Obesity rates have been on the rise in the United States for quite some time. Unfortunately, the fairly widespread knowledge that rates are rising hasn’t stopped them from doing so. According to recent data from the Behavioral Risk Factor Surveillance System (BRFSS), adult obesity rates now exceed 35 percent in nine states, 30 percent in 31 states and 25 percent in 48 states. Mississippi and West Virginia have the highest adult obesity rate at 39.5 percent, while Colorado has the lowest at 23 percent. Between 2017 and 2018, the adult obesity rate increased in Florida, Kansas, Minnesota, Missouri, New Mexico, New York, and Utah, decreased in Alaska, but remained stable in the rest of states and D.C. Obesity continues to be a problem, but is it because people aren’t trying to tackle it, or are there flaws in the suggested solutions?
“As a dietitian working in diabetes and weight management for the last 20 years, obesity and related health concerns are challenges that I see daily,” said Blount Memorial registered dietitian Angie Tillman. “The commonly held theory in weight management is ‘calories in/calories out.’ Basically, this means if we burn more calories daily than we consume, theoretically, we should lose weight. If it is that simple, however, why don’t we see obesity rates decreasing, instead of continuing to rise? In fact, most studies on weight loss show poor long-term success, even when weight loss is achieved initially,” she said. “Sure, people will lose weight on a very low-calorie, or even a very low-calorie liquid diet, but long term maintenance is unusual,” she added.
“One alternative, or perhaps additional, theory to ‘calories in/calories out’ is the ‘Carbohydrate Insulin Model of Obesity (CIM),” Tillman continued. “According to the CIM, recent increases in the consumption of processed, high-glycemic load carbohydrates produce hormonal changes that promote fat storage, increase hunger and lower energy expenditure. The basic premise is that high-carbohydrate diets raise insulin levels. These chronically high insulin levels promote fat storage and decrease fat metabolism. This, in turn, leads to increased body weight, decreased insulin sensitivity, an increased risk of type 2 diabetes and, potentially, other chronic diseases,” she explained.
Ultimately, Tillman says, both the CIM model and the ‘calories in/calories out’ model have a place in the obesity conversation. “There is evidence for both models,” Tillman said. “The bottom line is if you have struggled with weight loss and obesity-related illnesses, particularly type 2 diabetes, and you have already tried the ‘calories in/calories out’ approach without success, a reduced-carbohydrate diet and intermittent fasting are two strategies you should consider. Different levels of carbohydrate restriction definitely can be effective, and a reduced-carbohydrate diet can help reduce your appetite, which can lead to a lower overall calorie intake,” she said. “Intermittent fasting, or restricting your hours of eating to certain times of day also can help lower insulin levels and blood glucose, as well as improve your sensitivity to insulin overall,” she added.