Morbidly obese and starvation

I’m watching a program here on the Discovery channel about a woman who is more than 700 lbs having surgery for her weight.

Her first hospital breakfast after surgery was (to me) a huge portion of pancakes and maple syrup. This surprised me, but the doctors on the documentary was talking about food retention being completely counterproductive due to the body’s ‘starvation mode’.

It got me wondering: would a very obese person starve slower than a moderately-weighted person? If me and a very obese person were on a desert island with only a small amount of tropical fruit to survive on, would the obese person be at a considerable nutritional advantage, using their own fat as an energy source?

More to the point, has a very obese person ever been in a starvation situation in recorded history - and if so, how did they get on?

An obese person will die of malnutrition as opposed to pure starvation in case of lack of food. If all the proper nutrients are provided, including basic proteins and fats, but not a single carbohydrate nor any extra protein or fat that can count as energy, the obese person will lose weight. They will lose weight really fast. At 700 lbs we’re talking a few lbs a day. Starvation mode or not your body can’t pull energy out of thin air. Yes, your metabolism will become very efficient and your energy levels will shoot to hell, but with even 100% efficiency that is forbidden by the laws of physics you still need a baseline amount of energy to continue life, and if that energy does not come from without it will either come from within or you will die. No ifs or buts. Of course, the less you weigh the less energy you need.

Here’s a rough mathematical explanation:

Assuming your overall metabolic efficiency factor is represented by S which is somewhere between 0 and 1. Your input energy is the stuff you eat we can represent with I and your energy requirement is E. Now, let’s call net energy deficit (i.e. energy you spent on everything but did not consume) L. The basic metabolic formula becomes

L = S*I - E

However, these are not numbers, although theoretically they are quantifiable values, in reality they are functions of a few interdependant variables. We do not know these functions and it’s probably not very possible to completely determine them but we can make approximated functions by figuring out relationships and approximate coefficients.

Now, S, your efficiency, is a function of your food intake, genetics, hormonal levels, activity and who knows what else. Your intake can basically be considered everything you eat but it’s reasonable to attribute digestability to intake and not to general efficiency. So your intake is the part of food that you digest. Now your E, your energy expenditure is a function of your body mass, lean body mass, activity levels, and probably a lot of other factors as well.

Now, starvation mode is when your intake I starts approaching 0 due to either lack of food or lack of digestion, your efficiency is raised to compensate and minimize energy deficit. However, if you notice, even if your efficiency was 1 (and it can’t exceed 1 due to those pesky laws of thermodynamics) an I of 0 means you are guaranteed to have some energy deficit, specifically -E. As your food intake drops to 0, E will drop due to low energy levels and general increase of efficiency. but E cannot drop to 0 since you need energy to sustain life function by definition.

Therefore, regardless of any particular details of your metabolic activity or any starvation mode it is impossible to avoid an energy deficit if your food intake is 0. Thermodynamically speaking it’s also highly unlikely your efficiency can change all that much - in the absolute best case you are using almost all of the food you eat. If you don’t eat any food that energy will have to come from fat reserves, muscle, organ tissues, or something.

Starvation might be dangerous in all sorts of ways but it is impossible to maintain or gain chemical energy in your body without shoveling it in your self somehow. Now the peculiarity comes in that since efficiency is related to so many things, sometimes eating slightly more than you are now can lead to a greater energy deficit (and hence greater weight loss).

IANAD, etc. Don’t try this at home.

Doctor dopers can probably fill in some of the functions and variables above with actual relationships ( I would expect most of them to be positive bell curves with varying coefficients ) and provide cites.

Oh sorry I guess I failed to answer your question entirely.

Yes. An obese person has an extreme energy advantage. They need a lot more energy but they have a lot more as well. If all the micronutrients are provided and the only issue is energy, then the obese person can last for a much longer time without if ample water is available. One pound of metabolized body fat is generally considered to be about 3500 kcal of energy. Using various BMR formulas a 700lbs person will need about 5000 kcal a day just to maintain basic life function, and if they move about, it’s more than that. The BMR formulas are probably not very valid for 700lbs people (or a lot less valid than for non-obese people), but even if we assume a metabolic requirement of 14000 kcal a day which is rather extreme, they are still at a significant nutritional advantage to you.

At first they would be losing 4lbs a day but soon they would be losing less and less and still not suffering any of the terrible effects of starvation (as long as proper micronutrients are provided and the right amount of proteins and lipids to sustain basic life function). By the time they would be 300lbs they would be losing less than a pound a day if they didn’t move around too much. They would be at abour 300lbs after about 6 months even using our extreme initial estimate of 14000 kcal.

I wouldn’t be surprised if a 700lbs person could last a year without food. However, this is all disregarding various organ problems due to metabolizing that much body fat for that long. I do not know if such a thing is survivable.

So what are the proper micronutrients? Does that mean the obese person could only survive if he had one chicken per day? Or one mouse? Or am I misunderstanding what you mean by proteins? You say earlier that he would die of malnutrition before starvation…does that mean his organs would just shut down? (Sorry for all the questions, just curious.)

You would think they would at least try to get her to eat something healthy. You can get calories without eating total crap.

Well technically protein isn’t a micronutrient. By micronutrients we basically mean the things that you get in multivitamin and mineral tablets: the vitamins, mineral elements such as iodine and zinc and so forth. It also includes other compounds such as some types of lipids. Basically these are things that your body needs to survive but doesn’t need in massive amounts.

Without artificial supplements you essentially only need to eat as single piece of fruit and a few grams of meat each day to get all the required micronutrients.

Proteins are proteins, they are one of the big three macronutrients. Proteins are particularly important in this situation because they are the main structural material of the body. The body can get all the energy it needs to survive just by burning those fat reserves, however it can only get energy. It can’t use fat to repair damage so it needs a constant protein supply even if it’s getting all its energy from internal reserves.

Without medical intervention a person suffering from severe malnutrition will almost certainly die of infection long before organ failure occurs. Without the necessary micronutrients and proteins the body loses the ability to repair damage. That in turn leads to open wounds on the skin and inside the digestive tract which allow free access to any bacteria around. Added to that the immune system itself suffers due to malnutrition and is unable to fight infections. If you want a graphic description of one of the fastest acting forms of malnutrition read up on the description of death form scurvy: teeth fall out, gums bleed, skin develops sores that won’t heal.

Probably nobody in the history of the world has ever died of malnutrition. Instead they die of things like septicemia, pneumonia or from communicable diseases as a result of malnutrition.

Pancakes and syrup are empty calories but they aren’t crap. The meal is essentially pure carbohydrate with a small amount of fat. For an invalid just recovering from surgery it’s a good meal precisely because it is empty calories. It’s a very clean burning meal that provides energy without taxing the digestive system or the liver or kidneys.

Any dietary change can wait until the patient has recovered from surgery.

Thanks Blake, that was really interesting.