolism: TEM. 2010;21(6):337-44. doi: 10.1016/j.tem.2010.01.006. PubMed PMID: 20133150.
  16. Beckman LM, Beckman TR, Sibley SD, Thomas W, Ikramuddin S, Kellogg TA, et al. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass surgery. JPEN Journal of parenteral and enteral nutrition. 2011;35(2):169-80. doi: 10.1177/0148607110381403. PubMed PMID: 21378246; PubMed Central PMCID: PMC4284080.