What About Exercise?
The health benefits of regular exercise are indisputable. Dr. Michaelson certainly encourages it and will gladly assist his patients in designing a program that works for them. But its contribution to weight loss is modest, as many chronically overweight people who have tried it in conjunction with conventional "low-calorie, low-fat," "eat less, exercise more," "calories in, calories out," "a calorie is a calorie" diets can, to their misery, attest.
Decades of experience in the treatment of obesity have convinced Dr. Michaelson that the vast majority of stubbornly overweight individuals are suffering from a genetically determined metabolic disorder characterized by excessive insulin secretion in response to a carbohydrate meal. This results in wide fluctuations in blood sugar, "insulin resistance," and excessive fat production and storage. Repeated episodes of low blood sugar cause hunger that is both pathologically frequent and pathologically intense. These individuals experience a craving for sweet or starchy food that equals or exceeds an alcoholic's craving for a drink or an addict's desperate need for a fix of opioids or cocaine.
For individuals suffering from this condition — variously termed "metabolic syndrome," "insulin resistance," "prediabetes" or (Dr. Michaelson's preferred term) "chronic relapsing hyperinsulinemic obesity" cannot be successfully treated by exercise alone, although exercise can help. Without restricting carbohydrate consumption first, however, the benefits of exercise will be limited.
In Dr. Michaelson's practice, the initial emphasis is on adherence to the YES NO MAYBE list. To the extent to which a patient's "compliance energy," or ability to be "good," is finite, Dr. Michaelson wants all of his patient's effort to be directed towards avoiding NO foods. Exercise can sometimes induce hunger and, more problematically, it can, consciously or unconsciously, persuade patients that a seductive piece of chocolate cake won't hurt too much because they spent a sweaty hour on the treadmill that morning. Wrong.
Once the patient has progressed half or two-thirds of the way toward his or her goal weight — and living by the Method has become second nature — exercise becomes more of a clinical priority. It also becomes less difficult, and for some less dangerous, without all of that excess weight. Before then, patients are discouraged from exercising much more than they already do, and to do so because they enjoy it, not because they think it will help them lose weight.