NOTE: What’s New in the New Edition, 1 is here; and here is the Amazon book page.

Scribner wanted the new edition to show people how to lose weight. We were happy to do that. I’d been planning to devote 2012 to weight loss and obesity blog posts, and then to write an obesity and weight loss book in 2013. We just moved the schedule up and squeezed the ideas into Perfect Health Diet.

Our book offers a unique take on obesity and weight loss. Some of the science is original to us – the ideas do not appear in Pubmed – and the conclusions are unusual for diet books:

The best diet for weight loss is delicious and does not generate cravings or more than mild hunger. You can – and should! – lose weight with minimal suffering. The popular diets that generate the quickest short-term weight loss are not optimal for long-term sustainable weight loss; they are prone to yo-yo weight regain. Unlike those diets, the Perfect Health Diet offers a path to lasting weight less and permanent restoration of normal weight and normal body composition.

If we’re right about the science and these conclusions, then our book could be a game-changer for weight loss.

Filling in Some Missing Context

The major defect of squeezing our obesity & weight loss material into Perfect Health Diet, instead of distributing it over two books, is that we didn’t have space to provide a lot of context to the obesity material. Our stage-setting chapters were devoted to the general question of “what’s a healthy diet” and were framed with a discussion of Michael Pollan’s food rules, not with discussion of issues specific to obesity and weight loss.

So let me add some context here.

The Recipe for a Popular Weight Loss Book

The recipe for a popular weight loss book seems to be:

Declare that doltish mainstream authorities are stuck in some absurdly mistaken view, and their loyalty to this paradigm has led them to overlook the key to weight loss.

The key to weight loss is simple: give up a single villainous food.

This formula has been followed to good effect by Dr. William Davis (Wheat Belly) who vilifies wheat, Gary Taubes (Good Calories, Bad Calories and Why We Get Fat) who vilifies carbs in general or sugar specifically, and Dr. Robert Lustig (Fat Chance) who vilifies sugar.

The view that authors attribute to mainstream authorities is, often, a straw man. Here is Gary Taubes in his Reddit “Ask Me Anything” describing the absurdly mistaken view that he calls “calories in, calories out”:

Imagine we have a pair of identical twins. Say 18-year-old boys. Every day we measure their energy expenditure and every day we feed them exactly how many calories they expend. So we match calories in to calories out. They get both the same diet with one exception: one gets 300 calories of sugar or HFCS where the other gets 300 calories of a different carbohydrate or of fat. Then we continue this feeding experiment for the next 20 years or so…. If you believe obesity is about calorie-in-calories-out and that’s the only thing that matters, then both twins are going to end up exactly the same weight with exactly same amount of fat on their body and they’re both going to end up expending the same amount of energy.

The view he is describing is that dietary quality doesn’t matter a whit, only quantity of calories matters: the only thing that affects body weight, fat mass, and energy expenditure is how many calories were consumed, and how many calories are consumed isn’t affected by dietary quality.

In other words, a diet of nothing but cotton candy, Twinkies, and Coca-Cola would generate after 20 years exactly the same body composition and health as a diet of fish, rice, and vegetables.

Is there a single person in the world who holds this view?

Here is a review of Dr. Lustig’s Fat Chance:

The book repeats and expands on the main point of contention in the sugar wars: whether our bodies treat all calories the same. The old guard says yes: A calorie is a calorie; steak or soda, doesn’t matter. Eat more calories than you burn, you’ll gain weight. Lustig believes that our bodies react to some types of calories differently than others. [PAJ: emphasis added]

The “old guard” does not always take kindly to the assertion that it never occurred to them that the body might react differently to different foods. The article notes:

[A] leading endocrinologist, who asked to go unnamed, called Lustig an “idiot.”

These are times when I wish our diet approved of popcorn!

Now, let me be clear: these authors are giving good advice. Indeed, we give the same advice. With Drs. Davis and Lustig, we recommend eliminating wheat and added sugar; with Taubes, we believe the average American should cut carb intake roughly in half. Taking these steps will help people lose weight.

But these books have significant flaws:

The advice is incomplete . There are many factors which promote obesity. Removal of a single factor will rarely normalize weight.

. There are many factors which promote obesity. Removal of a single factor will rarely normalize weight. The scientific background is misleading. It often seems that the goal is not so much to provide insight, as to set up a compelling and entertaining narrative. The story reads like the script of a Hollywood action movie: a frightening and mysterious problem appears which befuddles everyone – a solution is proposed – a hero implements the solution.

Perhaps it is not possible to write books more popular than these, but I think it is possible to write books that provide more insight and have a better chance of delivering lasting weight loss to readers who are willing to invest effort.

Obesity is a complex disorder, and many factors contribute to it. I think we did a fairly good job of addressing many of those factors – enough to enable nearly all readers to lose weight effectively, but also to gain a deeper understanding of obesity and its causes.

The Puzzle of Fatty Acid Ratios

The focus on wheat, sugar, and carbs in the popular diet books ignores what may be the primary cause of the obesity epidemic. In my Q&A with Latest in Paleo readers, I gave six reasons why omega-6 fats promote obesity. Some of these are discussed in detail in the book.

Any explanation for the obesity epidemic should account for the accumulation of omega-6 fatty acids in the body that has coincided with the obesity epidemic:

This is a plot found on p 115 of the book; the data was compiled by Stephan Guyenet of Whole Health Source, the circles are the omega-6 fraction in adipose tissue, and the crosses are the obesity rate among 18-29 year olds. It is hard to make sense of this pattern if omega-6 fats are not causing the obesity epidemic. No carb-centric explanation for obesity will tend to make omega-6 fats accumulate this way. Unlike some of the other weight loss books, we make a good faith effort to explain data like this.

Why Do Low-Carb Diets Work?

The omega-6 accumulation is only one of a number of puzzles that a good theory of weight loss and weight gain should explain. Another is the efficacy of low-carb diets.

If carbs don’t cause obesity, why do low-carb diets promote weight loss?

This issue is explored in chapter 17, where we show reasons why reducing carbs to 30% of energy or less will be beneficial for weight loss, but also why there’s generally little long-term benefit from further reductions in carb intake. Low-carb is good, but very low-carb isn’t better for long-term weight loss.

The Problem of Yo-Yo Weight Loss

Another important puzzle: Why is yo-yo weight loss and regain so common?

Here is Jay Wright’s weight loss history, mentioned in the book at page 184:

Although he had successful short-term weight loss on a number of diets, including very low-carb Paleo, they always made him hungry and sooner or later the weight was regained.

On our diet, Jay reached his normal weight in October 2011. He emailed me a happy new year wish, and remains at his normal weight 15 months later – the first time since college he’s been able to maintain that weight.

Why did our diet normalize his weight permanently without hunger, when other weight loss diets led to hunger and weight regain? That is the primary subject of our chapter 17, and is one of our original contributions to the theory of obesity.

Malnutrition and Weight Gain

We argue that malnutrition is a potent cause of increased appetite and weight gain.

A theme of Weston A. Price’s Nutrition and Physical Degeneration is that pregnancy depletes nutrients in the mother, frequently leading (especially in closely spaced pregnancies) to malnutrition in both mother and child.

If we’re right, then this could be why pregnancies, especially closely spaced pregnancies, tend to produce maternal weight gain.

I got a New Year’s update from Jennifer Fulwiler, another source of a reader report in the book (on p 11). She’s now pregnant with her sixth child, and left a comment noting her much improved health this pregnancy:

I have been following the PHD for this pregnancy. The results have been amazing. In fact, with all five of my previous pregnancies I had debilitating, severe morning sickness. On the PHD, I had almost none!

In an email she gave further details:

My husband and I have a reality show that recently started airing [insert joke here about what we may have done to be deemed “reality show material”], and when the episodes air I’ve been engaging with fans on social media. One of the most common responses I get is that people are shocked that I look so healthy, since I’m pregnant with my sixth child in eight years. A lot of people just assume that women who have many and/or closely spaced pregnancies simply have to be overweight. I used to assume that too. In fact, that had been my personal experience: I seemed to add a few pounds with each pregnancy, and after I had my fifth child I found myself tired, achy, and 35 pounds overweight. Thanks to the PHD I lost all the weight, and when the show was filmed, in my first trimester of pregnancy with my sixth child, I weighed the same as I did the day I got married, and felt better than I ever had in my life. A lot of people who watched the show asked me what my secret was, and of course I directed them to the PHD!

Here’s the first episode of Jennifer’s reality show:

She does indeed look healthy, energetic, and more than a match for a Texas scorpion!

Conclusion

I mentioned the other day that we got a 4* review at Amazon:

This diet has controlled my cravings. After almost 40 years of interest in and great benefits from proper nutrition, I believe this is as close to perfect eating as we can get…. I didn’t give it 5 stars for two reasons: 1. no recipes…but can get those online and 2. very technical, leaving more explanation or clarification.

That about covers the pros and cons of our book as a weight loss guide. Our story isn’t quite as simple as the other diet books. Perfect Health Diet doesn’t resemble a Hollywood action movie.

But if you want to understand the science and find a successful program for long-term weight loss, we’re the best choice on the market. Perfect Health Diet will eliminate cravings and hunger, get you close to perfect eating, and help you normalize weight for the rest of your life.