#letsrecover

Debunking in process:

(1) Guyenet, Stephan, 2009, ‘'The body fat setpoint”, Whole health source:  After 6 weeks of massive overfeeding, both lean and overweight subjects gained an average of 10 lb (4.6 kg) of fat mass and 6.6 lb (3 kg) of lean mass. Consistent with what one would expect if the body were trying to burn off excess calories and return to baseline fat mass, the metabolic rate and body heat production of the subjects increased.

So, the studied subjects gained weight when overfed, which resulted in an increased metabolic rate and heat production.  No new information -- the fact that metabolic rate increases as body weight increases is well-known and glaringly obvious.

So yes, we are overweight because we eat too many calories relative to energy expended. But why are we eating too many calories? There are a number of reasons, but one reason is that the system that should be defending a low fat mass is now defending a high fat mass. Therefore, the ideal solution is not simply to restrict calories, or burn more calories through exercise, but to try to work with the system that decides what fat mass to 'defend'. Restricting calories isn't necessarily a good solution because the body will attempt to defend its setpoint, whether high or low, by increasing hunger and decreasing its metabolic rate. That's why low-calorie diets, and most diets in general, typically fail in the long term. Restricting calories works for fat loss, but most people find it miserable to fight hunger every day.

Unfortunately, recent studies have shown that set point can increase but rarely, if ever, decreases, according to neuroscientist Dr. Sandra Aamodt, who speaks at TEDGlobal about why dieting does not work:  "From an evolutionary perspective, your body's resistance to weight loss makes sense. When food was scarce, our ancestors' survival depended on conserving energy, and regaining the weight when food was available would have protected them against the next shortage. Over the course of human history,starvation has been a much bigger problem than overeating. This may explain a very sad fact: Set points can go up, but they rarely go down. [...] Sadly, a temporary weight gain can become permanent. If you stay at a high weight for too long,probably a matter of years for most of us, your brain may decide that that's the new normal. [1]"  Congratulations, followers of MinnieMaud, you now have a new set point.

(2) El Ghoch, Marwan et.al, 2014, ‘’Anorexia Nervosa and Body Fat distrubution: A systematic review”, MDPI:  "Partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females [...]  After short-term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy age-matched controls. [...] The abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration, indicating that preferential central distribution of body fat is a transitory phenomenon.

Again, no new information is presented.  Trunk adiposity redistributes with the maintenance of weight restoration.  This information does not support MinnieMaud in any way, as Gwenyth Olwyn asserts that that increased trunk adiposity will occur in any patient with a restrictive eating disorder.  However, the phenomenon has only been indicated in patients recovery from anorexia nervosa in which he or she lost a significant amount of central body fat, resulting in a low total body fat percentage.

(3) M. Kalm, Lea & D. Semba, Richard, 2005, ”They starved so that others could be better fed: Remembering Ancel Keys and The Minnesota starvation study”, The Journal of Nutrition:  Enough food must be supplied to allow tissues destroyed during starvation to be rebuilt … our experiments have shown that in an adult man no appreciable rehabilitation can take place on a diet of 2000 calories [actually 2000 kcal (8368 kJ)] a day. The proper level is more like 4000 [4000 kcal (16,736 kJ)] daily for some months. The character of the rehabilitation diet is important also, but unless calories are abundant, then extra proteins, vitamins and minerals are of little value.

Unsurprising, even the Minnesota Starvation Experiment does not support MinnieMaud, as patients recovering from anorexia nervosa often need around 3,000 - 4,000 calories to restore weight for several months.  However, this data should not be extrapolated to all sufferers of restrictive eating disorders.

(4) Tetyana, 2014 ”Hypermetabolism in Anorexia nervosa”, Science of Eating Disorders:  After achieving a healthy weight, individuals recovering from anorexia nervosa still typically need to eat more calories to maintain their new healthy weight — more than healthy individuals of the same weight who do not have eating disorder histories — usually at least 50 to 60 calories per kilogram per day (e.g., about 2500-3000 calories for an individual weighing 50 kg (110 lb). This hypermetabolic periods tends to last between 3 – 6 months after weight restoration

My favorite science writer, Tetyana!  She is an amazing and concise writer with an excellent grasp on the nuances of scientific research and the human brain.  Regardless, the studies Tetyana reviews involve refeeding and weight gain in patients with anorexia nervosa.  However, those studies do not advocate the need for increased caloric intake after three to six months.  The only way to know how much a patient will need during and after weight restoration is to consult a medical doctor and a dietitian -- not Guru Gwyneth or Senpia Sarah.

(5) ES Mayer, Laurel et.al, American Society for Nutrition, 2009 ”Adipose tissue distribution after weight restoration and weight maintenance in women with anorexia nervosa”, The American journal of clinical nutrition

I do not even have to look at this study to voice my main objection:  disproportionate trunk adiposity is common among patients recovering from anorexia nervosa.  Yes, weight redistribution and adiposity will normalize with the maintenance of a stable weight.  However, studies concerning adipose tissue distribution only support weight redistribution as an occurrence, not the MinnieMaud guidelines.

(6) E. Schebendach et.al, 2008, ”Dietary energy density and diet variety as predictors in outcome of anorexia nervosa”, The Americal journal of clinical nutrition:  Basically, this study correlated decreased diet variety and decreased energy density to increased risk of relapse.  The study found that the caloric value between the success and failure groups did not differ significantly;  however, patients within the failure group were more likely to have fat intakes of less than the recommended 30% total intake.

This study is very interesting!  However, I do not see how the data presented within supports MinnieMaud.  Patients with decreased diet variety and restricted fat intake were more likely to relapse.  Even more interestingly, the study advocated for a healthy, moderate diet that includes a variety of foods:  "Maintenance of a healthy diet is central to the recovery process."  A healthy diet involves an intake of approximately 30% fat, which not commonly seen in followers of MinnieMaud, especially individuals  who consume a pint of Ben and Jerry's  ice cream, which contains over 80% of the daily recommended fat for an intake of 2,000 calories and close to 70% the daily recommended fat for an intake of 2,500 calories.

(7) Arnold, Carrie, 2013 ”Eating disorders and laxative abuse: What you need to know”, ED bites(8) Arnold, Carrie, 2013 ”Puberty and eating disorders - the perfect storm”, ED bites

Carrie Arnold is another of my favorite science writers.  I have no complaints about any of her articles, as she is well-researched and articulate in her findings.  Regardless, these articles are not supportive or even relevant to MinnieMaud, just excellent information.

(9) Bamford, B. et. al, 2014 ”Eating disorder symptoms and quality of life: Where should clinicians place their focus in severe and enduring anorexia nervosa?” International Journal of Eating Disorders:  

Findings suggest that improvements in [quality of life] may be dependent on symptom change and weight gain. Treatments seeking solely to improve QoL may be unlikely to produce lasting change and clinicians should maintain a focus on weight and behavioral symptoms as much as on improvements in QoL.

Once again, this study involves patients suffering from severe, chronic anorexia nervosa and does not present any information that is particularly surprising -- weight gain and symptom reduction results in a higher quality of life.

(10) Arnold, Carrie, 2013 ”When dieting gets dangerous”, ED bites(11) Arnold, Carrie, 2013 ”Exactly whose weight are you over?”, ED bites:  Certainly, if you’re completely sedentary, have velcroed your sweatpants-covered ass to the couch and do nothing all day but stuff Twinkies in your gob, then you might have some changes you wish to make for your overall well-being. But if you eat a varied diet, if you move your body, if all measures of health are good, and your weight is stable, then let me ask again: exactly whose weight are you over? You might be overweight relative to population norms but at a perfectly healthy weight FOR YOU.

Yay, Carrie Arnold!  She makes a valid point in that population norms cannot accurately be applied to individuals.  However, I still do not see how this article supports MinnieMaud, which does not advocate for a varied diet or healthy movement for the body.  Also, while this article may have the strongest relation to MinnieMaud and while Carrie Arnold is a fantastic writer, this article is still an opinion piece and not based on scientific studies.

In summary, the bloggers at letsrecover tried and failed to "science."  Cute.

References:

[1]  Dr. Sandra Aamodt's TED Talk "Why Diets Don't Work" summarizes data from the following studies:

Matheson et al.  2012.  Healthy lifestyle and habits and mortality in overweight and obese individuals.  Journal of the American Board of Family Medicine 25(1):  9 - 15.

Blair, S. N. and Church. T. S.  2004.  The fitness, obesity, and health equation.  Journal of the American Medical Association 292(10):  1232 - 1233.

Flegal et al.  2012.  Association of all-cause mortality with overweight and obesity using standard body mass index categories:  a systematic review and meta-analysis.  The Journal of the American Medical Association 309(1):   71 - 82.

Increased trunk adiposity is most often seen in patients recovering from anorexia who have lost a significant amount of body fat and have remained at an unhealthy percentage of body fat for several months.  If a patient has an adequate amount of adipose tissue around the midsection, why would the body continue to store adipose tissue in that region?  

However, most patients recovering from restriction will experience bloating and water retention due to delayed gastric emptying, slow bowel motility, and an increase in glycogen storage form food, which carry four molecules of water per one molecule of glycogen.

Complete article:  You are not a unicorn, debunked

Sure!  Let me break down the letsrecover post into more easily digestible pieces, since the post is quite lengthy:

This has everything to do with triage. Triage is very well explained in THISarticle, but I will try to simplify it as much as I can.In order to really explain what you ask for, I will have to begin with explaining in depth what survival mode is, bear with me.

Triage is a system used in emergency environments to try to maximize the number of survivors. For example, when a person arrives at a hospital unconscious; the hospital staff will need to decide what treatment is most critical to make sure the patient survives. Is priority number one surgery, medication, wound care, respirator, x-ray, or something else?

Ignore the YourEatopia article.  I do not consider Gwenyth Olwyn to be a source of reliable information.  Otherwise, she is correct in the definition of "triage," although I am skeptical of the existence of a "survival mode."  The human body does not have "modes," but instead makes necessary metabolic alterations to insure increased survival, so perhaps these alterations could be summarized as a "survival mode."

The body does the same thing when it goes into survival mode (and survival mode is what all of this is about!). When you starve yourself, the body eventually needs to perform triage: What do I need to do to survive? Ah, okay, my chances of survival will increase if I stop spending energy on metabolism, temperature, cell renewal, and hormone production.And so the body “turns off” these functions for now, and prioritizes your heart, lungs, and brain, and in addition it stores fat whenever possible (both to keep itself warm without spending much needed energy, and to have something to eat the next time you starve it). If the body had not done this, you would have been dead a long time ago.

Again, these statements are generally correct, although metabolism, thermogenesis, cell renewal, and hormone production are not stopped completely in the face of an energy deficit, just significantly decreased in rate in order to redirect energy to the more vital functions, as she explains in the next text:

Here is what would happen if the body did not perform triage: The body keeps spending energy on all biological functions as if there was no starvation happening. It keeps up heartbeats, breath, brain, metabolism, temperature, digestion, cell renewal, hormone production, and the constant maintenance of fat- and muscle mass - even if it doesn’t have energy available for even a tiny fraction of this. As your body becomes more and more energy deficiant (and that happens fast!), all these things will function worse and worse, and after very short time heart failure (or multi organ failure) will strike. Goodbye, dear life…

True!  If the body were to continue to "spend" energy by maintaining the normal metabolic processes, then the energy would be depleted very quickly, and all organs would eventually fail.

And now, back to your question: Why will undereating and exercise in recovery “make us fat”?Because both undereating and exercise makes sure your body never has enough energy to trust that it is safe to “turn on” all the suppressed functions. Because the body is very cautious, and because it does whatever it takes to survive, it will not - ever - spend energy on metabolism, temperature, hormone production, etc, unless it is absolutely sure it is safe. Remember, your body cannot possibly know whether it is starved voluntarily or involuntarily (WHY would anyone starve voluntarily?); and so it will always treat starvation as if it is a famine.Your metabolism will never speed up unless you first increase your intake of food. (This is why it is possible to gain weight on extremely low amounts of food.)

Hmm..  I feel like the post is beginning to become questionable at this point.  While the body will continue to redirect energy to the more vital metabolic processes in the face of an energy deficit, such an energy deficit will vary depending on resting metabolic rate.  In other words, what may be "under-eating" for one body may be an adequate intake for another separate body.  Also, I am assuming that she is referring to intense aerobic exercise that would burn a significant amount of calories, such as running and mountain biking, and not yoga, gentle walking, or strength training, which can actually help build muscle in recovering anorexics ("Exercise in eating disorder recovery:  beneficial or detrimental?" via Science of Anorexia;  article contains cited sources).

Otherwise, she is again generally correct, although the body must maintain a minimal amount of energy metabolism, thermogenesis, and hormone production regardless of caloric intake, simply because these functions are necessary for survival, although these processes are reduced drastically during starvation, hence the fatigue, intolerance to cold temperatures, and amenorrhea that is common among individuals with restrictive eating disorders.

Restriction is an enormous stressor for the body. Exercise in recovery also counts as restrictive behaviour - because it robs the body of the energy it desperately needs for repairs.Stress in itself, too, often leads to suppression of biological functions and fat storage - again, because the body experiences threat, and threat makes the body do whatever it takes to survive (triage).In addition, if you exercise in recovery it does not matter how much you eat to “support energy expenditure” - the body is still so stressed by the exercise that it will prioritize survival above repairs (triage), i.e. it will keep biological functions suppressed and keep storing fat.

Once again, she is generally correct --  aerobic exercise does prevent the body from using the energy depleted during the exercise for other functions, which can very obviously worsen the effects of starvation.  However, she is completely inaccurate in asserting that any exercise will stress the body to the point of increasing fat storage within adipose tissue.  If this assertion were true, then any individual who diets and exercises would have an increased body fat percentage.

I think an important point to make is that the body will expend energy wherever is the most vital, so if an individual has a vital organ that has been damaged through starvation, such as the heart or liver, then the body may use the increased energy in an attempt to repair those organs while allowing the exercise to "damage" less vital organs, such as skeletal muscle and bone.  Therefore, exercising while underweight or while at a severely malnourished state can be very dangerous, regardless of intake, which I think is the point that she is trying to explain.

Regardless, exercise will not make a person "fat."  Exercise increases muscle mass and can also increase bone density in individuals who are no longer malnourished or underweight.  However, I feel that her next argument will be that anyone eating less than 2,500 calories will, in fact, be considered "malnourished."

When I say “storing fat”, I mean that the body will store fat mainly around the mid-section. It does that for two reasons: To protect inner organs, and because there is just not enough energy to spread it out over the whole body - yes, that process demands energy.The (almost) same goes for muscle mass. Starvation makes the body start to eat itself (it has to eat something when food intake is limited), and the body will “eat” whatever is available - not only fat mass, but also muscle mass and bone mass. So, starvation makes us lose a huge amount of muscle mass. It is not possible for the body to simply “rebuild muscle mass” just because you exercise - because no one can do everything with nothing. In fact, we can hardly do anything with nothing, and the possibility to do hardly anything with nothing lasts for a very short time. In order to rebuild muscle mass, you need to have a body that is able to build itself up properly; not a body that will become so stressed that it rather goes into starvation mode.

Ahh!  Okay.  I know that Gwenyth Olwyn asserts that every body will store adipose preferentially around the midsection in order to protect vital organs;  however, this increased trunk adiposity is more commonly seen in recovering anorexics who have experienced long-term starvation that has resulted in a dangerously low body fat.  When asked, my dietitian replied that not everyone in recovery experiences this altered body fat distribution, and the patients who experienced this phenomenon is the result of a long-term absence of healthy body fat.

Honestly, the rest of this text is incomprehensible to me.  Weight-bearing exercise has been shown to increase muscle mass and bone density in patients recovering from anorexia, as long as the exercise was paired with nutritional rehabilitation;  the links to these studies are provided at the end of my exercise in recovery article at Science of Anorexia.  However, in patients that are not undergoing nutritional rehabilitation, or are restricting, exercise will result in the depletion of muscle mass and an increase in body fat percentage, which I think is the point she is trying to illustrate.  Once again, I believe that she is also defining "under-eating" as being beneath 2,500 calories.

And so, what happens when you eat minimums and rest instead? Exactly; your body will soon begin to trust that the famine is over, and then it can safely stop suppressing functions and storing fat - because it knows that the energy intake will keep it alive until tomorrow. Metabolism, temperature, hormone production, cell renewal, etc will start working normally again, because the heartis not in an immediate danger that needs constant attention.

If you exercise too early after an eating disorder, it would be as meaningless as touching the paint before it has dried - it wouldn’t be pretty, and you would have to start over when you could have just waited.

I strongly encourage everyone to read THIS about how dangerous exercise is physically, and THIS about what exercise usually does to ED-patients mentally. In these posts everything written here is explained even more in depth.

Once again, she is generally correct, although she is once again demonizing any exercise in recovery as being a thief of energy, which is generally only true in patients that are malnourished or underweight.  Again, I am ignoring the YourEatopia article.

Final Conclusion:

The information provided within this post are generally accurate in terms of how the body reacts to an energy deficit.  However, the blogger does not address the main concern of the person asking the question:  How will eating 2,500 - 3,000 calories with no exercise prevent the body from becoming overweight?  She provides more of an answer to how restricting and exercising will result in a higher body fat percentage, which is partially true.  

However, the fact remains that eating 2,500 - 3,000 calories while remaining sedentary will absolutely result in an increase in body mass for a great majority of people.  Yes, this increase in body mass will be both muscle mass and adipose tissue;  however, once adequate muscle mass is restored, the body will continue to store excess energy in the form of triglycerides within the adipose tissue and glycogen within the liver and skeletal muscles.