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June 05, 2004

Nutrition and Exercise No Cure for Obesity? « Social Issues »

Dean says it is not.

He's got lots of scientific studies that support his position.

There's only one problem with scientific studies: they are only as good as their methodology. And I must assume one thing about these studies: they don't actually control the intake of the dieters. When the study shows that significant numbers of obese people gain weight on a caloric intake and exercise total that would cause non-obese people to lose or maintain weight, I have to assume that the dieters are overestimating their exercise or underestimating the snacks they sneak.

Why? How can I be so positive? How can I sneer so easily at the scientific studies?

Because there is a body of evidence that is being absolutely ignored. If you look in the right direction, you see the simple truth: if you exercise sufficiently and eat properly, you will lose weight rapidly. The proof? Army and Marine Corps basic training programs.

Thousands upon thousands of people, men and women, some who qualify as obese, have entered the training programs. I'd like to say, "not one has failed to lose weight", but I haven't been personally present at every graduation to verify that... Suffice to say that the military controls your exercise as well as your food intake, and even though there is no real attempt made to reduce caloric intake, the severe restriction on snacking does have that effect.

And everyone loses weight. Some put it back on immediately after leaving, but that is due to that person.

Dean has some good tear-jerker stories about people who want to lose weight so badly, but can't, that they start crying when talking about it. He describes the pain they go through as being the equivalent of giving yourself 2nd-degree burns every day with a match, and claims most people wouldn't go that far even if it would ensure they would never get cancer. It's a fallacious argument, because the pain of losing weight is not equivalent to pain undergone in prevention, it is more equivalent to something like chemotherapy: pain undergone as a cure. And most people do undergo the pain of chemotherapy, which is far worse than the pain of hunger and exercise.

Dean's got some good points, and I hardly consider my argument a slam-dunk against his. Heck, most people may still agree with him.

However, I must respectfully disagree with Dean: obesity is largely in the person's mind. Other than the something-less-than-1%-of-the-total-population who actually have glandular/hormonal dysfunction, people who do not lose weight are not willing to change their lifestyle enough to lose weight. They want to lose the weight without the sacrifice. The first step to losing weight is always to change your attitude about food, and these people simply aren't taking that step. I understand their anguish, but the first place they need to look for their failure is themselves, and the way they sabotage their own efforts.

Posted by Nathan at 10:42 PM | Comments (13)
» Dean's World links with: Embracing Ignorance
» The Queen of All Evil links with: The Few, The Proud...The Obese?
» Michael Williams -- Master of None links with: Disabled By Fat 2
Comments

You have made the classic binary-thinker mistake. "If you eat less and exercise more you will lose weight, therefore, eating less and exercising more must cure obesity."

This is bullshit for a half-dozen reasons, but it all comes down to "either/or" thinking.

But no one, including me, has ever suggested that if you eat less and exercise more you will not lose weight. Of course you will. The question is how much you can lose that way if you are obese, and how long you can maintain it.

The military is hardly the best source to look at for your data. First, the military will not accept people who are obese as enlistees. Second, the military fires (or at least will not promote and encourages the retirement of) people who tip over into obesity and can't get their weight back down. So much for whatever "proof" the miltiary can deliver about what is "obviously" true.

But then, why are we even having this conversation? You admit you don't know what the research shows. You admit that you don't even care what the research shows. You merely know what you know, and you aren't interested in letting facts get in your way. So, really, that being the case, what's for us to discuss?

Posted by: Dean Esmay at June 6, 2004 08:11 AM

I guess we could start with why you are so willing to use such strong argumentative techniques with someone who merely disagrees with you.
We could then move on to why you thought such an aggressive and combative final paragraph was necessary or even helpful.
I guess I pressed a button or two of yours, and for that, I apologize. Would you like to label them more clearly next time so I don't invite such impugning of my intellect next time?

Posted by: Nathan at June 6, 2004 09:11 AM

When you get obese, you gain more fat cells. Fat cells divide when they absorb too much(and thus become too big to sustain themselves at their current size). These new fat cells stay in your body, and continue to absorb all the stuff fat cells absorb. Because these cells don't go away, they get what the other fat cells that were previously there used to miss. Since your cells store more, it's harder to lose the weight. At least this is my understanding of it.

Posted by: John Dibble at June 6, 2004 09:15 AM

As I said in the comments of my own blog, you are busy dismissing studies you have never even looked at. This shows a clear lack of interest in facts.

And am I angry? Or are you just defensive? The fact is that obese people have a condition that will be fatal in virtually all cases, and 99 out of 100 of them fail to achieve and keep normalweight status. That's a fact. Your belief--and it is merely a belief--that they could lose it if they really wanted to is quite frankly an insulting assumption, and one that contributes to the misery of tens of millions of people.

Posted by: Dean Esmay at June 6, 2004 03:01 PM

Okay, I guess I'm wrong and defensive. I'll read follow all the links to the 3000 pages you linked and return with a report, contrite if needs be.

Posted by: Nathan at June 6, 2004 03:34 PM

Okay, just read through all of it...I just skimmed through the posts at the end, since those seemed to be just testimonials/letters and responses, apparently not backed up by any different studies.

...guess what?

There is little in that big mass of stuff (and nothing definitive) that contradicts what I said, which is (restated):

A change of attitude, diet, and exercise is the best cure for obesity.

In fact, there was even a direct contradiction between the studies. One said that people are not obese due to what their parents fed them, and another clearly states that carb-based formulas for infants does cause obesity!

The studies show that exercise alone won't do it. I never said exercise alone could. The studies show that low-calory and low-fat diets won't do it. I never said that, either. The studies show that low-fat or low-calory diets combined with exercise won't do it. I never said that, either. These are all the same (or similar) studies I've seen before. I'm no ignorant rube, despite Dean's insistence. Interestingly, several of the studies show that many people do have success with simply a low-carb (Atkins) diet. I wasn't even asserting something as simple as that. I also never once said that obesity was due to overeating, and just eating less could cure it.

No, I said that anyone can lose weight, that it would take sacrifice and effort to maintain weight loss, and that the biggest obstacle to permanent weight loss is in the person's head.

Because, as was said at least twice, other research shows that bodies have a "set-point" for weight, and after the weight-loss program (surgery, drugs, diet, or exercise) is complete, the body goes back to its set point. I learned about 18 years ago that you can re-adjust your set-point after about a year of maintenance. And the studies Dean cited show that behavioral modification techniques are excellent for maintenance of weight. So: set a goal to lose 30 pounds on a low-carb and increased exercise regimen. Once that goal is reached, you shift to maintenance, but otherwise relax. If you gain even one pound on any day, you go back to diet/exercise until its lost (usually within a week). So you have a year of being careful but not extreme. Once your set-point is adjusted (and you wait 2 years to make sure), you go through the whole process again. You can lose 150 pounds in 10 years that way, and it's not constant pain...it's short periods of quick weight loss interspaced with years of comparatively easy maintenance.

Something new I learned: some to most (the number wasn't really clear) people have their set points set too high even before the age of 2, both from mother's diet and carb-based formulas. These people might have an excuse...except that nothing in the other studies said they can't lose weight on an Atkins + exercise program with maintenance intervals, it just shows that they have a more difficult task than someone who became obese later in life.

Something else I needed to be reminded of: because of the creation of fat cells, surgical removal of fat cells may be a good way to get past the plateau, and may be necessary to be to attain a truly lean BMI. I had learned about this long ago, but didn't really consider it much because the the problem is usally discouragement within the first 30 pounds, before the number of fat cells really makes a difference.

Drugs work, too. That's an easy way out, but not the only way. Dean is being slightly dishonest by implying this is the only reasonable hope.

Look, I never said it was easy. But it is simple. I have problems with my weight. I am constantly at the limit of what is permissable with the military (although I've recently had significant success with Atkins). My limit goes up due to age, and my weight goes up with it. I have felt the same frustration. I have yoyo-d over a span of 10 pounds. I know it is hard. But I know the problem starts with me and the stuff going on in my head. Maybe that's not true for everyone, but there is nothing in the studies that indicates it isn't the exact same situation for the bulk of that 99% that cannot lose weight permanently. In fact, the study really doesn't make it clear why the people regain the weight, it merely makes the clear point (one I never once argued with) that impermanent weight loss is worse than never losing weight at all, and that dieting alone is the worst way to lose weight.

Behavioral scientists have done study after study that show that people forget a significant portion of the food they eat each day....some people up to 25% of their calories is forgotten when telling their doctor/weight loss aide what they ate. The inaccuracy drops down to less than 5% when they carry a pencil and paper with them...but they still cheat, because they've had people with videocameras follow people around to prove to them they aren't recording everything in the notebook. I wish I had the study available, but googling can't seem to find it and it was in my Behavior Modification Textbook from 15 years ago. I think the title was "Behavior Modification", if that helps.

Maybe I said it too flippantly. Maybe I didn't caveat it enough. But there is nothing in any of the studies Dean linked to that said that 99% of the people cannot lose weight. It said that 99% of the people do not maintain weight loss, and that is an entirely different thing altogether. If they didn't lose weight at all, Dean would be right: drugs are the only hope.

By the way, I also never said obese individuals have less discipline. But here is another factual conclusion gleaned from the information in the studies:
If a person had the proper diet, exercise level, and attitude towards food in the first place (meaning from inside the womb, apparently), they wouldn't be obese in the first place. Exercising alone has been proven to not be enough. I agree, and never said that. Diet alone is usually not enough (although 2-3 of the studies indicated the Atkins diet might be), but I never said that either.
And yet, eating a low carb diet and exercising 1000 calories a day will not result in permanent weight loss if they use food as a comfort, or if they snack without thinking, or if they fear losing weight (don't laugh: humans fear change).
Thus, there needs to be a support system in place to change the whole attitude toward food.

There wasn't a single study that indicated this won't work.

Dean, I will give you the log-in codes to my blog if you provide me with 2 valid studies that show that even a simple majority of obese people cannot permanently lose weight using an Atkins diet combined with a moderate increase in exercise and behavioral modification training/counseling and 18 months of follow-up assistance in maintenance. I'd be surprised if it's even been tried with 2000 subjects in a test/control group structure. If you don't want the log-in to my blog, I'll buy you something off of your wish list for approximately $50 and give a full public apology.

Posted by: Nathan at June 6, 2004 04:58 PM

Actually, as I ubderstand it, a big part of Atkins once you have lost weight is maintaining it by life-style change. To just lose weight, Grandma's copy of the 1920's Gra_pefruit [kicked out by a bloody nanny filter] Diet works!

Were I to seriously undertake a program, it would be a form of Atkins - because I can see myself staying on a modified form for life. Others might find a standard diet easier.

But there are other things. I don't know about the 99% figure the two of you are tossing around, but I was in hospital a few years back for two weeks: same food/portions/exercise as everyone else on the ward. I gained twelve pounds!

Anyhoo, another bit of recent research:
*Study: Molecule 'Vacuums Up' Fat from Mice*
Seems fat acts like cancer, and may be controlled the way some cancers are.

Posted by: John Anderson at June 6, 2004 07:03 PM

And here are some facts that I don't consider irrelevant:

APPENDIXA 231 is a well-known fact that physical activity is a good predictor of weight mainte- nance (Foreyt, 1999~. A review of successful weight maintainers reveals that they engaged in more strenuous activities such as running, weight lifting and aerobics than regainers, and participated in more activities that made them sweat (McGuire et al., 1999a). Specifically, 52 percent of maintainers reported engag- ing in three or more episodes that made them sweat in a typical 7-day week compared with 32-36 percent of the regainers and controls (McGuire et al., 1999a). Although, it is important to note it has been demonstrated that both gainers and maintainers reported decreases in total calories expended thorough physical activity. However, maintainers reported a decrease of only 500 calories per week where gainers reported a decrease of almost 1,000 calories per week at 1-year follow-up (McGuire et al., l999b). Self-Mon~toring Self-monitoring is the cornerstone of behavioral treatment (Foreyt, 1999~. One of the common findings observed in individuals who are successful at long- term weight loss is that maintainers report extensive use of behavioral strategies for reduction in dietary fat intake, self weighing, and physical activity (McGuire et al., 1 999a). Taking a closer look at self weighing as a form of self-monitoring, it has been shown that 55 percent of maintainers reported weighing themselves at least once each week, where only 35 percent of the regainers reported weigh- ing themselves frequently (McGuire et al., 1 999a). Other forms of self- monitoring, such as keeping a food or exercise record, functions to assist the patient in assessing overall intake of various foods in relation to the amount of exercise performed. Despite the fact that caloric intake may be underestimated, the records sensitize patients to the eating and exercise portion of their lifestyle (Blackburn and Kanders, 1994~. Problem Solving Generally, it has been shown that those individuals who confront life's stressors with a positive problem-solving attitude are more likely to have greater success in any endeavor (Foreyt, 1999~. All aspects of effective obesity treat- ment involve improved problem solving and confrontational skills. A survey of weight maintainers showed that 95 percent of them utilized problem solving or confrontational technique. In comparison, only 10 percent of those who relapsed used problem solving skills and instead, tended to use escape-avoidance ways of coping with stress, such as eating, smoking, or taking tranquilizers (Blackburn and Kanders, 1994~. These findings support the theory that once an individual makes a behavioral change, relapse occurs in the face of insufficient coping skills (Blackburn and Kanders, 1994~.

There's all sorts of good stuff in that document. Enjoy!

Posted by: Nathan at June 6, 2004 11:04 PM

Hmmmm. I can see both sides of the story, as I live this nightmare daily and did it for a 24 year stint in uniform.

And, in the end, chose a regular retirement rather than a medical retirement - all revolving around my weight.

I can tell you, if you have an endocrine system problem (hypothyroidism in my case) it's a real pain in the butt trying to maintain a sufficient level of physical activity that meets PT standards but does not trip the body over into an adrenal response, where the body burns protein, vice fat, to meet the demand.

There you are, working your ass off, and getting weaker. Synthroid helps, but I'm a poster child for the fact that for some people, the bovine derived hormone worked one hell of a lot better than the synthetic, which is not true for everyone.

From my perspective as a high school and college jock, combat arms soldier, and fat guy, you're both right, and it's one hell of a lot more complex than anyone realizes.

Posted by: John of Argghhh! at June 7, 2004 09:19 AM

I've always struggled with my weight, even as a very talented juniors tennis player I still had a round face and broad shoulders. Sure enough the problem was medical. I did go on medication nearly a decade ago, and still carry on with it...

On the advice of one my physicians, I also moved to a 1,200 calorie diet. I consider this diet what has probably saved my life and kept me from becoming monsterously large. But even on 1,200 cals, I am still a "chunky" girl. I was encouraged to drop my caloric intake as far as 200 calories more, but just couldn't find it in me to go lower.

Exercise is difficult for me due to a physical disability, but getting in a little walking or pool time helps burn cals.

There is something we need to talk about, and it's the people who intenionally gain weight to qualify for Gastric Bypass surgery. I can't tell you how many posts I have read on health-related bulletin boards about food binges, donning heavy clothes for dr. appts., and other insanity in order to GAIN weight, because some folks feel gastric bypass is the only way they will succeed in losing weight, and the surgery won't be performed (generally) on people under 250 lbs... It's so sad.

Being a healthy weight is surely a challenge...often, there is an emotional connection to overeating, too. It's not an "I eat when I am sad" or "I eat when I am happy" thing, but maybe an inability to control the impulse to eat in the first place, regardless of one's mood.

For myself, I will stick with the low-cal diet and avoid invasive procedures...Lord knows we can't be sure what's worse for you in the long run.

The best thing anyone trying to lose weight can do is enlist the emotional support of those around them. There are nonprofit weight loss groups, plus friends and family can help too.


Posted by: Jo at June 7, 2004 02:11 PM

According to what I've read, the most dangerous "eating for comfort" is not eating when sad or happy (although those aren't good, either), but eating when bored. The ol' appetite vs. hunger thing. One intriguing article discussed having three spice mixes: "sweet" (powdered cocoa), "hot" (cayenne pepper), and "italian" (grated romano cheese and powdered onion/garlic) to sprinkle on bland diet food to increase the flavor quotient to help satisfy the appetite rather than hunger, but without adding significant carbs or calories. I haven't tried it yet, but I do know that most of my wagon-fallings are when I just *need* something flavorful, so it just might work.

Posted by: nathan at June 7, 2004 04:35 PM

I find the discussion about obesity and it's cure sad. there are so many prejudices out there that are hard to uproot. I have done the dieting and exercise thing for over 25 years and what did I get for all my suffering and hard work? Obese.

somewhere it was decided that weight loss and such should be alot of effort and work. is that because of the work ethic in this country that if there is no effort there is no payoff?

pills are the easy way out or whatever. where does anyone get the idea that being thin should be hard?? also setpoint is not arbitrary all it is is the amount the body determines is needed to survive dieting (famines). it is not complicated.

the setpoint can be brought down by eating there is no other way.

don't eat enough the body has to make up for it somewhere. fat and muscles are where it gets the make up fuel. the more often and the more amount it has to tap into the more fat it needs in storage, and if the famines are severe (which most dieting efforts are) then the metabolism has to be brought down until the famine is over and when the famine is over (because you can't stand the hunger pain anymore) then fat must be replaced to match the setpoint.

setpoint doesn't go up and stay there unless you are having periods of times you famine, some people it only takes a mild famine to set them up for fatness. famines are defined in two ways.

alot of caloires but poor nutrtion which for some is the triggor to save up and store for winter message or

very high quality just not enough caloiric wise.

second by undereating (such as ignoring hunger because of being in a position not to be able to eat such as at a meeting or in the middle of working)you put yourself on the famine feast cycle which keeps you fat.

if you lose weight the first part you lose is muscles, just read that a few minutes ago in the search of starvations studies. you lose 2/3 of your weight in muscles and exercise doesn't preserve them.

second since fat is bulkier you will look heavier than you actually look. 3 pounds by the way = one size, 10 pounds for most is a size so 7 pounds of that is muscles since muscles are denser and cause alot of weight to be lost with little in the size department.

also 1200 caloires is a famine diet, no doubt about it, you are losing muscles not alot of fat that is why you feel chunky.

here is a personal example. when I was lighter in weight I was very chunky okay I was fat!!! I was very large and looked heavier than I was.

once I started the naturally thin approach which is based on biology not outside appearances, I realized i was still on the famine feast cycle which was keeping me fat all those years even tho weight stayed the same for 12 years. (even tho I thought I was eating enough obviously I wasn't)

once I increased my eating and found the hunger cues I was missing I gained over 40 pounds. well that is necessary as part of teh recovery. I stablized and stopped gaining even tho I was eating all the time, I plataued for 14 or so months, (also required) and then poof I noticed my clothes getting larger, I was actually shrinking, I did not know how much I lost becaue you are not allowed to weigh yourself, that is a no no as the numbers will drive you crazy.

but at the doctors office (3 different ones in fact) the loss was 20 pounds. I lost 3 sizes. I don't have food thoughts all the time anymore, unless I am hungry, hunger starts in the brain not tummy, I have increased energy, it takes little exercise to build up my muscles and strength compared to the days I was jogging 12 miles a week plus walking and weights.

I have more muscles now than I did then. and I am less active now then I was then.

the cure for obesity is not eating less but rather eating more and eating better. it is not about bad foods good foods (I still ate doritos with my cottage cheese during my plataue because I was hungry for it I still drank my pop when I was hungry for it, and I made sure to eat alot of real foods too)hunger starts with food thoughts, binging starts out by not eating enough over time.


I did not count caloires and still dont' I do not know how many calories I ate during the gain plataue and loss, (tho I did notice an aversion to my old favorites such as chocolate gradually took hold)

I did not stop eating because I thought I should but rather kept eating until I couldn't eat another bite. so now I don't look as bulky as I did when lighter, even tho I am still heavier.

the weight I lost was truly fat, never has a doctor who examined me ever said you have the hardest tightest stomach muscles I have ever felt, you truly are a walker my gyn doctor said this to me. when I was on weight watcher and jogging and weight lifting I never had such muscles in my stomach or legs like I do now.

it turns out that if you exercise while dieting (1200 caloires is a diet, 1500 is so is 2000 if your body needs more than this) you do not release human growth hormones and thyroid stimulating hormones in response to exercise only people who are eating enough do, that explains why I am getting muscular on little effort (compared to past attempts)

it explains why all those years when lighter my back hurt all the time, the pain was excurciating, but now heavier but more muscular my back hardly bothers me anymore and (even tho I was lighter I was an avid exerciser, i walked and hiked trails all teh time. but my back still bothered me all the time.

I see some of my friends who lost weight (one in particular has kept it off for over 12 years) and I see flab, they walk and exercise with weights yet they are flab, I can see that when they wear shorts or bathing suits, of course I don't say anything because I don't want to hurt their feelings and I have said they are not eating enough and burning up their muscles but they don't believe me.

so the cure to obeisty is a change of attitude people need to step outside the box as it were and realize the old ideas are not working, and you cannot blame 98 percent of dieters with lack of willpower, no one can use sheer willpower against their strong survival instincts and no one can be in pain forever, hunger and cravings are painful, if they were not there would be little incentive to eat.

pain and survival are not good friends. look what happens when you have a headache that doesn't go away for several days how long can you use willpower to endure it? or are you going to take medications or go to the doctor if that doesn't help?

why do we treat hunger pain any differently?

if it didn't hurt you wouldn't take the necessary steps to stop it, put your hand on a hot stove and what happens? what if it didn't hurt? you would probably leave it there burning it up, not unless you consciously say get my hand off the stove.

what would happen if diets did not fail? we would probably die of starvation before we realized whe were not eating enough. pain is for our protection.

RR

Posted by: Roberta at July 18, 2004 02:55 PM

Well, I cannot tell you your experiences are false. I can suggest that perhaps you are interpreting your experiences incorrectly, because the conclusions I reach from my experiences are the exact opposite of yours.
I've dropped 17 pounds in 6 months using my new understanding.

The point we agree, perhaps, is that the body resists losing weight. That merely means you have to find ways around those obstacles your body puts up so it doesn't use muscle for energy, but uses fat instead.

But the key is persistence. And yes, hard work (although my experience indicates a higher baseline of activity is more important than a vigorous workout), because there is very little in the world worth achieving without some effort. If it were easy, everyone would do it, no? My concern about drugs is that drugs always have side effects...remember Phen-Fen? You lost weight, then died of a heartattack before you could enjoy it.

Finally, hunger "pains" aren't pain at all. They are called hunger "pangs", but English has degraded that term enough that people have forgotten the original term. It may feel like pain, but that is entirely the interpretation of your mind. It doesn't have to be seen as pain, the way the pain from damaged nerve endings are. If you were right, you could point to a nerve ending that was damaged...but you can't, because it is an entirely different sensation than damage.

And even the hunger pangs can be minimized or eliminated by approaching your diet properly, particularly by eliminating refined carbohydrates and sugars, and minimizing naturally low-fiber carbohydrates and sugars. Also, eating cinnamon helps that, too, interestingly.

Your plight is said, and I have sympathy and empathy for you, but 25 years of trying may simply be because you have put in 25 years of effort in the wrong techniques...

Posted by: Nathan at July 18, 2004 03:14 PM
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