common sense

OK, let’s look at Aziz’s assertions:

- the human body is a complex organism that reacts to sharply reduced food intake in a number of ways – primarily, but not exclusively, by burning fat stores.

Questionable. It reacts primarily to sharply reduced food intake by burning glycogen stores, by reducing its metabolic rate, by cannibalizing proteins (muscle tissue) and fat, and by causing physical depression (tiredness, poor mood) and sharply increasing hunger.

There is also substantial reason to believe that the fat storage-and-release mechanisms are messed up in chronically fat people, so that when the body SHOULD be burning its fat stores, it just goes into starvation mode instead, lowering the metabolism and even catabolizing muscle tissue preferentially over burning fat. To a certain extent it has to do this, especially if you’re not eating enough protein, because some body tissues require glucose and it’s quite difficult to convert fat into glucose (and glycogen stores deplete very quickly).

None of this should be surprising, as we were not designed for the lifestyle we actually live today, with food abundance and with hard manual labor rarely required. Nor should it be surprising that people only undergo food shortages (starvation) and heavy exercise regimens (brutally hard manual labor) when forced to do so. Nor should it be a surprise if some people’s bodies react differently to abundance than others, and are more likely to slip into a pathogenic state unintentionally where their bodies can’t burn fat “normally.” That doesn’t require “hormone problems,” just a body that can’t achieve homeostasis easily in modern conditions.

- Thermodynamics are important, and fundamental, because reduced food = less energy for maintenance of the human body. So that energy has to come from somewhere.

Since we are not living in an age or civilization where famine is a real phenomenon, thermodynamics have receded from being among the most important factors to being among the least. That’s my central assertion, and I’m far from alone in making that assertion; quite a few physicians who regularly treat obesity, and quite a few obesity researchers, agree.

- people who are obese CAN lose weight down towards a more “natural” level if they diet (eat less overall, and eat more nutritiously) and excercise (routine physical activity that raises your heart rate). This must be a permanent lifestyle change for the weight loss to be maintained.

Well, yes. Which also means that to be a permanent lifestyle change, it must be something they can actually live with. And, it’s important to emphasize the first part, where you say that obese people can lose weight "down towards" a more healthy level. For most obese people, for complex reasons that partly but do not entirely involve genetics, it is possible to move down towards a MORE healthy weight but probably not possible to get down to "slender" or even "ideal weight" and stay there.

Case in point: I was at one time exercising approximately 2 hours per day, about 6 days per week, and eating a strict low-fat, calorie-controlled diet. I dropped considerable poundage, but at some point hit a plateau and could never, no matter what I did or how hard I worked, get below about 225 pounds without being absolutely miserable (and even going with “absolutely miserable” I couldn’t get below 220). I was working with a professional trainer and dietician and following all the latest guidelines. And I was still medically obese, by both the generic weight charts and also by measuring body fat percentage. Nothing I did could get me below that number, nothing. Even though I was pretty much hungry and obsessing over food and tired all the time.

I now weigh about 245. I’m still obese. I’m considerably happier and less uncomfortable. I no longer obsess over food, nor do I feel the need to obsessively work out. Arguably, I’m healthier for all of this.

- If you are obese, and you think to yourself “it is just genetics, and mainstream research shows that diet and excercise do not help and I will probably be at the same weight I am now after 5 years” then you are being a fatalistic, lazy fool. Just because the weight loss does not “maintain” does not mean you should not do the diet and excercise anyway. You should, and anyone who tells you you’ll be fat again in 5 years anyway can kiss your ass.

Dangerous reasoning. One that experience shows often leads to people getting fatter and more despondent than ever. What’s most dangerous about it is that there is much evidence that unrealistic expectations caused by such careless statements massively increase people’s tendency toward obesity, making them fatter and harming their health greatly. Not to mention what it does to their self-image.

I don’t much disagree with the rest. :-)

P Mike:

Here is a list of articles on the matter at the National Institutes of Health. Nothing so simplistic as you assert, and some of it directly contradicts your assertions.

Here is a bunch of CDC articles on the subject. Once again, they don’t say anything so simplistic as what you claim, and some of what they say is directly in disagreement with you.

Here is a bunch of stuff from the Surgeon General. As with the other two sources, they are nowhere near as simplistic nor as foolish as your assertions.

So, P Mike, it appears to me that if there’s any “conspiracy” here, it’s a conspiracy of know-it-all jackasses who don’t bother to actually research anything before opening their mouths.

Willow: Of course most fat people got that way by burning fewer calories than they consumed. As I’ve said many times, thermodynamics matter. It’s just that, in the modern advanced industrial world, those become less and less important and other factors become far more important.

Look, there is substantial reason to believe that once your body gets past a certain level of overweight, it literally can’t easily get down more than a certain amount. Why? My theory is that obesity is basically a one-way ticket; our bodies don’t really understand what morbid obesity is because we didn’t evolve to worry about that. So the number of people who ever got more than moderately overweight was always vanishingly rare until the mid to late 20th Century (and, prior to the 20th century, being fat was considered a status symbol). It should be unsurprising that some people, who have no genetic "defects" or whatever, just have meetabolisms that are better able to put on fat than take it off. Their systems fight harder against burning fat than healthy people, and their bodies will often preferentially burn muscle tissue, nerve tissue, and everything else before cracking into the fat stores. And the fatter they get, the more messed up their metabolisms are and hence the harder it is to reverse all this.

Fat cells are not little gasoline tanks that fill up when we eat and empty as we walk about in the world. They don’t work that way at all, and the body doesn’t work that way.

Let me try to use a car analogy: if a car will not start, does that mean it has no gasoline? Yes, possibly, but the list of other potential causes is much greater than one possibility.

I’ve also pointed out, repeatedly, that virtually ALL researchers agree that diet and exercise programs are good for HEALTH. It’s just increasingly the consensus medical view (among those who actually study and practice the related medical disciplines) is that change of habits to sensible diet and moderate regular exercise is beneficial to health, will help take some pounds off, and will usually prevent obesity from getting worse–and that’s about it.

What reduced caloric intake and exercise usually can’t do is provide any permanent elimination of chronic obesity; virtually all the research and clinical experience supports that, too. Moderate weight loss on the order of, say, 5 to 30 pounds, is about all caloric restriction and exercise have to reliably offer most chronically fat people. Well, except they also help prevent obesity’s onset, arrest it in its tracks, and help improve health in other areas. But most of those people, even the most diligent ones who get medical counseling, dietician assistance, regular exercise, and regular coaching sessions and peer support groups, will still be fat.

Yes, some of this is luck of the genetics draw; we all know people who eat whatever they want, whenever they want, and never grow more than marginally overweight. Lucky them; they’re in the minority and always have been.

It is a danger to a fat person’s health and well-being to tell them that if they "really wanted to" they could lose all the overweight. It’s not possible in most cases, and efforts to try are more likely to leave the fat person fatter in the long run. Once again, that’s not being insulting, it’s the factual experience of virtually all chronically obese people and those medical professionals who work with them.

Oh, but I will admit that Lyle’s a mighty smart guy, so (as I even told him) if anyone can crack the obesity problem he’s more likely than average to do so. But consider me the guy from Missouri: show me and I’ll believe.

So, you’re "aligned with Aziz" but you’re pretty much admitting that every damned thing I said is true?

Edgar: The National Weight Control Registry automatically excludes everybody who has failed. It is, ipso facto, a registry of the rare 1% or so who do not fall into the normal pattern. It would also almost certainly include the large swath of people who were never chronically overweight to begin with, but rather gained weight temporarily due to stress or other unusual life patterns and whose overweight quickly went away once they resumed their normal patterns, which as I’ve already mentioned is a real phenomenon. All of this is addressed in the Adiposity 101 article, if you’d bother reading it.

The article also documents in multiple places the very real phenomenon of fat people getting fatter on caloric intake that the thermodynamic-worshippers say they should be losing weight on. If you’d actually bother reading it, and addressing my real arguments instead of arguments I haven’t made, we might get somewhere.

Also, Edgar, I have repeatedly stated–to the point of absurdity now–that diet and exercise are effective for weight maintenance. Unless you can acknowledge that, I’m done with trying to reason with you, because obviously you’re arguing with the Dean in your head rather than the actual Dean.

Oh, and language about "conspiracies" is just inflammatory and silly. If there’s any "conspiracy" I suppose it’s those who are hawking diet books and gym memberships and whatnot who don’t really have much motivation to admit that obese people becoming nonobese and staying that way is something not even 1% of those who diligently apply themselves will achieve. No one wants to hear that all they can reasonably expect is moderate weight loss, weight maintenance, and improved health. But that is the exact truth.

And yes, by the way, the Adiposity 101 article also documents studies wherein fat people simply did not lose fat from diet and exercise, and merely lost muscle tissue and suffered metabolic slowdown and other starvation symptoms instead. People like Lyle claim they’ve got systems that will get around that, but they can’t actually prove it in clinical study or show that their programs actually do work on these subjects long-term.

If you can’t get over the obsession with the laws of physics and start acknowledging that morbid obesity may just be an abnormal, pathological physical state which we have not evolved to deal with and wherein the body might simply refuse to burn fat stores like it needs to (think of it like clogged fuel lines if you will), then there’s nothing I can do to get your head out of this notion that all fat people have to do is eat less and exercise more and they’ll become slender. The obsession with saying that this will cure them if they just apply themselves is the real magical thinking. And it’s often dangerous, leading them to unrealistic expectations that spiral into even worse weight and health problems.

You two are certainly showing that you’re not about to let facts get in your way. [shrug] You can stick to your faith-based understanding that obese people can become non-obese and stay that way long-term simply through diet and exercise if you want, but all the evidence available shows that this fails more than 99% of the time. You dance around those facts all day long and refuse to address them directly with anything other than arm-waving and bloviating, and then blame me for being stubborn? Heh. Whatever.

Anyone who studies the literature has already found the studies which show that many fat people gain weight and/or fail to lose it on caloric intake that supposedly "should" cause them to lose weight. Obviously, some people don’t bother doing their homework or actually looking at data before drawing their sweeping conclusions.

I learned long ago not to argue with people who won’t let facts get in their way. I’ll only note that there’s nothing wrong with weight maintenance or better health; what’s wrong is to tell people that they can eliminate obesity through diet and exercise. That would be what we call a lie, because most of them cannot, and the overwhelming bulk of scientific data shows that to be true.

It’s folks like you who make fat people fatter, FWIW.

What the obese can hope for is moderate weight loss and better health. They can also hope to end the obscene flagellation that comes from the ridiculous belief that they can take all the overweight off "if they really want to" and that they only lack discipline and willpower.

New therapies for the chronically obese are coming online all the time, and many show great promise. They’d get more respect and work even better if more people would acknowledge that lack of discipline and willpower are not the primary issues.

Edgar: Oh please, the article I linked for you has plenty of scientific references. You just, apparently, haven’t taken the time to study the document more than superficially.

OK, I see I didn’t answer questions directly. So here:

So, it seems fair to say that you don’t believe that calories in and out is the primary determinant of weight but rather that, in the modern world, something else is.

Correct. And we don’t know with precision what that "something else" is. Nobody does, although there are several theories and I suspect there are multiple ways which this might happen. It’s like looking at a car engine that is not burning gasoline efficiently. What causes that? Is it clogged fuel lines? Maybe. Is it gunk in the gas tank? Maybe. Is it a bad fuel pump? Maybe. Is it clogged intakes? Maybe. Is all of that good but the spark plugs are fouled so the gas doesn’t burn right? Maybe.

If I’m right about your position, please tell me: what do you suspect makes people gain weight?

At the most superficial level, they gain weight because they’re consuming–and storing–more energy than they’re expending. But this all by itself is not an entirely voluntary thing, because autonomous systems we have limited conscious control of (like, say, our heartbeat or our need to urinate) exert a major influence.

Eating and physical activity patterns exert an influence. But they aren’t the primary influence, especially once pathological obesity sets in. Essentially, what appears to happen is that the body’s fat storage mechanisms kick into high gear, while the body’s fat burning mechanisms become retarded. This is why we see, in study after study, very fat people losing muscle mass and experiencing all the other major symptoms of crisis-mode starvation even while swimming in a sea of their own fat. The fat cells aren’t letting go of their stores like they should, like an automobile engine with its fuel intakes badly clogged and corroded. You can pump the gas pedal repeatedly and keep it down to the floor, but the gas still isn’t going to get to the engine like it should, or be burned properly when it gets there. You can keep filling the tank with more and more and more gas, but since it can’t get into the engine properly to get burned in the first place, you’re just going to get a heavier and heavier gas tank.

There are multiple ways to try to get more gas into the engine. So far, nobody’s come up with anything that can reliably do this for the chronically obese. We can improve the fuel expenditure rate somewhat, but that’s about it.

A similar but not identical question: what allows people to sustain their weight despite heavy caloric restrictions? I’m not looking for precision…just some ball-park ideas.

Essentially, it appears to me that our bodies have mechanisms that make it easy to take off maybe 5 to 30 pounds of excess fat, but we did not evolve/were not designed with systems that can deal with responding properly to amounts of body fat beyond that, because having enough caloric intake to become more than that amount overweight was vanishingly rare in our species until modern times. It looks like, for some people, their bodies just don’t know how to get rid of more than 30 or so pounds. It becomes like a pitcher plant or a venus flytrap; you tip over into pathological obesity, and it was easy to get into but now you can’t get out. The body thinks it’s very near the weight it’s supposed to be, and won’t let you drop much below that–and this set point can be reset upwards much more easily than it can be set downwards.

There’s more of course; there’s evidence of viral influence in many people, there’s evidence that modern processed foods make the body’s energy regulation mechanisms act in bizarre ways in some people, there’s even evidence that maternal factors in utero and diet and activity patterns in infancy and childhood exert an influence on all of that. Everything about the modern lifestyle is radically different from what it was for most people even 100 years ago, and it should be unsurprising if our bodies act in multiple unpredictable ways, chronic obesity being one of those many modern diseases.

The problem with focusing with monomaniacal obsession on thermodynamics is that it’s like trying to fix a broken car that won’t drive properly by insisting that if you pump the gas pedal hard enough and long enough, the car will start performing like it’s supposed to.

What this conversation often looks to me is this: “Dean, you’re being ridiculous! Everyone knows that if you just push down on that damned gas pedal hard enough, the car will drive, dammit! What’s wrong with you, don’t you understand basic physics?!?!?”