Case Study: Weight Gain Mystery

Follow along as we solve a real-life health enigma.

Hi,

Let’s try something new.

Examine is all about looking at the full body of evidence from randomized, controlled human trials.

But that can get a little dry. Maybe an occasional case study can help immerse us in real-life applicability.

Today’s case

In 2007, I was a summer intern at a mindfulness research center at Massachusetts General Hospital.

One of the participants in the mindful eating program wasn’t losing weight and couldn’t figure out why. The participant, who we’ll call Dennis, was holding steady, if not slightly gaining.

The suspects

1. A variety of medications are linked to weight gain. Dennis couldn’t remember all of his medication names, but he didn’t recall taking anything new since he started the program.
2. There may have been some measurement error from Dennis weighing himself at different times of the day and sometimes weighing himself more frequently on weekdays, compared to weekends.
3. Dennis recorded everything he ate for a trial run, and seemed to have a good awareness of his macronutrient intake. (It’s important to note that daily tracking isn’t the best option for everyone!) But we weren’t sure if he was measuring his food intake accurately on a daily basis.

The verdict

The culprit was #3 above.

Dennis loved peanut butter. (Side note: I absolutely, unwaveringly, and to my detriment love peanut butter, while Examine’s other co-founder Sol sees it as the worst of the nut butter options. If you think he’s so so wrong, or for some strange reason think he’s right, let me know so that we can settle this issue.)

Most people don’t limit their peanut butter intake to the two-tablespoon serving size. If you’re a peanut butter fiend eating it by the spoon, you pile that PB onto the biggest spoon in your drawer, and reapply as necessary.

Some people estimate accurately, others play it safe and overestimate, and then there’s people like Dennis. Here’s my back-of-the-envelope calculation for Dennis:

12 week program x 5 days a week eating peanut butter x an extra half tablespoon not accounted for per eating x 48 kcal per half tablespoon

That amounts to 2,880 calories, which isn’t a ton. But not so fast!

Dennis, like myself, had peanut butter at the top of his list of trigger foods. Eating trigger foods makes it more likely that you’ll eat more trigger foods, or other highly palatable foods, especially salty and sweet treats.

12 week program x 2 days a week of extra eating induced by trigger food x 250 kcal per extra eating

That’s 6,000 more calories, which brings the caloric total of these peanut-butter episodes to 8,880 calories. At 3,500 calories per pound of fat, not accounting for other factors, that’s about 2.5 pounds of fat.

Case closed. The peanut butter seemed to explain Dennis’s weight.

He was eating mindfully and regularly attending the group exercise and nutrition classes at the hospital. But a couple times a week, he let off steam for a couple of minutes by eating triggered snacks after eating peanut butter, which ended up canceling out his weight loss.

The takeaways

1. Little things add up over time. It’s not the once-a-month feast that does it, it’s usually the little habits that add up over time. Luckily, good habits also compound over time. So each time you practice moderation or restraint, and succeed, that behavior is etched into a potential habit.
2. Most people have trigger foods. I don’t have a citation for this, but from my limited experience, most people have a specific food that especially causes them to eat more food. Being aware of that food can improve your relationship with it: some people do best to be circumspect and intentionally moderate their intake, while others don’t keep it in the house as a rule, and still others are able to eat intuitively. There are lots of different strategies, and you have to find the one that works best for you.
3. Leave no stone unturned. Health issues don’t always have neat and tidy explanations. Digging is necessary to uncover the fulcrum from which the outcome is determined. Even if you think you’re eating well, sleeping great, and so on, it doesn’t hurt to re-investigate all the possible facets.

This was a relatively simple case. A training session for prospective candidates enrolling in the Examine Health Detectives Agency. In the future, we may explore more complex cases involving health conditions. If you’re interested in solving some mysteries and you enjoyed following along today, just reply back and let me know!

Sincerely, Kamal Patel Co-founder, Examine