Sunday, May 17, 2009

Naturally Skinny People

We all know a few of them. Those naturally skinny people who seem to be able to eat whatever they want, and never gain an ounce. Those people who can truly just "take a taste", and stop, without scarfing down the entire piece of chocolate cake. What is up with these people? Are they really different from the rest of us?

The answer is yes, they really ARE different. They are a genetic variant, and they make up less than 30% of the population. And they make the rest of us feel guilty for struggling with our food intake, because they just don't understand that we are biologically wired differently. They say things like "Just listen to your body," and they don't realize that we ARE listening. It's just that our bodies, and their bodies, are not saying the same thing.

We make literally hundreds of conscious and unconscious decisions every day on eating. Naturally skinny people don't have to think consciously very much about this, because their bodies are giving them good, reliable signals on when to eat, how much, and when to stop. There are many chemical signals involved in feeling full and satisfied, including leptin, insulin, ghrelin, CCK, GLP-1, dopamine, and Peptide YY. Naturally skinny people have appetites that are like fine-tuned machines - it is relatively effortless for them to control their food intake, because their appetites are on "auto-pilot" - it simply isn't that hard for them. For the rest of the population,it is not so easy. Even minor "malfunctions" in our fullness signals mean that we can unconsciously eat a few more calories; small calorie increases over time can lead to big weight gain. Weight gain itself can "snowball", since excess weight itself can lead to further "malfunctions" in our ability to regulate intake.

Human eating behavior is very complicated. Hunger and fullness (or "satiety") is controlled by numerous chemical signals in our brain, gastrointestinal tract, and fat cells. These signals can be affected by genetics, environment, types of food eaten (some foods make you HUNGRIER, ironically), exercise, stress, sleep, psychological factors, medications, illness, and other factors. This is a lot to look at, a lot to control. It is tough to do on your own; that is why people come to our program for help.

The next time someone tells you to "just push away from the table", tell them to just hold their breath for sixty seconds. It won't kill them, of course, but the physiologic drive to take a breath will be almost overwhelming. They probably won't understand that you face a similar physiologic drive to eat, but hey, it will be fun for a minute to watch them struggle with something for a change! But don't despair -there are MANY tactics to help you control your appetite and drive to eat. There are specific ways of eating, exercising,and lifestyle measures, and sometimes medication changes, and different ways of addressing medical issues, that can make the battle much easier!

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