You Shall Not Covet Another Body's Metabolism

We come to the last commandment, and to the one I find myself thinking about most often in clinic. It governs something interior — not what we do, but what we envy, and what we conclude about people because of it.

Two people, the same plan, different outcomes

Every clinician who works in this area has watched the following. Two patients, similar age, similar starting weight, given the same advice and following it with comparable diligence. After six months one is down 22 lb and the other is down 6.

The temptation — for the patient, and I am afraid sometimes for the doctor — is to conclude that the second person is not really trying. The evidence says otherwise.

Individual variation in response to identical, supervised interventions is large and well documented. In controlled overfeeding studies where intake was strictly managed, weight gain across individuals varied roughly threefold for the same excess calories — and the variation clustered within twin pairs, pointing squarely at inherited differences in how efficiently energy is stored and burned.¹ The same spread appears in weight loss trials, where controlled interventions produce outcomes ranging from substantial loss to none at all in people following the same protocol.²

Add to this what I described in the fifth commandment: over 500 genetic loci associated with body weight, heritability estimates approaching those of height, and people in the highest genetic risk band roughly ten times more likely to develop obesity at comparable behaviour.

Two people can do the same thing and get different results. This is not an excuse anyone is making. It is a finding, replicated for decades.

The particular cruelty of comparison

Coveting another body’s metabolism does something specific and destructive. It makes your own progress feel like failure by holding it against a standard that was never available to you.

The colleague who lost 30 lb by “just cutting out bread” is not lying, and is also not a controlled experiment. You do not know their sleep, their medications, their thyroid, their genetics, their history of dieting, or how their body would have behaved on your plan. What you have is one data point and a story attached to it.

The more useful comparison is longitudinal and internal: are you better than you were? That question has an answer you can actually act on.

And now the harder part: do not judge

The tenth commandment is about the heart, so let me be direct about what this material demands of us.

Weight stigma is common, and it is harmful in ways that are measurable. Experiencing weight-based discrimination is associated with increased risk of mortality, independent of body mass index itself.³ It is associated with disordered eating, avoidance of exercise in public, depression, and — crucially for my profession — avoidance of medical care.

Patients who feel judged by clinicians attend less, delay presenting with symptoms, and receive poorer care. Stigma does not motivate weight loss. The evidence indicates it predicts weight gain.⁴

I include this in a series aimed at people who want to lose weight because the two things are not in tension. You can want to change your body and simultaneously refuse to hold anyone in contempt for theirs — including yourself.

What this means in practice

• Judge your plan against your own history, not against someone else’s outcome.
• If your response is slow, change the plan, not your opinion of yourself. Slow response is information: it may mean more structure, more protein, more resistance training, an investigation of thyroid or medication effects, or a conversation about pharmacotherapy.
• Ask your doctor directly whether medication is appropriate for you. The GLP-1 drugs work partly by acting on the same brain systems that defend body weight. Someone with a strong genetic predisposition is not weak for needing them, any more than someone with familial hypercholesterolaemia is weak for needing a statin.
• Notice the language you use about other people’s bodies — and about your own, in front of your children, who are listening more carefully than you think.
• Extend to yourself the assumption you would extend to a patient: that you are probably doing your best with the body you were issued.

The end of the series

Ten commandments, and the arc has been deliberate. We began by insisting that a permanent problem needs a permanent approach, and we end by insisting that the approach must be yours — suited to your genetics, your circumstances, and your life, and pursued without contempt for yourself or anyone else.

If you take away only two things: persistence beats intensity, and measurement beats belief. Everything else in these ten articles is commentary on those two.

Thank you for reading. If this series has been useful, the newsletter will let you know when I publish something new — and the diabetes remission guide I am working on applies these same principles to blood sugar.