1.6 What to Expect on the SWLL

Here we look at five peo­ple. Their sit­u­a­tions are very dif­fer­ent. The ease or dif­fi­cul­ty with which they lose weight will vary, as will their abil­i­ty to keep it off.

First, though, a word about Body Mass In­dex (BMI). BMI is a stan­dard­ized mea­sure of how lean or over­weight a per­son is. Here are the ranges:

To learn more about BMI read Ap­pendix 1—Body Mass In­dex (BMI)

San­dra and Josephine are twins. They are both 38 years old, and 5’5″ tall. They both weigh 162 lb. which trans­lates to a BMI of 27. This puts them near the mid­dle of the over­weight cat­e­go­ry.

Maria is the twins’ moth­er. She is 60 years old. Her height is 5’4″ and she weighs 204 lb. Her last in­crease in weight raised her BMI to 35. This puts her in the stage II obese cat­e­go­ry. She was un­hap­py be­ing stage I, and she views the tran­si­tion as a cri­sis.

Tra­cy has a BMI of 33, putting her well into the obese range. She has prob­lems oth­er as well as her weight. Her pe­ri­ods are ir­reg­u­lar. She has hair grow­ing on her face and she is los­ing hair from her head.

Ray’s sit­u­a­tion is dire. He is a Pima In­di­an. He is 5’11” and weighs 400 lb., putting him high up in the mor­bid­ly obese range.

San­dra is con­fi­dent that she can lose the weight. She’s done it be­fore when she has gone on a diet, but the weight has al­ways come back. This time she is de­ter­mined to keep the weight off. She de­cides to adopt the SWLL.

Her task is fair­ly easy. She needs to make some changes to what she eats, adopt a mod­er­ate ex­er­cise pro­gram, and try to build more ac­tiv­i­ty into her life.

When Josephine was younger she wore a size 2 dress. She knows that she will nev­er again fit into that dress, but she yearns to get as close as pos­si­ble. She fig­ures that she needs to be 126 lb. or less, with a cor­re­spond­ing BMI of 21.

Josephine needs to lose 36 lb. That’s twice as much as San­dra. Los­ing the weight will take longer, but the main prob­lem will be to keep it off. Josephine will have to adopt a more rig­or­ous ex­er­cise pro­gram than her sis­ter. She will also have to eat less. To main­tain such a low weight she may have to ac­cept that she will al­ways be slight­ly hun­gry.

Maria has a long jour­ney ahead of her. Her first step should be to get a phys­i­cal exam. After the exam she will know how many of the com­po­nents of metabol­ic syn­drome she has (see the “Health” chap­ter for de­tails). It is im­por­tant that the doc­tor un­der­stands the ef­fi­ca­cy of lifestyle changes in cor­rect­ing these con­di­tions. Many doc­tors just pre­scribe drugs.

At­tain­ing her goal of be­ing lean and fit will take a long time, pos­si­bly up to two years. But there will be re­wards along the way. As she starts to get fit she will be able to par­tic­i­pate in some of the twins’ ac­tiv­i­ties. There is the joy of shop­ping for new clothes as she sheds weight. Best of all, she knows that this change in her con­di­tion is per­ma­nent.

She also has oth­er prob­lems. Her pe­ri­ods are ir­reg­u­lar. She has hair on her face and on oth­er in­ap­pro­pri­ate parts of her body. The hair on her head is start­ing to re­cede in a man­ner sim­i­lar to male pat­tern bald­ness. She fears that un­less she can get her weight un­der con­trol, she is like­ly to be­come di­a­bet­ic.

Tra­cy con­sults her doc­tor. He finds that her con­di­tion is caused by a dis­ease: poly­cys­tic ovar­i­an syn­drome, or PCOS. The name of the dis­ease comes from the fact that the af­flict­ed wom­an’s eggs do not ripen and eject from the ovary. This is caused by an in­ter­rup­tion in her hor­mone sys­tem.

A cru­cial mech­a­nism of PCOS is in­sulin re­sis­tance. If this can be al­le­vi­at­ed the symp­toms are great­ly less­ened.

Hap­pi­ly for Tra­cy, med­i­cal sci­ence now has a so­lu­tion. The drug met­formin, also known as Glu­cophage, reg­u­lates the re­lease of sug­ar into the blood stream and also makes her body more sen­si­tive to in­sulin.

Lifestyle has a role to play in man­ag­ing PCOS. The diet is stricter than the SWLL diet in that it re­stricts foods that would cause a sharp spike in blood sug­ar. This in­cludes re­fined grains and food and drinks con­tain­ing sug­ar. Fruits can be eat­en in mod­er­a­tion, as part of a meal. Ex­er­cise is im­por­tant both in burn­ing ex­ist­ing glyco­gen (the form in which the body stores glu­cose) and in build­ing mus­cle to ab­sorb fu­ture glyco­gen.

PCOS is not a treat-it-your­self dis­ease. Some­one di­ag­nosed with PCOS should be un­der a doc­tor’s care and, ide­al­ly, be re­ceiv­ing ad­vice from a nu­tri­tion­ist.

Many oth­er Pima In­di­ans are in Ray’s sit­u­a­tion. In fact, Pima In­di­ans are among the heav­i­est groups of peo­ple in the world. Sci­en­tists hy­poth­e­size that this is be­cause of the way they evolved.

Pima In­di­ans are in­dige­nous to the south­west­ern Unit­ed States and North­ern Mex­i­co. This is an area of desert, and liv­ing con­di­tions are harsh. Over gen­er­a­tions the Pi­mas were sub­ject­ed to re­cur­rent famines. It is thought that they evolved a “thrifty gene,” which tells the body to, when­ev­er food is avail­able, pack it away as fat to help sur­vive the next famine. Another fac­tor is that their metabolisms are fan­tas­ti­cal­ly ef­fi­cient. A Pima In­di­an can sub­sist on 700 calo­ries a day, where­as some­one of Euro­pean de­scent would starve on less than 1,200 calo­ries.

Pima In­di­ans to­day can be di­vid­ed into two groups: those who main­tain the tra­di­tion­al lifestyle, and those who have adopt­ed mod­ern ways.

The tra­di­tion­al lifestyle group is in Mex­i­co. They eat a diet that em­pha­sizes corn and beans and has lit­tle meat. The ra­tio of nu­tri­ents is: 10% fat, 15% pro­tein and 75% com­plex car­bo­hy­drates, co­in­ci­den­tal­ly the same as the SWLL. To main­tain them­selves, they av­er­age 23 hours of phys­i­cal la­bor each week. The re­sult is that they are lean and healthy.

Pima In­di­ans in Ari­zona have adopt­ed a mod­ern lifestyle, with its ready ac­cess to high fat foods and lit­tle need for ex­er­tion. The re­sult is widespread obe­si­ty and type 2 di­a­betes, both oc­cur­ring at ear­ly ages.

Be­cause of their ge­net­ic make­up, it is more dif­fi­cult for the Pi­mas to lose weight than any oth­er pop­u­la­tion. Yet lifestyle changes work when­ev­er they are tried. Pima In­di­ans who go on a low fat, high com­plex car­bo­hy­drate, diet and who ex­er­cise reg­u­lar­ly all lose weight and their di­a­bet­ic symp­toms are re­duced or elim­i­nat­ed.

In a sense, Ray is more for­tu­nate than Tra­cy. If he choos­es to, Ray can solve his prob­lem on his own. If he adopts the SWLL he will grad­u­al­ly at­tain a healthy weight. He will have to be more rig­or­ous than oth­er peo­ple. He will have to strict­ly con­trol his food in­take. He will have to ex­er­cise longer and hard­er. He will have to learn and ap­ply ev­ery scrap of in­for­ma­tion in this book. But, in the end, he will suc­ceed.

Of course, do­ing it by him­self, while pos­si­ble, is not op­ti­mum. Ray is at least pre-di­a­bet­ic and prob­a­bly has di­a­betes. A doc­tor should su­per­vise Ray’s con­di­tion and pos­si­bly add med­i­cal in­ter­ven­tions, such as drugs. A nu­tri­tion­ist should tai­lor a diet to his spe­cif­ic con­di­tion. Fi­nal­ly, a pro­fes­sion­al train­er should show him how to start ex­er­cis­ing.

 

This chap­ter pos­es a ques­tion: What can you ex­pect with the SWLL? As can be seen from the ex­am­ples above, the an­swer is not sim­ple. What you can ex­pect de­pends on three main fac­tors:

1) Your goals. The more am­bi­tious your goal, the more rig­or­ous your ad­her­ence to the SWLL will have to be and the longer it will take you to achieve that goal.

2) Med­i­cal prob­lems. If your be­ing over­weight is caused by a med­i­cal con­di­tion, then your pri­ma­ry source of ad­vice should be your doc­tor. You should not im­ple­ment the ideas in this or any oth­er book un­less your doc­tor in­structs you to do so.

3) Genes. Some peo­ple have more dif­fi­cul­ty main­tain­ing a lean weight than oth­ers due to their ge­net­ic make­up. The Pima In­di­ans are an ex­treme ex­am­ple of this. Another ex­am­ple is peo­ple of African de­scent. Their rest­ing metabol­ic rate is low­er than that of peo­ple of Euro­pean de­scent. So peo­ple of African de­scent have to work hard­er to achieve and main­tain a lean weight.

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