The threats are the reasons why it is so difficult to control your weight.
Many people think saying this is making excuses for people being
overweight. Not true. The responsibility for your weight is always
yours. But how can you control your weight without understanding why you
are overweight? Figuring out why things happen is not the same as making an
excuse. A pair of cousins, who helped revolutionize obesity research, provide
the best example showing how knowing isn’t just another excuse.

There are many fascinating threats, but I think the most interesting
involves a pair of cousins from Pakistan whose amazing story opened up an
entirely new scientific understanding of how we become overweight.
At four months, the cousins became unnaturally hungry. Starved for food,
they could never eat enough. The problem was so bad that even after liposuction
and surgery, the 190 pound eight-year-old girl still could not walk. Her two-yearold
cousin, weighing in at 65 pounds, was destined to the same fate.

When the parents locked the pantry, the ravenous cousins went so far as
to eat frozen fish fingers and search garbage bins for more food. They were
obsessed with finding and eating food.

Dozens of doctors found nothing wrong with the cousins. You can imagine
what people thought about the kids. They were gluttons. They had no willpower.
They were lazy. They were weak. The parents must be bad parents. It was all
in their mind. All they needed to do was eat less and exercise more.

Then scientists made a startling new discovery: the cousins didn’t produce
a hormone called leptin. It turns out leptin is used to regulate hunger in your
body. If your brain can’t sense leptin, it thinks you need to eat so your brain
makes you feel hungry to make you eat. This is what was happening all the
time to the poor cousins. They felt a strong and constant hunger because they
lacked one simple chemical. Isn’t it amazing how a simple fault could create
such a dramatic change in behavior?

Once injected with leptin the cousins’ hunger became normal, as did
their weight. It wasn’t about willpower at all; it was about how their bodies
worked.

Interestingly leptin was only discovered in 1994, after years of hard and
complex work by dedicated scientists. Before 1994, we had no idea hunger was
regulated by hormones like leptin.

Since the discovery of leptin, scientists have found many different hormones
and systems used by the body to regulate hunger and weight.
Now it’s true, most people don’t have a genetic problem as severe as the
cousins. What people do have is a lot of small issues that when added together
make it hard to control their weight.

Please keep an open mind as to why people find it hard to lose weight.
We still have a long way to go in our understanding of how our bodies work.
One thing we do know, it’s not just about willpower, as the cousins could
have told you.

The big question: were the cousins making excuses for their hunger or
was a lack of leptin the reason for their hunger? Clearly it was the reason and
a reason is not an excuse.

Notice how finding the reason for their hunger allowed a treatment to
be developed to help the cousins. They were not cured because they still had
to get continued leptin injections, but they were helped immensely.
And that’s the whole goal with the threats: understanding all the different
ways you can become overweight helps you create your perfect diet.

I’ll say it until you get tired of hearing it, but we each have different bodies
and live in different environments, so we are each overweight in our own
way. That’s why you need to figure out which strategies work for you and how
extreme you need to be in following the strategies. We’ll talk a lot more about
this idea when we begin covering the strategies.

While we clearly aren’t all overweight because of genetic problems with
leptin production, there are still a lot of other factors that can contribute to
being overweight. You could be leptin resistant, for example. While you may
produce enough leptin, your body may simply not listen to it anymore, this
is called being resistant.

As a Type II diabetic I produce some insulin, but I am insulin resistant,
which means my cells simply don’t listen to the insulin hormone anymore.
If you are leptin resistant, the effect is much the same as not producing any
leptin at all: you are really hungry. Your brain simply doesn’t get the signal to
stop eating, so you just keep on eating and eating. Researchers at the Oregon
Health and Science University have found at least one mechanism causing
leptin resistance, so leptin resistance is a real physical problem you could have.

This is just another reason why obesity is a disease, not a character flaw.
Are you leptin resistant? Even a little? How would you know if you were?
You wouldn’t. You couldn’t possibly know if you are leptin resistant.

You could be feeling really hungry every day of your entire life because
you are leptin resistant and you wouldn’t even know it. Your willpower could
be so strong that you only ate one extra candy bar a day because of this hunger,
but in time eating that little bitty extra candy bar every day is still all it would
take to make you overweight.

And what do you get for your heroic yet unseen battle with your very real
feelings of hunger? Ridicule. Discrimination. Hatred. People laugh at you
behind your back, call you weak, and say you aren’t a good person.
Having leptin resistance would make you feel hungry. All the time. Are
you really not supposed to eat when you are hungry all the time? Is it realistic
to expect people who are really hungry not to eat even a little more than they
should?

The problem is your feelings of hunger are private. Nobody knows how
hungry you feel inside so they judge you on the outside according to their own
experience of hunger. That’s like judging how much another person’s twisted
ankle must hurt. You simply don’t know the hunger another person feels, just
like you don’t know much hunger the cousins felt.

Is a thin person to be applauded for being thin, when it’s because they
have less intense feelings of hunger? Is a heavy person who wages a titanic
battle every day with their weight to be looked down on because they have
become overweight, but far less overweight than they would be without putting
up such a tremendous fight?

Few people are leptin resistant, but many people have characteristics
that make them prone to being overweight. What are some other ways of
being overweight?

You could have a low NEAT quotient, which means you naturally burn
300–800 fewer calories on average than other people. Or your senses can be
wired to get a lot more pleasure out of fat and sugar, which makes you an easy
target for addiction. Or you could be a non-taster, someone with a relatively
poor sense of taste. Non-tasters have been found to be more overweight than
others. Or food could empty out of your stomach slower, which contributes
to weight gain. Or you could have fewer dopamine receptors in your brain,
which is related to food addiction. Or you could have a virus. Or you could
have more efficient calorie extracting bacteria in your stomach. Or you could
produce too much of the hormone ghrelin, which makes you hungry. Or you
could live in a situation where you don’t get much exercise. Or maybe your
mother was starved when you were in her womb, which reprogrammed your
metabolism to turn food into fat more efficiently. Or maybe you have a mix
of very small genetic changes that add up to making you hungry. Or maybe
you have impaired executive function, which reduces your ability to inhibit
inappropriate actions. Or maybe you have lost weight and your body is burning
fewer calories and making you hungry so you’ll gain the weight back. Or
maybe you have food close to you all day so you eat more. Or maybe you always
buy popcorn in the super-humongous size, which makes you eat more. Or
maybe you always put big bowls of food out so you’ll eat more. Or maybe you
are bored so you’ll eat more. Or maybe you are under stress so you’ll eat more.

Or maybe you often eat in a large group which makes you eat more.

Phew, I need to stop and take a breath!

But do you start to see now? There are many, many ways you can become
overweight. That’s why I call all these reasons threats. They are threats to
push your weight out of control.

Most threats center on making you hungry so you’ll eat more. Some
might say it’s just hunger, tough it out and simply don’t eat. But would you ask
someone who is really thirsty to never drink? Would you ask someone who
had to go to the bathroom to just hold it forever? Would you ask someone who
was tired to never sleep?

The answer is probably “no” to all of these questions because these are all
drives. While we can put off drives for a while, we all expect to give into them
eventually. Eating is a drive too. Later we’ll talk about strategies to naturally
control the eating drive.

A number of other threats center on not getting enough exercise. Some
might say just exercise more. Interestingly enough, exercise is not a drive, so
we don’t exercise naturally. In our modern world, exercise is strictly voluntary
and not enough of us are volunteers. Later we’ll talk about strategies for
exercising more.

I have a dream that some day a group of brilliant scientists will develop
a magic machine you can use to diagnose all the different ways you are
overweight.

You’d walk into the machine and it would gently attach probes all over
your body. Then it would start calculating.

The machine would take a look at your DNA and be able to catalog all the
little and big genetic mutations that impact your weight. It could take a look
at your metabolism and your hormones. It could look into your memories
and take a look at your environment to see what you could change. It would
look at everything.

After a long while it would spit out why you are prone to being overweight
and give you treatments and suggestions on how to fix everything.
But we don’t have a magic overweight diagnosis machine, not yet anyway.
And we aren’t even close to knowing all the reasons why we are prone to be
overweight.

In this book I am trying to do the next best thing. You’ll learn about many
of the threats we know about now and you’ll also learn how to formulate your
own plan for staying on your diet. It’s not as good as the magic machine, but
it’s a good start.

Before I started thinking about the reasons for falling off a diet as a group
of related threats, it was difficult to create a complete plan for staying on my
diet. You need a wider perspective on what’s going on or all the threats will
keep getting you. The idea of threats provides a good framework for understanding
the problems and finding practical solutions.

As you are reading the threats, please mark which threats you think apply
to you the most. Use a 0–5 scale. If a threat doesn’t apply you then write down
a 0 by the threat. If the threat is 100% you then mark it with a 5.
We’ll use this information later to create your personal plan for controlling
your weight.

You may feel overwhelmed by the number of threats, but please don’t
worry. Some of them won’t impact you at all. Those that do can usually be
countered with a few strategies. That’s why we are learning about the threats.
Once you know about the threats you can then turn around and defeat them.
We’ll dive directly into the strategies after spending the next several chapters
talking about the threats.

There are a lot of threats. Don’t feel like you need to read every word of
every threat right now. Just browse and focus on the ones you are most interested
in. You can always come back later and read more.