Ivania Rivas @IvaniaRS

All too often, there is a lack of nuance in discussions surrounding obesity and weigh loss. In this series of tweets, I address the core issues, while also touching on several important, yet overlooked topics. I suspect much of this content will be new to most conventionally trained doctors. Understanding Obesity: The Role of Hormones and Nutrients The Calories In/Out (Energy Balance) model of obesity is wrong Imagine if you went to a doctor, and after assessing you, they said - ‘Of course you feel terrible, you have a fever of 40°C (104°F). All you need to do is bring down your fever and you’ll feel better’. Would you be happy? While this information is accurate enough, it is completely unhelpful, in that it doesn’t provide any advice at all on how to actually bring the fever down. Patients attending doctors for assistance with weight loss often receive equally useless commentary. In line with the "calories in/calories out" model of obesity, they are simply told they need to expend more calories than they take in. The problem is, they are often not given any advice on exactly HOW to do this. And when they are given advice, it is often completely wrong. Many doctors advise patients to restrict fat intake, primarily on the basis that it is more energy dense than either protein or carbohydrate. The problem is, the Calories in/Calories out energy balance model of obesity completely ignores the sciences of biochemistry and endocrinology, overlooking differing effects of fat, protein and carbohydrates on hormones. By oversimplifying the cause of obesity to a simple case of caloric balance, incorrectly presumed to be entirely under volitional control, obesity is thought to represent a failure of will power. In essence, the implication is that most obese individuals are lazy and overindulgent, something that is both manifestly false and an egregious form of medical gas-lighting. The truth is, low fat foods, which typically contain large amounts of carbohydrates, have been scientifically proven to cause weight gain. It's not however, that doctors give poor advice maliciously. Many doctors after all, follow their own advice, which may explain why in 2015, nearly 60% of Australia’s doctors were overweight or obese. Hormonal Influences on Weight Gain Most people are aware that thyroid hormone helps to regulated our metabolism, and that deficiencies can result in weight gain. The fact is, there are at least a dozen hormones whose dysregulation has been associated with weight gain. For example, high cortisol levels as seen in Cushing’s syndrome may lead to distinctive fat deposits known as "moon face" and "buffalo hump." By far the most significant obesogenic hormone, however, is insulin. Insulin and obesity A 1996 study conducted in Bogalusa, Louisiana, highlighted the crucial role of insulin in obesity . Over an 8-year period, the study measured insulin levels in children and young adults. It found that those with the highest insulin levels (in the top 25% at both the beginning and end of the study) were 36 times more likely to become obese compared to those with the lowest insulin levels (in the bottom 25%). Specifically, the risk of becoming obese was just 2% for those with the lowest insulin levels, while it soared to 72% for those with the highest insulin levels. Type 1 diabetics well know that fattening effect of insulin. Before they are diagnosed, and commence insulin therapy, many type 1 diabetics are dangerously underweight. The reality is that, without insulin, the body cannot store fat. The commencement of insulin therapy can rapidly reverse this emaciation, research showing that type 1 diabetics gain an average of 5.1kg (11.2lbs) during their first year of insulin therapy . Despite its life saving potential in type 1 diabetics, up to 60% of type 1 diabetics may deliberately reduce or skip insulin doses due to its fattening effect – a condition referred to as diabulimia . Further evidence of insulin's fat-storing effects is the development of localised fat masses at sites of injection. Known as lipohypertrophy, this can occur in anyone who injects insulin, one study reporting that 49% of all insulin injecting type 2 diabetics developed lipohypertrophy . * *Importantly, many adults diagnosed with type 2 diabetes may actually have an autoimmune form that impairs insulin production. This condition, known as Latent Autoimmune Diabetes in Adults (LADA), is present in about 10% of diagnosed type 2 diabetes cases. Individuals with LADA are often more slender than typical type 2 diabetics and may even be underweight. While a strict low-carb diet is generally beneficial for these individuals, insulin therapy is often necessary.

Be kind to everyone. You never know what someone is going through.

The mental health benefits of exercise are as or even more important than the physical health benefits. Better mood, greater clarity of thought. Anyone who exercises regularly knows this.

Practice protecting and helping others, even when there's no direct benefit to you.

“I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past, I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.” — Bene Gesserit, Litany Against Fear (from the novel Dune)

“It’s impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all.” ~J.K. Rowling

Today is the first day of the rest of your life

The importance of being there for your kids! Her happiness! 💓

The answer to many of life’s problems:

You want to be useful to others, the first step is to not be angry, quick-tempered, irritated. Everyone is dealing with a lot of stress in their daily lives. If you are being calm, cheerful, supportive, you are already bringing a lot of value to the table.

an unfortunate home is a pile of stuff a fortunate home is a set of rituals so it is for many things

7 habits of highly energetic people:

Harsh truth: a fit parent is a better parent. Here're 7 ideas for integrating your kids into your fitness journey:

@LuisRoding 😬

Tobi Emonts-Holley @tobi_emonts

4 years ago

It's a dad's duty to be as fit as possible. Kids are motivators, not excuses.

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“Descubrió que la respuesta a todo era amor y trabajo, amor y trabajo”

@aatanacio ¡Felicidades! Qué excelente que puedan hacer experimentos cómo éste y abrirse tantas otras oportunidades. ¿Puede alguien que no vive y no tiene negocios en Estados Unidos comprar un negocio ahí ?

Good parenting is about mastering the art of balance. Keeping a close eye, but not intervening all that much...making kids feel safe, but not that much either. Although difficult at first, stronger, antifragile adults will thank us in the future.

@ricardojfr00 @petergyang Jajajaja que situación tan representativa.

3 criteria for success: 1) you’re happy 2) you're healthy 3) you’re making other lives better Everything else is noise.