Expert: We don't have any known way to make obese people thin except gastric bypass surgery, which has a 2% mortality rate by itself.
Thin person: But I am very thin!
That's about 50% of the conversation in the comments to the Paul Campos interview. It's about as useful as the following exchange:
Expert: We don't have any known way to make short people tall, except for extreme surgeries and hormone injections.Let's explore the possible rejoinders to this:
Megan: But I am 6'2"
1. Obesity is increasing in the population, so it can't be genetic.
Well, average height is also increasing in the population. Does that mean that you could be as tall as me, if you weren't too lazy to grow?
Twin studies and adoptive studies show that the overwhelming determinant of your weight is not your willpower; it's your genes. The heritability of weight is between .75 and .85. The heritability of height is between .9 and .95. And the older you are, the more heritable weight is.
2. Height doesn't have anything to do with health.
Actually, it may. Being taller puts a greater strain on your circulatory, cardiovascular, and musculoskeletal systems. Tall people are prone to all sorts of problems at higher rates, especially in their back. That doesn't make it any more sensible to suggest that we need a public health campaign to help tall people shrink.
3. We don't have any good way to make people shorter, but we do know how to make them lose weight.
Actually, this is rubbish: we don't know how to lose weight. Some of the things Paul Campos is saying about obesity are controversial, but this isn't. Every single study which has attempted to make overweight people get thin without very risky surgery has failed completely and utterly. Fewer than 1% of patients ever keep the weight off.
Highly educated people who have managed to get their body weight down 5-10% from where their body naturally wants to be confuse what they are doing with what someone obese enough to cause significant medical problems would need to do, which is get their weight down 50% or more from where their body apparently wants it. They are not the same thing. The amount of weight loss that these sanctimonious slenderizers have achieved has no statistically significant health benefits. Let me repeat: losing twenty pounds will not make you healthier. If you have diabetes and high blood pressure, there is an extremely modest improvement in test results. Unfortunately, it's even harder for diabetics to lose weight than the rest of us.
Fat tissue makes people want to eat--it sends out for takeout. And hunger is a signal on par with thirst or pain. You can ignore it, if you have sufficient willpower. But just as most people can't withstand torture (a minority can), most people can't ignore the constant demand from their body for food. Gina Kolata's Rethinking Thin describes it thus:
Every time the result was the same. The weight, so painstakingly lost, came right back. But since this was a research study, the scientists looked at more than just weight loss . . . they measured metabolic changes and psychiatric conditions and body temperature and pulse. And that led them to a surprising conclusion: fat people who lose large amounts of weight may look like someone who was never fat, but they are very different. In fact, by every measurement they seemed like people who were starving.
On every count, the weird, bizarre, almost depraved behavior that Ancel Keys reported when he studied young men who were deliberately starved in his experiment during World War II was just like what Hirsch observed among the formerly obese subjects at Rockefeller University Hospital. Something ws driving these people to regain their weight, and it was not a deep-seated desire to be fat.
Their metabolisms, for example, had changed so that they hung onto, clung to, every calorie that was consumed, making it harder for them to stay thin. Before the study began, the fat people had a normal metabolism--the number of calories burned per square inch of body surface was the same as for people who had never been fat. That changed substantially after they lost weight, with fat people burning 24% fewer calories per square meter of surace area than were used by people who were naturally thin.
The Rockefeller subjects also had a psychiatric condition that had been termed "semi-starvation neurosis". Hirsch's patients dreamed about food; they fantasized about food, or breaking their diets. They secreted food in their rooms. They daydreamed about food. And they binged . . . eventually more than fifty people went through the months-long process of living in the hospital and losing weight, and every one of them had the physical and psychiatric symptoms of starvation.
If when eating a normal 2,000-2,500 calorie diet, you do not spend significant amounts of your day fixating on food--fantasizing about it, binging, hiding it, strategizing how to procure it--you do not have anything interesting to say to someone who is struggling with obesity. You do not have better willpower than they do. You do not "care about myself" more. You are not more "serious about a healthy lifestyle" because you took off the eight pounds you gained at Christmas. You are no more qualified to lecture the obese on how to lose weight than I am qualified to lecture my short friends on how to become tall. You just have a different environmental and genetic legacy than they do. You're not superior. You're just somewhat thinner.
To put it another way: I have NEVER had a BMI above the normal range. How much more awesome am I than you? 30%? After all, you have to work at it. My willpower is apparently 100% natural.
I fearlessly predict that more than one person will respond with some variation on "there were no fat people in concentration camps/but I told you, I totally lost 20 pounds last year by taking up marathon running!" Yes, we could solve America's obesity problem by putting everyone in the country on sawdust bread and cabbage soup. We could also just shoot anyone whose BMI is over 28. Are these good solutions? Because short of that, we don't have much.
4. Then we need to intervene with the kids, so they don't get fat in the first place
Schools have tried this; so far, it's no more successful than adult interventions. You can get a very small effect over the short term, but eventually, the kids start eating again. Yes, school meals are crap. I assure you, they were also crap thirty years ago, and sixty years ago. Yes, P/E has been cut in some schools, but there's little evidence that exercising makes you lose weight by itself. Unless you control their access to food completely--and you can't--those kinds of environmental interventions don't work.
5. So why is America getting fatter, Miss Smartypants?
Some combination of the following:
1. Hyperpalatability of food: the Seth Roberts/chain restaurant haters hypthesis. The processors have perfected combinations of fat, salt and sugar that addict us, causing us to eventually swell up like a balloon.
But French restaurants have been doing this for over a century, and for most of that century, thinness has been inversely correlated with poverty. Your body doesn't care whether it gets its fat and sugar from a Ho-Ho or a Chocolate Eclair.
2. Increasing prevalance of corn in the supply chain: the Michael Pollan/Cato hypothesis. Maybe: corn doesn't seem to be very good for you. But I'm skeptical of monocausal hypotheses.
3. Calories are getting cheaper. Self explanatory. In my view, the dominant reason. People eat more calories because they like it, and can afford to.
4. Animal fat. Eh, maybe. We sure eat a lot more of it than we used to. But we eat a lot more of everything. And without controlling for socioeconomic status, it's hard to tell whether vegetarians are thinner.
5. Larger portions. Special case of "calories are getting cheaper". I think it's less persuasive than many people think. It's true people will eat a great deal at a sitting if you give them a great deal. But if people were so easy to fool, long term, about their caloric intake, we'd all weigh eight zillion pounds.
As I pointed out elsewhere, a simple error of 50 calories a day--half a slice of Pepperidge Farm All-Natural Whole Wheat Bread--would make us gain five pounds a year apiece. Given inherent calculation error, no one is watching their calories this carefully. Our appetites are doing the work for us. Maybe you eat an extra 2,000 stealth calories at dinner, but you're not so hungry the next day. Conversely, try dining on Macaroni Grill's new 390 calorie scallop salad. Unless you're on a permanent diet, I bet you feel peckish before bed.
6. We're getting older. It is normal to gain weight as you age, unless you are in a fairly calorie-deprived environment. An aging demographic will naturally produce a fatter population. This does not account for the growing number of super-obese people with BMIs over 40, even over 50. But it accounts for at least some of the central shift.
7. We quit smoking. Smoking makes you quite a lot thinner, particularly after 25. Now that fewer adults smoke, more adults are gaining weight.
Reasons we aren't getting fat:
1. We don't know how many calories are in the food we're eating. I'm pretty sure my great-grandmother didn't either. She still knew that pound cake made you fat, and lettuce didn't.
2. We exercise less. We haven't gotten noticeably more sedentary in the past decade or so, but the weights keep shooting up. Also, there's no evidence that exercise makes you lose weight--ever discussed dieting with a long distance runner or ballerina?
3. Poor people don't have access to good groceries. They had even worse access ten, thirty, fifty years ago. Using starch and cheap sugar as substitutes for vegetables and lean meat is not a recent invention--George Orwell discussed it in the Road to Wigan Pier. Frozen vegetables are very good for you, and within the budget of everyone.
4. We're eating too many empty carbs. Processed carbs entered--and dominated--the American diet in the second half of the nineteenth century. Working people at the turn of the century ate virtually no meat, little fat, and few vegetables; their diets were mostly beans, white flour, polished rice, pasta, and potatoes, washed down by sugared coffee or tea. Folks who want to blame the "food pyramid" should read a cookbook from 1950. Grandma didn't need a food pyramid to rely mostly on carbs; carbohydrates were what she could afford.
There is a really, really deep resistance to the idea that appetite is as powerful a modulator as it appears to be. I can't help but believe that at least part of this is simply that thinness, especially for women, is tightly correlated with socioeconomic status and urban living, and nice upper middle class people who have been on a slight diet for most of their adult lives just cannot believe that a) this isn't making them healthier and b) it isn't making them better people.
But while a lot of what Paul Campos says is controversial, this isn't. You can find the same results yourself by reading any study of weight loss: outside of gastric bypass surgery, no system has ever produced any significant long-term weight loss. None. As Paul remarked to me once, "We've run this experiment approximately 220 million times and the result is always the same. Why can't anyone believe it?"
His controversial assertions are about the correlation between weight and health, and the benefits of gastric bypass surgery. I'll leave those for another day. But even if he's entirely wrong about those things, we're still left with the core fact: we have tried, and failed, for more than fifty years, to find a way to make people thinner. Arguably, we should stop. Certainly, we shouldn't count on any cost savings from controlling obesity to fund our future health efforts. It is much more likely than not that obesity will stay the same, or get worse.
Well I think the people who have lost a lot of weight are in a different category to people who ask why you can't be tall, as they've done it.
Says she who has only ever intentionally dieted for the total of one afternoon, although if I understand the dieting research correctly, my complete lack of willpower is probably why I haven't gained weight overall since reaching adulthood.
As I pointed out elsewhere, a simple error of 50 calories a day--half a slice of Pepperidge Farm All-Natural Whole Wheat Bread--would make us gain five pounds a year apiece. Given inherent calculation error, no one is watching their calories this carefully. Our appetites are doing the work for us.
I agree, but soda messes up the bodies ability to accurately predict how many calories have been consumed. It's 140 calories, but the body doesn't feel like it consumed 140 calories. Even diet sodas increase the number of calories a person consumes in a day. In my mind that's the biggest difference in food intake we've seen over the last fifty or so years. Like you said, all it takes is a difference of 50-100 calories a day to start packing on the pounds.
Compare fruit juice (e.g., apple or grape) to soda.
Once you pull away the "it's natural" mysticism...you'll be surprised.
Apple Juice:
http://caloriecount.about.com/calories-apple-juice-i9400
(~120 calories in a cup = 8 oz).
Why do you think drinking diet soda "causes" you to eat more? Serious question. Correlation = causation? Or is there a study that compares, oh, sparkling water to diet coke? Sparkling water to still water? Diet coke to still water?
Why do you think drinking diet soda "causes" you to eat more?
Artificial sweeteners increase your appetite.
Once you pull away the "it's natural" mysticism...you'll be surprised.
It's not the calories is that your body is able to accurately asses the calories in juice, milk etc based on the level of sweetness and its viscosity. Non-diet sodas do not have the viscosity of juices, so your body assumes there are less calories per soda than there actually is.
It's not the calories, but that your body does not accurately predict just how many calories are in each soda.
Secondly, I'm not aware of any time where juice was drank as much as soda is now.
Actually, to take that further, I'm not aware of any time where juice was drank as much as juice is now, outside perhaps of merry binges at harvest festivals. For my grandparents' generation (WWII), "juice" was a 6oz glass of something you had with breakfast, as juice was harder to get out of season, and much more expensive.
Bowels and taste permitting, a person can now drink three or four gallons of apple juice, orange juice, or lemonade in a week for less than $10, all year round.
Count me in the camp of soda haters.
10+ years ago, a really smart doctor was looking into my hypertension. She didn't tell me to drop 20 pounds (well, she DID say it WOULD help...) but told be to drop soda instead. My stable weight did go down some, but, more importantly, the red wine I have ultimately replaced the soda with is much tastier ;)
I like your fat people/tall people analogy, but a different one suggests itself to me: fat people/men. It's well established statistically that women have longer lifespans than men. So if we want better health, why don't we achieve it by using medical interventions to turn men into women? We could require every male human being, after leaving a viable semen sample on deposit, to undergo gender reassignment surgery and hormonal treatments, so that they would all be female from then on.
Except that, of course, they wouldn't really be physiologically equivalent to people who were female from birth. Surgical and hormonal treatments aren't that good. After the change, half the population of women would now be gender-reassigned women. And the statistics on women's health might well change drastically. In just the same way, if gastric bypass were made compulsory for all obese people, a lot of them might end up nonobese in outward appearance; but they wouldn't necessarily be physiologically the same as naturally thin people, and the health statistics for naturally thin people might look different.
Thanks for blogging about this topic.
Not only that . . . at least a significant portion of the survival difference is that men are more likely to smoke . . .
What about very tall, obese men?
I'm guessing that at some point we'll want to round them up and put them on an iceberg...
Obesity will soon replace Global Warming as the panic du'jour, assuming that Iran or Korea don't do anything silly with all of the fissionable material they've been collecting.
I think there's a potential viral component as well. In other words, I think the 'obesity' epidemic may well be an actual viral epidemic, much as ulcers turned out to be largely due to a bacterial infection instead of all the various environmental and psychological causes cited while I was growing up. (Lower your stress! Eat bland foods!) I don't think that's the sole cause (i.e., there's plenty of room for both genetics and environment as well), but I won't be at all surprised if by 2020 or so we've established a clear link between a virus family and a subset of obesity cases. ..bruce..
Yeah, or maybe it's the result of brain parasites. Who knows?
I think there's a more simplistic explanation though: humans are genetically programmed to horde resources in the form of body fat. In fact, it's not just humans: who hasn't seen an obese pet? This is a sound genetic strategy when resource availability fluctuates between scarcity and plenty, but it has bad outcomes when resources are always plentiful.
Biodiversity, in its infinite wisdom, imparts varying degrees of this urge into the population, and our environment culls those who are unoptimized for the situation at hand in the form of lower social status and earlier deaths, resulting in lower birth-rates. If things keep playing out as they are, the obesity rate will naturally decline because the food-craving urge will be ameliorated genetically.
Of course, when we reach some sort of Malthusian threshold or suffer from an apocalyptic famine, the folks who don't think much about eating are likely to be the first to go, and those with the "obesity" gene will prosper.
A lower socio-economic status results in a lower birth rate????
You might want to check your notes.
Back in the day before 99% of all children survived to adulthood, a lower socio-economic status meant fewer children surviving to adulthood. Also, when being poor meant being at the border of starvation, it meant difficulty conceiving, a problem underweight women still have. It's just that underweight isn't the normal condition of the poor anymore.
I think there's a potential viral component as well.
Amen! Amazing how this gets glossed over. I don't think that this applies to all cases, but I'll bet that a few cases of obesity are related to infections...
Megan, you're doubling down on this contrarian argument that's bordering on the absurd. I think you should take a step back and reread what Paul actually said and what the responses to it were. They weren't your stereotype; they were overwhelmingly highly skeptical of his arguments. You're sounding more and more like his twin, and I have to say I can't respect you all that much when you make such, for a lack of a better word, stupid arguments.
Also, I should clarify this point:
"But if people were so easy to fool, long term, about their caloric intake, we'd all weigh eight zillion pounds."
The reason this isn't true is because your base metabolism scales on weight. If you eat 3000 calories a day, you will eventually end up at a weight that requires 3000 calories a day to break even. Same with 2500 or 2000 or whatever. People are in fact easy to fool, long term. Numerous studies have shown people constantly underestimate both the amount they eat and the calories their food contains.
Also, you dismissed the corn argument without even discussing it. Corn itself isn't really unhealthy, but the prevalence of HFCS in the vast majority of food products in the past 20 years has had some noticably negative health effects. I would think you as a libertarian would be particularly interested in the degree to which our policy of massive corn subsidies has influenced what goes into our food. I'd love to see a post on that.
1) Basal metabolism doesn't scale that effectively on weight--not enough to absorb a 2000 calorie a day surplus. Fat burns fewer calories than muscle, and is also insulating.
2) The very fact that people are easy to fool, yet weight fluctuates relatively little in most people, indicates that in fact, knowledge of calories cannot help them lose much weight.
3) HFCS may have bad health effects. They have not been proven. I'm willing to believe the exist. But it's speculative.
4) I'm against farm subsidies. But I'll bet you a million dollars that if we end them, we're still fat. Obesity is increasing worldwide.
Megan,
I also think you're clinging too closely to the contrarian argument. System-wide, consistent and lasting weight loss may be extremely difficult to achieve because of human nature. But in most INDIVIDUAL cases, lasting weight loss can be achieved through changes to lifestyle - read: diet, activity, and exercise, but also certain other contributory lifestyle changes.
As someone who personally went through a change in lifestyle from journalist to combat infantry soldier in Iraq (where I lost 30 pounds in the first 90 days in country) back to journalism and writing full-time (where I gained it back plus about 4 pounds over the past five years), there is no doubt in my mind that changes in lifestyle are important.
Unfortunately, in the real world, most of us aren't paid to wear body armor and spend our days chasing down moojies in the streets. Would that it were so! For most of my career, I've been paid to sit at a computer and write... and in order to function as a writer, I've found I need to keep a steady course of caffiene and sugar coursing through my veins (otherwise I either fall asleep or lose focus because all I can think of is going out and finding that caloric fix).
Not a great combination. But manageable when I gave up journalism and got into just being a marketing copywriter, so I could go home at 5 and then go work out.
The point: We spend most of our non-food-prep time waking hours at work, and work has changed. The combination of an information-based society ties many of us to computers, phones and cubicles, or management of those who are. When we get home, we have labor-saving devices whose benefits have largely been channeled not into increasing leisure time (which we can use for physical activity), but into allowing us to work longer hours at sedentary jobs.
Diet alone ain't gonna do it. Solve the workplace puzzle, though, and I think you can put a dent into it.
In the military, it's not unusual for some commanders to authorize a two-hour lunch period in the middle of the day to allow people to get in a mid-day workout. THis is in addition to an organized unit PT program.
Bill Gross, head of the bond operations at PIMCO, and a long-distance runner himself, frequently takes off in the middle of the day to go running.
I think there's a lot to be said for this. People won't get up early. And at the end of the day, there's kids who need help with homework, dinner to be made, household chores, etc. But people WILL go work out in the middle of the day if employers encourage it and resource it to a certain extent.
Hmmm. So in a country with universal conscription into the armed forces, young men would all be thin and fit. Then that would help set their body set-point for the rest of their lives.
But if this was true, then the USA and other similar countries would see a ever rising level of obesity since the 1960s.
And countries that still have conscription like Korea would not...
I'm actually being serious here.
MM makes it sound like obesity is just the natural by-product of food addiction, an addiction with a genetic basis.
If that's the case, then it sounds like a pretty hopeless situation given how unsuccessful our society is at curing other types of acquired addictions: alcohol, drugs, cigarettes, etc.
If that's the case, then it sounds like a pretty hopeless situation given how unsuccessful our society is at curing other types of acquired addictions: alcohol, drugs, cigarettes, etc.
There are more "ex-smokers" currently living in the US than "smokers"... seems that "addiction" isn't really "hopeless", or even that important.
MM wrote: 1. Obesity is increasing in the population, so it can't be genetic )) Well, average height is also increasing in the population. Does that mean that you could be as tall as me, if you weren't too lazy to grow? Twin studies and adoptive studies show that the overwhelming determinant of your weight is not your willpower; it's your genes. The heritability of weight is between .75 and .85. The heritability of height is between .9 and .95. And the older you are, the more heritable weight is.
I don't think you're getting out of that one so easily. The average height in Europe has also been increasing since the world wars, and quite rapidly in the more northern countries. While different individuals finish out at different heights that are apparently hereditarily determined, the population average needs some other factor to explain it. That factor is proposed to be infant health and nutrition:
http://www.informahealthcare.com/doi/abs/10.1080/03014469500003702
In other words, while genetics ultimately put the brakes on height, there appear to be factors early in childhood development that can variably scale the outcome.
Now suppose that an obese person may not be able to control their body's weight setpoint any more than their height, but there was a factor in their childhood development that shifted their bodymass setpoint higher up on the scale. What and where might that factor be found, and if it exists, can it explain the upward trend in overweight Americans?
And is Paul Campos, smart and well-read though he may be, completely overlooking that kind of factor in his research?
There's some suggestion that it's epigenetic--mothers with poor nutrition may produce fat kids. But the other factor is that kids have access to a lot of calories. Calories used to be expensive, and kids who didn't have money didn't get too many of htem. Notice that wealthy parents are obsessed with not letting their kids have sugar, etc. because it's unhealthy.
You seem to be giving insufficient weight to the fact that people have to get fat in the first place. It's not just about losing weight, it's about gaining weight. I think we can all agree that it is easier to stop yourself getting fat than it is to get thin once you're fat already. I'm happy to give up on the already-fat in favor of concentrating our efforts on the not-yet-fat. Whaddya say?
Well, except to the degree that willpower is heritable. Not that there's an easy way to test that. Heritable doesn't mean unchangeable, either; it may mean that some people have to put in an (unfairly) much larger amount of effort, effort that may not be worth it if the benefits are small (as you point out).
I'm confused. Megan, how do you reconcile this:
"Calories are getting cheaper. Self explanatory. In my view, the dominant reason. People eat more calories because they like it, and can afford to."
with this:
"You can find the same results yourself by reading any study of weight loss: outside of gastric bypass surgery, no system has ever produced any significant long-term weight loss. None."
If you believe that a primary cause for our population's weight increase is an increase in calorie intake, why do you reject the proposition that reducing calorie intake will meaningfully slow or retard our weight gain?
More to the point, how do you explain the fact that, according to you, eating more calories will tend to cause you to gain weight, but eating fewer calories will not cause you to lose weight?
Because it seems more sensible to me to explain the (long term) failure of most weight loss methods not on the method, but on our failure to adhere to it for long periods of time. Which seems to imply that we do know how to lose weight (more or less permanently) but we haven't figured out how to change people's behaviors for a long enough period of time without serious supervision or coercion.
Additionally, although I haven't read Campos' book, I must say I'm skeptical of the level of dismissiveness you and he seem to have about the correlation between "healthy" behaviors (as opposed to weight, per se) and health. I would be much more interested in reading a post that resulted from you going back and reading and summarizing for us some of these studies that purport to show that eating "right" and exercising don't correlate well with health.
"If you believe that a primary cause for our population's weight increase is an increase in calorie intake, why do you reject the proposition that reducing calorie intake will meaningfully slow or retard our weight gain?"
If we can't effectively prevent people from smoking crack, how on earth do we expect to prevent them from eating too much?
I acknowledged precisely this point when I wrote: "we do know how to lose weight (more or less permanently) but we haven't figured out how to change people's behaviors for a long enough period of time without serious supervision or coercion."
Namely we know _how_ in a strict physiological sense. But getting people to do it is very hard (for more than just a few weeks or months, that is).
As I read it, the linkage you are missing is:
--people tend to stay close to their "natural" weight. Starvation = lose 20 lbs, cheap food = gain 20 lbs.
--the "obesity epidemic" is caused by most folks sliding a bit to the right (gaining 20 lbs), thus pushing a bunch of folks who were on the edge of the arbitrary BMI threshold past that threshold.
The point, IIRC, is that because changes in weight of 20lbs aren't strongly correlated to changes in health or lifespan, we should just calm down on the obesity outrage.
Ok, well, if that's all, then fine.
I feel like there is a lot of rhetoric (on both sides) in both of these threads that is getting way overblown. :shrug:
"Which seems to imply that we do know how to lose weight (more or less permanently) but we haven't figured out how to change people's behaviors for a long enough period of time without serious supervision or coercion."
Megan admitted that, if we put these people in a concentration camp, they'd have to lose weight. There's no question that it's possible, if we're willing to resort to sufficiently extreme measures. But when you say that they can lose weight "more or less permanently", you imply that we just have to teach them to eat healthier, and they're "fixed". According to the Rockefeller study that was discussed in the post, they'll have to struggle painfully every day of their lives.
The US has had a debate lately on torture and whether it's ever acceptable, even in order to get information that could save innocent people's lives. We need to ask ourselves if obese people should be forced to choose between a constant state of starvation (which sounds like a type of torture to me) and the contempt and ridicule of society. You're boiling it down to simply "reducing calorie intake" without discussion of what that means for the people involved. Would you approve of a constant state of partial starvation as a form of punishment for convicted criminals?
Which population group has larger public health costs on a per-member basis: the obese or gay males? If we expect the obese to stay away from food for their own benefit, can we similarly expect gay males to stay away from gay bars for the same reason?
Hey, if the President can't give up butts for his health, why should the gays have to give up butts?
But such people would NOT be starving!
There is a huge amount of dishonesty operating here. You lose weight by increasing your activity level and *slightly* reducing the caloric intake your body currently uses.
If you are currently sustaining 180 pounds on 2200 calories per day, you'd eat about 1700 and at the same time increase your activity level (ideally with weight training and high-intensity cardio for 30-40 mins at a time).
As weight drops (and if you don't go wild on the cardio, you will mostly be losing fat anyway), you adjust your caloric intake *upward* because at the new, higher activity level, you can have more and more calories.
I'm quite sick of the myth that losing weight means a starvation diet and that long-term weight maintenance at a lower weight means permanent semi-hunger. That's simply not at all true, and one reason people can't sustain weight loss is because they believe they must deny their body the very fuel it needs to keep the darned fat off in the first place.
This is (surprisingly to some) also true even if your metabolism is trashed out from eating disorders and/or crash diets. You can, with more effort (and mental preparation for the strong likelihood that you will gain some weight in the short term), still ultimately end up eating lots of calories and being at a healthy level of physical activity and not being at an unhealthy bodyfat level (not the same as overweight/obese, and certainly the distinction should be made). And oh yeah, you can still lose weight over the long term even with a wrecked metabolism, but certainly it takes more work in the short term.
Unfortunately, the human metabolism is not as static as you postulate. How do you think "wrecked metabolisms happen in the first place? You start off dropping from 2200 to 1700, but eventually your body adapts, and decides that 1700 calories is equilibrium. You stop losing weight, so you drop to 1400 calories. Lather, rinse, repeat, and wonder why you're starving and weight-stable at 1000 calories a day.
This, by the way, is exactly what happens in anorexics, a population I think we can all agree is expert at calorie-counting and portion control. After an initial big drop, they lose weight much more slowly than you'd expect given the massive calorie deficits. It's not uncommon for someone to lose a pound every two or three weeks while eating 1000 calories below basal metabolic rate and compulsively exercising for hours a day.
Emma B-
Lather, rinse, repeat, and wonder why you're starving and weight-stable at 1000 calories a day.
Why would you expect anything different?
This was the "natural" experience for 99% of mankind for the entire of history of our species- until the last 200 hundred years or so.
Which human's metabolism should be called "wrecked"? The primitive human who can survive "long-term" on 1000 cal/day if necessary, or the obese pig who says he's "starving" without 6 times that amount?
Fletch, the reason such a metabolism is "wrecked" (wibble's term, not mine) is that appetite doesn't necessarily adjust to match metabolism. Your weight might be stable, but you'll constantly be struggling with extreme hunger. Wibble's assertion that it's easy to lose weight without hunger, but that's not true once the body adjusts to a given level of calorie restriction. Once this happens, you're pretty much locked into weight gain if you want to move the equilibrium so that you can eat more.
Of course, that's only a problem if you accept that gaining weight is bad bad bad, but in light of these threads, I think we can assume.
BTW, former eating-disordered person AND former obese person here -- within 30 lbs of morbidly obese at one point (meaning that I weighed about 200 lbs, in case you aren't familiar with the BMI weight strata). I don't think I have ever eaten anywhere near 6K calories in my life, and believe me, I know from calorie counting. That was a bonus free gift from the anorexia, just like the "wrecked" metabolism that bounced me from anorexic to obese, I know what I'm talking about when I say that I was obese on 2000-2500 cals/day. But hey, thanks for bringing out the gluttony stereotype!
The idea that the obese unknowingly eat ridiculous amounts because they're too stupid to know better bugs the crap out of me, and it doesn't even make sense. Just about every obese woman around has done Weight Watchers and Jenny Craig and half-a-dozen others, all of which spend inordinate amounts of time teaching you about portioning. Been there, done that, got the digital food scale and the Fitday account. IME, you can be off by 300-500 calories without weighing and journaling food. But 3 or 4 THOUSAND calories? That's just risible.
@Emma
But you are at the same time INCREASING YOUR ACTIVITY LEVEL.
You just completely ignored what I said, and you even ignored that I said it can actually work even with people who have disordered feedback mechanisms. You don't want to believe that it can work, so you ignore the details that don't suit your narrative.
In fact, my post mentions explicitly that you will be modifying your caloric intake over time from the original 1700 postulated.
Anorexics purposely starve themselves. They do not feed their bodies and often do not strength-train (they can't do it on the minimal food they consume), so you cannot sit there and use a purposely dysfunctional population as 'proof' that diet and exercise cannot work for fat loss long-term.
Also, you are completely and utterly wrong about weight loss. I lose 1 lb per week or more exercising about 20-30mins per day (averaged out over 7 days-- i have days where i do nothing really and days where i do about an hour total). My body isn't special, I just don't do a bunch of low-intensity cardio (which is proven to not really work for long-term weight loss).
Calorie deficits are not the path to weight loss. That has been repeated over and over, and you're just wilfully disregarding that fact. You can't starve your way to long-term healthy weight loss. We should agree on that, but it messes with the notion that your weight is this magical beast you have zero control over.
No, wibble, I saw what you said, I just disagree. You stated that you get to increase your calorie intake *upward* as you add exercise. That's a very limited strategy, because it gets really difficult to increase exercise after a certain point, and metabolic dysregulation can go a lot farther. If you plateau at 1700 calories, adding a 300-calorie exercise deficit doesn't actually allow you to eat more -- it just allows you to start losing weight again at a reasonable clip. If you plateau again, which most people eventually will, what do you do then? Cut food, add more exercise, or quit losing weight. That's why I brought up anorexics (and BTW you're wrong about anorexics and lifting, but this post is long enough already), just to demonstrate that the body's ability to achieve equilibrium over time is pretty much unlimited, even at ridiculous energy deficits. If you don't have that much weight to lose, or if you are, say, a male with a higher initial intake, you can make it to goal before that equilibrium gets too psychologically unpleasant. If you have more weight or a lower consumption to begin with, you have to work harder and harder and harder to fight it.
I also strenuously object to the statement that I just "don't want to believe that it can work", because I'm an apostate rather than a skeptic. See, I *lost* the weight. 80 lbs, to be precise, from an obese size 18 down to
I started dieting sensibly enough, and without any preexisting metabolic handicaps. The first 20 lbs came off like lighting, the second 20 lbs were pretty easy too, the next 20 lbs were harder but doable, but the last 20 lbs were where it got ugly. I added exercise and then cut back food and eventually got to my goal weight, eating about 1800 calories a day at maintenance (and exercising regularly). I stayed there about five minutes before I started gaining a little weight back, just a couple pounds, but I wanted to crack down before the regain got out of hand. I cut down my food a little more, just to lose those pounds, and when that didn't work I upped the exercise. I religiously food-journaled and weighed everything that went in my mouth, so it's well-documented that I eventually GAINED weight on 1500 cals/day, with 5 hours of intensive lifting workouts (plate-a-side squats, not the little pink weights) and four 5K runs a week. I finally started passing out regularly, and my doctors and my husband had a come-to-Jesus with me.
Turns out that the metabolic stress I'd been putting myself through over the year-plus of dieting had "wrecked my metabolism" -- that is, it completely trashed my hypothalamic-pituitary axis. I did such a thorough job that I had to resort to infertility treatment to become pregnant, and five years later, I still haven't been able to get off the thyroid medication. It ultimately took a 35-lb regain and three years to get my metabolism sorted out so that I could eat reasonable amounts of food, which is way more than "some short-term weight gain". That's what a really disordered feedback mechanism looks like, and it takes a lot more to fix it than a few weights workouts and a little extra willpower.
The take-home point here is that I didn't start out this round of weight loss by starving myself or with a metabolic disadvantage. I started out with the kind of moderate weight-loss strategies you describe, but my body adapted to those over time, and I had to significantly up the ante even to get out of the BMI overweight category. I did all the right stuff, and it didn't get me any farther than "a little plump", so I had to push harder and harder until I wound up doing myself serious damage. Is it any wonder I'm a little disillusioned?
To be clear, it's not that I don't think it's possible to lose some weight through diet and exercise. I'm questioning the feasibility of losing a LOT of weight, and maintaining that loss for the long term. Some people do it easily, and it's nice for you that you've been able to drop some weight with reasonable methods, but my experience was very, very different.
Gah, HTML fail. Should read: "80 lbs, to be precise, from an obese size 18 down to < 20% bodyfat, until it all went to hell. When I'm telling you that you're wrong about metabolic downregulation, I'm saying that my direct experience with that entire process contradicts your theory about the ease of continued weight loss. It's history, not a bedtime story to make myself feel better about being fat."
@Emma
You retained weight loss of 55 pounds or so, and simply because that is not 'a lot' to you doesn't mean that weight loss via diet and exercise are impossible or shouldn't be attempted.
You were simply unable to sustain the specific numeric weight loss that you desired, which is not the same as 'gaining it all back and then some' at all, which is what you keep insisting is bound to happen.
My 'postulations' are based on actual sustained weight loss of other people, who in fact helped me realise diet and exercise actually can work, and thus got me to try it in the first place.
Perhaps all of them are the edge cases, and you're the norm. Perhaps it is the other way round.
Also, losing 80 pounds in much less than 80 weeks is by many standards not the moderate path to weight loss, so an argument can be made that your dieting experience was closer to a crash diet than many of the other experiences referenced.
I do think the state of weight loss research is quite sorry, and that studies should be designed better, and gather detailed information on how people ate and spent time in activity prior to the study.
First, I totally am on board with the notion that BMI (or even weight, generally) is a stupendously stupid and crude measure of health. Specifically, that by these measures obese != unhealthy, necessarily. This is the point Campos and Megan were making about bell curves, and people within only 20lbs or so of the obese cutoff obsessing over their weight.
I just feel like this a criticism of how we talk and think about obesity, not obesity itself. If they think we've defined obesity too liberally, I'm totally on board with that.
But then I feel as though the criticism veers off into this crazy land where losing weight is just IMPOSSIBLE, for EVERYONE. And that seems pretty silly to me.
Second, if it is indeed the case that eating a healthy diet and being generally active is tantamount to torture for some people, well, ok. (And here I'm not talking about people who are technically obese according to some bogus BMI statistical jiggery. Let's assume we're talking about people whom we'd all agree are far enough overweight to be genuinely suffering health consequences.) I'm not advocating forcing these people to change their lifestyle and suffer for the rest of their lives like some sort of gestapo. It's a free country, and all that.
But the experience you describe sounds suspiciously similar to that of an addiction, to food. (Maybe it's just because I'm re-reading Infinite Jest at the moment.) Namely, that my understanding is that addicts don't ever really stop wanting their substance. That craving goes on and on for the rest of their lives. And might even resemble what you're calling torture.
Nowhere do I argue for torture via forced starvation or that obese people should suffer the contempt and ridicule of society. But I do think that obesity (at some level) should prompt a discussion with one's physician about whether the pains of losing weight are worth the potential health benefits. And that it is indeed possible for people to lose weight in these circumstances, in a healthy fashion. Hard. But possible. That's all.
It is worth noting that it is mostly women that are getting fed this message that losing weight is IMPOSSIBLE. Men seem to more often just do the exercise and eat a little less, and then keep it up when they start seeing results after a couple weeks.
With the exception of women who have decided that weight training won't turn them into Chyna (an unfortunately small pool of women, but much larger than just female bodybuilders), most women try to do exercise at a 'light' pace, see no results and then become very convinced that weight loss is IMPOSSIBLE.
Plus, between the twin poles of women who eat secretly but don't count it in their calories and women who are so paranoid about calories they starvation diet, most women who want to lose 50 pounds are walking around with trashed out metabolisms and no idea how to actually keep fat off.
It really needs to be acknowledged that while the extreme obesity occurs in both men and women, the vast majority of people in the street who believe diet and exercise are worthless are female.
Also nobody talks about the bizarre levels of liquid retention in very obese people (400+ pounds). In many cases, these folks' organs are swimming around in liquid rather than fat. This may partly explain how doctors get 700 pound people with 'good' cholesterol levels and other supposed signs of decent health.
just seems like food, particularly carbohydrates like sugar and simple starches, have become so inexpensive the people can afford enough to realize the genetic weight potential.
Even the carbohydrates referenced as being eaten a century ago: beans and flour (far more likely a whole wheat flour than white -- cheaper to process)were more complex -- i.e. left the person feeling full longer.
The 50 calories a day thing cuts both ways: 100, or even 50 years ago, work on average was far more physical in nature. People easily were burning 400 or 500 more calories a day.
Cheap food + desk work = more weight
The only thing I have to say is that I went through several months fixating on food, and then I stopped fixating on food and my appetite became naturally much smaller. This was indeed only losing a mere twenty pounds that I had acquired since college, and yes, at the suggestion of a doctor who also suggested exercise and statins, as my cholesterol level had gone up for the first time in my life. And yeah, my cholesterol level went from 228 to 120 and has stayed there, and I really have no idea if there's a real long term improvement, though the exercise part seems a bit beneficial. I have no idea if the experience would apply to other people, probably not to people who are actually obese considering the various data.
I think "thin" is too broad a term, really, and that's part of the problem.
I will never be 125 pounds. I am 5'8" and built a bit like a linebacker. Despite the fat that 125 pounds is considered an "ideal" weight for my height, that's just not happening.
In order to look as attractive as society would want me to, I should probably be about 15-20 pounds lighter than I am. I'm not. I've come to peace with that because, yes, not going hungry, disordering myself, or obsessing about food are more worthwhile to me than getting down to a size 10 is. But I used to weigh 60 pounds more than I do. That was clearly unhealthy behavior that didn't need to last. With some changes to what I ate and how much of it I ate, I managed to get my body down to a set point (and boy is it ever one) that's much healthier for my overall well-being.
Is everyone going to be thin? No. But you have to do a lot of destructive, unhealthy eating to get yourself up to 300, 400, 500 pounds. Surely you can't be considering that "unavoidable?"
Not even close. If you think just eating in a destructive and unhealthy manner a whole lot, is ONLY is going to get you up to that weight, you are mistaken. Not saying that eating has nothing to do with it, but guess what? this group of people are human like the rest of us, and like humans, their bodies are complex organisms. There are a variety of reasons why they get this fat. But let me explain something here, you are completely ignorning the fact that there are other factors working in a body (besides eating) that make someone that fat. Your mere suggestion above, sugest that somehow, genetics has nothing to do with it.
Do you really think that if you started to eat "destructively" you would get that fat?
Note what Megan said above:
"Twin studies and adoptive studies show that the overwhelming determinant of your weight is not your willpower; it's your genes. The heritability of weight is between .75 and .85. The heritability of height is between .9 and .95. And the older you are, the more heritable weight is."
This statistic applies to everyone, not just the somewhat chubby, but the truly, very fat. Falling back on old tired,, destructive stereotypes of people is not going to cut it.
"But you have to do a lot of destructive, unhealthy eating to get yourself up to 300, 400, 500 pounds. Surely you can't be considering that "unavoidable?"
Falling back on old stereotypes of destructive, unhealthy eating is not going to cut it. Not saying that calories have nothing to do with it, but these are people, with complex bodies like the rest of us. There are a variety of reasons why people get this fat. Do you really think that eating a lot is the sole reason, or even the main or largest reason for their weight? These body sizes are so unusual, I find it very interesting that you just about ignored what Megan said about the genetic component of weight which applies to everyone, not just the merely fat. It applies to the super-fat too:
"Twin studies and adoptive studies show that the overwhelming determinant of your weight is not your willpower; it's your genes. The heritability of weight is between .75 and .85. The heritability of height is between .9 and .95. And the older you are, the more heritable weight is. "
Read about set-point theory.
Sorry about the double posts above. I'm not sure what happened there.
You're right that restricted calorie dieting acts like famine on both mind and body and should definitely be avoided, but...
2. We exercise less. We haven't gotten noticeably more sedentary in the past decade or so, but the weights keep shooting up. Also, there's no evidence that exercise makes you lose weight--ever discussed dieting with a long distance runner or ballerina?
I believe that kids absolutely have become more sedentary in recent decades. When I was a kid, TV sucked most of the time, and variants of 'pong' were about it for video games. So we played outside a lot more and sat in front of a screen a lot less.
Ever discussed dieting with a long distance runner or ballerina?
Long-distance runners and ballerinas are not the same. Endurance athletes do not have to watch their diets to avoid getting tubby. The idea that frequent, vigorous exercise won't make you leaner (and healthier) is just wrong.
My point was that a shocking number of these folks who "don't need to diet" are between borderline and full blown anorexic; check out the message boards on any running site.
I'm a runner and have spent lots of time around distance athletes for 20 years. We eat like pigs because we burn calories like hummingbirds. In the tough phase of marathon training an average sized man can safely eat 5,000 calories a day. Cyclists during the Tour de France eat 10k+ per day. Serious athletes have to eat. Food is fuel. You simply cannot perform without it. I don't know what kind of people you meet on running message boards, but I'm guessing they're more dilettantes than runners.
Well, message boards are not a great indicator of your average distance runner. Your more intense distance runner? Maybe, and that probably pollutes the control group. It is unsurprising to me that some people who'd post on them have intense and dangerous eating habits.
I've been a runner all my life, and it is definitely a chicken/egg argument. I am most likely a runner because I am thin and have a lot of energy, but I am certain it goes the other way too. Running fast and far gives me greater dietary leeway than my more sedentary friends, and when I eat poorly I use it as a motivation to go run. Or, I abstain from a crappy snack to prepare for a run, etc.
But "exercise" defined generally, if at all, may be as lousy an indicator as a running message board. A 13 minute per mile 5K runner is not exercising at all like someone clocking miles at 8 or 7 per. For me, I feel like I benefited from being in a very strenuous cross country and track program in high school. It taught me that busting your ass will not kill you-- and that it can be fun. By comparison, my friends who did not go through a difficult sports program do not tend to exercise nearly as hard as I do. And I am no great athlete. I didn't even run varsity. I am sure their exercise is hard, but many runners I know don't even set a demanding goal and find the run itself proof of great effort. A cross country alum would never look the run itself as proof of great effort.
My comments here rely on some very crappy data indeed-- my life and my basic guesswork-- so feel free to tear it apart. Still, I think that if there is a magic bullet for weight loss that many if not most people can handle, it would be strenuous exercise. Turtle paces are not even in the same league, and my bet is they pollute the data that says "exercise does not help."
Do you have any idea how many calories those runners (or cyclists, of which I am one) are eating each day? Hint: It's not the average amount.
Is there anything you know nothing about that you don't feel free to comment on as an authority?
As for the other, they may have become more sedentary in recent decades, but that problem hasn't changed significantly in the last twenty years. Yet the kids still get fatter.
This isn't exactly coherent. Poor people in the cities don't have access to good groceries. Did you ever walk around West Philadelphia(outside of UPenn's campus)? Or North Philadelphia? Sure, frozen veggies are within the budget of everyone, but trying getting to a grocery store in the places I mentioned. They are almost non-existent. How many people are going to take public transportation to do their weekly grocery shopping?
The question is not whether they have *good* access; the question is whether access to groceries is driving them to get fat. Since obesity is increasing, for this to be a significant factor, access would have to be getting *worse*. It's not.
try getting frozen veggies home on public transportation.
May not work out too well.
Actually, it takes quite a while for them to defrost unless it's August, because I used to do just that. But again, the issue is not whether this is a problem. It is whether more peole today have to get veggies home on public transportation, which is what would have to be true for this to be driving obesity rates. It just isn't.
I lived in Philly (Fairmount) without a car and shopped at small local groceries mostly, but occasionally walked the 15-20 minutes to a bigger one. I never had trouble buying brown rice, beans, fresh fruit and veg, whole grain cereals and breads, lean meat, tofu, pasta, potatoes, etc. If you want to eat good foods it's not hard. Google "supermarkets philadelphia" and go to the map result to see how wrong you are about "non-existant".
your post made me hungry. I ate a banana. I am also training for a half-marathon. This has has no noticable impact on my weight which remains in the (most healthy!) slightly overweight category, but has made it more likely that I will engage in a conversation about running shoes or proper hydration.
One thing I find interesting is the tendency - encouraged by national average statistics- to think that any weight loss is a good thing, and equally good in all cases. This is perfectly legitimate when thinking about the national budget or carbon emissions - a dollar saved is good in a fixed sort of way that can then be compared to whatever was lost or given up in saving it. It is not accurate when we consider weight loss in the population. Five pounds more or less whether in a year or a month may be good, bad or meaningless depending on the person, and national averages obscure that information.
When I got semi-serious about running and trained for and completed a half-marathon, I actually gained a bit of weight, mostly because I was eating so much after long runs. I was about 5lb over my usual going into the training and about 15lb over coming out, but my cardio, blood pressure and cholesterol were all way better. I then got serious about weight lifting and managed to drop the excess weight.
I do think that half-assed exercise is almost worse than no exercise, since the person flails about, sees no results, and is then convinced that exercise can't possibly help.
Surprised nobody discussed the automobile's role in this:
* People no longer have to walk to go to work and run their errands, resulting in less exercise.
* People can load up their vehicles with more food than they could carry home, resulting in fewer trips to the grocery store and more "temptations" around the house.
* People can stay in their homes and get fatty food delivered to them on a lark. One more "temptation".
Of course the microwave is just as bad -- cooking takes work and exertion. Taking something out of the freezer and hitting a button doesn't.
Perhaps the solution is that people need to force themselves to burn more calories in order to eat :-/
humans are genetically programmed to horde resources in the form of body fat.
Take a look at Princes William and Harry. No one in their family has missed a meal in 1000 years - they and their ancestors have had unlimited access to hyper-palitable food for 50 generations.
Well, that was part of my point: their ancestors didn't suffer from food scarcity so it's entirely possible that the "fat genes" faded away in the bloodline.
Put the children of a Russian peasant in their positions, and you'd probably see a different outcome.
Ignoring the fact that you are assuming that every single one of William and Harry's ancestors for the past 1000 years has been wealthy royalty, which is demonstrably false, 1000 years is not anywhere CLOSE to long enough for genes basic to survival to "fade away." I'm guessing prince William was born with an appendix, and how long has it been since his ancestors needed that?
A Russian scientist was able to breed tame silver foxes within his lifetime. One would think that genes governing aggression are "genes basic to survival".
Surely you are aware that there have been fat English kings? The armor gallery at the Met has a body armor of a very rotund king.
Tann,
Yes, but look at the current crop of european royals, nearly all thin, and look at their ancestry. You can go back 30 generations full of titled ancestors, each of whom had a staff of servants preparing their meals. Generations of exposure to hyper-palitable food hasn't created a generation of morbidly obese people. None of their ancestors had a lot of heavy lifting or toiling in the fields to do either.
http://en.wikipedia.org/wiki/File:Crown_Prince_H%C3%A5kon_(50).jpg
or
http://en.wikipedia.org/wiki/Felipe,_Prince_of_Asturias
For much of that time, the Royals were training for battle...which was much more strenuous than battle is today (not that you see many fat infantrymen). Leading troops into battle was a fundamental part of reigning until recently (both George VI and Churchill wanted to lead the Normandy landings).
Losing weight is not rocket science. Burn more than you consume. Sure, the details are tricky, and you are fighting thousands of years of evolution. That means it's hard. It doesn't mean it's impossible.
Five years ago, I was 5"5", 250 pounds, and had a 46" waist. I started watching what I ate and working out daily. I'm down to 150, 34" waist. And I've also lost any willingness to listen to people talk about how impossible it is to lose and keep off weight.
me, December 2k4
me, December 2k8
Kudos, you look awesome.
It's not just what you eat; it's what you eat ate.
Eggs from chickens with a natural diet have bright orange (not yellow) yolks, thick whites, and are high in omega-3's. Broccoli grown on rich, living soil tastes better, and fills you up. Grass fed beef taste better then corn-fed, though it's not as tender.
grr, first post gave an error.
I'd add one more factor: Fewer people cook at home, both because of lack of time, and because of lack of knowledge.
Megan, are you familiar with the work of Dr. Weston Price?
He wrote a book called "Nutrition and Physical Degeneration."
It's worth a stroll through the bookstore or library for a peek; the photographs alone tell a powerful story about the costs we pay not for being fat, but for eating too many empty calories and not enough nutrition-rich foods.
A problem of too much processed food instead of real food.
Personally, I think the single most essential part of controlling health care is taking on the food lobby. Canola oil? Sold as a healthy oil? Get real. It's an industrial product made mostly from rape seed and soy beans; both of which are not digestible without fermentation. While palm oil is maligned. Yet coconut oil is essential to many healthy cuisines; Thai food anyone?
It's not just regulation capture, which abounds in food, it's also propaganda by industrial food producers.
Megan,
Wow, I've never found so much to disagree with in any of your postings. I did a QUICK google search and came up with the following studies which showed successful weight loss AND maintenance of lost weight after 1+ years. One study showed success after 5 years.
The first link is a meta-analysis of 29 studies meeting their criteria for US based studies, structured weight loss programs, and had follow-up for 2+ years. Studies which were focused on very low energy diets found successfuly weight loss maintenance of 7.1kg (mean) after 4-5 years on average. 6 of the studies also had groups that reported the inclusion of exercise had significantly greater weight loss maintenance than those who exercised less (I'm reporting almost verbatim from the results section).
So an analysis of 29 studies meeting some basic criteria refute the foundation of your post. And below is a bunch of links, and each of those contains links to more studies there-in.
http://www.ajcn.org/cgi/reprint/74/5/579?ijkey=135d9a64f60898da68da6cf961e93d8e17d43e5d
http://www.ajcn.org/cgi/content/full/82/1/222S
http://www.nih.gov/news/health/feb2009/nhlbi-25.htm
http://content.nejm.org/cgi/content/full/360/9/859
http://www.diabeteshealth.com/read/2009/04/03/6144/moderately-protein-rich-diet-better-for-long-term-weight-loss-says-university-study/
http://www.ncbi.nlm.nih.gov/pubmed/16002825
My assertion to you is:
1. People can and DO lose weight and maintain that loss with dietary control and with and without exercise.
2. Exercise aids in this and is consistently shown to aid in this.
Now, I've documented a fair number of studies which pretty solidly refute your claims. Can you point me to YOUR studies showing, as you said, "Actually, this is rubbish: we don't know how to lose weight. Some of the things Paul Campos is saying about obesity are controversial, but this isn't. Every single study which has attempted to make overweight people get thin without very risky surgery has failed completely and utterly. Fewer than 1% of patients ever keep the weight off."
And I hope that you have multiple sources for it, because one researcher with a contrarian point of view will often make news for publishing a questionable study with a bold claim.
Joe
I did a QUICK google search and came up with the following studies which showed successful weight loss AND maintenance of lost weight after 1+ years. One study showed success after 5 years.
How much weight are we talking? Megan's point was people can keep off that extra 10-20lbs it's the extra 50 or 100 that we haven't foudn a way to keep off short of surgery.
Jmo - The studies I quoted showed 7.1kg, or 15.62 pounds.
However, the argument that obese people need to drop 50-100 pounds is quite false in the general population. The negative health effects of obesity largely dissapear once you get into the "overweight" BMI curve (i.e. a shift from above 30 to between 26-29.9 BMI).
Now, I'm trying to find statistics on where the BMI curve falls, because here's what we currently have:
http://www.win.niddk.nih.gov/STATISTICS/
"Nearly one-third of U.S. adults are obese"
So about 30% are 30+ BMI....but what's the mean or median of that population?
http://www.cdc.gov/nchs/data/databriefs/db01.pdf
Page 3 shows that the vast majority of those obese individuals (Per 2005/2006 NHANES data) is in the 30-35 range.
A 20 pound drop, on average for a 5'9 male, is a drop of 3 BMI points.
For a 5'5" female, a 20 pound drop is about a 3.3 BMI drop.
Now, I can't find the data for what the median/mean BMI of the obese population is....but I imagine a 20 pound drop might decrease the proportion of US obesity from ~33% down to maybe 20% of the population.
And we're agreeing that a 15-20 pound drop is definitely sustainable.
So where exactly is the argument? This 50-100 pound stuff is bunk.
Tree Joe,
no it's not bunk. It's not bunk because there is no material difference in health outcomes or health costs for people between about 22 BMI and 35 BMI.
The central argument against targeting obesity is in your own post. The increase in obesity is almost all due to people gaining 10 or 20 pounds and moving from 28 BMI to 31 BMI. And there is NO difference in health outcomes or health costs (other than prescribing drugs to people at 31 BMI because they are "obese") between people at 28 and 31. So we could wipe out the obesity "epidemic" by spending a lot of money to get people to reduce calorie intake and exercise more and accomplish exactly nothing other than waste a bunch of money.
There are different health outcomes and health costs for the morbidly obese (people above 40 or 45 BMI). And for those people dropping below 30 would involve dropping 50 or 100lbs or more. And we don't know how to do that short of creating a totalitarian food state.
So we know (expensive) ways to help people lose 20lbs but it doesn't matter and we don't know how to help people for whom it does matter. Does that sound like the basis for good public policy?
Mmm...I think that this implies that is a difference between someone who is 200 pounds overweight and someone who is 30 pounds overweight. If you don't know how much weight someone needs to lose then I think you might be comparing apples and oranges or people who with a few lifestyle changes can lose that freshman 15 and the obese who can't lose half their bodyweight or even 15 pounds to literally save their lives.
Tim,
First off, it's incredibly cheap and relatively easy to impose programs to help people lose 20 pounds. I've been on the educational side, and 2 people can easily provide nutritional and educational counseling to about 200 individuals at any given time, more depending on how the program is set up, and even more as time goes on and they require less constant follow-up. And we're talking the type of rigorous counseling/classes that has been proven to work in studies; real-world would require less rigor for the sake of research.
Shifting the entire overweight/obese range down by 3 BMI point is not insignificant. That's a shift to the entire curve, which will significantly reduce incidences of T2 diabetes and other costly co-morbidities.
What you are saying is that the "obesity epidemic" being vastly reduced by a mean 20 pound loss wouldn't do much, because the problem children need to lose more than 20 pounds. Sure....but they'd all GAIN by losing 20 pounds. And at some point, you'd be shifting alot of people further down the risk-range.
So yes, I think the basis of good public policy is trying to get the entire obese population to lose and maintain the loss of 20 pounds :)
Joe
Should we just tax calories, if being overweight is a problem and cheap calories are the cause?
That would be humorous....6000 years of a race fighting for plentiful food, only to lead to the race making it harder to obtain food stores.
> 1. Obesity is increasing in the population, so it can't be genetic.
>Twin studies and adoptive studies show that the overwhelming determinant of your weight is not your
>willpower; it's your genes. The heritability of weight is between .75 and .85. The heritability of height is
>between .9 and .95. And the older you are, the more heritable weight is.
Heritability coefficients are just a special type of correlation coefficient and compare variance on one dimension to variance on another. If something changes across the board, it has no impact on a correlation coefficient. So for instance, in 1978 the correlation between the length and weight of a car was .946. If we imagine that the government passed a law requiring the addition of 500 pounds of ballast to all cars, this would make both long and short cars heavier, but not change the correlation coefficient. On the other hand, we can imagine regulations that would affect the cars differently by length, and such regulations would affect the correlation between length and weight.
Anyway, the point is that heritability coefficients are very tricky to interpret. What you mean is that "about .8 of the observed variance in weight appears to be driven by variance in genes, holding constant the common environment."
Also note that a heritability coefficient says nothing about which genes are responsible for the coupling of genotype and phenotype. Since things like time preference are heritable, it's conceivable that some of the mechanism isn't just corporeal things like the thyroid, but mental things that could plausibly be called "willpower."
I indeed assume that much of it is mental. Pain is just mental, but that doesn't make it irrelevant. Everything I know about overweight people suggests that they have an insistent voice telling them to eat all the time that I just don't have. In that context, it seems meaningless to talk about willpower. When I'm super-hungry, I'm a terrible, mean, angry person who can't stop eating either. If you told me I had to live that way all the time, I'd kill you.
When I'm super-hungry, I'm a terrible, mean, angry person who can't stop eating either. If you told me I had to live that way all the time, I'd kill you.
I would have said the same about cocaine when I was 23- why am I not an "addict" any longer? Why is "obesity" different?
But what percentage of obese people are doomed to be obese and what percentage are obese because of the culture? The Japanese aren't obese and I doubt it is soley due to genetics.
It's partly because food is much more expensive there.
But they do have sumo wrestlers.
I indeed assume that much of it is mental. Pain is just mental, but that doesn't make it irrelevant. Everything I know about overweight people suggests that they have an insistent voice telling them to eat all the time that I just don't have. In that context, it seems meaningless to talk about willpower. When I'm super-hungry, I'm a terrible, mean, angry person who can't stop eating either. If you told me I had to live that way all the time, I'd kill you.
That really sums it up perfectly.
Megan:
1950 isn't far back enough to get a good handle on diet and obesity. Carbohydrates, especially simple sugar, has been the major driver of obesity, and specifically diabetes and cardiac disease. Look up "diseases of civilization".
I recommend reading Weston Price and Gary Taubes (Good Calories, Bad Calories).
Our failure to figure out how to reduce obesity may have something to do with how, since the 1950s, it's been treated as a psychiatric disorder ("hunger research") rather than a metabolic one. Also, diet is firmly in the field of public policy, and thus politics, which has had the expected impact on its Quality.
Weston Price's work is eye opening, isn't it? I recommended it elsewhere in this thread.
I'll check out Gary Taubes, thank you for the rec.
Zic: Cool. And reading Price is revelatory. The photos blow me away every time.
You'll *love* Good Calories, Bad Calories. It may also convince you to that the industrial food producers are not the biggest villains in this sorry sorry tale.
If they aren't villains then who is - we must have our villains!
Worry not smilerz. There are villains, but you'll need to read the book to find out who they are.
Very glad to see lots of independent recommendations for "Good Calories Bad Calories" by Taub. As someone who worked in the field, his characterizations of how it actually works are spot on.
We need to ask ourselves if obese people should be forced to choose between a constant state of starvation (which sounds like a type of torture to me) and the contempt and ridicule of society.
Given that obesity is increasing, and one plausible explanation is that people can afford more and better food, we need to ask ourselves if 50 years ago some number of people lived in a constant state of tortured starvation because food was more expensive.
If not, then the "people can't help it" explanation is nonsense. Going strictly by the orginal post, if cheaper food = more calories = fatter, then less calories = thinner. Starvation scare stories don't apply unless you can find some from 1950 about thinish people acting deeply weird because butter cost more, or explain why we're genetically programmed to act like we're starving when food is cheap, but not to do so when it's expensive.
I suspect the starvation stuff is a matter of habit: if you're used to 5,000 Calories/day, then going to 2,000 causes you to freak out a bit. But if you've never been to 5,000, then you're not going to freak out. So...the answer (for anyone not wishing to be fat) is to not let yourself got to 5,000 to begin with.
Rob-
2 things:
1. we need to ask ourselves if 50 years ago some number of people lived in a constant state of tortured starvation because food was more expensive.
Penn & Teller had a nice point on this in their episode, showing a picture from the waist up of a man who looked handsome, attractive, and a model weight. Then, they zoomed out to show that the guy was actually a Depression-era farmer.
2. One of the confounding factors here is that there are different groups of fat people. Some people got fat by eating 5000 Cals/day; these people find it much easier to lose weight later (Subway's Jared falls into this class, incidentally--a lot of his weight gain was actually on Subway's much higher calorie sandwiches!). Others are just genetically unlucky, and manage to remain fat on diets in the normal 2000-2500 Cal range. It's just not that simple.
Given that obesity is increasing, and one plausible explanation is that people can afford more and better food,
Then why aren't these people morbidly obease:
http://en.wikipedia.org/wiki/Prince_Carl_Philip,_Duke_of_V%C3%A4rmland
http://en.wikipedia.org/wiki/Henri,_Grand_Duke_of_Luxembourg
Click on the links to their siblings, children and parents - none of them are heavy.
This has been pretty eye opening. It makes me wonder at an off topic question:
If weight and health don't correlate well, what does correlate well with health? If we shouldn't be focusing on weight, is there something we should be? Specifically, does exercise improve health, even if it doesn't reduce weight? I seem to remember another post mentioning that most of the benefit is just from walking regularly.
This question also occurred to me. One of Campos' arguments seems to be that a BMI of 30 is a random artificial number used to define overweight. Fine, so government should try to get people with high BMI to lose weight. But don't we need something, or at least don't doctors need some measure to let them know if they should be conducting extra tests on their patients? It seems BMI, if used properly, is an inexpensive measure for doctors to use and given our healthcare costs, it seems reasonable to have a way to not have to test everyone all the time for heart disease and diabetes. If eating and exercising are better indicators of health, doctors can maybe ask patients about their eating/exercising habits, but many people don't really track their eating habits and lie about their exercise habits. So we still need a metric that is cheap and easy to measure.
sorry for typo. I wanted to say "govt shouldn't try to get people to lose weight."
Yes, exercise absolutely makes people healthier (but not always any thinner). People who exercise have stronger immune systems, and stronger muscles help prevent many common injuries (pulled muscles and broken bones).
Of course, this only applier to moderate exercise. Past a certain point, you start hurting yourself more with the exercise than the benefits you get from doing it.
"4. We're eating too many empty carbs. Processed carbs entered--and dominated--the American diet in the second half of the nineteenth century. Working people at the turn of the century ate virtually no meat, little fat, and few vegetables; their diets were mostly beans, white flour, polished rice, pasta, and potatoes, washed down by sugared coffee or tea. Folks who want to blame the "food pyramid" should read a cookbook from 1950. Grandma didn't need a food pyramid to rely mostly on carbs; carbohydrates were what she could afford."
The above is total hogwash.
I don't have to read a cookbook form 1950. I actually ate the stuff popular at that time, as did my 4 (much) older brothers and sisters. A lot of what we ate was what my parents ate as kids. I don't have to "research" what "working people" ate in the earlier 1900s because my grandparents WERE working people (a plasterer and railroad clerk), as were most of my aunts and uncles. My father (born 1900) was the only one of 6 kids to go past working class. They ate meat and potatoes, along with certain long lasting vegetables like carrots (lack of refrigeration back then). Stews, using cheap cuts of meats, were VERY popular. So were various sausage (a way to use the worst parts of meat) with certain ethnic groups. Other cheap meats included kidneys, liver, pig knuckles, etc. These were the "working man's" meats. My father loved that stuff.
Every single working class area had real, honest to goodness, butchers. You could even buy horsemeat (still available at the butcher when I was a kid). Instead of prime rib, they'd have chuck, along with the cheap meats I mentioned above. Slaughterhouses were common in or around ALL cities where the vast majority were working class. You know what the UN was before it was the UN? It was where all sorts of slaughterhouses were. Before that, they were located where Park Ave and Grand Central are now. That area was real working class years ago.
Ever hear the history of Long Island? You'll hear potato farms. All destined for New York City to feed the working classes. Pork came from right across the Hudson, Secausus, when I was a kid. The place stank to high heaven.
Anybody who says the working class ate what the author says they ate has ZERO actual experience with old working class diets. The same diet, meat and potatoes, that evolved in the 50s to the middle class that evolved from working class parents.
Here's another WRONG thing in the article: "4. Animal fat. Eh, maybe. We sure eat a lot more of it than we used to. But we eat a lot more of everything. And without controlling for socioeconomic status, it's hard to tell whether vegetarians are thinner."
Ever hear of Lard? It was the basic fat used in everything and was readily available into through the 1970s. In the 50s, 60s, and into the 70s, when supermarkets had actual butchers, the butcher would keep "suet" (fat trimmings). When you got something like beef for roasting, the butcher would ask if you wanted some suet and would put it on top of the meat. That's how you got the makings of gravy. Today, if you roast beef, it's hard to get enough "drippings" to make enough gravy.
Great comment. Again, it's not what we eat, it's what we eat ate before we eat it. That pork from the 50's isn't like todays pork.
Heres' another bit of my food nostalgia.
Many years ago 2 of my father's friends came up with a neat idea. You see, those working class people had to go to the butcher for meat, the baker for bread, and the produce store for veggies and the grocer for other things.
They decided to put all this stuff under one roof. They came up with a name for it: "supermarket". It was in Jamaica, NY.
Then they figured that they could open a lot more. With that, they'd get buying power with suppliers. With that, they could lower prices. They'd sell more, for less, and still make more money. So the working people got lower prices. They REALLY expanded after WW 2.
Their name was Cullen (actually it was Cullen and his brother in law Kennedy) and they called the store "King Kullen". They're still in business, still family controlled by Cullens and Kennedys, and doing pretty well. I know many of them - having grown up with them. That supermarket idea seems to have been a pretty good idea.
Who knows, maybe their idea of "supermarket" with lower prices helped contribute to people getting fatter.
The point is not that no one had meat. The point is that they stretched that meat with a lot of "empty" carbs--the "potatoes" of meat and potatoes. And bread. And cookies. Etc. If you look at gross consumption 50 years ago, we were eating a whole lot of processed grain.
After years of trying without success, I've lost 30 pounds in the last year, in a remarkably steady fashion (mostly three pounds each and every month). I haven't used "willpower" and I certainly haven't done any exercise, though I'm absolutely eating less. So I do think you're right, in that neither willpower nor exercise are going to work.
The problem is, I can't explain what it is about what I'm doing that IS working (marriage? Greek yogurt? opening of a local Jimmy John's?). If I look at the demographics of obesity, the most likely explanation is that my income increased by 40% (though I am not spending more on food). I don't know how this makes it easier for me to eat less, but perhaps it does.
Your activity level may have increased. I lost a few pounds several years ago without exercising or eating less simply from having an upstairs office at home and going up and down the stairs 15-20x per day. I had been so sedentary at the time that just going up and down the stairs for random little things burned enough calories to lose a few pounds in a few weeks. It was the only change to my otherwise still sedentary routine.
Your activity level may have increased. I lost a few pounds several years ago without exercising or eating less simply from having an upstairs office at home and going up and down the stairs 15-20x per day. I had been so sedentary at the time that just going up and down the stairs for random little things burned enough calories to lose a few pounds in a few weeks. It was the only change to my otherwise still sedentary routine.
Tim H What works ?
Marriage and money both reduce stress;
Your body demands and stores less ergs.
I hope I am not so far down on the list of comments that I get missed, but I think there is one factor Megan has ignored, and that is how fast we eat.
Our body may naturally control our caloric intake via our appetite, but appetite takes some time to generate and send signals. If you order a big burger from any fast food place, that's about 900 calories. I can (an did) scarf that down faster than my body could register that I do not need anymore food. It's not that food is more fattening, its that it is becoming more convenient to eat fast. By forcing myself to eat slower, via appetizers and foods that take longer to eat, my caloric intake dropped significantly, without the discomfort of starving myself. In fact, just yesterday I ate lunch at a restaurant (which has not happened in some time) and I was amazed how full I felt after not finishing a meal that a year ago would have left me feeling hungry.
I have no data about this aside from personal experience, but it seems that both in the past, and in the "old" world, people made a bigger occasion out of a meal, slowing down their eating via silly social protocols.
Another few random gripes:
1.Why are we still using BMI? I realize its easy to calculate, but body fat measuring devices are cheap and plentiful. You cannot get good conclusions in an absence of good data.
2. Why is metabolism calculated as calories used per surface area of the body? Does this assume that most of our calories are used to to keep up our body temperature? And if this is true, shouldn't people in cold climates be noticeably thinner than those in hot climates? And shouldn't the spread of air conditioning be consider a factor that is making us all fat?
BMI is an incredibly simple and easy way to determine someone's approximate obesity. It's not a good determiner in the 20-30 range, but it's pretty good from 35 and up.
Body fat measuring devices are incredibly unreliable, short of a total immersion tank and those aren't feasible. You can't apply even very trained individuals using calipers on different people across different states. Electric-current body fat analysis is extremely poor at measuring total body fat but actually decent at measuring deltas (i.e. you lost 10 pounds and it shows a 3% drop in body fat, it's half-way accurate).
3. Metabolism isn't calculated as calories used per surface area of the body....I don't know where you got that idea. Calorie is a unit of energy production (it's actually a unit of heat, but it's similar to how a watt is a unit of electrical energy and can be applied to various ways).
4. People in cold climates tend to store more fat right under the skin as an insulatory measure. Long-distance swimmers tend to have "smoother" bodies because of this, while shorter-distance swimmers will get more "ripped". Same concept.
This is were I got the calories per surface area calculation. I thought it was rather odd.
Oh, okay. See it now.
In that sense, it makes sense and is to be expected. All it's saying is that fat disproportionately increases body surface area while non-linearly increasing basal metabolic rate. That's pretty much physiology 101 stuff. Fat takes almost no calories to maintain itself. Therefore, if you are fat, your calorie consumption per meter of body surface area will not be linear to a thin person.
I would argue that study has a few things not being mentioned in it's summary. #1 is that a fat person's (i.e. 35 BMI) metabolic rate should not be equivalent in proportion to a thin person's as a function of body surface area.
#2 starvation mode, a real physiological mode, is one of the few ways to truly, albeit temporarily, make your basal metabolic rate change. When the body senses starvation, it will actually take certain actions that slow down the body and decrease it's caloric needs.
It's the equivalent of unplugging a laptop and setting it to "conserved" mode :)
Joe
Ken, I think you make a good point. And this is something that schools can do - lengthen the lunch period. Many schools are cutting lunch time to make time for more extra-curricular activities. Some schools only leave 20 minutes for lunch and then take away recess. I don't know if this contributes to childhood obesity, but it just doesn't seem healthy to force kids to rush through meals.
Based on my memory of school, if my lunch were 20 minutes longer, I would eat just as fast, and spend an extra 20 minutes playing outside.
If you want to apply this principle to schools, you'd have to serve really small portions and make people go for seconds and thirds. Physically go and stand in line again. This might make desert not worth it for some...
School lunch is one meal out of three or four in a day and cannot be the cause of childhood obesity. In another post here I noted that families that eat dinner together around a table have less obesity than kids who eat in front of the television. Care to guess about what types of food are eaten at the table versus the couch? How about the number of calories and the make-up of those calories- fat, carbs and protein.
I know this is a blog, but I still think that, in this case, you should cite your sources. Some of these claims seem dubious (ie we get as much exercise as we used to), but I imagine people would be more inclined to accept them if they could parse through the studies.
I think what Megan was saying is that we do not exercise significantly less than we did 10 years ago and yet the obesity rate has grown measurably since then.
I think the onus might be on you to prove that Americans in 2009 are more sedentary than they were in 1999 because having lived through the entire span, there doesn't seem to be a lot of difference.
Agreed, and this seems true not only for exercise but for a lot of other things that have been brought up in these comments about diet and health.
We've got more organic (supposedly healther) foods available.
Restaurants offer more low-carb/low-fat/fad-diet-of-the-month entrees.
There are more ready-to-eat or microwave diet meals available (Lean Cuisine, Weight Watchers, etc).
And we still keep getting fatter.
Blighter, the onus is not on me, because I am not asserting any claim as fact. Looking around while you live through a decade does not count as evidence. Do you believe that a typical job from today requires as much physical labor as did a typical job in the past? If not, are you sure the average person has made up any missing exercise via after-work activities?
Blighter-
I think what Megan was saying is that we do not exercise significantly less than we did 10 years ago and yet the obesity rate has grown measurably since then.
That's because "Work" is not considered to be "exercise"- and we simply don't work as hard as we used to.
For instance, I led a three man "receiving" crew at an office furniture distribution center in 1988. Each and every desk, credenza, and 5 drawer file "sliploaded" onto a 53' trailer had to be pulled off a stack and manually placed onto a pallet to be unloaded by forklift- until we got a "clamp truck" in 1992.
All of a sudden, only the top layer had to be "handled" (The doorway of our 1920's-era building dock wasn't as tall as a modern trailer)- the rest only needed to be slid away from the walls- and we were more efficient with a two man crew and new tech than with 3 people while also exerting less effort (and burning less calories...)
Anecdotally:
I recently (3 yrs ago) started exercising pseudo regularly and paying slightly more attention to what I eat(fewer cheeseburgers, no calories through drinks). It's cut over 20 lbs off, and more importantly I look and feel WAY better.
Technically I'm still obese (In the 'George Clooney is obese' sort of way), but am significantly better off.
While calling it an 'obesity epidemic' is ridiculous and the contempt we pile on people unconcienable, pushing people to be 20 lbs lighter and healthier seems like a good goal.
Megan, you've been on a roll of late. Another excellent post.
Although all this discussion of effective weight loss does remind me of an old favorite joke of mine:
Want a sure-fire way to lose 10 pounds of ugly fat? Cut off your head.
Just wanted to say thank you Megan for exploring this topic in a complex, nuanced and dignified way. Thank you for not being satisfied with the conventional wisdom out there about fat people which largely seems to rely on stereotyped caricatures. I would love to think that you talked to Paul Campos because I suggested that you should on a previous blog comment. But it doesn't matter.
Thank you.
Related to Tim H's post above:
Serious question here.
Last year, I lost 27 percent of my body weight, dropping my BMI from obese to the middle of normal. I've been obese my whole life up till then. Kept it off for 6 months before getting pregnant 3 months ago, and have gained an appropriate amount for the pregnancy so far.
I kept careful records, and I have a pretty good idea of how I lost the weight. Like Tim H, it's hard to answer the question of why I was able to do it then and not before, but I have some theories.
Is my experience meaningless outside myself? Can it help no one? Is it pointless or even harmful to write and talk about my experience? I struggle to put into words what I went through last year. I am not a person with above average virtue or will power. And yet I cannot help but feel that I have achieved something meaningful and worth celebrating, and encouraging others to attempt.
You should by all means mention your experience, and whether the loss was beneficial to you or not (are you healthier, have more energy, etc).
I suggest giving it the perspective of a few years before deciding what your experience really means. It's even harder to maintain than lose, especially with the added wrinkles of pregnancy and new motherhood.
I lost 80 lbs several years ago, and was convinced I'd found the secret. Then I had a health condition which necessitated major weight-gaining drugs (15 lbs in six weeks!), and regained 35 lbs total. Two pregnancies later, I've dropped about 15 lbs of that 35, but I'm still 20 up from my low. I'm not technically overweight now, but in some ways I feel fatter than I did when I was truly obese. I'm pretty sure I won't see a size 4 again, but now an 8 feels like a failure rather than a goal.
I learned lessons from the whole experience, but some of them weren't good ones, and that only became obvious over five years.
Hey I haven't read any of the comments because I'm supposed to be, like, working at my real job? But thought I would toss this in the mix:
Attended a FASCINATING research seminar a year or two ago by a peds endocrinologist who studies obesity using mouse models and who had found that a mouse born to an obese mom became obese itself even when it ate EXACTLY the same diet/amount as a normal thin mouse born to a thin mother mouse. It wasn't "genetic" in the sense of heritable, because the mice were all from the same inbred background (and therefore genetically identical). It wasn't "environmental" because the mice were housed in the same conditions and fed exactly the same diet. Somehow the in utero exposure to a "fat" mommy mouse altered the genetic program of the baby mouse such that it was permanently unable to maintain the "normal" mouse weight. Don't know if it's been published.
So maybe people are getting fatter because the mommies were all a little fatter, and there's nothing in diet or exercise they can change, because it is part of a genetic program instituted when they were but little feti. Wouldn't show up in genetic studies, because it's not a Mendelian or other trackable genetic mutation--just using same genes different ways.
Yeah, people aren't inbred mice, but it was a way of thinking about "hereditary" and nature vs nurture that often gets overlooked.
"Expert: We don't have any known way to make obese people thin except gastric bypass surgery, which has a 2% mortality rate by itself.
Thin person: But I am very thin!
That's about 50% of the conversation in the comments to the Paul Campos interview"
HOLY STRAWMAN!!! I didn't see a single comment like this on the previous post. That is an extremely unfair representation of your commenters.
Also:
"Outside of gastric bypass surgery, no system has ever produced any significant long-term weight loss. None"
Look at the studies (and pictures!) in the comments above. We know how to make an individual lose weight long term. Fewer calories, more exercise. I have lost 100 pounds and kept it off for years. So has my brother. What we don't know how to do is make the population as a whole lose weight. Both you and Campos seem to obscure the difference between these very different points. It's fine if you want to argue against a government policy on obesity. But don't tell me that we (our society, rather than our government) should give up on trying to help fat people have a life again.
"But don't tell me that we (our society, rather than our government) should give up on trying to help fat people have a life again."
Please speak for yourself. Not all fat people think they should base their happiness on other people's approval or decide living a good life has to weight when they are thin. Or that being fat means not having a "life."
Wait five years and more. If you keep it off, congratulations. Know that you are extremely rare. It's a little bit like saying "look! I got a Ph.D in astrophysics in harvard. Anyone can do it now and there is no excuse why everybody can't."
No. Not everyone can go to Harvard or lose massive amuonts of weight AND (the and is crucual here) keep it off for the rest of their lives.
ha! major freadian slip above with weight/wait. sorry!
At my funeral, even if I'm 80 years old, someone will say, "Sure, he lost 100 pounds, but if he'd lived just a few years longer he would have gained it all back."
By forcing myself to eat slower, via appetizers and foods that take longer to eat, my caloric intake dropped significantly, without the discomfort of starving myself.
That works for me too, except that I pass through a starvation period after I stop but before my body realizes I'm full. I have to physically separate my portions in restaurants and tell myself to eat this part but take that part home. I also have to observe strict limits on things like bread and tortilla chips before dinner.
Absolutely. Welcome to the club.
"If when eating a normal 2,000-2,500 calorie diet, you do not spend significant amounts of your day fixating on food--fantasizing about it, binging, hiding it, strategizing how to procure it--you do not have anything interesting to say to someone who is struggling with obesity. You do not have better willpower than they do. You do not "care about myself" more. You are not more "serious about a healthy lifestyle" because you took off the eight pounds you gained at Christmas. You are no more qualified to lecture the obese on how to lose weight than I am qualified to lecture my short friends on how to become tall. You just have a different environmental and genetic legacy than they do. You're not superior. You're just somewhat thinner."
- Megan
As a thin person this is why I never give advice to or how to lose weight. I personally have no idea what it is like nor do I know how to do it.
Interesting article. One obviously can't solve the health problems of a country of 300 million people with a short blog on the Atlantic. There are several somewhat universal truths- 1. Diets to lose weight do not help people keep weight off. 2. Obesity is probably the consequence of an eating addiction just like liver disease results from alcholism or lung cancer results from smoking. Not all obese people have an eating addiction just like not all people with liver disease or lung cancer have substance abuse problems. Treatment for those who do have an addiction is probably not a lost cause. Programs that have high rates of success like TOPS or WeightWatchers have many elements of 12 step programs.
I tend to agree that people tend towards a stable weight but do not agree that there is one lifetime "band" or stasis weight. Based on my personal experience this "stability" seems lifestyle influenced. When I was in a high stress job with little time for recreation my stable weight regardless of how much I ate seemed to settle in at a portly 210-215 lbs. In a role with much less stress and a regular excercise program I gradually lost weight and now hover between 175 and 180. I would say that my health has improved and my healthcare costs are lower- I'm sick less often and according to most studies much less likely to be affected by diabetes, heart disease and many forms of cancer. The author doesn't mention much about the incidence of these diseases as related to weight or more specifically to percent body fat.
I don't know how relevant it is try to create a single picture of the causes of obesity in a country as large as the United States when as the author and commentators have pointed out that rural Americans live longer than urban ones (fewer car accidents on those country roads or is it eggs from range fed chickens?) and especially those that live in inner city areas where the only food readily available is fast food. I think it more likely means that we have solved the hunger problem but not the nourishment problem.
I have also read studies and our pediatrician has told us that family's who eat together around a table every night have lower incidence of obesity. Kids who watch more than eight hours of television and eat in front of the TV are more likely to be obese and to have diseases like juvenile diabetes. It is probably pretty safe to say that the quality and amount of food consumed by kids in front of the TV is different and not in an improved way. Guess which ones get better grades in school and have fewer behavioral problems as well?
There has also been some interesting research lately on genetic switches and the role of evolution on diet and fat storage. There may be acquired traits that can be passed from parents to children. Maybe this accounts for weight having a lower rate of heritability than height? I think I read once that while the average height is increasing the variability of height is not. If this is true it does mean that something is allowing more of us to come closer to our genetic potential. The genetic mechanism for weight or fat storage is probably different from height. Environmental factors that may affect the fat storage genes "settings" are probably more complex. So, it may not be unreasonable to tell an overweight person to lose weight but they may need some help.
Do you think that Obama will be serving Light Beer this evening, at his race-a-palooza festival?
Ha! Perfect think to quip about on Ta-Nehisi's open thread. You should click on over sometime.
Congratulations, bearing! That is fantastic. I know this isn't a diet blog, but if you can, share some of what you did -- you can certainly help me. I'm one of the marginal cases -- just trying to lose an extra 20 I've put on over the last few years. It crept up on me. I'd like it to creep off.
In a thread like this, I'm kind of embarrassed to reply, but okay.
The short of it: first I developed the habit of twice-a-week exercise (no weight loss followed this step), and after 6 months of that began a serious shot at calorie restriction. Which I managed mostly by eating lots and lots of vegetables, buying smaller dinner plates, eating on schedule, and making sure I ate enough fat to feel satisfied -- which for me was about 50% of my calories.
The long of it I chronicled on my blog -- here's the chronological index of posts, up through my first 5K in May. Pictures included.
The threading seems kind of screwed up.
Someone asked if I felt better. Absolutely, but I will be the first person to point out that it's very possible that the main reason I feel better is because I have kept up the exercise habit. I always ate healthy food before, just too much of it I believe; and I wasn't unhealthy before, unless you subscribe to the theory that obesity itself is unhealthy; but I wasn't very fit, got winded going up stairs, etc. I'm feeling great now.
I mentioned that I am several months pregnant -- This is my fourth pregnancy, and I am definitely having an easier time of it this time around than in any of my previous ones. Hardly any nausea, and the first-trimester tiredness has not been nearly as severe. I was probably borderline gestational-diabetic in my previous pregnancies (first baby was born 10 lbs 11 oz, the other two both over 9 lbs) -- if I manage to keep my weight gain under control this pregnancy, I am really looking forward to seeing if I achieve a more normal birth weight this time.
Incidentally, one area of health risks of obesity I don't remember being covered in Campos's book are pregnancy-related health risks. I'm pretty sure that obesity is associated with worse outcomes in pregnancy, although I don't know what are the weight ranges where it starts to be a serious problem, nor do I know if they are caused by medical interventions. I'd like to know more about this.
Actually, I really liked the blog Escape from Obesity: www.escapefromobesity.blogspot.com
Point 5.4 (we eat more animal fat than we used to) is way off. We eat much, much less lard, tallow, cream, butter, whole milk, egg yolks, etc., than we used to. We do eat a lot more vegetable oil than we used to. Browse through any cookbook from around 1900. Nearly every recipe will call for generous amounts of butter, lard, or cream.
U.S. Animal Fat Consumption
If you're going to make the claim that height is equivalent to weight, you cannot also be an apologist for all the things that make people fat.
If food companies and their dastardly combination of salt, sugar and fat are causing an "addiction" to food, then what you're dealing with is a nationwide addiction, not a genetic problem. You can't have it both ways- either it's purely genetic and therefore uncontrollable or it's a problem caused by outside sources. I would place stock in the latter option.
The reason why diets aren't successful is because people who are accustomed to eating whatever they want (hamburgers, donuts...you know, all those sugars and fats we're addicted to) aren't going to stick with a vegetable-and-protein-based diet because it doesn't taste as good. Period.
What needs to occur, in my opinion, is that food education needs to start young- in families and in school. It's easier to break a habit you don't possess then spend an entire lifetime fighting a learned habit.
Maybe the answer is diverting all those corn subsidies to broccoli and asparagus subsidies. Likely? No. Effective? I would argue yes.
Miss Bee- it's not an either / or situation regarding the addiction/genetics argument. Genetic tendencies are expressed in particular environments- thus, we could say that a huge amount of weight is genetics AND we have some pretty bad food environments in the USA which is why the genetic tendency towards larger weights is getting expressed in the way that it is.
Or- to put it another way- if weight is 75% heritable it's 25% "nurture" rather than "nature," as it were.
There's no doubt that chunkiness is a tendency on my mom's side of the family- she was chubby, her mother was chubby, her grandmother was chubby, and I'm chubby. But I get more chubby when I eat lots of empty carbs and don't exercise and I lose some weight when I eat mindfully and I'm more active.
Both are true.
I agree with you, njoseph. I was never implying that so-called "chubby" people (those whose genetics pre-dispose them to being a bit bigger) would ever be rail thin, but there are things that can be done to induce weight loss. I guess I look at it this way:
Diet and exercise are to overweight people as high heels are to short people. They're both very obvious, little things that can be done to alter the state of your body without surgery.
High heels are something that are worn outside and make you taller. Diet and exercise are quite literally lifestyle changes that require time, effort and willpower. Anytime willpower is involved, it says to me "habit", "learned" and "addiction".
Although, after a long day in heels, it does take significant willpower to keep walking in them.
High heels are something that are worn outside and make you taller. Diet and exercise are quite literally lifestyle changes that require time, effort and willpower. Anytime willpower is involved, it says to me "habit", "learned" and "addiction".
--------
No. Diets don't work in the long wrong and it doesn't have a thing to do with willpower. And I'm not sure why the evidence provided here about the genetic component to weight, is so easily ignored in your comment above, in favor of "food addiction."
Look:
"You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back," said Traci Mann, UCLA associate professor of psychology and lead author of the study. "We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people."
http://www.sciencedaily.com/releases/2007/04/070404162428.htm
slientbeep, you mean the same article that says this:
"Eating in moderation is a good idea for everybody, and so is regular exercise," Mann said. "That is not what we looked at in this study. Exercise may well be the key factor leading to sustained weight loss. Studies consistently find that people who reported the most exercise also had the most weight loss."
No one on here (me included, if you read) is implying that diet alone is the answer. Diet and exercise. Period. Of course, the study you so readily decide to toss around didn't choose examine both diet and exercise. Hmmm, funny.
Finally, to point out... the article in Science Daily never actually addresses why diets fail- it simply says that they do. I would argue a good number of diets fail due to lack of sustainability... also known to me as willpower.
I also find it fascinating to read this post and the comments when I'm fasting today for religious reasons. Go figure- the Jews could give up pork and cheeseburgers for two thousand years but we still have to fast a few times a year to remind ourselves how powerful our appetites are.
There's a holy day today?
Tish B'aev, the day the Romans broke through the inner wall of the Temple or Jerusalem, ninth day of an attack?
Without commenting on the substance of Megan's argument, this has got to be her best flame yet. Bravo.
as an aside
I am struck by the fact that in today's society -- being overweight has a strong connotation with poverty.
What a society we have created -- where being poor means eating too much.
100 years ago being poor meant being chronically underweight to the point where your growth was stunted.
I remember when stopping smoking was 'the single biggest thing that could be done to add 6-7 years to people's lives.' I suppose the message of these recent posts is maybe we ought to relax and enjoy it. Recently I had a beer drinking patient who said his father was 'told to drink for his blood pressure.' I believe there is some data that regularly drinking beer but not wine does keep your BP down. 'I know more old drunks than old doctors' is as an old rejoinder to physician advice. I hope I live long enough to see us worrying about if people are drinking enough beer.
They work for some and not for others. The question that is still worth asking is WHY? What is different about the people for whom they do work? It's not a worthless question, because if we could answer it, maybe we could learn how to expand the pool of successes.
Why do we need to expland the pool of successes? You missed the part of dieting actually being harmful to most people.
Eating healthy and excercising is one thing. No one is arguing that people shouldn't go for a healthy diet and excercie. Dieting in terms of calorie restriction is another.
There are alternative to something that scientifically, over and over again, has been proved not to work in the long run. That "something" being dieting.
Consider this:
http://www.ars.usda.gov/is/AR/archive/mar06/health0306.htm:
“Chronic dieters are those who either have failed at a sequence of diets, or, after successfully losing weight, gain back the pounds and start the dieting cycle all over again,” explains ARS physiologist Marta D. Van Loan. “For obese folks who can’t find a healthful weight-loss regimen that gives them lasting results, this alternative to conventional dieting may offer greater and more sustainable improvements to several key indicators of their health.”
It's called HAES. Health At Every Size. Look it up.
Why do we need to expand the pool of successes? How about, because some people would *like* to lose weight? Who am I to tell them to want something different?
You know these are interesting question.
I guess it comes down to who "we" are and who exactly is trying to expand the pools of successes. If this is government trying to help, Megan has offered plenty of evidence, including Paul Campos and Gina Kalota, that trying to expand the long-term of diet successes for the vast majority of people, fails time and time again. Why put govt. money into something that fails over and over again for the vast majority of people, that namely being dieting?
Maybe they can try something else besides dieting to encourage healthier lifestyles for the majority of people, such as what is suggested in the above USDA articled called HAES.
And of course there is this old adage: doing the same thing over and over again, and expecting different results each time can be considered insane.
Now to be clear, if someone is merely fat, and has 20-30 lbs to lose because they really do have a poor diet (this is called set-point theory, please look it up) then they probably can lose all that weight, maybe with sustained excercise and diet. And that's maybe because there is study, after study that shows that this is not going to work for most people.
If we are talking about the super-fat who weight 100 lbs. or more than the average person in america, there is gastric bypass, which is an extremely risky surgery. That being said, what people decide to do with their bodies, with careful consideration with their doctors, is their business.
"Who am I to tell them to want something different?"
Good point. Who are any of us to tell someone that they should be thin or fat?
Megan, please read this book - Good Calories, Bad Calories by Gary Taubes.
http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462/ref=sr_1_1?ie=UTF8&qid=1248982420&sr=8-1
I second that. If you like science, you'll (a) appreciate this book, and (b) be tremendously disillusioned about what has passed as nutritional "science" over the past few decades.
Rob Lyman,
http://en.wikipedia.org/wiki/Henri,_Grand_Duke_of_Luxembourg
You'd have to say Henri is pretty thin for a guy in his mid 50s. But, if you scroll down to the ancestory section and clink on his ancestors 2, 3 and 4 generations back, all of them are royal and all are thin. If it were true that unlimited access to hyper-palitable food made you obese, this class of people who be "fork lift through a hole in the wall" obese. It just doesn't seem to the be the case.
You say, "Let me repeat: losing twenty pounds will not make you healthier. If you have diabetes and high blood pressure, there is an extremely modest improvement in test results."
This is untrue. In fact, even for the obese, a very modest weight loss can bring about a meaningful reduction in high blood pressure and severity of (or risk of developing) type 2 diabetes. One of the best things someone on the edge of developing type 2 diabetes can do for themselves is lose 10 or 20 pounds and keep it off. Even if they're still fat afterwords, they cut their risk of developing the disease.
The above is all basic primary care medicine stuff that they were teaching 10+ years ago when I was in medical school. It hasn't changed since then.
So while it may be quite hard for very fat people so become non-fat, they can definitely become slightly less fat and appreciably more healthy.
Thank you Brent. So many people are dismissing a 20 pound mean weight loss of an obese population as meaningless. It's huge, in in the aggregate (pun not intended).
Anecdote time: I know some (not a ton) of type 2 diabetics who started controlling their diet and adding exercise to their lifestyle to avoid insulin. Alot of them remain overweight/on the border of obesity, but dropped 10-30 pounds and greatly improved their health markers and diabetic control. They may not be BMI-healthy, but they are definitely healthier than they were based upon common markers/statistics we use.
Except that this seems to be more evidence for the point that simply being slightly overweight is not a good proxy for being unhealthy. Obese people with health issues improving their unhealthy condition by losing weight is not evidence that everybody who weights 10 lbs more than some supposed 'healthy' weight needs to embark on a crash diet.
I think that is fundamentally what Campos is arguing even if he is laying on the hyperbole a bit.
One of the best things someone on the edge of developing type 2 diabetes can do for themselves is lose 10 or 20 pounds and keep it off.
This is where I think a lot of us start talking past each other.
You're talking about people who already have a health issue losing weight, and not even making a reduction to the magic 'healthy' weight. I'm certain it works out well for them.
What Campos and MM are arguing is that the Obesity Police are generalizing from this sort of data and theorizing that everyone who weighs slightly (lets say 10-15 lbs) more than that 'magic' weight needs to take the extra weight off, regardless of the amount of pain and effort that it would take.
The question is how many of those slightly overweight people are actually going to avoid future health problems by engaging in heroic efforts to lose a few pounds. Campos and MM's arguments suggest not that many, because some simply aren't going to be able to reliably keep their weight to the magic number and some wouldn't have developed the problems regardless of their weight.
Actually, I believe the finding is that they have very significant improvements in their numbers as long as they diet, but that when they stop (i.e. when their blood sugar goes back closer to normal) the gains mitigate.
Megan,
Much of your argument that our bodies fight weight loss is predicated upon the concept of a "natural" weight. I'm willing to assume, for the sake of argument, that two things are true: (1) humans have a natural weight and (2) it has hard to sustain a weight significantly lower than the natural weight. But whether an individual can lose a significant amount of weight and keep that off would necessarily depend upon where the starting point is in relation to the natural weight. In other words, what if my current weight is much higher than my natural weight? Yet another way to think about it: Perhaps it is much easier to be heavier than your natural weight than it is to be lighter than your natural weight.
Your argument here does have some Chicago School in it: You can't lose weight because if your body wanted you to weigh less you would have already lost the weight. But the story you tell just fails to account for the scores of people who have lost significant amounts of weight and kept it off for sustained periods. Perhaps the vast majority of people who are able to do that were significantly heavier than their natural weights.
This observation is in no way intended to combat your conclusions about obesity as a public health problem that can be solved. But it does suggest you need to be more careful with what you say. Some people can and do lose weight and keep it off. Those people - who presumably are at present heavier than their natural weights - should not be discouraged by your saying "humans can't lose weight."
Do these studies showing its impossible to lose weight (outside of gastric bypass) have a randomly selected set of subjects? In other words do they start with a selection of people from the phone book, identify the ones who are overweight, and then have them try a system for weight loss? Or do they advertise for people who want to participate in a weight loss study and then choose from the people who respond? If they are advertising for people who want to participate in a weight loss study, then there is a good chance of ending up with a pool of subjects dominated by people who have tried and failed to lose weight on their own (people who were able to successfully choose to eat less and exercise more on their own would have no reason to respond to an advertisement for a weight loss study). It wouldn't be that surprising that people who had tried and failed to change their eating and exercise habits in the past would fail again. These studies may show no more than that people are consistent in their choices regarding changing habits.
While I agree with many of your points, I think your use of heritability estimates needs a little clarification. People usually assume that a heritability estimate of 0.9 means that genes are 90% responsible for a trait. Heritability doesn't mean that - it refers to the fraction of overall trait variance that can be accounted for by additive genetic variance as estimated by regression models.
Here's a quote from a review on heritability that speaks to your height example (Visscher et al, Nature Genetics, April 2008):
"For example, the well-documented secular rise in height in many human populations is not at odds with reported heritabilities of about 0.8, but is likely to reflect changes in the environment resulting from improved nutrition and medical care."
Bingo. The Japanese started eating
more-better after WWII, and feeding
their children milk; Lots of 6 ft
sinosoids (sic) now. :)
So if your body "wants" to be at a certain weight, it should also be impossible to artificially gain weight and keep the weight on. Yet as we know from various people who do this ("feeders" and such) that it's not true. It's in fact quite easy to convince your body that it needs to be fat
Actually, it's apparently not that easy. Most people can gain weight within a zone of about 10-30 pounds. But over that, experiments show they stop gaining--one study with prisoners had a guy eating like 10,000 calories a day and not gaining. Again, you can eat slightly more than your body wants, or slightly less than your body wants, for some duration. But there's little evidence that you can move outside of a pretty narrow range.
Come on, Megan, you're usually more careful with your wording than that. You mean something like "few subjects in controlled studies have succeeded at eating less than their bodies want for some duration."
But every person who HAS permanently changed his or her eating habits -- and several commenters on this thread, including me, claim to have done so -- is a piece of evidence that "you can" do it. I'd say there is plenty of evidence that it's difficult, but "can" has to do with possibility. It's possible.
All i can tell you is, statistically, your likelihood of keeping off the weight for ten years is well under one percent. People do it. But not a lot of people.
Given that no distinction is made between fat and muscle in such statistics, as well as no distinction between changes in metabolism and bodyfat, I'd say the data is inconclusive that diet and exercie don't work. Dropping a lot of weight with a radical starvation diet and keeping that off for 10+years-- yeah, can see that being a problem.
But that isn't representative of people who actually maintain lower weights long-term. They aren't crash-dieting their ways there in the first place, so trying to tell them 'nyah nyah you'll just gain it back anyways!' is both horrifying and misleading. They aren't undertaking the type of useless diet that would result in hard-to-maintain weight loss.
And I do find it quite appalling that bearing, who is a woman, is pretty much the only person getting singled out in these threads, by other women!, as 'guaranteed' to 'gain it all back anyway'.
Huh, I hadn't noticed, but now that you mention it... The fatalism is really pretty amazing. I expect that maintenance will require vigilance, but I don't see how assuming it's not possible could possibly help me. I prefer to be determined to be one of the few who succeeds. I'm already ahead of the odds having maintained for 6 months (had to stop counting when I got pregnant).
I admit to snorting a little bit at Emma B's comment,
...only because "new motherhood" was ten years ago for me. This is my fourth child.
"Also, there's no evidence that exercise makes you lose weight--ever discussed dieting with a long distance runner or ballerina?"
Really? This makes me think of when Ron Paul is talking about economics. He makes some good points, says some interesting things, and then he busts out "going back to the Gold Standard" and its all down hill from there.
Exercise makes people lose weight. Doctors, scientists, and pretty much everyone knows this. Studies show it
http://www.unm.edu/~lkravitz/Article%20folder/exandwtloss.html
It's proven every season on the Biggest Loser where drastically obese people lose lots and lots of weight without being starved or having gastric bypass surgery. In fact the trainers get after them if they don't eat enough food.
I'm not saying that solving the issue on a society wide level is easy. I think it's pretty clear that poor metrics like BMI cloud the actual extent of the issue, and that alone makes it hard to deal with. But on an individual scale we know how to reduce excess body fat in a manner that is beneficial to health: good nutrition, exercise, and hydration. Figuring out how to apply this to the broader population is not a waste of time.
The people on the Biggest Loser are doing something like eight hours of intensive cardio a day on an 1800 calorie a day diet. Yet, that will make you lose weight. It's also not a sustainable lifestyle for almost anyone. Look at what happened to the very first winner.
But when you look at just how much exercise you have to do to burn off a single hamburger, it's pretty clear that no one except an olympic athlete gets thin without diet modification.
This is true but your logic doesn't seem to be correct. People don't lose weight comparing treadmill hours to hamburgers. They lose weight by making tiny lifestyle changes and then sticking to those changes over long periods of time.
Megan, when one tries to lose weight via excercise, one doesn't need to burn off the entire calorific content of one hamburger, they only need to burn off the calories not already used for normal dietary sustenance. Suppose a burger is 1000 calories. You don't need to burn 1000 calories, you need only burn 200-300 calories in order to lose a small amount of weight. For a 185 lb male, this may only require about 2 miles on a treadmill, or about 30 minutes of lightly intense cardio for most people. This is what many health professionals recommend. This is something that normal people can do on a daily basis. It does not require Olympic level training to do such a thing.
Honestly, it doesn't really seem like you know what you are writing about.
It's not exactly true that no one except an Olympic athlete gets thin without diet modification. Bike tourists lose weight with a diet modification that generally consists of stuffing themselves with food. When I rode my bike in France for a month, on the Find Every Bakery and Eat There diet, I lost weight. When I rode across the US, I lost twenty pounds; everyone who rode with me lost weight, and the leader said that everyone who rides across the US loses weight.
Bike tourists are not Olympic athletes-- they're regular people, typically (currently, in the US) in their fifties and sixties, who like to ride their bikes.
Megan, when one tries to lose weight via excercise, one doesn't need to burn off the entire calorific content of one hamburger, they only need to burn off the calories not already used for normal dietary sustenance. Suppose a burger is 1000 calories. You don't need to burn 1000 calories, you need only burn 200-300 calories in order to lose a small amount of weight. For a 185 lb male, this may only require about 2 miles on a treadmill, or about 30 minutes of lightly intense cardio for most people. This is what many health professionals recommend. This is something that normal people can do on a daily basis. It does not require Olympic level training to do such a thing.
Honestly, it doesn't really seem like you know what you are writing about.
I'd like to see some statistics comparing obesity interventions with other medical interventions. Also, vis the keeping weight off thing, how does this compare with the keeping cancer off thing 10 years later?
How about this.
A repressive social environment, improperly balanced diet, pollutants and hormones, all lower testosterone levels. This causes heart problems and causes people to carry more weight (mostly independently). It also means that when people exercise their fitness doesn't improve as it should, leading to less healthly eating, more sedentary lifestyle, and still lower testosterone levels...
Whether you lose weight or not exercise is good for you health, no? Your height/weight analogy is a bit of a reach. Surely appeptite makes it difficult to change your average weight but it's not impossible. When tv comes out with a 'Biggest Height Changer' program then we'll chat about this.
No mention of Paleolithic diets?
If we are going to blame the problem on genetics, why not talk about what people actually ate before the development of agriculture, and what our genes predispose us to eat?
Mostly grubs, fruits, nuts, and wild game. Quite a bit different than your FDA approved food pyramid.
If we look at indigenous tribes around the world, very few eat any kind of processed grain. Unsurprisingly they still consume 1500-2000 calories, but have no obesity or diabetes.
If you think about it, many of the explanations for obesity can be attributed in some part to Paleolithic explanations. Lack of secondary nutrients increases hunger, while carbohydrate dense foods mean we can consume 1000+ calorie meals without even realizing it. Try eating 1000 calories of meat, fruit, or nuts and you will realize how impossible it is for our ancestors to overeat.
Corn has essentially taken these problems into overdrive.
I find it kind of goofy how Megan writes off the exercise component of this. If you've ever studied paleontology you know that Humans are designed to travel. Walking is one of the most efficient methods of movement in the animal kingdom. A human can literally jog down a gazelle after it overheats from it's patterns of sprint/rest. The fact that we sit in rooms in front of luminescent boxes 75% of the day obviously has some effect.
This explains a lot about obesity in general but not about the recent rise in obesity. I'm a big fan of paleo style eating since it worked for me in almost no time. I wasn't ever obese but in 6 months of paleo eating every woman in my office was commenting about how I had totally changed my body. The big problem with paleo is it is hard to keep up over long periods of time since everyone else is eating crappy food. The peer pressure gets to you. I'm pretty sure that obesity would drop if we punitively taxed just 3 things: breakfast cereal, soda, and juice.
My new off the cuff theory is that a a society uses up its food by either eating or procreating. Since we don't procreate we just get bigger (obviously this insight fails if you drill down into the demographic).
NateS Paleolithic Pacers
Yes. More:
Some people's ancestors were Cursorial Hunters; Others not.
They could run a horse down; Think Pepe LePew in the cartoons.
This requires metabolic and mental qualities others do not have.
"Of course, when we reach some sort of Malthusian threshold or suffer from an apocalyptic famine, the folks who don't think much about eating are likely to be the first to go, and those with the "obesity" gene will prosper."
Then how will we know who to pick last for dodge ball?
"Dieting" doesn't work, if "dieting" means trying some radical new food intake for a few weeks or months, and then going back to your previous overeating. Lots of studies show that. Just as lots of studies would presumably show that the effects of working out dissipate if you completely quit, and that you can't take one aspirin that will kill every headache for the rest of your life.
But does any study show that people who consistently change their eating patterns for the rest of their lives are mysteriously unable to see any difference? I don't believe it for a minute. That would violate at least one law of thermodynamics, for one thing.
No, because no one's ever been able to get a statistically significant group of people to consistently change their eating habits. Nor would you, if you experienced what obese people apparently do when they restrict their calorie intake enough to produce weight loss.
This raises an interesting philosophical question. What is the cost of quackery? If you are fat, is it better to just accept the studies and accept it or is it better to try and get thin? Similarly, if you have cancer, is it better to accept your fate (according to statistics) or is it better to try some crazy snakeoil? I would suggest that fat people should and sick people shouldn't. Why?
Well, if I am a policymaker whose hope is to force unwilling subjects to lose weight, that would be a problem. But if I'm just an individual who intends to change his diet, the message of impossibility is just false.
Yes! This is the exact point I have been wanting to make. The whole thread suffers from a failure to distinguish between
o how a population can be "made" to change its collective behavior, and
o how a person who WANTS to change his behavior can be helped to succeed.
They are not the same.
I'm beginning to believe that the key to success is wanting to change the behavior in and of itself, rather than only as a means of achieving a desired weight.
I think few people can keep doing what they don't want to do in the absence of immediate and ongoing reward; and that numbers going down on the scale might be enough reward, but that numbers staying the same on the scale probably aren't, at least not for long. But lots of people can do what they really want to do, even if it's hard.
For me, I got tired of eating too much and constantly thinking about food, and I decided I really wanted to change that. Weight loss followed.
Which is the problem with the studies. They start from a completely wrong method of how to lose weight (usually starvation diets and minimal low-intensity exercise from participants) and are shocked when results don't persist.
There is a lot of data on the fitness/muscle-building side of things suggesting completely different information on how the human body behaves, but since it's not directed towards unstructured weight loss, it's not as immediately seizable for an agenda that weight loss is rare and impossible to do without being unhealthy.
No, because no one's ever been able to get a statistically significant group of people to consistently change their eating habits.
But have they tried waterboarding?
Some small number of people are able to control eating habits (obsessives often have no problem), some aren't. The idea we can or should coerce the latter into behaving like the former is flawed to say the least. Our brains just aren't wired for it.
The best we can hope for is drugs to modify metabolism or change how our brains work.
With regard to the dangers of being obese, apparently Europeans (as a population) tolerate this better than Asians or others. The given explanation for this has been that 'there was an epidemic of diabetes' (from obesity presumably) some time ago in Europe and the susceptible gene pool was reduced.
Maybe fat isn't a bad thing, its a sign that a culture does not have to do as much to stay thin, like exercise (claims that exercise has no effect on weight are bogus). Being fat equals being affluent.
We are making cheaper and more convenient foods and people have more money to pay for it. These people also have way more time to eat it.
Compared to our ancestors who toiled away 80 hours of hard industrial labor only to make a few bucks, we sit in front of computers, blogging, and have food delivered to our doorstep.
We are also eating a lot more. Claims that empty carbs have no effect on the waste-line are bogus as well. When families sat down at the dinner table 50 years ago, they were not met with Hungry Man microwaveable meals or mountains of gravy covered mashed potatoes. Meals were sensible...and meals also happened at a consistent time every single day. Dinner was always served at 630PM my mother tells me. Our eating habits now have us eating erratically throughout the day...sometimes skipping meals all together and "making up for it" by taking out a large Papa John at midnight.
I also suspect that people were ok with hunger 50 years ago. We have the privilege now to eat every time we feel a stomach bubble. People used to get hungry and dealt with it...there wasn't this "I heart snacks" mentality. If you wanted some food, then you had to eat what was around (fruit, nuts, peanut butter) or wait till dinner. According to Marc Summers Food Network show Unwrapped, folks didn't start warming to the idea of vending machines till the later half of last century. Watch an episode of Mad Men and tell me how many machines you see spitting out Drake's Apple Fruit Pie.
The best way to decrease waste-lines in this country is to education and make sure that people are not getting fat because of lack of information.
50 years ago was 1959. Food was pretty plentiful in the U.S. The TV dinner was invented in the mid 1950s. And I hear tell from my mother that they ate a lot of mashed potatoes. Potatoes are cheap as hell, and were then too. They also had snacks in the 50s -- cookies and everything. I'm not saying that your point is wrong. I just wouldn't say that 50 years ago things were all that different. Or at least not different enough to account for the massive spike in obesity.
Even in the mid to late 50's the TV dinner was still a novelty, not the daily dinner as it is for so many folks today. I don't have evidence of this...my point of reference is Happy Days, Mad Men, the Food Network, and a few articles from Time archives.
I suspect that if anyone was to take the time to study eating habits of 1959 and 2009 we could solve this problem. A good place to start is the OECD.
The last OECD report stated that France spends a lot of time sitting around eating (like we did back in '59) and have relatively low obesity rates. The U.S. on the other hand, and our "shove as much food as possible down our face as fast as we can" eating habit has high obesity rates.
What does this mean? That "fast" foods like TV Dinners, Mc-Dee's, etc. are making us fatties.
http://economix.blogs.nytimes.com/2009/05/05/obesity-and-the-fastness-of-food/
The heritability point is also puzzling to me. A classic example is that of corn seed. Take two breeds of corn; plant them side by side with the exact same soil, exact same watering, exact same level of sunshine, exact same fertilizer. Any difference will be due to the difference in breeds, b/c the environment is the same; hence, heritability is 100% here. But even though heritability is 100%, any difference caused by the breeds will be totally swamped by the difference if you prevented one plant from getting sun, or water, or soil.
So in a modern American environment where everyone has access to pretty much the same kinds of food, heritability should be high. That doesn't mean that increasing levels of fatness are caused by genes; maybe I'm wrong, but I thought it was basically impossible for the human genetic pool to have changed that much over the past 50 or 100 years.
"So why is America getting fatter,
"Calories are getting cheaper. Self explanatory. In my view, the dominant reason. People eat more calories because they like it, and can afford to."
This is significant no doubt, but:
#1) It argues against the idea that the rise in weight we've seen over the last 40 years should be inherently difficult to reverse.
Since the 1960s the "overweight" in the population have increased by near 50% and the "obese" by about 2.5X. [data]
But Woodstock Nation was hardly a land of the food deprived, with the average person fighting off the pain of not ever getting that extra meal. All the Twinkies and crispy barbeque potato chips anyone ever wanted to cure the munchies were right there. Believe me.
There doesn't seem to be any apparent physiological reason why the population couldn't live happily and fulfilled on the same amount of calories today. I don't think there's been any DNA shift that resulted in appetite being more controllable in the 1960s than now.
(It's very imaginable that people could get "hooked" on more lower-cost calories, the way they do on tobacco or other drugs, and that once they get so hooked it is physiologically hard to reverse the process -- but that's another issue.)
#2) The increase in calorie consumption since the 1960s is not enough to account for the general increase in body weight since then. Which points to something else...
"Reasons we aren't getting fat:
"We exercise less. We haven't gotten noticeably more sedentary in the past decade or so, but the weights keep shooting up. Also, there's no evidence that exercise makes you lose weight --ever discussed dieting with a long distance runner or ballerina?"
I think you grossly underestimate the importance of this factor.
There is no doubt at all that calorie consumption in average daily life has fallen significantly over the last 40 years. How many employment stories have you read (written?) about the disappearance of the labor force that used to be able command good salaries, without its members even having a high school diploma, by supplying physical labor? Back then it existed, now it doesn't.
The same change has occurred in in household life. Think of "1900 House" where the kids had to stand over the live fire stirring the pot with the family laundry in it. The 1960s were almost half way back to there.
When I was a kid the chores I tried to get out of, in an upper-middle class suburban household, included pushing the lawn mower, snapping clippers a thousand times to trim the hedges, hauling laundry out to the line to hang, shoveling snow up and over my shoulder, and a whole lot of other labor. When I got out of it all, if the World Series wasn't on TV in the afternoon when I got home from school, I was off with my kid cronies to some empty lot to play ball, or tressspass in some old lady's back yard, or some such thing that usually involved having to run. No video games, no 200 channels of TV on the set in my bedroom, no internet, etc. (Sometimes I did get to watch Soupy Sales).
Household time-and-motion studies today show that people who are active within the house have significantly lower BMI than the sedentary. By "active" I don't mean running an hour on a treadmill to work off a couple Hostess Cupcakes. I mean things like standing up to answer the phone (like we always had to do in primitive times -- and sometimes transverse a flight of stairs too!) ... getting up and leaving the room during TV commericals ... moving around between different rooms for minor tasks... going up and down stairs frequently ... etc. It's the calorie burning in continual everyday activity that matters.
Philipson and Posner did a study that combined #1 (cheaper calories) and #2 (fewer calories consumed), taking #2 to be more important, and applied them through a simple economic model in which individuals have an optimum weight of choice for the cost of having it.
Given how both the cost of calories has fallen, and the cost of burning calories has risen -- i.e., people must now consciously go out and spend time (and maybe pay for club memberships, etc.) to get the exercise that used to be a given in their daily lives, it's entirely logical that their average preferred weight would go up.
All this indicates there should be nothing too inherently difficult, at least from a physiological point of view, to reverse general weight gain on the scale that has occurred from the 1960s until today, if people actually decide they want to do it. This is reinforced by the fact that prevelance of overweight is inverse to income in our day -- the richest want to be thinnest and they are. That's just a question of what's their optimum weight to them.
Of course culturally, getting millions of people to want to do it, when there are persuasive reasons why they don't want to do it, is another matter.
On the Becker/Posner blog they put it more bluntly in recent days: more people are overweight today because they want to be, the marginal benefits of weight loss are so slight they aren't worth the cost of losing weight in today's world, even though that weight loss is attainable.
Note the scale of weight loss I am talking of as "attainable" -- return to the Woodstock Era, 1960s -- is not losing 40% of body weight to avert imminent risk of massive coronary. In the short term health risks are concentrated at the weight extremes. But it could in the long-term future avert massive costs from diabetes, joint replacements, and other chronic ailments that are finally felt late in life after carrying that extra weight around all those years.
On the Becker/Posner blog they put it more bluntly in recent days: more people are overweight today because they want to be, the marginal benefits of weight loss are so slight they aren't worth the cost of losing weight in today's world, even though that weight loss is attainable./
Exactly. People show an incredible response to monetary motivation, and the only current motivation to maintain a healthy weight is, well, your health. Not counting the uninsured and under insured (which is a non-trivial amount of people to be sure), there is no monetary penalty for being overweight. The cost for health insurance is not pegged to your weight even though weight has been shown to be one of the largest factors in determining health risk. Employers have been shouldering the majority of this burden, and they've consequently been promoting healthier lifestyles to reduce costs. Employers who offer incentives for weight loss have seen quite a bit of success, thus showing that some people are overweight because they simply don't have a good reason to be otherwise.
One might also consider if a "demographic transition" is in play with obesity rates.
Wealthy societies esteem the thin, poor societies esteem the hefty.
(Not without reason. My mother had a sister who died of tuberculosis in the 1930s in Maine, when the state of the art of medicine was to leave her out on the sanitarium porch in the winter to get "the air". When I was a kid my grandmother, after seeing her daughter waste away to nothing and death literally, relentlessly bribed me to eat a little more, have another glass of milk, put on another pound. Easy money!)
If there's a demographic transition in play one would expect that when a poor society becomes rich the population will suddenly "put on a lot of weight" as people who were born into a world where zaftig is good suddenly get to live the dream. People born later into a rich society will then go the other way, with obesity then declining.
Looking at rates of obesity by state one sees ...
1) Mississippi
2) West Virginia
...
47t) Connecticut
47t) Rhode Island
47t) Vermont
50) Massachussetts
51) Colorado
I haven't run a regression but it looks like there's a correlation to my eyeball.
If so, some might say, "the poorest are fattest, the richest thinnest" but I'd wager its closer to the truth to say: "the most recently prosperous are fattest, those prosperous the longest are thinnest".
And if that's so, this problem will be partially self-correcting in time.
As long as we're looking for possible reasons/explanations for the increase in obesity, has anyone considered the increase in the availability of air conditioning? Nothing takes my appetite away more than being too warm. Is it a coincidence that my wife and children often need to bring sweatshirts along when we go out to eat during our summer vacations in Florida? Perhaps AC keeps our bodies in a permanent state of storing up fat for the winter. And I'd guess that few things discourage children and adults from going outdoors on a hot day more than the availability of a soft couch in a cool room.
Ooga booga, so do nothing? If only someone could develop a mathematical study of such issues, (let's call it, statistics), and then develop a form of this study that works to discriminate between various contributing factors (let's call it, multiple regression analysis), and then apply this technique to producing an actual study (e.g., "Dietary intake, exercise, obesity, and noncommunicable disease in rural and urban populations of three Pacific Island communities," or "Obesity and Health Status in Rural, Urban, and Suburban Southern Women"). I'm such a dreamer.
As Megan is bothered by people who boast about losing 15-25 lbs, let me offer my view on this subject as a former fat man who has lost 176 lbs in the last 19 months by caloric control and exercise. I am 32 years old and last year around January I weighed in at 386 lbs (I am 6'1)
I know I am talking about myself and my n=1, but I have been around enough fat people trying to lose weight to make the following rough generalizations:
(1) Metabolism is an extremely complicated subject and no one has a hang on it, period. We are still another 10-15 years from understanding metabolism the way we understand lets say the kidney function. We understand metabolism like we understood genes in the 80s.
(2) The point about height heritability and weight heratibility is misleading. Weight has a big agency compenent. Height has almost none. If we let nature takes it's course, yes weight's heritability is very high. But so what? Do we let nature takes it course in other areas of life? The fact that we do have an agency element in weight is salient. Public policy on issues of weight does and should take into account the fact that heritability of weight is qualitatively different than heritability of height. For example, I lost 176 lbs in 17 months. Can I grow taller or shorter in 17 months? Now Megan will say, aha, but you will get it back. Yes, I might and probably will. But if I control myself and not eat more than 2200 calories a day, I am sure I won't get to 386 again. Will it suck to monitor calories everyday? That's the cost you pay for being thin or you accept obesity and real all hellish results of morbid obesity.
(3) To suggest that 386 lbs at 6'1 is somebody's natural weight is mostly likely not true in most cases contrary to what Megan is implying. Neither is 350 or 300 or even 275 for most people of average height.
(4) Most people who get morbidly obese (type 3 and above) are not ill and can in fact lose weight if they try. It will require discipline, self control, support, strong will etc. etc. but it can be done without resorting to surgery.
(5) Yes genes play a part but genes also play a part in just about everything. Risk taking, addictive behavior etc. all have some level of genetic predisposition and that's life. Of course it sucks to be cursed with poor metabolism and bad genes. So what? Is that an excuse we accept in any other area of life? It just means that you have to try harder which is unfair but not anymore unfair than being born poor or stupid or having abusive parents or being born in Mogadishu. Just like some people take longer to read, or have to try harder at memorizing or have a harder time trying certain things because of their poor genes is not fair but neither is anything else in life.
(6) The point I agree about with Megan is the fact that most people do gain the weight back. Thats statistically true and most research does bear that out. I disagree on the solutions. Is the solution to lift our hands and just accept type 3 obesity? Or do we need to do understand metabolism, physcological aspects of weight gain better so we can come up with better ways to lose weight.
Oh yes, I ate on average 1000 calories a day when I did not exercise and 1250 calories when I did exercise which was 5 days a week for an hour on the elliptical (30 mins morning and 30 mins evening)
I ate a pound of orange roughy or tilapia with salads for dinner (500 calories), 4 whole weight bread pieces with fat free hummus for lunch (300)and water melon plus apple for breakfast (200 calories)plus 7-8 diet sodas a day (o calories). The 5 days I exercised, I ate another half a pound of fish in the morning before I hit the gym. I also broke down my breakfast, lunch and dinner into two parts so I ended up eating 6 times equally spaced in the day.
Think of running:
Is a social policy likely to succeed if it depends on forcing everyone to run 5 miles a day? No. Is it hard to get in shape to run 5 miles? Yes. Does it even feel a bit like torture at first? Yes; if you haven't run before, running makes your legs sore, your lungs feel like they're going to explode, your side hurt, etc.
But is it therefore correct to suggest that it's nearly impossible to run 5 miles, that hardly anyone has ever done it, that everyone who runs 5 miles finds it to be torture, that if you hope to run 5 miles you might as well give up? Not at all. Millions of people are already doing it, and outside of the morbidly obese or disabled, hundreds of millions more could do it if they tried. In fact, after a relatively few months, running eventually becomes so enjoyable that you'll feel like it's "torture" when you don't run (b/c of travel, say).
It's not the states business to tell it's citizens how to live.
That said, Megan, your argument is wildly flawed in a way that is deeply and profoundly impressive:
"We don't know any way to make people thin."
Well, we do know how to make people thin. What we don't know to make them want to be thin more than they want to eat.
More simply, what we don't "know" is how to force them to accept our values and want to be thin, like we think they should. (I is not the governments place to do so.)
Let also just add that your height analogy is comically pitiful. If you quit eating you will lose weight. It is a thermodynamic inevitability. The same can not be said of growing taller. I would think -anyone- could understand the distinction.
You are attempting to claim that one can no more lose weight than he can decide to grow taller. This is an utterly and profoundly absurd thing to say.
We know very well how to lose weight. What we don't know is how to make people want to do it. Change comes from within.
All your points on "Rethinking Thin" show is that forcing someone to change their behavior doesn't change their values. When you remove the coercive forces, they return to their previous behavior. When they change their values, no coercion is necessary, the changes simply happen.
Obesity is a moral failing, and it has a lot in common with laziness. I don't impose my morals on others; they are how I live -my- life.
If you quit eating you will lose weight.
And if you cut your legs off, you will lose height (it's physically inevitable!). Neither is necessarily a good idea.
That's funny :)
I don't think you can really compare dieting to a double leg amputation.
But we can say they both may be extremely undesirable for some people. As Megan put it:
I indeed assume that much of it is mental. Pain is just mental, but that doesn't make it irrelevant. Everything I know about overweight people suggests that they have an insistent voice telling them to eat all the time that I just don't have. In that context, it seems meaningless to talk about willpower. When I'm super-hungry, I'm a terrible, mean, angry person who can't stop eating either. If you told me I had to live that way all the time, I'd kill you.
I think it says a lot about the soundness of the argument that you are comparing dieting to a double leg amputation.
I'll just leave it at that.
Seth Robert's idea was mischaracterized. The idea that when the body sees the same strong flavor and associates it with lots of calories then appetite ("hunger set point") increases. I remember it best with the evolutionary just-so story. When we got to be choosy about a high calorie food in our prehistory the body would prioritize eating those big meals of fatty mammoth for those few weeks.
The situation is more a consequence of the importance of branding than some diabolical food science conspiracy which knows how to reach the pleasure centers of the brain. Fast food restaurants and food brands are super good at this because they work hard at it. Most cooks actually aren't, when I go to the Indian place and get tika masala it's actually different every time even though they benefit from the consistency and regularity of the modern food market. But every Jack in the Box Chicken Supreme has tasted the same over the last 10 years. Same with every Kraft Macaroni and Cheese.
The population just needs to be having more of these consistent experiences over the same time that obesity is rising for the idea to make sense. That certainly seems to be the case. So while we don't know yet, we also can't dismiss it yet either.
An aside, I totally agree that whole diabolical food science line of argument is silly. An eclair is SO MUCH BETTER than a ho ho.
Draw your own conclusions:
http://content.nejm.org/cgi/content/full/357/8/753