Still more evidence that heredity matters.
I suspect in another 20 years, 30 tops, the whole antiquated “eat less and exercise more” mantra (which has definite health benefits, but is of only marginal utility in reversing obesity) will look foolish.
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dean,
i don’t understand how it could. just look at "the biggest loser." every single person on that show lost massive amounts of weight by….eating less and exercising more. it seems obvious that if energy out > energy in you will lose weight. whether that constitutes too great a lifestyle change for some (or most) people is sort of a different issue, but if you do eat less & exercise more you WILL lose weight.
Zach: Quite correct, and also quite meaningless. You can bet your bottom dollar that if you follow all contestants on "The Biggest Loser" for five years, at the end of five years the vast majority of them will be as heavy or heavier than they were when they started. Shows like this only serve to promote the “just eat less and exercise more” illusion, the same illusion that keeps almost-worthless programs like Jenny Craig and Weight Watchers in business.
Despite over a half-century of obesity research, no program of eating less and exercising more has ever–stress, ever –shown that diet and exercise are of more than marginal utility in reversing obesity.
Mind you, such programs have been shown to bring on health benefits, if they’re done in proper moderation. They can retard or stop obesity’s onset, and decrease it a bit. But otherwise, all they’re good for is, maybe, keeping a handful of pounds of fat off and a small amount of muscle pounds on, if done properly and in appropriate moderation.
These are the facts. No one likes hearing them, because it either depresses them or takes away their ability to sneer haughtily at fat people.
If you want a proper way of looking at it, consider this statement: "Look at sports! Why, many people can obviously run at 15 miles per hour with only some training and discipline. Therefore, what is wrong with the goal of having people run 15 miles per hour all day, every day?" That’s the same reasoning the "eat less and exercise more" cultists use. It’s scientifically worthless thinking.
By the way, if you don’t believe it, try to get hard figures for the success rate of Weight Watchers or Jenny Craig or any diet book. If they even give you any–most refuse to release such data–they will be giving you a bunch of hand-waving tap-dancing figures, like, "a majority who stuck with the program permanently kept off extra weight," without revealing things like "a majority" means maybe 55%, and "extra weight" being counted as as much as a few pounds. And, they’re including people in there who were only 10 or 20 pounds or so overweight to begin with.
These programs don’t fracking work to cure obesity. They just don’t.
so basically what you’re saying is that if you exercise more and eat less you will lose weight. but then if you stop exercising and start eating more the weight will come back? color me shocked. i still don’t see how that invalidates the "mantra" that less food + more exercise = decrease in obesity.
zach,
The best book I ever read on this subject was Gary Taube’s Good Calories, Bad Calories.  It’s a huge tome, not a cute diet book, and much of it was about the damaging effects of carbohydrates, but he does a really great job of presenting the evidence on why just eating less and exercising more doesn’t work long-term.
One of the reasons this is hard to understand is we all have this mental model that fat is a passive storehouse for the extra calories we eat; just eat less, and the storehouse gets emptied out, what’s so hard about that? Taubes presents in concise form the tons of evidence that we have that that’s just not how it works. Fat is alive and active, not passive. In people with obesity problems, fat tissue siphons off more than its share of calories, leading to increased hunger, leading to overeating to keep muscle and brain supplied. He gave an example of mice with a particular mutation whose fat is so "greedy" that you can starve the mice until their bodies start to consume their own internal organs, and they still have nice big fat deposits.  Now, Taubes is convinced that the reason this is happening is because we’re all eating too many carbs, and that might or might not be true, but it’s a big eye-opener to realize that overweight people might overeat because they’re fat, not the other way around.
When a fat person diets down to a thin person’s weight, it doesn’t solve those metabolic problems which led to their weight problem in the first place or make them just like a naturally thinner person. There are powerful mechanisms that are designed to keep us in energy balance. These mechanisms can be temporarily overcome by force of will, especially when under the kind of scrutiny that a TV show might bring to bear, but it’s hard to the point of near-impossibility to defeat them permanently, which is why so many people lose weight temporarily and then gain it all back. Evolutionarily speaking, hunger is a cue that really SHOULD be hard to ignore, and it is.  If someone is strong-willed enough to ignore their hunger cues, the body will try to restore energy balance by expending less energy, which is why people who are dieting frequently feel like crap.
Personally, I’m starting to wonder if the problem isn’t partly congenital, as opposed to genetic, although genetics obviously plays a big role too. Genetics doesn’t explain why obesity is getting so much more prevalent in Western societies. It may be the carbs, but I also know there are well-documented although still poorly-understood effects on metabolism of maternal metabolism and eating habits during pregnancy. In other words, my kids (born of an overweight refined-carb eating mother) are probably permanently unlike kids born two generations ago under vastly different food-consumption circumstances – it’s not just the carbs they’re eating, but the carbs I ate, and maybe the carbs my mom ate as well.
Yes Zach, I’m saying that if you just quickly put one foot in front of the other, in alternating sequence, with determination and discipline, you will be able to travel at 15 miles per hour. Please get back to me when you manage to do that for 16 hours per day, 7 days per week. It’s just basic physics and a little discipline, right?
Otherwise, what Elizabeth said. I haven’t read Taubes’ book, but I’ve studied the issue of obesity extensively and everything she says is right on the money. Although we haven’t even addressed the very real evidence that popular diet and exercise (“eat less and be more active”) programs aggravate and increase obesity.
Elizabeth,
thanks for that. The "storehouse" model is definitely the one I have been working from. How appropriate the "living" model is, given (certainly anecdotal) evidence of weight loss as seen by the biggest loser (for one instance, as well as millions across the country) seems to me to be an open question. But there is research on it, and I defer to that knowledge.
As I said above (and this gets to dean’s point), whether the lifestyle change involved is feasible for your average person or not is sort of a separate issue from the energy in / energy out thinking. However, obesity (especially childhood) is still epidemic in this country in ways that are not replicated in other countries. Why? We share heredity with people in England, Spain, France, etc., all with significantly lower obesity levels than the U.S. Heredity is a factor but it cannot be the ONLY factor, and there must exist treatments or, more likely, early interventions, that work.
zach,
I don’t think anyone could possibly argue that it’s impossible to lose weight – I’ve done it myself. Lots of times. :-) And there’s the problem. The problem is that fat people who lose weight tend to exhibit symptoms similar to the ones exhibited by thin people on starvation rations, because the fat person’s body is trying to get back to the weight it "wants" to be at. Â
Google "Minnesota starvation experiment" to see what it’s like for a normal-weight person to eat much less than they need. The men in that experiment were successful at avoiding eating and losing weight, just the same way that fat people can be for a time. The problem is that doing so results in all kinds of symptoms that are a result of the body’s attempt to get back to energy balance. Some of them are pro-eating (constant hunger, obsessing over food) and some of them are anti-energy-expenditure (reduced body temperature, lethargy) and some of them are just signs of distress (loss of sex drive, depression). Â
It’s entirely possible to put up with any of these symptoms temporarily. What is so difficult that it borders on impossible (apparently) for most people is to ignore them forever. Fat people’s bodies act like they’re starving when they’re put on a diet which would be adequate for a thin person. Expecting "starving" people who are constantly surrounded by food (as dieting people are in US culture) to voluntarily restrain themselves from eating as much of it as their bodies want is deeply unrealistic, and statistics bear me out on this.Â
I agree with you that some environmental factors must also be in play, such as carbs/HFCS (Taubes’ theory) or congenital factors, or even a silent viral epidemic (this has actually been proposed, there are apparently viruses which can lead to weight gain) but it’s pretty clear that appeals to individual willpower simply. do. not. work., even for people who demonstrate ample willpower in other arenas of their lives.  Almost no one has the willpower to voluntarily starve in the midst of plenty, and the fact that they don’t look like they’re starving doesn’t change how it feels.
Seth Roberts has a hypothesis about obesity too: that the taste of modern food kicks our appetites into hyperdrive. Fast food and packaged supermarket food has strong artificial flavors and is exactly the same every time. Many of us have what’s called the "thrifty gene" which causes us to store calories when there is plenty of food in case there’s a famine later, and Roberts thinks that today’s foods overstimulate that tendency.
If there’s a famine, I can outlast a skinny person or even, I’d wager, most people reading this. Unfortunately, there probably isn’t a famine coming any time soon, and my extra fat is not a survival advantage in this environment.
Most people do not think very much about their eating habits and cannot really sustain conscious attention to them. Generally, people eat when they’re hungry and stop when they’re satisfied. (There are many other unconscious triggers. The fascinating book Mindless Eating is all about these.) So for the majority of people, the question is not "how do I lose weight?" (eat less, obviously). The question is "how do I eat less?" If something is not done about hunger, sustained weight loss is very, very difficult.
Fortunately, Roberts has developed a technique that seems to help a lot with the overactive appetites that overweight people experience. I have lost two pants sizes over the last year or so on his plan.
With regard to exercise, there was an interesting article in the New York Times a few months ago where researchers discovered that exercise was essentially useless for weight loss. Exercise makes you hungrier, so you eat more, and the result is no net calorie deficit. For obvious reasons, your body wants to replace those calories it burned. In fact, it may want to build up a small surplus just in case you work out as hard tomorrow!
Jerry,
I hope it works for you. I have been through this cycle too many times personally to trust a 1-year-old weight loss as permanent, but I’m definitely rooting for you.
I figure that it’s more important to eat well than eat less— fewer refined carbs and high fructose corn syrup, and more natural foods, veggies and yes, meats.
For someone like me, who is living in the land of fruits and nuts, that’s pretty easy. We even have Trader Joe’s, which is stepping away from the preservatives and over-processed foods (and unlike Whole Foods, is actually geared to be inexpensive.) For someone who doesn’t have the resources of locally grown natural abundance, it’s much harder and more expensive.
Of course, the obesity figures around here aren’t pretty. Just because something is available doesn’t mean it’s taken advantage of.
And… overweight != obese. The differences are usually pretty obvious even to the casual observer. (I’m the sort who believes that the standardized scale isn’t correct; if somebody’s got lots of extra pounds but is light on his or her feet, indicating a good level of health, I’m going to think of them as overweight even if their weight pushes them into the obese range.)
Anyway. Eat well. Exercise in moderation. Be able to climb a flight or two of stairs without wheezing.* I’ll call that good if you will.
*Recent conversation with my sister: she says she’s worried about Evil Rob’s weight because she heard him wheezing. I say, "Well, he *is* asthmatic." She hadn’t known that, or that cold air is particularly bad for him…
Thanks, Elizabeth. The weight I’ve lost so far is just a start; I need to lose about twice again as much as I’ve already lost, which could take another couple of years at this rate. So by the time I finish, if I do, I’ll already have had some long term success.
As I said, I lost a lot of weight on Atkins… probably 75 pounds in nine months. That was a very awesome experience, but it happened too fast, I think. It was too easy to think of it as something I’d do for a while and then stop.
Actually if you look at the Europeans, you will discover that they are rapidly developing the same problems we are. Do some research on what’s known as "Syndrome X "and you’ll find that while for some time Americans led the world in it, other modern countries are catching up fast. This despite the fact that Europeans tend to pay more for food and walk more often than we do.
But all this also misses a very important point: Clearly, if people have cheaper access to fattening foods and
are easily able to maintain a sedentary lifestyle (which was rare in earlier, poorer times), then, we’re going to see the incidence of obesity skyrocket. This should be no surprise. But note: nothing I’ve said so far is in contradiction to that.
Obviously, eating more and exercising less can greatly increase weight.
However, there’s multiple complicating factors there. The most important, though, is this: there is substantial evidence that for a large contingent of the population, once they go beyond a certain level of overweightness–more than a little bit of spare flab, basically–their body’s ability to reduce back to the old weight is crippled.
In other words, it’s a lot like chemical addiction; it’s easy for most people to try almost any drug and not get hooked on it. However, with regular use, some people will slip into addiction, and once they’re addicts they can never go back to occasionally drinking or smoking or whatever and not put themselves *hugely* at risk for getting out of control again. It’s like a pitcher plant or a roach motel–easy to get in but very hard to get out.
This shouldn’t be hard to understand. Historically, only the very wealthy were prosperous enough to be able to eat enough and live leisurely enough to get fat. Now it’s easier for people to do because they can afford it and have more opportunity to do so. Yet, despite the fact that we’re seeing more fat people, we all also know people who are quite sedentary, eat whatever the heck they want whenever they want, and never gain weight. Which, once again, points to the fact that genetics (and as Elizabeth rightly points out, congenital factors) plays a major role here.
Look, the bottom line is this: over a half-century of research on fat people shows that long term the success rate of reduced caloric intake and increased physical activity is barely 1%. It’s pathetic. Yes, you can temporarily lose weight that way. You can also, as I already said, retard obesity’s onset or even stop it in its tracks this way. You can also increase your health this way. But obesity is a medical condition, and *no* study has ever–as in, ever–shown it to be an effective way for the obese to become and stay non-obese.
If you’re lucky enough to see the "Biggest Loser" contestants again five years from now, you’ll find most of them have put some or all of the weight back on, and some will be heavier than they were when they started the show. The only exceptions *may* be people who had only become obese fairly recently before the show (sometimes normalweight people can temporarily gain weight due to stress factors and then have it come off again pretty easily so long as they weren’t obese for very long), or who’ve become rich and famous and employ full-time trainers and such.
Does all of this refer to just obesity or also those that are in the 10-30 lbs overweight? I mean, how is obesity defined?Â
Paul,
I would have to look back at the research to come up with a more evidence-based guess (I’m not a researcher by any means but I’ve read a lot about this), but I would say offhand that most people have a range, from 5 to maybe 20 pounds depending on the person, where they can gain/lose fairly easily based on purely environmental factors. This is true for both obese and normal-weight people; most people can, for example, experience a small weight gain when someone in the office starts bringing in pastries every day or a small loss when they give up after-dinner ice cream. I would guess that at much more than 5% of the person’s current body mass, it starts to get much, much harder for the person to maintain a permanent change in weight. For many people that includes up as well as down, although for people with obesity tendencies up is usually much easier to maintain!
Obesity as medically defined is a specific amount of weight overweight. There is unfortunately no consistent way to define it, but there are various ways that are all pretty similar; a good rule of thumb is that if you’re carrying 30 pounds or more of excess body fat, you’re obese. By that definition, about 1 in 3 people in the U.S. (and, increasingly, pretty close to that in places like Europe and Japan) are obese. You may well be obese without knowing it, and no that’s not a joke. "Obese" in medical discussion does not mean "disgustingly fat." It means "fat enough to pose a significant health risk."
Similarly, people hear the term “morbidly obese”and they think it means incredibly overweight, Fat Albert overweight. No, it means you’re so fat you are highly at risk for dying from it. Morbidly obese people are usually diabetic or pre-diabetic, usually have severe cardiovascular and respiratory risks, severe risk for crippling arthritis, and other problems.
I generally agree with Elizabeth, by the way: it’s perfectly normal and reasonable for the average person, including the average fat person, to be able to lose between 5 and 20 pounds or so with a program stressing moderation, better habits, and a bit more activity. Beyond that, though, diet and exercise programs, including those you get from so-called "professionals," are generally ineffective and arguably dangerous.
Research? About half of all posts on junkfoodscience.com are about the obesity epidemic (eg, the increase in obesity in children – who have not increased in average weight for, oh, twenty years) with links to research.Â
Recently, MC4R genetics is in the news – a genetic pre-disposition, if not cause.Â
Â
Even more recently, it has been shown that fat cells shrink during dieting – but do not decrease in number. Possibly explaining why elderly and former athletes gain weight, almost certainly explaining why dieters who start eating normal amounts of food and doing normal exercising regain weight.
Uh, not trying to abuse the privilege, but can’t resist a bit more.
While on a diet, as in that "Biggest Losers" show, you are deliberately taking in less nourishment than you need so as to force your body to use stored fat (and some muscle, but that’s another story). This cannot go on indefinitely.
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http://junkfoodscience.blogspot.com/2008/03/one-little-magic-word.html
At the end of the 30-month follow-up, the authors admitted the participants were still eating 231 to 326 calories per day less than they were [even] at the start of the study — while they were all regaining weight. And remember, “changes in energy intake did not differ significantly between treatment groups.â€
Examining the weight changes seen throughout the maintenance period, the authors reported there was “no significant differences between treatment groups.†In other words, none of the expensive and intrusive interventions proved any more effective in achieving long-term weight loss than no interventions. No mention was made of the adverse long-term health problems documented from repeated yo-yo dieting, losing and regaining weight.
Their comments and conclusions, however, were strikingly different from the study’s actual findings.
Maintain. What a funny little word to describe their findings. Most people think that “maintain†means to keep in a steady condition for a period of time… the typical picture of a rebounding weight trajectory seen in weight loss studies. There was no weight loss maintained for 30 months, as you might have come away believing, upon hearing the reports. Even more remarkable, perhaps, is that this rebound was seen even among a select study population.
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