The beginning and end of this review are going to be fairly personal because the topic is very personal to me. I’ve been overweight for most of my life. After years of being in and out of therapy for food and body issues, I finally recently got around to seeing a nutritionist. She recommended this book to me.
Author Emily Cooper makes a point of classifying overweight/obesity as a disease and believes that it should be recognized and treated as such, especially since various medical organizations have called obesity a “multi-metabolic hormonal disease state.” She spends much of the book, which can be a bit science-heavy at times, describing some of the many hormones involved in regulating metabolism and hunger, such as insulin, leptin, ghrelin, etc. When these hormones are out of whack, the brain and body are not accurately perceiving the amount of fat that is stored or may not be getting the message that the appetite has been satiated.
While there are many genetic and environmental causes for this kind of imbalance, which Cooper touches on, she spends a lot of time explaining how ineffective diets are in the long term. Although they may work for a while, ultimately they will stop working and not only do most people regain the weight within 5 years, many will gain even more than they had lost. Cooper calls this “diet fog” and describes how it results in metabolic changes that lead the body to perceive itself as malnourished, so the body compensates by slowing metabolism, increasing hunger, and reducing satiety signals. She has found in her medical practice that people who are underweight share similar metabolic profiles as people who are overweight/obese. She notes that medical professionals, medical textbooks, and lots of research make it clear that diets ultimately aren’t the answer, but due to the diet product industry and complicated science, diets continue to be encouraged, even by the doctors who should know better.
The best way to treat overweight/obesity is by correcting metabolic imbalances, which typically requires seeing a doctor. However, Cooper does point out other things that people can do to make changes, such as not under-fueling exercise. I also appreciate that while she leans towards prescription medications over supplements, she recognizes that supplements can have their place. While I don’t personally have a stake in whether supplements and vitamins are recommended, I like the indication that she is open-minded. She is also realistic about the results, stating that some people will lose weight very quickly, some very slowly or not at all (especially given how tricky it can be to balance metabolism), and many will be somewhere in the middle.
I will admit that towards the end of the book I was skimming because she’s sharing patient stories that I just didn’t have much of an interest in. There are also times that the author can be a bit repetitive. My main quibble, minor though it may be, is that the book lacks an index, which makes it hard to refer back to certain information.
This book was a revelation to me, both in terms of the answers it provides and the way it described what things are like for “normal-weight” (Cooper’s description) people. For example, this paragraph blew me away:
“When the metabolism is functioning normally, food generally isn’t overly attractive–a bag of chips in the cupboard or donuts at the office should not call to you to the point of distraction. However, if the metabolism is not functioning normally and appetite receptors are not firing properly, food . . . may relentlessly beckon to you. While someone with normal appetite receptor function may pick up a handful of potato chips and move on, someone with a malfunctioning feedback loop will probably be distracted by the chips and will have to wage an internal battle in order to ignore the urge to eat all of them” (p. 102).
Normal weight people really aren’t preoccupied with food the way I am? They really don’t have to argue with themselves about what to eat/not eat? I asked my husband (normal weight and with presumably normal metabolic functioning) about this, and he confirmed it. For years I thought if I just found the right therapist or the right food plan or the best way to increase willpower and self-discipline I could make long-term changes. I succeeded for a couple of years after a diabetes diagnosis, but recently undid all of my progress. To know that all of this could be due to an actual medical condition that can be medically corrected brings me so much hope. It may be a life-changer, and I recommend it to anyone who has struggled with overweight or obesity.