By Duane Graveline, M.D., M.P.H.
As a family doctor for 23 years and USAF flight surgeon for ten years before, I consider myself thoroughly experienced in weight control. In the military I was responsible for the health of flight crews which demanded rigid control of any obesity tendency.
The DNIF, Duty Not Involving Flying, form was my major weapon, for it hit them in the wallet. I was "Mister bad guy" when I issued this form to any of my flight crew comrades for I flew with these people almost daily as part of my job but it got the job done. No sane flight crew-member ever overtly crossed the base flight surgeon, so we got along fine.
Civilian practice was something else. Weight control got to be my biggest and most unrewarding challenge. I was spending hours on weight control, familiarizing my patients with the calorie content of various foodstuffs and recommended meal composition, avoidance of seconds, keeping low calorie snacks handy, low calorie cooking and meal preparation, walking each day for exercise with long discussions of the calories burned by each mile of walking - all the things usually transmitted in any reasonable doctor/patient relationship, yet most of these time consuming patients would not lose weight.
I even suggested calorie counting to them so they could add together each apple or cracker and stop at 2000 calories and they still did not lose weight. Clearly I was wasting my time. This was not medicine, at least not the kind of medicine I wanted to practice and I welcomed every opportunity to have them enroll themselves in supervised weight loss programs where they still may not lose but at least I could gain peace of mind and return to "doctoring".
As a medical student my biochemistry classes had fully indoctrinated me in the caloric needs of the human body for basal needs and for varying degrees of exercise. Additionally I learned that both proteins and carbohydrates yielded 4 kilocalories per gram, while fats yielded 9, which I usually rounded off to 10 for our calculations as to dietary intake.
Starting my medical school education in 1955 I was convinced that weight loss was a simple matter of calorie restriction. Your body is an engine and without sufficient energy in the form of food it will burn fat and you will lose weight. Then you would lose the protein from muscles. In my mind back then, it was simple.
Was I ever wrong! I have to admit I had some successes with weight loss but far more failures. Most of these people I wrote off as chronic liars. They were not counting calories or portions accurately. It was a form of unintentional self-deception.
Then I read Banting's Letter on Corpulence. Banting, a casket-maker by trade, lived his first 65 years, at least the adult portion, on a diet largely consisting of bread, milk, sugar, potatoes and beer (almost 90% carbohydrate diet).
Near death from obesity and severe diabetes ( Banting was 5 feet 5 inches tall and weighed 202 lbs ), he went on to live another 18 years on a daily diet of mostly meat and fish and green vegetables (10% carbohydrate diet) initiated by Dr Harvey. He lost 35 pounds in 38 weeks and was able to maintain his new weight of 165 lbs by this low carbohydrate diet alone until his death at the age of 83.
Along with the progressive disappearance of almost 40 extra pounds of weight, his diabetes disappeared. You must read William Banting's chronicle. This document was the instrument that changed my concept of weight control.
I now realize that in many cases of uncontrollable obesity, the type of diet appears to make a world of difference. Protein and fat is the secret. The more you rely on protein and fat in your diet the easier it will be for excess fat to melt away and the easier it will be to maintain ideal weight.
Where Banting told us how to do it 180 years ago, former serious, type 1 diabetic, Richard Bernstein MD, re-introduced this concept in 1980 with his book, Dr. Bernstein's Low-Carbohydrate Solution to Diabetes. And more recently Laurence Chalem has picked up this concept in his book, Essential Diabetes Leadership. Although both Bernstein and Chalem were focused more on diabetes and extending their own good health, their information is directly relevant to weight loss.
Like Banting, their secret appears to be a rigidly carbo-restrictive diet (10-15%) with protein (30-35%) and fat (50-55%) responsible for the rest. This is the most effective and palatable weight loss diet and one which I could have offered my frustratingly obese patients, but they didn't teach me that in medical school.
When I tried this carbo-restrictive diet of eggs, meat of all kinds, nuts, butter with just a touch of such vegetables as cauliflower and broccoli, no sweets, weight loss was amazing. Breakfasts were usually eggs. Lunch and evening meals were plenty of meat and vegetables. I had only a few extra pounds so it did not take but a few weeks to become fat free and you don't feel hungry.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Updated August 2011