Satiety-Focused Weight Health
“calories control the skirmishes, but satiety ultimately determines the winning or losing of the game”
“you cannot win a fight with an ancient, extremely complex basic body system that is wrapped into every part of your functioning – it’s better to make nice”
Satiety-focused weight health is proposed as a foundational model on which to build an approach to supporting each individual’s efforts to attain and maintain a body composition and weight most compatible with their long-term health, in the context of their goals, their choices, their individual circumstances and their inherent body tendencies. Of course, this is not new and many, many people have already put a lot and a lot of effort into this way of thinking over a long time. I think it is worth specifically naming in order to facilitate communication and to encourage the development of a cohesive set of strategies. Surely others will come up with better ways of expressing this and better conceptual models.
In this model, sustained or excess hunger is regarded as a symptom requiring attention, investigation and problem-solving. Sustained or excess hunger is also regarded as counter-productive, and something to be responded to by eating. Therefore, the determination of whether hunger is excess is made principally by tracking changes in body composition as accurately as possible with today’s limited tools.
Calorie balance is monitored by tracking changes in body composition over time. General health, individual circumstance, over-all quality of life and individual goals take precedence over total body fat when considering body composition targets. If reduction in body fat stores is desirable and this is not occurring, interventions are chosen that don’t require restriction of food intake in the face of sustained hunger (no imposition of a calorie cap). The interventions are designed to facilitate achieving satisfactory satiety while undergoing weight loss. Failure to see improvement in body fat levels over time is a valuable feedback from the body that more needs to be done to reduce appetite drive and facilitate satiety. Any attempt to impose a calorie cap will ruin this essential feedback and sabotage progress towards a successful long-term strategy (which will actually be composed of a combination of strategies).
Of course, every effort is already being taken to help with hunger as much as possible during weight loss interventions. The shift is in the concept going from (1) the calorie cap being the prime and beneficial intervention, with hunger being addressed secondarily as much as possible within the calorie cap to (2) the achievement of satiety while body energy stores remain stable or intentionally decrease as the prime and beneficial target, with excess hunger (and attitudes supporting the tolerance of excess hunger as desirable behaviour) being potentially harmful.
Will this style of intervention be enough to meet the needs of all those who would benefit medically by reduction in body fat content? As of today, no, nope, I don’t think so. I do think that as of today we have the knowledge and interventions to make satiety-focused weight health the preferred medical pathway for the vast majority of those whose health is being affected by excess body fat and/or by fat within the abdomen (including, that is, people within the normal weight range who are “metabolically obese”).
Satiety-Focused Weight Health is a model in process.
It requires consideration of three hypotheses:
- there is enough evidence to determine that sustained or excess hunger as a side-effect of weight loss interventions is inherently harmful and this harm outweighs the benefits (and/or lack of evidence to the contrary).
- there is enough evidence to determine that there is inherent harm to the individual and to the public at large in any professional or “official” advice that gives or supports the attitude that subjecting oneself to sustained hunger, for the prospect of better health (loss of excess weight) is a good thing and that people who do this are following medical advice (and/or lack of evidence to the contrary).
- we have enough knowledge base now to make a satiety-focused approach to weight health a practical reality for the great majority of people (maybe not for those with certain genetic causes or unusually difficult circumstances). When normal function of the body weight control system is not achieved by means of appropriate food choices and the, in practical terms, best effort to achieve best health and elimination of things that interfere with proper appetite/satiety balance – nutritional ketosis can be considered as a tool for assistance with management of hunger.
I am putting forth the challenge that it is time to give careful thought, discussion and research to each of these hypotheses. (Standing with many others in this regard.)
If the medical advice for calorie restriction in the face of sustained or excess hunger is determined to cause harm, then I fear that if we are to be saved there must be a formal, sustained public education campaign refuting the use of Hunger-Inducing-Therapies, and everything that finds it’s root in HIT. This includes daily/weekly restrict/re-bound cycling and strategic meal skipping/skimping, which might also increase the risk of food “addiction” and/or brain sensitization. Obviously, I may be wrong about this, and much more discussion and evidence needs to be brought to bear. But, as far as I can see, there is no proof of the long-term safety and efficacy of Hunger-Inducing-Therapies as a treatment for high body fat composition. I don’t even think the safety aspect has been the subject of any significant research effort.
I also acknowledge that there has been a great effort into finding ways to reduce or eliminate hunger while undergoing calorie restriction intended to achieve reduction in high body fat load. Most people working in the field have moved away, even well away, from meer acceptance of the side-effect of sustained hunger as part of treatment. There is also the movement rejecting dieting and the many people who have come to think that it can be healthier to accept one’s current high weight rather than continuing to undergo cycles of calorie-restricted dieting. Thus, the approach to the individual patient under medical care has shifted and continues to shift.
The great problem is that the idea of calorie restriction and the perception of Hunger-Inducing strategies as safe and effective (and “good” behaviour) has become pervasive in the culture for decades I think this cultural effect has probably caused even more damage than the harms to individuals specifically prescribed such diets. I think the result has been a rolling disaster and nothing but a massive “official” effort to refute this attitude will undo the damage.
Would somebody please prove me wrong.
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For a keeper (a person with a tendency to easily put on increased body fat) everything about their health and their life will be involved in their ability to attain/maintain their best body composition. So there are 1,000s of potential interventions and I do not want to repeat here lists of things that have been said before.
The most important of the helpful interventions that are not widely discussed are written about under my “Key Keys” page.
- the assessment of each individual’s carbohydrate tolerance at the present point in time and, as needed, adjustment of the type of carbohydrate and the total amount. For some people, simply eliminating sugars in liquid form and cutting back on other sweets may be enough. On the other side of the spectrum, some may only realize their best improvements in health by cutting total carbohydrate to 20 or 30 grams per day. The point of this is to achieve improvement in metabolic health, including the possibility of reduction in blood pressure (if elevated and depending whether there are other causes of the high blood pressure at play), improvement in blood sugar (if elevated), improvement in blood fats (if elevated). The useful clinical marker to determine when the needed carbohydrate target has been met is substantial improvement and commonly normalization of the triglyceride to HDL ratio. Most often, but not in every case, this is accompanied by significant weight loss.
- the strategic use of nutritional ketosis as a means of reducing hunger. This requires attention to both total carbohydrate intake while also avoiding high protein intake.
- the use of nutritional ketosis as a potential means to help various symptoms beyond appetite, which can improve health and thus improve the function of the appetite/satiety system.
- dealing with any issues of triggering foods or food “addictions”, and all other addictions as well, as they are likely to inter-play
- addressing disordered or chaotic eating patterns, from mild to diagnosable eating disorders
- strenuously targeting any sleep issues until, if at all possible, fully resolved
- finding ways of dealing with stress
- as individually appropriate, include activity, focusing on safety and avoiding injury. Place a stronger emphasis on activity as health and sense of well-being improves, as weight comes towards target and as a key strategy during maintenance
- targeting reduction of inflammation in the body – by all the above means and by systematically considering all other sources of inflammation relevent to that person.
- review medications to see if there are any that might be interfering with weight control and then to consider whether any adjustment to those medications can be made
- systematically target optimal status for all the essential nutrients
- systematically target all symptoms and medical problems
- etc, etc