Always Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently is a recently published book by David Ludwig. The author is a professor of nutrition at the Harvard T.H. Chan School of Public Health. The book reaffirms what metabolic and weight loss surgery research has demonstrated several years ago. Obesity is not simply the result of excess calorie consumption. It is rather the direct consequence of a change in hormones that control body weight, energy metabolism and appetite. The end result is a vicious cycle of cravings, hunger, and binge eating that results in excess weight accumulation. Cutting down on calorie intake by itself does not result in durable weight loss. The underlying cause of obesity, i.e. the hormonal imbalance, MUST be addressed first in any weight loss treatment model.

Ludwig explains that obesity is a state of starvation rather than a state of excess. The fat cells are engorged with calories but the brain has no access to these stores due to high insulin levels. As a result, the brain sends signals to eat more placing the overweight individual in a never-ending cycle of overeating and weight gain. From this perspective, it is easy to understand that cutting down on calories to lose weight, in the setting of the above mentioned hormonal imbalance, can only result in more hunger, more eating and more weight gain. Thousands of individuals in the greater Houston area who attempt to lose weight every year are all too familiar with this experience. Eat less and move more is in fact a futile approach to lose weight when the metabolic machinery of your body is malfunctioning.

What causes this hormonal imbalance? According to Ludwig, the low fat, very high carbohydrate food that we have been eating for the last 40 years, raises insulin levels and promotes fat accumulation. The obesity epidemic we suffer from today is the result of our modern processed food diet culture. Accordingly, he recommends getting rid of processed carbohydrates to lose weight. His program for weight loss starts with two weeks free of simple sugars and grain products as well as any form of processed carbohydrate like fructose corn syrup. Patients are allowed to consume non-starchy vegetables, fruits and beans. Whole grains are slowly reintroduced. All meals are based on whole natural foods with high quality meat and fat products. A diet high in good fats found in nuts, olive oil, avocados, fish… is highly recommended by Ludwig as it lowers insulin levels and calms chronic inflammation of rapidly expanding fat cells. This is the first step in jump-starting your metabolism to start weight loss.

The value of this book lies in its approach at debunking the myth of eat less and move more to lose weight. Weight loss is difficult to achieve without addressing the underlying hormonal abnormality. As a weight loss and metabolic surgeon, I think that good quality nutrition is important for durable weight loss. However, the most effective approach to reducing insulin levels in the body remains metabolic surgery like gastric sleeve and gastric bypass. For most obese individuals, the damage to gut and fat cells is too advanced. Retraining fat and gut cells is best achieved with weight loss surgery. Weight loss surgery, contrary to previous assumption, is a hormone altering procedure. I wouldn’t be opposed however to start all obese patients with a diet program as proposed by Dr. Ludwig and monitor response. Those who fail to achieve the desired weight loss will be offered metabolic and bariatric surgery like gastric sleeve. Those who lose their excess weight will be spared surgery. In either case, adopting a wholesome and natural diet free of processed carbohydrates remains crucial to maintain weight loss for the long run.